Evaluation of a dental benefit plan for children conducted in Auvergne, France, since 1992

Abstract

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.

Association of caries experience in 12-year-old children in Heidelberg, Germany, and Montpellier, France, with different caries preventive measures

“…Taking into account the prevalence of fissure sealants, the DMFT values of the different subgroups, and indications regarding dental attendance frequencies, it is concluded that practitioners in Heidelberg focus more on primary prevention, whereas the independent dentists in Montpellier perform more secondary preventive measures. This assumption accords with the findings of Tubert-Jeannin et al (21) who pointed out that French dentists would prefer to undertake restorative procedures as opposed to practicing preventive measures. Furthermore, the responses of children in Montpellier revealed that they saw a dentist only when they or their parents had observed a pathologic change in at least one tooth.…”

“…On the one hand, this may indicate that dentists in Montpellier apply fissure sealants in children with a higher caries risk, as is indicated by the fillings and carious lesions present in these children. On the other hand, the importance of the fact that fissure sealants are not paid for by the social security service must not be underestimated (21).…”

“…professional tooth cleaning, individual demonstrations of how to improve oral hygiene, information to patients on avoiding cariogenic food, application of varnish or gel with F-concentrations of 23 200 or 12 500 ppm, respectively) provided by independent practitioners for children and adolescents from 6 to 19 years of age. In 1993, these services were extended to include fissure sealing of molar teeth but, to date, patients in France have to pay for these sealants (21). Furthermore, German schoolchildren are obliged to have an annual dental examination and to receive basic instructions in oral health care (i.e.…”

Caries management decision: Influence of dentist and patient factors in the provision of dental services

“…Restorative treatments are listed, but professionally provided preventive care (except sealants) does not generally qualify for reimbursement, which consequently discourages prevention and encourages operative care. 9,36 This system of remuneration does not promote comprehensive care, as treatments conserving and optimizing the longevity of the patient's dentition are not covered. 31 The development of modern concepts in caries management thus depends on other developments to many factors, such as initial and continuous dental education, health education for patients, and the dental care system.…”

Restorative Treatment Strategies Reported by French University Teachers

“…Professionally provided preventive care does not generally qualify for reimbursement, a limi-tation that discourages prevention and encourages operative care. 33 This may influence the curriculum and dental school treatment plans.…”