Orthodontic care in an insured population in Washington: demographic factors

Few studies have used insurance claims data to investigate demographic factors related to orthodontic care. This study sought to describe age and sex distributions in a large, insured population in Washington. Additionally, the demand for orthodontic care was evaluated with respect to county population, and the impact of the availability of orthodontists was investigated. All orthodontic claims in 2001 were retrieved from the Washington Dental Service database, along with associated provider and patient information. A total of 102,984 claims were included in this study. A large percentage of subjects (86%) were less than 20 years old, with most patients in their early teens. Overall, about 64% of all orthodontic patients were female. The demand for orthodontic treatment was the highest in the counties with the largest populations. Although there was considerable variation in the data, the number of orthodontic claims submitted by general dentists tended to decline as the availability of orthodontists increased.     

Dental Sealant Usage in Virginia

This trend study reports the results of a survey designed to determine usage of dental sealants in Virginia. A total of 2,434 general dentists, dental hygienists, and pedodontists were sent questionnaires regarding usage, technics, products, educational experience, and public interest in dental sealants. Increases in the provision of sealant coverage and in public interest for this preventive measure were noted. Approximately three-fourths of general dentists and dental hygienists working in a general or pedodontic practice are offering sealants to their patients. Pedodontists are the largest group of providers, with nearly 100 percent of pedodontists applying sealants. Recent graduates are applying sealants more often than earlier graduates. Preference for Delton clear color, light-cured material was shown. In general, a lack of professional knowledge about sealants continues to exist. Professional organizations and academic institutions may want to plan additional continuing education offerings for practitioners and to consider increased dental education instruction for students.     

Internet usage by pediatric dental practices in Connecticut

PURPOSE: The aim of this study was to determine Internet usage by pediatric dental practices in Connecticut. METHODS: A seven-item anonymous survey was mailed to all the 64 pediatric dentists in private practice in Connecticut. Each survey form was mailed along with a stamped and pre-addressed return envelope. Frequency distribution analyses and chi-square tests were performed. RESULTS: The survey had a response rate of 73%. More than three-fourths of the pediatric dental practices were connected to the Internet. Seventy-two percent of the practices submitted third-party claims electronically. Almost all of the respondents did not use email to communicate with patients or to discuss individual patient issues with other health care providers. Only two-fifths of the practices had a World Wide Web site. CONCLUSIONS: Most of the pediatric dental practices in Connecticut were connected to the Internet. Electronic third-party claims submission was the predominant Internet service used by these practices.     

Root canal treatment in a population-based adult sample: differences in patient factors and types of teeth treated between endodontists and general dentists

OBJECTIVE: The purpose of this study was to identify in a population-based study the differences between general dentists and endodontists with regard to types of teeth treated, fees, and patient characteristics. BASIC RESEARCH DESIGN: The "Florida Dental Care Study" was a prospective cohort study using a representative baseline sample of 873 dentate adults. In-person interviews and clinical examinations were conducted at baseline, 24 months, and 48 months, with 6-monthly telephone interviews between those times. Dental record information was abstracted afterward. RESULTS: A total of 100 root canals were performed in participants during the study period. While generalists performed the majority of endodontic procedures in all teeth, the percentage of molars treated by endodontists was significantly higher than the percentage of anterior teeth and bicuspids treated by endodontists. Data on fees were available in 85 of the cases. The trend was for endodontists fees to be higher, but the difference in fees was statistically significant only for molars. There were no statistically significant differences between generalist and specialist patients with regard to income, fear of pain, and frustration from previous dental care. However, a significantly higher percentage of patients treated by endodontists had dental insurance. CONCLUSIONS: Although the number of teeth ultimately treated in this representative sample of a dentate population was small, results do suggest that endodontists' fees were higher, they performed a higher percentage of molar root canals, and their patients were more likely to have dental insurance, as compared to general dentists who did root canals.     

Geographic distribution of specialist orthodontists and orthodontic providers in Japan

ObjectiveThis study aimed to clarify the geographic distribution of specialist orthodontists and dentists who provide orthodontic services in Japan.MethodsWe obtained data on the populations of 1750 municipalities in Japan in 2010 by referring to the census. We obtained data on the number of dentists who mainly provide orthodontic services (specialist orthodontists) and the number of dentists, including general dentists, who provide orthodontic services (orthodontic providers), by referring to the Survey of Physicians, Dentists, and Pharmacists. Furthermore, we referred to the directory on the website of the Japanese Orthodontic Society (JOS) to obtain data on JOS-qualified orthodontists. To assess the distribution of specialist orthodontists and orthodontic providers, we used Lorenz curves and Gini coefficients.ResultsThe median value for the number of specialist orthodontists and number of JOS-certified orthodontists per 100,000 persons aged between 5 and 40 years old was 0, while that of orthodontic providers was 27.5. Gini coefficients for specialist orthodontists and JOS-certified orthodontists were 0.523 and 0.615, respectively. On the other hand, the Gini coefficient for orthodontic providers was 0.258.ConclusionsRegional inequalities in the availability of specialist orthodontists are high, and medical access to specialist orthodontic services may be limited in areas other than urban districts. In municipalities with a population of fewer than 50,000 inhabitants, the number of specialist orthodontists was very low, but orthodontic providers were relatively evenly distributed. Our research results suggested that studying the distribution of specialist orthodontists and orthodontic providers can provide valuable information for developing dental care policies.     

Patterns of oral care in dental school and general dental practice

This study compared patterns of oral care provided by predoctoral dental students for patients seeking treatment at the University of Washington (UW) with patterns reported for general dental offices by the Washington Dental Service (WDS). Dental care included about 5 million services provided to 880,317 patients by 2,803 WDS general dentists and about 45,600 dental services provided to 9,488 patients by 155 UW dental students during 1999. There was high fidelity between databases and randomly surveyed patient records for treatment provided in both UW (95 percent) and WDS (97 percent) populations. While patient age patterns were generally similar, UW students completed more procedures for young children and for adults older than seventy-four years but completed fewer procedures for age groups of from thirteen to eighteen and from forty-five to fifty-four than general dental offices. The relative mix of all services completed by UW and WDS providers was similar (ANOVA, P=0.82). Within categories of service, the percentage of total services completed by students compared to those submitted by community dentists to WDS was about the same for examinations, radiographs, fluoride and sealants, amalgams, composites, single crowns, and endodontics. The percentage of total procedures completed showed a greater emphasis by UW students on inlays/onlays, dentures, extractions, and periodontal maintenance, and lesser experience with implants, orthodontics, sedation, and emergency procedures than general dental offices. We conclude that the relative distribution of clinical services provided by UW dental students is comparable to those procedures reported to WDS by dental offices in the adjacent community.     

Dental safety net capacity: An innovative use of existing data to measure dentists’ clinical engagement in state Medicaid programs

Background

The demand for dentists available for state Medicaid populations has long outpaced the supply of such providers. To help understand the workforce dynamics, this study sought to develop a novel approach to measuring dentists’ relative contribution to the dental safety net and, using this new measurement, identify demographic and practice characteristics predictive of dentists’ willingness to participate in Indiana's Medicaid program.

Methods

We examined Medicaid claims data for 1,023 Indiana dentists. We fit generalized ordered logistic regression models to measure dentists’ level of clinical engagement with Medicaid. Using a partial proportional odds specification model, we estimated proportional adjusted odds ratios for covariates and separate estimates for each contrast of nonproportional covariates.

Results

Though 75% of Medicaid‐enrolled dentists were active providers, only 27% of them had 800 or more claims during fiscal year 2015. As has been shown in previous studies, our findings from the proportional odds model reinforced certain demographic and practice characteristics to be predictive of dentists’ participation in state Medicaid programs.

Conclusions

In addition to confirming predictive factors for Medicaid enrollment, this study validated the clinical engagement measure as a reliable method to assess the level of Medicaid participation. Prior studies have been limited by self‐reported data and variations in Medicaid claims reporting.

Practical implications

Our findings have implications for state Medicaid policymakers by enabling access to data regarding dental providers’ level of participation in Medicaid in addition to identifying factors predictive of such participation. This information will inform Medicaid program plans and provider recruitment efforts.     

The provision of orthodontic services by general dental practitioners. 1. Methods and descriptive results

Information regarding orthodontic service provision by general dental practitioners in Australia is limited. The aim of this survey was to determine the amount and variety of orthodontic services provided by general dental practitioners in the Melbourne Statistical Division, Victoria, Australia. A random sample of 307 dentists drawn from the Victorian Dentists Register was surveyed by mailed questionnaire: 218 (71%) replied. Data were collected using a fortnight log. During this time 59 per cent of the dentists saw at least one orthodontic patient; one dentist saw 66 orthodontic patients. Removable orthodontic appliances were used by 35 per cent of the dentists and fixed orthodontic appliances by 18 per cent. Twenty-six per cent provided comprehensive orthodontic treatment, 22 per cent aligned incisors, and 21 per cent corrected anterior cross-bites. The general dental practitioners surveyed provided a wide range of preventive and interceptive orthodontic services to generally a small percentage of their patients.     

Variations in self-reported provision of services by general dentists in private practice

BackgroundVariations in dentists&;apos; provision of services have been documented, but information about contributing factors is limited.MethodsThe authors used responses to a 2003 survey of general dentists in private practice in California (46 percent response rate; 3,098 dentists included in the final sample) to assess variations in service provision and its correlates. They used logistic regressions to assess the correlation of various characteristics with the self-reported percentage of time spent providing services.ResultsThe results show variations in services provided by general dentists in private practice. Multiple factors, including the dentist&;apos;s sex, region of practice, employment of hygienists, patients&;apos; race and population income in the area of practice were significantly and independently associated with provision of services.ConclusionsThe survey results reflect practice variations that existed before the latest economic downturn, which resulted in a loss of jobs and medical and dental insurance. The data serve as the baseline for future studies of changes in dental practice and for assessing the impact of the 2010 health care reform legislation on dental practice.Practice ImplicationsImprovements in oral health care, the recent economic decline and health care reform may lead to changes in dental practice and in the dental workforce.     

Procedures provided to Medicaid recipients by pediatric, general and public health dentists in the commonwealth of Virginia: fiscal years 1994 and 1995.

PURPOSE: The purpose of this study was to report any differences found among the mean percentages of procedures performed by three types of dental providers for each type of service performed. The study focused on the types of services provided by dentists to Medicaid children in Virginia. METHODS: Medicaid claims field for dental patients younger than age 21 were obtained and analyzed for fiscal years 1994 and 1995. Dental providers were categorized according to their practice: general practice (GP), pediatric dentist (PD) and public health dentist (PH). Each type of practitioner (GP, PD, and PH) was evaluated for percentages of diagnostic, preventive, and corrective services provided to their Medicaid patients. The preventive category was subdivided into preventive services (scaling, prophy, fluoride and oral hygiene instruction) and sealant services. RESULTS: For each type of service, the mean percentages of procedures performed were compared among the three types of dental providers. The evaluation of the diagnostic procedure variable resulted in the finding that GP practitioners performed a significantly greater percentage of diagnostic procedures to their Medicaid patients than do PD and PH dentists (p < 0.0001). The percentage of preventive procedures performed by PD and GP dentists was not significantly different but was significantly lower than those performed by PH dentists (p < 0.0001). Finally, PD dentists performed a significantly greater percentage of corrective procedures than both GP and PH dentists (p > 0.0037). CONCLUSION: Differences were found among the mean percentages of procedures performed by the three types of dental providers for each type of service performed.     

上海地区口腔医师对牙髓再生治疗认知及应用情况调查

目的: 调查上海地区口腔医师对牙髓再生治疗认知及应用状况。方法: 采用多级、整群、随机抽样方法: ,从上海城区和郊区各随机抽取5个区,选取区内三级医院、牙防所、二级医院、民营医院诊所及私人诊所,以及3家口腔特色三级甲等医院的儿童口腔、牙体牙髓病及口腔综合医师,对每个调查单位内的所有相关口腔医师进行问卷调查。采用SAS 9.13软件包对数据进行统计学分析。结果: 共调查三级医院13家,牙防所8家,二级医院15家,民营医院及私人诊所20家,以及3家口腔特色三级甲等医院。调查相关口腔医师834人,回收有效问卷588份（70.5%）。知晓牙髓再生治疗者占总调查人数的68.2%,其中应用牙髓再生治疗者占20%。继续教育学习班是上海地区口腔医师学习牙髓再生治疗的主要途径（33.3%）,且对牙髓再生治疗感兴趣（85.8%）。对操作流程不熟悉是未应用的最主要原因（41.5%）。结论: 受教育程度较高的中青年牙体牙髓病及儿童口腔专业医师对牙髓再生治疗认知和应用率均较高,且对牙髓再生治疗继续教育学习班更感兴趣。应增加牙髓再生治疗继续教育学习班并增加实训课内容,以解决应用过程中对流程不熟悉的瓶颈。     

Method of payment for children's dental services by practice type and geographic location.

The purpose of this project was to evaluate practice type and geographical differences in methods of payment accepted for children's dental services. A survey was mailed to 2000 general dentists and 1000 pediatric dentists randomly selected to provide representation from the 50 United States. Dentists were asked to specify the type of practice and the state in which they primarily practice. The survey included Medicaid, dental insurance, preferred provider organizations (PPO), and self-payment as payment options. Dentists were asked to indicate whether they never, occasionally, or frequently accepted each option of payment for children's dental services. Responses were received from 1245 (42%) dentists, including 723 general dentists and 522 pediatric dentists. Chi-square statistical analysis revealed significant practice type and regional differences in the acceptance of Medicaid for payment. Pediatric dentists accept Medicaid more frequently than general dentists (P < 0.001). Most dentists accept dental insurance and self-payment, while few indicate involvement with a PPO. The study revealed significant practice type differences only in the acceptance of Medicaid as payment for children's dental services. On a geographic basis, there were significant differences in the acceptance of Medicaid and dental insurance.     

The provision of orthodontic services by general dental practitioners. 2. Factors influencing variation in service provision

Previous work has shown that variations exist amongst general dental practitioners in the volume and type of orthodontic services provided, the type of orthodontic appliances used, and the objectives of the orthodontic treatment. The aims of this survey were to identify practitioner characteristics that account for variations in the level of orthodontic services provided and which distinguish providers and non-providers of orthodontic services. Multiple regression analysis revealed that four practitioner characteristics explained 41 per cent of the variance in the number of orthodontic patients treated. Dentists who treated more orthodontic patients: 1) treated more general practice patients; 2) frequently used multiple sources to keep up to date in orthodontics; 3) perceived their patient base to contain more children; and 4) were likely to have attended a Truitt course. Eleven variables best distinguished providers from non-providers of orthodontic treatment; 1, 2 and 3 above had the highest correlation with the discriminant function. The Null Hypothesis that selected characteristics of dentists providing orthodontic services were no different from those of dentists not providing orthodontic services was rejected. The provision of orthodontic services was associated with a higher level of continuing orthodontic education as well as treating more general practice patients, especially children.     

Texas dentists' attitudes toward the Dental Medicaid program

PURPOSE: The purpose of this study was to report the attitudes of Texas dentists toward the Dental Medicaid program. METHODS: A self-administered survey was mailed to all pediatric dentists and a random sample of general dentists. RESULTS: Surveys from 347 (69%) of 500 dentists (171 of 295 general dentists [58%] and 169 of 205 pediatric dentists [82%]) were returned. 57% of pediatric dentists and 29% of general dentists (P<.0001) treated at least 1 Medicaid patient in the past year. The major areas of dissatisfaction were: (1) broken appointments; (2) low reimbursement levels; and (3) patient noncompliance. This mirrors results from studies in Iowa, Louisiana, Ohio, Washington, and California. Both pediatric and general practitioners identified the following barriers to core for the Medicaid population: (1) low dental IQ; (2) few providers; and (3) no transportation. CONCLUSIONS: The major areas of dissatisfaction included both programmatic and patient-related factors. Attributes of the system (eg, lower reimbursement levels) are more modifiable than attributes of the patient population (eg, patient noncompliance and low dental IQ). Underfunding of dental Medicaid is endemic to all states studied in the literature. Providers, legislators, and government programs should target the programmatic problems with future efforts and funding.     

Cost and productivity analysis of orthodontic care in Finland

Abstract– The aim of the study was to investigate the costs of orthodontic care provided for children and adolescents up to the age of 18 by municipal health centers in Finland, and to study the productivity of these services. The data were gathered by a questionnaire sent to all health centers; 96% responded. The majority of respondents estimated the share of orthodontic care as 10% of the total gross costs of dental care, given that 14% of all dental visits were for orthodontic reasons. To study the productivity in individual health centers, the output was measured by the estimated number of completely treated patients. The cost of orthodontic treatment per completely treated patient was, on average, FIM 7358, ranging from FIM 1299 to FIM 24 751. The strongest explanatory factor for the average total costs of orthodontic clinics was the number of general dentists with little experience in providing orthodontic treatment. Other explanatory factors were the number of orthodontists or experienced dentists, the percentage of orthodontic tasks performed by auxiliary personnel, and the timing of treatment. Savings might be obtained by devolving treatment to orthodontists or experienced dentists in-stead of to dentists with little orthodontic experience, and by starting treatment early. The estimated optimal size for an orthodontic clinic was found to be a unit with 830 completely treated patients per year, but most of the orthodontic clinics were in fact much smaller with, on average, 133 completely treated patients per year.     

Rural versus urban analysis of dental procedures provided to Virginia Medicaid recipients

PURPOSE: The purpose of this study was to report the distribution of procedures provided to Virginia Medicaid children by 3 types of dental providers in rural and urban areas. METHODS: Medicaid claims filed for dental patients less than 21 years old were obtained and analyzed for fiscal years 1994-1995. Dental providers were categorized according to their practice type: (1) general practice (GP); (2) pediatric (PD); and (3) public health (PH) dentists. Each type of practice was categorized as practicing in a metropolitan, urban, rural, or completely rural location and evaluated for percentages of preventive, diagnostic, and corrective services provided. RESULTS: Rural areas had a higher percentage of significant providers than did metropolitan or urban areas. General dentists performed more diagnostic and preventive but fewer corrective procedures than pediatric dentists. Pediatric dentists and general dentists in completely rural areas performed more corrective procedures than their counterparts in metropolitan or urban areas. CONCLUSIONS: General, pediatric, and public health dentists in metropolitan and urban areas perform slightly more diagnostic services and fewer corrective services than practitioners in more rural areas.     

Patients with special health care needs in general and pediatric dental practices in Ontario

The objective of this study was to determine the involvement of Ontario's general and pediatric dentists in providing care to patients with special health care needs (PSHCNs). A questionnaire was developed and sent to a randomly selected sample of general dentists and to all pediatric dentists in Ontario; response rates were 52% and 90%, respectively. Most general dentists and all pediatric dentists reported that they provided a full range of dental services to PSHCNs. Most (80%) general dentists treat PSHCNs of all ages, whereas 60% of pediatric dentists report only treating PSHCNs up to the age of 18 years. A majority of both groups report treating PSHCNs whose dental care is paid through various government-funded programs. Most general dentists received training in the treatment of PSHCNs in undergraduate dental school, and 40% reported taking continuing education courses in this area. Most pediatric dentists received this training during their advanced dental specialty training, and 29% reported taking continuing education courses in this area. The results of this survey appear to demonstrate that general and pediatric dentists in Ontario provide a full range of dental services to PSHCNs, treat patients with a variety of disabilities and of all ages and are interested in pursuing continuing education that focuses on the delivery of dental care to PSHCNs. However, the results may be inaccurate because of question design flaws and responder bias among the 52% of surveyed general dentists who returned their questionnaires.     

Reporting of child abuse: a follow-up survey of Texas dentists

PURPOSE: Child abuse is a disturbingly common finding in society today. There have been substantial and significant increases in the incidence of child abuse since the last national incidence study was conducted in 1986. Kassebaum first reported the under-reporting of child abuse by Texas dental professionals in a survey in 1986. The objective of the current study was twofold: (1) assess the level of knowledge and attitudes among dental professionals on the important issue of child abuse; (2) evaluate and compare the results of the current study with a similar survey conducted in 1986. METHODS: A 24-question survey similar in format and content to the 1986 questionnaire was mailed to 1,046 Texas dentists, randomly selected from a membership roster provided by the Texas Dental Association. Both general dentists and selected specialists were included in the study group. The questionnaire consisted of multiple-choice and dichotomous yes/no questions. RESULTS: There were 383 responses to the questionnaire, yielding a response rate of 38%. The majority (N=289) of the respondents were general dentists. In answering questions about suspected and reported cases of child abuse, nearly 50% of the responding dentists reported they had suspected at least 1 case of child abuse. In the 1986 study, only 36% of the responding dentists reported they had suspected at least 1 case of child abuse. Between 1986 and 2001, the survey has shown that the percentage of dentists who reported at least 1 case to authorities slightly increased from 19% in 1986 to 25% in 2001, but the ratio of suspected to reported cases had not changed since 1986. CONCLUSIONS: Although the composite percentage of suspecting and reporting cases of child abuse from this survey is higher than the percentage demonstrated in 1986 study, there was no significant change in the relative ratio of reported cases to suspected cases in both surveys. This indicates that under-reporting of child abuse cases is still a significant problem in the dental profession in Texas.     

A survey of participation in managed care programs by endodontic specialists

A survey was published in the Quarterly Survey of Dental Practice (QSDP) Special Topics that dealt with contractual agreements in dentistry. This survey evaluated general dental practitioner participation apart from that of dental specialists in general. The Quarterly Survey of Dental Practice survey was modified and used in the present study to specifically determine the participation by endodontists in various contractual insurance agreements, including Preferred Provider Organization and Health Maintenance Organization programs. A 10% sample of practicing endodontists was randomly selected to participate in this survey. Questionnaires (331) were sent out, and 229 or 69% were returned. Total participation by endodontists responding to this survey in any Health Maintenance Organization and/or Preferred Provider Organization insurance plans was 31.3%; however the total percentage of patients treated under these insurance plans was only 6.6%. These results were similar to those in the 1994 survey in which it was shown that 27% of the general dental practitioners and 41% of the dental specialists participated in one or more of these insurance programs and treated respectively, 5% and 9%, of their patients under these plans. Although participation in various managed care programs by endodontists in this survey was close to one-third, the total number of patients treated under these plans was low. Overall patients treated under fee-for-service arrangements by endodontists responding to this survey formed 85.3% of their patient pool. It does not appear from the results of this survey that managed care insurance has a significant impact on the practice of endodontics. It can be postulated that endodontists are unwilling to accept more than a small reduction in fees to join managed care plans, and they also desire to retain full control of their dental practice.     

Orthodontic education and practice in Canada: perceptions of the profession as shown in a recent survey

A questionnaire survey concerning the training and practice of orthodontics was mailed to 20 per cent of the licensed dentists and to dental specialists in the provinces of Ontario, Manitoba, Alberta, and British Columbia between March and August of 1987. The response rate was 49.4 per cent. Many dentists and orthodontists who completed the survey reported declines in patient load during the past three years. Dental schools are perceived to be providing inadequate orthodontic training, in both the undergraduate dental curriculum and in the area of continuing education. A desire for an increase in time, quality, and applications was expressed. Between 20.1 and 34.2 per cent of fully-banded orthodontic cases are being treated by general practitioners.