Impact of infrastructure on graduate dental education and dental clinic productivity

Using all-inclusive data from 126 U.S. Department of Veterans Affairs health care facilities that provide dental services, this study identified the staffing infrastructure under which the Veterans Health Administration can provide graduate dental education without compromising dental clinic productivity. From regression analyses, we found that teaching residents has a negative impact on staff dentists' productivity; however, when the dental assistant to provider ratio is greater than or equal to 1.0, dental residents' workload contribution can offset the negative impact on overall clinic productivity. In the presence of dental residents, the dental assistant, front-desk personnel, and dental treatment room to provider ratios have a positive impact on productivity. The optimal ratios were calculated as 1.5 for dental assistants, 2.1 for dental treatment rooms, and 0.57 for front-desk personnel.

How does the keystone state compare nationally?

Census Bureau reports were used to develop data for "average" dental establishments in the Commonwealth of Pennsylvania with comparison to national averages. The need to monitor dental establishment activities beyond the confines of one's own practice is emphasized.

Prosthodontists in Private Practice: Current and Future Conditions of Practice in the United States (Part I)

PURPOSE

The purpose of this study was to use data from surveys of prosthodontists to examine the current conditions and characteristics of prosthodontists in private practice in the United States.

MATERIALS AND METHODS

Characteristics of prosthodontists and conditions of practice are based on the 2002 Survey of Prosthodontists and the 2005 Survey of Prosthodontists. Both surveys were conducted by the American College of Prosthodontists. Several characteristics of private practice/practitioners are estimated including age, gender, number of patient visits, hours in the practice, employment of staff, and financial conditions (gross receipts, expenses of the practice, and net income of prosthodontists)

RESULTS

In 2004, the average age of private practitioners was 50 years. Years since graduation from dental school averaged 23.4 years, and years since completion of residency was 18.3 years. Prosthodontists spent an average of 35.7 hours per week in the office and 29.5 hours treating patients. In 2004, the average gross revenue per owner of a private practice reached $782,130, and mean net income was $258,490. The largest percentage of prosthodontist time was spent providing six procedures including fixed prosthodontics, implant services, complete dentures, operative care, diagnosis, and partial dentures.

CONCLUSION

The United States spends about $1.8 billion on prosthodontic services provided by prosthodontists in private practice. Prosthodontists spend $1.1 billion dollars in expenses and treat an estimated 1.1 million patients per year.

Injury reports in a dental school: a two-year overview

As teaching institutions, it is vital for dental schools to collect data on accidental injuries to identify potential problems, improve the quality of care of patients, and educate future practitioners about risk management. Our data reveal important trends concerning such injuries. These data were compiled over a two-year period (2001-03) from accident reports at one dental school. We categorized the accidents as follows: source (instrument causing the injury), recipient of injury, time of day, location within the dental school where the injury occurred, and body part injured. The population examined in this study consisted of predoctoral and postdoctoral dental students, staff, faculty, and patients of the dental school. The majority of injuries occurred in the predoctoral clinic toward the middle to the end of the scheduled clinic periods. The instrument most likely involved was a needle, and the body part most commonly injured was a finger. The collection and analysis of injury data may be used to identify trends that will aid in the prediction and prevention of these injuries and, at a national level, serve as a benchmark that other dental schools can employ to assess their relative frequency of injury.

Percutaneous injuries of dental personnel at the University of the West Indies, School of Dentistry

AIM

To report the results of a survey of all percutaneous injuries occurring in 2003-2004 to staff and students at the dental school in Trinidad.

METHOD

Data were collected via 163 questionnaires administered to all dental surgery assistants, the current clinical students (years 3, 4 & 5), the interns, part-time and full-time academic staff.

RESULTS

A 71% response rate was obtained. The number of persons reporting one or more sharps injuries at the dental school was 42 (37%). Of these, 17 (40%) were percutaneous. Needlesticks and periodontal scaler injuries were the most common. There was no significant correlation (p>0.05) between injury and gender, age group, dominant hand or needle recapping technique. 75% of respondents described their concern of contracting a blood-borne disease from a sharps injury as "high" and 59% of the respondents followed the school's recommended protocol following the injury. 50% of the injuries among the students and interns were not reported.

CONCLUSIONS

A more rigorous programme of risk management with respect to sharps injuries needs to be designed and implemented at the school. There is also a need to improve surveillance of and reduce the underreporting of these injuries.

Dental establishment business activity in New York State counties at start of the millennium

Bureau of the Census reports for 2002 were used to develop business data for "average" dental establishments in each of the counties in New York State. On average, between 1997 and 2002, when compared to national information, the number of New York State dental establishments increased at a slower rate, had a smaller resident population per establishment, reported lower gross receipts, had fewer employees and paid lower salaries to employees.

Dental establishment business activity in California counties at the start of the millennium

The Bureau of the Census reports for 2002 were used to develop business data for "average" dental establishments in each of the counties in California. On average, between 1997 and 2002, when compared to national information, the number of California statewide dental establishments increased at a greater rate, had a smaller resident population per establishment, reported lower gross receipts, had fewer employees, and paid lower salaries to employees.

Canadian orthodontist Internet user profile

An anonymous, self-administered, mail-out survey of Canadian Orthodontists was conducted to evaluate the characteristics of orthodontic Internet use. The response rate was 45.6% (304 of 667). A total of 76.6% of orthodontists reported having Internet access at work, and an additional 12.4% reported having Internet access from a different location. Statistically significant associations between Internet usage and office staff size (P < .001) and years of practice (P = .046) were observed. Offices with larger staffs had greater Internet access. Number of staffs and number of case starts were positively correlated (P < .001, r = 0.498). The odds ratio for having Internet access on the basis of increased case starts from the less than 100 to 300-399 categories was 5.67. Although not statistically significant, there was a trend for greater Internet access by younger practitioners.

Evaluation of dental waste management in two cities in Palestine

Disposal of dental waste was investigated at 37 randomly selected clinics in Ramallah and AI-Bireh cities: 31 private practices and 6 public/NGO clinics. Dentists were interviewed regarding their disposal of different forms of dental waste. Disinfectants and X-ray processing solution were thrown down the drain. For sharps, 13.5% of dentists used puncture-resistant containers (only in the public/ NGO clinics), 45.9% discarded needles directly in the garbage after being recapped and 40.5% placed the used needles and blades in closed plastic bottles before throwing in the general garbage. Blood-soaked dressings and amalgam waste were also thrown in the garbage. While 10.75% of dentists were vaccinated against hepatitis B, 47% of the staff at private clinics were not.

Safety-net dental clinics

BACKGROUND

Federal policy supports and funds community-based clinics to provide health care to low-income and underserved groups. This study examines the role of community dental safety-net clinics in providing dental care for these populations.

METHODS

The authors administered a cross-sectional survey of all identified safety-net dental clinics in Illinois. Seventy-one of 94 clinics responded (response rate, 76 percent), describing their history, operations, patients, staffing and dentist relationships. An in-depth analysis of 57 clinics presents comparisons of three categories of clinics, sponsored by community health centers (23), local health departments (21) and private services agencies (13).

RESULTS

Clinics were distributed across the state; 80 percent were located in facilities with other health care providers, and all provided dental care to low-income and other underserved groups. Clinics provided more than 3100 annual dental visits, operated with limited staffing and budgets, and had referral relationships with local dentists. Clinics with full-time dentists or any dental hygienists had higher annual numbers of dental visits.

CONCLUSIONS

These clinics provide dental care to groups with traditional access barriers. Although they represent a small portion of all dental care, their mission and role make them a key component of strategies to address the dental access problem.

PRACTICE IMPLICATIONS

Local and state dental practitioners and coalitions seeking to expand dental access should consider their community dental safety-net clinics as partners. Efforts to expand theese clinics should include considering optimizing staffing for better dental productivity.

National survey of endodontics in general dental practice in France

The purpose of this paper was to gather both qualitative and quantitative information on endodontic treatments performed by French dental practitioners, and to identify the factors influencing the duration of endodontic procedures. A questionnaire was addressed in a two-rounds distribution to 2000 dentists selected by the quotas method in the whole country. A total of 790 (39.5%) questionnaires containing useful information were returned. The duration of endodontic treatment increases according to the number of roots to treat. The pulpal preoperative status has an influence on the duration of treatment, which is longer for a tooth with a necrotic pulp. Three variables strongly influence the duration of endodontic treatment: the number of patients attended per day, the number of appointments required for this treatment and the presence of a wage earner in the office. Continuing education also seems to be a variable having some influence on the duration of treatment. Financial considerations are also taken into account and there was general agreement that the current remuneration system of the French Health National Insurance is inadequate. Further, when one compares the total cost of an endodontic treatment with the fees fixed by the Health Insurance, it is clear that such procedures afford no positive financial return for a majority of practitioners. Moreover, the return becomes even more negative for teeth with a necrotic pulp. The findings presented in this study constitute the first stage of the medico-economic analysis concerning the endodontic practices in France. Prospective studies to gather precise information on the duration of endodontic treatments and a cost-analysis of endodontic practices could assist in the decision making process for practitioners or for the policy makers in the formulation of policies regarding application and reimbursement of endodontic treatment.

A baseline study of the demographics of the oral health workforce in rural and remote Western Australia

BACKGROUND

A shortage of dental practitioners in Australia is predicted for the future, and the greatest effect of this will be felt in rural and remote areas. Strategies are needed to increase the recruitment and retention of dental practitioners in these areas. Part of this process is to assess the demographics of the oral health workforce.

METHODS

A postal questionnaire survey was undertaken in 2002, that involved all registered dentists, therapists and hygienists in rural and remote Western Australia.

RESULTS

Rural dentists are predominantly male, early middle aged, married, UWA trained, Australian born with one to two children. Rural dental therapists are predominantly female, in their mid-thirties, married, Australian born, trained in Western Australia, with two children. Male dentists worked slightly more hours per week than female dentists. The majority of the workforce does have access to email and the internet. Taking leave is a problem for most dentists because of difficulties in finding locums.

CONCLUSIONS

The rural dental workforce capacity and demographic distribution need monitoring and analysis. This will determine the dental workforce's future ability to deliver the necessary services in rural and remote regions, where currently there is a dental workforce shortage.

Pennsylvania dental establishments in 2001

Census Bureau reports for 2001 were used to develop data for "average" dental establishments in the counties of the state of Pennsylvania. There have been marked decreases in the number of residents per establishment and the proportional representation of smaller dental establishments (less than five employees) since 1980. Dental establishment "average" employee salaries ranged from $17,400 to more than $37,100 in the various counties. The need to monitor dental establishment activities beyond the confines of one's own facility is emphasized.

The increasing demand and necessity for a team approach

The role of professionals complementary to dentistry (PCDs) has changed radically in recent times and further changes are likely in the foreseeable future. The modernisation of dentistry throughout the UK dictates that the existing workforce takes into account the substantial contribution which can be made by PCDs in addressing the unacceptable levels of disease which exist in many parts of the country.

Risk of exposure to Legionella in dental practice

Aerosols generated in dental operations are a source of exposure to microorganisms proliferated within dental unit waterlines (DUWL) biofilm. It has been suggested that presence of Legionella species in these aerosols may contribute to potential health hazards for dental staff and patients. The article attempts to provide a brief overview of the current knowledge about Legionella, its prevalence in DUWL, immunological reactions of the dentists and concepts for prophylaxis of Legionella in dentists' work place.

Survey of oral and maxillofacial surgeons' offices in Virginia: anesthesia team characteristics

This survey assesses whether oral and maxillofacial surgeons in the state of Virginia are prepared for inspection of their offices. A survey asking pertinent questions on the availability of specific equipment and the educational qualifications of the anesthesia care team was developed and sent to 155 offices. Seven questions were asked regarding the availability of nurses, types of life support training, (formal or informal), the surgeons and anesthesia care personnel, and the presence of a defibrillator. Questionnaires were short and simple to encourage compliance with the study guidelines. A total of 128 (82.6%) questionnaires were returned. Only 42 of 128 (32.8%) offices employed nurses, and 6 of the 42 nurses were not considered as part of the anesthesia care team. Only 36 of 128 (28.1%) of the offices had assistants with formal anesthesia assistant course training from the American Association of Oral and Maxillofacial Surgeons (AAOMS) or the American Dental Society of Anesthesiology (ADSA). However, 93% of the assistants who participated in the anesthesia had current basic life support training (BLS) training, and 74% of the surgeons had current advanced cardiac life support (ACLS) training. The AAOMS Office Emergency Manual was present in 118 of 128 offices (92.2%), and 124 of 128 offices (96.9%) had defibrillators. The survey suggests that the surgeons are well prepared from the standpoint of having a defibrillator present and the AAOMS Office Emergency Manual available as a template for the team to use in order to answer questions that the inspection team may ask of the primary anesthesia care provider and surgeon. The majority of the surgeons had current ACLS certification, and the office anesthesia assistants had current BLS training. Most of the assistants did not have formal course training, which indicates that on-the-job training is probably the norm. Less than one third of the offices had nurses.

3,940 New York State dental establishments with no employees

Despite the increasing size of most dental establishments, 3,940 New York State dental establishments had no employees in 1999. The distribution, gross receipts data and suggested establishment arrangements are reviewed.

Hepatitis B prevalence and infection control among dental health care workers in a community in South Korea

OBJECTIVES

The objectives of this study were to investigate the prevalence of hepatitis B vaccine and use of infection control procedures by dental health care workers in Taegu, South Korea.

METHODS

Information was obtained with a mailed questionnaire sent to 300 private dental practices. Surveys were received from 177 dentists, 104 dental hygienists, and 46 dental assistants. All dental health care workers were asked to donate a blood sample for analysis of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs).

RESULTS

Vaccination against hepatitis B virus was reported by 63 percent of the respondents. About 40 percent of all participants answered that they were anti-HBs positive, while another 43 percent did not know their status. About 89 percent of dentists reported that they wore a mask with all patients, while hygienists (13.6%) and assistants (13.0%) were less likely to do so. Reported use of gloves (4.5%) and protective eyewear (14%) with all patients was extremely low in every group. Among the 56 dentists who were tested for HBV markers, 23 did not receive the vaccine against hepatitis B, and 13 percent (3 of 23) were positive for HBsAg as carriers.

CONCLUSIONS

About 37 percent (120 of 327) of dental health care workers surveyed in this study in Korea did not receive the vaccine against HBV infection. Basic barrier techniques to prevent cross-contamination were not being used consistently. Nationwide guidelines for barrier techniques and hepatitis vaccinations should be developed and disseminated to dental personnel.