Competition and market structure in the dental industry.

We use Survey of Dental Practice data from 1983 to 2012 to examine market power of dentists and hygienists in private practice. Our findings are consistent with a dental market wherein practices use hygienist services as a "loss leader" in order to steer patients into more lucrative dental services, which exhibit the ability to markup price above marginal cost. Both dental care exhibits an elasticity of demand of roughly - 0.2, while hygienist care exhibits and elasticity of demand of nearly - 0.6. Another theme that emerged from our findings is the evidence for significant economies of scale in the dental market. The overall returns to scale parameter of 2.1 suggests significant increasing returns to scale are available to the typical dental practice. Given that the typical practice has 1.5 dentists, the finding is not surprising. While returns to scale diminishes with visit volume, the largest quartile of practices still has meaningful increasing returns to scale of roughly 1.75.

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.

Preparing the Future Dental Hygiene Workforce: Knowledge, Skills, and Reform.

With the health care delivery system in transition, the way in which oral health care services are delivered in 2040 will inevitably change. To achieve the aims of reduced cost, improved access, and higher quality and to advance population wellness, oral health care will likely become a more integrated part of medical care. An integrated primary care system would better meet the needs of an increasingly diverse and aging U.S. population with uneven access to health care services. By 2040, trends suggest that a smaller proportion of dental hygienists will work in traditional solo dental offices; many more will practice with multidisciplinary health care teams in large-group dental and medical practices and in a variety of non-traditional community settings. This integration will require changes in how dental hygienists are educated. To shape the skill sets, clinical judgment, and knowledge of future practitioners, current dental hygiene curricula must be reexamined, redirected, and enhanced. This article examines some of the factors that are likely to shape the future of dental hygiene practice, considers the strengths and weaknesses of current curricula, and proposes educational changes to prepare dental hygienists for practice in 2040. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Interventions for enhancing the distribution of dental professionals: a concise systematic review.

BACKGROUND: A spatially unequal distribution of dentists or dental care professionals (D/DCPs), such as therapists or hygienists, could reduce the quality of health services and increase health inequities. This review describes the interventions available to enhance this spatial distribution and systematically assesses their effectiveness. METHODS: Electronic databases (Cochrane CENTRAL, Medline, Embase, CINAHL) were searched and cross-referencing was performed using a standardised searching algorithm. Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted time series were included. Studies investigating a minimum of one of four interventions (educational, financial, regulatory and supportive) were included. The primary outcome was the spatial distribution of D/DCPs. Secondary outcomes were access, quality of services and equity or adverse effects. This review was registered (CRD42015026265). RESULTS: Of 4,885 articles identified, the full text of 201 was assessed and three (all investigating national policy interventions originally not aiming to change the distribution of D/DCPs) were included. In one Japanese study spanning 1980 to 2000, the unequal spatial distribution of dentists decreased alongside a general increase in the number of dentists. It remained unclear if these findings were associated. In a second Japanese study, an increase in the number of dentists was found in combination with a postgraduate training programme implemented in 2006, and this occurred alongside an increasingly unequal distribution of dentists, again without proof of cause and consequence. A third study from Taiwan found the introduction of a national universal-coverage health insurance to equalise the distribution of dentists, with statistical association between this equalisation and the introduction of the insurance. CONCLUSIONS: The effectiveness of interventions to enhance the spatial distribution of D/DCPs remains unclear.

Using Registered Dental Hygienists to Promote a School-Based Approach to Dental Public Health.

We examine a strategy for improving oral health in the United States by focusing on low-income children in school-based settings. Vulnerable children often experience cultural, social, economic, structural, and geographic barriers when trying to access dental services in traditional dental office settings. These disparities have been discussed for more than a decade in multiple US Department of Health and Human Services publications. One solution is to revise dental practice acts to allow registered dental hygienists increased scope of services, expanded public health delivery opportunities, and decreased dentist supervision. We provide examples of how federally qualified health centers have implemented successful school-based dental models within the parameters of two state policies that allow registered dental hygienists varying levels of dentist supervision. Changes to dental practice acts at the state level allowing registered dental hygienists to practice with limited supervision in community settings, such as schools, may provide vulnerable populations greater access to screening and preventive services. We derive our recommendations from expert opinion.

Perception of Nepalese dental hygiene and dentistry students towards the dental hygienists profession.

OBJECTIVES: This study investigates student and stakeholder perceptions of the role of the dental hygienist in Nepal. The impact of these perceptions on the professionalization of dental hygienists is described whilst exploring the consequences for oral health workforce planning. METHODS: Dentistry and dental hygiene students from one dental college in Nepal were asked to complete an anonymous questionnaire; 171 students returned the questionnaire containing a mix of forced response and open-ended items. Quantitative data were analysed using SPSS® 22. These data were complemented with qualitative information from survey open questions and from semi-structured interviews with key informants from several relevant organizations. Qualitative data were manually analysed and coded. Data were triangulated to contextualize quantitative data. RESULTS: A high level of positive regard for the role of the dental hygienist in Nepal was evident amongst dentistry and dental hygiene students in this college. Both groups believe that the dental hygienist can play a major role in raising oral health awareness in Nepal. The scope of practice of the dental hygienist was unclear with issues surrounding the scope of practice and reports of illegal practice by dental hygienists. Significant differences (P < 0.001) were noted between dental hygiene and dentistry students in relation to their opinion regarding independent practice and the need of supervision by a dentist. DISCUSSION AND CONCLUSION: Supervision of the dental hygienist by dentists and issues surrounding the scope of practice are polarizing the relationship between dentists, dental hygienists and the relevant professional organizations. This could hinder cooperation between these oral health professionals and might lead to underutilization of the dental hygienist. To improve the understanding about the roles of each oral health professional, establishing functional relationships and intraprofessional education involving dentistry and dental hygiene students needs to be introduced. This will benefit the introduction of preventative oral health services in Nepal. Government jobs and incentives to increase the retention and distribution of oral health professionals should be created. The government and professional organizations need to consider professionalizing the dental hygiene workforce and formalize the scope of practice. The unique demographic details of Nepal require a paradigm shift in oral health workforce management in Nepal.

Expanded Scopes Of Practice For Dental Hygienists Associated With Improved Oral Health Outcomes For Adults.

Dental hygienists are important members of the oral health care team, providing preventive and prophylactic services and oral health education. However, scope-of-practice parameters in some states limit their ability to provide needed services effectively. In 2001 we developed the Dental Hygiene Professional Practice Index, a numerical tool to measure the state-level professional practice environment for dental hygienists. We used the index to score state-level scopes of practice in all fifty states and the District of Columbia in 2001 and 2014. The mean composite score on the index increased from 43.5 in 2001 to 57.6 in 2014, on a 100-point scale. We also analyzed the association of each state's composite score with an oral health outcome: tooth extractions among the adult population because of decay or disease. After we controlled for individual- and state-level factors, we found in multilevel modeling that more autonomous dental hygienist scope of practice had a positive and significant association with population oral health in both 2001 and 2014.

Australian dentists: characteristics of those who employ or are willing to employ oral health therapists.

BACKGROUND: There has been an increase in the availability of oral health therapists (OHTs) in the oral health workforce in the last decade. The impact these clinicians will have on the oral health of the general public is dependent on access pathways and utilization. This study aimed to profile Australian dentists who employ or are willing to employ OHTs and to explore the degree of association between dentist characteristics and employment decisions. METHODS: This cross-sectional study used a random sample of Australian dentists (n = 1169) from the Federal Australian Dental Association register in 2009. Participants were sent a postal questionnaire capturing dentist characteristics and oral health practitioner employment information. RESULTS: An adjusted response rate of 55% was obtained. Dentists willing to employ OHTs included non-metropolitan dentists, dentists in multiple surgery practices and those considering practice expansion. Age, gender and sector of practice were not significantly associated with retrospective employment decisions or willingness to employ in the future. CONCLUSIONS: Certain characteristics of dentists or of their practice are associated with their history of employment and willingness to employ OHTs. Employment decisions are more commonly related to entrepreneurial aspirations (expressed as a willingness to expand), sector of practice, surgery capacity and regionality over gender and age. Understanding the factors that influence the employment of OHTs is important in enhancing access pathways to the services provided by OHTs.

Oral health workforce planning part 2: figures, determinants and trends in a sample of World Dental Federation member countries.

BACKGROUND AND AIM: A range of factors needs to be taken into account for an ideal oral health workforce plan. The figures related to dentists, specialists, auxiliaries, practice patterns, undergraduate and continuing dental education, laws/regulations, the attitudes of oral health-care providers and the general trends affecting the practice patterns, work conditions and preferences of oral health-care providers are among such determinants. Thus, the aim of the present study was to gather such information from a sample of World Dental Federation (FDI) member countries with different characteristics. METHODS: A cross-sectional survey study was carried out among a sample of FDI member countries between March 2, 2012 and March 27, 2012. A questionnaire was developed addressing some main determinants of oral health workforce, such as its structure, involvement of the public/private sector to provide oral health-care services, specialty services, dental schools, trends in workforce and compliance with oral health needs, and a descriptive analysis was performed. The countries were classified as developed and developing countries and Mann-Whitney U-tests and chi-square tests were used to identify potential significant differences (P > 0.05) between developed and developing countries. All data were processed in SPSS v.19. RESULTS: In the18 questionnaires processed, the median number of dentists (P = 0.005), dental practices (P = 0.002), hygienists (P = 0.005), technicians (P = 0.013) and graduates per year (P = 0.037) was higher in developed countries. Only 12.5% of developed and 22.2% of developing countries reported having optimal number of graduates per year. It was noted that 66.7% of developing countries had more regions lacking enough dentists to meet the demand (P = 0.050) and 77.8% lacked the necessary specialist care (P = 0.015). Although developing countries reported mostly an oversupply of dentists, regardless of the level of development most countries did not report an oversupply of specialists. Most developed countries did not feel that their regulations (87.5%) complied with the needs and demands of the population and most developing countries did not feel that their undergraduate dental education (62.5%) complied. Migrating to other countries was a trend seen in developing countries, while, despite increased numbers of dentists, underserved areas and communities were reported. DISCUSSION: The cross-sectional survey study suggests that figures related to optimum or ideal oral health workforce and fair distribution of the available workforce does not seem to be achieved in many parts of the world. Further attention also needs to be dedicated to general trends that have the capacity to affect future oral health workforce.

Increased number of dental professionals in New York State counties.

Despite decreases in the population for 49 of the 62 counties in New York State between 2006 and 2013, the number of dentists increased in 52 counties. In addition, in 2013, there were more dental hygienists than dental establishments in 54 of the state counties. This change in landscape from 2000 to 2006, when the number of dentists decreased in 27 counties and a sizeable proportion of the state had little or no coverage, is reviewed using federal and state government reports.

Feasibility of colocating dental hygienists into medical practices.

OBJECTIVES: To test the feasibility of colocating registered dental hygienists (RDHs) into medical practices and to evaluate parent/caregiver oral health characteristics. METHODS: From December 2008 to April 2009, we colocated five RDHs into five medical practices identified for their service to low-income children. Dual-function exam rooms were built in each office. Caregiver-child dyads were recruited from the practices for program evaluation. We used both qualitative (key informant interviews) and quantitative (survey) methods to evaluate the project. Feasibility was measured by assessment of RDH and practice factors that facilitated and/or created barriers to colocation, sustainability of services 5 years after colocation, and caregiver satisfaction with services. Caregiver oral health knowledge, attitudes, beliefs, and behaviors were also measured. RESULTS: Over 27 months, five part-time RDHs provided care to 2,071 children. Children of caregiver-child dyads (n = 583) recruited for evaluation were young (mean age = 1.8 years), white (46 percent), non-Hispanic (56 percent), and publicly insured (68 percent Medicaid/11 percent State Children's Health Insurance Plan). Key informant interviews revealed various factors that facilitated and created barriers to program adoption, implementation, and sustainability. Most barriers were overcome. Five RDHs remained in the practices 2 years after program initiation and four remained after 5 years. At 1 year, 27 percent of caregiver-child dyads returned for evaluation and were highly satisfied with services. Caregivers reported favorable oral health characteristics and few barriers to receiving preventive dental care at baseline and 1-year follow-up. CONCLUSIONS: Colocating RDHs into medical practices is feasible and an innovative model to provide preventive oral health services to disadvantaged children.

A survey of dental hygienists in the United Kingdom in 2011. Part 1--demographics and working patterns as dental hygienists.

AIMS: The aims of this survey were to establish the demographic profile of dental hygienists (DHs) and dental hygienist/therapists (DH/Ts) in the United Kingdom in 2011 and their patterns of practice as DHs. METHODS: A 10% sample of all those registered with the General Dental Council as DHs or DH/Ts in April 2011 were sent a pre-piloted questionnaire, explanatory letter and stamped addressed envelope. The questionnaire contained a total of 100 questions, 24 of which related to demographics and working patterns. All 100 questions were solely on tasks/work performed by DH, none related to other types of work performed by DH/Ts. Three mailings were distributed between May and July 2011. The resulting data were entered into an Excel spreadsheet. Where appropriate, differences between the responses from DHs and DH/Ts were statistically tested with the chi-squared test. RESULTS: Five hundred and sixty-one DHs and DH/Ts were sent the questionnaire, by the third mailing 371 (66.1%) had responded and returned completed questionnaires. The respondents were 288 DHs, 79 DH/Ts and 4 who did not specify which category they were. The mean year of qualification of the DHs was 1990 and for the DH/Ts 2005. One hundred and twenty-four (33%) reported that they worked full-time, 235 (63%) part-time and the remainder that they were not working as DHs or DH/Ts or had retired. The average number of clinical hours worked per week was reported as 24.6 hours for DHs and 25 hours for DH/Ts, but there were regional variations. For DHs the mean percentage of patients treated under NHS contract was 15.5% and for DH/Ts it was 40.2%. Again there were regional variations and in Scotland these figures were 45.5% for DHs and 70% for DH/Ts. Two hundred and forty-eight (69%) of all respondents were either fully or partly self-employed and 221 (62.7%) worked in two or more locations. CONCLUSIONS: The results of this study provide a snapshot of the demographics and practice patterns of DHs and DH/Ts in the UK in the summer of 2011. They confirm the results of a survey that was conducted in England in early 2011 and of a survey that took place in Scotland in 2009.

Envisioning an oral healthcare workforce for the future.

Health is critical to human well-being. Oral health is an integral component of health. One is not healthy without oral health. As health is essential to human flourishing, it is important that an oral healthcare delivery system and workforce be developed and deployed which can help ensure all citizens have the potential to access oral health care. As such access does not generally exist today, it is imperative to advance the realization of this goal and to develop a vision of an oral healthcare workforce to functionally support access. Public funding of basic oral health care is an important element to improving access. However, funding is only economically feasible if a workforce exists that is structured in a manner such that duties are assigned to individuals who have been uniquely trained to fulfill specific clinical responsibilities. An essential element of any cost-effective organizational system must be the shared responsibility of duties. Delegation must occur in the oral health workforce if competent, cost-effective care is to be provided. Desirable members of the oral health team in an efficient and effective system are as follows: generalist dentists who are educated as physicians of the stomatognathic system (oral physicians), specialist dentists, dental therapists, dental hygienists, dually trained hygienists/therapists (oral health therapists), oral prosthetists (denturists), and expanded function dental assistants (dental nurses).

Mentors matter: relationships that increase the number of oral health professionals serving the underserved.

Access to oral healthcare is a persistent problem in the United States. One barrier to this multifaceted issue is the shortage of oral healthcare providers who are willing to provide care for underserved populations. Mentoring relationships with oral health professionals is one solution that will increase the number of public oral health professionals. Using narrative inquiry, this interpretive study explored the relationships that public health dental hygienists had with mentors who leveraged their capital to empower those they mentored. The stories of six dental hygienists practicing in public health and four of their mentors were gathered through one or two 60- to 90-minute interviews. Qualitative data analysis was used to untangle and make meaning of their narrations. The findings are reported in the words of dental hygienists and their mentors, wherever possible, to embrace the voice of the participants. The Iroquois legend of The Three Sisters is used as a metaphor to illustrate the mentoring relationship. These mentor relationships, in which there was mutual growth, were built on a symbiotic, natural bond. The dental hygienists recalled relationships with multiple mentors who leveraged their social and political capital to empower and thereby encouraged a career path in public health.

A dental hygienist who's A Lakota Sioux calls for new mid-level dental providers.

High rates of tooth decay and gum disease plague her native Pine Ridge Indian Reservation, along with the rest of Indian Country.

Use of social networking for dental hygiene program recruitment.

PURPOSE: Social networking has become a popular and effective means of communication used by students in the millennial generation. Academic admissions officers are beginning to utilize social networking methods for recruitment of students. However, the dental hygiene literature has reported little information about the use of social networking for recruitment strategies. This paper describes one institutions' process of creating and implementing a social network site for prospective and current students.

Improving oral health in Pakistan using dental hygienists.

This paper reviews the healthcare system, available dental care, and oral health status of people in Pakistan. Considering the enormous unmet oral health needs, the insufficient supply of dental professionals and the current unstructured dental hygiene curriculum in Pakistan, a mission, vision, and goals for professional dental hygiene in Pakistan is recommended. The authors offer recommendations for competency-based dental hygiene education and practice, professional credentialing, a practice act, and a dental hygiene scope of practice to promote the health, welfare, and quality of life of the Pakistani people. Specifically, the authors recommend increasing the number of quality dental hygiene programs, establishing the dental hygienist as a primary care provider of oral health services, enhancing current dental hygiene curriculum, and establishing a dental hygiene council with responsibility for educational requirements and regulation of dental hygienists in Pakistan.