Oral Health Care Workforce Research Articles

Planning the future of oral health care workforce: Moving beyond demographic change.

The adoption of Universal Health Coverage for oral health care will not be sufficient to ensure that health care resources are accessible in accordance with needs for care. Government intervention in planning and allocating resources will be required to replace traditional market forces if market failure is not to be replaced by government failure. In this paper we explore the limitations of current 'fixed in time' approaches to planning the oral health care workforce and present an enhanced dynamic model for workforce planning that responds directly to changes in population, evidence-based best practice and new models of care.

Expanding the functions of dental assistants in Bulgaria and perceptions about their role in the Bulgarian healhcare workforce

The study queries a sample of dentists and dental assistants in Bulgaria about their understanding and perceptions of Expanded Function Dental Auxiliaries (EFDA). The study considers whether expanding the skillset of dental assistants to function in specific scenarios without personal supervision by the dentist may be a viable strategy to address various oral health inequities in the country. An anonymous survey was conducted among 103 practicing dentists and 100 dental assistants throughout the country. The questionnaire consisted of 20 questions that probed respondents' understanding about the duties performed by EFDAs and their potential to increase productivity and efficiency of the dental workforce. Sociological (poll) and statistical (alternative analysis) methods were used in the survey. The majority of respondents were female. Most worked in the larger cities. One worked in a village. Most were ethnic Bulgarians and none were Roma, reflecting the racial imbalance in the national workforce. Two-thirds (67%) believed that dental assistants with appropriate training are capable of doing expanded dental procedures without personal supervision by a dentist. The majority (83.7%) believed that EFDAs could improve efficiency of a dental practice, while 58.1% indicated that with appropriate training, they could perform expanded duties as well as the dentist. However, only one third believed that EFDAs could increase practice output (38.9%); enhance the quality of the dentist's work (37.4%); or decrease patient anxiety (31.5%). Though most respondents (78.3%) believed that a patient would not be receptive to an EFDA placing a restoration without personal supervision by the dentist, two thirds of respondents (66.5%) would like to see dental assistants trained to perform expanded duties otherwise reserved for dentists. Most respondents felt that EFDAs could help to build a well-functioning dental team. Most respondents believed that EFDAs can benefit the efficiency of a practice, suggesting that Bulgarian dental professionals would respond favorably to enhancing the skillset of assistants with expanded functions. The study suggests they are skeptical about "general" versus "personal" supervision. EFDAs may potentially provide improved access by underserved communities, while building a more inclusive oral healthcare workforce reflective of the population.

Varying Manpower Alters Dental Health in a Developing Health Care System

ObjectivesThis study assessed relationships between oral health care workforce and dental health in 12-year-olds in a developing health care system in Iran from 1992 to 2014 and compared these findings with the most recent corresponding findings in selected countries. MethodsData regarding oral health care workers from 1962 to 2014 were extracted from the comprehensive human resource data bank of the Shahid Beheshti Research Institute of Dental Sciences. Data regarding decayed, missing, and filled permanent teeth (DMFT) of 12-year-olds, extracted from official statistics, described dental health. Comparisons with other countries utilised the database of the World Health Organization. Changes in the DMFT index with fluctuations in the number of oral health care workers were investigated using exploratory data analysis methods. Associations of DMFT with the density of the oral health care workforce were evaluated using a multiple linear regression model. ResultsThe trend in supply of dental workforce in Iran began to expand in the 1970s and, after a reduction in 2003 to 2007, reached a peak by 2014. Means of DMFT indices of 12-year-olds in Iran fluctuated between 1.50 and 2.40 from 1992 to 2014. The relationship between the dentist to population ratio and the DMFT index of 12-year-olds showed a downwards trend (r = −0.994; P < .001) until 1998 and afterwards an upwards trend (r = 0.887; P < .001). Globally, the DMFT index decreased in countries with a preventively-oriented oral health care workforce. ConclusionsIncreased numbers of dentists have no significant impact on improving dental health in 12-year-olds. To promote dental health, the system providing health services should implement a preventively-oriented approach when planning for the oral health workforce.

Uncertainties around COVID-19 from the perspectives of oral health care workers during the first wave of SARS-CoV-2 infections in British Columbia, Canada.

BackgroundThe first wave of COVID-19 infections caused disturbances in all aspects of personal and professional lives. The aim of this study was to explore the ways in which that first wave of novel coronavirus infections resulted in uncertainties, as experienced by members of the oral health care workforce in British Columbia, Canada.MethodsThis qualitative inquiry purposefully recruited frontline oral health care workers, including dentists, dental hygienists, certified dental assistants, and administrative staff, via remote semi-structured interviews between April 20 and May 4, 2020. Coding, categories, and themes were inductively assigned.ResultsA total of 45 interviews, lasting between 39 and 74 minutes each, were conducted involving 18 dentists (6 females), 12 dental hygienists (11 females), 6 certified dental assistants (all females), and 9 administrators/front-desk staff (7 females). Fifty-one hours of audio recordings and more than 650 single-spaced pages of transcripts were produced. Five main themes emerged pertaining to uncertainties surrounding COVID-19, patient care, personal lives and infectiousness, concern for the future, and variations among different pandemics. Certitudes were less evident, but surfaced mostly when considering a potential new normal resulting from the pandemic.ConclusionParticipants indicated that the uncertainties they felt were dependent upon what is known, and unknown, about the pandemic and the provision of oral health care during the first wave of infections. Future studies are needed to include the viewpoints of oral health care workers from other provinces, as well the perceptions of patients who received oral health care during the height of the first wave of the pandemic.

Assessing School-Based Oral Health Interprofessionalism through Public School Nurse Perceptions

INTRODUCTION The need for oral health resources in the school setting is an integral part of the overall health of students. Studies have shown that not only do school nurses encounter dental emergencies in students, but they encounter children in pain more frequently than not due to oral cavity issues. Therefore, this study sought to examine the current knowledge and accessibility of oral health resources for nurses serving school-aged children. METHODS Guided by an ecological framework, this study surveyed South Carolina school nurses (n= 42) about their access to oral health resources, knowledge of their students’ dental health status and unmet needs, and challenges associated with receiving dental care. RESULTS Two-thirds of school nurses saw urgent dental cases at least once a semester. Three quarters of the school nurses made referrals to a dentist at least once a semester. Half of the school nurses offered an annual dental screening. As a part of continuing dental care, referral completion for school-aged children was a challenge due to social determinants. DISCUSSION This study directly aligns with the forthcoming 2020 Surgeon General Report on Oral Health, which includes a section on ‘Oral Health Integration, Workforce and Practice’. This study reveals how school nurses are on the forefront of addressing children’s health needs and their ability to contribute to the integrated oral healthcare workforce. CONCLUSION Overall, a need exists to continue to elevate school nurses as interprofessional oral health practice champions to improve the oral health of children in South Carolina public schools.

Oral healthcare workforce planning in post-Brexit Britain.

The terms of the United Kingdom's (UK's) departure from the European Union (EU) are currently being negotiated. It is therefore uncertain exactly what effect they will have on planning the UK's oral healthcare workforce. Nevertheless, as 16% of dentists currently registered with the Genral Dental Council (GDC) have migrated to the UK from EU countries, this factor must be taken into consideration by workforce planners. However, it is far from being the only factor. This opinion piece therefore describes the current numbers of non-UK EU dentists and DCPs registered with the GDC and poses the question 'will they remain in the UK in the future'? It then comments on the current legislation on recognition of non-UK dental qualifications. It goes on to consider the Migration Advisory Committee's recommendation for dental practitioners, the oral healthcare needs of the population of the UK, who could address them and the implications for the Advancing Dental Care project

Brexit - Consequences for the UK's Oral Health Workforce?

On Friday, 20 December 2019, after three and a half years of discussion the Parliament of the United Kingdom (UK) voted decisively that this country should leave the European Union (EU). For many of us this was a sad day. However, this political decision has been made and intensive negotiations will now take place between the UK and the EU's negotiating teams to agree the details for the UK's future relationship with the EU. It is still far from clear exactly what the consequences of the resulting deal will be for both parties. A number of previous articles and editorials have speculated on the possible consequences for health and oral health in the UK. Key areas include workforce, research and regulations for medicines and medical and dental equipment. This editorial will consider the implications for the UK's Oral healthcare workforce.

Genomics of periodontal disease and tooth morbidity.

In this review we critically summarize the evidence base and the progress to date regarding the genomic basis of periodontal disease and tooth morbidity (ie, dental caries and tooth loss), and discuss future applications and research directions in the context of precision oral health and care. Evidence for these oral/dental traits from genome‐wide association studies first emerged less than a decade ago. Basic and translational research activities in this domain are now under way by multiple groups around the world. Key departure points in the oral health genomics discourse are: (a) some heritable variation exists for periodontal and dental diseases; (b) the environmental component (eg, social determinants of health and behavioral risk factors) has a major influence on the population distribution but probably interacts with factors of innate susceptibility at the person‐level; (c) sizeable, multi‐ethnic, well‐characterized samples or cohorts with high‐quality measures on oral health outcomes and genomics information are required to make decisive discoveries; (d) challenges remain in the measurement of oral health and disease, with current periodontitis and dental caries traits capturing only a part of the health‐disease continuum, and are little or not informed by the underlying biology; (e) the substantial individual heterogeneity that exists in the clinical presentation and lifetime trajectory of oral disease can be identified and leveraged in a precision medicine framework or, if unappreciated, can hamper translational efforts. In this review we discuss how composite or biologically informed traits may offer improvements over clinically defined ones for the genomic interrogation of oral diseases. We demonstrate the utility of the results of genome‐wide association studies for the development and testing of a genetic risk score for severe periodontitis. We conclude that exciting opportunities lie ahead for improvements in the oral health of individual patients and populations via advances in our understanding of the genomic basis of oral health and disease. The pace of new discoveries and their equitable translation to practice will largely depend on investments in the education and training of the oral health care workforce, basic and population research, and sustained collaborative efforts..

The healthcare systems and provision of oral healthcare in European Union member states. Part 10: comparison of systems and with the United Kingdom.

Since 2015, a series of papers which describe the systems for the provision of health and oral healthcare in nine European Union (EU) countries (France, Germany, Greece, Ireland, Italy, Poland, Romania, Spain and Sweden) have been published in this journal. This tenth and final paper in the series compares aspects of the systems for each country, with each other and with that in the United Kingdom (UK). The topics which have been covered are the organisation and funding of oral healthcare, national populations and oral healthcare workforce, education of dentists, uptake of oral healthcare, expenditure on oral healthcare and oral epidemiology. The comparison shows that there are wide differences between the care provision systems between the individual countries. In all of them, oral healthcare continues to operate outside the mainstream healthcare systems. In particular, the proportion of costs paid for them from public funds, raised through taxation or through compulsory social insurances, and those paid for by individual patients varies greatly. No comparable data exist on quality of care.

For preventive medicine to include oral health care, the dental profession, licensing agencies, payers, and the public must effect change

Dentistry is represented to the US public in large part by the various professional associations, which speak for the interests of general and specialized dentists, mostly in private proprietary practice. Unfortunately, the interests of dental professional associations may often be in conflict with those of the public. To resolve this continued disparity, it behooves the dental leadership to become more involved with the overall health care system than continuing to enhance the economic interests of the profession without sufficient regard for the world-wide burden of unmet dental needs. An assessment of policy failures is provided with some recommendations for greater involvement of organized dentistry in the integration of oral and general health care. Dentistry must recommit itself to being a health profession rather focusing on the business aspects of health care. Another aspect to be considered is a reorganization of the American Dental Association to better represent the oral health care workforce.

Workforce diversity in dentistry - current status and future challenges.

The racial and ethnic diversity of the US oral health care workforce remains insufficient to meet the needs of an increasingly diverse population and to address persistent health disparities. The findings from a recent national survey of underrepresented minority dentists are reviewed and recommendations are made for enhancing diversity in the dental profession.

Did Intraprofessional Training with Dental Therapists Affect Dental Students’ Attitudes Toward Caring for the Underserved?

Dental therapy was recently introduced as a new oral health care workforce model to increase care for vulnerable populations in Minnesota. Nine dental therapy and 98 dental students began intraprofessional training at the University of Minnesota in 2009. The aim of this longitudinal study was to determine whether intraprofessional education with the dental therapy students would affect the dental students' attitudes toward caring for underserved populations. One class of dental students was surveyed annually between 2009 and 2013 using the Attitudes Toward Health Care survey to measure attitudinal changes about treating vulnerable patients across their four years of dental school. Participation ranged from 68% to 99% in each year. The results showed that the dental students had positive attitudes toward treating vulnerable patients on entering dental school, but their attitudes became less positive over the four years. While the composite survey results were similar to other studies using the same instrument, variations were seen by domain. These students' attitudes about societal expectations and personal efficacy remained stable, while their dentist/student responsibility and access to care attitudes showed statistically significant declines. Their positive attitudes toward treating the underserved declined over four years regardless of intraprofessional training with dental therapy students. As attitudes toward caring for vulnerable patients are shaped by both personal attitudes and societal norms, additional research is needed to determine whether the addition of an intentional curricular thread may alter results over time compared to intraprofessional training alone.

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.

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).

Towards Building the Oral Health Care Workforce: Who Are the New Dental Therapists?

In 2009, Minnesota Governor Pawlenty signed into law a bill approving the creation of a new dental team member: the dental therapist. The intent of this legislation was to address oral health disparities by creating a dental professional who would expand access to dental care in Minnesota. This study aimed to describe the characteristics of the first class of dental therapy students at the University of Minnesota and to ascertain the values and motivations that led them to choose a career in dental therapy. Four surveys were used to create the composite profile of the ten students in this first dental therapy class: 1) the California Critical Thinking Skills Test, 2) the Learning Type Measure, 3) the Attitudes Toward Healthcare Survey, and 4) a values and motivation survey that included demographic data. The results of the surveys revealed interacting influences of the students' background, personal self-concept, and environment leading to a career decision to pursue dental therapy.

Trends in the Oral Healthcare Workforce and the Delivery of Care and Their Implications

Trends in the Oral Healthcare Workforce and the Delivery of Care and Their Implications

Emerging Allied Dental Workforce Models: Considerations for Academic Dental Institutions

The U.S. surgeon general defined the national oral health care crisis in 2001 in Oral Health in America: A Report of the Surgeon General. The report concluded that the public infrastructure for oral health is not sufficient to meet the needs of disadvantaged groups and is disproportionately available depending upon certain racial, ethnic, and socioeconomic factors within the U.S. population. Now, several new workforce models are emerging that attempt to address shortcomings in the oral health care workforce. Access to oral health care is the most critical issue driving these new workforce models. Currently, three midlevel dental workforce models dominate the debate. The purpose of this report is to describe these models and their stage of development to assist the dental education community in preparing for the education of these new providers. The models are 1) the advanced dental hygiene practitioner; 2) the community dental health coordinator; and 3) the dental health aide therapist.

Access to Care and the Allied Oral Health Care Workforce in Kansas: Perceptions of Kansas Dental Hygienists and Scaling Dental Assistants

Access to oral health care continues to be a problem in the United States. Research has called for innovative approaches to improve access to oral health care and reduce oral health care disparities. Successful alternate approaches have been reported. In 1998 the Kansas Legislature passed a proposal to enhance access to care and manpower needs by allowing dental assistants to provide supragingival scaling, a service traditionally assigned to dental hygienists. In 2000, Mitchell et al. investigated the perceptions of Kansas dental hygienists and scaling dental assistants in relation to House Bill 2724 (HB 2724), which allows dental assistants to perform coronal scaling. The intent of the study was to collect baseline data in relation to HB 2724. The purpose of the present study was to follow up on the impact of HB 2724 six years after legislation. Both groups report satisfaction with their professions: scaling dental assistants believe the delivery of care in Kansas has changed, and areas of Kansas previously noted as dental health professional shortage areas are now served by either a registered dental hygienist or scaling dental assistant.