Pressures on public dental services require new approaches to managing demand.
Objective: this study aimed to assess the reasonableness of patient presentation for emergency dental care by means of developing and evaluating indices of relative need for care.
Methods: the study examined associations between subjective indicators and clinical judgement of urgency for ’emergency’ dental care in adults using the public sector in South Australia and New South Wales. Patients aged 18+ years with a minimum of six teeth, seeking urgent dental treatment in nine clinics were asked to participate. Personal interviews were conducted with 839 dentate adults. These provided socio-demographic, subjective oral health status indicator and dental visiting data. Patients then had an oral examination and were assessed for urgency of dental treatment.
Results: patients assessed as ‘urgent’ comprised 36% of subjects. Variables having a statistically significant association with ‘urgency of care’ included age, education, experience of toothache, pain in teeth with hot or cold food/fluids, pain in jaw while opening mouth wide, sore gums, bleeding gums, pain at night, difficulty sleeping, staying home more than usual, avoiding usual leisure activities and worry/concern (Chi-square p<0.05). Difficulty sleeping (OR=3.8), pain in the jaw when opening wide (OR=2.7), having a broken filling (OR=1.7), having a loose tooth (OR=2.5) and bleeding gums (OR=0.6) were associated in a logistic regression model with needing to be seen within 48 hours. This model correctly identified 88.4% of cases which were non-urgent, but only 50.8% of patients identified as urgent were correctly identified.
Conclusion: the model of relative need may be a useful tool in screening out those who do not need to be seen more than accurately predicting those requiring emergency care. Supported by the SA Dental Service and NSW Oral Health.
K. Roberts-Thomson*, L. Luzzi, K. Jones, A. Spencer
Presented at the 80th General Session and Exhibition of the IADR, 6-9 March 2002, San Diego, USA