Caries progression and care patterns in children Population based studies

The aims of this thesis were to describe patterns of caries progression and of preventive and curative care provided to child populations, and secondly, to provide insight into treatment variation and factors that influence it.
In a systematic review the annual increase in caries experience in permanent teeth in Western child populations was quantified. Then, a classification model for caries risk categories based on claimed restorations was evaluated and the mean number of new restorations at follow-up was examined. Both the increase in caries experience and the number of restorations followed predictable patterns. The increase was strongly dependent on the past caries experience and resulted in different trend lines of caries progression.
In a feasibility study, outcome indicators for oral health were selected, developed and tested in practice. Caries-related outcomes showed evident differences between dentists and reflected differences in their treatment approaches.
In an observational study using claims data from dentists, longitudinal preventive and curative care patterns in Dutch children were distinguished over a period of 4-5 years. Then it was analyzed whether these were related to the self-reported preventive and curative orientations of the dentists, and which other dentist, and patient characteristics were predictors of the provided care. Treatment variation in preventive and curative care was expected because patients and their caries risk differed. However, after correction for patient characteristics like age and socioeconomic position, several dentist and dental practice characteristics also appeared to predict care patterns. This indicates that the provided care was not only patient-centered but also supplier-driven.