Swedish Quality Registry for Caries and Periodontal Diseases - a framework for quality development in dentistry

Abstract

Objectives: There is a need for monitoring dental health and healthcare, as support for quality development, allocation of resources and long-term planning of dental care. The aim of this paper is to describe the concept and implementation of the Swedish Quality Registry for Caries and Periodontal Diseases (SKaPa).

Materials and methods: The SKaPa receives information by automatic transfer of data daily from electronic patient dental records via secure connections from affiliated dental care organisations (DCOs). The registry stores information about DCOs, dental professionals and patients. Information on a patient level includes personal identifier, gender, age, living area, dental status, risk assessments for caries and periodontitis, and dental care provided. In addition, data generated from a global question on patient-perceived oral health are uploaded. In total, more than 400 variables are transferred to the registry and updated daily.

Results: In 2018, all of the 21 public DCOs and the largest private DCO in Sweden were affiliated to SKaPa, representing a total of 1,089 public and 234 private dental clinics. The accumulated amount of information on dental healthcare covers 6.9 million individuals out of the total Swedish population of 10 million. SKaPa produces reports on de-identified data, both cross-sectional and longitudinal.

Conclusion: As a nationwide registry based on automatic retrieval of data directly from patient records, SKaPa offers the basis for a new era of systematic evaluation of oral health and quality of dental care. The registry supports clinical and epidemiological research, data mining and external validation of results from randomised controlled trials.

Keywords: Odontology; big data; epidemiology; oral health; quality registry.

Figure 1.

The principal design of the SKaPa concept. PROM, patient-reported outcome measures.

Figure 2.

Mean number of decayed or filled tooth surfaces for individuals of different ages (third molars excluded). Time period: 2010–2016. Data are based on all individuals in the different ages with a comprehensive examination.

Figure 3.

Percentage of patients 20 years and older with documented periodontal pocket depth of all persons with comprehensive oral health examination in the various dental care organisations (DCOs). Number of patients: 2012 n = 1,288,462 and 2016 n = 1,307,573.

Figure 4.

Percentage distribution of reasons for tooth extraction in 2016 in patients 20–90 years old grouped into six categories: Endodontic, Dental caries, Periodontal diseases, Dental fracture, Orthodontics, and Other reasons. Number of patients with comprehensive oral health examination in 2016, n = 1,337,145. Number of patients with one or more teeth extracted, n = 91,468. Total number of tooth extractions, n = 207,339.

Figure 5.

Percentage of patients 20 years and older who received stepwise excavation of deep caries lesions, of those with restorative therapy due to caries in 2013 (17,748/384,362) and 2016 (21,171/359,045), respectively, per dental care organisation (DCO).

Figure 6.

Percentage distribution of four main groups of treatment procedures related to periodontitis in patients aged 20 years and older: information and oral hygiene instruction, scaling and root planing, tooth extraction and surgical treatment. Total number of treatment procedures and treated patients during 2010–2011: 820,059/385,765; and 2015–2016: 1,102,479/477,012.