Update on Electronic Dental Record and Clinical Computing Adoption Among Dental Practices in the United States.

This study sought to re-characterize trends and factors affecting electronic dental record (EDR) and technologies adoption by dental practices and the impact of the Health Information Technology for Economic and Clinical Health (HITECH) act on adoption rates through 2012. A 39-question survey was disseminated nationally over 3 months using a novel, statistically-modeled approach informed by early response rates to achieve a predetermined sample. EDR adoption rate for clinical support was 52%. Adoption rates were higher among: (1) younger dentists; (2) dentists ≤ 15 years in practice; (3) females; and (4) group practices. Top barriers to adoption were EDR cost/expense, cost-benefit ratio, electronic format conversion, and poor EDR usability. Awareness of the Federal HITECH incentive program was low. The rate of chairside computer implementation was 72%. Adoption of EDR in dental offices in the United States was higher in 2012 than electronic health record adoption rates in medical offices and was not driven by the HITECH program. Patient portal adoption among dental practices in the United States remained low.

Dental Group Practice and the Need for Dentists.

This study compared the number of patients treated per year by general dentists and dental hygienists in solo practice and by those employed by a large group practice. Information on the annual number of patient visits to solo general dental practitioners comes from the 2013 American Dental Association (ADA) Survey of Dental Practice. Patient visits were divided by 2.5 to estimate the number of patients treated annually. The data on group practices come from HealthPartners (HP) of Minnesota, a large not-for-profit medical and dental Health Maintenance Organization that accepts insurance contracts based on global budgets and is financially at risk. In 2013, solo general dentists averaged 1,350 patients, while the average HP general dentist treated 2,052 patients. HP general dentists thus treated over 700 more patients annually than did solo practitioners. This large difference has major implications for the future of the dental delivery system and dental education. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Practice Location Characteristics of Non-Traditional Dental Practices.

Current and future dental school graduates are increasingly likely to choose a non-traditional dental practice-a group practice managed by a dental service organization or a corporate practice with employed dentists-for their initial practice experience. In addition, the growth of non-traditional practices, which are located primarily in major urban areas, could accelerate the movement of dentists to those areas and contribute to geographic disparities in the distribution of dental services. To help the profession understand the implications of these developments, the aim of this study was to compare the location characteristics of non-traditional practices and traditional dental practices. After identifying non-traditional practices across the United States, the authors located those practices and traditional dental practices geographically by zip code. Non-traditional dental practices were found to represent about 3.1% of all dental practices, but they had a greater impact on the marketplace with almost twice the average number of staff and annual revenue. Virtually all non-traditional dental practices were located in zip codes that also had a traditional dental practice. Zip codes with non-traditional practices had significant differences from zip codes with only a traditional dental practice: the populations in areas with non-traditional practices had higher income levels and higher education and were slightly younger and proportionally more Hispanic; those practices also had a much higher likelihood of being located in a major metropolitan area. Dental educators and leaders need to understand the impact of these trends in the practice environment in order to both prepare graduates for practice and make decisions about planning for the workforce of the future.

An evaluation of CPD activity of dentists in Wales.

INTRODUCTION: Ongoing professional education is essential for dental professionals to maintain and update their clinical skills and knowledge. There is a current trend towards mandatory Continuing Professional Development (CPD) for dentists within Europe and beyond. Mandatory CPD will ensure high professional standards and enable mobilisation of the dental workforce within Europe. In 2002, the UK General Dental Council (GDC) implemented a system of mandatory CPD for dentists practicing in the UK. The Wales Deanery is situated in the School of Postgraduate Medical and Dental Education, Cardiff University. It provides verifiable CPD courses for dentists and dental care professionals (DCPs) currently practicing in Wales and has recorded professionals' attendance on these courses since 2001. The project aimed to investigate the CPD activity of dentists in Wales, using these data. METHODS: The Wales Deanery database holds data on the CPD courses undertaken by 1178 dentists working in Wales since 2001. A number of hypotheses were investigated using a variety of statistical methods. RESULTS: Dentists were undertaking significantly fewer hours of CPD in Mid and West Wales compared to the North and South of the principality. Sole practitioners were found to engage in less CPD than those in group practices, but these differences did not reach statistical significance. Dentists who employed a hygienist or therapist completed more hours of CPD than those who didn't employ either. There were no gender differences in engagement in CPD. CPD participation was consistently and significantly higher in mid and late career than in early career. CONCLUSIONS: This study provides a greater understanding of the CPD habits of the dental workforce in Wales. Practice staffing levels, location of practice and time since graduation were found to have the greatest impact on engagement in CPD activity. These findings will be used by the Deanery to inform future education provision for dental professionals in Wales.

Evolving trends in size and structure of group dental practices in the United States.

In this study, the authors examined recent trends in the growth of dental establishments and dental firms, including geographic location. In this article, they also present information about the demographic characteristics of dentists who work in a dental practice that is part of a larger company that delivers dental care in multiple locations. The number of dental establishments (single locations) and the average size of these establishments grew from 1992 to 2007. Large multi-unit dental firms grew in terms of number of establishments and the percentage of total receipts. Large multi-unit dental firms represent a small but growing segment of the dental market. Dentists less than thirty-five years old were most likely to work in a practice that was part of a larger company, and females were more likely than males to work in such a setting. The percentage of dentists working in these settings was also found to vary by region and state. The authors present a typology of dental group practice and suggest that future research should take into account the differences so that appropriate conclusions can be drawn and generalizations across categories are not made.

The use of office-based sedation and general anesthesia by board certified pediatric dentists practicing in the United States.

The purpose of this study is to explore the use of office-based sedation by board-certified pediatric dentists practicing in the United States. Pediatric dentists have traditionally relied upon self-administered sedation techniques to provide office-based sedation. The use of dentist anesthesiologists to provide office-based sedation is an emerging trend. This study examines and compares these two models of office-based sedations. A survey evaluating office-based sedation of diplomates of the American Board of Pediatric Dentistry (ABPD) based on gender, age, years in practice, practice types, regions, and years as a diplomate of the ABPD was completed by 494 active members. The results were summarized using frequencies and percentages. Relationships of dentist age, gender, and number of years in practice with the use of intravenous (IV) sedation was completed using two-way contingency tables and Mantel-Haenszel tests for ordered categorical data. Relationships of office-based sedation use and the type of one's practice were examined using Pearson chi-square tests. Of the 1917 surveys e-mailed, 494 completed the survey for a response rate of 26%. Over 70% of board-certified US pediatric dentists use some form of sedation in their offices. Less than 20% administer IV sedation, 20 to 40% use a dentist anesthesiologist, and 60 to 70% would use dentist anesthesiologists if one were available.

Dentists demonstrating professionalism: Dentists in private practice settings provide free or reduced-fee care.

Access to oral health care is an issue that has received attention at the local, state, regional, and national levels. This study focuses on how dentists in private practice settings attempt to address problems regarding access to care through personal initiatives. These dentists donate or discount services in their own offices to individuals who face access barriers. These donated or discounted services may go unreported and unnoticed. The research question addressed in this study is: What was the amount and type of free and reduced-fee care that dentists in the community of Brookline, Massachusetts, provided during the 2008 calendar year.

The involvement of Iowa dentists in hospice care.

The relationships between dentist characteristics and professional education with involvement of Iowa dentists in hospice care were investigated. Using the 1999 Iowa Health Professional database, a survey requesting information regarding involvement in and training for care of hospice patients was mailed to all licensed dentists (N = 1,210). Two mailings yielded a 54.6% response rate. Of the 638 dentist respondents, the mean age was 47, 86% were male, 88% general dentists, and 295 (46%) reported providing some treatment for hospice patients. At least one dentist reported providing hospice patient care in 72 of Iowa's 99 counties. About 90% of dentists treating hospice patients were general practitioners. Males were more likely to provide treatment (p < 0.0313). Neither dentist age nor years in practice were significant predictors. Dentists were more likely to treat hospice patients in the office (IO, 40%). The most prevalent treatments were denture relines (31% IO; 71% OO), examinations (16% IO; 68% OO), and emergency treatment (12.5% IO; 53% OO). More than 86% of surveyed dentists indicated that their professional education did not adequately train them to meet the clinical, psychosocial, communication, or spiritual needs of hospice patients.

Facilitating the transition of patients with special health care needs from pediatric to adult oral health care.

BACKGROUND: Without guidelines or policies in dentistry for transitioning adolescents with special heath care needs from pediatric to adult oral health care, little is known about traditional support services. The authors surveyed pediatric dentists about their transition of adolescent patients with and without special health care needs (SHCNs) to adult care. METHODS: In 2009, the authors e-mailed a pilot-tested survey modified from a survey used for U.S. pediatricians to 4,000 pediatric dentists. The survey included demographic questions and questions regarding services and barriers associated with the transition of patients to adult care. RESULTS: Responses were obtained from 1,686 (42.2 percent response) pediatric dentists who were mostly in group or solo private practices and were younger, in that most had completed their education in the preceding 15 years. More than one-half practiced in suburban settings, and most worked with both dental hygienists and dental assistants. Most assisted patients with SHCNs with their transitions to adult care, and the predominant barrier to transitioning to adult care was availability of general dentists and specialists who were willing to accept these new patients. Pediatric dentists' answers paralleled those of pediatricians for the most part in terms of services provided and barriers to transition. CONCLUSIONS: Most responding dentists helped adolescents with and without SHCNs make the transition into adult care, but the major barrier was the availability of general dentists and specialists. CLINICAL IMPLICATIONS: With an office protocol in place that includes trained staff members, transitioning patients (especially those with SHCNs) to adult care can be facilitated to provide the appropriate oral health and support services.

The management of developmentally absent maxillary lateral incisors--a survey of orthodontists in the UK.

OBJECTIVE: To investigate the orthodontic management of patients with developmentally absent maxillary lateral incisors. MATERIALS AND METHODS: A questionnaire was mailed to all orthodontists on the specialist list held by the British Orthodontic Society. RESULTS: The questionnaires (57.3% response) were analysed in two groups: Group 1 consisted of orthodontists who worked only in an orthodontic practice environment; Group 2 consisted of orthodontists who worked full-time or part-time in an environment where there were restorative dentists available for advice. Group 1 orthodontists were significantly more likely to recommend (p = 0.006) space closure in the management of developmentally absent maxillary lateral incisors. Group 2 orthodontists were significantly more likely to recommend (p = 0.004) minimal preparation bridges. Group 2 orthodontists also saw significantly more patients with hypodontia (p

Digital radiography in dentistry: a survey of Indiana dentists.

OBJECTIVES: The purpose of this study was to assess the number of Indiana dental practices that utilize digital radiography and to identify the reasons for using or not using digital radiography. METHODS: A questionnaire was sent to a random sample of 300 licensed dentists in the State of Indiana. Demographic, clinical and digital technology responses were obtained. The data were analysed using SPSS 12.0 (Statistical Package Social Sciences) software; t-tests and Pearson's chi(2) test were performed on several variables with significance levels set at P< 0.05. RESULTS: One hundred and fifty-two dental practices (51%) responded to the survey. Thirty dental practices (19.7%) used digital radiography in their office. Twenty-two (73%) of the dentists using digital radiography were general practitioners. The number of dentists in a practice was a significant factor in predicting the use of digital radiography (t=2.57, P=0.011). CONCLUSIONS: The results of this study indicate that digital radiography is more commonly used by general dentists in group practices.

Contemporary dental practice in the UK: demographic data and practising arrangements.

OBJECTIVES: To investigate, by questionnaire, various aspects of primary dental care provision in the North West of England and Scotland. METHOD: A questionnaire containing 79 questions was sent to 1,000 practitioners, selected at random, in the North West of England and Scotland. Non-responders were sent another questionnaire after a period of 4 weeks had elapsed. RESULTS: Overall a response rate of 70% was achieved. The majority of practitioners were practice principals (65%), working in a group NHS practice (80%) located in a city or town centre (49%). On average 10-20 patients were treated each session with fewer patients treated per session under private arrangements. Many practitioners were found to lack hygienist support (44%) and to employ unqualified dental nurses (82%). Younger practitioners were more likely than senior colleagues to have access to up-to-date computers whilst 37% and 74% of respondents never used CAL programmes or magnification respectively. Contemporary cross-infection control standards were used by the majority of practitioners, although 3% of practitioners reported only autoclaving their handpiece once a day. CONCLUSIONS: The majority of practitioners, involved in this study, worked under National Health Service (NHS) regulations as principals in a group practice where the workload was greater than the private/independent sector. Contemporary cross-infection procedures were used routinely. In contrast computer-aided learning programmes and magnification were not used routinely. The practitioners in this study employed significant numbers of unqualified dental nurses.

[Prevention of oral cancer: practice patterns in a dentists' group]. / Prevenzione del cancro orale: la pratica odontoiatrica in un campione di operatori.

Annually, 3000 people in our country die for oral cancer. Contrarily to other forms of cancer that require the use of instrumental diagnostic tools, the oral cavity is easy to examine and the cancer is usually preceded by precancerous conditions. The problem of the diagnostic delay can be explained through a underestimation of the lesions of the oral cavity by patients and a lack of sensibilization to prevention topics from dentists. Our work has inquired in the activity of a group of dentist with more than ten years than experience on accuracy of the anamnesis, objective exam and appropriate of the resource to specialists, and that with the aim not to measure the clinical abilities but to estimate the attitude towards the Prevention topics, in special way in the field of the malignant tumors of the oral cavity.

Internet usage by pediatric dental practices in Connecticut.

PURPOSE: The aim of this study was to determine Internet usage by pediatric dental practices in Connecticut. METHODS: A seven-item anonymous survey was mailed to all the 64 pediatric dentists in private practice in Connecticut. Each survey form was mailed along with a stamped and pre-addressed return envelope. Frequency distribution analyses and chi-square tests were performed. RESULTS: The survey had a response rate of 73%. More than three-fourths of the pediatric dental practices were connected to the Internet. Seventy-two percent of the practices submitted third-party claims electronically. Almost all of the respondents did not use email to communicate with patients or to discuss individual patient issues with other health care providers. Only two-fifths of the practices had a World Wide Web site. CONCLUSIONS: Most of the pediatric dental practices in Connecticut were connected to the Internet. Electronic third-party claims submission was the predominant Internet service used by these practices.

Use of rubber dam and its association with other endodontic procedures in New Zealand.

The use of rubber dam for endodontic treatment in New Zealand was analysed by a national survey of general dental practitioners. The response rate was 79 percent. Rubber dam was used routinely by 57 percent, its use increasing among practitioners graduating since 1969. A greater percentage of practitioners with less than 10 years experience used rubber dam than did more experienced practitioners. Use of rubber dam was associated with sodium hypochlorite and EDTA as canal irrigants. Reamers were the favoured hand instrument of non-users of rubber dam. No significant differences were found in the canal obturation techniques of users and non-users, but rubber dam users used the long-cone paralleling method of radiography significantly more than non-users. Practitioners in solo practice used rubber dam significantly less than those in group practice. Rubber dam users attended significantly more refresher courses in endodontics than non-users.

Career preferences of pediatric dentistry advanced education students.

A questionnaire addressing career preferences of pediatric dentistry advanced education students was mailed to 52 training programs. Two hundred and thirty-two completed surveys from 45 responding programs were returned. Men were in combined specialty programs significantly more than women (P < 0.05, chi-square) and U.S. citizen students were significantly older than non-citizens (P < 0.05, t-test). The collected data reflected differences in career preferences between men and women, and citizens and noncitizens. Women reported a significant preference for private practice, part-time associate and public health practice than did men. Although not significant, men declared equal preference for full-time private practice either solo or as an associate. Noncitizens were found to have a significant preference when compared to citizens for academic full- and part-time, hospital/institutional full- and part-time, research, full- and part-time positions, and for additional training.

To solo or not to solo.

An analyst from the ADA Survey Center provides a brief overview of the differences and similarities of solo and nonsolo (group) practices, based on data gathered from the 1995 Survey of Dental Practice.