Productivity in Minnesota dental practices with increased visits by older patients

A 30-year review of a geriatric dentistry teaching programme

OBJECTIVE

To review the development of the Geriatric Dental and Special Needs Education programme at the University of Iowa over the last 30 years.

BACKGROUND

The programme at Iowa evolved from a didactic elective programme taught by a single faculty person to a required didactic and clinical programme, which includes a Special Care Clinic in the dental school and a mobile unit with portable dental equipment which serves ten area nursing homes with comprehensive care.

MATERIALS AND METHODS

Changes have been made in the programme over time based on formal and informal feedback from students and graduates, and we have also looked at the impact of the programme on dental services to our target population.

RESULTS

The factors influencing the curriculum development are identified and discussed.

CONCLUSION

As no dental schools are the same, some general applications are suggested from the Iowa experience.

Trends in service provision among Australian private general dental practitioners over a 20-year period

AIM

To-investigate time trends in service provision.

DESIGN

Five cross-sectional surveys across a 20-year period.

SETTING

Australian private general practice

PARTICIPANTS

A random sample of dentists.

METHODS

Mailed questionnaires were collected in 1983, 1988, 1993, 1998 and 2003 (response rates 71%-76%).

MAIN OUTCOME MEASURES

Services per visit, annual services per dentist; annual services per patient.

RESULTS

Total services per visit increased over the study period from 1.78 to 2.37 (Poisson regression; P<0.05). However the annual number of services provided per dentist did not vary significantly, reflecting a trend among dentists to supply fewer patient visits per year. The annual number of services provided per patient increased from 3.47 to 5.50 (OLS regression; P<0.05), reflecting both increased service rates per visit and increased numbers of visits by patients. Dentists provided less restorative, prosthodontic and extraction services per year, but more diagnostic, preventive, endodontic and crown and bridge services. The annual care received per patient also included more diagnostic, preventive, endodontic and crown and bridge services but differed from the dentist pattern through increased rates of restorative services over the study period.

CONCLUSIONS

The content of dentist workloads has changed to include less emphasis on removal and replacement of teeth and more effort on diagnosis and prevention aimed at retention of natural dentitions.

Practice activity trends among oral and maxillofacial surgeons in Australia

Background

The aim of this study was to describe practice activity trends among oral and maxillofacial surgeons in Australia over time.

Methods

All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires.

Results

Data were available from 79 surgeons from 1990 (response rate = 73.8%) and 116 surgeons from 2000 (response rate = 65.1%). The rate of provision of services per visit changed over time with increased rates observed overall (from 1.43 ± 0.05 services per visit in 1990 to 1.66 ± 0.06 services per visit in 2000), reflecting increases in pathology and reconstructive surgery. No change over time was observed in the provision of services per year (4,521 ± 286 services per year in 1990 and 4,503 ± 367 services per year in 2000). Time devoted to work showed no significant change over time (1,682 ± 75 hours per year in 1990 and 1,681 ± 94 hours per year in 2000), while the number of visits per week declined (70 ± 4 visits per week in 1990 to 58 ± 4 visits per week in 2000).

Conclusions

The apparent stability in the volume of services provided per year reflected a counterbalancing of increased services provided per visit and a decrease in the number of visits supplied.

Service provision trends among Australian private general dental practitioners: 1983/84 to 1998/99

AIM

To investigate time trends in service provision.

DESIGN

Four cross-sectional surveys across a 15-year period.

SETTING

Australian private general practice.

PARTICIPANTS

A random sample of dentists.

METHODS

Dentists were surveyed by mailed questionnaire in 1983, 1988, 1993 and 1998 (response rates 71%-75%). Data were weighted to provide representative estimates for the age by sex distribution of private general practitioners in 1983, 1988, 1993 and 1998.

MAIN OUTCOME MEASURES

Services per visit, annual services per dentist, annual services per patient.

RESULTS

Total services per visit increased over the study period from 1.78 to 2.14 (Poisson regression; p < 0.05). However the annual number of services provided per dentist did not vary significantly, reflecting a trend among dentists to supply fewer patient visits per year. The annual number of services provided per patient increased over the period from 3.47 to 5.22 (OLS regression; p < 0.05), reflecting both the increased service rate per visit and increased numbers of visits by patients. Dentists provided less restorative, prosthodontic and extraction services per year, but more endodontic and crown and bridge services. The pattern of annual care received per patient also included more endodontic and crown and bridge services but differed from the dentist pattern through increased service rates over the study period in areas such as restorative, diagnostic and preventive.

CONCLUSIONS

While dentists are providing a similar number of services annually, the content of their workload has changed to include less emphasis on removal and replacement of teeth and more effort on maintenance and retention of natural dentitions.

Private dental visits per dentist in Spain from 1987 to 1997. An analysis from the Spanish national Health Interview Surveys

OBJECTIVES

In view of the sharp increase in the number of dentists in Spain, the aim of the present study was to analyse changes in the private dentist workload in Spain over the period 1987-97.

METHODS

Data were taken from censuses of the population and of dental practitioners, and from the Spanish National Health Interview Surveys. The percentage of people that had visited the dentist in the 3 months prior to the survey was calculated, and of these, the percentage whose last visit was private. The total number of visits made by those people was taken as the estimate of total private visits in Spain during 3 months. Total private activity in 1 year was derived by multiplying this estimate by four. Annual private activity was then divided by the number of dentists.

RESULTS

From 1987 to 1997, the Spanish population grew 2.5% (from 38.7 to 39.7 million) and the number of dentists increased by 136.1% (from 6373 to 15,044). The total annual number of private dental visits (+/-SE) was 35.7 +/- 1.0 million in 1987, and 48.9 +/- 2.0 million in 1997 - a 36.8% increase. Thus, the mean number of private dental visits per dentist decreased 42.0% (from 5610 +/- 152 to 3251 +/- 133).

CONCLUSION

A significant reduction in private dental visits per dentist is taking place in Spain.

Practice activity trends among Australian private general dental practitioners: 1983-84 to 1998-99

AIM

To investigate time trends in practice activity.

DESIGN

Four cross-sectional surveys across a 15 year period.

SETTING

Australian private general practice.

PARTICIPANTS

A random sample of dentists.

METHODS

Dentists were surveyed by mailed questionnaire in 1983, 1988, 1993 and 1998 (response rates 71%-75%). Data were weighted to provide representative estimates for the age by sex distribution of private general practitioners in 1983, 1988, 1993 and 1998.

MAIN OUTCOME MEASURES

Hours per year worked, patient visits per hour and patient visits per year.

RESULTS

The number of patient visits per year declined across the period, related to parallel decreases in the number of patient visits per hour (ANOVA; P<0.05), while there was no significant difference during the period in the number of hours per year devoted to work. The interaction of dentist sex by time of survey indicated that while numbers of patient visits per year had remained stable for female dentists, there was a trend for the higher number of patient visits per year among male dentists at the beginning of the survey period to decline over time.

CONCLUSIONS

Male dentists had higher levels of practice activity compared with female dentists, but a decline in the number of patient visits per year reflected a convergence of male practice patterns towards that of female dentists.

Geriatric dentistry in long-term-care facilities: current status and future implications

The status of oral health care of geriatric patients in long-term-care facilities is reviewed. Barriers to improving the dental management of institutionalized geriatric patients are discussed. The elderly population segment is the fastest-growing population, which presents a great burden to dental health professionals. Institutionalized geriatric patients are currently not receiving adequate care, and the number of these patients will double by the year 2020. The future implications are of considerable importance. Commitment by dental professionals to meet the oral health needs of this underserved population is key to the improvement of and change in the current status of this population.

An in vitro evaluation of the integrity of stainless steel crown margins cemented with different luting agents

The elderly population is retaining more teeth which require extensive restorations. The purpose of this study was to identify a luting agent which had the least marginal breakdown when used with stainless steel crowns. Thirty-six caries-free molars were selected, prepared for stainless steel crowns, and embedded in acrylic to support the crown and tooth. The crowns (Unitek/3M) were cemented with 4 different luting agents: (A) Fleck's Cement, (B) Ketac-Cem, (C) All-Bond C & B Cement, and (D) Panavia EX Cement. All the restored teeth were thermocycled and divided into 3 experimental groups. Twelve teeth were stained. The remaining teeth were occlusally loaded and stained. The remaining 12 teeth were thermocycled and stained again. The stainless steel crowns were then sectioned and photographed at 7.5x mag. The dye penetration was evaluated by measurement of the percentage of dye penetration from the crown margin to the cusp tip on each side. Statistical analysis found that the least dye penetration was with All-Bond C & B Cement (p = 0.0001). The most extensive penetration was observed in Ketac-Cem Occlusal loading was a significant factor (p = 0.0001) increasing the dye penetration, but the crown-tooth gap was not.