Analysis of human resources for oral health globally: inequitable distribution

BACKGROUND

Oral diseases affect most of the global population. The aim of this paper was to provide a contemporary analysis of 'human resources for oral health' (HROH) by examining the size and distribution of the dental workforce according to World Health Organization (WHO) region and in the most populous countries.

METHOD

Publically available data on HROH and population size were sourced from the WHO, Central Intelligence Agency, United Nations, World Bank and the UK registration body. Population-to-dentist and dental-workforce ratios were calculated according to WHO region and for the 25 most populous countries globally. Workforce trends over time were examined for one high-income country, the UK.

RESULTS

The majority of the world's 1.6 million dentists are based in Europe and the Americas, such that 69% of the world's dentists serve 27% of the global population. Africa has only 1% of the global workforce and thus there are marked inequalities in access to dental personnel, as demonstrated by population to dental-workforce ratios. Gaps exist in dental-workforce data, most notably relating to mid-level clinical providers, such as dental hygienists and therapists, and HROH data are not regularly updated. Workforce expansion and migration may result in rapid changes in dentist numbers.

CONCLUSION

Marked inequalities in the distribution of global HROH exist between regions and countries, with inequalities most apparent in areas of high population growth. Detailed contemporary data on all groups of HROH are required to inform global workforce reform in support of addressing population oral health needs.

Dental Personnel Treated for Idiopathic Pulmonary Fibrosis at a Tertiary Care Center - Virginia, 2000-2015

In April 2016, a Virginia dentist who had recently received a diagnosis of idiopathic pulmonary fibrosis (IPF) and was undergoing treatment at a specialty clinic at a Virginia tertiary care center contacted CDC to report concerns that IPF had been diagnosed in multiple Virginia dentists who had sought treatment at the same specialty clinic. IPF is a chronic, progressive lung disease of unknown cause and associated with a poor prognosis (1). Although IPF has been associated with certain occupations (2), no published data exist regarding IPF in dentists. The medical records for all 894 patients treated for IPF at the Virginia tertiary care center during September 1996-June 2017 were reviewed for evidence that the patient had worked as a dentist, dental hygienist, or dental technician; among these patients, eight (0.9%) were identified as dentists and one (0.1%) as a dental technician, and each had sought treatment during 2000-2015. Seven of these nine patients had died. A questionnaire was administered to one of the living patients, who reported polishing dental appliances and preparing amalgams and impressions without respiratory protection. Substances used during these tasks contained silica, polyvinyl siloxane, alginate, and other compounds with known or potential respiratory toxicity. Although no clear etiologies for this cluster exist, occupational exposures possibly contributed. This cluster of IPF cases reinforces the need to understand further the unique occupational exposures of dental personnel and the association between these exposures and the risk for developing IPF so that appropriate strategies can be developed for the prevention of potentially harmful exposures.

Developing a national dental education research strategy: priorities, barriers and enablers

OBJECTIVES

This study aimed to identify national dental education research (DER) priorities for the next 3-5 years and to identify barriers and enablers to DER.

SETTING

Scotland.

PARTICIPANTS

In this two-stage online questionnaire study, we collected data with multiple dental professions (eg, dentistry, dental nursing and dental hygiene) and stakeholder groups (eg, learners, clinicians, educators, managers, researchers and academics). Eighty-five participants completed the Stage 1 qualitative questionnaire and 649 participants the Stage 2 quantitative questionnaire.

RESULTS

Eight themes were identified at Stage 1. Of the 24 DER priorities identified, the top three were: role of assessments in identifying competence; undergraduate curriculum prepares for practice and promoting teamwork. Following exploratory factor analysis, the 24 items loaded onto four factors: teamwork and professionalism, measuring and enhancing performance, dental workforce issues and curriculum integration and innovation. Barriers and enablers existed at multiple levels: individual, interpersonal, institutional structures and cultures and technology.

CONCLUSIONS

This priority setting exercise provides a necessary first step to developing a national DER strategy capturing multiple perspectives. Promoting DER requires improved resourcing alongside efforts to overcome peer stigma and lack of valuing and motivation.

Assessment of volatile organic compounds and particulate matter in a dental clinic and health risks to clinic personnel

This study was conducted to assess (1) levels of volatile organic compounds (VOCs) and particulate matter (PM) in a dental clinic in southern Taiwan and (2) dental care personnel's health risks associated with due to chronic exposure to VOCs. An automatic, continuous sampling system and a multi-gas monitor were employed to quantify the air pollutants, along with environmental comfort factors, including temperature, CO2, and relative humidity at six sampling sites in the clinic over eight days. Specific VOC compounds were identified and their concentrations were quantified. Both non-carcinogenic and carcinogenic VOC compounds were assessed based on the US Environmental Protection Agency's Principles of Health Risk Assessment in terms of whether those indoor air pollutants increased health risks for the full-time dental care professionals at the clinic. Increased levels of VOCs were recorded during business hours and exceeded limits recommended by the Taiwan Environmental Protection Agency. A total of 68 VOC compounds were identified in the study area. Methylene methacrylate (2.8 ppm) and acetone (0.176 ppm) were the only two non-carcinogenic compounds that posed increased risks for human health, yielding hazard indexes of 16.4 and 4.1, respectively. None of the carcinogenic compounds increased cancer risk. All detected PM10 levels ranged from 20 to 150 μg/m(3), which met the Taiwan EPA and international limits. The average PM10 level during business hours was significantly higher than that during non-business hours (P = 0.04). Improved ventilation capacity in the air conditioning system was recommended to reduce VOCs and PM levels.

Texas dental establishments in 2011

OBJECTIVE

To document the evolving Texas dental establishment pattern between 2000 and 2011 as the profession seeks to provide care to the burgeoning population of the state.

METHODS

Published results from the Department of Commerce, Census Bureau's annual study of business patterns for each county and state (with specific information on numbers of establishments, employees, salaries and resident population) were used to permit a review of these developments.

RESULTS

Between 2000 and 2011 there was an almost 30% increase in dental establishments, predominantly in establishments with greater number of employees. Statewide the average number of employees per establishment increased to 6.6, ranging by county from 3.6 to 9.9 employees; with an average state salary of $47,000, ranging by county from an average of $35,000 to $59,000.

CONCLUSION

The burgeoning state population growth is being matched by a greater proportional increase in dental establishments, but a smaller percentage increase in the number of dentists. The need to monitor dental establishment activities beyond the confines of one's own facility is emphasized.

Electronic Dental Record (EDR) Use in Saudi Arabia: An Exploratory Study

The purpose of this exploratory study is to provide an overview of the electronic dental records (EDR) systems used at National Guard Health Affair (NGHA) hospitals in the Kingdom of Saudi Arabia (KSA). Different sources of data were collected between February 18 and March 16, 2014. Sources of data included interviews with key informants. Key informants interviews included one 30 minute interview with an information technology specialist working at NGHA; seven 30-40 minute interview with dentists working in both the NGHA hospital and affiliated NGHA Primary Healthcare Clinics (PHCs). Two dental ward clerks were interviewed for 30 minutes and two dental directors were interviewed for 1 hour each. Four main themes emerged as a result of the analysis of the data. The main themes that emerged centered on staff satisfaction and workload, incomplete information, missing files, and adoption of EDRs. There were several challenges identified with the use of EDRs in Saudi Arabia. The challenges related to resistance to use the EDRs by clinical staff; lack of computer skills by clinical staff; usability of the systems; lack of interest in using EDRs; and lack of a clear management change strategy. Moving forward, these issues should be addressed so that more EDRs are implemented in all healthcare institutions in Saudi Arabia.

Use of electronic dental records in Brazil

This study aims to provide both a quantitative and a qualitative analysis of the usability of the most popular electronic dental records in Brazil regarding its clinical and administrative features. The softwares not only will be evaluated regarding their usage among the Brazilian dental professionals but also regarding their functionalities (present, used and desired) and the difficulties encountered by the dentists during their use.

Economic impact of dental hygienists on solo dental practices

The fact that a significant percentage of dentists employ dental hygienists raises an important question: Are dental practices that utilize a dental hygienist structurally and operationally different from practices that do not? This article explores differences among dental practices that operate with and without dental hygienists. Using data from the American Dental Association's 2003 Survey of Dental Practice, a random sample survey of U.S. dentists, descriptive statistics were used to compare selected characteristics of solo general practitioners with and without dental hygienists. Multivariate regression analysis was used to estimate the effect of dental hygienists on the gross billings and net incomes of solo general practitioners. Differences in practice characteristics--such as hours spent in the practice and hours spent treating patients, wait time for a recall visit, number of operatories, square feet of office space, net income, and gross billings--were found between solo general practitioners who had dental hygienists and those who did not. Solo general practitioners with dental hygienists had higher gross billings. Higher gross billings would be expected, as would higher expenses. However, net incomes of those with dental hygienists were also higher. In contrast, the mean waiting time for a recall visit was higher among dentists who employed dental hygienists. Depending on personal preferences, availability of qualified personnel, etc., dentists who do not employ dental hygienists but have been contemplating that path may want to further research the benefits and opportunities that may be realized.

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.

Dental establishments in Tennessee

Census Bureau data indicate a continuing national increase in the number and size of dental establishments. These developments are reviewed for the State of Tennessee during the past decade, including the number of establishments, employees, population per establishment and related factors.

The impact of a continuing education oral health program on providing services for young children by dentists, dental hygienists and dental assistants

PURPOSE

The purpose of this study was to determine the impact of a 4 hour continuing education (CE) program on the oral health knowledge and behaviors of dentists, dental hygienists and dental assistants in providing oral health services to young children in West Virginia general dental practices.

METHODS

A free CE program was provided for 92 general dentists, 123 dental hygienists and 37 dental assistants (n=252) at 4 sites across West Virginia. Participants completed a pre- and post-test on topics including the timing of the first dental exam, fluorides, xylitol, Alternative Restorative Technique (ART) and their practice pattern of caring for children under 3 years old. A 6 month follow-up questionnaire was mailed to participants to assess outcomes.

RESULTS

Participants showed a 22% increase in knowledge from the pre-test to the post-test (p<0.001) for all questions except for ART, which showed no change. The majority of dentists and hygienists (89%) increased their comfort in providing services for children under 3 years old. Participants (80%) stated they would increase the number of children under 3 years old they examine, yet 6 months after the program only 42% responded affirmatively (p<0.001). At the time of the program, 62% reported that they currently examine children at 1 year of age, and there was no significant change 6 months later. While 54% responded that they would contact their local physicians about early oral health care, only 27% followed through.

CONCLUSION

This program significantly increased the participants' knowledge and comfort level for providing infant and toddler oral health care. However, it did not motivate most to alter their practice behaviors to conform to national best practice guidelines.

Dental practice and musculoskeletal disorders association: a look at the evidence

Disorders localized to the musculoskeletal system are a common problem among dental personnel. This study has the aim of surveying epidemiological studies reporting positive associations between dental practice and musculoskeletal disorders (MSKDs). The focus was to evaluate the size of reported risk increase and the extent to what alternative causal explanations were considered. Reports with significant links (p value <.05) were systematically selected from 2 electronic databases. Twenty-five studies were identified. Risk measures were reported in 8 studies, and all of them presented weak associations. The impact of at least 1 competing explanations was analyzed in 32% of studies, but adjustment was considered not adequate in half of them. The evidence on dentistry as a profession with potential risk for development of MSKDs remains questionable. Further research is needed to more carefully elucidate the risk and the impact of MSKDs in this particular occupational group.

Mapping dental establishments in Oklahoma just before the recession

Census Bureau data indicate a continuing increase in the number and size of dental establishments in the period just prior to the recent recession. During this same period, the combination of a limited increase of the population in Oklahoma and limited proportional increase in the numbers of dentists and dental establishments resulted in decreases in population-to-dental facility ratios. The usual favorable expectations of an economic upswing after a recession for dental establishments may need to be tempered given these developments.

Prevalence and associated factors of musculoskeletal pain among the dental personnel in a dental school

OBJECTIVE

To study the prevalence and associated factors of musculoskeletal (MS) pain among the dental personnel. In addition, impacts and treatment of MS pain were reported.

MATERIAL AND METHOD

Random sampling of 390 participants from the name lists of dental personnel working in each department. Self-administered questionnaires were equally distributed to three groups of dental personnel namely clinical instructors, postgraduate students, and dental assistants. The present study was conducted as a survey in the Faculty of Dentistry, Mahidol University, Bangkok between December 2008 and January 2009.

RESULTS

Three hundred and ninety questionnaires were delivered and 164 questionnaires were returned (response rate 42.5%). The participants with MS pain were 32 clinical instructors (20.3%), 52 postgraduate students (32.9%), and 74 dental assistants (46.8%). Their mean age was 33.0 +/- 9.1 years old. The MS pain found respectively was shoulder pain 72.2% (n = 114), neckpain 70.3% (n = 111), and low backpain 50.6% (n = 80). The participants with shoulder and neckpain were combined and defined as cervicobrachial pain. The associated factor of cervicobrachial pain was working status. Being a clinical instructor and postgraduate student were associated with cervicobrachial pain with OR being 4.7 [1.3, 7.1] and 4.6 [1.6, 13.4], respectively. The impacts of MS pain among the dental personnel included usage of pain relieving medication (34.8%), seeking medical evaluation (32.3%), reduction in working hours (27.2%), difficulty sleeping (22.8%), and work absence (10.8%), respectively. The treatments of MS pain utilized to alleviate those impacts were Thai traditional massage (51.9%), medication (28.5%), physical therapy (15.8%), acupuncture (7.6%), and alternative medicine (4.4%), respectively.

CONCLUSION

Cervicobrachial pain was the most prevalent MS pain among the dental personnel and working status was associated with their MS pain problems. The impact of MS pain was predominantly usage of pain relieving medication. Thai traditional massage was the most utilized treatment.

Mapping dental establishments in New York State just before the recession

Census Bureau data indicate a continuing increase in the number and size of dental establishments in the period just prior the recent recession. During this same period, the combination of a relatively limited increase of the population in New York State and increasing numbers of dentists and dental establishments resulted in decreases in population ratios, particularly in New York City. The usual favorable expectations of an economic upswing after a recession for dental establishments may need to be tempered given these developments.

Mapping dental establishments in Massachusetts just before the recession

Bureau data indicate a continuing national increase in the number and size of dental establishments in the time just prior to the recent recession. During this same period in Massachusetts, there were marked increases in the number of individuals employed in dental facilities, and there was a combination of a minor increase of the population and limited proportional increase in the numbers of dentists and dental establishments. This resulted in small changes in population-to-dental facility ratios in most counties in the state. The usual favorable expectations of an economic upswing after a recession for dental establishments may need to be tempered given the increased overhead costs resulting from increased numbers of employees and the fact that the state has the highest dentist-to-population ratio in the country.

Estimating determinants of dentist productivity: new evidence

OBJECTIVE

Productivity (output per unit of input) is a major driver of dental service capacity. This study uses 2006-2007 data to update available knowledge on dentist productivity.

METHODS

In 2006-2007, the authors surveyed 1,604 Oregon general dentists regarding-hours worked, practice size, payment and patient mix, prices, dentist visits, and dentist characteristics. Effects of practice inputs and other independent variables on productivity were estimated by multiple regression and path analysis.

RESULTS

The survey response rate was 55.2 percent. Dentists responding to the productivity-related questions were similar to dentists in the overall sampling frame and nationwide. Visits per week are significantly positively related to dentist hours worked, number of assistants, hygienists, and number of operatories. Dentist ownership status, years of experience, and percentage of Medicaid patients are significantly positively related to practice output. The contributions of dentist chairside time and assistants to additional output are smaller for owners, but the number of additional dentist visits enabled by more hygienists is larger for owners.

CONCLUSION

As in earlier studies of dental productivity, the key determinant of dentist output is the dentist's own chairside time. The incremental contributions of dentist time, auxiliaries, and operatories to production of dentist visits have not changed substantially over the past three decades. Future studies should focus on ultimate measures of output--oral health--and should develop more precise measures of the practice's actual utilization of auxiliaries and their skill and use of technology.