Open Access Research article

Heavy consumption of dental services; a longitudinal cohort study among Finnish adults

Annamari Nihtilä12*, Eeva Widström34 and Outi Elonheimo2

Author Affiliations

1 Helsinki Health Centre and Institute of Dentistry, University of Helsinki, Helsinki, Finland

2 Network of Academic Health Centres, Institute of Clinical Medicine, Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland

3 National Institute for Health and Welfare, Helsinki, Finland

4 Institute of Clinical Dentistry, University of Tromso, Tromso, Norway

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BMC Oral Health 2013, 13:18  doi:10.1186/1472-6831-13-18

Published: 24 April 2013



A reform to Dental Care legislation in 2002 abolished age limits restricting adults’ use of public dental services in Finland. In the Public Dental Service (PDS) unit of Espoo, the proportion of adult patients rose from 36% to 57%. The aim of this study was to investigate heavy use of dental services by adults and its determinants.


A longitudinal cohort study was undertaken based on a PDS patient register. Of all adults who attended the PDS in Espoo in 2004, those who had six or more visits (n=3,173) were assigned to the heavy user group and a comparison group of low users (n=22,820) had three or fewer dental visits. A sample of 320 patients was randomly selected from each group. Baseline information (year 2004) on age, sex, number and type of visit, oral health status and treatment provided was collected from treatment records. Each group was followed-up for five years and information on the number and types of visit was recorded for each year from 2005 to 2009.


Most heavy users (61.6%) became low users and only 11.2% remained chronic heavy users. Most low users (91.0%) remained low users. For heavy users, the mean number of dental visits per year (3.0) during the follow-up period was significantly lower than initially in 2004 (8.3) (p<0.001) but 74.8% of heavy users had had emergency visits compared with 21.6% of the low users (p<0.001).

A third (33%) of the visitors in each group had no proper examination and treatment planning during the 5-year follow-up period and two or more examinations were provided to fewer than half of the heavy (46.1%) or low (46.5%) users.

The mean number of treating dentists was 5.7 for heavy users and 3.8 for low users (p<0.001).


Frequent emergency visits were characteristic of heavy users of dental services. Treatment planning was inadequate, probably partly due to the many dentists involved and too many patients requesting care. Better local management and continuous education are needed to ensure good quality adult dental care and to reduce heavy consumption.

Health services research; Dental services; Longitudinal register study; Public dental service; Adult and elderly population; Complicated treatment needs; Heavy users of oral health services