Dental corporates abroad and the UK dental market.

The UK government opened NHS dentistry to competition in 2006. By 2015-2016 just over three quarters of NHS contracts were held by non-corporate providers with corporate contracts, on average, having a lower £:UDA (unit of dental activity) value and higher UDA targets than non-corporate contracts. The corporate market share continues to expand through inorganic and organic growth and new financial backers are entering the arena. It is not known how these changes will affect the profession though inspiration can be drawn from overseas markets. In this article I aim to provide an overview of the dental corporate market in the USA and Australia as well as some insight as to how the sector stands in England.

Barriers to sealant guideline implementation within a multi-site managed care dental practice.

BACKGROUND: The purpose of this study was to identify barriers frequently endorsed by dentists in a large, multi-site dental practice to implementing the American Dental Association's recommendation for sealing noncavitated occlusal carious lesions as established in their 2016 pit-and-fissure sealant clinical practice guideline. Although previous research has identified barriers to using sealants perceived by dentists in private practice, barriers frequently endorsed by dentists in large, multi-site dental practices have yet to be identified. Identifying barriers for these dentists is important, because it is expected that in the future, the multi-site group practice configuration will comprise more dental practices. METHODS: We anonymously surveyed the 110 general and pediatric dentists at a multi-site dental practice in the U.S. The survey assessed potential barriers in three domains: practice environment, prevailing opinion, and knowledge and attitudes. Results were summarized using descriptive statistics. RESULTS: The response rate to the survey was 62%. The principal barrier characterizing the practice environment was concern regarding liability; endorsed by 33% of the dentists. Many barriers of prevailing opinion were frequently endorsed. These included misunderstanding the standard of practice (59%), being unaware of the expectations of opinion leaders (56%) including being unaware of the guideline itself (67%), and being unaware of what is currently being taught in dental schools (58%). Finally, barriers of knowledge and attitudes were frequently endorsed. These included having suboptimal skill in applying sealants (23% - 47%) and lacking knowledge regarding the relative efficacy of the different ways to manage noncavitated occlusal carious lesions (50%). CONCLUSIONS: We identified barriers frequently endorsed by dentists in a large, multi-site dental practice relating to the practice environment, prevailing opinion, and knowledge and attitudes. All the barriers we identified have the potential to be addressed by implementation strategies. Future studies should devise and test implementation strategies to target these barriers.

[A woman at the chair is nothing out of the ordinary. Dental practice by female dentists in the Netherlands.] / Een vrouw aan de stoel is heel gewoon. De beroepsuitoefening van vrouwelijke tandartsen in Nederland.

Women currently make up 40% of the dentist population in the Netherlands. On the basis of enrolment in educational programmes their share can be expected to grow to more than half. The literature shows gender differences in preferences regarding work setting and duration of the working week. Men and women also differ from each other with respect to the way dental care is provided. The presented data demonstrate an increase in the number of women working in dentistry and research data have confirmed the presumed differences between male and female dentists. Women are less likely to be the owner of a practice, women who do own a practice are more likely to collaborate with colleagues and have a shorter working week. With regard to providing dental care, women seem to be slightly more orientated to the individual patient and are more likely to pay attention to the patient's general health. Theories about work values provide explanations for these gender differences. Women's preference for collaboration accords with the general development in dental care to work in teams.

Dental Management Survey Brazil (DMS-BR): creation and validation of a management instrument

Questionnaires for the assessment of knowledge and self-perception can be useful to diagnose what a dentist knows about management and administration. The aim of the present study was to create and validate the Dental Management Survey Brazil (DMS-BR) scale, based on meetings with experts in the field. After having elaborated the first version, 10 audits were performed in dental offices in order to produce the final version, which included nine dimensions: location, patient, finance, marketing, competition, quality, staff, career, and productivity. The accuracy of the instrument was measured by intrarater and interrater reliability. In the validation phase, 247 Brazilian dentists answered a web-based questionnaire. The data were processed using Stata 13.0 and the significance level was set at 95%. The instrument had intrarater and interrater reliability (ICC-0.93 and 0.94). The overall average of respondents for the DMS-BR scale was 3.77 (SD = 0.45). Skewness and kurtosis were below absolute values 3 and 7, respectively. Internal validity measured by Cronbach's alpha was 0.925 and the correlation of each dimension with the final result of the DMS-BR ranged between 0.606 and 0.810. Correlation with the job satisfaction scale was 0.661. The SEM data ranged between 0.80 and 0.56. The questionnaire presented satisfactory indicators of dentists' self-perception about management and administration activities.

Dental Practice as the Population Demographics Change in Massachusetts.

General population demographics in the United States, individual states, and counties are undergoing dramatic changes. Long-term customary populations, which provided the bulwark for many successful dental practices, are being replaced by the many minority populations (in particular, the Hispanic population), foreign-born residents, and many for whom English may not be their first language. These developments are reviewed for the Commonwealth of Massachusetts and its counties in an effort to challenge practitioners by the extent of these developments.

Dental therapy practice patterns in Minnesota: a baseline study.

OBJECTIVES: A chronic shortage of dentists, the importance of oral health, and the lack of access to care led to the introduction of a new oral health practitioner in Minnesota, the dental therapist. Dental therapy graduates from the University of Minnesota have been in practice since 2012. To date, there has been no formal study of how they have been incorporated into dental practice. The purpose of this study was to obtain baseline knowledge of dental therapists' practice patterns in Minnesota and determine if dentists' patterns of work changed after a dental therapist was employed. METHODS: Four dental practices were sampled purposefully to obtain various practice types and geographic locations within Minnesota. Secondary data were collected from practice management software databases in each practice between January-March, 2015. Data were used to describe the work undertaken by dental therapists, the types of patients seen and payer mix. Additionally, data from 6 months before and after employment of the dental therapist were collected to determine whether dentists' practice patterns changed after a dental therapist was employed. RESULTS: Dental therapists were employed full-time, seeing an average of 6.8 patients per day. No distinct pattern emerged with regard to ages of patients seen by dental therapists. Dental therapists saw up to 90% of uninsured patients or patients on public assistance. Restorative services across practices comprised an average of 68% of work undertaken by dental therapists. Dentists delegated a full range of procedures within the dental therapy scope of practice indicating trust and acceptance of dental therapists. Dentists in two practices began to take on more complex dental procedures after a dental therapist joined the practice. CONCLUSION: Dental therapists are treating a high number of uninsured and underinsured patients, suggesting that they are expanding access to dental care in rural and metropolitan areas of Minnesota. Dentists appear to have an adequate workload for dental therapists and are delegating a full range of procedures within their scope of practice. Dentists performed fewer restorative and preventive procedures after a DT was hired.

New York State Dental Establishments and Dentists: 2007-2012. Economic Survey.

Every five years a series of studies is carried out by the Census Bureau which provides an opportunity to review the basic economic well-being of the many industries at the national, state and county levels. A comparison of dental economic data from the 2007 and 2012 studies for the period that encompassed the 2007-2009 "Great Recession" details the general economic difficulties faced by the dental profession during this period.

[Prevention and Information for Patients Undergoing Periodontal Treatment: Potentials for Improvement from the Patients' Perspective]. / Prävention und Aufklärung im Rahmen der Parodontitisbehandlung: Verbesserungspotenziale aus Patientensicht.

2 334 patients from 29 dental practices took part in a written survey on their experiences with dental treatment in general as well as treatment of periodontal disease (response rate 80.8%). 72.6% of all participating patients fully agreed that they could recommend their dentist to their friends. 63.6% of patients undergoing treatment of periodontitis (N=328) rated this treatment as "excellent". However, for important aspects (prevention, patient information, treatment) potentials for improvement became obvious. 43.7% of patients treated for periodontitis were not completely satisfied with information on how this disease develops; 40.7% saw potentials for better information on preventive care (dental-hygiene, nutrition). An even higher percentage of patients actually not treated for periodontitis was interested in more information on prevention (51.4%). The results of the survey show that dentists should offer information and exercise on how to prevent periodontal desease more actively. There is a lack of research on the present state of affairs and potentials for improvement concerning treatment and prevention of periodontitis including the patients' perspective.

Practice settings and dentists' job satisfaction.

BACKGROUND: The nature and organization of dental practice is changing. The aim of this study was to explore how job satisfaction among dentists is associated with dental practice setting. METHODS: A survey measured satisfaction with income, benefits, hours worked, clinical autonomy, work-life balance, emotional exhaustion, and overall satisfaction among dentists working in large group, small group, and solo practice settings; 2,171 dentists responded. The authors used logistic regression to measure differences in reported levels of satisfaction across practice settings. RESULTS: Dentists working in small group settings reported the most satisfaction overall. Dentists working in large group settings reported more satisfaction with income and benefits than dentists in solo practice, as well as having the least stress. CONCLUSIONS: Findings suggest possible advantages and disadvantages of working in different types of practice settings. PRACTICAL IMPLICATIONS: Dentists working in different practice settings reported differences in satisfaction. These results may help dentists decide which practice setting is best for them.

The relationship between altruistic attitudes and dentists' Medicaid participation.

BACKGROUND: The authors investigated the role of private practitioners in the dental safety net, including the provision of care for Medicaid enrollees and attitudinal factors that affect participation. METHODS: In 2013, the authors sent a mixed-mode survey to all general dentists in Iowa assessing their current Medicaid participation and factors affecting participation, including attitudinal statements about altruism, the Medicaid program, and the government's role in providing access to dental care. RESULTS: Fifty-six percent of responding dentists accepted new Medicaid-enrolled patients; dentists living in nonmetropolitan areas were significantly more likely to accept Medicaid than were those in metropolitan areas. Results from a logistic regression model demonstrated that participating dentists scored significantly higher in altruistic attitudes and perceived problems with Medicaid as less important. CONCLUSIONS: Dentists who accepted Medicaid-enrolled patients had significantly more positive attitudes about Medicaid administration and altruistic attitudes in general. Investigators in future studies should examine how these attitudes are shaped by educational and professional experiences. PRACTICAL IMPLICATIONS: Dentists' perceptions about Medicaid potentially are modifiable by changing program policies in ways to improve access for vulnerable populations, including new Medicaid enrollees.

Massachusetts dental establishments in 2011: after the last recession.

Census Bureau reports for 2007 and 2011 (before and after the last recession) were used to develop data for "average" dental establishments in the counties of Massachusetts. Any changes should be considered while bearing in mind the American Dental Association (ADA) 2013 report indicating that spending for dental services has stagnated. In terms of these findings, the need for continued monitoring of dental establishment activities beyond the confines of one's own facility is emphasized.

New York State after last recession. Dentists and dental establishments.

Data from the U.S. Census Bureau and the New York State Office of the Professions indicate an increase in emigration and immigration, resulting in slowing in the overall growth of New York State's population, with accompanying modifications in the numbers of dentists and dental establishments in state counties. In addition, ADA data suggest that per capita dental spending has not rebounded since the end of the last recession. While there have been many changes at the county level, there does not seem to have been dramatic changes in the overall state numbers of dental practitioners and establishments through the early years of the current decade.

Peri-implantitis prevalence and treatment in implant-oriented private practices: a cross-sectional postal and Internet survey.

This survey aimed to estimate the subjective prevalence of peri-implantitis and its management in the private with and without board certified specialization. For this purpose, a cross-sectional postal and internet survey of 521 dentists, representing all members of the Swiss Society of Oral Implantology (SGI) was conducted (year 2010). The questionnaire consisted of four sections assessing 1) general information regarding the practice setting and education, 2) general questions regarding implantation profile and 3) specific questions regarding the prevalence and experience with the management of peri-implantitis. In the fourth section, therapy options of three exemplary cases were assessed. The data were separately evaluated and compared for specialists (S) and n₋specialists (N-S). A total of 253 questionnaires could be included in the present study. The results revealed that specialists placed significantly more implants than non-specialists. The subjective prevalence of cases with peri₋implantitis was 5-6 and 7-9% after 5 and 10 years, respectively. The polled dentists perceived periodontitis (N-S: 72%; S: 80%), smoking (N-S: 71; S: 77%) and bad compliance (S: 53; N-S: 61%) as the most important risk factors for peri-implantitis. Chlorhexidine was the most frequently used antiseptic agent for disinfection. A surgical approach to treat peri-implantitis was reported by more than 80% of all dentists. Specialists used significantly more resective or regenerative approaches than non-specialists.