FUTURE OFDENTISTRYIn private practice most care is provided to
those who are willing and able to pay the den-
tist's standard fee for the services rendered.
Individuals with unmet needs who are unable or
unwilling to pay the provider's fee generally do
not effectively demand care from the private prac-
tice sector. These individuals with diseases not
treated in private practice are likely targets for
new public policies intended to improve their
access to care. To be effective these new policies
must have the necessary resources to translate
unmet need into effective demand. With existing
programs, too often such resources are inade-
quate (Barnett and Brown, 2000).
Demand Approach to Dental Care
Since most dental care in the United States is
provided through private markets, an assessment
of the demand for dental services is important
for understanding access to dental care (Brown,
1989; Brown and Lazar, 1998; and Tuominen,
1994). The demand for dental
services is significantly respon-
sive to changes in dental fees -
the higher the fees, the lower the
demand. Other factors that
influence the level of demand
include income, family size,
population size, education lev-
els, prepayment coverage, health
history, ethnicity, age, and other
conditions.
Most factors that positively in-
fluence demand for dental care
have been expanding. The United
States economy has grown
robustly for most of the past two
decades, resulting in an increase
in discretionary income among
Americans (Beazoglou et al, 1993;
Brown et al, 1994). People are
becoming more knowledgeable
about dental health and what is
required to maintain it. As the
population has become more
affluent and educated, the value
placed on oral health has
increased. In addition, the desire
for esthetic dentistry has grown
and will probably continue to do
so. All of these factors have enhanced the demand
for dental services. Disease levels and trends also
are important to obtain a complete view of the con-
ditions influencing the demand for care.
Dental caries has been the primary foundation of
the demand for dental services in modern times and
as shown earlier, dental caries has been declining in
almost all segments of the child population and to a
lesser degree in adults up to about the age of 45
years (Brown, 1989; Brown et al, 2000a; Brown et
al, In Press). With this decline comes a decline in
the need for dental services to treat caries. The pop-
ulation 45 years of age and older experienced caries
in substantial amounts during their younger years
and will require continued management of the con-
sequences of the original caries.
Due to changing disease patterns, the dental
sector is going through a transition from a service
mix that has been predominately therapeutic to a
service mix that will be mostly preventive. As seen
in Table 4.1, cleanings and examinations more than
doubled between 1959 and 1999, while amalgamFinancing of and Access to Dental Services
Percentage of Patients Receiving Selected Dental Services
from Private Practitioners in the United States, by Year* The data for 1999 were derived prior to the publication of the ADA 1999 Survey of Dental
Services Rendered report; and may, therefore, differ slightly from the published report.
Source: ADA, 1994 and 2001.20.1%19.90.920.120.61.61.713. 0NANA- 8 %
25. 54 .015 .9- 4
2.92.9- 8
NANA30.1%24 .9- 8
8. 59.65 .23.25. 4NANA4 2. 8 %38 .6- 8
5 .3- 2
5 .32.64 .94. 41.945. 4 %37.210.63.04 .05 .93.33.74 .24. 8Procedure 1959 1969T A BLE 4 .11979 1990 1999 *Oral ExaminationProphylaxisFluoride TreatmentAmalgam, 1 SurfaceAmalgam, 2 SurfacesCrownRoot CanalExtractionResin - AnteriorResin - Posterior