Academic Dental Public Health Diplomates: Their Distribution and Recommendations Concerning the Predoctoral Dental Public Health Faculty

Objectives : The purpose of this study was to assess the representation of academically based diplomates of the American Board of Dental Public Health (ABDPH) and to identify their perceptions on the training of dental public health predoctoral faculty. Methods : Data were collected by a mailed, self-administered, 13-item questionnaire. The population was the 48 diplomates of the ABDPH as of March 1997 associated with academic institutions. Results : Twenty of the 55 US dental schools had a diplomate of the ABDPH with a mean of 1.8 diplomates per school with a diplomate. An average of 4.5 full-time faculty members per school were associated with teaching dental public health. A master's degree in public health (MPH) was the most frequently suggested educational requirement for dental public health faculty. Continuing education courses were training needs perceived for dental public health faculty. The lack of time, money, and incentives, along with perceived rigidity of requirements for board certification, were reported as major barriers for faculty becoming dental public health board certified. Conclusion : Numerous challenges confront the development of a strong dental public health presence in US dental schools. These challenges include, among others, insufficient numbers of academic dental public health specialists and insufficient motivations to encourage promising candidates to pursue specialty status.     

Are Dental Hygienists Prepared to Work in the Changing Public Health Environment?

Health care reform, the changing public health environment, and a lack of clarity about what defines a ‘public health professional’ create challenges as well as opportunities for dental hygienists who wish to pursue positions or careers in public health.BackgroundAlthough many studies have been conducted about dental hygienists in clinical practice, there are few describing dental hygienists working in public health positions, particularly in non-clinical roles, or how well their education and other resources prepared them for these roles. Competency statements and the 10 Essential Public Health Services to Promote Oral Health in the U.S. provide a public health framework to assess what skills will be required for future opportunities that may emerge for dental hygienists.MethodsPublished literature, recent unpublished survey data, selected professional health care reform documents, competency statements, accreditation standards, and the 10 Essential Public Health Services to Promote Oral Health in the U.S. were analyzed. Competencies in public health/dental public health provide an overview of skills needed by dental hygienists who will be seeking public health positions. Health reform statements describe the need for more leadership and workforce models in public health, while the 10 Essential Services can serve as a framework for career preparation/transition.ConclusionsThe literature does not provide a comprehensive historical review or current profile of dental hygienists who work in various public health positions or their various roles, especially non-clinical roles. More research is needed regarding current positions, degree and experience requirements, and role responsibilities. Additionally, the credentials and public health background of the faculty teaching community/public health courses in dental hygiene programs requires exploration. Follow-up studies of dental hygiene program graduates could help determine how well courses prepare students for public health activities or careers and what resources aid in transitioning from clinical to public health positions. Dental hygienists need more information about education, continuing education and employment opportunities related to pursuing a career in public health.     

Training status and interest in certification of nondiplomate faculty teaching predoctoral dental public health

OBJECTIVES: A survey was conducted to better understand the training needs of faculty members without dental public health (DPH) specialty board certification who teach DPH to dental students. METHODS: An 11-item questionnaire was sent to 193 non-DPH diplomate faculty members at US dental schools who were dentists and at least one of the following: a member of the American Association of Dental Schools Community and Preventive Dentistry Section, a referral from an academic American Board of Dental Public Health diplomate, a DPH faculty listed on the school's Web pages, a DPH contact from the AADS Institutional Directory, or the school's dean if no other contact. RESULTS: A 70 percent response rate was obtained. Seventy-nine percent of the respondents taught at least one national board-related DPH topic. Among these faculty members, 67 percent have or are in training for the master of public health, 26 percent have completed or are in a DPH residency, and 63 percent desire training in one or more of the DPH topics. The majority (64%) does not plan to take the specialty exam, while 28 percent plan to take the exam within five years. About half reported no personal incentives to take the exam and 39 percent perceived no institutional incentives. CONCLUSIONS: These nondiplomate teachers of predoctoral DPH desire training, but appear to have barriers and perceive few benefits to achieving DPH board certification.     

Reforming dental workforce education and practice in the USA

The USA dental education programmes are facing challenges similar to those confronting countries around the globe, particularly amongst the industrialised nations. The purpose of this study was to evaluate the educational programmes of 15 USA dental schools to determine their impact on improving workforce diversity and oral health care access. The study investigates the predictors of public service plans of dental school seniors in Pipeline and non‐Pipeline Program dental schools. We analysed baseline and post‐intervention data collected in the American Dental Education Association (ADEA) Annual Survey of Dental School Seniors and a set of contextual variables. Public service plans (dependent variable) was predicted by four types of independent variables: intervention, contextual, community‐based dental education (CBDE), and student characteristics. Findings from the study show that access to a state or federally sponsored loan repayment program was the most significant predictor of public service plans and that increasing educational debt was the most significant barrier. In the short‐term we may be able to sustain the USA loan repayment programs to motivate senior dental students to provide public service to address the oral health care access crisis. However, in the long‐term, a new workforce development initiative will be required to transform dental education and practice, modelled after the well‐respected licensure programmes for Physician Assistants and/or Advanced Practice Registered Nurses, to expand oral health care access, particularly amongst vulnerable population subgroups, such as low‐income children and families.     

Report of recommendations from the National Dental Public Health Workshop, February 10-12, 2002, Bethesda, MD

A two-and-a-half day workshop was held beginning February 10, 2002, to review the current state of dental public health training in the United States with the aim of creating recommendations that would address identified problems and lead to improvements in the quality of dental public health training. This workshop, held in Bethesda, Maryland, was sponsored by the Health Resources and Services Administration (HRSA) through a contract with the American Association of Public Health Dentistry (AAPHD). Workshop invitees included the program directors of all accredited dental public health residency programs in the United States and Canada, selected dental public health residents, and additional consultants invited based on their expertise in dental public health education. The recommendations have been placed into three categories: training, financing, and workforce development. Along with background and process summaries, these recommendations are reported here.     

Dental school applicants by state compared to population and dentist workforce distribution

Millions of Americans face significant barriers that limit their access to oral health care, including the lack of dental health care professionals willing to provide dental services in underserved areas. The purpose of this study was to evaluate the relationship between the geographic distribution of dental school applicants and the population and number of dentists by state. Data from the Associated American Dental Schools Application Service (AADSAS), the American Dental Association (ADA), the U.S. Census Bureau, and the U.S. Department of Commerce were used to determine the total number of dental school applicants, dentists, and populations by individual state. Results suggest that, based on national averages, the majority of states may have too few dentists to meet current and future state population needs. Also, many of these same states may have too few dental school applicants when compared to state population and dental workforce figures. It was concluded that states may wish to consider targeted initiatives aimed at increasing the sizes of their dental school applicant pools in order to help address current and future local or regional dental workforce needs.     

Minority dental faculty development: responsibility and challenge

Over at least the last twenty years, the American Dental Education Association (ADEA) has given attention and priority to increasing the number of underrepresented minority (URM) dental school applicants, enrollees, and faculty members and to meeting the challenges of achieving diversity in the oral health workforce of the future as racial and ethnic minorities continue to grow and are expected to comprise more than 50 percent of the U.S. population by the middle of the twenty-first century. Dental schools have the responsibility of preparing dentists to provide oral health care for the nation's population. This includes creating a workforce of adequate size and racial/ethnic composition. As part of ADEA's priorities to improve the recruitment, retention, and development of URMs in the dental profession, with funding from the W.K. Kellogg Foundation, ADEA launched the Minority Dental Faculty Development Program in 2004. The intent of the program is to foster academic partnerships, mentoring, and institutional commitment and leadership designed to increase the number of URM individuals interested in and prepared for careers in academic dentistry.     

Dental school faculty shortages increase: an update on future dental school faculty

The 1999 publication of the American Association of Dental Schools (AADS) President s Task Force on Future Dental School Faculty revealed a crisis in the shortages of dental school faculty. Stakeholders from around the nation have used the AADS Task Force report to address the crisis. In addressing one of the AADS Task Force recommendations, the American Dental Education Association (ADEA), formerly AADS, gathered additional data through a new survey of dental school deans to elucidate the current state of faculty shortages. Based on this research, ADEA projects that the number of unfilled budgeted faculty positions in U.S. dental schools now approaches 400. Survey respondents identified retirement as the leading reason for full-time faculty separations, while separation to enter private practice was the second most frequent reason for leaving the institution. Offering a salary competitive with that of private practice was identified as the most critical factor in recruiting future faculty. A number of short and long-range strategies to recruit and retain faculty are presented. Ultimately, the dental school faculty shortage places in jeopardy the general and oral health of the public.     

Emerging allied dental workforce models: considerations for academic dental institutions

The U.S. surgeon general defined the national oral health care crisis in 2001 in Oral Health in America: A Report of the Surgeon General. The report concluded that the public infrastructure for oral health is not sufficient to meet the needs of disadvantaged groups and is disproportionately available depending upon certain racial, ethnic, and socioeconomic factors within the U.S. population. Now, several new workforce models are emerging that attempt to address shortcomings in the oral health care workforce. Access to oral health care is the most critical issue driving these new workforce models. Currently, three midlevel dental workforce models dominate the debate. The purpose of this report is to describe these models and their stage of development to assist the dental education community in preparing for the education of these new providers. The models are 1) the advanced dental hygiene practitioner; 2) the community dental health coordinator; and 3) the dental health aide therapist.     

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.     

Evaluating the impact of the ADEA Admissions Committee Workshops

Drawing on the interconnection of workforce diversity and oral health access, the American Dental Education Association (ADEA) is leading a novel approach to improve student body diversity in U.S. dental schools through an admissions committee development program. With funding provided by the Pipeline, Profession, and Practice: Community-Based Dental Education program and the Robert Wood Johnson Foundation, ten dental directors/deans of admissions from a cross-section of U.S. dental schools were selected through a competitive application process to participate in a Train-the-Trainers Admissions Committee Workshop. After completing intensive training that was built on legally sound admissions practices, these new trainers copresented ADEA Admissions Committee Workshops in two-member teams at six U.S. dental schools. This report summarizes the evaluation of both the train-the-trainers workshop and six workshops held in summer 2009. Also summarized are post-workshop outcomes relative to structural diversity at the participating schools.     

Residency Training in Dental Public Health: Assessment of Status, Needs, and Issues

The opportunities for public health training have declined over the years while the need for public health skills is likely to increase. This paper reports the results of a project, sponsored by the Health Resources and Services Administration, which answers the question of "how best to invest in the dental public health education system so as to fulfill the profession's responsibilities to protect and improve the oral health of individuals and society.' An information base on dental public health education, practice, and specialization was developed from an extensive review of the literature and a survey of dentists concerning employment and practice requirements for public health dentists. An advisory group considered this information, met to discuss the issues involved in dental public health training, and provided advice to the project staff. Based on the information gathered as part of the project, recommendations were made to: (1) develop a grant program to support advanced education in dental public health; (2) increase the competencies of dentists who are working in public health positions and not eligible for board certification via off-site residencies; (3) develop model programs in areas of great need, such as general public health, management, policy, prevention, environmental health and research, that in conjunction with a basic public health core, could satisfy the eligibility requirements of the American Board of Dental Public Health; (4) develop student loan forgiveness programs for dentists and dental hygienists working in public health; and (5) develop additional credential recognition programs for dental public health workers.     

Dentistry''s Public-Private Interface: A Federal Perspective

Each dental public health worker is confronted with a wide variety of organizations with which a professional relation can be developed. Decisions about which relations should receive priority, and the kind of relations that may be expected, are easier to define if each possible organizational interface is placed in one of three categories: (1) professional associations; (2) the employing bureaucracy and its sister agencies; and (3) the organizations performing the same dental public health functions as the worker, but within different geographic parameters. A three-dimensional model is developed, using as an example the organizational interfaces of the chief dental officer, US Public Health Service; with national level associations, the federal government; and with dental public health workers at the international and state levels of government. Current issues of importance to the American Association of Public Health Dentistry are identified according to the principal relations needed with other national associations, the federal government, and international and state governments.     

The dental therapist movement in the United States: A critique of current trends

Dental therapists are members of the oral health workforce in over 50 countries in the world typically caring for children in publically funded school‐based programs. A movement has developed in the United States to introduce dental therapists to the oral health workforce in an attempt to improve access to care and to reduce disparities in oral health. This article critiques trends in the United States movement in the context of the history and success of dental therapists practicing internationally. While supporting the dental therapist movement, we challenge: a) the use of dental therapists treating adults, versus focusing on children; b) the use of dental therapists in the private versus the public/not‐for‐profit sector; and c) requirements that a dental therapist must also be credentialed as a dental hygienist.     

Oral hygiene and gingival health in Danish dental students and faculty

This survey attempted to determine the status of oral cleanliness and gingival health in 150 dental students and 101 faculty members in a dental school. Without advance notice, plaque deposits were scored, using the Plaque Index System, and gingival health was determined using the criteria of the Gingival Index System. The 1st-year students had the poorest hygiene and gingival health. An improvement (P less than 0.01) was noted in the 2nd-year students who were still not in clinical training but had completed a course in preventive dentistry including oral hygiene techniques. Further improvement (P less than 0.05) was found in students participating in the clinical courses (3rd and 4th years). However, some deterioration of both hygiene and gingival status occurred in the senior 5th year. Among the faculty, the best oral hygiene and gingival state were found in members of departments in which clinical work centered around patient motivation toward prevention and tooth conservation. The scores for plaque and gingivitis were worse in the departments of oral surgery, dental materials, orthodontics and the basic science departments. Almost all departments and every class showed a few individuals with very poor oral hygiene. It is suggested that regular patient contact influences the personal attitude toward oral hygiene, and that professional activity and emphasis on different aspects of the curriculum may be reflected in the attitude of health professionals toward oral health.     

Trends in allied dental education: an analysis of the past and a look to the future.

Allied dental healthcare providers have been an integral part of the dental team since the turn of the 19th century. Like dental education, allied dental education's history includes a transition from apprenticeships and proprietary school settings to dental schools and community and technical colleges. There are currently 258 dental assisting programs, 255 dental hygiene programs, and 28 dental laboratory technology programs according to the American Dental Association's Commission on Dental Accreditation. First-year enrollment increased 9.5 percent in dental hygiene education from 1994/95 to 1998/99, while enrollment in dental assisting programs declined 7 percent and declined 31 percent in dental laboratory technology programs during the same period. Program capacity exceeds enrollment in all three areas of allied dental education. Challenges facing allied dental education include addressing the dental practicing community's perception of a shortage of dental assistants and dental hygienists and increasing pressure for career tracks that do not require education in ADA Commission on Dental Accreditation accredited programs. The allied dental workforce may also be called upon for innovative approaches to improve access to oral health care and reduce oral health care disparities. In addition, allied dental education programs may face challenges in recruiting faculty with the desired academic credentials. ADEA is currently pursuing initiatives in these and other areas to address the current and emerging needs of allied dental education.     

The role of the dental hygienist in the public health sector; an Australian perspective

A review of the literature on dental hygienists and their utilisation in the dental workforce is presented. Dental hygienists are employed as part of a dental team in the prevention and management of the two most common and costly oral diseases; dental caries and periodontal disease. The potential scope for dental hygienists in the public health sector in Australia is examined in the light of broader issues relating to changing disease patterns, service delivery and the treatment of patients with special needs. Prevention and treatment of oral disease by the dental hygienist in schools, institutions, nursing homes, hospitals and residential facilities is discussed, with emphasis on such issues as legislation, productivity and quality assurance. Implications for the future training of dental hygienists are presented and recommendations made for increasing their utilisation in the public sector.     

美国牙科教育的现状、挑战及对策

美国牙科教育发展至今,无论从广度还是深度上已经较为成熟。但也存在一些问题亟待解决,包括通过持续培训、教学改革及培养科研人员,以保持高的学术水平;通过改进牙科课程设置、教学方法、成绩评估来满足目前及以后公共健康护理需要;将科技发展运用到临床诊疗中。了解美国目前的口腔医学教育情况,将有助于我国口腔医学教育改革,提高口腔医学教育质量。     

Attitudes toward National Health Insurance: dentists, dental students, and dental hygiene students

The attitudes toward National Health Insurance held by 126 second year dental students and 108 second year dental hygiene students enrolled in the state of Wisconsin, U.S.A., were measured and compared with the attitudes held by practicing dentists in the U.S.A. Although some similarities were noted, marked differences were revealed, with students, generally, preferring broader coverage and more government involvement than practicing dentists. There is virtually no published data in this area, and more research is needed, as the success or failure of any National Health Insurance plan depends critically on the altitudes of both health care providers and those studying to become health care providers.