Our aim was to identify the heavy use of dental services among children and adolescents in the Public Dental
Service (PDS) of one of the biggest cities in Finland, and compare oral health and treatments provided for heavy and low
All patients under 18 years of age having had 6 or more dental visits (n. 2,285) in 2004 and a comparison
group of those having had 3 or fewer visits (n. 27,957) were selected from the patient register of the PDS of the city of Espoo.
A sample of 245 patients was randomly selected from each group and information on age, sex, dental status, number and
types of visits and treatments provided was collected from their treatment records.
Seven percent of the children
and adolescents who had visited the PDS in 2004 were heavy users according to the definition used. Their visits accounted
for 26.3 of all dental visits of children and adolescents. The heavy users were classified as basic care heavy users
and orthodontic heavy users. The mean treatment time for the basic care heavy users was 3 hours and 50 minutes, and for
orthodontic heavy users 3 hours and 23 minutes; it was 40 minutes for the low users. Heavy users were on average 1.8 years
older than low users. The basic care heavy users had more treated and untreated caries (mean DMFT/dmft 4.0 and
D/d 2.4) than the low users (DMFT/dmft 0.95 and D/d 0.4). Of the low users, 43.6 had a
healthy periodontium (CPI 0) compared with 27.4 of the basic care heavy users and with 30.8 of the
orthodontic heavy users. The most frequently provided treatments for heavy users were orthodontic care and fillings by
dentists and for low users preventive measures and examinations. Most of the heavy users (66.4) received less
complicated orthodontic treatment given by a dentist compared with only 7.9 of the low users. Despite the low users'
significantly better oral status compared with basic care heavy users there were only minor differences in the type of
preventive measures provided for the two groups. The orthodontic heavy users received fewer preventive measures than low
Our study revealed two main reasons for heavy use of dental services: high numbers of orthodontic
treatments provided by dentists and high numbers of decayed teeth in a small number of children. To increase productivity,
orthodontic care should be provided more efficiently and preventive care needs to be targeted more carefully.
Vol.10 – n.1/2009
Harvard: A. Nihtil, E. Widstrm (2009) "Heavy use of dental services among Finnish children and adolescents", European Journal of Paediatric Dentistry, 10(1), pp10-12. doi:
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