ADA.org: Future of Dentistry Full Report

FUTURE OFDENTISTRY

to keep pace. Other states, such as Minnesota,
Missouri, Michigan, Nebraska and Wisconsin
showed declines in their dentist-to-population ratios
even though their populations were not growing as
quickly as the national average. The number of
active dentists in those states grew little or not at all.
Nearly one-half of the United States states showed
an increase in the dentist-to-population ratios. Most of
these states have not expressed significant concerns
regarding the adequacy of the size of their dental work-
force. Some have expressed concerns that they may be
entering a period of over-abundance of dentists.
As mentioned before, dentist-to-population ratios
are crude measures of the adequacy of the dentist
workforce and should be used with caution.
Clearly, this admonition also applies to regional
workforce assessments. When the dentist-to-popu-
lation ratios are adjusted for productivity increases
a different picture emerges (see Figure 3.7). The
productivity-adjusted ratiosshow an increase in the
productive capacity of the dentist per 100,000 pop-
ulation for most states between 1993 and 1999.
However, some states have lost productive capacity,
even with adjustments for increases in productivity.
In summary, the national dentist workforce seems
to be adequate. Moreover, it can remain adequate if
major new programs are not enacted, declines in
dental school graduates do not occur, and produc-
tivity continues to rise. However, circumstances can
change. The nation and the dental profession must
follow the national workforce trends carefully
and be ready to act when circumstances warrant
action.
Regional workforce issues do exist and may
become more pronounced in the future. How-
ever, given these widely varying workforce condi-
tions among the states, it is apparent that one
overall national policy will not fit the specific
needs of various states. States with a sufficient
number of practitioners will require a different
policy than those states in which the number of
dentists is declining. Those latter states face
potentially serious workforce issues that should be
addressed with their state-specific needs and cir-
cumstances in mind.

THE ORGANIZATION AND
MANAGEMENT OF DENTAL PRACTICE

In 1997, 92% of active professional dentists were
in private practice. Of these, 79% were sole pro-

prietors (Valachovic, 2000). Most dental school

graduates plan to own their practice.

As owners of their practices, dentists must be

skilled business managers as well as dedicated cli-

nicians. They are the "CEOs" supervising pro-

duction, expenses, and employment challenges of

a business. As employers, dentists supervise the

training, delegation of duties, and schedules for

employees. This supervision also includes OSHA

regulations, infection control, and waterline safe-

ty. Ethical considerations in patient management

and business practices will remain an essential

component to successful dental practice.

ALLIED DENTAL HEALTH PERSONNEL

The dentist's ability to expand the service capac-

ity of his or her practice lies, in part, in the ability to

delegate tasks to dental assistants and dental hygien-

ists. Research from the 1970s has demonstrated that

many functions could be delegated safely, effectively,

and with quality comparable to those provided by den-

tists (Mullins et al, 1979; and Mullins et al, 1983).

Delegation of many functions to dental assistants

and dental hygienists has proven to be beneficial to

dentists and their patients (Mullins et al, 1979; and

Mullins et al, 1983). As a result, the role and duties

of dental assistants and dental hygienists is expected

to increase.

Dental Hygienists

The number of dental hygienist graduates has

increased from3,953 in 1990 to 5,023 in 1997, an

increase of 27.1% (ADA, 2000).

Although the number of graduating hygienists

has increased during the past ten years, the availabil-

ity of trained hygienists to dental practices appears to

be reduced. In an unpublished survey of Minnesota

dentists, 36% of those dentists responding indicated

that they were unable to take new patients because of

a lack of dental hygienists (Minnesota Dental

Association, 2000). The average time required to hire

dental hygienists was 23 weeks and the average time

to hire a new registered dental assistant was

17 weeks in 2000 (Minnesota Dental Association,

2000).

Dental Assistants

Graduates of dental assisting programs increased

Clinical Dental Practice and Management