Recent trends in the utilization of dental care in the United States

The authors examined trends in the utilization of oral health services in the United States from 1997 to 2010, including breakdowns by age and poverty level. They examined trends in one major driver of utilization: insurance coverage. The results suggest that the recent economic downturn did not result in an overall decrease in the utilization of dental services. Rather, the findings suggest an earlier decline from 2003 to 2008. In this article, the authors report that the overall trend masked significant variation by age and poverty level. Among children, there was steady growth in utilization from 1997 to 2010. This appears to have coincided with a shift away from private insurance toward public coverage and a significant drop in the percentage of uninsured children. Among non-elderly adults, however, utilization has been falling steadily since 1997 among all but the wealthiest income group. During the great recession from December 2007 to June 2009, the decline in utilization accelerated among those in the lowest income group. The decrease in adult utilization appears related to a decrease in private insurance coverage and an increase in public coverage and noninsured rates. As a consequence of these trends in coverage, the authors predict a continued decline in the utilization of dental services among non-elderly adults.     

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.     

Longitudinal trends in the use of individualized radiographic examinations at dental schools in the United States and Canada

In the spring of 2002, a mail survey was conducted to determine the use of individualized radiographic examinations (selective radiography) for comprehensive care patients at all sixty-four U.S. and Canadian dental schools. Results from previous surveys were used to evaluate the long-term longitudinal trends. Among sixty-two schools (97 percent response rate), selective radiography was used by 34 percent of schools for dentulous adult patients, by 100 percent for edentulous adults, and by 28 percent for children. Having a credentialed chief of service increased the likelihood that selective radiography would be used for dentulous adults (odd ratio[OR]=2.36) and for children (OR=2.33). Selective radiography for dentulous adults increased from 2 percent of schools in 1977 to 36 percent in 1997 and leveled off thereafter. Between 1987 and 2002, selective radiography for edentulous adults was used at nearly all schools (96-100 percent) and for children at about a quarter of dental schools (22-28 percent). Among the sixty-one schools for which there are complete data since 1987, the continuous use of routine radiography was most common (39 percent of schools) for dentulous adult patients, whereas the continuous use of selective radiography was uncommon (7 percent).     

Perceptions of dental aesthetics in the United States and Nigeria

The standard dental aesthetic index (DAI) is an orthodontic treatment need index based on perceptions of dental aesthetics in the United States. It is a regression equation that links perceptions of the social acceptability of dental aesthetics with the objective intraoral measurements of ten occlusal traits. For the index to be universally acceptable, the perceptions of dental aesthetics in other countries must be similar to those of the United States. This study was designed to determine whether the perceptions of dental aesthetics of Nigerian students are similar to those of different groups of the US population. The same 25 stimuli (photographs of dental configurations, a subset of the 200 stimuli used in deriving the standard DAI equation) were rated for dental aesthetics by Nigerian students. Their ratings were compared with ratings of the same 25 stimuli by US parents, students and orthodontists. Spearman rank-order correlations ranged from 0.75 to 0.84. These correlations were highly significant ( P < 0.0001), and showed that the perceptions of dental aesthetics of Nigerian students were very similar to those of the US groups. The study therefore concluded that standard DAI could be used as a screening tool and without modification in epidemiological surveys among Nigerians.     

Chronicling the dental therapist movement in the United States

There have been three attempts to introduce dental therapists (DTs) to the US dental workforce. This account will review early failed attempts to develop DTs, the recent successful Alaska initiative, the Minnesota legislature's authorization of DTs, state dental associations' deliberations on therapists in the workforce, and the efforts of national advocacy groups, foundations, and state legislatures to promote workforce innovation. It concludes with a discussion of the opposition to therapists from elements of organized dentistry.     

A chronology of dental education in the United States

Formal dental education in the United States began in 1840 with the opening of the Baltimore College of Dental Surgery. Other dental schools slowly began to emerge, gradually displacing the traditional preceptorship method of training for dentistry. The period of the late 1800s saw a surge in the number of dental colleges in the United States. These schools were largely proprietary in nature, meaning that they were not affiliated with major universities, were private, and were of a commercial nature and, usually, established to benefit their owners. As the trend toward affiliation of dental schools with universities gained impetus at the beginning of the 20th Century, and with the establishment of the Dental Educational Council of America, the trend continued. Finally, the Carnegie Foundation for the Advancement of Teaching formed a committee, under the direction of Dr. William J. Gies, to study the entire system of dental education in America. Out of this landmark study came the strong recommendation that all dental schools become affiliated with major universities. Shortly after that study, in the early 1930s, the last proprietary school was abolished. This article traces the histories of dental schools, past and present, in the United States.     

Innovations in dental education in the United States.

The amount of information which dental teachers wish students to absorb creates undesirable congestion of the curriculum. Individuals learn at different rates and if the course is designed for the average student, the better students are insufficiently challenged while the poor learner is left floundering. This problem is being met by the development of flexible, individualized instruction. As a result teachers are obliged to examine critically their goals and functions. If objectives are set for each course, teaching is planned to meet the objectives and methods of evaluation developed which are meaningful to the student, many of the criticisms laid by dentists against their education will be met. During the last decade the teaching of community dentistry has been developed in almost all dental schools as has the emphasis laid on preventive dentistry. In clinical teaching students are being introduced to patient care at an earlier stage resulting in better motivation and greater enthusiasm for the earlier parts of the course. Comprehensive patient care, the importance of occlusal dysfunction, the care of the handicapped and the utilization of auxiliary personnel are other areas of increasing importance. A significant development is the growing provision for an elective period during which the student may pursue his own particular interest.     

Wealth effect and dental care utilization in the United States

Objective: The purpose of this article is to examine the relationship of wealth and income and the relative impact of each on dental utilization in a population of older Americans, using data from the Health and Retirement Study (HRS). Methods: Data from the HRS were analyzed for US individuals aged 51 years and older during the 2008 wave of the HRS. The primary focus of the analysis is the relationship between wealth, income, and dental utilization. We estimate a multivariable model of dental use controlling for wealth, income, and other potentially confounding covariates. Results: We find that both wealth and income each have a strong and independent positive effect on dental care use of older Americans (P < 0.05). A test of the interaction between income and wealth in our model failed to show that the impact on dental care utilization as wealth increases depends on a person's income level or, alternatively, that the impact on dental use as income increases depends on a person's household wealth status (P > 0.05). Conclusions: Relative to those living in the wealthiest US households, the likelihood of utilizing dental care appears to decrease with a decline in wealth. The likelihood of utilizing dental care also appears to decrease with a decline in income as well.