Critical evaluation of health care delivery is sine qua non for future progress and improvements in an institution. Fytte et al1 studied the pattern of dental care services in Scotland and reported an increase in diagnosis, periodontics and orthodontics cases and a decrease in radical treatment modalities like extractions. Kountz and Lockart2 examined an American population seeking emergency dental care and reported their findings on chief complaint, age differences and gender ratio. Another interesting study concerning the dental treatment needs of the elderly in Switzerland by Stack et al3, revealed the tooth loss pattern and the variation between actual and subjective needs of the elderly. It is obvious that a retrospective analysis of a dental health care center is really helpful in planning better future prophylactic and therapeutic services to the patients. It was with these thoughts that the present study was undertaken. The primary aim of the present retrospective study was to assess the extent of dental care and the treatment provided at the emergency (ER) and primary dental care (PDC) clinics of the King Saud University College of Dentistry (KSUCD) in Riyadh. The findings of the present study might stimulate interest in assessing the health services provided in other health sectors. Emergency dental care at King Saud University College of Dentistry primarily provides relief to patients requiring immediate dental attention. Individuals who require temporary fillings, initial root canal therapy, extractions, drainage of abscesses, oral prophylaxis, adjustment of removable and fixed prostheses, screening, oral hygiene instructions (OHI), etc., are considered as primary dental care patients. These treatments are provided by interns who have completed their dental undergraduate courses. Both male and female interns treat patients at the emergency clinic which functions at the two Dental Colleges, one at the Darraiyah University Campus (DUC) and the other at the Malaz University campus (MUC) in Riyadh. The latter is a separate all-female campus, yet patients of both genders are treated. Even though dental care and relief is also provided by consultants at the specialist clinics as well as by the undergraduate students who treat patients under the supervision of the faculty, this sector of ER and PDC has been excluded from the present study.

 
The materials collected from the clinic consisted of records of patients treated during 1987 and 1988, both at DUC and MUC. The total number of patients treated under the ER and PDC were 10,863 during 1987 and 10,969 during 1988 at DUC. The corresponding numbers at MUC was 5,790 and 5,252, respectively. As there was no considerable difference between the data from MUC and DUC, the combined data are mostly presented in this report. For better visualization, the annual treatment data was further divided into four quarters in the Gregorian calendar. To simplify the assessment of dental care, the treatment categories were broadly classified into five groups. The restorative group included both temporary and permanent fillings besides initial root canal treatment. The oral surgery group included extractions, incision and drainage of abscesses, etc. Periodontal treatment included oral prophylaxis, root planing and oral hygiene instructions. Treatment under the prosthetic group included repair of ill-fitting dentures and minor adjustments of fixed prostheses. The last treatment category, "others" group, consisted of consultations and screening, suture removal, etc.

 
The yearly treatment report in emergency and primary dental care clinics during 1987 and 1988 is shown in Figs, 1 and 2. Different treatment procedures carried out every quarter during the above period are also available from these bar diagrams. The percentages of the various treatment categories provided to the patients in emergency and primary dental care clinics are shown in the pie diagrams [Figs. 3, 4J. Excluding the "others" category which consisted of consultations, screenings and suture removal etc, the restorative category in 1987 and 1988 constituted the major category of dental ER and PDC care [Figs. 3, 4). The second largest category was extractions. The relatively large number of restorative cases treated during the period under review reflects the conservative approach to preserving the teeth of patients reporting to the emergency and primary dental care clinic. The number of patients in the "others" category which includes diagnosis and consultations was consistently very high. Being an academic institution, it is not surprising that large number of these cases are referred to other staff and students' clinics of the College for further management. Chi-square "goodness-of-fit" tests were carried out to determine whether the difference between the various treatment categories [Figs. 3, 4] through the study period (1987 and 1988) was statistically significant. The results were highly significant (P < .01) for all treatments.
The  other consistent  observation  was  the uniform increase in the total number of patients treated in the first and last quarters of the year and a decrease in the second and third quarters (Table 1). Test of difference of two proportionals (the Z test) was carried out to see whether the difference between the number of patients in the first and last quarter of the year and the second and third quarter of the year was statistically significant. The results were highly significant (Z > 1.98, P < .05). The Z values for 1987 and 1988 were 21.81 and 11.51, respectively. The increase in number of patients during the first quarter (January-March) is possibly due to the reopening of the university after the semester break. Similarly, the increase in the last quarter (October-December) can be attributed to the university reopening after the annual summer vacation when the university staff and their dependents are back in Riyadh. The decrease during the second and third quarters corresponds to the summer period, more particularly to the third quarter of July to September, when the university and other academic institutions are closed for summer vacation. The decrease in the number of patients during the summer quarter is possibly due to the absence of staff and their dependents and also the extremely hot climate when most of the people were out of Riyadh. Interestingly, Al Yahya and Al-Shammery4 reported an increase in the number of broken dental appointments at the dental clinic of the school during this same period. This supports the impression that the major population of Riyadh were out of the city and, hence, were unable to keep the appointment.
The average number of dentists working per month in emergency and primary care clinics at DUC was 23 during 1987 and 20.1 in 1988. In MUC, the corresponding numbers were 15 during 1987 and 12 during 1988. The patient-to-dentist ratios in these clinics at DUC in 1987 and 1988 were 43.0 and 45.51, respectively. The corresponding numbers in MUC were 32.72 and 36.47, respectively. The patient-to-dentist ratio increased both in DUC and MUC from 1987 to 1988. The combined data showed an increase in the ratio from 38.93 in 1987 to 42.13 in 1988.
No attempt has been made to determine the gender ratio of patients seeking emergency and primary dental care in this study. Also, analysis of pediatric patients as a separate entity could not be determined due to paucity of information. The present study has revealed patterns of dental care in the primary and emergency dental care clinics. However, a comprehensive picture of total dental care available in the college of Dentistry is possible only after analysis of treatment patterns in the other sectors of the college.

 
Appreciation is extended to Dr. Nazeer Khan, Biostatisticran, Research Center, College of Dentistry at King Saud University for statistical analysis of data. Sincere thanks are also due to Dr. E.E. Guile for his valuable suggestions as well as reviewing the manuscript.