Future Dental Workforce Research Articles

Sociodemographic Profile and Career Decisions of Australian Oral Health Profession Students

This study collected and analyzed recent information regarding the sociodemographic profile and career decisions of Australian oral health profession students (earning B.D.Sc. and B.O.H. degrees) and the reasons for their career choice. Data were collected during the 2009-10 academic year via a web-based survey. A total of 829 students participated; the response rates for each oral health course at the seven participating universities ranged from 15.0 percent to 88.7 percent. The respondents had an average age of 21.4 years, ranging from eighteen to fifty-one. The majority of the respondents were female (61.4 percent), single (91.0 percent), and of Asian ethnicity (65.0 percent), and almost half had attended a public secondary school (49.7 percent). Most of the responding students either lived in rented accommodation (44.0 percent) or with their parents (28.6 percent), and 41.5 percent reported having an urban address. Most respondents' fathers (67.2 percent) and mothers (54.8 percent) had completed undergraduate or postgraduate education and were employed in managerial or professional occupations (68.5 percent and 54.9 percent, respectively). Most of the students said they had selected their course in high school (66.8 percent) and were most influenced in their career choice by self-motivation (85.3 percent) and caring for and helping other people (86.6 percent). The majority of the respondents reported wishing to work in a city (51.5 percent), practicing general dentistry (31.8 percent) in either the public or private sector (40.2 percent each). This article provides a preliminary look at the future dental workforce of Australia, identifying issues for further analysis and assisting each university to address current inequalities and challenges.

Self‐reported cultural skills from dental students and graduates from Melbourne, Australia

To explore Melbourne Dental School students and graduates' self-assessed levels of competence and skill regarding cultural issues which emerge in dental treatment, and their perceptions of the dental curriculum in addressing socio-cultural issues. Information was derived from a 59-item questionnaire consisting of three parts: socio-demographic; self-assessed level of culture competency within the clinical encounter; and cultural aspects in the dental curriculum. Data was collected from undergraduate dental students enrolled in the fourth year of 2006 and 2007 and fifth year of 2006 and from dentists who graduated in 2002 and 2003. A total of 133 students and 37 dentists took part in the survey. Response rates were 68.9% among students and 92.6% among dentists. The majority (students: 90.2%; graduates: 62.1%) indicated 'Very often'/'Always' treating patients from different cultural backgrounds. Distribution of competencies showed that participants felt fairly competent in communicating and establishing rapport, but less competent in dealing with patients' cultural practices, and patients' family involvement. The majority (students: 72.1%; graduates: 59.7%) perceived the coverage of socio-cultural aspects in the course as not adequate. Around 40% of participants indicated that inclusion of socio-cultural awareness in the dental curriculum was important or very important. Although there were some significant differences in participants' reports, they generally self-reported having good competency and skill in providing care to patients from different cultural backgrounds. Further exploration of these issues would enhance the future dental workforce's quality of care, professionalism and capacity for cultural competence.

Relative performance of different dental professional groups in screening for occlusal caries

The use of role substitution, where different levels of practitioner undertake the duties of the most qualified clinician, is common in medicine and dentistry. Proponents argue that role substitution has the potential to increase dentists' efficiency and effectiveness, thereby freeing up resources to improve access and reduce oral health inequalities. Given the current global economic climate, many countries are re-examining models of service provision to utilize role substitution. The objective of this study was to determine whether different members of the dental team could meet the diagnostic threshold set by the World Health Organization, when screening photographs of occlusal surfaces for dental caries. Participants were sampled purposively and included; final-year dental students, final-year hygiene-therapy students, primary care dentists, hygiene-therapists and dental nurses. Following a brief training package, participants were asked to score 102 clinical photographs of both carious and noncarious extracted teeth and determine whether the tooth was 'healthy' or had 'suspected decay'. The time delay between consecutive photographs was set at 8-s. Judgment decisions were compared against the International Caries Detection and Assessment System as the gold standard, with scores of two or less representing 'healthy'. Sensitivity, specificity and predictive values were determined for each participant and clinical group. Kappa was calculated to determine test-retest reliability. Dental nurses had the highest median sensitivity (87.9%), although all groups were comparable. The median specificity for the groups was lower than their sensitivity scores, with dentists scoring the highest (71.0%). Dentists also scored the highest median positive predictive value (57.8%), whilst dental nurses scored the highest negative predictive value (91.3%). The median level of agreement was high for all groups; the highest median score was for the final-year dental students (88.9%). Even with minimal training, different members of the dental team show the potential to screen for occlusal caries to a similar standard as primary care dentists. This requires further testing in vivo, but has important implications for the productivity and design of the future dental workforce.

The future dental workforce?

The Editor-in-Chief of the BDJ has previously raised important questions about dental workforce planning and the implications for dental graduates of recent changes and pressures. It is now time to revisit this issue. Much has changed since the last workforce review in England and Wales, and the rate of change is in all probability set to increase. First, at the time of writing this paper the momentous step of including dental care professionals (DCPs) on General Dental Council (GDC) registers in the United Kingdom has recently been completed. Second, the Scope of Practice of all dental professionals has been under consultation by the General Dental Council, and research evidence suggests that greater use should be made of skill-mix in the dental team. Third, within England, Lord Darzi has just published the 'Final Report of the NHS Next Stage Review', which emphasises 'quality care' and 'team-working' as key features of healthcare; this report was accompanied by an important document entitled 'A High Quality Workforce', in which plans for local workforce planning within the NHS are outlined, placing responsibilities at national, local and regional levels. Fourth, policy makers across the UK are wrestling with addressing oral health needs, promoting health and facilitating access to dental care, all of which have implications for the nature and shape of the dental workforce. Fifth, with the impact of globalisation and European policies we are net gainers of dentists as well as having more in training. Sixth, although there have been reviews and policy initiatives by regulatory, professional and other bodies in support of shaping the dental workforce, there has been little serious consideration of skill-mix and funding mechanisms to encourage team-working. Together, these events demand that we enter a fresh debate on the future dental workforce which should extend beyond professional and national boundaries and inform workforce planning. This debate is of great importance to future generations of dental healthcare professionals, funders, commissioners and providers of both dental services and dental education and training, and most importantly our patients and the public whom we serve. Furthermore, workforce planning must be linked to a philosophy of care which promotes promotion of health and embraces quality care, rather than merely treatment of disease, and addresses oral health needs and demands.

Dental School Applicants by State Compared to Population and Dentist Workforce Distribution

Millions of Americans face significant barriers that limit their access to oral health care, including the lack of dental health care professionals willing to provide dental services in underserved areas. The purpose of this study was to evaluate the relationship between the geographic distribution of dental school applicants and the population and number of dentists by state. Data from the Associated American Dental Schools Application Service (AADSAS), the American Dental Association (ADA), the U.S. Census Bureau, and the U.S. Department of Commerce were used to determine the total number of dental school applicants, dentists, and populations by individual state. Results suggest that, based on national averages, the majority of states may have too few dentists to meet current and future state population needs. Also, many of these same states may have too few dental school applicants when compared to state population and dental workforce figures. It was concluded that states may wish to consider targeted initiatives aimed at increasing the sizes of their dental school applicant pools in order to help address current and future local or regional dental workforce needs.

An analysis of preventive dental visits by provider type, 1996

Understanding preventive dental visit utilization patterns facilitates planning of the dental health services delivery system. The authors examine these patterns by analyzing the receipt of preventive dental services in the United States by type of dental provider. The authors analyzed data from the 1996 Medical Expenditure Panel Survey (MEPS) for the U.S. community-based population. They developed national estimates for the population with preventive dental visits by provider type, including the population with a preventive dental visit and mean number of preventive dental visits per person for socioeconomic and demographic categories. Respondents who are white, are older, are female, have dental insurance, are from higher income and education backgrounds, and reside in small metropolitan areas were more likely (P < .05) to receive preventive care from a dental hygienist than from a dentist. MEPS data showed that people's socioeconomic background and other demographic factors were associated with having a preventive dental visit with a dentist or dental hygienist. These factors also influence the per-person number of preventive visits by type of dental practitioner. These elements must be considered when planning for future dental work force needs. Estimating future dental work force needs through this analysis assists dentists in meeting patient demand and maximizing the productive output of all services rendered in their practices, including preventive services.

Dental Work Force Strategies During a Period of Change and Uncertainty

Both supply and demand influence the ability of the dental work force to adequately and efficiently provide dental care to a U.S. population growing in size and diversity. Major changes are occurring on both sides of the dental care market. Among factors shaping the demand for dental care are changing disease patterns, shifting population demographics, the extent and features of third-party payment, and growth of the economy and the population. The capacity of the dental work force to provide care is influenced by enhancements of productivity and numbers of dental health personnel, as well as their demographic and practice characteristics. The full impact of these changes is difficult to predict. The dentist-to-population ratio does not reflect all the factors that must be considered to develop an effective dental work force policy. Nationally, the dental work force is likely to be adequate for the next several years, but regional work force imbalances appear to exist and may get worse. Against this backdrop of change and uncertainty, future dental work force strategies should strive for short-term responsiveness while avoiding long-term inflexibility. Trends in the work force must be continually monitored. Thorough analysis is required, and action should be taken when necessary.