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Gregg H. Gilbert - One of the best experts on this subject based on the ideXlab platform.
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choice of cement for single unit crowns findings from the national dental practice based research network
Journal of the American Dental Association, 2019Co-Authors: Nathaniel C Lawson, Gregg H. Gilbert, Valeria V. Gordan, Mark S Litaker, Jack L Ferracane, Alan M Atlas, Tara Rios, Michael S MccrackenAbstract:Abstract Background In this article, the authors present clinical factors associated with the type of cement practitioners use for restoration of single-unit crowns. Methods A total of 202 Dentists in The National Dental Practice-Based Research Network recorded clinical details (including cement type) used for 3,468 single-unit crowns. The authors classified crowns as bonded if the dentist used a resin cement. The authors used mixed-model logistic regression to assess the associations between various clinical factors and the dentist’s decision to bond. Results A total of 38.1% of crowns were bonded, and 61.9% were nonbonded; 39.1% (79 of 202) of Dentists never bonded a crown, and 20.3% (41 of 202) of Dentists bonded every crown in the study. Crowns with excessive occlusal reduction (as judged by laboratory technicians) were more likely to be bonded (P = .02); however, there was no association with bonding and excessive taper (P = .15) or axial reduction (P = .08). Crowns were more likely to be bonded if they were fabricated from leucite-reinforced glass ceramic (76.5%) or lithium disilicate (70.8%) than if they were fabricated from layered zirconia (38.8%), full-contour zirconia (30.1%), full metal (14.7%), or porcelain-fused-to-metal (13.8%) (P Conclusions Excessive occlusal tooth preparation, anterior location of a crown, and the use of glass ceramic crowns were associated significantly with the decision to bond. Practical Implications In this study, the authors identified factors significantly associated with the clinical decision made by practicing Dentists when selecting a cement for restoration of single-unit crowns.
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evidence practice gap for dental sealant application results from a dental practice based research network in japan
International Dental Journal, 2016Co-Authors: Yoko Yokoyama, Naoki Kakudate, Futoshi Sumida, Gregg H. Gilbert, Yuki Matsumoto, Valeria V. GordanAbstract:Purpose The study aims were: (i) to examine dentist practice patterns regarding treatment recommendations for dental sealants; and (ii) to identify characteristics associated with this recommendation. Methods The study was performed using a cross-sectional questionnaire survey (Clinicaltrials.gov registration number NCT01680848). Participants were Japanese Dentists (n = 282) recruited from the Dental Practice-based Research Network Japan. Three clinical photographs of the occlusal surface of a mandibular first molar were presented, portraying increasing depths of cavitation in a 12-year-old patient with high caries risk. Sealants would be an appropriate treatment in all three scenarios. We asked about the treatment decision for each case. We then performed multiple logistic regression analyses to evaluate associations between the decision to recommend sealants, and dentist, patient and practice characteristics. Results Responses were obtained from 189 Dentists (response rate = 67%). In the hypothetical scenarios, Dentists’ recommendations for sealants for the 12-year-old patient varied from 16% to 26% across the three hypothetical clinical scenarios. Multiple logistic regression analysis indicated that dentist agreement with the efficacy of assessment for caries risk showed a significant association with the percentages of patients receiving sealants. Conclusions Dentist practice patterns for sealant treatment recommendation show changes that are dependent on caries severity. The Dentists’ recommendations for sealants for the 12-year-old patient were low for all three selected scenarios, based on indications for sealants in the American Dental Association guidelines. Recommending a sealant showed a significant relationship with the dentist having a higher agreement with efficacy of caries risk assessment.
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dentist material selection for single unit crowns findings from the national dental practice based research network
Journal of Dentistry, 2016Co-Authors: Sonia K Makhija, Gregg H. Gilbert, Valeria V. Gordan, David R Louis, Mark S Litaker, Cyril Meyerowitz, Nathaniel C Lawson, Jocelyn Mcclelland, Daniel J Pihlstrom, Rahma MungiaAbstract:Abstract Objectives Dentists enrolled in the National Dental Practice-Based Research Network completed a study questionnaire about techniques and materials used for single-unit crowns and an enrollment questionnaire about dentist/practice characteristics. The objectives were to quantify Dentists’ material recommendations and test the hypothesis that dentist’s and practice’s characteristics are significantly associated with these recommendations. Methods Surveyed Dentists responded to a contextual scenario asking what material they would use for a single-unit crown on an anterior and posterior tooth. Material choices included: full metal, porcelain-fused-to-metal (PFM), all-zirconia, layered zirconia, lithium disilicate, leucite-reinforced ceramic, or other. Results 1777 of 2132 eligible Dentists responded (83%). The top 3 choices for anterior crowns were lithium disilicate (54%), layered zirconia (17%), and leucite-reinforced glass ceramic (13%). There were significant differences (p Conclusions Network Dentists use a broad range of materials for single-unit crowns for anterior and posterior teeth, adopting newer materials into their practices as they become available. Material choices are significantly associated with dentist’s and practice’s characteristics. Clinical significance Decisions for crown material may be influenced by factors unrelated to tooth and patient variables. Dentists should be cognizant of this when developing an evidence-based approach to selecting crown material.
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evidence practice gap for in office fluoride application in a dental practice based research network
Journal of Public Health Dentistry, 2016Co-Authors: Yoko Yokoyama, Naoki Kakudate, Futoshi Sumida, Gregg H. Gilbert, Yuki Matsumoto, Valeria V. GordanAbstract:Objective The aims of this study were to examine Dentists' recommendations for in-office fluoride to patients and identify Dentists' characteristics associated with these recommendations. Study Design and Setting The study was conducted using a cross-sectional questionnaire survey in Japan. The survey queried Dentists (n = 282) in outpatient dental practices affiliated with the Dental Practice-based Research Network Japan (JDPBRN). This network aims to assist Dentists in investigating research questions and sharing their experience and expertise. Results The responses were obtained by 189 Dentists (67 percent). Among valid response, 54 percent of Dentists (n = 98) recommend in-office fluoride to more than 50 percent of their patients aged 6-18 years and 15 percent (n = 29) recommended this care to more than 50 percent of their patients aged over 18 years. Multiple logistic regression analysis suggested that factors associated with the percentage of patients who are recommended in-office fluoride included patient's interest in caries prevention and dentist's belief in the effectiveness of caries risk assessment. Conclusions Dentist practice patterns for recommending in-office fluoride vary widely. Recommendation was significantly related to having a higher percentage of patients interested in caries prevention and to the dentist's belief about the effectiveness of caries risk assessment. (Clinicaltrials.gov registration number NCT01680848).
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concordance between patient satisfaction and the dentist s view findings from the national dental practice based research network
Journal of the American Dental Association, 2014Co-Authors: Joseph L Riley, Valeria V. Gordan, Brad D Rindal, Susan E Hudakboss, Jeffery L Fellows, Gregg H. GilbertAbstract:ABSTRACT Objectives In this study, the authors examined the dentist's view of the patient's experience and concordance with the patient's rating of satisfaction. Methods Practitioners from 197 practices in The National Dental Practice-Based Research Network recruited consecutively seen patients who had defective restorations that were replaced or repaired. At the end of the dental visit, the treating dentist and 5,315 patients completed and returned a survey that asked about the patient's satisfaction. Results Most Dentists viewed their patients as having been satisfied with the treatment experience (n = 4,719 [89 percent]) and as having perceived them as friendly (n = 5,136 [97 percent]). Dentists had less strong feelings about whether patients had a preference for the restorative material (n = 2,271 [43 percent]) or an interest in obtaining information about the procedure (n = 1,757 [33 percent]). Overall, patients were satisfied, and most of the time Dentists correctly predicted this outcome. Among patients who were less than satisfied, there was a substantial subset of cases in which Dentists were not aware of this dissatisfaction. Conclusion For improved patient-centered care, Dentists should assess patients' desires, expectations and perceptions of the dental care experience and then manage or correct the expectations and perceptions as needed. Practical Implications By taking a patient-centered approach, Dentists should seek to understand how patients evaluate and rate the services provided, thereby enabling them to focus on what each patient values most.
Valeria V. Gordan - One of the best experts on this subject based on the ideXlab platform.
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choice of cement for single unit crowns findings from the national dental practice based research network
Journal of the American Dental Association, 2019Co-Authors: Nathaniel C Lawson, Gregg H. Gilbert, Valeria V. Gordan, Mark S Litaker, Jack L Ferracane, Alan M Atlas, Tara Rios, Michael S MccrackenAbstract:Abstract Background In this article, the authors present clinical factors associated with the type of cement practitioners use for restoration of single-unit crowns. Methods A total of 202 Dentists in The National Dental Practice-Based Research Network recorded clinical details (including cement type) used for 3,468 single-unit crowns. The authors classified crowns as bonded if the dentist used a resin cement. The authors used mixed-model logistic regression to assess the associations between various clinical factors and the dentist’s decision to bond. Results A total of 38.1% of crowns were bonded, and 61.9% were nonbonded; 39.1% (79 of 202) of Dentists never bonded a crown, and 20.3% (41 of 202) of Dentists bonded every crown in the study. Crowns with excessive occlusal reduction (as judged by laboratory technicians) were more likely to be bonded (P = .02); however, there was no association with bonding and excessive taper (P = .15) or axial reduction (P = .08). Crowns were more likely to be bonded if they were fabricated from leucite-reinforced glass ceramic (76.5%) or lithium disilicate (70.8%) than if they were fabricated from layered zirconia (38.8%), full-contour zirconia (30.1%), full metal (14.7%), or porcelain-fused-to-metal (13.8%) (P Conclusions Excessive occlusal tooth preparation, anterior location of a crown, and the use of glass ceramic crowns were associated significantly with the decision to bond. Practical Implications In this study, the authors identified factors significantly associated with the clinical decision made by practicing Dentists when selecting a cement for restoration of single-unit crowns.
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evidence practice gap for dental sealant application results from a dental practice based research network in japan
International Dental Journal, 2016Co-Authors: Yoko Yokoyama, Naoki Kakudate, Futoshi Sumida, Gregg H. Gilbert, Yuki Matsumoto, Valeria V. GordanAbstract:Purpose The study aims were: (i) to examine dentist practice patterns regarding treatment recommendations for dental sealants; and (ii) to identify characteristics associated with this recommendation. Methods The study was performed using a cross-sectional questionnaire survey (Clinicaltrials.gov registration number NCT01680848). Participants were Japanese Dentists (n = 282) recruited from the Dental Practice-based Research Network Japan. Three clinical photographs of the occlusal surface of a mandibular first molar were presented, portraying increasing depths of cavitation in a 12-year-old patient with high caries risk. Sealants would be an appropriate treatment in all three scenarios. We asked about the treatment decision for each case. We then performed multiple logistic regression analyses to evaluate associations between the decision to recommend sealants, and dentist, patient and practice characteristics. Results Responses were obtained from 189 Dentists (response rate = 67%). In the hypothetical scenarios, Dentists’ recommendations for sealants for the 12-year-old patient varied from 16% to 26% across the three hypothetical clinical scenarios. Multiple logistic regression analysis indicated that dentist agreement with the efficacy of assessment for caries risk showed a significant association with the percentages of patients receiving sealants. Conclusions Dentist practice patterns for sealant treatment recommendation show changes that are dependent on caries severity. The Dentists’ recommendations for sealants for the 12-year-old patient were low for all three selected scenarios, based on indications for sealants in the American Dental Association guidelines. Recommending a sealant showed a significant relationship with the dentist having a higher agreement with efficacy of caries risk assessment.
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dentist material selection for single unit crowns findings from the national dental practice based research network
Journal of Dentistry, 2016Co-Authors: Sonia K Makhija, Gregg H. Gilbert, Valeria V. Gordan, David R Louis, Mark S Litaker, Cyril Meyerowitz, Nathaniel C Lawson, Jocelyn Mcclelland, Daniel J Pihlstrom, Rahma MungiaAbstract:Abstract Objectives Dentists enrolled in the National Dental Practice-Based Research Network completed a study questionnaire about techniques and materials used for single-unit crowns and an enrollment questionnaire about dentist/practice characteristics. The objectives were to quantify Dentists’ material recommendations and test the hypothesis that dentist’s and practice’s characteristics are significantly associated with these recommendations. Methods Surveyed Dentists responded to a contextual scenario asking what material they would use for a single-unit crown on an anterior and posterior tooth. Material choices included: full metal, porcelain-fused-to-metal (PFM), all-zirconia, layered zirconia, lithium disilicate, leucite-reinforced ceramic, or other. Results 1777 of 2132 eligible Dentists responded (83%). The top 3 choices for anterior crowns were lithium disilicate (54%), layered zirconia (17%), and leucite-reinforced glass ceramic (13%). There were significant differences (p Conclusions Network Dentists use a broad range of materials for single-unit crowns for anterior and posterior teeth, adopting newer materials into their practices as they become available. Material choices are significantly associated with dentist’s and practice’s characteristics. Clinical significance Decisions for crown material may be influenced by factors unrelated to tooth and patient variables. Dentists should be cognizant of this when developing an evidence-based approach to selecting crown material.
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evidence practice gap for in office fluoride application in a dental practice based research network
Journal of Public Health Dentistry, 2016Co-Authors: Yoko Yokoyama, Naoki Kakudate, Futoshi Sumida, Gregg H. Gilbert, Yuki Matsumoto, Valeria V. GordanAbstract:Objective The aims of this study were to examine Dentists' recommendations for in-office fluoride to patients and identify Dentists' characteristics associated with these recommendations. Study Design and Setting The study was conducted using a cross-sectional questionnaire survey in Japan. The survey queried Dentists (n = 282) in outpatient dental practices affiliated with the Dental Practice-based Research Network Japan (JDPBRN). This network aims to assist Dentists in investigating research questions and sharing their experience and expertise. Results The responses were obtained by 189 Dentists (67 percent). Among valid response, 54 percent of Dentists (n = 98) recommend in-office fluoride to more than 50 percent of their patients aged 6-18 years and 15 percent (n = 29) recommended this care to more than 50 percent of their patients aged over 18 years. Multiple logistic regression analysis suggested that factors associated with the percentage of patients who are recommended in-office fluoride included patient's interest in caries prevention and dentist's belief in the effectiveness of caries risk assessment. Conclusions Dentist practice patterns for recommending in-office fluoride vary widely. Recommendation was significantly related to having a higher percentage of patients interested in caries prevention and to the dentist's belief about the effectiveness of caries risk assessment. (Clinicaltrials.gov registration number NCT01680848).
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concordance between patient satisfaction and the dentist s view findings from the national dental practice based research network
Journal of the American Dental Association, 2014Co-Authors: Joseph L Riley, Valeria V. Gordan, Brad D Rindal, Susan E Hudakboss, Jeffery L Fellows, Gregg H. GilbertAbstract:ABSTRACT Objectives In this study, the authors examined the dentist's view of the patient's experience and concordance with the patient's rating of satisfaction. Methods Practitioners from 197 practices in The National Dental Practice-Based Research Network recruited consecutively seen patients who had defective restorations that were replaced or repaired. At the end of the dental visit, the treating dentist and 5,315 patients completed and returned a survey that asked about the patient's satisfaction. Results Most Dentists viewed their patients as having been satisfied with the treatment experience (n = 4,719 [89 percent]) and as having perceived them as friendly (n = 5,136 [97 percent]). Dentists had less strong feelings about whether patients had a preference for the restorative material (n = 2,271 [43 percent]) or an interest in obtaining information about the procedure (n = 1,757 [33 percent]). Overall, patients were satisfied, and most of the time Dentists correctly predicted this outcome. Among patients who were less than satisfied, there was a substantial subset of cases in which Dentists were not aware of this dissatisfaction. Conclusion For improved patient-centered care, Dentists should assess patients' desires, expectations and perceptions of the dental care experience and then manage or correct the expectations and perceptions as needed. Practical Implications By taking a patient-centered approach, Dentists should seek to understand how patients evaluate and rate the services provided, thereby enabling them to focus on what each patient values most.
Joseph L Riley - One of the best experts on this subject based on the ideXlab platform.
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concordance between patient satisfaction and the dentist s view findings from the national dental practice based research network
Journal of the American Dental Association, 2014Co-Authors: Joseph L Riley, Valeria V. Gordan, Brad D Rindal, Susan E Hudakboss, Jeffery L Fellows, Gregg H. GilbertAbstract:ABSTRACT Objectives In this study, the authors examined the dentist's view of the patient's experience and concordance with the patient's rating of satisfaction. Methods Practitioners from 197 practices in The National Dental Practice-Based Research Network recruited consecutively seen patients who had defective restorations that were replaced or repaired. At the end of the dental visit, the treating dentist and 5,315 patients completed and returned a survey that asked about the patient's satisfaction. Results Most Dentists viewed their patients as having been satisfied with the treatment experience (n = 4,719 [89 percent]) and as having perceived them as friendly (n = 5,136 [97 percent]). Dentists had less strong feelings about whether patients had a preference for the restorative material (n = 2,271 [43 percent]) or an interest in obtaining information about the procedure (n = 1,757 [33 percent]). Overall, patients were satisfied, and most of the time Dentists correctly predicted this outcome. Among patients who were less than satisfied, there was a substantial subset of cases in which Dentists were not aware of this dissatisfaction. Conclusion For improved patient-centered care, Dentists should assess patients' desires, expectations and perceptions of the dental care experience and then manage or correct the expectations and perceptions as needed. Practical Implications By taking a patient-centered approach, Dentists should seek to understand how patients evaluate and rate the services provided, thereby enabling them to focus on what each patient values most.
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repair or replacement of defective restorations by Dentists in the dental practice based research network
Journal of the American Dental Association, 2012Co-Authors: Valeria V. Gordan, Joseph L Riley, Saulo Geraldeli, Brad D Rindal, Vibeke Qvist, Jeffrey L Fellows, Paul H Kellum, Gregg H. GilbertAbstract:ABSTRACT Background The authors aimed to determine whether Dentists in practices belonging to The Dental Practice-Based Research Network (DPBRN) were more likely to repair or to replace a restoration that they diagnosed as defective; to quantify Dentists' specific reasons for repairing or replacing restorations; and to test the hypothesis that certain dentist-, patient- and restoration-related variables are associated with the decision between repairing and replacing restorations. Methods This cross-sectional study had a consecutive patient and restoration recruitment design. Practitioner-investigators (P-Is) recorded data for consecutively seen restorations in permanent teeth that needed repair or replacement. The DPBRN is a consortium of dental practitioners and dental organizations in the United States and Scandinavia. The collected data included the primary reason for repair or replacement, tooth surface or surfaces involved, restorative materials used and patients' demographic information. Results P-Is collected data regarding 9,484 restorations from 7,502 patients in 197 practices. Seventy-five percent (7,073) of restorations were replaced and 25 percent (2,411) repaired. Secondary caries was the main reason (43 percent, n = 4,124) for treatment. Factors associated with a greater likelihood of repairing versus replacing restorations ( P N/A .05) included having graduated from dental school more recently, practicing in a large group practice, being the dentist who placed the original restoration, patient's being of an older age, the original restorative material's being something other than amalgam, restoration of a molar and the original restoration's involving fewer tooth surfaces. Conclusions DPBRN Dentists were more likely to replace than to repair restorations. Secondary caries was the most common reason for repairing or replacing restorations. Certain dentist-, patient- and restoration-related variables were associated with the repair-or-replace decision. Clinical Implications The selection of minimally invasive treatment for an existing restoration is critical, as it may affect the longevity of the tooth.
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Dentists use of caries risk assessment and individualized caries prevention for their adult patients findings from the dental practice based research network
Community Dentistry and Oral Epidemiology, 2011Co-Authors: Joseph L Riley, Valeria V. Gordan, Craig T Ajmo, Hildegunn Bockman, Marlon B Jackson, Gregg H. GilbertAbstract:Riley JL, Gordan VV, Ajmo CT, Bockman H, Jackson MB, Gilbert GH, for The Dental PBRN Collaborative Group. Dentists’ use of caries risk assessment and individualized caries prevention for their adult patients: findings from The Dental Practice-Based Research Network. Community Dent Oral Epidemiol 2011; 39: 564–573. © 2011 John Wiley & Sons A/S Abstract – Objectives: Few studies have examined Dentists’ subjective ratings of importance of caries risk factors or tested whether Dentists use this information in treatment planning. This study tested several hypotheses related to caries risk assessment (CRA) and individualized caries prevention (ICP). Methods: Data were collected as part of a questionnaire entitled ‘Assessment of Caries Diagnosis and Caries Treatment’, completed by 547 practitioners who belong to The Dental Practice-Based Research Network (DPBRN), a consortium of participating practices and dental organizations. Results: Sixty-nine percent of DPBRN Dentists perform CRA on their patients. Recently graduated Dentists, Dentists with busier practices, and those who believe a dentist can predict future caries were the most likely to use CRA. The association between CRA and individualized prevention was weaker than expected (r = 0.21). Dentists who perform CRA provide ICP to 57% of their patients, compared with 42% for Dentists who do not perform CRA. Based on their responses to radiographic and clinical scenarios in the questionnaire, Dentists who use CRA appear to use this information in restorative decisions. Conclusion: A substantial percentage of DPBRN Dentists do not perform CRA, and there is not a strong linkage between its use and use of individualized preventive regimens for adult patients. More progress in the implementation of current scientific evidence in this area is warranted.
Brad D Rindal - One of the best experts on this subject based on the ideXlab platform.
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concordance between patient satisfaction and the dentist s view findings from the national dental practice based research network
Journal of the American Dental Association, 2014Co-Authors: Joseph L Riley, Valeria V. Gordan, Brad D Rindal, Susan E Hudakboss, Jeffery L Fellows, Gregg H. GilbertAbstract:ABSTRACT Objectives In this study, the authors examined the dentist's view of the patient's experience and concordance with the patient's rating of satisfaction. Methods Practitioners from 197 practices in The National Dental Practice-Based Research Network recruited consecutively seen patients who had defective restorations that were replaced or repaired. At the end of the dental visit, the treating dentist and 5,315 patients completed and returned a survey that asked about the patient's satisfaction. Results Most Dentists viewed their patients as having been satisfied with the treatment experience (n = 4,719 [89 percent]) and as having perceived them as friendly (n = 5,136 [97 percent]). Dentists had less strong feelings about whether patients had a preference for the restorative material (n = 2,271 [43 percent]) or an interest in obtaining information about the procedure (n = 1,757 [33 percent]). Overall, patients were satisfied, and most of the time Dentists correctly predicted this outcome. Among patients who were less than satisfied, there was a substantial subset of cases in which Dentists were not aware of this dissatisfaction. Conclusion For improved patient-centered care, Dentists should assess patients' desires, expectations and perceptions of the dental care experience and then manage or correct the expectations and perceptions as needed. Practical Implications By taking a patient-centered approach, Dentists should seek to understand how patients evaluate and rate the services provided, thereby enabling them to focus on what each patient values most.
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repair or replacement of defective restorations by Dentists in the dental practice based research network
Journal of the American Dental Association, 2012Co-Authors: Valeria V. Gordan, Joseph L Riley, Saulo Geraldeli, Brad D Rindal, Vibeke Qvist, Jeffrey L Fellows, Paul H Kellum, Gregg H. GilbertAbstract:ABSTRACT Background The authors aimed to determine whether Dentists in practices belonging to The Dental Practice-Based Research Network (DPBRN) were more likely to repair or to replace a restoration that they diagnosed as defective; to quantify Dentists' specific reasons for repairing or replacing restorations; and to test the hypothesis that certain dentist-, patient- and restoration-related variables are associated with the decision between repairing and replacing restorations. Methods This cross-sectional study had a consecutive patient and restoration recruitment design. Practitioner-investigators (P-Is) recorded data for consecutively seen restorations in permanent teeth that needed repair or replacement. The DPBRN is a consortium of dental practitioners and dental organizations in the United States and Scandinavia. The collected data included the primary reason for repair or replacement, tooth surface or surfaces involved, restorative materials used and patients' demographic information. Results P-Is collected data regarding 9,484 restorations from 7,502 patients in 197 practices. Seventy-five percent (7,073) of restorations were replaced and 25 percent (2,411) repaired. Secondary caries was the main reason (43 percent, n = 4,124) for treatment. Factors associated with a greater likelihood of repairing versus replacing restorations ( P N/A .05) included having graduated from dental school more recently, practicing in a large group practice, being the dentist who placed the original restoration, patient's being of an older age, the original restorative material's being something other than amalgam, restoration of a molar and the original restoration's involving fewer tooth surfaces. Conclusions DPBRN Dentists were more likely to replace than to repair restorations. Secondary caries was the most common reason for repairing or replacing restorations. Certain dentist-, patient- and restoration-related variables were associated with the repair-or-replace decision. Clinical Implications The selection of minimally invasive treatment for an existing restoration is critical, as it may affect the longevity of the tooth.
Marko Vujicic - One of the best experts on this subject based on the ideXlab platform.
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rethinking dentist shortages
Journal of the American Dental Association, 2015Co-Authors: Marko VujicicAbstract:W ith the US health care system in the midst of a major transition spurred on by the Affordable Care Act, there is renewed debate over health workforce policy issues. One key question is whether the United States will face physician, nurse, and other health care provider shortages as health insurance coverage expands and several health care occupations experience aging and other demographic transitions. Dentistry is part of this debate. Much has been written over the years— empirical research, anecdote, and commentary—on whether the United States is facing, or will face, a dentist shortage. I classify this as one of those “soap opera” topics in health policy: You can tune out for several years, and when you return you realize you have not missed much of the plot. Assessing the current and future adequacy of the dentist workforce is both conceptually and empirically challenging. It requires modeling labor market choices of Dentists, dental school enrollment levels, and demand for dental care. It also requires a good understanding of barriers to dental care on the part of the population—what economists would call demand-side behavior. This brings me to a new analysis of the future supply of and future demand for Dentists released by the Health Resources and Services Administration (HRSA) in March. This analysis models the future supply of and demand for Dentists through 2025. The analysis predicts that, nationally, increases in dentist supply will not meet the increases in demand for Dentists, leading to an exacerbation of the existing shortage. Furthermore, the analysis predicts that every state and the District of Columbia will experience a dentist shortage by 2025. HRSA needs to be commended for taking a leadership role in developing a sophisticated empirical simulation model that aims to predict demand for and supply of various types of health care professionals, including Dentists. The agency is taking considerable strides to expand data availability and research efforts in this critical area of health policy. However, there are several important aspects of HRSA’s dentist workforce projections that merit discussion. The modeling of dentist supply, overall, is sound and empirically grounded. HRSA’s model predicts a rising supply of Dentists. The American Dental Association Health Policy Institute recently developed a sophisticated empirical model to predict the future supply of Dentists, and the analysis also predicts a rising supply of Dentists. Although there is no way to make an apples-to-apples comparison between the two models, both give the same big picture conclusion: there will be more Dentists in the market in the coming years. HRSA’s demand modeling is where there are some larger issues. The analysis, in my view, is based on assumptions that are inconsistent
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an analysis of Dentists incomes 1996 2009
Journal of the American Dental Association, 2012Co-Authors: Marko Vujicic, Vickie Lazar, Thomas P Wall, Bradley MunsonAbstract:Abstract Background The U.S. economy is beginning to recover from the most significant contraction since the Great Depression. Several sectors, including dentistry, have experienced reduced consumer demand and reduced earnings. Focusing on general practitioners, the authors analyzed trends in various factors that drive Dentists' income to identify which of these factors are most important in explaining the recent decline. They then offer their views on future trends in Dentists' net income levels. Methods The authors used data from a nationally representative survey of Dentists maintained by the American Dental Association (ADA) and data from the Agency for Healthcare Research and Quality's Medical Expenditure Panel Survey to analyze trends in real gross billings per visit, rates of collection of gross billings, number of visits to a dentist, percentage of the population who visited a dentist, population to dentist ratio and average real practice expenses. Results The authors found that the recent decrease in Dentists' net income levels was driven primarily by a decrease in utilization of dental care on the part of the population. Moreover, this decline in dental care use, although most pronounced during the economic downturn, appeared to have started before the downturn began. This suggests that more factors than solely the economic recession are affecting changes in dental care utilization patterns. Conclusions The authors' findings suggest that average real net income for Dentists may not necessarily recover to prerecession levels once economic conditions in the United States improve. This finding, combined with the potential implications of health care reform for dentistry, causes the authors to believe the future prospects related to Dentists' net income levels remain uncertain.
