Advancing Dental Education in the 21st Century: Phase 2 Report on Strategic Analysis and Recommendations.

In Phase 1 of the "Advancing Dental Education in the 21st Century" project, research was conducted and published on a number of serious challenges facing dental and allied dental education, both presently and projected to 2040. Those findings informed the strategic analysis and recommendations developed in Phase 2 of the project. This report provides an overview of the Phase 2 conclusions and presents recommendations to address the challenges identified.

Pay-for-performance incentive program in a large dental group practice.

Background: Dentists increasingly are employed in large group practices that use financial incentive systems to influence provider performance. The authors describe the design and initial implementation of a pay-for-performance (P4P) incentive program for a large capitated Oregon group dental practice that cares primarily for patients receiving Medicaid. The authors do not assess the effectiveness of the incentive system on provider and staff member performance.

The Oral Health Care Delivery System in 2040: Executive Summary.

This executive summary for Section 4 of the "Advancing Dental Education in the 21 Century" project examines the projected oral health care delivery system in 2040 and the likely impact of system changes on dental education. Dental care is at an early stage of major changes with the decline in solo practice and increase in large group practices. These groups are not consolidated at the state level, but further consolidation is expected as they try to increase their negotiating leverage with dental insurers.

Estimating the Number of Dentists Needed in 2040.

Numerous factors that underlie the need for dentists are undergoing significant changes. Three factors are especially important: 1) improvements in oral health; 2) lower expenditures per patient per year, giving dentists the incentive to treat more patients to maintain incomes that justify their investment in dental education and practice; and 3) dental schools' producing new dentists at a faster rate than the growth in the population. If these trends continue, there is likely to be a dentist surplus of between 32% and 110% by 2040.

Dental Group Practice and the Need for Dentists.

This study compared the number of patients treated per year by general dentists and dental hygienists in solo practice and by those employed by a large group practice. Information on the annual number of patient visits to solo general dental practitioners comes from the 2013 American Dental Association (ADA) Survey of Dental Practice. Patient visits were divided by 2.

Are Dental Schools Part of the Safety Net?

This article examines the current safety net activities of dental schools and reviews strategies by which schools could care for more poor and low-income patients. The primary data come from the annual Survey of Dental Education, a joint American Dental Education Association (ADEA) and American Dental Association (ADA) activity. The analyses use descriptive statistics and are intended to give ballpark estimates of patients treated under varying clinical scenarios.

Trends in Financing Dental Education, 2004-05 to 2011-12.

This article examines dental school financial trends from 2004-05 to 2011-12, based on data from the American Dental Association (ADA) annual financial survey completed by all U.S. dental schools.

How Many Dentists Are Needed in 2040: Executive Summary.

Five background articles in Section 2 of the "Advancing Dental Education in the 21 Century" project examined some of the factors likely to impact the number of dentists needed in 2040: 1) the oral health of the population, 2) changes in the utilization of dental services, 3) new technologies, 4) the growth of large capitated dental group practices, and 5) the demand for dental care. With this information, a sixth background article estimated the number of dentists needed in 2040 compared to the number expected if current trends continue. This executive summary provides an overview of findings from these six articles.

Introduction to "Advancing Dental Education in the 21 Century" Project.

In 1926, the Carnegie Foundation for the Advancement of Teaching published a report prepared by William J. Gies, PhD, a professor of biochemistry and founder of the Columbia University College of Dental Medicine. The Gies report examined the current status of dental education in the United States and Canada and made recommendations for a new direction.

The Oregon Dental Market A Case Study.

This case study examines changes taking place in the Oregon dental care system. Data were obtained from interviews with senior executives from several delivery organizations. Conducted by the senior author (HB), the summarized interviews were reviewed by informants.

The oral health of upper income Americans.

Background: Limited information is available on the oral health status of upper income Americans (>400 percent of the FPL). They constitute 33 percent of the population and account for 53 percent of dental expenditures.

Methods: Using 1999-2004 NHANES data, we examined differences in the mean number and percentage of decayed and filled permanent surfaces and missing teeth among age and family income groups.

Population-centered Risk- and Evidence-based Dental Interprofessional Care Team (PREDICT): study protocol for a randomized controlled trial.

Background: To improve the oral health of low-income children, innovations in dental delivery systems are needed, including community-based care, the use of expanded duty auxiliary dental personnel, capitation payments, and global budgets. This paper describes the protocol for PREDICT (Population-centered Risk- and Evidence-based Dental Interprofessional Care Team), an evaluation project to test the effectiveness of new delivery and payment systems for improving dental care and oral health.

Methods/design: This is a parallel-group cluster randomized controlled trial.

Impact of fee increases on dental utilization rates for children living in Connecticut and enrolled in Medicaid.

Background: In 2008, Connecticut's Medicaid program administration increased children's dental fees to match approximately the 70th percentile of what the market fees were for dental care in 2005. These Medicaid program changes occurred at the same time as a national economic recession, which took place from 2007 through 2009.

Methods: The authors obtained Medicaid eligibility, claims, and provider data before and after the fee increase, in 2006 and 2009 through 2012, respectively.

Federally qualified health center dental clinics: financial information.

Objective: Federally Qualified Health Center (FQHC) dental clinics are a major component of the dental safety net system, providing care to 3.75 million patients annually. This study describes the financial and clinical operations of a sample of FQHCs.

Dental therapists in general dental practices: an economic evaluation.

Dental access disparities are well documented and have been recognized as a national problem. Their major cause is the lack of reasonable Medicaid reimbursement rates for the underserved. Specifically, Medicaid reimbursement rates for children average 40 percent below market rates.

Impact of dental therapists on productivity and finances: III. FQHC-run, school-based dental care programs in Connecticut.

In many developed countries, the primary role of dental therapists is to care for children in school clinics. This article describes Federally Qualified Health Center (FQHC)-run, school-based dental programs in Connecticut and explores the theoretical financial impact of substituting dental therapists for dentists in these programs. In schools, dental hygienists screen children and provide preventive services, using portable equipment and temporary space.

Impact of dental therapists on productivity and finances: II. Federally Qualified Health Centers.

This article estimates the impact of dental therapists treating children on Federally Qualified Health Center (FQHC) dental clinic finances and productivity. The analysis is based on twelve months of patient visit and financial data from large FQHC dental clinics (multiple delivery sites) in Connecticut and Wisconsin. Assuming dental therapists provide restorative, extraction, and pulpal services and dental hygienists continue to deliver all hygiene services, the maximum reduction in costs is about 6 percent.

Impact of dental therapists on productivity and finances: I. Literature review.

This study examined the financial impact of dental therapists on Federally Qualified Health Center dental clinics (treating children) and on private general dental practices (treating children and adults). This article, the first of four on this subject, reviews the dental therapy literature and the dental access problem for low-income children. Dental therapists now practice in many developed countries, tribal areas of Alaska, and Minnesota.

Expanded function allied dental personnel and dental practice productivity and efficiency.

This study examined the impact of expanded function allied dental personnel on the productivity and efficiency of general dental practices. Detailed practice financial and clinical data were obtained from a convenience sample of 154 general dental practices in Colorado. In this state, expanded function dental assistants can provide a wide range of reversible dental services/procedures, and dental hygienists can give local anesthesia.

State case studies: improving access to dental care for the underserved.

Introduction: This article, a supplement to the work of the Institute of Medicine's Committee on Oral Health Access, examines dental access disparities, reviews societal strategies for reducing disparities, explores the relationship between state level public health and dental safety net efforts and utilization/oral health outcomes, and describes selected public health and safety net programs with special promise.

Methods: Data were obtained from interviews with state dental directors and safety net leaders and a review of the literature.

Findings: There is a two-fold difference in utilization rates between low- (<30 percent) and high- (56 percent) income families.

Community-based dental education: history, current status, and future.

This article examines the history, current status, and future direction of community-based dental education (CBDE). The key issues addressed include the reasons that dentistry developed a different clinical education model than the other health professions; how government programs, private medical foundations, and early adopter schools influenced the development of CBDE; the societal and financial factors that are leading more schools to increase the time that senior dental students spend in community programs; the impact of CBDE on school finances and faculty and student perceptions; and the reasons that CBDE is likely to become a core part of the clinical education of all dental graduates.