The impact of additional dental providers in the dental labor market on the income of private practice dentists.

This study estimates the impact that the entrance of hypothetical allied dental professionals into the dental labor market may have on the earnings of currently practicing private practice dentists. A simulation model that uses the most reliable available data was constructed and finds that the introduction of hypothetical allied dental professionals into the competitive California dental labor market is likely to have relatively small effects on the earnings of the average dentist in California.

Access to dental care and the capacity of the California dental care system.

The authors estimated the following levels of technical efficiency for three types of dental practices in California where technical efficiency is defined as the maximum output that can be produced from a given set of inputs: generalists (including pediatric dentists), 96.5 percent; specialists, 77.1 percent; community dental clinics, 83.6 percent. Combining this with information on access, it is estimated that the California dental care system in 2009-10 could serve approximately 74 percent of the population.

Preventive resin restorations: practice and billing patterns of pediatric dentists.

PURPOSE: The purpose of this study was to determine practice patterns of pediatric dentists for preventive resin restorations (PRRs) and if they believe a code should be added to the American Dental Association's current dental terminology (CDT) for the PRR. METHODS: A 16-question survey sent to 475 pediatric dentists randomly selected from the American Academy of Pediatric Dentistry database, addressed demographics, treatment planning, techniques in preparation and restoration, billing practices, and perceptions about the need for a CDT code for PRRs. RESULTS: Two hundred thirty-eight (50%) surveys were returned, revealing that 72% of respondents perform PRRs and 64% feel that a PRR code should be added to the CDT Fifty-two percent believe not having a CDT code could cause dentists to perform more invasive dentistry to comply with billing requirements that Class I restorations be in dentin. PRRs are commonly treatment planned for deep pits and fissures with questionable decoy not entering dentin. Up to 50% of respondents could be erroneously billing for PRRs. CONCLUSIONS: Most pediatric dentists perform preventive resin restorations in their office and believe that a code for the procedure needs to be added to the current dental terminology.

Where Do Pediatric Dental Residents Intend to Practice? Exploring the Influence of Loan Repayment Programs and Other Factors.

The high cost of dental education and consequent loan burdens contribute to the shortage of pediatric dental providers in rural areas (RAs). Economic incentives are meant to recruit practitioners to RAs. The aim of this study was to assess the ability of government subsidized loan repayment programs (GSLRPs) to recruit pediatric specialists to practice in RAs. A 26-item questionnaire was emailed to all 921 pediatric dental residents across the U.S. in 2015 for a cross-sectional study of factors influencing their choice of practice location. The instrument included information about GSLRPs, enabling the study to serve as a quasi-experiment on the level of funding needed to make GSLRPs effective. A total of 169 residents responded, for an 18% response rate; 74% of respondents were women and 86% had student loan debt. Among the respondents, 40.6% said they would like to practice in RAs, but only 4.1% actually intended to do so. Over one-third initially reported interest in GSLRPs for practicing in RAs. However, after being informed that the average GSLRP is $30,000 annually, one-third of those lost interest. Although 14.2% said no amount would convince them to consider practice in an RA, over half (53.3%) indicated willingness to consider it if the GSLRP were $40,000-$60,000. These results suggest that current GSLRP levels are insufficient to induce pediatric dentists to practice in RAs.

Costs and benefits of Papacarie in pediatric dentistry: a randomized clinical trial.

Papacarie gel is an agent that eliminates the need for local anesthesia and reduces the need for using a drill. However, there is no information regarding the cost per procedure. Therefore we analyzed the cost, per procedure, of Papacarie gel compared to the traditional method (drilling), and performed a comparison between these methods of carious tissue removal. A randomized clinical trial was performed with 24 children with an average age of 5.9 years old. Of these children, 12 were boys and 12 were girls, which resulted in a total of 46 restorations. Patients were separated into: Papacarie group (caries removal with the chemical-mechanical method - Papacarie gel) and Drill group (caries removal with the traditional method - drilling). Values of the materials used in the procedures, heart rate (before, 5 minutes during, and after dental treatment), and the total consultation duration were recorded. A level of significance of 5% was adopted. Papacarie had a lower cost per procedure ($ 0.91) when compared to the traditional method ($ 1.58). Papacarie provided a cost reduction of 42% compared to the traditional method. Using local anesthesia ($ 2.17), the cost reduction increased to 58%. In the procedure using drill + Papacarie ($ 1.37), the cost reduction was 33%. Heart rate, consultation duration, and number of restorations were not statistically different. Papacarie shows an excellent cost benefit for minimally invasive removal of carious tissue and is a feasible alternative for public health care.

Policy entrepreneurship in the reform of pediatric dentistry.

In a recently published IJHPR article, Cohen and Horev ask whether an individual who holds rightful governmental power is able to effectively "challenge the equilibrium" in ways that might "clash with the goals" of an influential group". This question is raised within the context of a shift in governmental policy that imposed the potential for cost management by HMOs acting as financial intermediaries for pediatric dental care in an effort to provide Israeli children better access to affordable dental care. The influential group referred to consists of Israel's private dentists and the individual seeking to challenge the equilibrium was an Israeli Minister of Health whom the authors consider to be a policy entrepreneur.The Israeli health care system is similar to that of the United States in that private benefit plans and self-pay financing dominate in dental care. This is in contrast to the substantial role of government in the financing and regulation of medical care in both countries (with Israel having universal coverage financed by government and the US having government financing the care of the elderly and the poor as well as providing subsidies through the tax system for the care of most other Americans).Efforts to expand governmental involvement in dental care in both countries have either been opposed by organized dentistry or have suffered from ineffective advocacy for increased public investment in dental care.In the U.S., philanthropic foundations have acted as or have supported health policy entrepreneurs. The recent movement to introduce the dental therapist, a type of allied dental professional trained to provide a narrow set of commonly-needed procedures, to the U.S. is discussed as an example of a successful challenge to the equilibrium by groups supported by these foundations. This is a somewhat different, and complementary, model of policy entrepreneurship from the individual policy entrepreneur highlighted in the Cohen-Horev paper.The political traction gained to change the equilibrium favored by organized dentistry - in both Israel and the U.S. - may reflect aspirations for care that is more accessible, patient-centered, accountable and equitable. Evolving aspirations may lead to policy changes to systematize the disparate, disaggregated dental care delivery system in both counties. A change in payment incentives to provide more value is being explored for medical care, and its expansion to dental care can be anticipated to be among the policies considered in the future.

Achieving health outcomes through professional dental care: comparing the cost of dental treatment for children in three practice modes.

The search for effective strategies to deal with prevention and treatment of oral disease focuses on children as a natural target population. This article reports data on the comparative costs of delivering dental care to children via (1) a school-based practice using Expanded Function Dental Auxiliaries, (2) a school-based practice without EFDAs, and (3) a group of unrelated private dental practices operating independent of the school system. Utilization of a dentist's services varied significantly between the children assigned to private care and those assigned to the school-based programs, but it cost less per patient to provide dental treatment through the private practitioners. If school-based practices are clearly more effective in reducing dental disease, in the long run the need for manpower and resources in these programs might be lowered to a point where they will become more cost-effective than private practices. If the two delivery modes are equally effective in reducing dental disease, however, results from the study indicate that private practices are more cost-effective and will probably maintain their cost-effective advantage over school-based programs.

Increasing access to dental care for medicaid preschool children: the Access to Baby and Child Dentistry (ABCD) program.

OBJECTIVE: Washington State's Access to Baby and Child Dent stry (ABCD) Program, first implemented in Spokane County in 1995, offers extended dental benefits to participating Medicaid-enrolled children and higher fees for certified providers. This study aimed to determine the program's effect on children's dental utilization and dental fear, and on parent satisfaction and knowledge. METHODS: The study used a posttest-only comparison group design. Trained interviewers conducted telephone interviews with 465 parents of chi dren ages 13 to 36 months (49% ABCD, 51% Medicaid-enrolled children not in ABCD). One year later, 282 of 465 parents completed a follow-up survey. Utilization and expenditures were calculated from Medicaid claims. RESULTS: Forty-three percent of children in the ABCD Program visited a dentist in the follow-up year, compared with 12% of Medicaid-enrolled children not in the ABCD Program. An ABCD child was 5.3 times as likely to have had at least one dental visit as a child not in the program. ABCD children were 4 to 13 times as likely to have used specific dental services. Parents of ABCD children were more likely to report having ever tried to make a dental appointment, less likely to report that their children were fearful of the dentist, and were more satisfied, compared to parents of non-ABCD children. CONCLUSION: The authors conclude that the ABCD Program was effective in increasing access for preschool children enrolled in Medicaid, reducing dental fear, and increasing parent satisfaction.

Do we still care about children's teeth?

The level of care for children over the past 5 years has become bimodal, with most children with low levels of dental caries having good maintenance care, but those with moderate to high caries receiving significantly poorer care. Capitation has led to supervised neglect for many children who develop dental decay. This is not at all unexpected considering the general lack of concern by the government and public dental services and the fact that the level of payment of GDPs is such that they cannot afford to treat children. The problems of the dental care of children in the UK are compounded by the lack of specialist paediatric dentists for the more difficult patient.

Funding sources for research for advanced education students in pediatric dentistry.

1. Of the hospital programs, 10 of 17 (41%) reported no funding requirement while only 5 of 33 (15%) school based programs reported no funding requirement. 2. Departmental funds were identified most often (N = 28) and ranked number one most often (N = 16) as the funding source for graduate student research. 3. The average level of research funding available for each student ranged from $100 to $3,500, with an average of $1,250. 4. One-half of the programs reported no change in their funding levels over the past five years. 5. Programs associated with dental schools reported more funding opportunities available to their students than programs associated with hospitals.

Pediatric and general dentists' participation in the North Carolina Medicaid program: trends from 1986 to 1992.

The purpose of this study was to report trends in dentists' participation in the North Carolina Medicaid program. Medicaid claims files for dental users younger than age 21 were analyzed for seven fiscal years (FY) from 1986 to 1992. Over the study period, the number of pediatric dentists filing any Medicaid claims remained constant but the number of participating general dentists decreased slightly. Intensity of participation, as measured by mean annual reimbursement and mean number of children treated per dentist, increased from FY 89 to 92 for both provider groups. The mean value of services provided for each dental users also increased slightly during the same period. The data revealed over time pediatric dentists treated a larger proportion of the youngest Medicaid dental users.

Economic implications of evidence-based caries prevention in pediatric dental practice: a model-based approach.

OBJECTIVES: This paper presents an economic model which can be used to assess the potential implications of evidence-based caries prevention in pediatric dental practice. METHODS: Assessment of the evidence indicated that most children in the United States were likely to experience dental caries, though the severity of the disease would be minimal in most of them. Based on the evidence, it was concluded that annual recall examination and topical fluoride application would suffice as the norm for caries prevention. A model was developed to estimate the extent and cost of caries prevention in a traditional and an evidence-based pediatric dental practice. RESULTS: The model showed that evidence-based caries prevention resulted in a one-third decline in the number of recall examination visits provided, while the ensuing patient revenues from recall appointments declined by two-thirds in a calendar year. CONCLUSIONS: Evidence-based caries prevention will likely result in a significant decline in preventive services revenues and create additional capacity in pediatric dental practices. This economic impact will likely be absorbed by the current undersupply of pediatric dentists and by the reformulation of practice revenue streams.

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.

Who shall care for the children of the poor and uninsured? Pediatric dentistry in the United States.

Although Medicaid was established at least in part to help alleviate dental problems for children of the indigent, the program has not been particularly successful. Some possible solutions to the problem of disparities in access to pediatric dental care are suggested, including access and workforce approaches. Whatever approaches are undertaken, cost-benefit analyses should be done to demonstrate economic value.

How to institute and develop a strategic marketing plan for your pediatric dental office.

As what may be the most important element in a successful pediatric dental practice, marketing is often misunderstood. It requires careful planning and a long-term commitment. Before implementing your marketing plan, understand the definition of marketing and what it will mean to your practice. To develop your plan, ask yourself several important questions that will help you analyze where you are now, as well as where you want to be. Then, promote your practice by incorporating 12 important qualities into your plan. The plan is the blueprint for your efforts to repeatedly, consistently, and positively communicate with your market for the long term.

Insurers' policies on coverage for behavior management services and the impact of the Affordable Care Act.

The impact of the Affordable Care Act (ACA) on dental insurance coverage for behavior management services depends upon the child's source of insurance (Medicaid, CHIP, private commercial) and the policies that govern each such source. This contribution describes historical and projected sources of pediatric dental coverage, catalogues the seven behavior codes used by dentists, compares how often they are billed by pediatric and general dentists, assesses payment policies and practices for behavioral services across coverage sources, and describes how ACA coverage policies may impact each source. Differences between Congressional intent to ensure comprehensive oral health services with meaningful consumer protections for all legal-resident children and regulatory action by the Departments of Treasury and Health and Human Services are explored to explain how regulations fail to meet Congressional intent as of 2014. The ACA may additionally impact pediatric dentistry practice, including dentists' behavior management services, by expanding pediatric dental training and safety net delivery sites and by stimulating the evolution of novel payment and delivery systems designed to move provider incentives away from procedure-based payments and toward health outcome-based payments.