[Increasing effectiveness of dental health care service. Could funds be saved by increased delegation to dental hygienists?].

The size and composition of the oral health team is in a changing process, and in Norway we find striking regional differences in the role of hygienists. The main differences are found between the regions delegating more of the screening/diagnosis and fissure sealing to the hygienists and those who do not. The present study examines cost-benefit aspects related to extension of the functions of dental hygienists. Treatment needs and actual functions of hygienists were studied in the Tromsø municipality, limited to the public sector and to the care of 3-16 year olds. Reduced need for dentists and net reduction in cost was calculated for a "moderate" alternative (hygienists do all diagnostic work and fissure sealings) and a "radical" alternative (hygienists do diagnostic work, fissure sealings and occlusal fillings). Findings revealed that the "moderate" alternative would release up to 15 per cent of the number of dentists occupied in the dental health care of children and adolescents. The additional effect by applying the "radical" alternative was found to be moderate. Although more dental hygienists must be employed to take over this work, about 40 mill NOK pr year could be saved in Norway by this delegation reform. This amount is about 6% of the total expenses of the Public Dental Health Service. To delegate more tasks to dental hygienists might provide the dentists with a more challenging and varied workday. Dentists will be able to carry out more of the complex operations demanding their special skills and training.