Objectives: A model for expanding access to care has been introduced in Minnesota. The model proposes that after a dentist prepares a tooth, the restoration can be placed by a restorative function (RF) dental assistant or hygienist. The purpose of this study is to compare the outcomes of teeth restored by RF personnel with those restored by dentists.
Methods : HealthPartners Dental Group (HPDG) has had RF staff practicing in selected clinics since 2006. Between 7/1/07 and 6/30/08, 455 restorations placed by RFs were matched with the same number of restorations placed by dentists. Restorations were matched on tooth number, ADA procedure code, and patient age group. Data on replacement restorations were collected for one year after the initial RF restoration.
Results : Patients receiving RF vs. dentist restorations were closely matched on age (29 and 31) and gender (58% male and 56% female). The distribution of number of surfaces involved in the restorations was; 1: 42%, 2: 44%, 3: 12%, 4+: 2%. Amalgam was used in 74%. Of 910 restorations, 17 (1.9%) had subsequent problems potentially related to the fill or crown placement over the course of one year. Problem rates were not different (p=0.13) for the RF (1.3%, 6/455) and dentist (2.4%, 11/455) restorations. The 6 problem RF restorations were placed by 5 different RF providers while 11 problem restorations were placed by 6 different dentist providers. All problems (100%) among RF restorations occurred in multiple surface restorations. Of the dentist restorations, 63.6% of problems occurred in multiple surface restorations (p=.24). Problem rates increased linearly with the number of surfaces restored from 1.1% for 1 surface to 4.2% for 4 or more surfaces or a crown (p=.06).
Conclusions : Problem rates for restorations are low and not different for RF vs. dentist placed restorations. Funded by HealthPartners Research Foundation #08-122.