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

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

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

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

Community factors predicting dental care utilization among older adults

BackgroundFew investigators have studied the influence of community factors on dental care utilization among older adults. The authors' objective in this study was to investigate the effect of community factors on dental care utilization after adjustment for individual factors.MethodsUsing data from a cross-sectional survey of Ohio residents, the authors assessed dental care utilization in a sample of 2,166 adults 65 years or older. They linked individual-level dental care utilization, predisposing factors (age, sex, race or ethnicity, marital status, education), enabling factors (poverty, dental insurance) and need-related factors (physical and mental health problems) with county-level data (socioeconomic environment and health resource environment) from the 2010 Area Health Resource Files (from the U.S. Department of Health and Human Services) and the American Community Survey (from the 2006-2010 U.S. census). By using multilevel logistic regression models, the authors evaluated the association between dental care utilization and community factors after adjustment for individual factors.ResultsThe results indicated that individual factors such as being female, married and nonpoor and having a higher educational level and private dental insurance were associated with higher odds of having utilized dental care. Furthermore, older adults living in a county with a higher dentist-to-population ratio were more likely to use dental services even after the authors adjusted the results for the individual-level factors (odds ratio = 1.10; P = .03).ConclusionsCounty-level dentist-to-population ratio has independent effects on older adults' dental care utilization even after adjustment for individual-level characteristics.Practical ImplicationsA comprehensive policy plan is required to intervene at both the individual and community levels to improve dental care utilization among older adults. By understanding the factors influencing dental care utilization among older adults, U.S. dentists will be better positioned to meet the dental needs of this population.     

Oral health status of rural adults in the United States

BACKGROUND: Many sociodemographic indicators of oral health disparity in the United States have been documented. Rural residence, however, has not been researched thoroughly, though it has been considered to be a potential indicator of disparity. The authors conducted this study to present information on the effects of rural residence on oral health in the United States. METHODS: The authors conducted their analyses using data from adults aged 18 to 64 years from the 1995, 1997 and 1998 National Health Interview Surveys and the Third National Health and Nutritional Examination Survey, 1988-94. The authors present national estimates for various oral health status indicators including dental insurance coverage, unmet care needs, frequency of dental visits, caries experience and prevalence of edentulism by rural/urban residence. RESULTS: The authors found that adults living in rural areas were more likely to report having unmet dental care needs and were less likely to have had a dental visit in the past year compared with adults living in urban areas. The prevalence of edentulism among rural adults was 16.3 percent-almost twice that of urban adults. Caries experience also was more likely to be greater among adults residing in rural areas. CONCLUSIONS: Oral health disparities exist among U.S. adults living in rural and urban areas. Compared with urban residents, rural residents were less likely to report a dental visit in the past year and were more likely to be edentulous. PRACTICE IMPLICATIONS: By understanding the rural/urban differences in adult oral health status, practitioners, policy-makers and rural health advocates will have better information to use to promote activities that better meet the needs of rural adults in the United States.     

The dental workforce in Kentucky: current status and future needs

Objectives: This study assessed the geographic distribution of dentists in Kentucky, determined socioeconomic correlates of practice location, estimated the future availability of dental providers, and made policy recommendations that could improve access to oral health care in Kentucky and other rural states. Methods: Dentists' addresses were mapped using a geographic information system. Poisson regression modeling and geospatial analyses were conducted using SAS v9.1 (SAS Institute, Cary, NC, USA) and ArcGIS v9.2 (Environmental Systems Research Institute Inc., Redlands, CA, USA), respectively. Data on the number of dentists (n = 2,391) per county (n = 120) were used for the regression models. Explanatory variables included: per capita income, 2006 intercensal population estimates, percent adults with six or more teeth removed, percent population uninsured, physician‐to‐population ratios, and region type. A simulation model was used to project dentist‐to‐population ratios to the year 2016. Results: The dental workforce analysis revealed disparities in the distribution of dentists between rural, urban, and Appalachian Kentucky counties. Dentists were more likely to be found practicing in areas with higher income and higher physician‐to‐population ratios. Compounding this geographic maldistribution, our projections suggest that the number of dentists per unit population will decrease over time in the near future, likely widening this disparity in rural and underserved areas. Conclusions: These results show present and widening workforce disparities in rural and socioeconomically depressed counties in Kentucky. Understanding the geographic distribution of dentists and the socioeconomic correlates of their practice locations may inform workforce development and reimbursement policies for the goal of improving access to oral health care in these areas.     

Demographics and distribution of dentists in Mississippi: a dental work force study

BACKGROUND: Many segments of the population experience one or more barriers to accessing quality oral health care, including availability of licensed dentists. The purpose of the authors' study was to analyze the availability of dentists in Mississippi by county over four decades to determine the geographic distribution of dentists, shifts in their distribution over time and how this distribution relates to population demographics. METHODS: Dentist-to-population ratios were determined by county from 1970 through 2000. The authors analyzed these data using standardized z scores and geographic information systems (GIS) technology. Results are presented graphically and geographically. RESULTS: Results showed that 55 counties were designated as dental health professional shortage areas in 1970, 51 counties in 1980, 30 in 1990 and 40 in 2000. Counties that have a more favorable ratio of providers to population were determined, indicating areas in which dentists are more likely to practice. CONCLUSIONS: Many geographic areas in Mississippi remain underserved. Identifying these areas is a critical first step when addressing the current state of Mississippi's dental work force. This type of information is useful for decision making as well as responding to the population's oral health care needs. PRACTICE IMPLICATIONS: Results of this study can assist current and future practicing dentists, dental school administrators and policy-makers in making informed decisions for determining suitable practice locations, dental school admissions criteria and areas to target for public health initiatives. This model also is useful for studying work force disparities in other health care professions.     

Dentist Workforce Trends in a Primarily Rural State: Iowa: 1997–2007

BackgroundState dental boards maintain minimal demographic and practice characteristics about licensed dentists. The authors describe the creation and monitoring of an enhanced surveillance system concerning Iowa's dentists.MethodsThe Iowa Dentist Tracking System (IDTS) was used to collect demographic, educational, practice arrangement, office location and work hour data for all active Iowa dentists beginning in 1997. IDTS staff members add newly licensed dentists to the system as practice locations become available. They also contact each dental office semiannually by telephone to update this information. The IDTS Advisory Committee meets annually to review these data and monitor trends.ResultsThe Iowa dentist workforce was relatively stable from 1997 through 2007; however, a large number of dentists are expected to retire during the next decade, which could create a shortage of providers, especially in rural areas. Although the percentage of male and female dentists who practice part time (< 32 hours per week) decreased between 1997 and 2007, young female dentists are more likely than young male dentists to practice part time.ConclusionsIDTS is a workforce tracking model that can be used to understand trends at the community, regional and state levels. An aging dentist workforce in Iowa could put a strain on the public's ability to access dental care, especially in rural counties.Practice ImplicationsIn the development of workforce policy, workforce tracking systems such as IDTS provide additional information in considering the number of dentists, location, accessibility and potential productivity of a workforce.     

The rise and fall of the Latino dentist supply in California: implications for dental education

The purpose of this study was to determine the number of Latino dentists in California, identify the schools and countries where they were educated, and compare Latino dentist demographics with that of the state's new demographics. From the 2000 California Department of Consumer Affairs list of 25,273 dentists, we identified Latino U.S. dental graduates (USDGs) by "heavily Hispanic" surnames and Latino international dental graduates (IDGs) by country and school of graduation. From the 2000 U.S. census Public Use Microdata Sample (PUMS), we described Latino dentist characteristics such as Spanish language capacity and practice location. The number of Latino dentists acquiring licenses to practice in California has fallen dramatically, by nearly 80 percent, between 1983 and 2000. This decline is not merely an affirmative action issue; it results in an issue of access. Latino dentists are far more likely to speak Spanish and be located in a heavily Latino area than non-Latino dentists. Currently, although the supply of Latino dentists is dwindling, the Latino population is growing rapidly. In California and out-of-state schools, first-year matriculation of Latino USDG must increase. Further, non-Latino dentists should be prepared and given incentives to learn Spanish and locate practices in areas of need. The reintroduction of IDG Latino dentists needs to be seriously considered.     

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.     

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.     

Use of public and private dental services by adults in Finland

Abstract – The aim of this study was to analyze the factors that affected the choice between public and private dental services in 1979, when 9% of adults had received their dental services in a public health center. In September 1979 the National Board of Health conducted a telephone interview among Finnish adults over 15 yr old. When a representative sample of 1992 adults was drawn, the response rate was 90.4%. All subjects over 17 yr of age who had used dental services within the last 5 yr were included in the study, making a final sample of 1368. According to the logistic function, the greatest differences were between rural and urban areas. Of the subjects living in urban areas, 18% had visited public health centers; and of those living in rural areas, 45% had visited health centers. Of the adults living in an urban selling, 70% and in rural areas 49% visited private dentists. Of the subjects who had used private dental services, nearly half were managers and upper white-collar workers; while of those using communal services, less than one third worked in such jobs. In urban areas managers and upper white-collar workers used private services twice as often as they used public services. In an urban setting, subjects who had visited a dentist during the last 2 yr had received treatment mainly in the private sector; and in a rural setting, subjects had been treated mainly in health centers.     

Foreign-trained dentists licensed in the United States: exploring their origins

BACKGROUND: The authors explored the origins of foreign-trained dentists seeking licensure in the United States. METHODS: The authors analyzed data received from the American Dental Association Department of Testing Services for candidates who took the National Board Dental Examinations (NBDE) Part II from 2002 through 2005. They also established proxies for the information they sought in lieu of existing direct data. RESULTS: A total of 4,136 candidates took NBDE Part II from 2002 through 2005. The greatest number of foreign-trained dentists originated from India, the Philippines and Colombia. CONCLUSION: The greatest number of potential U.S. dental licensees are primarily from Asia, the Middle East and South America. However, precise studies need to be conducted to generate more exact data about foreign-trained dentists who practice in the United States. CLINICAL IMPLICATIONS: The source of international dental graduates seeking licensure in the United States has implications for the licensure process and for the potential accreditation of foreign dental schools.     

Geospatial analysis of the urban and rural/remote distribution of dental services in Scotland,Wales and Northern Ireland

Aim: To address deficits in human resources for oral health data (HROH) in rural and remote areas in Wales, Scotland and Northern Ireland by spatially profiling and modelling the distribution pattern of dental practices according to Health Boards. Methods: National Health Service (NHS) dental practices were located and mapped against population and rural–urban classifications of Scotland, Wales and Northern Ireland, using Geographic Information System (GIS) tools. All data collected were at the smallest geographical statistical hierarchy level in each country, and population data were retrieved from the 2011 census. Results: A total of 1,695 NHS dental practices were mapped against 27 Health Board regions. In Scotland, Northern Ireland and Wales, 18.3%, 18.7% and 7.7%, respectively, of the population living in the most remote areas resided within 2.5 km of a dental practice. In each country, the Health Boards with the largest proportion of the population living more than 10 km from a dental practice were the Western Isles (Scotland), Western Health and Social Care Trust (HSCT) (Northern Ireland) and Hywel Dda University Health Board (UHB) (Wales). In each country, the highest practice-to-population (PtP) ratios were found in Forth Valley (1:7,194) (Scotland), Southern HSCT (1:5,115) (Northern Ireland) and Hywel Dda UHB (Wales) (1:7,907). Conclusion: Dental services are distributed unequally between urban and rural areas. PtP ratios coupled with GIS analysis are important tools to improve HROH distribution.Key words: Spatial distribution, rural, oral health, distribution     

An analysis of preventive dental visits by provider type, 1996

BACKGROUND: Understanding preventive dental visit utilization patterns facilitates planning of the dental health services delivery system. The authors examine these patterns by analyzing the receipt of preventive dental services in the United States by type of dental provider. METHODS: The authors analyzed data from the 1996 Medical Expenditure Panel Survey (MEPS) for the U.S. community-based population. They developed national estimates for the population with preventive dental visits by provider type, including the population with a preventive dental visit and mean number of preventive dental visits per person for socioeconomic and demographic categories. RESULTS: Respondents who are white, are older, are female, have dental insurance, are from higher income and education backgrounds, and reside in small metropolitan areas were more likely (P < .05) to receive preventive care from a dental hygienist than from a dentist. CONCLUSION: MEPS data showed that people's socioeconomic background and other demographic factors were associated with having a preventive dental visit with a dentist or dental hygienist. These factors also influence the per-person number of preventive visits by type of dental practitioner. These elements must be considered when planning for future dental work force needs. PRACTICE IMPLICATIONS: Estimating future dental work force needs through this analysis assists dentists in meeting patient demand and maximizing the productive output of all services rendered in their practices, including preventive services.     

Rural dentistry: opportunities for the next millennium in fixed and mobile practices

Many dentists assume that practice in California's rural counties would be hindered by lower income potential, professional isolation, and lack of specialists for assistance. The evidence suggests otherwise, however. Income data show that the population of many rural counties can well afford dental care. In addition, new uses of the Internet for teleconsulting and idea exchange has the potential for reducing isolation and providing access to specialized knowledge. Particularly for those practitioners who enjoy the rural lifestyle, such counties offer excellent potential for dental practice.     

Factors influencing recent dental graduates' location and sector of employment in Victoria

BACKGROUND: Recruitment and retention of dentists in the public sector and rural areas in Victoria has become increasingly difficult in recent years. There are little available data on the factors that influence the sector and location of practice of new dental graduates. The objective of this study was to investigate the factors considered by new graduates in determining the location and sector of employment after graduation, and influencing any early changes in career path. METHODS: Questionnaires were sent to dentists who Mgraduated from The Univrersity of Melbourne from graduated from The University of Melbourne from 2000-2003 who were currently practising in Victoria. There were 154 subjects to whom questionnaires were sent and 109 useable questionnaires were returned, a response rate of 74 per cent. RESULTS: Upon graduation, 53 per cent of the new graduates chose to work in the private sector only, compared to 15 per cent in public sector only and 33 per cent in both. At present, 71 per cent work in the private sector only, 17 per cent in the public sector only and 12 per cent in both. The most important factors for choosing to work in the private sector were receiving broad range of clinical experience, opportunities to familiarize with practice management and providing a continuity of care. The principal factors for practising in the public sector were clinical mentoring and advice, consolidating clinical skills and work environment. Initially, 48 per cent of the sample chose to work in metropolitan areas only, 39 per cent in rural areas only and 13 per cent in both. Factors that influenced the decision to work in rural areas were the broad range of clinical experience and remuneration, while the main factors for choosing to work in metropolitan areas were lifestyle and proximity to family and friends. CONCLUSIONS: This study found that a large proportion of new dental graduates initially chose to work in the public sector and rural areas on graduation primarily as a means of consolidating their clinical skills. However, retention of dentists in both these areas appears to be a problem, with less than 10 per cent of 2000-2001 graduates still than 10 per cent of 2000-2001 graduates still working in the public sector and only 20 per cent of 2000-2001 graduates still working in rural areas.     

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

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

Use of dental services: an analysis of visits, procedures and providers, 1996

BACKGROUND: While many studies have provided data on Americans' access to dental care, few have provided a detailed understanding of what specific treatments patients receive. This article provides detailed information about the types of dental services that Americans receive and the types of providers who render them. METHODS: The authors provide national estimates for the U.S. civilian noninstitutionalized population in several socioeconomic and demographic categories regarding dental visits, procedures performed and the types of providers who performed them, using household data from the 1996 Medical Expenditure Panel Survey, or MEPS. RESULTS: Data show that while the combination of diagnostic and preventive services adds up to 65 percent of all dental procedures, the combination of periodontal and endodontic procedures represents only 3 percent. Additionally, while 81 percent of all dental visits were reported as visits to general dentists, approximately 7 percent and 5 percent of respondents who had had a dental visit reported having visited orthodontists or oral surgeons, respectively. CONCLUSION: MEPS data show the magnitude and nature of dental visits in aggregate and for each of several demographic and socioeconomic categories. This information establishes a nationally representative baseline for the U.S. population in terms of rates of utilization, number and types of procedures and variations in types of providers performing the procedures. These nationally representative estimates include data elements that describe specific dental visits, dental procedures and type of provider, and they offer details that are useful, important and not found elsewhere. PRACTICE IMPLICATIONS: By understanding these analyses, U.S. dentists will be better positioned to provide care and better meet the dental care needs of all Americans.     

Using a geographical information system to map the distribution of dentists in Ohio

BACKGROUND: Studies have reported that dental care is the highest unmet health care need in the United States and have evaluated this in terms of individual determinants of access and utilization. None of these studies took into consideration the provider issues of availability and accessibility or of spatial relations. The aim of this study was to analyze issues of provider availability and accessibility in Ohio using a geographical information system, or GIS. METHODS: Three Ohio databases were geocoded using GIS software. The databases included all 6,132 dentists licensed to practice in Ohio, 1,898 dentists who had billed the state Medicaid program in 1998 and safety-net clinics that provided free or low-cost care. Each practitioner was mapped at the county and ZIP code levels. RESULTS: Results are reported using maps at the county and ZIP code levels. The maps showed that 69.4 percent of dentists practiced in 12 metropolitan counties, 14 percent in 17 suburban counties and 16.6 percent in 59 rural counties (rural non-Appalachian counties plus Appalachian counties). In Appalachia, the dentist-to-population ratio was about one-half that of the metropolitan counties. CONCLUSION: Obvious disparities exist in the distribution of dentists in Ohio, particularly in rural and Appalachian counties. The need to increase the availability of dentists in these counties is evident. PRACTICE IMPLICATIONS: GIS is a useful tool for evaluating provider distribution and availability and planning programs to attract dentists to areas with small numbers of dentists.