The French version of the GOHAI exhibits satisfactory psychometric properties but two items (one about swallowing, the other with complex sentence structure) had poor stability.

Expansion of French health insurance coverage has increased funding for dental care for economically disadvantaged adults. This study aimed to measure clinical and self-perceived oral health, behaviors, and use of dental services by adults who were eligible for such coverage. The regional agency that gives administrative services for the health insurance funds provided a sample of 900 adults aged 35-44 years, insured through this program. We reached 805 of these adults by mail; of these 18% were surveyed and clinically examined. Self-perceived oral health was measured by the Global Oral Health Assessment Index (GOHAI) and participants' attitudes to dental health, by questionnaire. Decayed and Missing teeth constituted 40% of the DMFT. Participants reported poor oral health (63%), and 79% perceived a need for care, although they used dental services infrequently and had poor knowledge of available services. Cost of care and number of carious teeth were important predictors of the GOHAI.

Usually, the French dental insurance system covers the cost of restorative treatment but does not reimburse the cost of preventive therapies. A French sick-fund covering self-employed persons tested a new dental benefit plan for children intended to provide an incentive to develop office-based preventive activities. The programme, which started in 1992, concerns all 4-year-old children of self-employed workers in a single French region (Auvergne). Participants undergo an annual examination by the dentist of their choice until their 15th birthday. If the child is seen every year, all services related to dental caries (preventive and restorative) are provided free of charge. An ongoing evaluation of the programme was necessary to determine its influence on the development of office-based preventive activities and the dental health of the participants. A cohort of children enrolled in the programme in 1992 was followed over 4 years to examine the patterns of service use. In addition, a cross-sectional study comparing the caries experience of all 8-year-old children participating continuously in the programme (test sample) with that of a sample of control children (n=90) was conducted in 1996. Data from the longitudinal follow-up indicate that 43.37% of the 551 children to whom the programme was offered in 1992 underwent an annual examination in the first year. Of the children enrolled in 1992, 55.2% were still participating in the programme in 1996. Results showed that independent practitioners continued to focus on restorative treatment rather than preventive therapy. Results from the cross-sectional study are in accordance with this trend. The number of caries-free children was identical in test and control samples and the mean dft, DMFT, DT and dt did not vary between the two groups (Student's t-test, P>0.05). However the mean number of filled teeth was significantly higher in the test children than in the controls (P<0.01). For children with caries, the mean dft was 23.5% greater in the test group than in the control group (P<0.05). In Auvergne, a large number of families were not ready to participate in a plan that required them to take their child to the dentist every year. There was not a perceived need for regular preventive dental care, an attitude probably reinforced by the interventionist approach undertaken by the dentists over the survey period. Moreover, the plan did not provide an incentive for dentists to develop office-based preventive activities.