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An integrated socio-dental approach to dental treatment need estimation

Adulyanon, Supreda; (1996) An integrated socio-dental approach to dental treatment need estimation. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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To improve on the traditional approaches of dental treatment need estimation, a new theoretical model of treatment needs composed of 'Normative', 'Impact-Related', 'Effective' and 'Accessible' treatment needs, is proposed. The aim of the present study was to develop an appropriate socio-dental indicator to generate 'Impact-Related Treatment Need', compare them with traditional professionally assessed normative need, and to explore the preliminary approach to assess 'Effective Treatment Need' for periodontal treatment. An oral health survey was carried out in Ban Phang district, Khon Kaen, Thailand. 501 people aged 35-44 years in 16 villages, selected by cluster random sampling process, were interviewed about oral impacts on daily performances and their oral health behaviours, and then were had clinical examinations. A concise indicator 'Oral Impacts on Daily Performances' (OIDP) was developed, based on measuring impacts on eight physical, psychological and social aspects of daily activities. Scores were calculated by multiplying the frequency by the severity scores of each performance, then scores were summated. The indicator was tested for psychometric properties on the study sample, using interviews and clinical examinations. Cronbach alpha of internal consistency was 0.65. Kappa of test-retest reliability ranged from 0.6 to 1.0. Criterion validity was shown by a strong relationship with general perceptions of oral impacts (p<0.001). Construct validity was demonstrated by significant differences of scores between groups with high and low prevalence of deep periodontal pockets, decayed and missing teeth, and number of functional teeth (p<0.001). The combination of specific OIDP scores and normative needs generated the impact-related need for various dental treatments. As expected, the percentage of people with need was decreased from normative need, when Impact-Related Treatment Need was applied. The differences were large in needs for prostheses, orthodontics and periodontal treatment (ranging from 21.7% to 40.2% of normative need); moderate for restorations (64%); and low for pulp care, extractions and treatment for deep periodontal pockets (81.7%-91.7%). A similar pattern of need reduction was obtained when increasing cut-off points of OIDP scores. An exploratory study to develop 'Effective Treatment Need' for periodontal treatment was done. It was shown, using logistic regression that plaque control and smoking were the behaviour-oriented risk factors which affected behavioural propensity for periodontal destruction. Receiver Operating Curve showed the appropriate cut-off point of plaque level at 0.8. Behavioural propensity was determined from people who are non-smokers with plaque index of 0.8 or lower, to generate Effective Treatment Need. The results indicated that the majority of people who had Impact-Related Treatment Need for periodontal treatment did not have the acceptable level of behavioural propensity required for effectiveness of treatment. The advantages of the socio-dental needs approach in dental care planning were demonstrated and discussed. It was concluded that the OIDP is a valid and reliable indicator of oral outcomes. Integrating it into Impact-Related Treatment Need, as well as further integration of behavioural propensity to generate Effective Treatment Need could provide alternative improved dental treatment need estimations.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: An integrated socio-dental approach to dental treatment need estimation
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Thesis digitised by ProQuest
Keywords: Health and environmental sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10099941
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