Developing a socio-dental system of dental needs assessment in children
The traditional normative approach to dental needs assessment has serious shortcomings. Studies aiming to improve the normative approach are limited to adults, and cover particular types of dental treatment. The objective of this study was to develop a comprehensive system of dental needs assessment in children using the socio-dental approach, and to compare it with the traditional normative approach. It was hypothesised that the proportion of socio-dentally assessed needs was significantly lower than that assessed normatively. All 1126 grade-6 primary schoolchildren aged 11-12 years in Suphanburi province in Thailand were invited and 1034 participated in a cross-sectional survey. They were dentally examined for normative treatment needs, interviewed to assess oral impacts and completed a self-administered questionnaire on demographic and behavioural data. The integration of oral impacts with Normative Needs generated Impact-Related Needs, while further considering oral behaviours and evidence-based treatment resulted in Propensity-Related Needs. The CHILD-Oral Impacts on Daily Performances (CHILD-OIDP) index was developed to assess oral impacts. The index was shown to be a valid, reliable and practical measure of oral health-related quality of life in 12-year-old Thai children. It has potential to be integrated into the socio-dental needs system. When the socio-dental approach was used to assess needs, there was a large reduction in the extent of needs, when compared to the normative approach. The prevalence of needs for treatment/care for non-progressive dental conditions decreased from 98.8% for Normative Needs to 39.5% for Impact-Related Needs (p 0.001). The amount of normative treatment required decreased further when Propensity-Related Needs were assessed. It is concluded that the socio-dental needs assessment approach decreases the amount of dental needs. The approach highlights not only the importance of oral health-related quality of life in needs assessment, but also incorporates a broader approach for dental care in meeting children's dental needs.