Evaluation of a dental care program for school beginners in a Paris suburb

OBJECTIVES: Dental care for children is available in France, but the method of administration is cumbersome: care is generally provided by private dentists, and parents can claim reimbursement of at least 70% of the costs afterwards. In the Département of Val d'Oise (north of Paris and including some densely populated suburbs), a scheme is in place to provide 100% reimbursement. To encourage participation, schoolchildren are screened by dentists who advise if treatment is needed. The objective of this study was to ascertain the effectiveness of screening as a stimulus for seeking dental care. METHODS: In two towns, 6-7-year-old schoolchildren were cluster-sampled to give 507 participants. At screening, about half of the participants were found to be in need of operative treatment. Questionnaires about demographic and other background factors were sent home. From those needing treatment, 186 (77%) sets of questionnaires were returned. These persons were the analytical basis of the study. Six months after screening, the 186 participants were examined to estimate whether they had sought and received treatment as advised. RESULTS: The majority of the participants came from low socioeconomic and deprived backgrounds. Most of the parents were born in countries outside Europe. Only about one-quarter of the children advised to seek treatment had actually done so after 6 months. Slightly under half of those who were treated had claimed the reimbursable amount after the treatment. Of the 186 participants needing treatment, 24% had more than 4 dt + DT but 70% of these had not received any care. CONCLUSION: These findings suggest that even when costs are totally reimbursed, most children in need of care do not receive it; the greater the need of care, the lower the likelihood of getting it. The deprived people and immigrants frequently inhabiting the Parisian suburbs seem to experience cultural, financial, linguistic, and administrative barriers to care, which impede uptake and which must be changed if these children are to enjoy improved dental health.