Factors associated with the recruitment and retention of dentists in the public sector

Objectives: There is an increasing demand for public dental services in Australia, with many community dental clinics unable to meet this demand because of an inadequate number of dentists in the workforce. The aim of this study was to identify factors contributing to the recruitment and retention of dentists in the public sector. Methods: A postal questionnaire survey of 180 dentists (response rate 75.6 percent) working in the Victorian public sector was undertaken to investigate the characteristics of public sector dentists, job satisfaction, remuneration, perceptions of public dentistry, future career intentions, and issues that relate to recruitment and retention of staff. Results: Victorian public dentists' main reason for entering the public sector was to work in a community‐based setting in a supportive and mentored environment. The main factors related to dentists leaving the public sector were poor remuneration, lack of clinical experience, and frustration with administrative policies. Victoria's oral health workforce shortages in the public sector are mainly attributed to retention issues. The potential for mentoring and a desire for helping those in need were factors attracting dentists to work in the public sector. Conclusion: There was a disproportionate number of female dentists in the public sector compared with the general population, and female dentists had a lower mean salary than male dentists regardless of experience. A range of factors were associated with retention, and gradual frustration because of poor remuneration and lack of professional autonomy were significant reasons for the decision to leave the public sector.     

Pathways in dental public health

Dental public health is one of the nine specialties of dentistry recognized by the American Dental Association Commission on Dental Accreditation. Dental public health has been defined as the "science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than as an individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis." This article will describe the many career and educational pathways dentists may follow to become irvolved in the practice of dental public health.     

National Health Care: Whither Goeth Dentistry?*

National health insurance is reemerging as an important issue on the national health policy scene. The continuing escalation of health care costs in the US and increasing numbers of individuals without access to health services are stimulating a variety of proposals to redesign the structure and financing of the American health care system. Some change in the current system toward a more national approach to health care is inevitable in the years ahead. While dental care is subject to pressures similar to other health care services, little attention is being accorded dental services in the various national health care proposals that are being advanced. This may be due largely to organized dentistry's reluctance to define a role for itself. If dentistry is to be included in such a plan, it is essential that concerted efforts start soon and that the various public and private sectors of dentistry work collaboratively to develop the dental component to such a plan. The future oral health of the public and the future health of dentistry as a profession depend on it.     

Oral health status and traditions in the Philippines

With an annual population growth of 2.71 per cent per year the government is harnessing all available resources so that every Filipino can enjoy a decent way of life. Since the majority of the population is in the rural areas, priority health services are directed towards this particular segment. Because of meagre income among the rural population all health services are given free, except for major operations, medicines and dental procedures such as the construction of partial and full dentures, porcelain restorations, root canal therapy and major oral surgery. Older people in the rural areas still adhere to their beliefs and traditions to alleviate the pain of toothache, particularly in the areas which cannot be reached by dentists. Because their fees are minimal the services of quack doctors/dentists and faith healers are still sought. In the Philippines, although dental health services have been given a low priority by the government, preventive dental health programmes are being implemented throughout the country. These include mouthrinsing with sodium fluoride solutions, supervised toothbrushing with fluoride toothpaste and the use of fluoride-containing varnish and fluoride tablets. Water fluoridation exists in two pilot areas and there is an intensive dental health education campaign. Indigenous health workers augment the inadequate dental manpower in attempting to attain and maintain the global indicator for oral health, which is 3 DMFT on average for age 12 years old.     

Addressing oral health disparities,inequity in access and workforce issues in a developing country

The health sector challenges in India like those in other low and middle income countries are formidable. India has almost one-third of the world’s dental schools. However, provisions of oral health-care services are few in rural parts of India where the majority of the Indian population resides. Disparities exist between the oral health status in urban and rural areas. The present unequal system of mainly private practice directed towards a minority of the population and based on reparative services needs to be modified. National oral health policy needs to be implemented as a priority, with an emphasis on strengthening dental care services under public health facilities. A fast-changing demographic profile and its implications needs to be considered while planning for the future oral health-care workforce. Current oral health status in developing countries, including India, is a result of government public health policies, not lack of dentists. The aim of the article is to discuss pertinent issues relating to oral health disparities, equity in health-care access, dental workforce planning and quality concerns pertaining to the present-day dental education and practices in India, which have implications for other developing countries.     

Geriatric oral health issues in Australia

Aim : To identify and discuss geriatric oral health issues in Australia. Methods : A discussion of the demographic trends, oral health trends, and barriers to dental care for older Australians is presented, together with a review of Australian public and private sector geriatric dental services, geriatric dental research, and geriatric dental education. Conclusions : Key geriatric oral health issues for Australia include: edentulism is decreasing and older Australians are retaining more natural teeth; coronal and root caries are significant problems, especially as older adults become more functionally dependent, cognitively impaired, and medically compromised; the oral health status of institutionalised older Australians is poor; the onset of severe oral diseases appears to occur in many older Australians prior to their institutionalisation, when they are homebound and dependent upon carers; carers of older adults do not have access to practical education about dental care; the majority of older Australians are eligible to use public‐funded dental services, but barriers limit their access to these services; few Australian public or private dental services are designed with a geriatric focus; geriatric dental education does not have a high profile in Australian dental schools; no specialty exists in Australia for geriatric dentistry, nor is there a national geriatric dentistry association.     

The professions of dentistry and dental laboratory technology: improving the interface

BACKGROUND: Dentistry's mission to provide rehabilitation services to patients who experienced dental disease is being jeopardized through the continual reduction of critical to quality skills and knowledge in dental laboratory technology being offered in dental and dental laboratory technician education. These reductions are creating a shortage of knowledgeable dentists and dental laboratory technicians who will be needed to address the projected public demand for laboratory-fabricated tooth replacements and restorations. METHODS: Demographic trend analysis supports a hypothesis that without immediate action by dentistry, substantial patient needs will not be met owing to inadequate levels of dental laboratory support for general dentists. RESULTS: The sophistication of laboratory-based rehabilitative and elective therapies demand closer cooperation between dentists and dental laboratory technologists. CONCLUSIONS: Dentistry must not abdicate its responsibilities in dental technology as it pursues a path away from rehabilitation services toward a projected future of prevention services. With decreasing educational exposure and training in dental laboratory procedures, dentists will have difficulty participating with dental laboratory technologists to fabricate laboratory-based rehabilitative and elective therapies. Without significant guidance from dental professionals in establishing laboratory standards in both education and practice, proprietary interests and commercial biases may set the laboratory and clinical standards of the future. CLINICAL IMPLICATIONS: Dentists will have limited experience or background to evaluate the dental laboratory technology offered in the marketplace and will be subject to the marketing of the industry. A shortage of educationally trained dental laboratory technologists will create a clinical and an economic burden on both dentists and patients.     

The pipeline from dental education to practice: the Pennsylvania experience

The pipeline from Pennsylvania dental education to Pennsylvania practice, rural practice, and low service area practice is described and analyzed. The article contends that pipeline development is an effective vehicle in meeting the public health mandate of ensuring access to dental care for all residents. Data from the American Dental Association served as the basis for addressing the two major research questions: 1) what are the educational origins of the dentist workforce in Pennsylvania, in rural areas of Pennsylvania, and in underserved areas of Pennsylvania? and 2) what is the proportion of Pennsylvania-educated dentists who practice in Pennsylvania, in rural areas of Pennsylvania, and in underserved areas of Pennsylvania? As an overall assessment, one can consider the Pennsylvania dental pipeline inadequate to meet the Commonwealth's public health goals. The pipeline is not adequately developed to repopulate the current Pennsylvania-educated dentist workforce, especially in the most needy areas. Understanding the prospects for further pipeline development is best achieved by considering the pipeline within the context of the practice model of dentistry and the current and future supply of dentists.     

Dental public health: new opportunities--new responsibilities

Major changes affecting oral health in the United States have provided new leadership challenges for public health dentistry. Two new roles for dental public health are proposed: leadership in the incorporation of expanded public health skills into the education of every clinical dentist; and a broadening of the specialty in a manner similar to that of preventive medicine, involving the creation of subspecialties in public health dentistry, occupational environmental dentistry, and management policy dentistry. The current status of community dentistry departments in dental schools and programs of public health education for dental personnel in schools of public health are reviewed. Content is suggested for the incorporation of expanded public health skills into the education of every clinical dentist.     

Dentistry and bioterrorism

Dentistry's role in responding to bioterrorism and other catastrophic events is evolving and may involve a wide range of activities. Organized dentistry. local dental societies. and interested individuals should make local emergency response planners aware of the services the dental profession can provide and should work to integrate dental resources to strengthen the disaster response capacity of community health care systems. With effective planning, education, and training, dentists can play a significant role in responding to acts of bioterrorism or other unforeseen events.     

Prevention of early childhood caries: a public health perspective

This paper proposes strategies for preventing early childhood caries (ECC), preferably for the greatest number of children at the lowest cost. Population-based, public health approaches are more likely to reach the target population groups at risk of developing ECC than individual, private practice-based approaches. Different prevention and early intervention strategies are discussed and the following recommendations are made: 1) Continue to promote community water fluoridation. 2) Evaluate the effectiveness of other public health oriented measures to prevent ECC. 3) Develop a national ECC and rampant caries registry. 4) Link oral health screening and easily implemented, low-cost interventions with immunization schedules and public health nursing activities. 5) Increase opportunities for community-based interventions conducted by dental hygienists. 6) Change insurance reimbursement schedules to provide incentives for dentists to prevent disease. 7) Include dentistry in new child health insurance legislation for children as well as parents of infants and preschool children.     

Prosthodontics--Past, present, and future.

1. The geographic areas served by licensed dental mechanics will increase in number and size in the future. 2. There will be increasing difficulties in supplying dental graduates of a high caliber from our faculties of dentistry to serve adequately in the field of prosthodontics. 3. More graduate (postdoctoral) programs will be needed to train dentists to treat difficult prosthetic patients. The need for prosthetic services is still with us and will continue to grow. Only with progressive thought and aggressive action can organized prosthodontics go forward to meet its challenges. A battle is not won on defense alone, for such has been the game plan to date. Currently, dentists have a reasonable way to deliver an important health service to the population at large. However, only with a rapid advancement in the concept of delivery of total prosthodontic care can the best interests of the public be maintained. Finally, the highest standards of practice and ethics must be the guiding principles to any future changes in the delivery of prosthodontic services to the public.     

Communicating with each other

Most dentists commit their professional lives to improving oral health by providing preventive and treatment services to their patients. In addition, dentists often participate in community, professional or legal activities that promote oral health. This paper describes five ways that dentists have worked with each other and with others to enhance oral health: (1) Dentists working with each other to promote oral health without the use of organized dentistry. Described as an example is the experience of all the periodontists in one city in the USA in providing community education. (2) Dental associations organizing or facilitating groups of dentists and other dental health professionals to develop and implement programmes that promote oral health. Two community-based educational efforts stimulated by the American Dental Association are described. (3) Dental specialty associations encouraging and facilitating specialists to work with other dentists to enhance their knowledge and skills in prevention, treatment and appropriate referral. The American Academy of Periodontology's efforts to teach communication skills to periodontists and diagnosis and treatment skills to general practitioners is cited as an example. (4) Dentists working with physicians and other non-dental health professionals to promote oral health. Integrating dental education into childbirth preparation classes for expectant parents is one instance of an interdisciplinary approach. (5) An individual dentist taking a leadership role to positively influence legislation to regulate a harmful substance. The efforts of one dentist to restrict the sale and promotion of smokeless tobacco are described. Working with other dentists, health care providers and legislators represent alternative ways that dentists have affected the oral health of individuals.     

Dental Public Health for the 21st Century: Implications for Specialty Education and Practice

A panel of public health practitioners sponsored by the Health Resources and Services Administration met December 6–8, 1994, to examine current roles and responsibilities for dental public health workers and to recommend changes in education and training to meet challenges posed by an evolving health care system. Overall, at least the same number, if not more, dental public health personnel will be needed in the future. While some new roles were identified, the panel felt that only small numbers of personnel will be needed to fill these new roles. Not all of these roles necessarily require a dental degree. The panel felt that a need exists for more academicians for dental schools, schools of public health, dental public health residencies, and dental hygiene programs; oral epidemiologists and health services researchers; health educators; and specialists in utilization review/outcomes assessment, dental informatics, nutrition, program evaluation, and prevention. To meet these personnel needs: (1) dental public health residency programs should be structured to meet the educational needs of working public health dentists with MPH degrees through on-the-job residency programs; (2) the standards for advanced specialty education programs in dental public health should be made sufficiently flexible to include dentists who have advanced education and the requisite core public health courses; (3) flexible MPH degree programs must be available because of the rising debt of dental students and the decreased numbers of graduating dentists; (4) loan repayment should be available for dentists who have pursued public health training and are working in state or local health departments; and (5) standards for advanced education in dental public health should be developed for dental hygienists.     

The Development and Practice of Social Dentistry in Germany

The traditions of social dentistry in Germany represent early forms of dental public health development. It was promoted in dental care facilities where salaried dentists delivered services to target groups, i.e., schoolchildren and sickness fund members. They enabled larger numbers of patients to receive dental care, especially those of lower class origin who otherwise would have remained untreated because of lack of financial resources or scarcity of manpower. School dental clinics not only delivered dental treatment, but also distributed oral hygiene and nutritional information to school-aged children. Social dentistry in the prefluoride era in Germany pursued an egalitarian and social-class oriented concept of dental care delivery, aiming at compensating the detrimental effects that the private practice-based, fee-for-service financed dental care system had produced in the lower classes of the population. The impact of the Nazi regime nearly abolished the institutions of social dentistry. They never were restored in West Germany after World War II. In East Germany dental care had been organized according to traditions of social dentistry, i.e., delivering services in dental treatment centers. Since the unification of the two German states, the institutions of dental care delivery in former East Germany have been restructured to fit the private practice-based model of former West Germany, eliminating most of the social dentistry institutions in the country.     

Gaining experience teaching community dentistry

From their personal participation, these two dentists recommend development of sites in which students of dental public health can gain practical experience for teaching community dentistry in a university.     

Changing patterns of oral health and implications for oral health manpower. Responsibility to the public

This paper examines organized dentistry's responsibility for informing the public about changing patterns of oral disease. The public is divided into two groups: governments and other organizations that are responsible for allocating funds for dental treatment, education and research, and the general population that is eligible to use dental services. Some governments in industrialized countries apparently believe that with the decline in caries, monies for dentistry can be reduced without affecting the oral health of the population. This assumption can be challenged, since oral disease levels in lower socioeconomic class groups and the elderly continue to be very high. Further, the goals of the dental care system should be raised to eliminate edentulousness. Dentistry needs to make the public aware that adequate care for the poor and elderly and eliminating edentulousness will require increased support for dentistry. At the patient level, regular users of care who are healthy should be informed that more frequent visits and complex services may have little effect on oral health. In contrast, infrequent users of dental care should be made aware that dentistry has the technology to prevent disease and the loss of teeth. One phase in the history of dentistry is coming to an end but another is beginning. In the new era the dental profession can make even greater contributions to the quality of life of individuals and society.     

Evidence-based dentistry: a clinician's perspective

Evidence-based dentistry is a discipline that provides best, explicit-based evidence to dentists and their patients in shared decision-making. Currently, dentists are being trained and directed to adopt the role of translational researchers in developing evidence-based dental practices. Practically, evidence-based dentistry is not usable in its current mode for the provision of labor-intensive services that characterize current dental practice. The purpose of this article is to introduce a model of evidence-based dental practice. This model conceptualizes a team approach in explaining problems and solutions to change current dental practice. These changes constitute an evidence-based dental practice that involves the electronic chart, centralized database, knowledge management software, and personnel in optimizing effective oral health care to dental patients.     

Should dentists become 'oral physicians'? No, dentistry must remain dentistry

Dentistry is not an allied health profession. It is not a paramedical profession. It is time that dentistry be recognized as the profession that offers patients some of the most complex surgery performed on the human body--namely, restorative dentistry and rehabilitation of the masticatory system. Dentistry is the only anatomically focused health care profession that is university-based and for which primary care responsibility is maintained by the profession. An inferiority complex about what it means to be a dentist has served only to confuse the public and bring us further from our goal of improving the health of all our patients. This inferiority complex is driven by the public and the medical profession, neither of which understands how dentistry fits into overall health care. It is essential that every academic health center have oral health education as an integrated part of health care education for dentists, physicians, nurses, allied dental personel, physical therapists, psychologists and all who receive university-based health care education. In this way, all the health professions and the public will see dentistry and oral health as essential to patients' overall health. The idea of emulating those who do not have the strength of basic-science education, practice complexity, surgical skills or community status by seizing a new title will not elevate the profession for the future. The public knows what a dentist is. It is our task to inform the public about the capabilities of dentists and the value of oral health and our profession. We can accomplish this best by assuring that our profession's name, "dentistry," is understood to represent one of the world's most accomplished surgical endeavors, one that is thoroughly integrated into the fabric of health care. Thus, good oral health will be thoroughly integrated into what it means to be healthy.