Managed care and dentistry: promises and problems.

At its inception in the mid-1950s, managed care held a number of promises for dental care providers and dental patients. Sometime during the development of managed care, however, many programs lost sight of the importance of provider equity. Using data from current programs, the authors contrast the original promises with the realities of managed care in dentistry.

Geriatric dentistry and prevention: research and public policy.

Changing demographics, including the increase in life expectancy and the growing numbers of elderly, has focused attention on the need for dental research activities to be expanded for geriatric dentistry. The elderly are at greater risk for oral disease, since gains in longevity result in more medically compromising conditions or systemic disease with oral manifestations. Also, as edentulism decreases and as more teeth are retained by the elderly, the pattern of oral diseases and the treatment of dental conditions will be altered. Barriers to self-care and professional care must be removed, and prevention and early intervention strategies must be formulated to reduce the risk of oral disease. Risk factors for oral diseases in the elderly can be reduced by personal home-care regimens, professionally provided preventive, diagnostic, and therapeutic care, changes in high-risk behavior, and a supportive environment. Generating new information about the prevention of oral diseases and conditions that have an impact on the elderly requires a substantial research effort. A research agenda for the elderly should include: epidemiologic studies of relevant oral diseases and related risk factors; investigations of patient and provider attitudes and behavior related to oral health; studies of the relationship between general health and oral health; development and testing of preventive and treatment strategies for conditions such as xerostomia, root caries, secondary caries, and gingival recession; and studies for the evaluation of the impact of the aging population on the dental delivery system. Public policy options to support geriatric oral health care and research are limited by the Government's pre-occupation with cost containment and the lack of visibility for dental programs.(ABSTRACT TRUNCATED AT 250 WORDS)

Advances in the epidemiological study of oral-facial diseases.

Both demographic patterns and disease distribution are changing rapidly in the United States. These developments have led to the recognition that the epidemiology of many conditions is poorly understood, and that other research has thus been hindered. Four areas of epidemiological study were chosen for detailed analysis of how new technology will affect the conduct of future research. These areas, selected because information about them will be increasingly needed in an aging society, were periodontitis, temporomandibular disorders (TMD) and other orofacial pain, salivary gland disturbances, and health services research. The potential effect of new technology was examined in the short, intermediate, and long term. While the nature of epidemiological study is unlikely to change with the advent of new technology, the scope of potential studies will become broader. Advances in diagnostic techniques from elsewhere will permit far more precise diagnosis than is possible at present. Computer technology will permit an efficient system of epidemiological surveillance to provide current data on trends in tooth loss, caries, and periodontitis--data which will complement the results of national surveys. Analytical studies to produce hypotheses on the etiology of oral conditions, especially in such poorly-understood areas as chronic pain and TMD, will help direct clinical research in those areas.

A children's oral health status index based on dentists' judgment.

The children's oral health status index was developed as an integrated measure for the direct appraisal of pediatric patient populations in private practices, dental clinics, or school programs. The index is derived from a paired preference experiment with five pedodontists and five general dentists acting as judges of oral health in 200 case comparisons. Four easily measured variables are united numerically by the index: decayed teeth, occlusion, tooth position, and missing teeth (which have not been exfoliated). Clinical applications of the index in three geographic areas have all had good results.

Changes in personality among male and female dental graduates.

This study examines changes in personality traits in male and female dental students and recent graduates. The Comrey Personality Scales were administered to two freshman classes, and the test was readministered two months after graduation for one class and twenty-six months after graduation for the other class. Sex. class, and test/retest scores were analyzed using a three-way analysis of variance with repeated measures for each scale. Significant test/retest differences consisted of increases on the Orderliness versus Lack of Compulsion Scale and Conformity versus Rebelliousness Scale and a decrease on the Activity versus Lack of Energy Scale. There were significant sex differences on the Activity versus Lack of Energy, Emotional Stability versus Neuroticism, and Masculinity versus Femininity Scales; a decrease on the Empathy versus Egocentrism Scale occurred among females in one of the classes. Dental students became increasingly more orderly and identified with established social values; they also became less competitive and less driven to excel. The dental school experience may partially explain these changes; however, other conditions, such as maturation and societal influences, may have been involved.