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This is the peer reviewed version of the following article: 
CITATION: Torppa‐Saarinen, E, Tolvanen, MM, Lahti, SM, Suominen, ALL. 
Changes and determinants of unmet oral health treatment need. 
Community Dent Oral Epidemiol. 2020; 00: 1– 8.  
 
 which has been published in final form at 
 
DOI https://doi.org/10.1111/cdoe.12587 
  
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Changes and Determinants of Unmet Oral Health Treatment Need
Torppa-Saarinen E. DDS, Institute of Dentistry, University of Eastern Finland. 
Mob. +358400942694, email: eeva.torppa-saarinen@fimnet.fi
Tolvanen M. PhD, Institute of Dentistry, University of Turku, Finland and Center for Life Course 
Health Research, Institute of Medicine, University of Oulu, Finland
Lahti S. PhD, Professor, Department of Community Dentistry, University of Turku, Finland; Turku 
Clinical Research Centre, Turku University Hospital, Finland
Suominen AL. PhD, Professor, Institute of Dentistry, University of Eastern Finland; Department of 
Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland; and Public Health 
Evaluation and Projection Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
All the authors were responsible for conception, design, and interpretation of the data. ET-S was a 
major contributor in writing the manuscript and AS, SL and MT critically revised the manuscript. AS 
was also responsible for data acquisition and MT for analysis of the data. All authors gave full 
approval and agree to be accountable for all aspects of the work. 
Abstract word count: 297
Total word count: 3624
Total number of tables/ figures: 5/0
Number of references: 28 
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Abstract 
Objectives 
Our aim was to describe the nature and determinants of the changes in unmet treatment need 
between the years 2000 and 2011 after a major oral health care reform and a wider supply of 
subsidized care.
 
Methods
The study used a longitudinal sample (n=3838) of adults who had participated in both the Health 
2000 and 2011 surveys (BRIF 8901). Those reporting self-assessed treatment need without having 
visited a dentist in the previous 12 months were categorized as having unmet treatment need. Two 
logistic regression models were applied to determine the effects of predisposing and enabling 
factors on change in unmet treatment need. Model 1 was conducted among those who reported 
unmet treatment need in 2000 and evaluated the determinants for improvement. Model 2 was 
conducted among those who did not have unmet treatment need in 2000 to evaluate the risk factors 
for having unmet treatment need by 2011. 
Results
Unmet treatment need was reported by 25% of the participants in 2000 and by 20% in 2011. Those 
with unmet treatment need in 2000 were less likely to report improvement by 2011 if they had poor 
subjective oral health, basic or intermediate education level, or poor perceived economic situation 
in 2000. Those who did not have unmet treatment need in 2000 were more likely to have it in 2011 
if they were males or from northern Finland, and less likely to if they came from central Finland or 
were older.
Conclusions 
The wider supply of subsidized oral health care during the study years did not lead to complete 
elimination of treatment need. The determinants of unmet treatment need, such as low or 
intermediate education level and perceived economic difficulties, should be used in targeting the 
services at those with treatment need to achieve better oral health outcomes.
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Introduction
According to Andersen´s behavioral model of service use, both contextual and individual 
predisposing, enabling and need factors influence service utilization and its outcome, perceived or 
professionally evaluated health1. Contextual enabling factors can include, for example, national 
health policies, financing, and organization of services. Individual predisposing characteristics can 
include demographic characteristics and education, while the household finances can be considered 
as an individual enabling factor. According to the model, the concept of need consists of population 
health, measured by health indices, as well as individual need expressed by perceived need, and 
service demand satisfied after professional need evaluation. The factors in the Andersen behavioral 
model have multidimensional effects on service utilization and service outcomes. The model has 
also been successfully applied to oral health.2-4
One important contextual factor example is the adult oral health care system in Finland, which 
changed fundamentally in 2002 when the whole adult population gained access to publicly-funded 
oral health services. Before 2002, only those born in 1956 or after were entitled to these5. It was 
anticipated that the wider provision of subsidized care would lead to more frequent service use and 
satisfy the need for oral health services. The target was to improve access to oral health care and 
reduce inequalities. However, in spite of that reform, we found an increase in individual self-
assessed treatment need in our longitudinal national study between 2000 and 20116. In the same 
study, we also found that regular service use led to good subjective oral health, as also suggested by 
Andersen’s model7.
Services should be targeted to those in need. Failing to do so results in poorer health and wider 
health inequalities. Inequalities in dental service utilization are considerable and globally 
consistent8. Inappropriate provision and use of services can also affect self-assessed treatment need 
1.Unmet treatment need (usually in the previous 12 months) has been used as an indicator of health 
care access and inequalities.9,10,11,12 It can be defined as the difference between the healthcare 
services required to cope with a health problem and the services received. 13. In Finland, waiting 
lists, cost, and travel distance have previously been the reported reasons for unmet treatment need 
14. Dental fear also leads to irregular attendance, which may lead to unmet treatment need15. Unmet 
treatment need can be viewed as an indicator of the effectiveness and fairness of a health care 
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system, and so it is useful for a country to monitor changes in unmet treatment need along with 
identifying its determinants.
This study utilized longitudinal survey data from a nationally representative health survey, the 
Health 2000 and the follow-up to that, the Health 2011.16,17 Our aim was to describe the changes in 
unmet oral health treatment need and to analyze the determinants of change between the years 2000 
and 2011 after a major oral health reform among Finnish adults.
Material and methods
Study design
The Health 2000 Survey, a population-based survey of adults aged ≥ 18, was conducted in 2000, 
with a follow-up undertaken in 2011 (BRIF 8901). All of those who were invited to participate in 
2000 were re-invited in 2011, unless they had at baseline refused to take part in any follow-up. In 
the 2000 survey, a stratified two-stage cluster sampling design was used. From each of the five 
university hospital districts used as strata covering the whole country, 16 clusters (health centers) 
were selected. The 15 largest cities and towns were included, and 65 other health centers were 
added according to the probability-proportional-to-size method. Systematic random sampling was 
used to select individuals from these 80 health centers. To match the population sizes in different 
clusters and to form a nationally representative data set of adults Finns, the participants were 
weighted using inverse probability weighting, which is a statistical technique for calculating 
statistics standardized to a population different from in which the data were collected. The Ethical 
Committee of the Helsinki University Hospital approved both of the studies, and informed consent 
was obtained from each participant. The self-reported data used in this study in 2000 were collected 
both by structured interview and self-performed questionnaires during the health examination, and 
in 2011 by structured interview during the health examination16,17. Of the updated Health 2000 
Survey main sample, that is, those aged 30 years or over; (n=7979), 89% (n=7087) participated in 
the interview. During the Health 2011 follow-up survey, they were 41 years or older, and 4283 of 
them participated in the interview again in 2011. This is 68% of the updated Health 2011 follow-up 
sample of this age group (n=6319). The follow-up data in this study included dentate participants 
who were born in 1970 or after and who had in interviews answered the questions on perceived oral 
health and service use in both 2000 and 2011 (n=3838); this was 61% of the updated Health 2011 
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sample. Analysis of loss showed that those having lost during the follow-up were more often male, 
less educated, older, resided in Central Finland and had more unmet treatment need than those who 
were followed up. (Table 1).
Measurements
Information on perceived oral health and service use both in 2000 and 2011 was used in the 
analyses. Subjective oral health was determined by the global single-item question: “How do you 
rate the status of your teeth and oral health?” with the response options: very good, good, average, 
poor and very poor. For analyses, subjective oral health was dichotomized to good (very good or 
good) or poor (average, poor or very poor). Self-assessed treatment need was determined by the 
question: “Do you think you currently need dental treatment?” with response options: yes or no. 
Last visit to a dentist was determined from the response options: during the past 12 months, 1-2 
years ago, 3-5 years ago, over 5 years ago or never. Those reporting self-assessed treatment need 
but not having visited a dentist during the previous 12 months were categorized as having unmet 
treatment need. All of the other options (no self-assessed need or visits within 12 months) were 
considered as not having unmet need. Unmet treatment need was categorized as having unmet 
treatment need either in 2000, in 2011, in both years, or in neither of these years.
Background and other health-related variables used in analyses were based on the Andersen model 
and determined in both 2000 and 2011 except for self-perceived health only in 2000. They consisted 
of contextual and individual predisposing factors (area of residence, gender, education), enabling 
factors (perceived economic situation, self-perceived health, dental fear) and need (pain or 
discomfort with teeth or dentures). Age was grouped by year of birth: 1956-1970, 1946-1955 and 
1945 or before. Age cohorts were determined on differences in access to subsidized oral health care. 
The younger cohort had been entitled to subsidized care, whereas the two older cohorts gained 
access to it after the baseline examination in 2000. Education level was categorized as basic, (12 or 
less years of basic education), intermediate (vocational education), or higher (college or university). 
The area of residence in Finland was defined as the university hospital districts of Helsinki 
(southern), Turku (western), Tampere (central), Kuopio (eastern), or Oulu (northern). Perceived 
household economic situation was determined by the question: “How do you describe the current 
balance between income and expenditure in your household?” with the response options: more than 
enough to cover our needs; enough to cover our needs; we have to compromise to some extent; we 
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have to cut our consumption; we have to compromise a lot but manage; or we have to make major 
compromises and do not manage on our own. Answers were grouped into three categories: very 
good (more than enough to cover our needs), good (enough to cover our needs), and poor in the 
cases of compromising or cutting down in consumption. Self-perceived health was determined by 
the question: “What is your present state of health?” with the response options: good, fairly good, 
average, fairly poor, or poor. Answers were grouped into good (good or fairly good) or poor 
(average, fairly poor or poor). Pain and discomfort was determined by the question: “Have you 
during the past 12 months had toothache or any other trouble related to your teeth or dentures?” 
with response options: yes or no. Dental fear was assessed with the question: “Do you think that 
visiting a dentist is: not at all frightening, somewhat frightening, or very frightening?”
Additionally, the follow-up survey in 2011 asked about people´s reasons for not attending a dentist. 
The response options were: queueing, travelling connections, and service fees. The question was 
answered by 3644 respondents.
Statistical analysis
The occurrence of unmet treatment need and changes in it were examined and cross-tabulations 
were used to evaluate their associations with gender, age group, education, area of residence, 
general health, pain or discomfort, subjective oral health, perceived economic situation, and dental 
fear.
Two logistic regression models were applied to determine the associations of gender, subjective oral 
health, pain and discomfort, area of residence, age, education, dental fear, and economic attainment 
at baseline with improvement or worsening in unmet treatment need. Model 1 was applied to those 
who reported unmet treatment need in 2000 and evaluated the determinants for improvement (that is 
not having unmet treatment need) in 2011. Model 2 was applied to those who did not have unmet 
treatment need in 2000 and evaluated the risk factors for having it by 2011. Analyses were 
conducted using weighted data. The weights in 2000 were based on age, gender, living area, and 
mother tongue18and updated for 2011. All analyses were conducted using weighted data, taking 
cluster design into account. According to Härkänen et al.19, statistical methods based on weighting 
provide quite accurate results. All analyses used IBM SPSS 25.0. 
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Results
The gender distribution among the age groups was fairly even. Of males, 41% were born in 1956-
1970, 30% were born in 1946-1955, and 29% were born in 1945 or before. Of the females, 42% 
were born in 1956-1970, 30% were born in 1946-1955, and 28% were born in 1945 or before. 
Unmet treatment need diminished over the years and was reported by 25% of participants in 2000 
and by 20% in 2011 (Table 2). The prevalence of unmet treatment need for females was lower than 
for males both in 2000 and in 2011. There was a cohort-gradient of unmet treatment need, with a 
smaller proportion of the oldest cohort reporting it than the younger cohorts in 2000 and 2011. A 
bigger proportion of the basic and intermediate educated groups reported unmet treatment need than 
the highest educated group. Unmet treatment need prevalence differed across the country, with 
eastern and northern Finland having the highest. 
A higher proportion of those reporting unmet treatment need in both years were male (Table 3). 
There was no difference in poor subjective oral health in 2000 within the unmet treatment groups. 
The majority of those who had unmet treatment need in both years, also had poor subjective oral 
health but reported less pain or discomfort related to teeth or dentures than those with no unmet 
treatment need. A higher proportion of those with unmet treatment need in both years reported poor 
perceived economic situation and high dental fear.
Unmet treatment need and subjective oral health were associated among both genders. (Table 4). 
Those with unmet treatment need in both years reported most often also poor subjective oral health 
in both years. Accordingly, those with no unmet treatment need in both years reported also good 
subjective oral health in both years.
In the logistic regression, (Table 5), Model 1 applied to those who had unmet treatment need in 
2000 and compared those who improved (coded as 1) to those who still had unmet treatment need 
in 2011 (coded as 0). Those with unmet treatment need in 2000 were less likely to report 
improvement by 2011 if they had poor subjective oral health, basic or intermediate education level, 
or poor perceived economic situation in 2000. Model 2 was conducted among those who did not 
have unmet treatment need in 2000 and compared those who developed unmet treatment need by 
2011, (that is, worsened, coded as1), to those who did not develop it (coded as 0). Those who did 
not have unmet treatment need in 2000 were more likely to have it in 2011 if they were male or 
from northern Finland, and less likely if they came from central Finland or were older. 
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Reasons given for non-attendance were: queueing (18% of participants) and service fees (7% of 
participants). Only 1% of respondents mentioned travelling difficulties. 
Discussion
Unmet treatment need for oral health care in the Finnish adult population diminished between 2000 
and 2011, but was substantial, being reported by 25% of the population in 2000 and by 20% in 
2011. Prevalence of unmet treatment need varied by age cohort, the lowest prevalence was in the 
older cohorts in both years. Females reported less unmet treatment need than males. Those having 
no unmet treatment need also reported better subjective oral health. Basic or intermediate education, 
poor subjective oral health, and perceived economic difficulties at baseline determined the 
persisting 8% of unmet treatment need. Those with no unmet treatment need in 2000 also were less 
likely to have it in 2011 if they lived in central Finland or belonged to the older birth cohorts. 
Conversely, males or those living in northern Finland were more likely to have accrued unmet 
treatment need in 2011. The determinants of change thus differed depending on the direction of the 
change. 
Our findings suggest that the change in contextual enabling factors seemed to be effective in 
diminishing unmet treatment need during the 11-year period. In terms of contextual change, age 
limits on subsidized care were removed and access to care universally guaranteed. This contextual 
change in service provision seems to have provided opportunities for dental care, as need for care 
due to pain and other dental problems was less prevalent in 2011. Of these contextual factors, 
equitable access was also found to be important in reducing social inequality in a Swedish cohort 
study after their health care reform in 2008 20. In a French cohort, prevalence of need for dental care 
was higher among participants of low socio-economic status. In that study, income level and 
national origin were more strongly associated with need for dental care than insurance cover level. 
Although the findings of that study are from a country with a different service provision context to 
Finland, they nevertheless confirm these factors as strong determinants21.
All of the predisposing factors according to the Andersen model (that is, area of residence, gender, 
and education) were strong determinants of unmet treatment need. They also determined the 
changes in unmet treatment need. Since the regions have differences in contextual factors, such as 
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availability, the area differences might be via those, because the regions have differences in them. 
The regions with highest unmet treatment need have had the highest prevalence of edentulousness 
in the past, and their service provision has remained low16. Perceived economic troubles, living in 
eastern or northern Finland, male gender, dental fear, and intermediate or basic education level in 
2000 led to higher prevalence of unmet treatment need in 2011. These may, again, be consequences 
of contextual factors that is finding service fees too high, and difficulty accessing services due to 
long travel distances, which are more typical in eastern and northern parts of the country. Some 
further changes should be implemented to target these contextual factors and the changing need for 
services. Similar findings to ours have been reported from a study in Sweden22 in which factors 
such as long-term illness and financial problems were associated with refraining from seeking 
dental care among adults.
The pain or discomfort related to teeth or dentures need factor seemed to lead to service use, but 
those without this factor in 2000 more often had unmet treatment need in 2011. The persistence of 
unmet treatment need means that the outcome and organization of urgent care should also be 
examined in Finland, as suggested by a recent review23.
Inequalities in Finnish oral health care use and self-rated oral health were identified in a study 
carried out from 2001 to 200724. In that study, reduction in pain and discomfort was greater in the 
more advantaged portion of the population, indicating persisting inequalities in oral health and 
service use. One reason for this might be that awareness of oral health care reform may also differ 
among different socioeconomic status groups. Variation in oral health service utilization in Europe 
is large, and some countries with universal health care seem to encourage the use of preventive 
services25. According to our findings, Andersen´s behavioral model seemed useful in identifying 
different determinants of unmet treatment need in oral health services. The Andersen model has 
also been found to be useful in previous studies26. However, the determinants of change in unmet 
treatment need have not been investigated in those previous studies.
The high response rates in the Health 2000 Survey and the 2011 follow-up are strengths of this 
study. Even though the participation rates were lower in the Health 2011 Survey than the Health 
2000 Survey, over 70% had participated in both surveys, which is high for longitudinal studies. 
Lowest participation rates were seen among the youngest men. Our longitudinal cohort included 
61% of those having participated in both surveys, and this can also be regarded as very good. Loss 
to follow-up is nevertheless always a problem and is most likely to concern those at greater risk of 
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treatment need and non-use of services. This is the case also in our longitudinal study, which is a 
limitation. The weights provided by the survey were used to correct it, but the findings may be 
affected by recall bias19. The data were weighted based on age, gender, living area, and mother 
tongue to form a nationally representative data set of adults Finns. Since the weights were based on 
several variables, and not used to create comparable groups, but to form a nationally representative 
data set, using on of those as an independent variable did not harm our results but allowed us to see 
the differences according to the university hospital districts. The longitudinal study design is a 
strength, and the statistical approaches allow us to clearly point out the main findings and to draw 
conclusions on change in unmet treatment need and the determinants of it. Some differences in 
study methods and the health care systems make comparison with findings from other countries 
difficult, which is a limitation. The measurements used are well established and widely used in 
population studies, although most of those studies have been cross-sectional. The measurement of 
unmet treatment need may differ among studies and underestimate the need for services. While 
differences in defining unmet treatment need exist, the 12-month reference period seems to be 
widely used .11,27 Unmet need, so defined, has been captured in international studies such as the 
Survey on Health, Ageing and Retirement, the European Union Survey of Income and Living 
Conditions, and the WHO Study on global ageing and adult health, SAGE9,28 The equal timelines 
are a strength in our study. To further examine and understand the factors leading to unmet 
treatment need, the different time periods between check-ups and visits and reasons for unmet need 
could be examined especially in Finland, where the individual recall intervals have been 
recommended since 1990´s. Attention to co-occurring risk factors for poor access to needed care 
should be given in order to reduce disparities among populations.28
Our findings are important in understanding the interplay between service utilization and perceived 
oral health. The findings offer new information for planning the supply of services. Unmet 
treatment need is very common among certain groups of adult Finns. Subsidized care should be able 
to target resources at those who need and benefit the most. Using simple and easy questionnaires 
within other sections of social and healthcare, asking about the need for oral health services along 
with relevant background questions, might help in targeting resources to those at risk and reduce 
unmet oral health treatment need.
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ACKNOWLEDGEMENTS
The Health 2000 and Health 2011 Surveys were organized by the Finnish National Institute for 
Health and Welfare (THL) and partly supported by the Finnish Dental Society Apollonia and the 
Finnish Dental Association. ET-S acknowledges a personal grant from the Finnish Dental Society 
Apollonia. The authors declare no potential conflict of interest with respect to the authorship or 
publication of this article.
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Population-Based Provincial Comparison Health Policy 20009;5:87-101
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does ´access to health care´ mean? J Health Serv Res Policy 2002; 7(3):186-8
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13. Ghafari M, Bahadivand-Chegini, S, Nadi T, Doosti-Irani A. The global prevalence of dental 
healthcare needs and unmet dental needs among adolescents: a systematic review and meta-
analysis. Epidemiol Health 2019; 41: e2019046.
14. http://ec.europa.eu/eurostat/data/database/population and social conditions/Health/Health 
care/Unmet needs for health care/self-reported unmet needs for dental examination
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of the Need for Dental Care in Adults. PLoS ONE 2016;11:e0158842.
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using Andersen´s behavioural model. Community Dent Health 2013 Jun;30:102-107.
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27. http://ec.europa.eu/eurostat/statistics-explained/index.php/Unmet health care needs statistics 
(Oct. 25, 2019)
28. Shi L, Stevens GD. Vulnerability and unmet health care needs. The influence of multiple risk 
factors. J Gen Intern Med. 2005;20(2):148–154.
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Table 1. Baseline sociodemographic characteristics of interviewed dentate participants who were 
born in 1970 and answered in questions on perceived oral health and service use in the Health 2000 
Survey (n=5648) according to follow-up status in the Health 2011 Survey. Lost to follow-up: 
participated in 2000 but not in 2011. Followed up: participated in both surveys.
Lost to follow-up
n=1,810 
Followed-up
n=3,838
% (n) p-value*
Women 45.2 (874) 52.9 (2,110) <0.000
Born
1956-70 33.4 (595) 40.6 (1,599)
1946-55 24.2 (404) 30.4 (1,146)
-1945 42.4 (811) 29.0 (1,093)
Education (missing n=62) <0.001
Basic 46.1 (835) 28.0 (1,056)
Intermediate 32.7 (563) 35.9 (1,364)
Higher 21.2 (376) 36.1 (1,392)
Area of residence 0.021
Southern 35.4 (624) 34.0 (1,279)
Western 13.5 (254) 14.2 (560)
Central 24.5 (433) 21.9 (816)
Eastern 15.8 (294) 16.7 (646)
Northern 10.9 (204) 13.1 (537)
Unmet treatment need * 30.9 (540) 25.3 (969) < 0.001
Those who reported self-assessed treatment need but had not visited a dentist during the previous 12 
months.
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Table 2. Unmet treatment need (%) in 2000 or 2011 by sociodemographic characteristics 
determined at baseline.
Unmet treatment need
%
In neither 
year
Only in 
2000
Only in 
2011
In both 
years
p
All 63 17 12 8
Gender Male 58 19 13 10 <0.001
Female 66 16 11 7
1956-70 59 19 12 10 <0.001
1946-55 60 19 11 10
Born
-1945 69 13 11 7
Education Basic 62 17 11 9 <0.001
Intermediate 59 19 13 9
Higher 67 16 12 5
Area Southern 63 17 12 8 <0.001
of Western 68 16 10 6
residence Central 69 14 9 8
in Finland Eastern 58 20 12 10
Northern 54 18 17 11
Prevalence of unmet treatment need in year x is the sum of ‘only in x’+ ‘in both years’.
p-value Χ2-test
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Table 3. Unmet treatment need (%) in 2000 and 2011 by background and health-related variables. 
Unmet treatment need
%
In 
neither 
year
Only in 
2000
Only in 
2011
In both 
years
p
Gender Male 43 50 50 56 <0.001
Self-perceived 
health in 2000
Poor 28 32 28 34 0.123
Pain or discomfort In 2000 37 23 40 31 <0.001
related to teeth or 
dentures
In 2011 36 38 27 27 0.001
Poor subjective 
oral health
In 2000 22 52 26 68 <0.001
In 2011 20 23 39 54 <0.001
Perceived Very good 19 18 15 15 0.001
economic situation Good 45 41 44 36
in 2000 Poor 36 41 42 50
Perceived Very good 25 23 21 12 <0.001
economic situation Good 45 48 42 51
in 2011 Poor 30 30 37 37
Dental No 64 50 62 49 <0.001
fear Somewhat 29 34 31 34
in 2000 Very 7 17 7 17
Dental No 69 64 62 57 <0.001
fear Somewhat 27 29 30 30
in 2011 Very 4 7 8 14
p-value Χ2-test
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Table 4. Unmet treatment need by subjective oral health between 2000 and 2011. P-values <0.001 
 Unmet treatment need
%
Subjective oral health In neither 
years
Only in 2000 Only in 2011 In both years
ALL     
Good in both years 69 47 55 29
Poor only in 2000 12 31 9 20
Poor only in 2011 10 6 23 11
Poor in both years 9 16 13 40
MALES     
Good in both years 66 42 49 25
Poor only in 2000 12 31 9 17
Poor only in 2011 12 7 25 11
Poor in both years 10 20 17 47
FEMALES     
Good in both years 70 53 60 34
Poor only in 2000 13 31 9 23
Poor only in 2011 9 5 21 12
Poor in both years 8 11 10 31
 
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Table 5. Logistic regression model for change in unmet treatment need according to enabling, 
predisposing and need variables at baseline. 
Model 1a Model 2b
OR 95% CI p OR 95% CI p
Male gender 0.88 0.64–1.19 0.40 1.32 1.07–1.64 0.01
Poor subjective oral 
health (ref=Good)
0.53 0.39–0.73 <0.01 1.05 0.81–1.36 0.74
Pain or discomfort 
related to teeth or 
dentures (ref=No)
0.91 0.65–1.26 0.56 1.01 0.81–1.25 0.96
Area of residence 
(ref=Southern Finland)
   Western 1.13 0.69–1.85 0.63 0.82 0.58–1.15 0.25
   Central 0.90 0.60–1.36 0.62 0.72 0.53–0.98 0.04
   Eastern 0.96 0.64–1.45 0.85 1.19 0.88–1.62 0.26
   Northern 0.83 0.54–1.30 0.42 1.54 1.13–2.09 0.01
Age cohort 
(ref=1956-1970)
 
   1946-1955 0.86 0.58–1.29 0.47 0.71 0.54–0.92 0.01
   -1945 0.70 0.46–1.04 0.08 0.66 0.50–0.87 <0.01
Education (ref=Higher)
   Intermediate 0.71 0.49–1.02 0.06 0.92 0.71–1.19 0.54
   Basic 0.61 0.41–0.93 0.02 1.28 0.97–1.70 0.09
Dental fear (ref=No)
   Somewhat 1.07 0.77–1.49 0.67 1.17 0.92–1.47 0.20
   Very 1.29 0.84–2.00 0.25 1.02 0.66–1.57 0.93
Perceived economic
situation (ref=Good)
   Poor 0.71 0.51–0.98 0.04 1.14 0.91–1.44 0.27
   Very good 0.82 0.53–1.27 0.38 0.83 0.61–1.13 0.23
a Model 1: improvement=having unmet treatment need in 2000 but not in 2011.
b Model 2: worsening= no unmet treatment need in 2000 but having it in 2011.
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