Access to Dental Care in the US Time for Change?? Dr. Ana Karina Mascarenhas Immediate Past President, AAPHD Associate Dean of Research, Chief of Primary Care, Nova Southeastern University College of Dental Medicine
What is all the fuss about?
Have you met this Child? Deamonte Driver
Have you met this Child? Dylan Stewart Age 5 4 filling and 8 crowns
The Need
Distribution of Dentists in Ohio Susi and Mascarenhas, 2002
Ohio Population to Dentist Ratio Susi and Mascarenhas, 2002
Mississippi Population to Dentist Ratio Krause et al, 2005
Dental Health Professional Shortage Areas in Mississippi by County, 2000. Krause et al, 2005
Distribution of Dentist in Illinois, 2006
Iowa Kuthy et al. Dentist Workforce Trends in a Primarily Rural State: Iowa: 1997-2007. JADA 2009, 140: 1527-1534
Iowa Kuthy et al. Dentist Workforce Trends in a Primarily Rural State: Iowa: 1997-2007. JADA 2009, 140: 1527-1534
Florida Dentist to Population Ratios 2009-2010 Bamashmous and Mascarenhas, 2011
What are these numbers? 4622 6997 9900 50,813,326
Dental Health Profession Shortage Areas (DHPSA) These 9,900 dentists would employ an additional 15,228 dental assistants 11,016 dental hygienists Or the equivalent of Two graduating dental school classes Nearly three graduating dental hygiene classes More than two graduating dental assisting classes Source: American Dental Education Association, Unleashing the Potential.
U.S. Designated Dental Health Professions Shortage Areas 1991, 2000-2011 Source: Shortage Designation Branch, Office of Workforce Evaluation and Quality Assurance, Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services
U.S. Population Living in D-HPSAs* and Estimated Underserved Population Living in DHPSAs, 1991 and 2000-2011 Source: Shortage Designation Branch, Office of Workforce Evaluation and Quality Assurance, Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services * Designated Health Professions Shortage Areas
Dentists Needed to Achieve Target Ratio and Remove Designation in D-HPSAs*, 1991 and 2000 2011 Source: Shortage Designation Branch, Office of Workforce Evaluation and Quality Assurance, Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services * Designated Health Professions Shortage Areas
THE MATH! STUDENTS EACH STUDENT SAW 7 PATIENTS PER DAY AT EXTERNSHIP RESIDENTS EACH RESIDENT SAW 14 PATIENTS PER DAY 4,700 STUDENTS WOULD SEE 32,900 PATIENTS/VISITS 4,700 RESIDENTS WOULD SEE 65,800 PATIENTS/VISITS 240 DAYS IN SCHOOL DURING THE YEAR 240 DAYS IN SCHOOL DURING THE YEAR 7,896,000 PATIENTS/VISITS 15,792,000 PATIENTS/VISITS
THE MATH! IF 20 NEW SCHOOLS OPEN WITH AN AVERAGE CLASS SIZE OF 100, RESULT IN ADDING 2,000 GRADUATES TO THE 4,700 WE NOW GRADUATE. THE 6,700 TOTAL GRADUATES PER YEAR IS IN THE BALLPARK OF THE 1980s GRADUATES WHILE THE POPULATION IS GROWING VERY FAST AND ACCESS IS GETTING WORSE.
Estimated Changes in Number of Dentists in the Dental Workforce, 1995-2040 From 2014 to 2027, it is estimated that more dentists will leave the workforce than enter it These data assume that the number of graduates remains at 4,850 after 2007 and retirement age is 65 Source: American Dental Education Association
Dental School Graduates through 2030 Source: American Dental Association, February 22, 2011
New Dental Providers Community Dental Health Coordinator Oral Preventive Assistant Advanced Dental Hygiene Practitioners Dental Health Aide Therapist
Community Dental Health Coordinator (CDHC) Dental team member connected to a responsible supervising dentist. Scope: Extensive care coordination services, screening, limited preventive and palliative care Settings: Health and community settings such as clinics, schools, churches, senior citizen centers, Head Start Programs and other public settings CDHC come from the community in which they will serve
Oral Preventive Assistant (OPA) Dental team member connected to a responsible supervising dentist. Scope: Collecting diagnostic data, preventive care including prophylaxis Settings: Health and community settings such as clinics, schools, churches, senior citizen centers, Head Start Programs and other public settings, private practice
Advanced Dental Hygiene Practitioner (ADHP) Dental team member connected to a responsible supervising dentist, possibly via teledentistry Scope: diagnostic, preventive, restorative, prophylaxis, and simple extractions Settings: Health and community settings such as clinics, schools, churches, senior citizen centers, Head Start Programs and other public settings, private practice
Dental Health Aide Therapist (DHAT) Dental team member connected to a responsible supervising dentist, possibly via teledentistry Scope: preventive, restorative, pulpotomy, prophylaxis, and simple extractions Settings: Health and community settings such as clinics, schools, churches, senior citizen centers, Head Start Programs and other public settings DHAT come from the community in which they will serve
Edelstein BL. Training new dental health providers in the US. 2009, W.K. Kellog Foundation.
Alaska Dental Health Aide Therapist Minnesota Dental Therapist Advanced Dental Therapist (Advanced Dental Hygiene Practitioners)
The writing is on the Wall Alaska Minnesota Other states considering: Maine Connecticut California Washington 33 other states have demonstrated interest
The horse if out of the barn!!
And Sprinting Away
OR
AAPHD s Vision Optimal Oral Health for All
AAPHD Policy on Access to Dental Care AAPHD recognizes a number of current best practices and promising new strategies that have the potential to improve access to oral health services for all communities: Community-based prevention programs, e.g., community water fluoridation School-based and school-linked programs, e.g., sealant and fluoride varnish programs Expanded use of non-dental personnel, e.g., medical care providers providing oral health assessments and fluoride varnish applications Reform of publicly-financed health care programs, e.g., establishing market-based reimbursement policies in Medicaid Expanded use of new and emerging types of dental personnel, e.g., Alaska Dental Health Aide Therapist Strengthening the dental public health infrastructure, e.g., statutory authority for a state dental director Involvement of multiple partners, e.g., oral health coalitions in many states. Assuring that any efforts to increase access to health care through reforms to insurance programs include dental benefits commensurate with medical benefits. AAPHD recognizes that health care providers have a moral obligation to heal the sick and infirm regardless of financial inequities. All individuals should have access to needed oral health prevention and treatment services as a basic moral right.
Resolution on the Need for Formal Demonstration Programs to Improve Access to Preventive and Therapeutic Oral Health Services Whereas, The American Association of Public Health Dentistry views access to preventive and therapeutic oral health services as vitally important for all Americans, Whereas, the AAPHD desires to foster broad-based policies and programs to help alleviate oral diseases, Whereas, many populations, such as the Alaska Native population living in remote and isolated villages, have overwhelming unmet oral health needs, Whereas, access to preventive and therapeutic oral health care for these populations is not readily available, Whereas, in compliance with federal law, the Alaska Native Tribal Health Consortium has initiated a pilot program based on a long-standing training model to begin to address Native Alaskans unmet needs with their Dental Health Aide Program, and Whereas, other model programs may now exist or be created that could provide effective and novel ways to improve access for high need populations, then Be it resolved, the American Association of Public Health Dentistry strongly supports innovative demonstration programs aimed at improving access to preventive and therapeutic oral health services for underserved populations and commits to working with the communities of interest to assure an independent and formal evaluation and dissemination of accurate information to the public and the profession about such model programs.
WK Kellogg and Macy Foundations Charge 1. Outline a proposed curriculum for 2-year postsecondary school education and training for dental therapists 2. Outline considerations concerning location and placement of such educational programs 3. Assess career path implications of the curriculum 4. Assess issues and opportunities regarding 4. accreditation of such programs
Competencies 1. Assessment and judgment 2. Preventive care, per protocol 3. Therapeutic care, per protocol 4. Pharmacological and emergency management, per protocol 5. Professional and community responsibility
The dental therapist curriculum is designed to be completed in 24 months (6 trimesters/8 quarters) and to serve as a template for a suggested core curriculum.
Questions 1. Is this provider a "safe" provider? 2. Would this provider improve access to dental care in the US? 3. Cost-effectiveness of this provider? 4. What are other solutions to the access problem?
The various indicators.five therapists who were The various indicators.five therapists who were included in this study are performing well and operating safely and appropriately within their defined scope of practice. The data indicate that the therapists who were observed are technically competent to perform these procedures within their scope of practice. The patients who were surveyed were generally very satisfied with the care they received from the therapists.
Solo General Dentist Solo Pediatric Dentist Small group practice
Almost ten years after the Surgeon General s report designating dental disease as the "silent epidemic", the nation continues to struggle with adequate access to and utilization of dental services. National Health Policy Forum - George Washington University, March 29, 2010 - Issue Brief No. 836 (http://www.nhpf.org/library/details.cfm/2779)
FOR WANT OF A DENTIST
Have you met this Child?
Thanks