Aarhus in Denmark, Adelaide in Australia, Saskatchewan in Canada, Bristol in England and Limerick in Ireland were chosen as representing five different systems for improving the dental health of children. Fluoridation apart, the system of dental care delivery seems to have little influence on the level of dental disease, but appears to have remarkable cost implications. The most expensive system employs salaried dentists to carry out all the operative procedures. Employing dental therapists to do the simple operative procedures reduces costs materially, but utilizing private dentists in an insurance scheme that encourages efficient practice may be less expensive still. The results of this study highlight the need for more detailed comparison of delivery systems, in order to advise public dental health authorities on the most effective and efficient systems for children.
An evaluation of the children's oral health care service was performed by an international assessment team who undertook a field programme in Denmark. Three counties were visited, one metropolitan, one urban and one rural. Data on dental health costs were collected and dental services in six municipalities selected at random were examined. Opinions of administrators at all levels and those of clients and providers were obtained and interviews also took place with staff and students at the two dental schools. The service was considered effective insofar as active dental disease was closely controlled by restorative care and a high level of dental awareness was instilled in all sections of the child population. The service was also clearly adequate since participation of schoolchildren was almost universal. However, resource expenditure on both professional personnel and clinical facilities was considered high and the efficiency of the service was possibly rendered less than optimal by a degree of over-provision in 'passive' prevention and orthodontics. The appropriateness of devoting so much resource to children at the expense of the population as a whole was also regarded as questionable as was the lack of a fluoridation programme. Client groups wholeheartedly supported the service as a result of the high quality of care and the attractive, considerate image projected by clinics and staff. The overall excellence of the service was a matter of satisfaction to administrators, of gratification to clients and of pride to the providers whose morale was high.
The Danish children's oral health care service has been so successful in achieving its objectives that it will need to change and adapt in order to survive. It is suggested that the service should gradually become community-based rather than child-based. This process can be commenced by introducing treatment for the elderly, the handicapped and the indigent, converting the school clinics to municipal oral health units. Although it is important that private practice is maintained, private dentists should be encouraged to work in the system part-time, leading teams of supporting auxiliary personnel trained within an integrated system. Eventually, the facilities could form the basis of primary health care centres. The lessons to be learnt from the Danish experience have a wider application to other countries. In developing countries it is obvious that they should first place limited dental resources into public health prevention and only invest in expensive treatment clinics as funds become more available. Manpower planning should ensure that personnel are not overtrained for the needs of the community. In developed countries, increasingly more resources will need to be channelled into adult dental care, and dental education must lead the profession into this new era. Difficult though these changes will be, the stable relationships that have developed between the various arms of the service under the guidance of the Danish Dental Association, will ensure that the profession will survive and flourish for the benefit of the Danish people.
A comparison was undertaken of dental care for children in Edinburgh and Helsinki. The evaluation centred upon an epidemiological investigation of the dental health of children in the 5-, 12- and 15-year age groups. This was performed by examiners using standardized procedures who were drawn from both countries. They employed an established system of data recording and processing (SPEED). Using these data, and background information from official and other sources, an assessment was made of the effectiveness, adequacy, efficiency and appropriateness of the services. Children's dental health, particularly in the youngest age group, was generally better in Helsinki than in Edinburgh as were both the population coverage and extent to which disease was controlled. However, the services in Edinburgh were marginally the more economically efficient. This arose from their being provided mainly by independent contractors working under a fee per item of service rather than by a public salaried system. In neither city was the delivery of dental services supplemented by water fluoridation nor was extensive use made of auxiliary personnel. The decrease in caries prevalence in recent years has profound implications for the dental services in both countries. It calls for continuing re-appraisal of present policies on expenditure, manpower, dental education and ways of delivering dental care.