Srisilapanan, Patcharawan; (1997) Assessing dental treatment needs in older people: A socio-dental approach. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Normative treatment need overestimates need and has other shortcomings. The integration of socio-dental indicators and other related factors, such as general health status should lead to a more realistic and appropriate needs assessment for dental service planning. The main objective of this study was to compare the needs estimates based on normative treatment need alone with the normative treatment need plus a socio-dental indicator to assess perceived oral impacts on daily performances, general health factors, behavioural propensity and economic status. A socio-dental indicator, the Oral Impact on Daily Performances (OIDP) was used in the new approach mainly to assess the lay people's perception about the oral impacts. Under nutrition, two chronic medical conditions; diabetes mellitus and heart disease, were chosen as general health factors to integrate into the normative treatment need. 707 older people, 549 dentate and 158 edentulous, aged 60-74 years living in an urban community in Chiang Mai, Thailand were clinically examined and interviewed. The edentulousness rate was 11.9%. 41.2% and 11.1% of the dentate subjects had coronal and root caries respectively. 72.5% of dentate subjects had one or more teeth with loss of attachment of 6 mm or more whilst 62.9% had at least one or more mobile teeth. Using the normative approach, 11.7% of dentate older people needed some restorative treatment, 28.6% needed extraction, 72.5% needed periodontal treatment, 60.7% needed partial dentures and 79.7% of edentulous people needed full dentures. When using the new socio-dental approach, there was a substantial reduction of need. Only 11.5% needed periodontal treatment, 9.1% needed partial dentures and 23.5% of edentulous people needed full dentures. By integrating different factors with normative need, different levels of treatment need were generated namely 'normative', 'general health related', 'impact-related', 'propensity related', 'accessible' and 'non-accessible' treatment needs. The percentage of older people with these different levels of need decreased compared to normative need. In 'normal health' group, when compared to normative treatment need taken as 100%, the 'impact-related treatment need' for partial dentures, full dentures and periodontal treatment need was 50.5%, 60.5% and 16.4% respectively. 'Propensity related treatment need' decreased to 13.8% and 69.9% for periodontal (non-rigid definition) and partial dentures treatment respectively. 'Accessible treatment need' reduced to 14.5%, non-accessible treatment need' reduced to 20.8% and 32.9% in dentate and edentulous subjects respectively. 13.2% of dentates who had normative treatment need for partial dentures had 'general health related treatment need' due to underweight. In edentulous subjects, 39.7% had 'general health related treatment need'. 6.2% of dentates who had normative treatment need for periodontal treatment had 'general health related treatment need' in relation to diabetes mellitus. In 'general health' group, when compared to normative treatment need taken as 100%, 'propensity related treatment need' decreased to 3.0% and 45.4% for periodontal treatment in group with high level of periodontal disease and for partial dentures treatment respectively. 'Accessible treatment need' reduced to 2.4% and 12.7%, 'non-accessible treatment need' reduced to 3.6% and 27.0% in dentate and edentulous subjects respectively. By integrating a socio-dental index (OIDP) with normative need, the rank order of 'impact-related dental treatment need' changed as the condition- specific score of OIDP changed, compared to the rank order of normative need. Dental treatment needs which had higher impacts on people's daily performances moved to a higher rank. 'Impact-related treatment need' varied depending on the different cut-off points of condition-specific OIDP score. In most dental treatments, the higher the cut-off points, the lower the proportion of older people with 'impact-related treatment need'. Results showed that a socio-dental approach markedly reduced estimates compared with normative dental treatment needs estimation.

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