Medicaid patients in dental school clinics: do personal and professional experiences matter?

The purpose of this study was to explore dental and dental hygiene students' and faculty members' personal experiences with Medicaid prior to coming to dental school as well as their professional/educational experiences with patients on Medicaid during their dental/dental hygiene education and how these experiences relate to their professional attitudes and behavior concerning treating patients on Medicaid. Survey data were collected from 317 dental students, fifty-five dental hygiene students, and fifty-seven clinical faculty members at the University of Michigan. The results showed that while responding students' confidence concerning treating Medicaid patients increased over the course of their education, their intention to treat these patients actually decreased. The more personal experiences with Medicaid these students had before dental school, the more they enjoyed treating Medicaid patients, the more confident they were when treating these patients, and the more likely they were to treat these patients in the future. The more professional experiences these students had during dental school, the more they enjoyed treating Medicaid patients, and the more confident they were when treating these patients, but the less likely they were to treat them in the future. In conclusion, experiences with Medicaid before dental school as well as professional experiences during dental education correlated with later professional attitudes and behaviors. The implications of these findings for dental education are explored.     

Work environment perceptions of full-time dental educators: does gender matter?

This study investigates whether female and male full-time dental faculty members in U.S. dental schools differ in their workplace experiences and perceptions. A questionnaire was mailed to the 2,203 U.S. members of the American Dental Education Association (ADEA) in May 2001, and 870 faculty members responded (response rate: 40 percent). The data of the 738 full-time employed faculty members (female: 257, 34.8 percent; male: 481, 65.1 percent) were analyzed. The results showed that male and female faculty did not differ significantly in the average hours per week worked (men: 46.1 vs. women: 47.1), in the amount of time spent on research (11.67 percent vs. 12.76 percent), and in available grant support (20.1 percent vs. 19.7 percent). Men were more likely than women to have office space (99.2 percent vs. 96.5 percent; p = .0 12), secretarial support (87 percent vs. 75.8 percent; p = .000), protected time for research (37.8 percent vs. 31.6 percent; p = .056), and lab space (23.2 percent vs. 10.6 percent; p = .000). Compared to men, women spent more time on teaching (men: 16.84 percent vs. women: 19 percent; p = .078), and perceived the work environment as less supportive (30 percent vs. 9.3 percent; p = .000). While 73.8 percent of men felt welcome as members of the dental school community, only 50.2 percent of the women felt welcome (p = .000). Male and female respondents differed significantly in the degree of experienced and perceived harassment. We thus concluded that female and male faculty members differ in their experiences and perceptions of the academic climate at U.S. dental schools. These results may be useful when school leaders explore effective recruitment and retention strategies for dental faculty members.     

What's in a dental practice-based research network?: Characteristics of Northwest PRECEDENT dentists,their patients and office visits

ObjectivesThe authors conducted a study to describe the general dentists, practices, patients and patient care patterns of the dental practice-based research network (PBRN) Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT).MethodsNorthwest PRECEDENT is a dental PBRN of general and pediatric dentists and orthodontists from five U.S. states in the Northwest: Idaho, Montana, Oregon, Utah and Washington. The authors collected data from general dentists in Northwest PRECEDENT (n = 101) regarding the diagnosis and treatment of oral diseases in a survey with a systematic random sample of patients (N = 1,943) visiting their practices. They also obtained demographic data from the general dentists and their patients.ResultsThe authors found that 50 percent of the general dentists were 51 to 60 years of age, 14 percent were female and 76 percent were non-Hispanic white. More than one-half (55 percent) of the dentists had practiced dentistry for more than 20 years, 83 percent had private solo practices and 32 percent practiced in rural community settings. The majority (71 percent) of patients visiting the dental practices was in the age range of 18 to 64 years, 55 percent were female and 84 percent were non-Hispanic white. In terms of reasons for seeking dental care, 52 percent of patients overall visited the dentist for oral examinations, checkups, prophylaxis or caries-preventive treatment. In the preceding year, 85 percent of the patients had received prophylaxis, 49 percent restorative treatments, 34 percent caries-preventive treatments and 10 percent endodontic treatments.ConclusionsNorthwest PRECEDENT general dentists are dispersed geographically and are racially and ethnically diverse, owing in part to efforts by network administrators and coordinators to enroll minority dentists and those who practice in rural areas. Estimates of characteristics of dentists and patients in Northwest PRECEDENT will be valuable in planning future studies of oral diseases and treatments.     

Private dental coverage: who has it and how does it influence dental visits and expenditures?

BACKGROUND: Dental insurance has had a significant impact on dentistry and dental care use. Dental insurance coverage may influence people's decisions to use dental care. During 1996, 42.9 percent of all dental expenditures were paid by private dental insurance. METHODS: The focus of this analysis is on private dental coverage, use and expenditures for the U.S. civilian community-based population during 1996. The authors provide national estimates for the population with private dental coverage, the population with a dental visit, mean number of dental visits per year and mean total expenditures for several socioeconomic and demographic categories during 1996, using Medical Expenditure Panel Survey, or MEPS, data. RESULTS: Poor and low-income people were less likely to have private dental coverage than were people with higher incomes. People without coverage at all income levels were less likely to report a dental visit than were people with coverage. When they controlled for coverage, the authors found that education at any income level did not appear to affect the likelihood of people's having multiple visits or higher expenditures. CONCLUSION: People with private coverage are more likely to visit a dentist, have a greater number of visits and have higher expenditures than are those without coverage. Private dental insurance coverage, however, is not the only determinant of dental care use. MEPS data also show that other factors play key roles. Comprehensive strategies designed to improve dental care use should keep each of these determinants in mind. PRACTICE IMPLICATIONS: While dentists may have a limited ability to influence people to seek care initially, they may be in a better position to influence the amount of care patients obtain, thereby helping make sure that patients receive the care that they need and want.     

Do Canadian dentists find dental research useful?

The aim of this joint CDA-IMHA study was to investigate what Canadian dentists think about the utility of dental research. A questionnaire was sent to all dentists in Canada with the December 2001 edition of JCDA. By April 1, 2002, 2,788 questionnaires, representing a response rate of approximately 16%, had been returned. In this first article in a 3-part series, we address the theme of research utility. The results show that 82% of respondents think that dental research has an important or very important impact on the dental health of Canadians. Furthermore, 98% of respondents claim to have modified an element of their clinical practice after having been informed of some research results.     

Arab dentists’ refusal to treat HIV positive patients: a survey of recently graduated dentists from three Arab dental schools

Objective: To assess intended refusal of recent graduates from three Arab dental schools to treat HIV?+?patients and factors associated with this intention.

Materials and methods: In 2015, convenience samples of recent dental graduates were included from Libya, Egypt and the United Arab Emirates. Participants responded to a questionnaire assessing personal background, knowledge of oral manifestations and fluids transmitting HIV, perceived adequacy of training and self-efficacy to manage blood exposures, attitude to risk of infection, moral beliefs and willingness to treat HIV?+?patients. Logistic regression assessed factors associated with intended refusal to treat HIV?+?patients.

Results: The overall response rate was 552/710 (77.8%), mean age?=?23.7 years with 41.8% males. The mean (SD) scores for knowledge of oral manifestations and fluids transmitting HIV were 5.5 (1.3)/8 and 4.2 (1.7)/7. The mean (SD) scores for attitude to risk of infection and moral beliefs were 2.9 (1.0)/4 and 2 (0.9)/3, respectively. One-third of respondents indicated intention to refuse treating HIV?+?patients. Knowledge of body fluids transmitting HIV and moral beliefs were associated with lower odds of refusing to treat HIV?+?patients (OR?=?0.86 and 0.38) whereas attitude indicating greater concern for risk of infection was associated with higher odds (OR?=?1.54).

Conclusions: One third of dentists from three Arab dental schools indicated they would refuse to treat HIV?+?patients. Adequate knowledge and moral beliefs reflecting professional ethics were associated with lower odds of refusal counterbalancing the association with attitude indicating increased concern for risk of infection with implications for dentist education and training.     

Professional education and practice arrangements: are there gender differences among paediatric dentists in Israel?

AIM: To assess gender differences in professional education, practice setting and working arrangements among dentists in Israel, who primarily treat children. SUBJECTS: All 112 participants in the meeting of the Israeli Society of Dentistry for Children that was held in February 1999. METHODS: A questionnaire completed during the meeting. RESULTS: Seventy participants (63 per cent) completed the questionnaire and returned it. There were 43 females and 27 males. Less than half of the population were specialists (40 per cent of the females, 48 per cent of the males). No significant differences were found in the educational background and working in academia between females and males. With regard to practice arrangement, males significantly reported more frequently working in two clinics or more, than females (P = 0.049), and working in clinics with general practitioners (GPs) and specialists in various fields in dentistry, while more women reported working with either GPs or specialists (P = 0.007). In all other variables, no significant gender differences were found. The results of our study show that paediatric dentistry in Israel appears as a branch of the profession which shows great sexual equality of opportunity.     

Rural dentists: Does growing up in a small community matter?

BackgroundThe aging of the dental work-force has implications for both patients and dentists, especially those in rural and underserved areas. Anecdotal information regarding dental workforce trends indicates that students from rural communities are more likely to practice in rural communities than are students from urban areas. Although the medical literature supports this premise relative to physicians, there are no data to verify this statement relative to dentistry. Therefore, the authors decided to study whether this premise applies to dentistry.MethodsThe authors conducted a retrospective analysis of dental student records from a Midwestern dental school for the years 1980 through 2010 to determine if there was a statistical correlation between the size of a dental student's town of origin and the size of the community where he or she practiced after graduation. They also examined what role, if any, the student's sex played.ResultsDentists from rural areas were approximately six times more likely to practice in a rural area than were dentists from urban areas. Female dentists were only slightly less likely to practice in a rural community than were male dentists.ConclusionDentists from rural communities were more likely to practice in rural communities than were dental students from urban areas.Practice ImplicationsTo ensure future access to care in rural communities, rural dentists may want to recruit actively or work closely with dental students from rural areas when hiring associates or seeking purchasers for their dental practices.     

Patients are not equally susceptible to periodontitis: does this change dental practice and the dental curriculum?

In the 1960s and 1970s, data became available indicating that most of the adult population had periodontal disease and that effective bacterial removal prevented and treated periodontitis. This information led to a systematic approach to the management of periodontal disease and influenced teaching of periodontics in dental schools. We now know that most adults have only gingivitis and very mild localized periodontitis. A small percentage, albeit representing substantial numbers, of adults have generalized severe periodontitis. We also recognize that a few currently known and measurable risk factors, including diabetes, smoking, and genetics, can identify the patients who are at risk for the severe generalized cases that require extensive therapy and intensive prevention, as well as patients at risk for a less-predictable response to treatment. This review will discuss the evidence that supports the change in our knowledge and understanding of periodontal disease. The question now becomes at what point, and how, do we integrate this new knowledge into the dental curriculum?     

Autotransplantation of premolars: does surgeon experience matter?

Autotransplantation of premolars is a well-established method to rehabilitate aplasia of premolars. Nevertheless, with the introduction of titanium implants, not all surgical units offer this procedure. The aim of this study was to examine the predictability of autotransplantation of premolars on orthodontic indication as suggested by Andreasen et al., when performed by surgeons with or without prior experience of this procedure. A prospective protocol was implemented in 2001. All patients treated with autotransplantation of premolars during the years 2001–2015 were recalled to evaluate the long-term status of the teeth. The state of root development, need for endodontic treatment, presence of an apical pathology or ankylosis, and tooth loss were recorded. The results were divided into two groups according to the surgeon’s experience: senior surgeons with prior training and experience in the procedure and junior surgeons without prior experience. A total of 89 teeth (66 patients) were treated. The mean observation time was 10.1 years (range 1.0–15.1 years). The long-term survival rate was 95%. No statistically significant difference between the results of the two groups of surgeons was found. Autotransplantation of premolars on orthodontic indication could be adopted successfully in the hospital setting regardless of surgeon experience.