Supply Of Dentists Research Articles

A study on regional distribution and changes in the Korean dentist workforce

Purpose: Despite previous research showing that there is an excess of dentists in Korea, there are demands to increase the number of dentists, with some local governments requesting the establishment of dental colleges and dental hospitals. Therefore, this study aims to propose long-term policy directions regarding the supply and demand of dentists in Korea by analyzing the distribution of dentists relative to the population and the current status of dentists by region.Methods: This study used public data. WHO's key indicator, active dentists per 100,000 population, was calculated by year, and differences in active dentists by region were analyzed using ANOVA.Results: From 2012 to 2022, the average annual rate of the number of active dentists per 100,000 people was 2.39%, which was higher than the average annual population growth rate(0.10%)(Table 1). The regional averages were ‘gu’ 66.52±55.78, ‘si’ 38.50±10.87, and ‘gun’ 29.91±7.35, showing a significant difference (p<0.0001), confirming the existence of a gap.Conclusions: The supply and demand of health care professionals is the most important factor for the stable operation of the health care system. To resolve regional differences, it is desirable to utilize existing dentists rather than creating new dentists.

A Study on the Current State of Pediatric Dentists and the Adequacy of Supply and Demand Based on Covered Services

The aim of this study was to identify the current state of pediatric dentists, evaluate the adequacy of pediatric dentist supply and demand, and find out the perception of all pediatric dentists on the current state of pediatric dentists and policy establishment. An Online survey was conducted among pediatric dentists. The questionnaire was subdivided into ‘general characteristics’, ‘number of dental treatments and working days per year’, ‘proportion of covered services’, ‘perceptions of supply and demand of pediatric dentists’. Through the Korean Academy of Pediatric Dentistry, the Health Insurance Review and Assessment Services, the National Health Insurance Service (NHIS), and the Korean Statistical Information Service, the current state of pediatric dentists, the number of claims for covered services, and the decrease in births per year were investigated. Dental clinics claiming to be pediatric dentistry reached half of all medical institutions, but only 3.78% of pediatric dentists actually worked. 61.36% of all pediatric dentists were concentrated in the metropolitan area, showing a national imbalance. Although the population of children and adolescents have continuously decreased over the past 20 years, the number of NHIS-covered services has shown a continuous increase. Over the past 10 years, the optimal supply of pediatric dentists has been maintained at around 4,000. According to the analysis, 92.15% of pediatric dentists thought that it was necessary to prepare policies and support measures at the government level. This study is expected to be used as basic data for establishing a demand estimation method for pediatric dentistry specialists in the future.

The Push to Integrate Mid-Level Providers into Dentistry

The Push to Integrate Mid-Level Providers into Dentistry

Cost-effectiveness of Dental Workforce Expansion Through the National Health Service Corps and Its Association With Oral Health Outcomes Among US Children

Despite considerable efforts to improve oral health for all, large disparities remain among US children. A dental professional shortage is thought to be among the determinants associated with oral health disparities, particularly for those residing in underserved communities. To evaluate the cost-effectiveness of expanding the dental workforce through the National Health Service Corps (NHSC) and associations with oral health outcomes among US children. A cost-effectiveness analysis was conducted to estimate changes in total costs and quality-adjusted life years (QALYs) produced by increasing the NHSC funding for dental practitioners by 5% to 30% during a 10-year period. A microsimulation model of oral health outcomes using a decision analytic framework was constructed based on oral health and dental care utilization data of US children from 0 to 19 years old. Data from the nationally representative National Health and Nutrition Examination Survey (NHANES, 2011-2016) were linked to county-level dentist supply and oral health professional shortage areas (HPSAs) information. Changes in prevalence and cumulative incidence of dental caries were also estimated. Sensitivity analyses were conducted to assess the robustness of results to variation in model input parameters. Data analysis was conducted from August 1, 2021, to November 1, 2022. Expanding dental workforce through the NHSC program. Changes in total QALYs, costs, and dental caries prevalence and cumulative incidence. This simulation model informed by NHANES data of 10 780 participants (mean [SD] age, 9.6 [0.1] years; 5326 [48.8%] female; 3337 [weighted percentage, 57.9%] non-Hispanic White individuals) found that when funding for the NHSC program increased by 10%, dental caries prevalence and total number of decayed teeth were estimated to decrease by 0.91 (95% CI, 0.82-1.00) percentage points and by 0.70 (95% CI, 0.62-0.79) million cases, respectively. When funding for the NHSC program increased between 5% and 30%, the estimated decreases in number of decayed teeth ranged from 0.35 (95% CI, 0.27-0.44) to 2.11 (95% CI, 2.03-2.20) million cases, total QALY gains ranged from 75.76 (95% CI, 59.44-92.08) to 450.50 (95% CI, 434.30-466.69) thousand QALYs, and total cost savings ranged from $105.53 (95% CI, $70.14-$140.83) to $508.23 (95% CI, $598.91-$669.22) million among children residing in dental HPSAs from a health care perspective. Benefits of the intervention accrued most substantially among Hispanic children and children in low-income households. This cost-effectiveness analysis using a decision analytic model suggests that expanding the dental workforce through the NHSC program would be associated with cost savings and a reduced risk of dental caries among children living in HPSAs.

Latino dentists in the U.S. Census from 1980 to 2019: Implications for dental care access.

This study describes the supply of Latino dentists in the United States from 1980 to 2019, as tabulated by the Census. The number of Latino dentists per 100,000 Latino population was compared to the number of non-Hispanic White (NHW) dentists per 100,000 NHW population. These four-decade comparisons were made for the entire country as well as the five states having the largest Latino populations. Data from the decennial census and the American Community Survey were used to identify the nationwide population, the number of dentists, and their respective Spanish-language abilities, stratified by race/ethnic group (Latinos and non-Hispanic Whites). In 1980, there were only 18 Latino dentists for every 100,000 Latino population in the entire nation, compared to 70 NHW dentists per 100,000 NHW population. While there was an increase to 21 Latino dentists per 100,000 in 1990, the supply remained virtually the same over this almost 40-year period, ending back at 18 per 100,000 in 2019. In comparison, there were about four times as many non-Hispanic White dentists as Latino dentists. This national discrepancy was also reflected in the five states that were evaluated. Similarly, Latino dentists were far more likely to speak Spanish than NHW dentists at both the national and state levels. The Latino dentist supply, already inadequate in 1980, has remained virtually unchanged over the past almost 40 years. The authors believe that this deficiency will have profound consequences, and recommend that initiatives be undertaken to increase the number of Latino dentists.

The price of private dental services: results from a national representative survey of Ireland

IntroductionDental services in Ireland are delivered in a mixed public–private system but the majority of dental care is paid for out-of-pocket by individuals. Ireland is not unusual in the global context where public subsidisation for oral healthcare is limited in many countries. This is despite the fact that oral health plays an important role in well-being and despite international evidence on the negative impact of user fees on utilisation of beneficial healthcare. However, there has been little up-to-date assessment of the prices faced by individuals for a range of non-acute care services in Ireland, including dental care. This paper presents an up-to-date assessment of private dental prices in Ireland for a range of preventive, primary, and complex services based on a nationally representative survey.MethodsThe total sample size for the desk-based survey was 103, accounting for 6% of private dentists in Ireland, weighted to reflect the geographic distribution of dentists. Dentists were selected at random from the publicly available list of dentists participating in the Dental Treatment Benefit Scheme. The adult price of 10 different services covering core preventive, primary, and complex procedures were identified from public websites for the selected dental practices.ResultsResults showed that in addition to there being an uneven supply of dentists across the country, dental prices also vary with some notable variations by region and type of service. In particular, dental practices located in border counties, and those in rural areas typically show lower mean prices relative to non-border counties and urban areas. These factors need to be considered when planning how to reduce inequalities in access to oral health services in Ireland.

Health Indicators as Measures of Individual Health Status and Their Public Perspectives: Cross-sectional Survey Study.

BackgroundDisease status (eg, cancer stage) has been used in routine clinical practice to determine more accurate treatment plans. Health-related indicators, such as mortality, morbidity, and population group life expectancy, have also been used. However, few studies have specifically focused on the comprehensive and objective measures of individual health status.ObjectiveThe aim of this study was to analyze the perspectives of the public toward 29 health indicators obtained from a literature review to provide evidence for further prioritization of the indicators. The difference between health status and disease status should be considered.MethodsThis study used a cross-sectional design. Online surveys were administered through Ohio University, ResearchMatch, and Clemson University, resulting in three samples. Participants aged 18 years or older rated the importance of the 29 health indicators. The rating results were aggregated and analyzed as follows (in each case, the dependent variables were the individual survey responses): (1) to determine the agreement among the three samples regarding the importance of each indicator, where the independent variables (IVs) were the three samples; (2) to examine the mean differences between the retained indicators with agreement across the three samples, where the IVs were the identified indicators; and (3) to rank the groups of indicators into various levels after grouping the indicators with no mean differences, where the IVs were the groups of indicators.ResultsIn total, 1153 valid responses were analyzed. Descriptive statistics revealed that the top five–rated indicators were drug or substance abuse, smoking or tobacco use, alcohol abuse, major depression, and diet and nutrition. Among the 29 health indicators, the three samples agreed upon the importance of 13 indicators. Inferential statistical analysis indicated that some of the 13 indicators held equal importance. Therefore, the 13 indicators were categorized by rank into seven levels: level 1 included blood sugar level and immunization and vaccination; level 2 included LDL cholesterol; level 3 included HDL cholesterol, blood triglycerides, cancer screening detection, and total cholesterol; level 4 included health literacy rate; level 5 included personal care needs and air quality index greater than 100; level 6 included self-rated health status and HIV testing; and level 7 included the supply of dentists. Levels 1 to 3 were rated significantly higher than levels 4 to 7.ConclusionsThis study provides a baseline for prioritizing 29 health indicators, which can be used by electronic health record or personal health record system designers or developers to determine what can be included in the systems to capture an individual’s health status. Currently, self-rated health status is the predominantly used health indicator. Additionally, this study provides a foundation for tracking and measuring preventive health care services more accurately and for developing an individual health status index.

Abstract PO-263: Racial equity and oral cancer: Exploring the relationship between dentist supply and the Black-White disparity in late stage diagnosis

Abstract Background: Oral cancer is one of the most common cancers for Black men in America, and a leading cause of cancer mortality. Like many other cancers, survival in Black adults lags behind Non-Hispanic White adults. One explanation for the mortality and survival gap may be due to the propensity for Black adults to be diagnosed at later stages. The prognosis for early stage oral cancer can be quite positive. Despite inconsistent screening reccomendations, dental professionals have established oral cancer screening as a standard of care for all comprehensive evaluations. However, in addition to the lack of access to dental coverage, limited availability of dental professionals may be, in part, driving the disparity in late stage diagnoses for Black Americans. Objective: This study aims to estimate the relationship between the Black-White disparity in late stage oral cancer diagnoses and the supply of dentists. Methodology: Data for this study comes from the Center for Disease Control (CDC) Wonder portal and the Agency for Healthcare Research and Quality (AHRQ) provider dataset. To develop a measure of Black-White disparity in late stage oral cancer diagnoses, first, the proportion of late stage diagnoses of all oral cancer diagnoses were obtained for both Non-Hispanic Black and Non-Hispanic White adults for years 2011-2015. Data was aggregated to Health Servica Area level and restricted to states in the Southeast. The outcome of interest was derived by the difference between the Non-Hispanic Black proportion of late stage diagnoses and the Non-Hispanic White proportion. This exploratory study utilized a linear regression model to estimate the relationship between this difference and the supply of dental professionals per capita in each paired Health Service Area (HSA). Results: The mean proportion of late stage diagnoses were 70.8% and 61.9% for Non-Hispanic Black and Non-Hispanic White adults, respectively. The mean difference in late stage diagnoses, at the HSA level, was approximately 8.0%. This differnce, appeared to decline as the per capita supply of dentists increased (Est = -0.03, p < 0.05). Putting this association in context, to reduce the Black-White disparity in late stage diagnoses by 1-percentage point, 33 dentists per 100,000 population must be added to the HSA. Conclusion: Greater availability to dental professionals may play an important role in reducing racial disparities in oral cancer. Still, this exploratory work is only the begining for inferring a causal relationhip between increasing dental supply and decreasing differences in late stage oral cancer diagnoses. Even under the assumption of causality, policies aiming to increase dental supply in shortage areas must ensure equitable and just access for Black communities. Citation Format: Jason Semprini. Racial equity and oral cancer: Exploring the relationship between dentist supply and the Black-White disparity in late stage diagnosis [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-263.

Measuring the quality of dental care among privately insured children in the United States.

To examine whether quality of dental care varies by age and over time and whether community-level characteristics explain these patterns. Deidentified medical and dental claims from a commercial insurer from January 2015 to December 2019. A retrospective cohort study. The primary outcome was a composite quality score, derived from seven dental quality measures (DQMs), with higher values corresponding to better quality. Hierarchical regression models identified person- and zip code-level factors associated with the quality. Continuously enrolled US dental insurance beneficiaries younger than 21 years of age. Quality was assessed for 4.88 million person-years covering 1.31 million persons. Overall quality slightly improved over time, mostly driven by substantial improvements among children aged 0-5 years by 0.153 points/year (95% confidence interval [CI]:0.151, 0.156). Quality was poorest and declined over time among adolescents with only 20.5% of DQMs met as compared to 42.6% among aged 0-5 years in 2019. Dental professional shortage, median household income, percentages of African Americans, unemployed, and less-educated populations at the zip code level were associated with the composite score. Quality of dental care among adolescents remains low, and place of residence influenced the quality. Increasing the supply of dentists and oral health promotion strategies targeting adolescents and low-performing localities should be explored.

Changes in dental care use patterns due to COVID-19 among insured patients in the United States

BackgroundDemand for dental services has been known to be linked closely to dental insurance and disposable income. Widespread economic uncertainty and health systems changes due to COVID-19 thus may have a significant impact on dental care use. MethodsUsing deidentified dental practice management data from 2019 and 2020, the authors observed variations in dental care use among insured patients since the COVID-19 outbreak (during the period of practice closure and after the reopening) by patient age, procedure type, insurance type, practice size, geographic area, and reopening status. The authors examined whether the rebound in procedure volumes at dental practices can be explained by county-level characteristics using hierarchical regression models. ResultsAlthough dental care use among privately insured patients fully rebounded by August 2020, use still remained lower than the prepandemic level by 7.54% among the publicly insured population. Demand for teledentistry increased 60-fold during practice closure. Geographic characteristics—such as median household income, percentages of rural or Black populations, and dental care professional shortage designations—were associated significantly with the number of procedures performed at dental practices. ConclusionsAs a result of COVID-19, dental practices experienced substantial decreases in procedure volume, particularly among patients covered by public insurance or residing in underserved areas. Practical ImplicationsDuring economic downturns, state health officials should be encouraged to adopt policies to expand access to oral health care for vulnerable populations via oral health promotion strategies and increasing the supply of dentists or midlevel dental care providers in underserved areas.

Forecasting for the need of dentists and specialists in South Africa until 2030.

To manage the increasing burden of dental diseases, a robust health system is essential. In order to ensure the oral health system operates at an optimal level going into the future, a forecast of the national shortfall of dentists and dental specialists in South Africa (SA) was undertaken. There is currently a shortage of dentists and specialists in SA and given the huge burden of dental diseases, there is a dire need to increase the number of these health care workers. The aim was to determine the projected shortfall of dentists and specialists in each of the nine provinces in SA. The projected shortfall was calculated based on the SA Disability-Adjusted Life Years (DALYs) for each province. The estimate for the evaluation of the Global Burden of Disease (GBD) for SA was obtained from the Institute of Health Metrics and Evaluation (IHME) Global Burden of Disease website. For each province, age standardized DALYs were calculated with mid-year population estimates obtained from Statistics SA 2018. In order to reduce the existing human resources for health (HRH) inequity among the provinces of SA, three scenarios were created focussing on attaining horizontal equity. The best-case scenario estimates a shortfall of 430, 1252 and 1885 dentists and specialists in 2018, 2024 and 2030 respectively. In an optimistic scenario, the national shortfall was calculated at 733, 1540 and 2158 dentists and specialists for the years 2018, 2024 and 2030 respectively. In an aspirational scenario, shortfalls of 853 (2018), 1655 (2024) and 2267 (2030) dentists and specialists were forecasted. Access to oral health services should be ensured through the optimum supply of trained dentists and specialists and the delivery of appropriate oral health services. Thus, the roadmap provided for upscaling the oral health services recognizes the influence of both demand and supply factors on the pursuit of equity.

The unplanned and unequal expansion of Dentistry courses in Brazil from 1856 to 2020.

This study analyzed the consequences of the disordered expansion of Dentistry courses on the distribution of professionals, the job market, and limitations of the National System of Higher Education Assessment (SINAES) developed as a guarantee of education quality. This observational, descriptive, and analytical study used secondary data from several official databases. The number of courses was obtained from the e-MEC registry. From the Higher Education Census, the study collected historical series of courses offered, number of candidates per open seat, number of individuals who initiated and completed the course, and information about professors in the public and private schools. The reports related to Dentistry courses from the National Health Council were also analyzed. The performance of undergraduate students was assessed from synthesis reports of Enade from 2004 to 2016. The number of dentists and their regional distribution was based on the Federal Dental Council, and Brazilian population and gross domestic product were collected from the Brazilian Institute of Geography and Statistics. Dentistry courses in Brazil grew exponentially from 1856 to 2020; among the 544 authorized courses, 82 currently have not yet started their activities. The fast expansion of courses in Brazil has worsened the regional asymmetries in the supply of dentist, and the SINAES has not been able to fully assure the quality of Dentistry courses. Brazilian dentistry, which has increased its scientific and technological development since the 19th century, with outstanding intellectual production, is at risk of a collapse due to a plethora of dentists.

A expansão não planejada e desigual dos cursos de Odontologia no Brasil de 1856 a 2020.

Este estudo analisou as consequências da expansão desordenada dos cursos de Odontologia sobre a distribuição dos profissionais, o mercado de trabalho e as limitações do Sistema Nacional de Avaliação da Educação Superior (SINAES) desenvolvido como garantia da qualidade do ensino. Este estudo observacional, descritivo e analítico usou dados secundários de vários bancos de dados oficiais. O número de cursos foi obtido no cadastro do e-MEC. A partir do Censo da Educação Superior, o estudo coletou séries históricas de cursos oferecidos, número de candidatos por vaga aberta, número de pessoas que iniciaram e concluíram o curso e informações sobre professores de escolas públicas e privadas. Também foram analisados ​​os relatórios relativos aos cursos de Odontologia do Conselho Nacional de Saúde. O desempenho dos alunos de graduação foi avaliado a partir dos relatórios de síntese do Enade de 2004 a 2016. O número de dentistas e sua distribuição regional foi baseado no Conselho Federal de Odontologia, e a população brasileira e o produto interno bruto foram coletados do Instituto Brasileiro de Geografia e Estatística. Os cursos de odontologia no Brasil cresceram exponencialmente de 1856 a 2020; entre os 544 cursos autorizados, 82 ainda não iniciaram suas atividades. A rápida expansão dos cursos no Brasil agravou as assimetrias regionais na oferta de dentista, e o SINAES não tem conseguido garantir de forma plena a qualidade dos cursos de Odontologia. A odontologia brasileira, que aumentou seu desenvolvimento científico e tecnológico desde o século 19, com destacada produção intelectual, corre o risco de colapso devido a uma infinidade de dentistas.

The role of dentist supply, need for care and long-term continuity in Health Resources and Services Administration-funded health centres in the United States.

Health Resources and Services Administration-funded health centres (HCs) are an important source of dental services for low-income and vulnerable patients in the United States. About 82% of HCs in 2018 had dental workforce, but it is unclear whether this workforce meets the oral health needs of HC patients. Thus, we first examined (a) whether dental workforce was associated with any dental visits vs none and (b) whether HC patients with any visits were more likely to have a visit at the HC vs elsewhere. We then examined (c) if need for oral health care and long-term continuity at the HC were associated with dental visits and visits at the HC. This study used the 2014 Health Center Patient Survey, a nationally representative study of US HC patients, and the 2013 Uniform Data System, an administrative dataset of HC characteristics. We also used the 2013 Area Health Resource File to measure the contribution of local supply of dentists. We included working-age adult patients (n=5006) and used multilevel structural equation models with Poisson specification. Larger dental workforce at the HC was significantly associated with 1% higher likelihood (relative risk [RR]: 1.01, 1.00-1.02) of any visits and 10% higher likelihood of a visit at the HC among those with a visit (RR: 1.10, 1.06-1.14). Patient self-reported oral health need was positively associated with 157% higher likelihood of dental visits (RR: 2.57, 2.29-2.88), and 42% higher likelihood of dental visit at the HC vs elsewhere (RR: 1.42, 1.19-1.69). Long-term continuity with the HC was not significantly associated with likelihood of dental visits, but was associated with 26% higher likelihood of visits at the HC among those who had any visits (RR: 1.26, 1.02-1.56). The findings highlight the potential impact of increasing dental workforce at HCs to promote access; the high level of need for oral health care at HCs; and the increased effort required to promote access among newer patients who may be less familiar with the availability of oral health care at HCs. Together, these findings reinforce the importance of addressing barriers of use of oral health services among low-income and uninsured patients.

Estimation and adequacy of dentist supply through the dental care productivity

Running title: Adequacy of dentist supply Objectives: The proper provision of dentists is very important for delivering the dental care that people need. The purpose of this study is to evaluate the adequacy of dentist supply and to predict the proper supply of dentists in Korea for the next 10 years. Methods and materials: Using the data from 2004 to 2017 in the Statictics Korea, the dental needs were measured as days of admission and the annual total dental care hours in 2020, 2023, 2026 and 2030 were predticted using regression analysis. The dental care productivity (average in-office hours) of dentists was analyzed using regression analysis including age, gender, education level and region as a confounder. The annual care hours were predicted according to seven scenarios based on the percentage of women among dentists, post-dentist education levels, the percentage of dentists in the metropolitan area, aging and retirement age. Results: The needed dentist based on the data in the Statictics Korea will be 27, 288 ~ 27, 311 in 2020, 28,104 ~ 28,1785 in 2023, 28,977 ~ 29,124 in 2026, and 30,174 ~ 30,413 in 2030. On the other hand, the number of dentists in Korea will be 26,945 in 2020, 28,813 in 2023, 30,682 in 2026 and 33,173 in 2030. The adequacy index of dentist supply will be -0.01 in 2020 to +0.10 in 2030. Conclusions: Our data showed that dentists will be adequately supplied in Korea for the next 10 years. Overall, the ratio between dentist versus 1,000 Koreans will be increased from 0.5 in 2019 to 0.7 in 2020, which will meet the mean of OECD countries.

The Impact of the ACA Medicaid Expansions on Dental Visits by Dental Coverage Generosity and Dentist Supply: Erratum.

The Impact of the ACA Medicaid Expansions on Dental Visits by Dental Coverage Generosity and Dentist Supply: Erratum.

The Impact of the ACA Medicaid Expansions on Dental Visits by Dental Coverage Generosity and Dentist Supply.

Low-income adults in the United States have historically had limited access to dental coverage and poor dental health outcomes. We examined the effects of the Affordable Care Act Medicaid expansions on dental visits among low-income adults focusing on the generosity of dental coverage and heterogeneity in effects by dentist supply. We used data from 2012, 2014, and 2016 Behavioral Risk Factor Surveillance System surveys. The main analytical sample included nearly 117,000 individuals <138% federal poverty level. We employed a quasi-experimental difference-in-differences design to identify the impact of the state Medicaid expansions on having a dental visit in the past 12 months by the generosity of dental coverage and dentist supply. Medicaid expansions were associated with a nearly 6 percentage-point increase in the likelihood of any dental visits in 2016 (over 10% increase from preexpansion rate) for individuals in Medicaid expanding states with extensive dental benefits. This increase, however, was concentrated in states with high dentist supply with no evidence of improvement in utilization in states with limited dental coverage or low dentist supply. Expanding Medicaid with generous dental coverage improved dental care use only in areas with high dentist supply with no evidence of benefits with low dentist supply or less generous coverage. Improving access to dental care may require both generous coverage and supply-side interventions to increase dentist availability.

The pediatric dental workforce in 2016 and beyond

BackgroundChildhood caries is a major oral and general health problem, particularly in certain populations. In this study, the authors aimed to evaluate the adequacy of the supply of pediatric dentists. MethodsThe authors collected baseline practice information from 2,546 pediatric dentists through an online survey (39.1% response rate) in 2017. The authors used a workforce simulation model by using data from the survey and other sources to produce estimates under several scenarios to anticipate future supply and demand for pediatric dentists. ResultsIf production of new pediatric dentists and use and delivery of oral health care continue at current rates, the pediatric dentist supply will increase by 4,030 full-time equivalent (FTE) dentists by 2030, whereas demand will increase by 140 FTE dentists by 2030. Supply growth was higher under hypothetical scenarios with an increased number of graduates (4,690 FTEs) and delayed retirement (4,320 FTEs). If children who are underserved experience greater access to care or if pediatric dentists provide a larger portion of services for children, demand could grow by 2,100 FTE dentists or by 10,470 FTE dentists, respectively. ConclusionsThe study results suggest that the supply of pediatric dentists is growing more rapidly than is the demand. Growth in demand could increase if pediatric dentists captured a larger share of pediatric dental services or if children who are underserved had oral health care use patterns similar to those of the population with fewer access barriers. Practical ImplicationsIt is important to encourage policy changes to reduce barriers to accessing oral health care, to continue pediatric dentists’ participation with Medicaid programs, and to urge early dental services for children.

Do Dutch dentists extract monopoly rents?

We exploit lottery-determined admission to dental school to estimate the payoffs to the study of dentistry in the Netherlands. Using data from up to 22 years after the lottery, we find that in most years after graduation dentists earn around 50,000 Euros more than they would earn in their next-best profession. The payoff is larger for men than for women but does not vary with high school GPA. The large payoffs cannot be attributed to longer working hours, larger investments while studying (opportunity costs and direct costs), or unpleasant aspects of working as a dentist. A plausible explanation is that dentists earn a monopoly rent. Results from regressions of dentists’ earnings on dentists density are consistent with this, as are the facts that the supply of dentists in the Netherlands is low and that the payoff does not vary with high school GPA.

A Clinical Vignette–Based Study of Physicians’ Adherence to Guidelines for Dental Referrals of Young Children

ObjectivesThe American Academy of Pediatrics (AAP) recommends an oral health risk assessment and referral to a dental home by a child's first birthday. We evaluated the adherence of primary care providers (PCPs) to AAP dental referral guidelines for children age <4 years and barriers to implementation of these guidelines. MethodsA cross-sectional survey of PCPs randomly selected from the 435 practices in North Carolina identified as providing well-child visits for Medicaid children age <4 years was completed in 2013. The PCPs’ referral recommendations were assessed using 4 vignettes of 18-month-old children at various risk of dental caries (low, moderate, high, or highest) and different levels of dentist supply (adequate or inadequate). Barriers to guideline adherence specified in the Cabana framework were analyzed for their associations with PCP adherence, using logistic regression models stratified by caries risk and dentist supply. ResultsThe survey yielded 219 (50%) usable responses from the sample of 435 PCPs. On average for all vignettes, 61% of providers chose a referral recommendation in agreement with guidelines. Underreferral averaged 40%. With adequate workforce, guideline-adherent responses varied from 26% for low-risk children to >90% for high-risk children. An inadequate workforce reduced adherence for most levels of risk. Generally, correct knowledge of risk status, barriers to risk assessment, and pediatric practice were associated with adherence, but not always in the hypothesized direction. ConclusionsPCPs’ adherence to referral guidelines varies according to caries risk and dentist supply, but generally they underrefer low- to moderate-risk patients by a significant degree.