Melbourne Dental School - Theses
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ItemEvaluation of changing normative needs for dental care in planning for the delivery of dental care to the Australian adolescent population( 1984)Normative needs represent a potential requirement for the use of dental resources. Therefore, changing normative needs should be anticipated in planning for the delivery of dental care. The aim of this study was to evaluate changing normative needs of the Australian adolescent population for restorative and exodontic treatment over the period 1980 to 1990. A predictive model composed of a population sub-model, disease sub-model, and resource requirements sub-model was developed. The disease sub-model was developed around the prediction of severity of dental caries (DMFT index). The severity of dental caries was predicted to decrease by 33.5 percent over the period. The backlog of untreated dental caries was found to be related to the severity of dental caries. Incidence of dental caries was calculated directly from the predicted severity of dental caries. Cross-sectional incidence overestimated the longitudinal incidence. The backlog and longitudinal incidence of dental caries decreased by 23.6 and 31.2 percent over the period. Backlog was two to three times the longitudinal incidence of dental caries. Backlog and incremental streams of needs were predicted on the basis of backlog and incidence of dental caries. In both streams the total number of teeth in need of treatment (TINOT) was equal to the number of teeth with dental caries plus a proportion of the previously restored teeth at risk of retreatment. In the backlog stream, previously restored teeth were related to the severity and backlog of dental caries. In the incremental stream, previously restored teeth were assumed to approximate the severity of dental caries (DMFT). In both streams a 0.10 proportion of restored teeth at risk one year and age earlier were indicated as requiring retreatment. Backlog TINOT was one-and-a-half to two times incremental TINOT. Over the period backlog TINOT decreased by 26.1 percent and incremental TINOT by 33.0 percent. Teeth in need of treatment were apportioned to individual items of treatment on the basis of a probable case-mix of treatment associated with the predicted severity of dental caries. As severity of dental caries decreased the case-mix of treatment items tended toward less complex items. Resource supply equivalents, rated skill units and 1980 dollars, were used to combine the need for different treatment items into single measures. The decrease in normative need expressed as resource supply was marginally higher than for TINOT. The predicted needs were multiplied by population number at each age and time to represent total population needs, demonstrating the "political-arithmetic" of the measurement and comparison of changing normative needs. The distribution of needs in the Australian adolescent population was investigated by the prediction of the prevalence of dental caries which represented the maximum percentage of the population with any need, and the percentage of the population with active caries in any one year who potentially require treatment. Approximately half the adolescent population have active caries in anyone year. The study demonstrated that changing needs must be correctly defined, predicted, and applied in planning for the delivery of dental care to the Australian adolescent population.