Practice-Level Variation in the Provision of Subsidised Dental Services to Adult Danes in 2019: A Register-Based Study.

OBJECTIVES

The aim was to investigate practice-level variation in common dental diagnostic, preventive, and care services provided for Danish adults who underwent a dental examination.

METHODS

This was a nationwide register-based study. Subsidised dental services delivered during the 13-week period subsequent to the provision of one of three eligible dental examinations (extended, basic, or recall examination) during the first 9 months of 2019 were investigated. Bayesian multilevel regression models were used to estimate the practice-level average predicted probability of supragingival care, subgingival care, individual prevention, bitewing radiographs, and endodontic treatment, and the average predicted count of extractions and direct restorations while adjusting for individual sociodemographics and dental treatments received during the previous 10 years.

RESULTS

The final sample included 445 516 examinations conducted in 1593 dental practices. Supragingival care after basic or recall examinations showed the lowest practice-level variation, with around two-fold difference between top and bottom 2.5%. Individual preventive services after recall examinations showed the highest variation with over 30-fold difference between top and bottom 2.5%. All other outcomes showed around 3- to 8-fold differences between practices at top and bottom 2.5% across all examination types. The differences across practices were smaller-1.2- to 3.0-fold-when the top 25% and bottom 25% were compared instead.

CONCLUSIONS

This study found considerable variation in diagnostic, preventive, and treatment services provided for Danish adults who underwent a dental examination. The findings highlight the need for research that can inform evidence-based practice through the development of quality clinical practice guidelines, continuing education programmes, and closer surveillance of care delivery.