Treatment needs and skill mix workforce requirements for prosthodontic care: a comparison of estimates using normative and sociodental approaches.

BACKGROUND: The traditional measure for assessing dental treatment needs and workforce requirements based solely on normative need (NN) has major shortcomings. The sociodental approach (SDA) to assess needs overcomes some of the shortcomings as it combines normative and subjective needs assessments and also incorporates behavioural propensity (Sheiham and Tsakos 2007). The objective of this study was to estimate and compare prosthodontic treatment needs and workforce requirements, using the normative and the sociodental approaches for different skill mix models. METHODS: A cross-sectional study was conducted on 732 university employees aged 30-54 years. Normative prosthodontic need was assessed using the WHO (1997) method. The SDA includes NN and also considers oral impacts, measured through the OIDP index, and behavioural propensity. Estimates of prosthodontic need and dental workforce requirements using the two methods were compared using McNemar and Wilcoxon Signed Rank test respectively. The dental workforce required for prosthodontic treatment based on NN and SDA approaches were then compared using different workforce skill mix models. RESULTS: The proportion of subjects needing prosthodontic treatment was lower by more than 90% when the SDA was used compared to NN. The number of dentists required for prosthodontic treatment per 100,000 people were 98.8 using NN compared to 2.49 using SDA. Using a skill mix approach, the requirements for dentists per 100,000 people decreased slightly when more denture procedures were delegated to dental therapists. CONCLUSION: There were very much lower levels of prosthodontic treatment needs and workforce requirements when using the sociodental approach compared to normative methods.

A comparison of moderate and high users of Alberta's universal dental plan for the elderly.

The characteristics and service utilization of 2,071 high and 2,337 moderate users of Alberta's dental plan from 1978-79 to 1990-91 are reported. High users are those who used the plan for 14 consecutive years; moderate users are those who used the plan in seven of the 14 years. Both groups were over 74 years of age in 1991-92. Compared to high users, moderate users lived in less urbanized regions, visited denturists more often and received far more complete dentures and fewer partial dentures. As a percentage of their total annual plan expenditures, moderate users spent less on diagnostic, preventive, periodontal and restorative services and much more on removable prosthodontic and denturists' services. However, during the study period, the moderate users increased their annual relative expenditures for diagnostic, preventive and, especially, periodontal services, and decreased them for prosthodontic services. With respect to specific preventive and periodontal services, the percentage of total annual expenditures for dental prophylaxis, topical fluoride applications, periodontal scaling, gingival curettage, and combinations of these, was much higher for the high user group. Despite these differences favoring the high user group, during the 14 year period, the moderate user group considerably increased its relative expenditures for dental prophylaxis, topical fluoride and periodontal scaling services. While the observed differences in service expenditures between high and moderate users were anticipated, the shift over time to using more preventive and periodontal services by both groups was an encouraging harbinger of the "new elderly" dental patients.

Removable partial denture design in Alberta dental practices.

Studies published in the dental literature have found, all too frequently, that dentists do not pay adequate attention to the design of cast removable partial denture frameworks. This study investigated removable partial denture design in Alberta dental practices. The authors considered various issues related to surveying, partial denture design, and provider education, as well as the possible collaboration of clinical dentistry with denturism in removable partial denture treatment. Although the study found that a significant proportion of Alberta's dentists get involved in designing the cast framework, relatively few undertake surveying. Instead, surveying tends to be deferred to dental technicians. As was the case in other studies, no clear reason for this trend emerged, and it appeared to be unrelated to remuneration or time utilization issues. Responding dentists perceived that their undergraduate education was adequate for providing removable partial denture care. The study also identified a need for small, hands-on continuing education courses. About half of the respondents indicated that it is appropriate for dentists to collaborate with denturists on complete denture care. However, very few respondents considered it appropriate to refer to, or collaborate with, denturists in removable partial denture care.

Alberta's universal dental plan for the elderly: differences in use over 6 years by two cohorts.

OBJECTIVES: Dental services use by two cohorts under the universal dental plan for the elderly in Alberta, Canada, was examined. METHODS: Two birth cohorts 65 to 69 years old at entry who used the plan from 1978 to 1979 (n = 17,816) or from 1985 to 1986 (n = 27,474) were analyzed over 6 successive years for differences in dental services use and costs. RESULTS: The 1985/86 cohort received 24% more visits per patient than the 1978/79 cohort. Their inflation-adjusted expenditures increased by 19% mainly as a result of increases in denturists' expenditures (33%) (dentists' expenditures increased just 4% because of lower plan fee increases). The 1985/86 cohort received relatively many more periodontal and fewer denture services. Annual attendance over 6 consecutive years was high, especially for the 1985/86 cohort and dentists' patients; 55% of the 1985/86 cohort who used dentists did so in 5 or all 6 years. CONCLUSIONS: Differences in plan expenditures per patient between the birth cohorts and dentists and denturists, along with the high continuity of care for dentists' patients, have important implications for planning and administering dental plans for the elderly. The large expenditure decreases for removable dentures and the large increases for periodontal services to the 1985/86 cohort are noteworthy.

Denture replacement during a 14-year period in Alberta's universal dental plan for the elderly.

Since 1973 Alberta's dental plan for the elderly has made government-sponsored, premium-free, comprehensive dental care available from both dentists and denturists in private practice to all residents older than 64 years. This article is based on an analysis that covered 260,000 patients from 1978 to 1992. It presents the frequency, nature, and cost of denture replacements to patients and pays particular attention to replacements administered within the allowable 5-year time limit stated by the plan for complete and removable partial dentures. During the 14-year period, about 55,000 dentures were replaced; 47% of these were replaced in the year after the individual's 5-year time limit had expired. Within the 5-year limit 1974 dentures were replaced at a nominal cost of +1.09 million, with nearly one half of these costs being attributed to denturists. Relative to the total number of dentures provided during the 14-year period, the denture replacement rate for dentists was 7% to 8%, and for denturists it was nearly three times greater at 21% to 22%. The replacement process included many crossovers by patients between dentists and denturists; for example, nearly one quarter of the 190 complete dentures initially provided by dentists were replaced by denturists within 5 years.

Changes in utilization of dental services of Alberta's universal dental plan for the elderly.

Since 1973, Alberta's dental plan for the elderly has made government-sponsored, premium-free comprehensive care by dentists and denturists available to all residents of the province over age 64. Details on the numbers and types of different services provided were previously unavailable from the annual reports. However, an examination of the plan's six-million records, covering nearly 260,000 different patients from 1978 to 1992, has now made it possible, for the first time, to conduct a detailed analysis of these dental services. Many time-related changes have occurred in the types of services provided. The number of removable prosthodontic services declined from 14 per cent of all services offered by dentists in 1978-79 to five per cent of these services in 1991-1992, but the services provided by denturists increased by a factor of four. The relative number of surgical and restorative dentistry services offered by dentists also declined. Preventive services grew modestly, but periodontal services grew dramatically from three per cent of all services provided by dentists to 22 per cent. These shifts in services from prosthodontics, restorative dentistry and oral surgery to preventive and periodontic services have important implications for the planning and administration of dental plans for the elderly.

Continuity of dental treatment by users of Alberta's universal dental plan for the elderly.

To evaluate the longitudinal utilization of Alberta's Extended Health Benefits dental plan for the elderly, its use over the preceding 13 years by patients over age 64, who had used the plan in 1991-92, was examined. Of these 96,596 patients, over half (56 per cent) were female and about two-thirds (68 per cent) received their dental care from a dentist only. However, for the older elderly and for those living outside Calgary and Edmonton, the percentage attending a denturist only or both a denturist and a dentist was greater. Only individuals over age 77, or about 20 per cent of plan participants in 1991-92, were eligible to use the plan over the entire 14-year period examined in this study. However, the regularity of previous annual utilization of the plan was high. About 60 per cent of 70-74 year olds had used the plan for five or more years, while close to 50 per cent of the 80-84 year olds--who were eligible to use the plan for the entire period of the study--had done so in eight or more of the previous 14 years. Despite varying plan eligibility according to patient age, the 96,596 patients who used the plan over the 14-year period made nearly 1.2-million patient visits, at which they received about 3.1-million dental services. The high continuity of annual usage demonstrates that this group is not under-utilizing dental services.

Denturists and oral health in the aged.

The activities of denturists have been the source of annoyance and alarm to dentists. The dental profession has been unsuccessful in curtailing the prosthodontic service provided by denturists directly to the public despite frequent warnings about the risk to oral health. In many countries denturists have become a legitimate part of the health service in competition with dentists. This article explains the historic circumstances leading to the widespread acceptance of denturists in Canada in contrast to the rejection of these services in Great Britain. It demonstrates that dentists generally were not opposed to an alternative complete denture service and that there is little evidence of a serious threat to the oral health from the complete dentures made by denturists.

The reaction of the dental profession to changes in the 1970s.

This paper explores the changing realities of dentistry in the 1970s: the development of denturism; the maldistribution of dental practitioners; the growth and activities of expanded function auxiliaries; the intrusion of the Federal Trade Commission into professional issues resulting in advertising, supermarket and franchise dentistry; and the effect of prepayment plans. These realities are considered in terms of their impact on the profession and the efforts by the individual practitioner and his representative organizations to come to terms with them.