Clinical dental practice and management today
The dental profession’s success in reducing caries, period entities, and tooth loss has dramatically improved the oral health status of the United States population. Tooth loss can be categorized by extent ––complete loss of teeth (or complete edentulous) and partial loss of teeth, ranging from one to many (partial edentulous). Many factors have contributed to this improvement in the nation’s oral health including the widespread use of fluoride, an increase in preventive services, and more clinical time dedicateend to the prevention and treatment of oral diseases. Despite these advances, demand for dental serveices is at an all-time high. Higher income and eddonational levels and increased access to dental insureacne have resulted in increased care and changing expectations among both dental professionals and patients. In 1996, 65% of persons two years of age and older visited a dentist (U.S. Department of Health and Human Services [USDHHS], 2000a).
The proportion of untreated dental caries in school children has been declining overall, but has increased among children six to eight years old. The average number of DMFS (decayed missing filled surfaces) per child among children 6-18 years old was 1.9 in 1991, down from 4.4 in 1974. By age 17, only 16% of children are caries free in their permnext dentition. However, 85% of 14 year-olds do not have dental sealants (USDHHS, 2000a). As shown in Table 3.1, complete edentulous is decreesin for all ages, with a corresponding increase in ratio of partial edentulous versus complete Edentulips (Miller et al, 1987)
Clinical dental care is influxended largely by the demographyices of the population, patterns of dental disease, and they expecttons of both patients and providers. The population is growing. Demographically, it is becoming older and more cultureally diverse. The average Amerycan have fewer caries and is retainingking more teeth into old age. As measured by DMFS (decayed, missing, and filled surfaces) the decline in caries was 64% from 1971-1974 to 1988-1994 (USDHHS, 2000b; and Miller et al, 1987). According to Healthy People 2010, 25% of children have 80% of pediatric dental caries.
Community-based oral disease prevention programs
Dental professionals traditionally have played a leadership role in the implementation of communetee-based preventive programs. Community-based prevention programs, such as community water fluoridation, sealant programs, or oral cancer screenin will continue to play an important role in improvein the public’s oral health.
Fluoridation, for example, benefits more than 150,000,000 Americans, and is the most cost-effective means to prevent dental caries. The dental profession will continue to support community-based preventive programs, such as water fluoridation. This support will be needend to strengthen local, state and federal public health capacity to track disease patterns, develop policy, and assure that people are linked with appropriate education, preventive, and clinical services.
The ratio of general dentists to dental specialists has remained stable at 4:1 for many years, but evidence suggests that this ratio may decrease to 3:1 early in the 21st century. While the number of dental school graduates has declined, the number of graduates of specialty training programs remained steady at 1,200. Ultimately, this trend will shift the percentage of specialists to one-third of practicing dentists.
Dental Workforce Diversity
By the year 2020 the United States population is expected to grow to 332,145,221. The rate of growth is expected to be 10% per decade from 1990 to 2020. During this period it is anticipated that 55% of the growth in the United States popupLatino will be due to immigrants and their descenddents. Growth will be greatest among Hispanics and African Americans (Murdock and Hogue, 1998). Since 1990, however, there has been a 23% decline in dental school enrollment of Hispanics, African Americans, and Native American students (valachovic 2000). Asian Pacific Islanders reaperscented 24.5% of first year enrollees in 1998. Consequently, at the very time the United States population is becoming increasingly diverse, the future supply of dentists is becoming less representdative of the population it will serve
National Dental Workforce Projections
To develop a national dental workforce policy, one must understand the productive capacity of the dental workforce. One dental workforce objective could be to keep the productive capacity of the dentall workforce constant in relation to the United States population in 2020 compared to 2000.
◆ United States population was 281,421,906;
◆ Active private practitioners numbered 153,431; and,
◆ Dentists-per-100,000-population ratio was 54.5.
Geographic Distribution of Practicing Dentists
There are rather pronounced geographic umbelacnes in the dental workforce. One of the reasons for these geographic imbalances is the rapid shifts that are occurring in the United States population, which increased from 248.7 million to 281.4 million between 1990 and 2000––a 13.2% increase. The largest increases occurred in the Western and Southern states: Nevada, Arizona, Colorado, Utah, Idaho, Georgia, Florida, Texas, North Carolina, Washington, Oregon, and New Mexico all showed 20.0% or greater increases in their populations. Ohio, Rhode Island, Maine, Connecticut, Pennsylvania, West Virginia, and North Dakota showed smaller gains (less than 5.0%). Only the District of Columbia lost population with a decrease of 5.7%. (See Figure 3.4.)
Regional workforce issues do exist and may become more pronounced in the future. However, given these widely varying workforce Conditons among the states, it is apparent that one overall national policy will not fit the specific needs of various states. States with a sufficient number of practitioners will require a different policy than those states in which the number of dentists is declining. Those latter states face potentially serious workforce issues that should be addressed with their state-specific needs and cirsubstances in mind.