Prosthodontists in Private Practice: Current and Future Conditions of Practice in the United States (Part I)

PURPOSE: The purpose of this study was to use data from surveys of prosthodontists to examine the current conditions and characteristics of prosthodontists in private practice in the United States. MATERIALS AND METHODS: Characteristics of prosthodontists and conditions of practice are based on the 2002 Survey of Prosthodontists and the 2005 Survey of Prosthodontists. Both surveys were conducted by the American College of Prosthodontists. Several characteristics of private practice/practitioners are estimated including age, gender, number of patient visits, hours in the practice, employment of staff, and financial conditions (gross receipts, expenses of the practice, and net income of prosthodontists) RESULTS: In 2004, the average age of private practitioners was 50 years. Years since graduation from dental school averaged 23.4 years, and years since completion of residency was 18.3 years. Prosthodontists spent an average of 35.7 hours per week in the office and 29.5 hours treating patients. In 2004, the average gross revenue per owner of a private practice reached $782,130, and mean net income was $258,490. The largest percentage of prosthodontist time was spent providing six procedures including fixed prosthodontics, implant services, complete dentures, operative care, diagnosis, and partial dentures. CONCLUSION: The United States spends about $1.8 billion on prosthodontic services provided by prosthodontists in private practice. Prosthodontists spend $1.1 billion dollars in expenses and treat an estimated 1.1 million patients per year.     

The Private Practice of Prosthodontists: Current and Future Conditions of Practice in the United States (Part 2)

PURPOSE: Data are used to examine current and future conditions important to the private practice of prosthodontics. A concern is raised as to whether the future supply of prosthodontists is in sync with the dynamics of the US population and patient population. MATERIALS AND METHODS: Four trends are examined using data from various sources. The trends include: (1) growth in the number of private practicing prosthodontists, (2) projections of the future number of private practicing prosthodontists, (3) first year enrollment in dental schools, and (4) enrollments and graduates in residency programs. RESULTS: The number of private practicing prosthodontists has increased modestly over the past 21 years, growing 1.33% per year. The number of private practitioners is projected to reach 4,125 in 2025. A key variable in this projection is the growing number of elderly adults. While dental school enrollments have been increasing, concern is raised about the amount of exposure by students to an undergraduate curriculum in prosthodontics. There has been a general decline in enrollment in the nation's prosthodontics residency programs at the rate of -2.9% per year. An average of 181 program graduates are needed to achieve the 4125 projected number of private practitioners. CONCLUSION: Increasing demand for services from prosthodontists is supported by an increasing US population size and a growing population of elderly. Efforts to grow the number of private practicing prosthodontists will have to consider several concerns including residency program enrollments, undergraduate exposure to prosthodontics, and the overall economic returns expected from engaging in the private practice of prosthodontics. Choosing a career as a private practicing prosthodontist is a timely consideration and complimented by expected increases in demand for care and favorable financial returns to practice.     

Current Trends in Use and Reuse of Nickel-Titanium Engine-driven Instruments: A Survey of Endodontists in the United States

IntroductionInformation is scarce regarding current usage practices of nickel-titanium (NiTi) engine-driven instruments in clinical practice. Therefore, the specific purpose of this survey was to assess trends among endodontists regarding the use and reuse of NiTi instruments.MethodsA 16-question survey was sent by e-mail to about 4000 active members of the American Association of Endodontists. Data were collected over a 6-month period and compared using chi-square tests.ResultsA total of 957 surveys were collected (response rate = 23%). Of the respondents, 40.2% worked in solo practices; among them, there were significantly fewer recent graduates (<10 years) compared with those who graduated more than 10 years ago. Furthermore, 41.7% were in a group practice, 4.3% in corporate practice, 10.7% in university settings, and 3% in the military. Overall, 98.3% of respondents reported using NiTi instruments. Respondents who graduated less than 25 years ago use NiTi instruments significantly more (99%) than those who graduated more than 25 years ago (92.6%). Although 22.9% of respondents buy presterilized instruments, 41.6% sterilize them before use, and 35.5% do not sterilize new instruments before use; dental officers in the military reported that they use sterile new instruments in 100% of cases. NiTi instruments were reused by 74% of respondents. The 2 largest segments of the specialist endodontic instrument market belonged to Dentsply (York, PA; 56.9%) and EdgeEndo (Albuquerque, NM; 28.8%).ConclusionsThere are significant differences in the use of NiTi instruments among types of practice and years since graduation. There were noticeable changes compared with findings reported about 10 years ago.     

A Survey of Private Prosthodontic Practice

This article reports the data of a survey of private prosthodontic practitioners. It reports incomes, overhead expenses, staff size, and character of prosthodontic practices. The study also develops a profile for a median prosthodontic practice and practitioner.     

A Survey of Private Prosthodontic Practice

The data from a survey of private prosthodontic practitioners are reported in this article. The author provides a brief look at employment status, number of employees, time spent in the office, number of patient visits per week, gross billings, net income, and practice expenses of prosthodontic practices. In addition, the author has developed a profile for a median prosthodontic practice and practitioner.     

Fluoridation and the Private Practice of Dentistry

Water fluoridation holds an important place in the history of Grand Rapids. This paper recounts the firsthand professional experiences of a dentist before and after he joined his father's established dental practice in Grand Rapids, only two years after fluoridation of the city's water supply began. The benefits of water fluoridation are documented through a review of office records. The prevalence of dental caries in patients who were born in Grand Rapids after water fluoridation began is low, and no case of a missing first permanent molar was found. Quadrant dentistry is no longer practiced. Children of parents born in Grand Rapids after the start of water fluoridation experience less decay than their parents, suggesting that factors in addition to water fluoridation have played a role in the downward trends in caries. The complete destruction of mouths of patients seen in this practice 50 years ago no longer happens, providing evidence of the benefits of water fluoridation, the most important advance ever in dentistry.     

Survey of implant experience by prosthodontists in the United States

PURPOSE: The paper presents results of a survey of members of the American College of Prosthodontists (ACP) conducted to determine experiences and practices with dental implants. MATERIALS AND METHODS: Preliminary survey questions regarding the prosthetic and surgical use of dental implants were developed. The master list of questions was distributed to communities of interest to establish the most pertinent items of interest. The final questionnaire was distributed to all members of the ACP living or practicing in the United States and members engaged in the U.S. armed services. Responses were compiled and analyzed to determine correlation of responses using the chi-squared test for count data (level of significance alpha = 0.05). Fisher's exact test was applied to all significant responses. RESULTS: Surveys were distributed to 1815 ACP members. A total of 554 (31%) surveys were completed. On the basis of age distribution of survey respondents, it was determined that the respondents were representative of the ACP membership. The majority of the respondents (82%; CI, 79% to 85%) treat patients with implant-supported prostheses, while 12% (CI, 10% to 15%) surgically place implants. Of those not placing implants, 24% reported a desire to place implants, while 43% of all respondents expressed a desire for an ACP-sponsored course in implant placement. Increased age of the prosthodontist correlated negatively with a desire to place implants (p < 0.0001). Dissatisfaction with implant placement by others correlates with willingness to surgically place implants (p < 0.0001). CONCLUSIONS: Most prosthodontists (82%) use implant-supported prostheses in their practices, but most of the implants are placed by non-prosthodontists. There is general satisfaction with implant placement regardless of the specialty of the practitioner placing the implants. Younger prosthodontists expressed a greater desire to surgically place implants but were not statistically more likely to do so.     

Hepatitis B Vaccine Usage Among Dental Practitioners in the United States: an Epidemiological Survey

A telephone survey of 283 nonfederally affiliated dental practitioners in the United States was completed in April 1986. The study's objectives were to determine hepatitis B vaccine usage among dentists nationwide, and to examine the epidemiologic characteristics of vaccinated and unvaccinated subjects. Forty-four percent of the participants had received at least the first of the three doses of HB vaccine. Acceptance of the vaccine was associated with the use of gloves during dental procedures and the subject's perception of high-risk patients in his or her dental practice. The most common reasons for not being vaccinated were concerns about vaccine safety and a lack of perceived need for the vaccine. The vaccination rate in this survey is higher than in earlier studies, indicating that acceptance of the vaccine by dental practitioners is increasing.     

A survey of program directors: trends, challenges, and mentoring in prosthodontics. Part 1.

PURPOSE: This study consisted of two parts. Part 1, a survey of program directors, was conducted to examine current trends in advanced education in prosthodontics in the United States. Part 2 will report on the survey results distributed to the deans of US dental schools to evaluate their observations of trends in prosthodontics. MATERIALS AND METHODS: A national e-mail survey of 45 program directors was used to collect enrollment data for years 1 to 3 of prosthodontics training for US and international dental school graduates, the total number of applicants and applications considered, and the trends over time of applicants to prosthodontic programs for US dental school graduates and for international graduates. In addition, the program directors were asked to rank 13 key factors that may have contributed to any changes in the prosthodontic applicant pool. Comments were accepted on why more or less US- or internationally trained applicants have applied. Program directors were also asked for information on student financial incentives, whether their programs were state or federally funded, and whether their sponsoring institution was a dental school. RESULTS: Of the 45 program directors, 39 responded, for an 86.7% response rate. Respondents reported that 64% of their enrollments were graduates of US dental schools. Between 2000 and 2004 the applicant pool in prosthodontics increased by 23%, with 41% of program directors reporting an increase in US-trained applicants, 46.2% reporting no change, and only 12.8% reporting a decrease. Using the Spearman correlation, there was a moderate, positive statistically significant correlation that the following factors contributed to an increase in the number of US dental graduates applying to prosthodontic programs: (1) mentoring by prosthodontists at the predoctoral level, (2) interest in prosthodontics among US dental students, and (3) society's demand for a higher level of training and credentialing, (4) data depicting current and projected income for dental specialists, and (5) number of trained prosthodontists full- or part-time faculty at the predoctoral level. Only five programs offered no financial packages to offset tuition. The remaining 34 respondents reported some financial package. Among the respondents, there were 25 state-sponsored programs, 9 sponsored by private universities, and 5 sponsored by hospitals or federal agencies. CONCLUSION: An increased applicant pool and more US-trained applicants to prosthodontics programs create a more competitive applicant pool for our specialty. Program directors reported that factors such as mentoring, society's demand for a higher level of training and credentialing, data depicting current and projected income for prosthodontists, exposure to prosthodontic faculty at the predoctoral level, the dollar value of prosthodontic training, and advances in implant, aesthetic, and reconstructive dentistry have all had some impact on increasing the applicant pool to prosthodontic training in the United States.     

Ten‐Year Survey of Program Directors: Trends,Challenges, and Mentoring in Prosthodontics. Part 1

Purpose: This study consisted of two parts. Part 1 was a survey of US program directors, and Part 2 reports on the survey findings distributed to the deans of US dental schools. Both surveys evaluated observations of trends in prosthodontic education. The first survey (2005) of program directors and deans was published in 2007. This second survey was conducted in 2009. The 2009 survey provided 10‐year data on trends in prosthodontics as reported by program directors. Materials and Methods: A national e‐mail survey of 46 program directors was used to collect enrollment data for years 1 to 3 of prosthodontics training for US and international dental school graduates, the total number of applicants and applications considered, and the trends over time of applicants to prosthodontics for US dental school graduates and for international graduates. In addition, the program directors were asked to rank 13 key factors that may have contributed to any changes in the prosthodontic applicant pool. Program directors were also asked for information on student financial incentives and whether their programs were state or federally funded, and whether their sponsoring institution was a dental school. Results: Of the 46 program directors, 40 responded, for an 87% response rate. Respondents reported that 66% of their enrollees were graduates of US dental schools. Between 2000 and 2009 the applicant pool in prosthodontics nearly doubled, with 50% of the program directors reporting an increase in US‐trained applicants, 42.5% reporting no change, and only 7.5% reporting a decrease. Using the Spearman correlation for the 10‐year survey, there was a positive, statistically significant correlation that society's demand for a higher level of training and credentialing and interest in prosthodontics among dental students contributed to an increase in the number of US dental graduates applying to prosthodontic programs. Only four programs offered no financial packages to offset tuition. The remaining 36 respondents reported some financial package. Among the respondents, there were 23 state‐sponsored programs and 6 sponsored by private universities; the remaining 9 were sponsored by hospitals or federal agencies. Conclusions: A nearly doubled applicant pool and more US‐trained applicants to prosthodontics ensure a much more competitive applicant pool for our specialty. In the 2009 survey, program directors reported that factors such as society's demand for a higher level of training and credentialing, interest in prosthodontics among US dental students, advances in implant, esthetic, and reconstructive dentistry, literature pertaining to the need of prosthodontists for the future, marketing of prosthodontics as a career, and the dollar value of prosthodontic training have all had some impact on increasing the mentored applicant pool to prosthodontic training in the United States.     

Prosthodontics as a Specialty Private Practice: Net Income of Private Practitioners

PURPOSE: The aim of this study was to use data from a survey of prosthodontists in the US to examine average net earnings of prosthodontists in private practice. MATERIALS AND METHODS: A survey of 2500 prosthodontists in the US was used to estimate the net earnings of practicing prosthodontists. The national average net earnings of prosthodontists in private practice was estimated along with average earnings for subgroups of prosthodontists. Estimates for private practitioners by age, gender, size of practice, full-time/part-time status, practice ownership, and by type of treatment procedures rendered by the practitioner were also included. RESULTS: Average earnings for prosthodontists in private practice on a primary or secondary basis were estimated to be $215,300 and for prosthodontists who own or share in the ownership of a private practice, $233,920. Reported earnings estimates ranged from $96,160 for non-owners of a private practice and $103,350 for part-time private practitioners to $233,920 for practice owners and $275,170 for prosthodontists in practice with two prosthodontists. The average earnings of prosthodontists who are practice owners were estimated to be 35% higher than the corresponding general practitioners. CONCLUSION: Average net earnings are often used to examine the current economic health of a profession. The average net earnings of prosthodontists in private practice exceed the average net income reported by the American Dental Association for all dentists and all general practitioners and they are competitive with earnings among all specialty groups. This evaluation of the net earnings of prosthodontists shows that prosthodontics offers a competitive career opportunity for the general dentist with a personal desire to pursue advanced dental education in a specialty as a profession.     

A survey of deans: trends, challenges, and mentoring in prosthodontics. Part 2.

PURPOSE: This study consists of two parts. Part 1, a survey of program directors, was conducted to examine current trends in advanced education in prosthodontics in the United States. Part 2 reports on the findings of a survey distributed to the deans of US dental schools to evaluate their observations of trends in prosthodontic education. MATERIALS AND METHODS: A national, electronic survey of 55 dental school deans was distributed by e-mail to evaluate an interest in specialty training, an interest in specialization in prosthodontics, faculty shortages, programs to address faculty shortages, predoctoral curriculum in prosthodontics, opinions regarding dental specialties, and the administrative position of prosthodontics within the schools. RESULTS: Of the 55 deans, 44 deans responded, an 80% response rate. Only five deans reported a decrease in the number of students seeking specialty training after dental school. The remaining 39 deans reported a large increase, slight increase, or no change in those seeking specialty training. In 29.6% of the deans' responses, an increased interest in prosthodontics was reported, whereas 16 deans reported no change in the level of interest. One or more open faculty positions in prosthodontics existed at 29 dental schools, and 28 schools offered at least one incentive or a variety of incentives to recruit faculty. The respondents to the deans' survey revealed predoctoral student exposure to prosthodontists was high, and exposure to postgraduate prosthodontics students was low. A survey of internal school programs that might have an impact on an increased interest in prosthodontics revealed the presence of a predoctoral mentoring program for prosthodontics in 80% of the institutions. The clinical curriculum included treatment of a variety of cases, including complex cases as defined by a diagnostic classification system. The response to whether dental specialties should be combined or remain individual provided some interesting data. Only 40.9% of the deans responded that prosthodontics was a separate department. CONCLUSION: Dental school deans reported an increased interest in specialty training. Predoctoral student exposure to prosthodontics was high due to the nature of their clinical experience and due to the exposure to full-time prosthodontics faculty. Many dental schools have programs, such as mentoring and new technology, which might have an impact on predoctoral students' increased interest in prosthodontics.