Dental safety net capacity: An innovative use of existing data to measure dentists’ clinical engagement in state Medicaid programs

Background The demand for dentists available for state Medicaid populations has long outpaced the supply of such providers. To help understand the workforce dynamics, this study sought to develop a novel approach to measuring dentists’ relative contribution to the dental safety net and, using this new measurement, identify demographic and practice characteristics predictive of dentists’ willingness to participate in Indiana's Medicaid program. Methods We examined Medicaid claims data for 1,023 Indiana dentists. We fit generalized ordered logistic regression models to measure dentists’ level of clinical engagement with Medicaid. Using a partial proportional odds specification model, we estimated proportional adjusted odds ratios for covariates and separate estimates for each contrast of nonproportional covariates. Results Though 75% of Medicaid‐enrolled dentists were active providers, only 27% of them had 800 or more claims during fiscal year 2015. As has been shown in previous studies, our findings from the proportional odds model reinforced certain demographic and practice characteristics to be predictive of dentists’ participation in state Medicaid programs. Conclusions In addition to confirming predictive factors for Medicaid enrollment, this study validated the clinical engagement measure as a reliable method to assess the level of Medicaid participation. Prior studies have been limited by self‐reported data and variations in Medicaid claims reporting

Comparison of opioid prescribing by dentists in the United States and England

Importance: The United States consumes most of the opioids worldwide despite representing a small portion of the world\u27s population. Dentists are one of the most frequent US prescribers of opioids despite data suggesting that nonopioid analgesics are similarly effective for oral pain. While oral health and dentist use are generally similar between the United States and England, it is unclear how opioid prescribing by dentists varies between the 2 countries. Objective: To compare opioid prescribing by dentists in the United States and England. Design, Setting, and Participants: Cross-sectional study of prescriptions for opioids dispensed from outpatient pharmacies and health care settings between January 1 and December 31, 2016, by dentists in the United States and England. Data were analyzed from October 2018 to January 2019. Exposures: Opioids prescribed by dentists. Main Outcomes and Measures: Proportion and prescribing rates of opioid prescriptions. Results: In 2016, the proportion of prescriptions written by US dentists that were for opioids was 37 times greater than the proportion written by English dentists. In all, 22.3% of US dental prescriptions were opioids (11.4 million prescriptions) compared with 0.6% of English dental prescriptions (28 082 prescriptions) (difference, 21.7%; 95% CI, 13.8%-32.1%; P \u3c .001). Dentists in the United States also had a higher number of opioid prescriptions per 1000 population (35.4 per 1000 US population [95% CI, 25.2-48.7 per 1000 population] vs 0.5 per 1000 England population [95% CI, 0.03-3.7 per 1000 population]) and number of opioid prescriptions per dentist (58.2 prescriptions per dentist [95% CI, 44.9-75.0 prescriptions per dentist] vs 1.2 prescriptions per dentist [95% CI, 0.2-5.6 prescriptions per dentist]). While the codeine derivative dihydrocodeine was the sole opioid prescribed by English dentists, US dentists prescribed a range of opioids containing hydrocodone (62.3%), codeine (23.2%), oxycodone (9.1%), and tramadol (4.8%). Dentists in the United States also prescribed long-acting opioids (0.06% of opioids prescribed by US dentists [6425 prescriptions]). Long-acting opioids were not prescribed by English dentists. Conclusions and Relevance: This study found that in 2016, dentists in the United States prescribed opioids with significantly greater frequency than their English counterparts. Opioids with a high potential for abuse, such as oxycodone, were frequently prescribed by US dentists but not prescribed in England. These results illustrate how 1 source of opioids differs substantially in the United States vs England. To reduce dental opioid prescribing in the United States, dentists could adopt measures similar to those used in England, including national guidelines for treating dental pain that emphasize prescribing opioids conservatively

The current status of dental education and the dental profession in Chile

Indexación: Scopus.Objective: To describe the current situation of the dental profession in Chile, including training and workforce issues. Material and Methods: Data were collected from different national institutions, which included information regarding number of current registered dentists, university of graduation, geographical distribution, professional position, additional specialty certifications obtained, the number and characteristics of dental surgeons who work in the public and private sectors, the traditional character of the university, the accreditation status of the undergraduate dental programs and the general population number. Results: Currently there are 32 schools of Dentistry in Chile, of which 21 have their quality certified. There are 19,100 Chilean dentists and 1,727 foreign dentists registered. The number of graduates from private universities has increased significantly. Currently, 2,164 dentists work for MINSAL. Less than a third hold a specialty certification. Forty-five percent of the dental specialists obtained their certification from universities. The current professional ratio is 104 dentists per 100,000 habitants. Conclusion: The number of dentists in Chile has increased progressively during the last years, mainly associated with the opening of new dental schools. Only 28% of the Chilean dental schools have certified their quality for the total duration of the undergraduate program. Regarding the workforce, there is a public/private and geographical inequities in dentists’ distribution.http://revista.uepb.edu.br/index.php/pboci/article/view/3875/pd

Dental workforce 2012

Summary: Access to reliable, comprehensive, timely and nationally consistent trend data is required to understand the current health workforce and for its future planning. There is particular interest in changes to the size and composition of the various health professions, and the potential impacts of these changes on health-care delivery. This report provides data on the Australian dental practitioner workforce in 2012. Size of the dental workforce In 2012, there were 19,462 dental practitioners registered in Australia. Three-quarters of these practitioners (14,687) were dentists. The number of employed dentists increased by 5.3%, from 12,599 in 2011 to 13,266 in 2012. There were 1,330 dentists working as specialists. Orthodontics was the most common specialty (518 dentists). In 2012, there were also 1,425 dental hygienists, 1,117 dental therapists, 1,100 dental prosthetists and 675 oral health therapists employed in their fields. Sex and age of the dental workforce Sex Dentistry is a male dominated profession; however, the proportion of female dentists increased to 36.5% in 2012 from 35.2% in 2011. Employed dental therapists, dental hygienists and oral health therapists, were predominantly women (96.9, 94.6% and 84.7%, respectively). Dental prosthetists were much more likely to be men. Women made up 14.7% of this workforce, an increase from 13.9% in 2011. Age The average age of dentists employed in 2012 was 43.4 (the same as in 2011) and 23.4% were aged 55 and over. Employed dental prosthetists, dental therapists, dental hygienists and oral health therapists were aged 49.1, 46.4, 37.4 and 31.0, on average, respectively. Working arrangements Dentists worked, on average, 37.0 hours per week in 2012, a slight decrease from 2011 (37.3 hours per week). In 2012, 31.7% dentists worked part time (less than 35 hours per week). The majority of employed dentists were working in private practice (79.7% of clinicians and 77.3% of all dentists). Most specialists worked in private practice (75.0%) and in Major cities (89.1%). Major cities had more dentists per capita than other areas in 2012 at 64.3 full-time equivalent (FTE) dentists per 100,000 population, and more than the Australian rate of 56.9 FTE dentists

Deep Learning for the Radiographic Detection of periodontal Bone Loss

We applied deep convolutional neural networks (CNNs) to detect periodontal bone loss (PBL) on panoramic dental radiographs. We synthesized a set of 2001 image segments from panoramic radiographs. Our reference test was the measured % of PBL. A deep feed-forward CNN was trained and validated via 10-times repeated group shuffling. Model architectures and hyperparameters were tuned using grid search. The final model was a seven-layer deep neural network, parameterized by a total number of 4,299,651 weights. For comparison, six dentists assessed the image segments for PBL. Averaged over 10 validation folds the mean (SD) classification accuracy of the CNN was 0.81 (0.02). Mean (SD) sensitivity and specificity were 0.81 (0.04), 0.81 (0.05), respectively. The mean (SD) accuracy of the dentists was 0.76 (0.06), but the CNN was not statistically significant superior compared to the examiners (p = 0.067/t-test). Mean sensitivity and specificity of the dentists was 0.92 (0.02) and 0.63 (0.14), respectively. A CNN trained on a limited amount of radiographic image segments showed at least similar discrimination ability as dentists for assessing PBL on panoramic radiographs. Dentists’ diagnostic efforts when using radiographs may be reduced by applying machine-learning based technologies

An investigation of occupational stress in New Zealand dentists : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University

The present study sought to identify the occupational stressors as well as the resultant psychological and physical stress outcomes for New Zealand dentists. Additionally, the direct and moderating effects of coping were explored in relation to the identified stress outcomes. To achieve this, quantitative data was collected in the form of selfreport questionnaires, these being the Occupational Stress Inventory, the Suicide Probability Scale and the Dental Satisfaction Survey. A random, nationwide sample of 500 New Zealand dentists were sent these questionnaires, with 210 dentists returning completed questionnaires. The present study also sought to overcome recent criticisms of the methodology frequently used in stress research. As such qualitative data was collected through interviews with twelve New Zealand, general dentists in the Manawatu region. The interview questions were designed to elicit the job-specific stressors of dentistry in New Zealand as well as the coping responses of New Zealand dentists. Discussion with the New Zealand Dental Association confirmed that the quantitative sample in the present study is representative of the general New Zealand population. However, the representativeness of the qualitative sample could not be established due to the small sample size. The results of the present study showed that there was a consistent positive relationship between coping and job satisfaction, and a consistent negative relationship for coping and strain, and coping and suicide probability. Additionally, coping was found to be a moderator in the stressor-stress relationship, with dentists high in coping experiencing less distress (than dentists low in coping) in conditions of both high and low stress. Sex differences were found to be significant for the role overload stressor, with female dentists reporting on average significantly higher levels of role overload. Significant group differences were also found between self-employed and employee dentists, with employee dentists experiencing significantly greater levels of physical environment stress as well as stmin. Overall, low to moderate levels of stressors. coping, suicide probability, job satisfaction and physical/psychological distress were reported, indicating that New Zealand dentistry may not be any more stressful than other occupations in New Zealand. In terms of methodology, the present study indicates that the Occupational Stress Inventory, being a general stress self-report questionnaire, does not measure job-specific stressors. Therefore, it is suggested that future research utilises questionnaires that have been designed to measure specific occupational stressors as well as the frequency and the intensity of these stressors

Two Kinds of Dental Shortages Fuel One Major Access Problem

Calls for expanding the dental workforce to address the shortage of dentists in certain geographical areas and of dentists treating Medicaid patients required in meeting the needs of low-income children who will be eligible for dental insurance by 2014

Dental Dam Utilization by Dentists in an Intramural Faculty Practice

Objectives: From casual observation of our colleagues, only a few individuals use the dental dam for operative procedures in their faculty practice. The purpose of this study was to obtain faculty perceptions of the dental dam, quantify its utilization in their intramural faculty practice, and determine the factors that influence dental dam usage.Materials and Methods: A survey containing 11 questions was sent to 19 faculty members who teach full time and maintain an intramural dental practice involving operative dentistry. Thirty electronic dental health records of the 19 providers were reviewed to gather the following information from restorative procedures they completed: isolation methods, tooth location and involved surfaces, and dental restorative material.Results: Overall, dental dam was utilized for 30% of all restorative procedures and was used less than 20% of the time for placement of class II and class III composite resins. Dental dam utilization rate by general dentists was 37% and 17.6% for prosthodontists. Those general dentists with prior history of military dental practice had a utilization rate of 78.6% and nonmilitary dentists only 7.6%. Eight faculty members responded to the questionnaire for a 42% return rate. Those who practiced dentistry in the military strongly agreed that the dental dam is the standard of care, improves their quality of restorative work, and should be documented in the dental record.Conclusions: There were significantly different dental dam utilization rates between general dentists and prosthodontists and between dentists with prior military experience and those without