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Aim

In Finland dental services are provided by the

public and the private sectors. Recent clinical

population studies have revealed great need for

periodontal and prosthetic treatment in adults.

The aim of this study was to analyse treatment

provided for those who visited the Public Dental

Service (PDS) in 2009.

Dental care: Do people get what they need in Finland?

Methods

The Chief Dentists of the PDS units (194) were

asked to collect data on patients and treatment

provided in three age groups (<18, 18-64 and

65+ years) and by provider category (dentist,

dental hygienist or assistant) from their

municipal data bases during the year 2009.

Ethical approval to collect the register data was

given by the R&D Centre of Welfare and Health

(STAKES). The items of treatment provided

were, in the PDS units, classified into 13 main

treatment areas following the Finnish Social

Insurance Institution’s schedule: (clinical)

examinations, complementary examinations

(radiology, laboratory tests), anaesthesia (local

anaesthesia, sedatives, nitrous oxide),

preventive care (instruction of oral hygiene,

dietary advice, fluoride varnishing, fissure

sealants etc.), endodontics, periodontics, oral

surgery, orthodontics, cariology (permanent and

temporary fillings, crowns of filling material),

prosthetics, treatment of bite dysfunctions,

certificates (most often for insurance companies

due to trauma) and other treatment (removal of

sutures, orthodontic brackets, local medications

etc.). Data were obtained from 166 PDS units

(86%).

Results

Altogether 8.9 million treatment

measures were provided for the 1.7

million patients. The largest

treatment categories were

examinations (including

radiographs), restorative treatment

and anaesthesia, making up about

60% of all treatment. Preventive

measures (8.4%) and periodontal

treatment (6.3%) were small

proportions of the total. Treatment of

bite disorders and prosthetics (each

0.5%) were rare. Working age adults

received half of all treatment

measures (53.2%), children and

adolescents a third (36.4%) and the

elderly 10.4% (Table 1).

On average, more than one

examination or orthodontic treatment

measure per patient was provided for

children and adolescents.

Table 1. Distribution (%) of treatment measures provided in the

Finnish Public Dental Service (PDS) by patient age group.

Treatment measures classified according to main treatment

disciplines. N=number of patients treated.

E Widström1,2 (*), M EKQVIST1, H TIIRA3, T SEPPÄLÄ1, J LINDEN1

1National Institute for Health and Welfare (THL), Helsinki, 2Institute of Clinical Dentistry, the Arctic University of Norway, and

3Helsinki Metropolia University of Applied Sciences, Finland

Conclusions

The study showed that treatment provided

in the Finnish PDS was not in

concordance with treatment needs in the

population. Relatively healthy children had

plenty of examinations and preventive

treatment measures and adults had mostly

restorative care when their needs were

more periodontal and prosthetic care.

Dental hygienists could have provided

more of the treatment.

Correspondence to:

Professor Eeva Widström

National Institute for Health and Welfare (THL)

P.O.Box 30, 00271 Helsinki, Finland

Email: eeva.widstrom@thl.fi

Main treatment disciplines

Distribution of treatment measures

by age

Distribution

of

(%) all

treatment

measures% (N=1 700 758)

0 - 17 yr (N=690 462)

18 - 64 yr (N=841 844)

65+ (N=171 920

)

Anaesthesia 22.7 69.1 8.2 11.3

Prevention 73.2 21.7 5.0 8.4

Endodontics 9.2 80.9 9.9 3.8

Periodontics 15.8 67.6 16.5 6.3

Oral surgery 24.8 59.7 15.5 5.2

Other treatment 38.2 51.5 10.3 2.6

Orthodontics 97.2 2.8 0.01 8.0

Filling therapy/cariology 20.4 65.3 14.3 21.0

Prosthetics 1.2 56.0 42.8 0.5

Treatment of bite dysfunctions 21.3 72.3 6.5 0.5

Certificates 31.4 57.5 11.1 3.4

Examinations 42.9 47.2 9.9 22.8

Complementary exam inc.

radiology 16.8 72.1 11.1 6.2

All treatment disciplines 36.4 53.2 10.4 100.0

Among adults, restorative treatment

and examinations were the most

frequently provided treatment

measures. Periodontics and oral

surgery were less frequent and

prosthetics and treatment of bite

dysfunctions were rare (Table 2).

About a fifth (17.8 %) of all treatment

measures were provided by dental

hygienists or dental assistants. They

provided a third of all treatment

measures (28.3 %) on children and

adolescents, 11.3 % on working age

adults and 14.3 % on the elderly.

Furthermore, they provided a major

part of the preventive (77.0%) and

periodontal (63.0%) treatment

measures and a fifth (20.0%) of the

examinations.

Table 2. Numbers of treatment measures provided per 1000

treated patients by age group in the Finnish Public Dental Service.

Main treatment disciplines

Number of treatment measures / 1000 treated patients by age group All

treatm

ent

meas

ures/

1000

treate

d

patien

ts

0 - 17 yr 18 - 64 yr 65+ yr

Anaesthesia 333 830 482 595

Prevention 792 193 218 439

Endodontics 45 328 196 200

Periodontics 130 455 545 333

Oral surgery 166 308 417 271

Other treatment 126 139 137 134

Orthodontics 1007 24 0.4 421

Filling therapy/cariology

554 1457 1561

1104

Prosthetics 1 27 102 24

Treatment of bite

dysfunctions 13 36 16 24

Certificates 140 210 16 181

Examinations 1237 1142 199 1198

Complementary exam

including radiology 1237 473 1114 325

All treatment 4705 5613 5303 5224