Oral Health Workforce Research Articles

Exploratory scoping of the literature on factors that influence oral health workforce planning and management in developing countries.

The purpose of this study was to scope the literature that exists about factors influencing oral health workforce planning and management in developing countries (DCs). The Arksey and O'Malley method for conducting a scoping review was used. A replicable search strategy was applied, using three databases. Factors influencing oral health workforce planning and management in DCs identified in the eligible articles were charted. Four thousand citations were identified; 41 papers were included for review. Most included papers were situational analyses. Factors identified were as follows: lack of data, focus on the restorative rather than preventive care in practitioner education, recent increase in number of dental schools (mostly private) and dentistry students, privatization of dental care services which has little impact on care maldistribution, and debates about skill mix and scope of practice. Oral health workforce management in the eligible studies has a bias towards dentist-led systems. Due to a lack of country-specific oral health related data in developing or least developed countries (LDCs), oral health workforce planning often relies on data and modelling from other countries. Approaches to oral health workforce management and planning in developing or LDCs are often characterized by approaches to increase numbers of dentists, thus not ameliorating maldistribution of service accessibility. Governments appear to be reducing support for public and preventative oral healthcare, favouring growth in privatized dental services. Changes to professional education are necessary to trigger a paradigm shift to the preventive approach and to improve relationships between different oral healthcare provider roles. This needs to be premised on greater appreciation of preventive care in health systems and funding models.

Longitudinal Changes in Proportions of Dental Services Provided by Australian Dentists, 1983 to 2010.

The objective of the study was to estimate the longitudinal change over a 26-y period in the proportion of dental services provided in 10 main service provision areas by Australian dentists. A random sample of Australian dentists was surveyed approximately every 5 y, commencing 1983 to 1984. The mean proportion of dental services provided was calculated from practitioner activity logs. Mixed effects regression models estimated the longitudinal change in the proportion of services provided, by dentists' age and birth-year cohort. Response rates across data collection waves ranged from 67% to 76%. Between 1983 to 1984 and 2009 to 2010, the mean proportion of diagnostic, preventive, and crown/bridge services provided tended to increase, and the mean proportion of restorative, oral surgery, and prosthodontic services tended to decrease. Mean proportions of endodontic and orthodontic services fluctuated. Relative to the youngest cohort (born after 1984), across cohorts of older to younger dentists, the proportions of diagnostic and preventive services increased, and restorative and prosthodontic decreased. Older cohorts provided the lowest proportions of diagnostic and preventive services (oldest cohort born before 1918: β = -32.1 ± 4.8; cohort born 1934 to 1938: β = -11.6 ± 3.2, respectively). Older cohorts provided the highest proportions of restorative and prosthodontic services (born before 1918: β = 27.3 ± 5.6; born 1919 to 1923: β = 10.5 ± 2.4, respectively). Some service area trends varied across birth-year cohorts. Endodontic service provision was declining for younger cohorts but increasing for older cohorts. Preventive service provision was increasing for younger cohorts but declining for older cohorts. This study identified trends not evident in previous time-series analysis. First, provision of restorative and oral surgery services, as a proportion of all services provided, was declining. Second, there were competing intercohort trends. These may indicate that new norms in dental education are influencing clinical decision making and that new trends in dental service provision may emerge as older dentists retire. Knowledge Transfer Statement: This study identified several trends in dental service provision and indicated that not all trends were consistent across all birth-year cohorts. Findings inform dental health care policy and priorities for dental education. In addition, the identified trends have implications for the future composition of the oral health workforce.

Current Status of Adding Dental Therapists to the Oral Health Workforce in the United States

Dental therapists are members of the oral health care workforce in over 50 countries of the world. Until recently, they have not participated as members of the professional dental team in the USA. It was not until the publication of Oral Health in America: A Report of the Surgeon General in 2000, describing the significant problem of access to dental care, that the issue of dental therapists emerged in the USA in a significant manner. Details of the development of dental therapists in the workforce in the USA through 2011 were previously chronicled by Mathu-Muju. Since then, there has been a major increase in interest and licensing of dental therapists in a number of states. This article updates the dental therapist movement to the present time. The literature and activities of the movement will be reviewed by the categories of research, education, and legislation/practice, as well as analytical essays and commentaries.

Educating North Carolina's Oral Health Workforce in an Evolving Environment.

In 2014, North Carolina had 4,681 actively practicing dentists and ranked 47th among US states in dentist-to-population ratio. The need for dentists is increasing as the population grows, and underserved areas persist. This commentary discusses the impact of the state's 2 dental schools and external factors on dental workforce trends.

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

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. 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. 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. 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.

Opportunities in oral health policy for Timor-Leste.

Timor-Leste faces an urgent set of challenges in oral health. The impact of oral diseases in terms of reduced quality of life and cost of treatment is considerable. This paper reviews progress on policy recommendations since the National Oral Health Survey in 2002, the first such national survey. Few proposals have been implemented to date, owing to (i) lack of local support for the recommendations, particularly on promotion of oral health; (ii) lack of financial and budgetary provisions for oral health; (iii) lack of focus on services, human resources and dental personnel; (iv) poor focus, design and implementation of policy and planning in oral health; and (v) lack of transport to facilitate health-care workers' access to remote areas. Based on this assessment, the present paper presents a reconfigured set of policies and recommendations for oral health that take into consideration the reasons for low uptake of previous guidance. Key priorities are promotion of oral health, legislative interventions, education of the oral-health workforce, dental outreach programmes, targeted dental treatment, dental infrastructure programmes, and research and evaluation. Interventions include promotion of oral health for schoolchildren, salt fluoridation, fluoride toothpaste and banning sweet stalls and use of tobacco and betel nut in, or near, schools. Timor-Leste should strengthen the availability and quality of outreach programmes for oral health. Dental therapists and dental nurses who can supply preventive and atraumatic restorative dental care should continue to be trained, and the planned dentistry school should be established. Ongoing research and evaluation is needed to ensure that the approach being used in Timor-Leste is leading to improved outcomes in oral health.

Developing core dental public health competencies for predoctoral dental and dental hygiene students.

Dental professionals are an "underutilized" workforce, when it comes to advocating for prevention and wellness in populations. The goal of this HRSA-funded project is to develop dental public health (DPH) competencies and curriculum for US predoctoral dental and dental hygiene programs. These competencies and accompanying curriculum are designed to better prepare the oral health workforce to meet the needs of the entire population, including the chronically underserved, those challenged by poor health literacy, or communities encountering barriers to accessing oral health care. By increasing the DPH competency of all graduating dental providers, in population-based approaches to preventing oral diseases rather than the existing exclusive focus on treatment, the number of providers who can respond to a population or the public's unmet needs and challenges, both in private practices and publicly supported clinics, will increase. This paper describes the competency development process and the eight competencies that were identified.

Dental Hygienists’ Awareness and Support for Existing and New Oral Health Workforce Models

The study investigated dental hygienists’ scope of services and level of satisfaction as well as their awareness and support to the existing and proposed oral health workforce models: expanded function dental auxiliary (EFDA), dental therapist (DT), and advanced dental hygiene practitioner (ADHP). The study sample consisted of all 676 dental hygienists from Cuyahoga County, Ohio. Data were collected by a self-administered mail questionnaire that assessed hygienists’ scope of services, levels of satisfaction with the services, and their awareness as well as support for workforce models; the last two were assessed on a scale of 1–10. The effective response rate to the survey was 26 %. Respondents’ average ratings for the knowledge levels for DT, ADHP, and EFDA were as follows: 2.8 ± 2.6, 4.0 ± 3.4, and 8.1 ± 2.6. Hygienists were most supportive of the EFDAs (7.7 ± 2.9), followed by ADHP (7.0 ± 3.4), and DT (4.0 ± 3.4). Findings indicate a need to improve respondents’ awareness of the dental therapist position.

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

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. 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. 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. 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.

구강보건인력의 전문가불소도포 건강보험 급여화에 대한 인식

구강보건인력의 전문가불소도포 건강보험 급여화에 대한 인식

Putting the mouth back in the head: HEENT to HEENOT.

Improving oral health is a leading population health goal; however, curricula preparing health professionals have a dearth of oral health content and clinical experiences. We detail an educational and clinical innovation transitioning the traditional head, ears, eyes, nose, and throat (HEENT) examination to the addition of the teeth, gums, mucosa, tongue, and palate examination (HEENOT) for assessment, diagnosis, and treatment of oral-systemic health. Many New York University nursing, dental, and medical faculty and students have been exposed to interprofessional oral health HEENOT classroom, simulation, and clinical experiences. This was associated with increased dental-primary care referrals. This innovation has potential to build interprofessional oral health workforce capacity that addresses a significant public health issue, increases oral health care access, and improves oral-systemic health across the lifespan.

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

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. 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. 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. 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.

양치교실과 학교구강보건실 이용 학생들의 구강보건 실태 비교

Objectives : The purpose of this study is to provide the basic data for the development of oral health education program and to make schoolchildren practice the right oral health care behaviors. Methods : Data were collected from 259 elementary school students including 134 boys and 125 girls in Busan from November 26 to December 20, 2012. The groups were tooth brushing group and dental clinic group. All statistical analyses were analyzed by frequency analysis and chi-square test using SPSS 18.0 program. Results : School dental clinic group showed higher awareness level of fluoride and sealant effect of prevention(p=0.000). Toothbrushing facility group showed higher awareness level of brushing tooth(p=0.011). School dental clinic group showed higher awareness level of fluoride toothpaste(p=0.000). Both school dental clinic group and toothbrushing facility group showed higher awareness level of oral health education(p=0.001). School dental clinic group showed higher awareness level for tooth brushing method after education(p=0.000). Both school dental clinic group and toothbrushing facility group showed higher level of education. Conclusions : School dental clinic group showed higher level for oral health knowledge and toothbushing facility group showed high level for oral health behavior. Both School dental clinic group and toothbrushing facility group showed higher level of oral health education and tooth brushing method after education. Both school dental clinic group and toothbrushing facility group proved to promote oral health. Activation of school toothbrushing facility is very important to change the oral health workforce.

Dental service mix among older adults aged 65 and over, United States, 1999 and 2009

The oral health of older Americans will assume increasing importance because of their increasing numbers and the evolving connections between oral health and general health. To establish a baseline and provide data for oral health workforce models, this report describes the types of dental procedures received by US adults 65 years and older in 2009 and looks at trends since 1999. Data for this analysis came from the 1999 and 2009 Medical Expenditure Panel Survey. The primary outcome variable represented the types of dental procedures that were received during a dental visit in the preceding year. Descriptive variables included dental insurance and poverty status. Analysis was restricted to adults aged 65 and over. In 2009, diagnostic and preventive procedures accounted for almost three-quarters of all services. Compared with services received by those with private insurance, there were significantly fewer diagnostic and endodontic procedures among those with public coverage. Between 1999 and 2009, the proportion of preventive services significantly increased, whereas the proportion of restorative and endodontic services significantly decreased. Also, the likelihood of receiving preventive procedures increased, whereas the probability of receiving restorative or endodontic services decreased. Findings point to a shift in the mix of dental services received by older adults during the two periods. The predominance of diagnostic and preventive procedures has important access and workforce implications. An expanded role for dental hygienists in helping to meet the oral health needs of older adults is possible given a hygienist's current scope of practice.

Oral health workforce planning Part 1 : data available in a sample of FDI member countries

Workforce planning is a resource to measure and compare current versus future workforce. Organised dentistry needs to focus on the benefits and the determinants and various systems of workforce planning together with the challenges, new trends and threats. The aim of the study was to identify data sources from countries relating to a selection of oral health indicators in a sample of FDI member countries. The potential for differences between developed and developing countries was also examined. A cross-sectional survey study was carried out among FDI member countries classified in developed and developing countries between October 2011 and January/February 2012. A questionnaire was developed addressing the availability of 40 selected indicators distributed in four domains. Mann-Whitney U-tests to identify differences between developed and developing countries and chi-square tests for the degree of information regularly available were carried out. There is an important lack of information about indicators relevant to oral health between FDI participating countries regardless of their level of economic development. Although not significant, the availability of indicators for developing countries showed higher variability and minimum values of zero for all domains. Surveys were the source of information more frequently reported. Standardised and reliable methodologies are needed to gather information for successful workforce planning. It is of utmost importance to increase the awareness and understanding of the member National Dental Associations regarding the role, basic elements, benefits, challenges, models and critical elements of an ideal workforce planning system.

Dental service mix among working‐age adults in the United States, 1999 and 2009

In the United States, health-care costs are increasing while state and federal budgets contract. In order to establish a baseline and provide data for alternative oral health workforce models, this report describes the types of dental procedures received by US working-age adults in 2009 and looks at trends since 1999. Data for this analysis came from the 1999 and 2009 Medical Expenditure Panel Surveys. The primary outcome variable represented the types of dental procedures undergone during a dental visit in the preceding year. Descriptive variables included dental insurance coverage and income. Analysis was restricted to adults aged 21-64 years. In 2009, diagnostic and preventive procedures accounted for >75 percent of all dental services received by working-age adults. Those with public insurance and those who were uninsured, as well as those with lower income, were less likely to receive these services than their peers. Between 1999 and 2009, small but statistically significant increases in the proportion of preventive and diagnostic procedures received occurred in the nation. The likelihood that a preventive service would be received during a visit also increased during this period, while the probability that a restorative procedure would be undergone went down. Preventive-type procedures represented the vast majority of dental services received by working-age adults in 2009. Between 1999 and 2009, receipt of preventive-type procedures generally increased while receipt of surgical-type procedures decreased. These findings emphasize the health-promoting role of the dental team and provide a baseline for the measurement of future trends.

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).

Transcultural dental training: addressing the oral health care needs of people from culturally diverse backgrounds

Australia is a culturally and linguistically diverse country with a population derived from over 140 countries and including 240 language groups. Reflecting this, there has been a significant increase in cultural diversity among undergraduate dental students. It has been recognized that in order for dental students to interact and respond effectively to the diverse cultural needs of their patients, students themselves must be aware of cultural differences and respect patients' worldviews. In response to this challenge, dental students will need to have the theoretical knowledge to understand culturally-influenced health behaviours as well as the ability to communicate effectively with culturally diverse patients. Currently, the culture of dental students contrasts with the patients they treat, which may in turn affect the interaction between dental students and their patients. Given this context, new graduates need both to effectively communicate with patients from diverse communities and have an understanding of culturally influenced health behaviours. It has been proposed that dental graduates need to improve their knowledge of a variety of cultural values, beliefs, practices and attitudes. The literature in the area of cultural awareness and education for oral health professionals concentrates on both exploring health professionals' knowledge and attitudes toward transcultural care or the need for transcultural training. This paper provides an overview of the transcultural issues in oral health care which might confront dental students when treating culturally diverse patients. It will also discuss possible modifications to the dental curriculum to ensure that the future oral health workforce understands the complex health care needs of a multicultural society. This information will give planners and stakeholders an insight into the nature of the cultural issues which future dentists are likely to encounter while treating patients from diverse cultural backgrounds. This would help to establish the need to incorporate transcultural awareness modules to enhance quality of care and to respond effectively and sensitively to cultural issues.

Reaction to “Oral Epidemiological Trends in Maryland”

The paper by Vargas et al. describes trends in oral health in Maryland over the past 10 years, illustrating Maryland's considerable progress in improving oral health for children covered by Medicaid 1. Some of the factors identified that impact children's oral health included the following: Strong dental and dental hygiene workforce. Death of 12-year-old Deamonte Driver because of a dentally related infection. Strong water fluoridation program statewide. Doubling of the percentage of Medicaid enrolled children under 21 years of age. Physician's participation in providing oral health preventive service. Increase in school-based sealant program resulting in a doubling of the percentage of Maryland children with sealants. The net result of these factors, as well as others, has been positive for the oral health of Maryland's children. In addition, over the past 10 years, Maryland has also seen modest reductions in edentulism and age-adjusted oral cancer incidence and mortality. While this is all good news, the findings of Vargas et al. also illustrate the oral health chasm that still exists in Maryland and, indeed, throughout the nation 1. The “chasm” issues include the apparent continuing disparities in oral health, which are largely related to geography, income, socioeconomic-ethnic status, and oral health literacy. While the caries experience in children declined over a 10-year period, there still remains a gap of 25-30 percent untreated caries, which is close to the national average. From this author's perspective, the benchmark comparison of Health People 2020's objective of 25.9 percent of 6- to 9-year-olds with untreated caries is appropriate but, simply stated, the benchmark itself is too low, given the resources in the nation and the amount of money spent on health care. The paper demonstrated Maryland's commitment to preventive care and their willingness to use the eight benchmarks created by the Pew Center for the States. However, the data reveal that the percentage of children with a preventive visit and who received dental treatment in 2009 still ranks below the national average. The lack of a statewide sealant program is a further illustration of the gap in prevention that continues. So, although Maryland has achieved success in reducing caries in children, it has probably reached a steady state until prevention becomes more widespread and the diagnostic coding and reimbursement system rewards the oral health workforce for preventive services and for rewarding improvements in health outcomes rather than paying for procedures. The unsettled state of the US economy and the resultant reductions in funding for Medicaid across many states suggests an increase in oral and systemic chronic disease problems in the future. A recent report in the New York Times demonstrated that more places are “defluoridating” water supplies to save money 2! How can that be helpful? Vargas et al. also point out that the poverty index has been increasing, thus putting more individuals with declining incomes into the Medicaid-eligible category. Indeed, at the national level, recent studies on The Pine Ridge Reservation in South Dakota demonstrated that 90 percent of adults and children had active decay and about half were missing teeth 3. Batliner points out that in the Pine Ridge community oral diseases are rampant and access to care is a “cruel joke”2, 4. The call by Batliner and others is to rethink the make up of the oral health workforce to include a midlevel provider (dental therapist) 2-6. There is considerable discussion of this issue as the most appropriate comprehensive means to address the oral health-care access problem. This author's reaction to the data of Vargas et al. is to compliment Maryland on its proactive status as it moves forward with health-care reform and health exchange to include dental. At the same time, there remains disappointment in how far Maryland and the nation needs to go to truly improve access to quality oral health care and to reduce the burden of disease. The data show that Maryland can be recognized as a leader at a pivotal time in the nation's commitment to the elimination of disparities, which improve access to care and for demonstrating the power of a committed coalition aimed at improving the oral and systemic health of its citizens. The author declares no conflict of interest.

Dental Education: Evolving Student Trends

As the health care professionals of tomorrow, the students of today are the future of our profession and will shape both dentistry and dental education. To provide historical perspective on today's students, this article summarizes trends in the demographics of allied, predoctoral, and advanced dental students in the United States over the past seventy-five years and reviews efforts made to promote the racial/ethnic diversity of these groups of students. These efforts include legislative initiatives and public and privately funded programs. An outlook for the future considers ways in which new technologies and social networks as well as coordinated interprofessional efforts might further promote the goal of educating students who reflect the diversity of the United States and position the oral health workforce to meet the country's needs.