Trends in Generalist and Specialty Advanced Dental Education and Practice, 2005-06 to 2015-16 and Beyond.

This article reviews the data on advanced dental education for the past decade and explores what advanced dental education might look like in the years leading up to 2040, including how its graduates will address the oral health needs of the population. The authors based these projections on published data about advanced dental education collected by the American Dental Association and other organizations. Nevertheless, a certain degree of speculation was involved. The article presents current data and trends in advanced dental education, environmental factors impacting advanced dental education, and lessons drawn from other areas of health care that support the potential scenarios that are described. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Dental School Vacant Budgeted Faculty Positions, Academic Years 2011-12 Through 2013-14.

The American Dental Education Association (ADEA) Survey of Dental School Faculty is conducted annually to provide an overview of the hiring and retention activity of U.S. dental school faculty. The survey collects data on the dental faculty workforce, including vacant budgeted positions by appointment and discipline, number of new and lost positions, sources of new hires, and reasons for faculty separations. This report highlights the results of three years of survey data, from the 2011-12 academic year through the 2013-14 academic year. After declining in previous years, the number of vacant faculty positions in U.S. dental schools has begun to increase, rising to 242 full-time and 55 part-time positions in 2013-14. Additionally, the number of schools having more than ten vacancies increased from five to 12. Although the number of vacancies has increased, the length of faculty searches that took more than one year declined from 25% to 16% in the same period. Retirements as a share of full-time faculty separations increased from 14% in 2008-09 to 31% in 2013-14. The current average retirement age of dental school faculty members is 69.7 years. The percentage of full-time faculty members leaving for the private sector remained constant over the last three years at approximately 16%. Full-time faculty members were more likely to be recruited from other dental schools, while part-time faculty members were more likely to come from the private sector.

Adequacy of patient pools to support predoctoral students' achievement of competence in pediatric dentistry in U.S. dental schools.

The aim of this study was to characterize the current status of predoctoral pediatric dentistry patient pools in U.S. dental schools and compare their status to that in 2001. A 2014 survey of school clinic-based and community-based dental patient pools was developed, piloted, and sent to pediatric predoctoral program directors in 57 U.S. dental schools via SurveyMonkey. Two follow-up contacts were made to increase the response rate. A total of 49 surveys were returned for a response rate of 86%. The responding program directors reported that their programs' patient pools had declined in number and had changed in character with more diversity and fewer procedures. They attributed the changes to competition, cost, and location of the dental school. The respondents reported that community-based dental education clinical sites continued to provide additional service experiences for dental students, with contributions varying by the nature of the site. A large number of the respondents felt that their graduates lacked some basic pediatric dentistry clinical skills and were not ready for independent practice with children. The results of this study suggest that the predoctoral pediatric dentistry patient pool has changed and general dentists may be graduating with inadequate experiences to practice dentistry for children.

Pediatric dentistry for the general practitioner: satisfying the need for additional education and training opportunities.

The Pediatric Oral Health Access Program is a joint project of the California Dental Association and the California Society of Pediatric Dentistry. The results have been remarkable in terms of the number of underserved children who have received oral health services. What is less certain is the number of general dentists who, as a result of the training, have been able and willing to provide comprehensive care to more and younger children.

Patient retention at dental school clinics: a marketing perspective.

The purpose of this investigation was to examine the drivers of patient retention at dental school clinics from a services marketing perspective. An analysis of patient characteristics at Virginia Commonwealth University School of Dentistry, screened between August 2010 and July 2011 (N=3604), was performed using descriptive statistics, cross-tabulations, and a binary logistic regression. The main findings were that 42 percent of patients in the study were retained and that no response to communication efforts (36 percent) and financial problems (28 percent) constituted the most common reasons for non-retention. Older age, having insurance, and living within a sixty-mile radius were significant drivers of retention (p<0.05). Patients who had completed disease control treatments had a significantly higher retention rate (62 percent) than those who did not (42 percent). Finally, some groups of dental students had higher retention rates than others (p<0.05), indicating that service providers were a driver of retention. The resulting insights benefit dental schools in recruiting patients with the greatest likelihood of returning for care, providing dental students with skills to better service them, and consequently increasing retention. This will lead to providing a continuum of care and student education and to ensuring the sustainability and quality of the school's educational programs.

Academic dentistry in the 21st century: professional dental education or development of a trade guild.

Over the last decade, 10 new dental schools have been established and several more are on the drawing board for the near future. The overlying philosophy for this new generation of dental school is driven by a combination of societal and financial issues. As with many profound changes in educational philosophy, sooner or later there are always the unintended consequences that must be confronted. This article addresses several of the potential consequences.

The role of insurance and training in dental decision making.

INTRODUCTION: The purpose of this investigation was to evaluate (1) the differences in treatment planning decisions between dental general practitioners and specialists and (2) the role of patients' insurance and/or type of treatment in decision making. METHODS: One hundred eighty subject charts were selected from 1,740 dental charts. Two specialists examined radiographs and reviewed the charts and then independently generated treatment plans. If there was disagreement between the 2 specialists, they discussed all aspects of the case until a consensus was reached. RESULTS: Four subjects were excluded. Thus, 176 patients were evaluated. A statistically significant difference (χ(2) = 202.303, P = .0001) was found between treatment plans designed by GPs and those designed by specialists. Patients' insurance status did not influence the degree of agreement between specialists and GPs. The odds ratio for Medicaid was 0.431 (95% confidence interval [CI], 0.103-1.801; P = .249), and for self-pay, it was 0.801 (95% CI, 0.328-1.955; P = .627). However, logistic regression analysis showed that the type of treatment plan designed by GPs (ie, endodontic treatment, endodontic retreatment, and extraction followed by implant placement) was significantly related to the degree of disagreement with the specialists (odds ratio = 4.522; 95% CI, 1.378-14.84; P = .013). CONCLUSIONS: Insurance did not play a role in the decision-making portion of the treatment plan. However, the type of treatment was found to be significant. Implant cases had the highest disagreement between the specialists and the general dentists.

Face symmetry assessment abilities: Clinical implications for diagnosing asymmetry.

INTRODUCTION: An accurate assessment of face symmetry is necessary for the development of a dentofacial diagnosis in orthodontics, and an understanding of individual differences in perception of face symmetry between patients and providers is needed to facilitate successful treatment. METHODS: Orthodontists, general dentists, and control participants completed a series of tasks to assess symmetry. Judgments were made on pairs of upright faces (similar to the longitudinal assessment of photographic patient records), inverted faces, and dot patterns. Participants completed questionnaires regarding clinical practice, education level, and self-confidence ratings for symmetry assessment abilities. RESULTS: Orthodontists showed expertise compared with controls (P <0.001), whereas dentists showed no advantage over controls. Orthodontists performed better than dentists, however, in only the most difficult face symmetry judgments (P = 0.006). For both orthodontists and dentists, accuracy increased significantly when assessing symmetry in upright vs inverted faces (t = 3.7, P = 0.001; t = 2.7, P = 0.02, respectively). CONCLUSIONS: Orthodontists showed expertise in assessing face symmetry compared with both laypersons and general dentists, and they were more accurate when judging upright than inverted faces. When using accurate longitudinal photographic records to assess changing face symmetry, orthodontists are likely to be incorrect in less than 15% of cases, suggesting that assistance from some additional technology is infrequently needed for diagnosis.

Ohio dentists' awareness and incorporation of the dental home concept.

BACKGROUND: The authors measured the awareness of the dental home concept among pediatric dentists (PDs) and general practice dentists (GPs) in Ohio and determined whether they included dental home characteristics for children 5 years and younger into their practices. METHODS: The authors sent a pretested 20-question survey to all Ohio PDs and to a random sample of approximately 20 percent of GPs in Ohio. The authors designed the survey to elicit information about dental home awareness and the extent to which dental home characteristics were incorporated into dental practices. RESULTS: More than 90 percent of both GPs and PDs incorporated or intended to incorporate into their dental practices the specific dental home characteristics mentioned in 20 of 41 items related to dental home characteristics. Of the respondents who did not already incorporate dental home characteristics into their practices, however, most did not intend to do so. Less than 50 percent of respondents in both groups responded positively to some items in the culturally effective group, and GPs were less likely than were PDs to provide a range of behavior management services and to provide treatment for patients with complex medical and dental treatment needs. PDs were more likely than were GPs to accept Ohio Medicaid (64 versus 33 percent). PDs were more likely than were GPs (78 versus 18 percent) to be familiar with the term "dental home." More recent dental school graduates were more familiar with the term. CONCLUSIONS: Most Ohio PDs' and GPs' practices included characteristics found in the definition of dental home, despite a general lack of concept awareness on the part of GPs. Research is needed to provide an evidence base for the dental home. Practical Implications. Once an evidence base is developed for the important aspects of the dental home and the definition is revised, efforts should be made to incorporate these aspects more broadly into dental practice.

How do UK dentists deal with adverse drug reaction reporting?

OBJECTIVE: Pilot investigation to establish the knowledge, use and education needs of general dental practitioners (GDPs) of the UK yellow card (YC) reporting scheme. DESIGN: Postal survey. MAIN OUTCOME MEASURES: GDP views and experiences.Results Of 130 respondents, 74.6% were aware of the scheme. There was greater awareness of the scheme among those with more years in practice (p = 0.003) and those who had trained in the UK (p = 0.002). Six GDPs reported using the YC scheme in the past four years (estimated overall use: 0.01 of a YC per GDP per year); 88.5% had never used the YC scheme. The main reason given was that they never saw ADRs (58.5%). GDPs who had received their undergraduate training in the UK were more likely to be aware of their responsibility to report ADRs as a dentist than those who had trained outside the UK (p = 0.009). While GDPs were able to identify a wide range of sources to help them learn about ADRs, over three quarters of respondents (76.9%) expressed a need for additional postgraduate training. CONCLUSIONS: Under-reporting of ADRs by healthcare professionals is a recognised phenomenon and GDPs appear to be no exception. The effect of providing additional postgraduate training on ADR reporting should be investigated.

Advanced dental education programs: status and implications for access to care in California.

Primary care residencies in dentistry include general practice residency and advanced education in general dentistry--collectively known as postdoctoral general--dentistry and pediatric dentistry. These primary care programs are the most likely to serve underserved populations during the training experience. An expansion of primary care dental residency positions in California has the potential to positively impact access to care in California. However, there are significant political and financial barriers to realizing this potential.

A cost-minimization analysis of root canal treatment before and after education in nickel-titanium rotary technique in general practice.

AIM: To compare root canal treatments performed before and after education in a nickel-titanium rotary technique (NiTiR) with respect to costs for instrumentation and number of instrumentation sessions in a County Public Dental Service in Sweden. METHODOLOGY: Following education, 77% of the general dental practitioners adopted completely the NiTiR. The randomly selected sample comprised 850 root canal treatments: 425 performed after the education, mainly using the NiTiR-technique (group A) and 425 performed before, using mainly stainless steel hand instrumentation (SSI) (group B). The number of instrumentation sessions in root canal treatments in group A and B was calculated. A CMA was undertaken on the assumption that treatment outcome was identical in group A and B. Direct costs associated with SSI and NiTiR were estimated and compared. Investment costs required for implementation of NiTiR were calculated, but not included in the CMA. RESULTS: Instrumentation sessions were counted in 418 (98%) root canal treatments performed in group A and 419 (99%) in group B. The number of instrumentation sessions in group A was significantly lower; 2.38, compared with 2.82 in group B (P < 0.001). Thus, on average, for every second root canal treatment performed after the education, one instrumentation session was saved. Root canal treatments in teeth with one canal, and three or more canals, were completed in significantly fewer instrumentation sessions after the education (P < 0.001). Direct costs of instrumentation sessions were SEK 2587 (USD 411) for group A and SEK 2851 (USD 453) for group B, for teeth with one canal, and SEK 2946 (USD 468) for group A and SEK 3510 (USD 558) for group B, for teeth with three or more canals (year 2011). Root canal treatments of teeth with two canals showed no significant difference with respect to number of instrumentation sessions and costs. CONCLUSIONS: Significantly fewer instrumentation sessions were required in group A, and root canal instrumentation therefore costs less than in group B. On the assumption that treatment outcome is identical in group A and B, root canal instrumentation performed after the education was more cost-effective.

Risk management in the dental office.

This article is devoted to risk-management strategies regarding oral surgical procedures in the general dental office. Lawsuits are more likely to be filed following poor outcomes related to oral surgical procedures rather than after operative or prosthetic dental procedures. The article is not meant to discourage practitioners from performing oral surgical procedures if they have the experience, training, and appropriate skill set to complete the planned procedure. Rather, it advises clinicians as to the steps one can take to limit the chances of litigation from occurring, and avoid the emotionally and painful time-consuming process associated with a malpractice lawsuit.

A preliminary analysis of the US dental health care system's capacity to treat children with special health care needs.

PURPOSE: The purpose of this study was to use existing data to determine capacity of the US dental care system to treat children with special health care needs (CSHCN). METHODS: A deductive analysis using recent existing data was used to determine the: possible available appointments for CSHCN in hospitals and educational programs/institutions; and the ratio of CSHCN to potential available and able providers in the United States sorted by 6 American Academy of Pediatric Dentistry (AAPD) districts. RESULTS: Using existing data sets, this analysis found 57 dental schools, 61 advanced education in general dentistry programs, 174 general practice residencies, and 87 children's hospital dental clinics in the United States. Nationally, the number of CSHCN was determined to be 10,221,436. The distribution, on average, of CSHCN per care source/provider ranged from 1,327 to 2,357 in the 6 AAPD districts. Children's hospital dental clinics had fewer than 1 clinic appointment or 1 operating room appointment available per CSHCN. The mean number of CSHCN patients per provider, if distributed equally, was 1,792. CONCLUSIONS: The current US dental care system has extremely limited capacity to care for children with special health care needs.