A comparison of dental hygienists' salaries to state dental supervision levels.

PURPOSE: The purpose of this study is to evaluate the effect of dental supervision on registered dental hygienists' salaries in the 50 states and District of Columbia by comparing the average dental hygiene salaries from the largest metropolitan city within each state from May 2011, the most recent valid data, in relation to the required level of dental supervision. METHODS: A retrospective contrasted-group quasi-experimental design analysis was conducted using the most current mean dental hygiene salaries for the largest metropolitan city within each state and the District of Columbia which was matched to the appropriate dental supervision level. In addition, a dental assisting salary control group was utilized and correlated to the appropriate dental hygienist salary in the same metropolitan city and state. Samples were obtained from the U.S. Department of Labor. A multivariate analysis of variance (MANOVA) statistical analysis was utilized to assess the relationship of the 5 levels of dentist supervision, with the registered dental hygienist salaries. The MANOVA analysis was also utilized to assess the control group, dental assistant salaries. RESULTS: No statistically significant results were found among the dental supervision levels on the measures of dental hygiene salaries and dental assistant salaries. Wilks's Λ=0.81, F (8, 90)=1.29, p=0.26. Analyses of variances (ANOVA) on the dependent variables were also conducted as follow-up tests to the MANOVA. CONCLUSION: Study results suggest dental hygienists who are required to have a dentist on the premises to complete any dental treatment obtain similar salaries to those dental hygienists who are allowed to work in some settings unsupervised by a dentist. Therefore, dental supervision does not seem to have an impact on dental hygienists' salaries.

A randomized trial on simplified and conventional methods for complete denture fabrication: cost analysis.

PURPOSE: This study aimed to quantify the costs of complete denture fabrication by a simplified method compared with a conventional protocol. MATERIALS AND METHODS: A sample of edentulous patients needing conventional maxillary and mandibular complete dentures was randomly divided into group S, which received dentures fabricated by a simplified method, and group C, which received conventionally fabricated dentures. We calculated direct and indirect costs for each participant including unscheduled procedures. This study assessed 19 and 20 participants allocated into groups S and C, respectively, and comparisons between groups were conducted by the Mann-Whitney and Student's t-test (α = 0.05). RESULTS: Complete denture fabrication demanded median time periods of 173.2 and 284.5 minutes from the operator for groups S and C respectively, and 46.6 and 61.7 minutes from the dental assistant (significant differences, p < 0.05). There was no difference between groups regarding postinsertion adjustments. Group S showed lower values for costs with materials and time spent by patients than group C during the fabrication stage, but not during adjustments. CONCLUSIONS: The median direct cost of complete denture treatment was 34.9% lower for the simplified method. It can be concluded that the simplified method is less costly for patients and the health system when compared with a conventional protocol for the rehabilitation of edentulous patients.

The management of dental caries in primary teeth - involving service providers and users in the design of a trial.

BACKGROUND: There is a lack of evidence for the effective management of dental caries in children's primary teeth. The trial entitled 'Filling Children's Teeth: Indicated Or Not?' (FiCTION) was designed to examine the clinical and cost effectiveness, in primary dental care, of three different approaches to the management of caries in primary teeth. However, before the FiCTION main trial commenced, a pilot trial was designed. Service provider (dentists and other members of the team including dental nurses and practice managers) and participant (child participants and their parents) involvement was incorporated into the pilot trial. The aim of this study is to describe service providers' and users' perspectives on the pilot trial to identify improvements to the conduct and design of the FiCTION main trial. METHODS: Qualitative interviews (individual and group) were held with dentists, dental team members, children and parents involved in the FiCTION pilot trial. Individual interviews were held with four dentists and a group interview was held with 17 dental team members. Face-to-face interviews were held with four parents and children (four- to eight-years old) representing the three arms of the trial and five telephone interviews were conducted with parents. All interviews were transcribed verbatim. Framework analysis was used. RESULTS: Overall, service providers, children and parents found the pilot trial to be well conducted and an interesting experience. Service providers highlighted the challenges of adhering to research protocols, especially managing the documentation and undertaking new clinical techniques. They indicated that the time and financial commitments were greater than they had anticipated. Particular difficulties were found recruiting suitable patients within the timeframe. For parents recruitment was apparently more related to trusting their dentist than the content of information packs. While some of the older children understood what a study was, others did not understand or were not aware they were enrolled. CONCLUSIONS: The findings provided valuable recommendations to improve the method of recruitment of dental practices and patients, the timing and content of the training, the type of support dentists would value and ways to further engage children and parents in the FiCTION main trial. TRIAL REGISTRATION: ISRCTN77044005.

The past and future evolution of the dental workforce team.

This article looks at changes in the number and mix of providers in the dental workforce over the past sixty years. First, enrollment trends in dental education programs are investigated. These educational programs feed directly into the dental workforce. Then, the changes in the dental workforce are examined. The focus of this investigation is the composition of the dental workforce and how the components of the workforce have changed over time. The forces that are responsible for these changes in the workforce are explored next. Finally, the possibility for workforce changes in the future is considered.

The impact of General Dental Council registration and continuing professional development on UK dental care professionals: (1) dental nurses.

OBJECTIVE: To investigate the impact of GDC registration and mandatory CPD on dental nurses' views, job satisfaction and intention to leave. DESIGN: Postal/online survey, conducted in parallel with a survey of dental technicians. SETTING: UK private and NHS practices, community services, dental hospitals. SUBJECTS AND METHODS: Representative sample of General Dental Council registrants. MAIN OUTCOME MEASURES: Job satisfaction; intention to leave profession (dependent variable in regression analysis). RESULTS: Eleven were ineligible (left profession, moved abroad); 267 (44% of those eligible) responded, all female. Respondents' mean age was 38.2 years (sd 10.74). The general principle of registration was endorsed by 67%, and compulsory registration by 51%, but the fee level by only 6%. Most nurses did not feel that registration had affected their view of dental nursing as a career (56%), their role (74%) or status (86%) within the dental team, or that CPD helped them to do their job better (76%). Fifty-six percent were not satisfied with their job, and 22% intended to leave the profession. Intention to leave was predicted by younger age and greater dissatisfaction with physical working conditions and opportunities to progress. CONCLUSIONS: Widely held criticisms regarding the costs and relevance of registration and CPD coupled with a potentially high level of attrition from the profession suggest a review of the fee and salary structure and greater financial support for CPD is warranted.

Economic feasibility of alternative practitioners for provision of dental care to the underserved.

This study assesses the viability of three alternative practitioner types for provision of dental care to the underserved. Key factors modeled include compensation, training and practice costs, productivity, and payer mix scenarios. Utilizing dental therapists or dental health aide therapists is cost-effective for enhancing access. However, to be sustainable, the practices will require a subsidy or a better reimbursement than modeled. Without tuition support, the debt burden will deter applicants mostlikely to treat the underserved.

Is skill mix profitable in the current NHS dental contract in England?

The use of skill mix in medicine is now widespread, yet it appears that its use in dentistry is not as prominent. Unlike doctors, dentists are required to mitigate the financial risk produced by their capital investment and ensure an adequate cash flow to cover their annual running costs. Examining the financial incentives for employing dental care professionals is therefore an important step to understand why dentistry appears to lag behind medicine in skill mix. It is also apposite, given the announcement of the coalition government to develop a new contract, which could introduce incentives for the use of dental care professionals in this way. The purpose of this short paper is to examine whether skill mix is profitable for general dental practices under the existing NHS contract in England.

How do we measure shortages of dental hygienists and dental assistants? Evidence from California: 1997-2005.

BACKGROUND: The authors examined the labor market for registered dental hygienists (RDHs) and dental assistants (DAs) in California from 1997 to 2005 to determine whether there was a shortage in either market. METHODS: This analysis used economic indicators interpreted within an economic framework to investigate trends in labor force numbers and market-determined wages for RDHs and DAs. Rising inflation-adjusted mean wages indicated a labor shortage, while declining inflation-adjusted mean wages indicated a labor surplus. RESULTS: From 1999 to 2002, the wages for RDHs increased 48 percent and then stabilized, indicating a shortage had occurred, after which the market achieved equilibrium. Wages for DAs increased 13.9 percent from 1997 to 2001, but then declined from 2001 to 2005, indicating a shortage that then became a surplus. The market for DAs may not have stabilized. CONCLUSIONS: Wages increased for RDHs and DAs, suggesting that labor shortages occurred in both markets. The large supply response in the market for DAs resulted in wages declining after their initial rise. PRACTICE IMPLICATIONS: Tracking the local labor markets for RDHs and DAs will enable dental professionals to respond more efficiently to market signals.

Economic evaluation of a risk-based caries prevention program in preschool children.

We have previously reported that, in young children, a risk-based caries prevention program compared with conventional prevention has a good caries-preventive effect. The present study aimed to assess the economic aspects of this program. We used the presence of mutans streptococci in plaque (Dentocult-SM) and/or the presence of incipient carious lesions at 2 years of age for risk assessment, and measured the outcome of caries (yes/no) at the age of 5 years. Dental assistants carried out the screening and preventive work. The economic analysis included the actual running costs of the program during the 3-year follow-up based on the time spent on dental visits. The costs per child per 3 years were significantly lower in the risk-based group (54 euros) than in the conventional prevention group (69 euros) (Student's t test, P = 0.004). If a dentist with an assistant had done all the work, the costs would have been twice as high. Compared to conventional prevention, the results suggest that risk-based prevention can be effective in reducing both costs and dental caries in preschool children, provided that the screening and preventive measures are delegated to preventive dental assistants.