Primary care dentistry: An Australian perspective.

INTRODUCTION: Primary care dentistry is the first point of contact that someone has with the dental system and is predominantly focused on the treatment and prevention of dental caries and periodontal disease. The aim of this paper was to review the Australian primary dental care system. METHODS: This paper reviews the primary dental care system in Australia, drawing on data reporting on the dental workforce, funding sources for dental care, oral health outcome measures and dental visiting patterns. RESULTS: Primary dental health care in Australia is predominantly provided by dentists working in private practice, with the number of dentists per 100,000 people in Australia increasing from 46.9 in 2000 to 65.1 in 2022. However, there has been a gradual shift over the past twenty years towards greater service provision by other members of the dental team who now represent one quarter of the dental workforce, and some expansion of publicly funded dental care. Despite this dentistry remains isolated from the rest of primary health care, and the lack of government funding means that many people continue to miss out of necessary dental care, particularly those living in regional and rural Australia and from low-income groups. CONCLUSIONS: Australians should be able to access primary dental care services when and where they need it with adequate financial protection, from services that are well integrated into the broader primary health care system to ensure they are able to achieve optimal oral and general health. For many Australians, this is not currently the case. CLINICAL SIGNIFICANCE: Australia is at a crossroads with respect to access to dental care, and there is a need for stronger advocacy from stakeholders to improve oral health outcomes and reduce inequalities.

Differences in the Ratios of General and Dental Specialists in Europe.

BACKGROUND: The European Economic Area (EEA) is composed of member states with a multitude of different regions. This study aimed to analyse the ratios of general dentists and dental specialists to the total population and the proportion of dental specialists to general dentists in 24 European countries and to explore specific intranational differences within 2 countries: France and Germany. METHODS: Available official documents and webpages from the United Kingdom and 23 of the 30 countries comprising the EEA were analysed. Data were expressed as absolute values, ratios of general dentists and dental specialists in the total of population, and percentages of dental specialists/dentists. The Mann-Whitney U test was used to clarify the main ratios that distinguish France from Germany, and cluster analysis was employed to determine similar areas. RESULTS: Significant differences were found between countries, with Ireland and Austria having the lowest ratio of dentists and Romania and Greece having the highest. The Czech Republic, the Netherlands, France, and Denmark had the lowest ratios of dental specialists to the total population. Lithuania, Sweden, and Germany had the highest number of dental specialists. Orthodontists were the most numerous specialists (5.0% of dentists), followed by oral surgeons (2.7%). In France, differences between departments were pronounced and associated with the presence of dental schools and per capita income. In Germany, only the correlation between per capita income and the density of oral surgeons was significant. CONCLUSIONS: Diverse ratios of general dentists and dental specialists to the total population and the proportion of dental specialists to general dentists were discovered within the examined countries, and their maximum values were 2.5, 5.7, and 4.1 times the minimum values, respectively. Differences were even found within the same country, as was the case in France and, to a lesser extent, in Germany.

Odontologia hospitalar: uma análise crítica sobre a inserção do cirurgião dentista na atenção terciária no estado do Rio Grande do Sul, Brasil / Hospital dentistry: a critical analysis of the role of the dental surgeon in tertiary care in the state of Rio Grande do Sul, Brazil

Objetivo: analisar a inserção do cirurgião dentista na atenção terciária no estado do Rio Grande do Sul, Brasil. Método: estudo descritivo ecológico, com uso de dados secundários registrados pelo Cadastro Nacional de Estabelecimentos de Saúde no ano de 2023. A coleta de dados foi realizada em duas etapas. Na primeira etapa também foram coletados os dados do CNES referentes à presença do cirurgião dentista, tipo de vínculo contratual e especialidades ofertadas pelos serviços. Já na segunda etapa os dados coletados foram referentes aos indicadores sociodemográficos dos profissionais com habilitação em odontologia hospitalar utilizando as informações disponibilizadas pelo Sistema WSCFO do Conselho Federal de Odontologia. A análise dos dados foi realizada com o suporte do software TabWin, versão 3.6, e do software estatístico R v. 4.2.3. Os dados foram analisados por meio de análise descritiva. Resultados: apenas 6,11% das instituições são certificadas e consideradas Hospitais de Ensino. A maioria dos estabelecimentos (87,14%) oferece atendimento pelo SUS. Quanto à presença de cirurgiões dentistas nos estabelecimentos, 64,63% dos estabelecimentos relataram tê-los, enquanto 35,37% não possuem esse profissional em sua equipe. Neste estudo, constatamos que uma correlação positiva do cirurgião dentista com o número de leitos de UTI adulto e ao maior porte do hospital. Conclusão: observa-se que ainda há necessidade de estruturação da atenção terciária no Estado do Rio Grande do Sul, no que se refere à odontologia hospitalar. Há poucos os cirurgiões dentistas com uma carga horária dedicada exclusivamente ao atendimento hospitalar clínico a beira leito.(AU)

Objective: To analyze the inclusion of dental surgeons in tertiary care in the state of Rio Grande do Sul, Brazil. Method: a descriptive ecological study using secondary data recorded by the National Register of Health Establishments in 2023. Data was collected in two stages. In the first stage, data was also collected from the CNES regarding the presence of a dental surgeon, the type of contractual relationship and the specialties offered by the services. In the second stage, data was collected on the sociodemographic indicators of professionals qualified in hospital dentistry using the information provided by the WSCFO System of the Federal Council of Dentistry. The data was analyzed using TabWin software, version 3.6, and R v. 4.2.3 statistical software. The data was analyzed using descriptive analysis. Results: only 6.11% of institutions are certified and considered Teaching Hospitals. The majority of establishments (87.14%) provide care through the SUS. As for the presence of dental surgeons in the establishments, 64.63% of the establishments reported having them, while 35.37% did not have this professional on their team. In this study, we found a positive correlation between the number of adult ICU beds and the size of the hospital. Conclusion: There is still a need to structure tertiary care in the state of Rio Grande do Sul, in terms of hospital dentistry. There are few dental surgeons with a workload dedicated exclusively to bedside clinical hospital care.(AU)

[Analyses on the quantity, structure and allocation equity of stomatologists in China].

Objective: To study the quantity, structure and allocation equity of stomatologists, in order to provide bases and advices for improving the allocation of stomatologists in China. Methods: On the basis of data from China Health Statistics Yearbooks and Brief Book of Administrative Divisions of the People's Republic of China, the general situation of stomatologists was analyzed by descriptive analysis. Gini coefficient was used to evaluate the allocation equity in 2010 and 2020. Results: The total number of stomatologists reached 2 780 hundred in 2020, which increased by 150.5% compared with that in 2010. The overall quality structure of stomatologists had improved. The gender proportion was balanced and the age distribution was reasonable. The team was mainly composed by the young people, in which the numbers under 44 years old accounted for 71.6% (1 991 hundred/2 780 hundred). The proportion of personnel with senior professional titles decreased to 7.9% (220 hundred/2 780 hundred) while the total number increased to 220 thousand. The distribution of stomatologists by population was fair. Gini coefficients of the whole country as well as the eastern, central and western regions were less than 0.3. Conclusions: The quantity, quality and allocation equity of stomatologists were still insufficient in China. It is necessary to optimize the human resources allocation for stomatologists. It is suggested to increase the talents supply through supply-side reform, medicine-education collaboration and multi-agent participation. And it is suggested to optimize criterions to improve the quality of stomatologists.

Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia.

CHAPTER 1: RETAIL INITIATIVES TO IMPROVE THE HEALTHINESS OF FOOD ENVIRONMENTS IN RURAL, REGIONAL AND REMOTE COMMUNITIES: Objective: To synthesise the evidence for effectiveness of initiatives aimed at improving food retail environments and consumer dietary behaviour in rural, regional and remote populations in Australia and comparable countries, and to discuss the implications for future food environment initiatives for rural, regional and remote areas of Australia. STUDY DESIGN: Rapid review of articles published between January 2000 and May 2020. DATA SOURCES: We searched MEDLINE (EBSCOhost), Health and Society Database (Informit) and Rural and Remote Health Database (Informit), and included studies undertaken in rural food environment settings in Australia and other countries. DATA SYNTHESIS: Twenty-one articles met the inclusion criteria, including five conducted in Australia. Four of the Australian studies were conducted in very remote populations and in grocery stores, and one was conducted in regional Australia. All of the overseas studies were conducted in rural North America. All of them revealed a positive influence on food environment or consumer behaviour, and all were conducted in disadvantaged, rural communities. Positive outcomes were consistently revealed by studies of initiatives that focused on promotion and awareness of healthy foods and included co-design to generate community ownership and branding. CONCLUSION: Initiatives aimed at improving rural food retail environments were effective and, when implemented in different rural settings, may encourage improvements in population diets. The paucity of studies over the past 20 years in Australia shows a need for more research into effective food retail environment initiatives, modelled on examples from overseas, with studies needed across all levels of remoteness in Australia. Several retail initiatives that were undertaken in rural North America could be replicated in rural Australia and could underpin future research. CHAPTER 2: WHICH INTERVENTIONS BEST SUPPORT THE HEALTH AND WELLBEING NEEDS OF RURAL POPULATIONS EXPERIENCING NATURAL DISASTERS?: Objective: To explore and evaluate health and social care interventions delivered to rural and remote communities experiencing natural disasters in Australia and other high income countries. STUDY DESIGN: We used systematic rapid review methods. First we identified a test set of citations and generated a frequency table of Medical Subject Headings (MeSH) to index articles. Then we used combinations of MeSH terms and keywords to search the MEDLINE (Ovid) database, and screened the titles and abstracts of the retrieved references. DATA SOURCES: We identified 1438 articles via database searches, and a further 62 articles via hand searching of key journals and reference lists. We also found four relevant grey literature resources. After removing duplicates and undertaking two stages of screening, we included 28 studies in a synthesis of qualitative evidence. DATA SYNTHESIS: Four of us read and assessed the full text articles. We then conducted a thematic analysis using the three phases of the natural disaster response cycle. CONCLUSION: There is a lack of robust evaluation of programs and interventions supporting the health and wellbeing of people in rural communities affected by natural disasters. To address the cumulative and long term impacts, evidence suggests that continuous support of people's health and wellbeing is needed. By using a lens of rural adversity, the complexity of the lived experience of natural disasters by rural residents can be better understood and can inform development of new models of community-based and integrated care services. CHAPTER 3: THE IMPACT OF BUSHFIRE ON THE WELLBEING OF CHILDREN LIVING IN RURAL AND REMOTE AUSTRALIA: Objective: To investigate the impact of bushfire events on the wellbeing of children living in rural and remote Australia. STUDY DESIGN: Literature review completed using rapid realist review methods, and taking into consideration the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for systematic reviews. DATA SOURCES: We sourced data from six databases: EBSCOhost (Education), EBSCOhost (Health), EBSCOhost (Psychology), Informit, MEDLINE and PsycINFO. We developed search terms to identify articles that could address the research question based on the inclusion criteria of peer reviewed full text journal articles published in English between 1983 and 2020. We initially identified 60 studies and, following closer review, extracted data from eight studies that met the inclusion criteria. DATA SYNTHESIS: Children exposed to bushfires may be at increased risk of poorer wellbeing outcomes. Findings suggest that the impact of bushfire exposure may not be apparent in the short term but may become more pronounced later in life. Children particularly at risk are those from more vulnerable backgrounds who may have compounding factors that limit their ability to overcome bushfire trauma. CONCLUSION: We identified the short, medium and long term impacts of bushfire exposure on the wellbeing of children in Australia. We did not identify any evidence-based interventions for supporting outcomes for this population. Given the likely increase in bushfire events in Australia, research into effective interventions should be a priority. CHAPTER 4: THE ROLE OF NATIONAL POLICIES TO ADDRESS RURAL ALLIED HEALTH, NURSING AND DENTISTRY WORKFORCE MALDISTRIBUTION: Objective: Maldistribution of the health workforce between rural, remote and metropolitan communities contributes to longstanding health inequalities. Many developed countries have implemented policies to encourage health care professionals to work in rural and remote communities. This scoping review is an international synthesis of those policies, examining their effectiveness at recruiting and retaining nursing, dental and allied health professionals in rural communities. STUDY DESIGN: Using scoping review methods, we included primary research - published between 1 September 2009 and 30 June 2020 - that reported an evaluation of existing policy initiatives to address workforce maldistribution in high income countries with a land mass greater than 100 000 km2 . DATA SOURCES: We searched MEDLINE, Ovid Embase, Ovid Emcare, Informit, Scopus, and Web of Science. We screened 5169 articles for inclusion by title and abstract, of which we included 297 for full text screening. We then extracted data on 51 studies that had been conducted in Australia, the United States, Canada, United Kingdom and Norway. DATA SYNTHESIS: We grouped the studies based on World Health Organization recommendations on recruitment and retention of health care workers: education strategies (n = 27), regulatory change (n = 11), financial incentives (n = 6), personal and professional support (n = 4), and approaches with multiple components (n = 3). CONCLUSION: Considerable work has occurred to address workforce maldistribution at a local level, underpinned by good practice guidelines, but rarely at scale or with explicit links to coherent overarching policy. To achieve policy aspirations, multiple synergistic evidence-based initiatives are needed, and implementation must be accompanied by well designed longitudinal evaluations that assess the effectiveness of policy objectives. CHAPTER 5: AVAILABILITY AND CHARACTERISTICS OF PUBLICLY AVAILABLE HEALTH WORKFORCE DATA SOURCES IN AUSTRALIA: Objective: Many data sources are used in Australia to inform health workforce planning, but their characteristics in terms of relevance, accessibility and accuracy are uncertain. We aimed to identify and appraise publicly available data sources used to describe the Australian health workforce. STUDY DESIGN: We conducted a scoping review in which we searched bibliographic databases, websites and grey literature. Two reviewers independently undertook title and abstract screening and full text screening using Covidence software. We then assessed the relevance, accessibility and accuracy of data sources using a customised appraisal tool. DATA SOURCES: We searched for potential workforce data sources in nine databases (MEDLINE, Embase, Ovid Emcare, Scopus, Web of Science, Informit, the JBI Evidence-based Practice Database, PsycINFO and the Cochrane Library) and the grey literature, and examined several pre-defined websites. DATA SYNTHESIS: During the screening process we identified 6955 abstracts and examined 48 websites, from which we identified 12 publicly available data sources - eight primary and four secondary data sources. The primary data sources were generally of modest quality, with low scores in terms of reference period, accessibility and missing data. No single primary data source scored well across all domains of the appraisal tool. CONCLUSION: We identified several limitations of data sources used to describe the Australian health workforce. Establishment of a high quality, longitudinal, linked database that can inform all aspects of health workforce development is urgently needed, particularly for rural health workforce and services planning. CHAPTER 6: RAPID REALIST REVIEW OF OPIOID TAPERING IN THE CONTEXT OF LONG TERM OPIOID USE FOR NON-CANCER PAIN IN RURAL AREAS: Objective: To describe interventions, barriers and enablers associated with opioid tapering for patients with chronic non-cancer pain in rural primary care settings. STUDY DESIGN: Rapid realist review registered on the international register of systematic reviews (PROSPERO) and conducted in accordance with RAMESES standards. DATA SOURCES: English language, peer-reviewed articles reporting qualitative, quantitative and mixed method studies, published between January 2016 and July 2020, and accessed via MEDLINE, Embase, CINAHL Complete, PsycINFO, Informit or the Cochrane Library during June and July 2020. Grey literature relating to prescribing,deprescribing or tapering of opioids in chronic non-cancer pain, published between January 2016 and July 2020, was identified by searching national and international government, health service and peek organisation websites using Google Scholar. DATA SYNTHESIS: Our analysis of reported approaches to tapering conducted across rural and non-rural contexts showed that tapering opioids is complex and challenging, and identified several barriers and enablers. Successful outcomes in rural areas appear likely through therapeutic relationships, coordination and support, by using modalities and models of care that are appropriate in rural settings and by paying attention to harm minimisation. CONCLUSION: Rural primary care providers do not have access to resources available in metropolitan centres for dealing with patients who have chronic non-cancer pain and are taking opioid medications. They often operate alone or in small group practices, without peer support and access to multidisciplinary and specialist teams. Opioid tapering approaches described in the literature include regulation, multimodal and multidisciplinary approaches, primary care provider support, guidelines, and patient-centred strategies. There is little research to inform tapering in rural contexts. Our review provides a synthesis of the current evidence in the form of a conceptual model. This preliminary model could inform the development of a model of care for use in implementation research, which could test a variety of mechanisms for supporting decision making, reducing primary care providers' concerns about potential harms arising from opioid tapering, and improving patient outcomes.

Desde la Admisión Hasta el Ejercicio Profesional. Una Revisión de las Carreras de Odontología en Chile / From Admission to Professional Practice, A Review of Dental Programs in Chile

RESUMEN: Al año 1991 sólo existían tres carreras de odontología en Chile: Universidad de Chile (1911), Universidad de Concepción (1919) y la Universidad de Valparaíso (1955 como sede de la U. de Chile). Actualmente, existen 21 universidades que dictan un total de 32 carreras de odontología, titulando aproximadamente 1500 nuevos profesionales cada año, lo cual, aparte de disparar las cifras de profesionales en nuestro sistema, levanta la duda de cuantos estudiantes se encuentran en formación y cuál es el perfil de admisión que se establece en estas instituciones. El objetivo de este artículo es conocer las cifras de los procesos de admisión, matrícula financiamiento y acreditación universitarios y discutirlas en base a la cantidad de profesionales habilitados para trabajar en nuestro sistema para así reflejar la situación actual que vive la Odontología en Chile. Se realizó un estudio descriptivo de corte transversal realizado en base a la revisión de las bases estadísticas públicas. A pesar de sus altos costos asociados a la implementación de espacios y materiales, la carrera sigue siendo altamente postulada. Los nuevos ingresos rondan en alrededor de 2.20 0 para primer año, llegando aproximadamente a 14.300 estudiantes en todos los niveles para el 2019. El Estado de Chile debería abordar los problemas que se desprenden de estos indicadores, a través de una discusión seria y sistemática, incorporando diversos actores y basándose en información sobre la real necesidad de atención en salud de la población y la disponibilidad estructural del sistema de salu d público y privado para soportar determinado número de profesionales. La apertura de nuevas carreras de odontología se visualiza como un problema, mientras el país avanza a pasos lentos en una regulación que es requerida de manera urgente.

ABSTRACT: In 1991 there were only three dental programs in Chile: Universidad de Chile (1911), Universidad de Concepción (1919) and Universidad de Valparaíso (1955, as campus of U. de Chile). Currently, there are 21 universities that teach a total of 32 dental programs, graduating approximately 1500 new professionals each year, which, in addition to increasing the number of dentists in our system, raises the question as to how many students are in training, and what is the admission profile established by these institutions. The aim of this article is to know the number of admissions, registration, financing, and university accreditation process, based on the number of qualified professionals working in our system, in order to reflect the current situation of dentistry in Chile. A descriptive cross-sectional study was carried out based on the review of the public statistical resources. Despite the high cost of the program, associated with the implementation and materials, the program has many applicants. The number of enrolled students each year in the first semester is around 2200. Therefore, a high number of students are currently enrolled in all semesters, totalling approximately 14,300 in 2019. The Chilean government should address this problem based on information about the real need for healthcare of the population, within the framework of the public and private health system to support a certain number of professionals. The opening of new dental programs is viewed as a problem, while the country is advancing slowly in a regulation that is urgently required.

Dental school tracks related to the retention of dentists in Thai government service: a cross-sectional survey.

BACKGROUND: The shortage of dentists working in rural hospitals is an important public health problem resulting from dentist distribution inequity. The Ministry of Public Health of Thailand (MoPH) has implemented a policy of recruiting students with a rural background to be dental students and return home after graduating. This study aims to examine the relationship between admission tracks during the academic years 2005-2011 on retaining dentists in Thai government service and identify the factors associated with retention and resignation. METHODS: A cross-sectional survey was conducted using an online questionnaire from 287 dentists who graduated from Chulalongkorn University (CU) between 2010 and 2016. Follow-up data consisted of the admission track, number of years spent in Thai government service, and factors that influenced their decision to stay or resign from Thai government service. Chi-squared analysis was used to analyze the data. RESULTS: The overall retention rate in Thai government service was 58.2%. Dentists in the rural track had a significantly higher retention rate than the normal track (p = 0.023). Female dentists who were married and graduated less than 3 years had a significantly higher resignation rate than others (p < 0.05). The main reasons for retention were "security in the profession," "high chance to pursue specialty training in the future," and "close proximity to hometown." Dentists from the CU rural admission tracks chose "close proximity to hometown" as the top reason, while others selected "security in the profession." The main reasons influencing resignation were "workplace far away from hometown" and "getting specialty training." CONCLUSIONS: These results indicate that dentists in the rural track had a significantly higher retention rate than the normal track. The most important factor influencing both retention and resignation was workplace location, where being near to their hometown improved the retention rate of rural dentists. Therefore, the MoPH should increase student admission into the rural track to resolve the inequity in dentist distribution.

Recruiting and retaining dental labor in federal facilities: Harder than pulling teeth?

The U.S. Veterans Administration (VA) is a large publicly financed health system that has long struggled with provider shortages. Shortages may arise at the VA because it offers different compensation than private sector employment options or because of differences in the way that labor is supplied to public versus private employers. In the mid-2000s, the VA adopted a more generous and flexible pay schedule for its dentists. We exploit this salary schedule change to study the impact of a positive wage shock on dental labor supplied to the VA, within a difference-in-differences framework. We find limited effects on VA separation and new hire rates overall-though early career dentists appear more sensitive to the wage change. More generous pay has its clearest effects on employment type for VA dentists, reducing the likelihood of being part-time by roughly 10%.

The Impact of the ACA Medicaid Expansions on Dental Visits by Dental Coverage Generosity and Dentist Supply.

BACKGROUND: Low-income adults in the United States have historically had limited access to dental coverage and poor dental health outcomes. OBJECTIVE: We examined the effects of the Affordable Care Act Medicaid expansions on dental visits among low-income adults focusing on the generosity of dental coverage and heterogeneity in effects by dentist supply. RESEARCH DESIGN: We used data from 2012, 2014, and 2016 Behavioral Risk Factor Surveillance System surveys. The main analytical sample included nearly 117,000 individuals <138% federal poverty level. We employed a quasi-experimental difference-in-differences design to identify the impact of the state Medicaid expansions on having a dental visit in the past 12 months by the generosity of dental coverage and dentist supply. RESULTS: Medicaid expansions were associated with a nearly 6 percentage-point increase in the likelihood of any dental visits in 2016 (over 10% increase from preexpansion rate) for individuals in Medicaid expanding states with extensive dental benefits. This increase, however, was concentrated in states with high dentist supply with no evidence of improvement in utilization in states with limited dental coverage or low dentist supply. CONCLUSIONS: Expanding Medicaid with generous dental coverage improved dental care use only in areas with high dentist supply with no evidence of benefits with low dentist supply or less generous coverage. Improving access to dental care may require both generous coverage and supply-side interventions to increase dentist availability.

Needs-based planning for the oral health workforce - development and application of a simulation model.

BACKGROUND: The World Health Organization's global strategy on human resources for health includes an objective to align investment in human resources for health with the current and future needs of the population. Although oral health is a key indicator of overall health and wellbeing, and oral diseases are the most common noncommunicable diseases affecting half the world's population, oral health workforce planning efforts have been limited to simplistic target dentist-population or constant services-population ratios which do not account for levels of and changes in population need. Against this backdrop, our aim was to develop and operationalise an oral health needs-based workforce planning simulation tool. METHODS: Using a conceptual framework put forward in the literature, we aimed to build the model in Microsoft Excel and apply it in a hypothetical context to demonstrate its operability. The model incorporates a provider supply component and a provider requirement component, enabling a comparison of the current and future supply of and requirement for oral health workers. Publicly available data, including the Special Eurobarometer 330 Oral Health Survey, were used to populate the model. Assumptions were made where data were not publicly available and key assumptions were tested in scenario analyses. RESULTS: We have systematically developed a needs-based workforce planning model for the oral health workforce and applied the model in a hypothetical context over a 30-year time span. In the 2017 baseline scenario, the model produced a full-time equivalent (FTE) provider requirement figure of 899 dentists compared with an FTE provider supply figure of 1985. In the scenario analyses, the FTE provider requirement figure ranged from 1123 to 1629 illustrating the extent of the impact of changing parameter values. CONCLUSIONS: In response to policy makers' recognition of the pressing need to better plan human resources for health and the scarcity of work in this area for dentistry, we have demonstrated the feasibility of producing a workable, practical and useful needs-based workforce planning simulation tool for the oral health workforce. In doing so, we have highlighted the challenges faced in accessing timely and relevant data needed to populate such models and ensure the reliability of model outputs.

Human Resources for Oral Health Care in South Africa: A 2018 Update.

To describe the current oral health care needs and the number and category of dental personnel required to provide necessary services in South Africa (SA). This is a review of the current disease burden based on local epidemiological studies and the number of oral health personnel registered with the Health Professions Council of South Africa (HPCSA). In SA, oral health services are rendered by oral hygienists, dental therapists, dentists, and dental specialists. Dental caries remains one of the most prevalent conditions, and much of them are untreated. The majority of oral care providers are employed in the private sector even though the majority of the population access the public sector which only offers a basic package of oral care. The high prevalence of caries could be prevented and treated by the public sector. The infrastructure at primary health care facilities needs to be improved so that dentists performing community service can be more effectively utilized. At present, SA requires more dental therapists and oral hygienists to be trained at the academic training institutions.

Analysis of the supply of specialized oral health care services in the Brazilian National Health System: Brazil, 2014. / Análise da oferta de serviços na atenção especializada em saúde bucal no Sistema Único de Saúde, Brasil, 2014.

OBJECTIVE: to analyze the availability of public specialized dental care services at Dental Specialties Centers (CEO) in Brazil in 2014. METHODS: secondary data on the CEO ratio and dental surgeon ratio were analyzed by population as well as the adequacy of the quantity of complete dental consulting rooms per CEO type, the adequacy of the ratio between the working hours of dental auxiliaries /technicians and those of dental surgeons and the adequacy of the availability of recommended minimum specialties. Possible statistical differences between macro-regions were verified. RESULTS: we found a ratio of one CEO per 217,797 inhabitants and one dental surgeon per 26,811 inhabitants; 97% of CEOs had the recommended number of dental consulting rooms; 26% had equivalent working hours between dental auxiliaries /technicians and dental surgeons; 60% offered the recommended minimum specialties. CONCLUSION: there were limitations in the provision of National Health System specialized oral health care services as well as regional differences.

Análise e caracterização do panorama da distribuição de Cirurgiões-Dentistas no Brasil / Analysis and characterization of the dentist's distribution overview in Brazil / Análisis y caracterización del panorama de la distribución de odontólogos en Brasil

Dentre a categoria odontológica, Cirurgiões-Dentistas (CDs) são os únicos profissionais que tem atribuição exclusiva de prestar assistência clínica direta ao público de forma independente, apresentando um papel importante na Odontologia. O objetivo deste trabalho é caracterizar o panorama da distribuição de CDs no Brasil, considerando-a entre estes profissionais em si e entre a população brasileira, apresentando considerações sobre o perfil profissional e mercadológico dos CDs. O trabalho consiste em um levantamento de dados acerca dos números de CDs no Brasil e do número de habitantes da população brasileira. Os dados mostram que existem 309.088 CDs em exercício no Brasil, os quais concentram-se principalmente nos estados de São Paulo, Minas Gerais, Rio de Janeiro e Paraná. Em nível nacional, há 1CD para 617,1 habitantes.Dentre os estados, Distrito Federal, São Paulo, Santa Catarina, Rio de Janeiro e Paraná apresentam os menores valores proporcionais. As regiões brasileiras Sudeste e Sul concentram os maiores percentuais de CDs do país, enquanto o Norte possui o menor percentual. Paralelamente, Sudeste e Centro-Oeste apresentam as menores proporções de CD/habitantes, enquanto o Nordeste apresenta a maior razão dessa distribuição. Os resultados apontam o atual perfil de distribuição profissional e mercadológica de CDs no Brasil, evidenciando disparidades entre as diferentes localidades do país, podendo assim representar um indicador importante acerca do planejamento mercadológico para os CDs, bem como fornecer reflexões acerca da discrepância entre a quantidade de CDs e o quadro de saúde bucal ainda presente no país(AU)

Among the dental category, dentists are the only professionals that have exclusive attribution of providing direct clinical assistance to the public independently, presenting an important prominence in Dentistry. The aim of this paper is to characterize the dentists' distribution overview in Brazil, considering it among these professionals in them and among the Brazilian population, presenting considerations in the job market. The paper consists of a survey of data about the numbers of dentists in Brazil and the number of inhabitants of the Brazilian population. The data show that there are 309.088 practicing dentists in Brazil, which are mainly concentrated in the states of São Paulo, Minas Gerais, Rio de Janeiro and Paraná. At the national level, there is 1 dentist for 617,1 inhabitants. Among the states, the Federal District, São Paulo, Santa Catarina, Rio de Janeiro and Paraná present the lowest proportional values. The Brazilian regions Southeast and South concentrate the largest percentage of dentists in the country, while the North has the lowest percentage. At the same time, the Southeast and Center-West have the lowest proportions of dentists/inhabitants, while the Northeast has the highest ratio of this distribution. The results show the current profile and job market of these professionals in Brazil, evidencing disparities between the different localities in the country, thus being able to represent an important indicator about market planning for dentists, as well as to provide reflections on the discrepancy between the quantity of dentists and the oral health situation still present in the country(AU)

Entre la categoría odontológica, los odontólogos son los únicos profesionales que tienen atribución exclusiva de prestar asistencia clínica directa al público de forma independiente, presentando un papel importante en la Odontología. El objetivo de este trabajo es caracterizar el panorama de la distribución de odontólogos en Brasil, considerándola entre estos profesionales en sí y entre la población brasileña, presentando consideraciones sobre el perfil profesional y mercadológico de los mismos. El trabajo consiste en un levantamiento de datos sobre los números de odontólogos en Brasil y del número de habitantes de la población brasileña. Los datos muestran que existen 309.088 odontólogos en ejercicio en Brasil, los cuales se concentran principalmente en los estados de São Paulo, Minas Gerais, Río de Janeiro y Paraná. A nivel nacional, hay 1 odontólogo para 617,1 habitantes. En los estados, Distrito Federal, São Paulo, Santa Catarina, Río de Janeiro y Paraná presentan los menores valores proporcionales. Las regiones brasileñas Sudeste y Sur concentran los mayores porcentuales de odontólogos del país, mientras que el Norte tiene el menor porcentaje. Paralelamente, Sudeste y Centro-Oeste presentan las menores proporciones de odontólogos/habitantes, mientras que el Nordeste presenta la mayor razón de esa distribución. Los resultados apuntan al actual perfil de distribución profesional y mercadológica de odontólogos en Brasil, evidenciando disparidades entre las diferentes localidades del país, pudiendo así representar un indicador importante acerca del planeamiento mercadológico, así como proporcionar reflexiones acerca de la discrepancia entre la cantidad de profesionales y el cuadro de salud bucal todavía presente en el país(AU)

Do Dutch dentists extract monopoly rents?

We exploit lottery-determined admission to dental school to estimate the payoffs to the study of dentistry in the Netherlands. Using data from up to 22 years after the lottery, we find that in most years after graduation dentists earn around 50,000 Euros more than they would earn in their next-best profession. The payoff is larger for men than for women but does not vary with high school GPA. The large payoffs cannot be attributed to longer working hours, larger investments while studying (opportunity costs and direct costs), or unpleasant aspects of working as a dentist. A plausible explanation is that dentists earn a monopoly rent. Results from regressions of dentists' earnings on dentists density are consistent with this, as are the facts that the supply of dentists in the Netherlands is low and that the payoff does not vary with high school GPA.

A Clinical Vignette-Based Study of Physicians' Adherence to Guidelines for Dental Referrals of Young Children.

OBJECTIVES: The American Academy of Pediatrics (AAP) recommends an oral health risk assessment and referral to a dental home by a child's first birthday. We evaluated the adherence of primary care providers (PCPs) to AAP dental referral guidelines for children age <4 years and barriers to implementation of these guidelines. METHODS: A cross-sectional survey of PCPs randomly selected from the 435 practices in North Carolina identified as providing well-child visits for Medicaid children age <4 years was completed in 2013. The PCPs' referral recommendations were assessed using 4 vignettes of 18-month-old children at various risk of dental caries (low, moderate, high, or highest) and different levels of dentist supply (adequate or inadequate). Barriers to guideline adherence specified in the Cabana framework were analyzed for their associations with PCP adherence, using logistic regression models stratified by caries risk and dentist supply. RESULTS: The survey yielded 219 (50%) usable responses from the sample of 435 PCPs. On average for all vignettes, 61% of providers chose a referral recommendation in agreement with guidelines. Underreferral averaged 40%. With adequate workforce, guideline-adherent responses varied from 26% for low-risk children to >90% for high-risk children. An inadequate workforce reduced adherence for most levels of risk. Generally, correct knowledge of risk status, barriers to risk assessment, and pediatric practice were associated with adherence, but not always in the hypothesized direction. CONCLUSIONS: PCPs' adherence to referral guidelines varies according to caries risk and dentist supply, but generally they underrefer low- to moderate-risk patients by a significant degree.

[Dentistry demographics of Center Val de Loire region: Opportunities and prospects]. / Démographie des chirurgiens-dentistes en région Centre-Val de Loire : opportunités et perspectives.

The Center Val de Loire region is particularly affected by the shortage of health professionals. The demographics of dentists are not immune to this situation and the retirement of a practitioner has become a real public health issue. For this purpose, bridges were created between the faculties of odontology of Nantes, Clermont-Ferrand and the Faculty of Medicine of Tours, to welcome short cycle students in Center Val de Loire region, to create a link with the liberal practitioners and to allow the students to confront the health issues of this territory.

[Evaluation of satisfaction with dental care from the standpoint of adult Brazilian users: a multilevel analysis]. / Avaliação da satisfação com a assistência odontológica na perspectiva de usuários brasileiros adultos: análise multinível.

The scope of this paper was to evaluate the satisfaction regarding dental care services and to identify the association between dissatisfaction and contextual/individual variables. It involved a cross-sectional study of a representative sample of 8,943 adults from 177 municipalities, in which 14.9% of adults were dissatisfied. In the multiple analysis there was a greater chance of dissatisfaction with dental services among adults residing in cities with greater social inequality (OR: 1.53, 95% CI: 1.31-1.81) and with a lower proportion of dentists per inhabitant (OR: 1.17; 95% CI: 1.00-1.37); yellow/black/brown/indigenous (OR: 1.12; 95% CI: 0.99-1.27); lower schooling (OR: 1.14; 95% CI: 0.98-1.33); consultation due to oral problems (OR: 1.23; 95% CI: 1.04-1.44); (OR: 2.60; 95% CI: 2.53-3.02) and impact of oral disorders on daily performance (OR: 1.48; 95% CI: 1.30-1.69). The implementation or adequacy of public policies with the aim of improving satisfaction with dental services should prioritize those municipalities with greater social inequality and with fewer dentists and socially disadvantaged users, who self-perceive oral problems, are dissatisfied with their oral health and suffer impacts resulting from oral problems.

Objetivou-se avaliar a satisfação quanto aos serviços de assistência odontológica e identificar associação entre a insatisfação e as variáveis contextuais/individuais. Estudo transversal multinível de dados secundários de uma amostra representativa de 8.943 adultos de 177 municípios. Encontravam-se insatisfeitos 14,9% dos adultos. Registrou-se maior chance de insatisfação com os serviços odontológicos entre adultos que residiam em municípios com maior desigualdade social (OR:1,53;IC95%:1,31-1,81) e com menor proporção de dentistas por habitante (OR:1,17;IC95%: 1,00-1,37); amarelos/negros/pardos/indígenas (OR:1,12; IC95%: 0,99-1,27); menor escolaridade (OR:1,14; IC95%: 0,98-1,33); consulta por motivo de problemas bucais (OR:1,23; IC95%: 1,04-1,44); insatisfeitos com os dentes e boca (OR:2,60;IC95%:2,53-3,02) e com impacto das desordens bucais no desempenho diário (OR:1,48;IC95%:1,30-1,69). A implementação ou adequação de políticas públicas com o intuito de melhorar a satisfação com os serviços odontológicos deve priorizar os municípios com maior desigualdade social e com menos dentistas e usuários socialmente desfavorecidos, que autopercebem problemas bucais, insatisfeitos com sua saúde bucal e com impactos decorrentes dos problemas bucais.

Avaliação da satisfação com a assistência odontológica na perspectiva de usuários brasileiros adultos: análise multinível / Evaluation of satisfaction with dental care from the standpoint of adult Brazilian users: a multilevel analysis

Resumo Objetivou-se avaliar a satisfação quanto aos serviços de assistência odontológica e identificar associação entre a insatisfação e as variáveis contextuais/individuais. Estudo transversal multinível de dados secundários de uma amostra representativa de 8.943 adultos de 177 municípios. Encontravam-se insatisfeitos 14,9% dos adultos. Registrou-se maior chance de insatisfação com os serviços odontológicos entre adultos que residiam em municípios com maior desigualdade social (OR:1,53;IC95%:1,31-1,81) e com menor proporção de dentistas por habitante (OR:1,17;IC95%: 1,00-1,37); amarelos/negros/pardos/indígenas (OR:1,12; IC95%: 0,99-1,27); menor escolaridade (OR:1,14; IC95%: 0,98-1,33); consulta por motivo de problemas bucais (OR:1,23; IC95%: 1,04-1,44); insatisfeitos com os dentes e boca (OR:2,60;IC95%:2,53-3,02) e com impacto das desordens bucais no desempenho diário (OR:1,48;IC95%:1,30-1,69). A implementação ou adequação de políticas públicas com o intuito de melhorar a satisfação com os serviços odontológicos deve priorizar os municípios com maior desigualdade social e com menos dentistas e usuários socialmente desfavorecidos, que autopercebem problemas bucais, insatisfeitos com sua saúde bucal e com impactos decorrentes dos problemas bucais.

Abstract The scope of this paper was to evaluate the satisfaction regarding dental care services and to identify the association between dissatisfaction and contextual/individual variables. It involved a cross-sectional study of a representative sample of 8,943 adults from 177 municipalities, in which 14.9% of adults were dissatisfied. In the multiple analysis there was a greater chance of dissatisfaction with dental services among adults residing in cities with greater social inequality (OR: 1.53, 95% CI: 1.31-1.81) and with a lower proportion of dentists per inhabitant (OR: 1.17; 95% CI: 1.00-1.37); yellow/black/brown/indigenous (OR: 1.12; 95% CI: 0.99-1.27); lower schooling (OR: 1.14; 95% CI: 0.98-1.33); consultation due to oral problems (OR: 1.23; 95% CI: 1.04-1.44); (OR: 2.60; 95% CI: 2.53-3.02) and impact of oral disorders on daily performance (OR: 1.48; 95% CI: 1.30-1.69). The implementation or adequacy of public policies with the aim of improving satisfaction with dental services should prioritize those municipalities with greater social inequality and with fewer dentists and socially disadvantaged users, who self-perceive oral problems, are dissatisfied with their oral health and suffer impacts resulting from oral problems.