Problems in oral health care financing for the elderly.

The oral health of America's aged has improved dramatically. As the number of elderly swell, their collective need and demand for comprehensive dental services will increase significantly. Payment for those services will pose problems for many, because few options exist for financing dental care among the elderly. Currently most charges are covered by individuals out-of-pocket. Although more older people than ever before have sufficient funds to include dental visits in their health services use, a large proportion of the elderly lack the personal resources necessary to have their numerous dental conditions treated. Innovation is critical. Greater public and private sector support for accessible and affordable dental services must be offered in the future to ensure that the oral health gains of the past decades are not lost because of a lack of financial mechanisms for supporting an adequate level of care.

Evaluating attitude change in community dental service programs in Minnesota, U.S.A.

Attitude changes of students participating in two community service programs at the University of Minnesota were evaluated using the semantic differential technique. Program I, a single day clinical experience at a state institution for the mentally retarded, involved 170 students; Program II, a 1-week clinical program in dental auxiliary utilization, involved 30 students. For each program, semantic differentials were designed to elicit scaled evauative responses toward concepts such as mental retardation and dentistry which were important to program objectives. Scales were administered in a pretest, post-test design. Statistically significant differences were noted for seven of eight target concepts, and appropriate attitude changes were inferred from these differences. Design of community programs and evaluation of desired attitude change using the semantic differential were discussed.

Testing the internal and external validity of a simplified dental caries index on an adult population.

This analysis of a caries index, proposed in 1966 to WHO as a simplified method of measurement, as tested on a 16- to 45-year-old population who were seeking dental care at the University of Minnesota School of Dentistry revealed several weaknesses associated with the index. An analysis of the external validity of this index, a comparison with subjects' DMFS scores, revealed a correlation coefficient of 0.71. Although the index purports to measure the prevalence and severity of dental caries by dividing the dentition into five zones representing increasing severity of dental caries experience, an analysis of this index's internal validity, i.e. whether these five zones truly represent a rank-order scale of severity, revealed misclassification rates of from 21% for the total population up to 44% for a subgroup. When zones were recombined to reduce the misclassification rates, the descriptive capabilities of the index were greatly reduced as most subjects were then classified in only one or two of the zones.

The effect of the new federalism on education for dental public health.

The interest of this paper was to explore the effects of the "New Federalism" on the future dental public health training. It has indicated that there is a need for an immediate source of funding in order to avoid curtailment of dental public health training programs, and an adverse change in the composition of future students. Further, the national character of public health training was recognized and the federal level of government was looked to anxiously in order to observe what will happen with the training and general purpose monies. Only with a definite and long-term commitment from government, whether it be centrally or regionally located, can dental public health programming flourish once again.

Diagnostic oddities of the strangest form.

It's called Munchausen's syndrome, after an 18th-century German soldier known for fabricating fabulous stories. Most clinical descriptions of this intriguing oddity are found in the medical literature, although examples of patients feigning dental diseases also have been documented.

A good deal for all.

Imagine a world in which dental insurance claims have been eliminated, patient records remain in the dental office, coordination of benefits is no longer an issue--and there's no one to fight with over denial of benefits. Can you think of a better medicine for reducing dental hypertension?

Professional satisfaction in dentistry.

The profile of the most satisfied dentist seems to be one of a contented, nonthreatened, positive person, who is active in the profession and community, has confidence in his management skills, and is positive about the direction of dentistry. He knows what he wants and has values that are likely to help him attain his goals. Certainly, many of the behaviors shown by highly satisfied dentists read like a prescription for avoiding professional burnout. By counseling the dissatisfied dentist to become more active professionally, to improve his or her practice management skills, to develop a positive attitude toward change in the dental profession, it should be possible to help these dentists gain more positive feelings about themselves and their profession. Although it is not certain that any change can be effected in the value structure of a currently dissatisfied dentist, it is possible to encourage the benevolent leader type to enter the profession whenever he or she can be identified.

Economic impact of dental service utilization by older adults.

A total of 747 general dental practitioners--in Arizona, Colorado, Connecticut, Florida, and Minnesota--responded to a questionnaire in 1988 by completing a detailed productivity report of patient services performed during a specified period. The results, based on 11,909 patient visits and 22,712 dental procedures, indicated that stereotypes of older adults as underutilizers of dental care are incorrect. This finding and others, detailed within this article, indicate that older adults make up a substantial portion of regular patients and that their utilization of dental services should increase throughout 1990.

Societal and professional forces affecting graduate dental education.

This paper examines and predicts the effects of societal and professional forces on the future of graduate dental education. Among those factors analyzed are professional developments, paraprofessional changes, public initiatives, and government policy and legislation. The paper concludes with a proposal that suggests the creation of a balanced and flexible dental care delivery system. This system incorporates the concept of the "supergeneralist" and "superspecialist" and uses the auxiliary as the flexible portion of the work force. Advantages of the system as well as the difficulties that might be encountered if such a system were adopted are given.

Current and future projections of dental school patient availability.

Results of a mail questionnaire received from 59 United States and ten Canadian dental schools indicated a potentially serious problem in obtaining and maintaining dental teaching patients. Most schools report at least one shortage that could eventually compromise the clinical education process. Future projections indicated a continuing problem due to perceived reductions in disease incidence. The importance of addressing this problem is accentuated by the dental schools' educational mission to provide sufficient clinical experiences in all subject areas of dentistry. The information derived from the questionnaire should provide background for dental administrators as they respond to the patient availability problem.

Characteristics of dental teaching patients.

Questionnaires were distributed to adult patients in a representative national sample of nine dental schools to solicit information on patient demographics, use of services, and perception of the care received. Responses from 2,346 patients were analyzed and compared to findings from various local studies. Results indicate: age range of patients and type of dental needs available to students is extremely variable among schools, the major referral system is through friends and relatives, most patients pay for all of their care and seek care at dental schools because of reasonable costs, transportation and parking pose significant problems for some patients, the majority of respondents had been patients for two years or less, and many patients want all of their clinical and interpersonal dental needs met in the school setting. Dental schools seriously need to consider such factors in light of current and projected teaching patient shortages.

Primary care practice patterns.

An interview survey of the primary care practices of a class of dental school graduates was conducted in 1977 as a part of a longitudinal study that was begun 11 years earlier, when these individuals entered dental school. Primary care was defined by the variety of dental treatment procedures used by the dentist and by his or her participation in interdisciplinary aspects of health care. The study showed that: (1) the urban or rural location of the practice was not associated with primary care; (2) the dentists' position in the practice (sole practitioner, group owner, and so forth) was associated with the variety of treatment procedures used; (3) predental school values, dental aptitudes, and dental school achievement were significant predictors of primary care practices; and (4) the two measures of primary care were uncorrelated, and there were several patterns of primary care being practiced.

Changes in the values of dental students and dentists over a ten-year period.

This paper investigates value changes in dental students and dentists over a ten-year period through a cross-sectional study of all dental students at the University of Minnesota in 1966 and 1976, and a ten-year longitudinal study of a class of dental students who entered in 1967. Findings in both studies showed significant differences in values over the ten-year period, but they could not be attributed to the dental school experience. Findings also showed that the values of the dentists in the longitudinal study changed significantly over the ten years from 1967 to 1977, to resemble those of dental school freshmen in 1976. Comparisons of the two studies indicated that changes in social values and the social pressures of professional role development could have accounted for the findings.

Current availability of patients in dental hygiene programs.

Dental hygiene programs were surveyed to determine current availability of patients to meet the training needs of dental hygiene students. Eighty-six percent of the programs responded. Widespread inadequate to marginal patient availability was reported in periodontics and radiology. Two major reasons cited for patient shortages were, first, that completion of treatment requires too much time, and, second, that people are unaware of the scope of services performed by students. Patient shortages do not appear to be contributing to changes in the curriculum or fiscal problems in dental hygiene programs.

Research review of oral health status and service use among institutionalized older adults in the United States and Canada.

United States and Canadian studies have reported that a relatively large proportion of the institutionalized, older adult population is afflicted with a host of dental diseases and rarely seeks dental services. Analysis of existing published information indicates areas of concern including the need for incidence data, consensus on appropriate measures, and samples that will provide representative and comprehensive information about compromised older adults, irrespective of institutional or homebound status. Special emphasis should be placed on determining risk factors for dental disease, through longitudinal study of older adults.