A Workforce Strategy for Reducing Oral Health Disparities: Dental Therapists.

This article seeks to chronicle how dental therapists are being used to bolster the supply of providers for the underserved and explore their potential to diversify the field of dentistry and improve public health. Of the factors that contribute to persistent oral health disparities in the United States, an insufficient oral health workforce figures prominently. A growing number of states are authorizing a midlevel dental provider (often called a dental therapist) to address this problem. Dental therapists work under the supervision of dentists to deliver routine preventive and restorative care, including preparing and filling cavities and performing extractions. They can serve all populations in 3 states, are caring for Native Americans in an additional 3 states under federal or state authority, and are being considered in about a dozen state houses.

Dental manpower in India: changing trends since 1920.

AIM: To analyse the changing trends in dental manpower production of India since 1920 and its development to date. METHODS AND MATERIAL: The databases consulted were those provided by the Central Bureau of Health Intelligence, Dental Council of India, and Ministry of Health and Family Welfare. STATISTICAL ANALYSIS USED: Descriptive statistics. RESULTS: In India, dental education was formally established in 1920 when the first dental college was started. Current data revealed that there are 301 colleges nationwide granting degrees in dentistry, with a total of 25,270 student positions offering annually. Both the distribution of dental colleges and of dentists varies among the regions of the country with the greatest concentration in major urban areas, resulting in limited coverage in rural regions. CONCLUSIONS: The current scenario indicates that there is lack of systematic planning in the allocation and development of dental colleges in India.

Workforce skill mix: modelling the potential for dental therapists in state-funded primary dental care.

BACKGROUND: South Central Strategic Health Authority [SHA], with a population of four million, is one of 10 regions of England with responsibility for workforce planning. AIM: To explore future scenarios for the use of the skill mix within the dental team to inform the commissioning of dental therapy training. METHOD: Data on population demography, oral health needs and demands, dental workforce, activity and dental utilisation were used to create demand (needs-informed) and supply models. Population trends and changing oral health needs and dental service uptake were included in the demand model. Linear programming was used to obtain the optimal make-up of the dental team. Based on the optimal scenario, workforce volumes and costs were examined across a range of scenarios up to 2013. RESULTS: Baseline levels of dental therapists were low and estimated as only achieving 10-20% of the current potential job competency. The optimal exploratory scenario in terms of costs and volume of staff was based on dental therapists working full time and providing 70% of routine care that is within their current job competency; this scenario required 483 therapists by 2013, a figure that appeared achievable. Increasing the level of job competency provided by therapists revealed potentially higher benefits in terms of reduced cost and requiring fewer dentists. CONCLUSION: The findings suggest that dental therapists can play a more significant role in the provision of primary dental care, both currently and in future; they also highlight the need for health services to routinely collect data that can inform workforce analysis and planning.

Status of the dental health care workforce in Shanghai, China.

OBJECTIVES: The status of the dental health care workforce in Shanghai was investigated in order to support and improve regional planning of this workforce. METHODS: Questionnaires were used to survey all dental medical units in Shanghai. Data were collected on the quantity, structure and levels of dental health personnel. RESULTS: A total of 852 dental medical units and 3,218 dentists were identified in Shanghai. The ratio of dentists to population is 1 : 5,201. CONCLUSIONS: Presently, the total dental health workforce in Shanghai is relatively sufficient, but its distribution is inequitable because there are fewer dental health personnel employed in the suburbs. Moreover, the structure of the dental health workforce in Shanghai is inequitable and specialists in preventive dentistry are lacking. The results of this study can be applied to help Shanghai achieve the rational distribution and efficient utilisation of the dental health workforce available.

Influence of private practice employment of dental therapists in Saskatchewan on the future supply of dental therapists in Canada.

The profession of dental therapy has long been held up as a model for reducing access to care barriers in high-risk, underserved populations worldwide. Dental therapists practice in many countries delivering preventive and basic restorative care to children and adults. In North America, dental therapy education and practice date back to 1972 with the establishment of training programs at the National School of Dental Therapy in Fort Smith, Northwest Territories, and the Wascana Institute of Applied Arts and Science in Regina, Saskatchewan, as a means of reducing access to care barriers in Canada's northern territories and to implement the Saskatchewan Health Dental Plan, respectively. At present, dental therapy in North America has reached a crossroads: in the United States, the profession is cautiously being explored as a solution for improving access to care in at-risk populations. In 2011, Canada's sole training program, the National School of Dental Therapy in Prince Albert, Saskatchewan, closed when the federal government eliminated its funding. This article examines the impact of private practice employment of dental therapists in Saskatchewan on the supply of dental therapist human resources for health in Canada's three northern territories (Northwest Territories, Nunavut, and Yukon), its role in the closure of the National School of Dental Therapy in 2011, and ramifications for the future of dental therapy in Canada.

The impact of additional dental providers in the dental labor market on the income of private practice dentists.

This study estimates the impact that the entrance of hypothetical allied dental professionals into the dental labor market may have on the earnings of currently practicing private practice dentists. A simulation model that uses the most reliable available data was constructed and finds that the introduction of hypothetical allied dental professionals into the competitive California dental labor market is likely to have relatively small effects on the earnings of the average dentist in California.

The changing complexity of geriatric health care and the implications for oral health care for the individual and community.

Geriatric healthcare has already changed. We are living longer and we are enduring those additional years with more severe chronic disease and a greater number of chronic diseases. Current mechanisms to improve oral health care for individuals and the community are considered in this paper. We are still yet to measure the effectiveness of these changes. Even more complex is the confusion and conjecture about what we should be measuring and whether what we measure actually has an impact on the quality of life.

Is general dentistry dead? How mid-level dental providers will affect the profession.

The rhetoric concerning mid-level providers and their impact on general dental practice is building in intensity. This is a complex issue and there is no clear picture of either the benefits or dangers to the public of such a delivery model, whether such plans are economically sustainable, or the role of general dentists in the configuration of future practices. The opinions of a representative sample of thinkers from various perspectives are sampled.

CDHC, a possible change agent promoting access to care.

Access to oral health care has been a topic of concern among dental and community health professionals in the United States for some time. The American Dental Association is piloting a new program aimed at expanding the current dental health workforce and alleviating some of the problems associated with access to care. This paper explores the potential benefits of the community dental health coordinator program while examining some of the lessons learned in its initial implementation in Oklahoma.

Getting help for children: the need to expand the dental workforce.

Millions of children in America suffer from poor oral health due to lack of access to dental care. The landmark U.S. Surgeon General's Report in 2000 highlighted significant disparities, yet poor oral health remains an epidemic. America's system of delivering dental care is poorly equipped to address access disparities. However, opportunities abound to improve access and expand the dental workforce. Creative thinking and innovative solutions are needed to expand care to children in need.

The policy context for skill mix in the National Health Service in the United Kingdom.

Workforce planning is essential if the future capacity of a state funded system and the supply of clinicians is to match the future need for care. Important aspects of this process are exploring the influences on productivity and the level of service that is necessary for a state funded system. Labour substitution has a direct impact upon the productivity of the workforce, yet the use of skill mix in dentistry is an area where the dental profession has lagged behind their medical colleagues. This brief paper explores the policy context for labour substitution, highlighting key barriers to its integration, potential drivers for change and future areas for research.

Global oral health of older people--call for public health action.

BACKGROUND: The aim of this report is (1) to provide a global overview of oral health conditions in older people, use of oral health services, and self care practices; (2) to explore what types of oral health services are available to older people, and (3) to identify some major barriers to and opportunities for the establishment of oral health services and health promotion programmes. METHODS: A postal questionnaire designed by the World Health Organization (WHO) was distributed worldwide to the Chief Dental Officers or country oral health focal points at ministries of health. WHO received 46 questionnaires from countries (39% response rate). In addition, systematic data were collected from the WHO Global Oral Health Data Bank and the World Health Survey in order to include oral health information on the remaining countries. In total, the data base covers 136 out 193 countries, i.e., 71% of all WHO Member States. RESULTS: Dental caries and periodontal disease comprise a considerable public health problem in the majority of countries. Significant disparities within and between regions are observed in epidemiologic indicators of oral disease. The prevalence rates of tooth loss and experience of oral problems vary substantially by WHO Region and national income. Experience of oral problems among older people is high in low income countries; meanwhile, access to health care is poor, in particular in rural areas. Although tooth brushing is the most popular oral hygiene practice across the world, regular tooth brushing appears less common among older people than the population at large. In particular, this practice is less frequent in low income countries; in contrast, traditional oral self-care is prevalent in several countries of Africa and Asia. While fluoridated toothpaste is widely used in developed countries, it is extremely infrequent in most developing countries. Oral health services are available in developed countries; however, the use of such services is low among the older people. Lack of financial support from government and/or lack of third party payment systems render oral health services unaffordable to them. According to the country reports, health promotion programmes targeting older people are rare and this reflects the lack of oral health policies. Although some countries have introduced oral health promotion initiatives, worldwide there are few population-oriented preventive or curative activities currently implemented that focus specifically on the elderly. Barriers to the organization of such programmes relate to weak national health policy, lack of economic resources, the impact of poor oral health, and lack of tradition in oral health. Opportunities for oral health programmes for old-age people are related to updated information on the burden of oral disease and need for care, fair financing of age-friendly primary health care, integration of oral health into national health programmes, availability of oral health services, and ancillary personnel. CONCLUSION: It is highly recommended that countries establish oral health programmes to meet the needs of the elderly. Relevant and measurable goals must be defined to direct the selection of suitable interventions to improve their oral health. The common risk factors approach must be applied in public health interventions for disease prevention. The integration of oral health into national general health programmes may be effective to improve the oral health status and quality of life of this population group.

Rural oral health workforce issues in NSW and the Charles Sturt University Dentistry Program.

Adequate numbers of dental, medical and allied health professionals in rural and regional areas of NSW are vital for the health of these populations and supporting local community structures and economies. Well-documented shortages of health professionals are a major social and political issue in rural and regional communities and this workforce shortfall is recognised by both the NSW Government State Plan and the State Health Plan. This paper outlines rural and regional dental workforce shortages in NSW and describes current rural oral health workforce initiatives, including the new Charles Sturt University Dentistry Program.

Allied dental personnel: will there be enough?

The escalating number and size of dental practices mean greater dependency on a ready supply of allied dental personnel. However, despite the increasing number of entry places in allied dental training programs, many places remain unfilled and large numbers of individuals do not complete the course of studies. A review of the changes in dental practice sizes and dental assistant, dental hygienist and dental laboratory technician programs raises concerns as to whether there will be enough allied dental personnel to meet the future needs of the profession. The need for increasing attention to this potential eventuality is stressed.

Emerging allied dental workforce models: considerations for academic dental institutions.

The U.S. surgeon general defined the national oral health care crisis in 2001 in Oral Health in America: A Report of the Surgeon General. The report concluded that the public infrastructure for oral health is not sufficient to meet the needs of disadvantaged groups and is disproportionately available depending upon certain racial, ethnic, and socioeconomic factors within the U.S. population. Now, several new workforce models are emerging that attempt to address shortcomings in the oral health care workforce. Access to oral health care is the most critical issue driving these new workforce models. Currently, three midlevel dental workforce models dominate the debate. The purpose of this report is to describe these models and their stage of development to assist the dental education community in preparing for the education of these new providers. The models are 1) the advanced dental hygiene practitioner; 2) the community dental health coordinator; and 3) the dental health aide therapist.

A national human resources plan for oral health: is it feasible?

UNLABELLED: The South African Department of Health has prepared "A National Human Resources Plan for Health". This plan proposes that the number of dentists produced annually be decreased from 200 to 120, the number of dental therapists increased from 25 to 600 and the number of oral hygienists from 70 to 150. OBJECTIVE: To assess the feasibility of this output plan. METHODS: This paper reviewed the national oral health status and needs, as well as the National Oral Health Strategy, and then assessed the appropriateness of the plan in relation to these findings. The current numbers of students in training and expected production over the next few years was analysed and the feasibility of the proposed production outputs against the current outputs. The current distribution of oral health personnel was also investigated. RESULTS: Substantial parts of the national oral health needs and strategy can be met and implemented by any of the three oral health professionals being trained. More than 80% of oral health professionals are urban-based and in the private sector. The current production of the five dental training institutions is about 320, compared to the proposed output of almost 900 in the plan. With institutions running at near full capacity, the proposed production numbers are not feasible in the short term. However a number of issues need further investigation: which oral health professional is best suited to meet the oral health needs of the population and implement the national oral health strategy, that will make a significant impact on the oral health of the population; how many oral health professional do we require and will the plan address issues of access to services and appropriateness (evidence-based, prevention bias) of care provided? CONCLUSION: There is a need for further investigation of the plan in consultation with all stakeholders, especially its cost implications and alternative strategies to reduce the incidence of oral diseases in the country.