PURPOSE: The concepts of need and demand are central in studies on dental care. In the literature, a normative definition is often used, but it pays little attention to the individual's personal comfort and quality of life. Need and demand for prosthodontic services are difficult to measure, as prosthodontic treatment is highly individual and not closely related to edentulousness. Need, however defined, does not always lead to demand for treatment, depending on a variety of factors. MATERIALS AND METHODS: The present article is part of a larger study in which the intention is to evaluate need and demand for prosthodontic treatment among the participants in a 1989 and 1999 longitudinal study of a population sample. As the first step, this article reports a conceptual analysis of the need concept from the literature. RESULTS: Need is stated as socially established in the interaction between patient and clinician. It makes demand dependent on available treatment options from the care provider and society. In the prosthetic treatment decision-making process, the emancipatory perspective with the patient-clinician dialogue is of utmost importance to achieve an optimal treatment result. CONCLUSION: The professional attitude toward need must be that there is no true objective or subjective need. Need is established only in a communicative dialogue with mutual respect between the professional and the patient.

PURPOSE: Patients' oral health needs are estimated through dialogue and professional assessment. The concepts of need and demand are vital to studies of dental care and oral health. Need does not always lead to demand for treatment or to utilization, depending on the gatekeeping processes between need and demand and between demand and utilization. Demand must be accepted with the understanding that there is no objective need and that demand depends on the patient's opinion. In accordance with this, the need for prosthodontic treatment is highly individual and is not automatically related to oral health status, making need and demand difficult to measure in that respect. Therefore, sociodental factors should be included and evaluated in studies of need and demand for utilization of prosthodontic care. MATERIALS AND METHODS: This theoretical and analytic paper focuses on the gatekeeping processes between need and demand and between demand and utilization of prosthodontic care. RESULTS: The concept of gatekeeping refers to the social and psychologic processes that transform need into demand and demand into utilization. It implies that they are complex processes that can render great differences between demand and actual utilization. CONCLUSION: It is not possible to estimate a patient's needs for prosthodontic care, since there is no objective need. Demand and utilization are factors that play an important role in the gatekeeping process. These factors are dependent on the patient's opinion, which is influenced by numerous factors.

PURPOSE: To assess, at a 10-year interval, changes in attitudes toward desire for implant treatment among middle-aged and older Swedish subjects with respect to dental status. MATERIALS AND METHODS: Three thousand subjects, residents of Orebro County, Sweden, were surveyed via the same questionnaire in 1989 and again in 1999 regarding their possible need for and interest in implant-based prosthodontic treatment. RESULTS: One thousand six hundred sixty-five subjects responded to both surveys. In 1989 few respondents indicated an interest in implant treatment, whereas in 1999, 92% of those who had not indicated an interest in the earlier survey now indicated that they desired implant treatment. The cohort reporting having no teeth had a considerable lower increase in desire. Among those who reported a possible treatment need (ie, missing 1 or more teeth and had not had them replaced or those who wore complete dentures), cost was the most commonly cited reason for declining implant treatment. CONCLUSIONS: There was a dramatic increase in the interest for implant treatment over the period from 1989 to 1999. Changes in awareness of implant treatment, along with an expansion in the number of qualified providers, may have contributed to this increase.

PURPOSE: The aim of this research was to investigate possible factors behind the desire for and changes in attitude toward implant treatment in a population of middle-aged and older individuals in Sweden. MATERIALS AND METHODS: In 1989 and 1999, questionnaires were sent to 3,000 residents in Orebro County, Sweden. Response rates were 79% and 68%, respectively. Those responding to both questionnaires yielded a longitudinal study panel. Logistic regression models were done with "desire of implant treatment" and "changes in desire of implant treatment" as dependent variables. RESULTS: Older people, non-city residents, and those with one or several missing and unreplaced teeth changed their desire for implant treatment between study years. Effects of age, residence, and better dental status disappeared during the 10-year study period. Those who were edentulous and those with removable dentures (pseudo R2: 0.17) expressed lower desire for treatment than those with all teeth remaining or only one or a few teeth missing (pseudo R2: 0.24) in 1989. High income significantly increased the probability to desire implant treatment for the study panel at both study occasions (P = .016 and P = .034 for 1989 and 1999, respectively). CONCLUSIONS: Factors influencing desire for implant treatment were primarily income and dental status. The influence of young age, urban living, and dental status regarding the subgroup with one or several teeth missing in relation to those with all their teeth disappeared during the 10-year study period

PURPOSE: The aims of this research were to describe the process leading to desire for implant treatment, describe how patients missing teeth gained information about implant treatment, identify gatekeeping factors for implant treatment, and note experiences in changes in oral health-related quality of life. MATERIALS AND METHODS: The constant comparative method for a grounded theory was used in collecting and analyzing data. Ten informants participated in the study, all of whom were treated with implant-supported fixed dentures during the past year. RESULTS: The emerging core category was that participants experienced a journey from social stigma to exhilaration. This process ended in the perspective that the participants' new lives with dental implants were very good and meant an end to their social stigma, but gatekeeping factors before treatment, such as cost and dental anxiety, were noted. The dentist's opinion and suggestions were the most decisive part of the decision-making process, and trust in the dentist and dental team was crucial in the decision to undergo treatment and in the overall treatment experience. Great improvement in oral health-related quality of life was noted. CONCLUSION: This qualitative study gives as the core category and main finding the importance of patients' trust and confidence in the dentist and his/her staff in the process of transforming desire for dental implant treatment into demand and also in making it more likely for patients to be satisfied with treatment regardless of complications.