Explore the vast range of titles available.

Reducing the Cost of Dental Care was first published in 1983. Spiraling heath care costs have encouraged health care practitioners, public policy-makers, and consumers to find ways of maintaining high quality care at affordable rates. Reducing the Cost of Dental Care examines a number of ways in which cost savings might be realized in dentistry. This collection of papers, written by health economists and dentists, brings together economic issues and health care aspects of the debate. Each of the six chapters addresses a particular issue concerning cost and quality of care. Chapter one shows the probable effects on dental costs of advertising, franchising, multiple-dentist practices, and greater use of auxiliary personnel. Chapter two explores alternatives for the delivery of dental care: prepaid group practices, government-sponsored programs, and dental care delivered in school and workplaces. The third chapter focuses on cost savings which could result from increased use of auxiliary personnel, a practice which is presently illegal. A chapter on changes in dental education suggests that less important material be eliminated from dental school curriculums and that students be trained to practice cost-conscious dentistry. Chapter five presents, through computer simulation, the varying costs of different patterns of care: preventative, intermittent, or care as a response to symptoms. Chapter six explores quality assurance systems which can monitor the type of treatment and the level of care and skill provided by dental personnel. The introduction and conclusion of the book deal with another important issue, cost increases which are due to third-party payment. The editors discuss the costs and benefits of the growth of dental insurance. Throughout, the aim in this volume is to present practical suggestions for reducing costs without sacrificing quality care. Where possible, the authors suggest ways of improving access to dental care for groups who are now outside the delivery systems. The papers are written to be accessible to dentists, economists, policy-makers, and all those involved in health delivery systems.

Since 1923, more than fifty countries have improved access to dental care by allowing midlevel providers-frequently called dental therapists-to offer preventive and restorative treatment, primarily in the public sector. A growing body of research has found that dental therapists provide high-quality, cost-effective care and improve access to care for underserved populations. This article explores the evolution of the dental therapy movement in the United States, where multiple barriers to oral health care have created persistent unmet needs. We examine developments since the 1940s that have led to the authorization of dental therapists in parts of Alaska and the states of Minnesota, Maine, and Vermont; and the approval of national accreditation standards for dental therapy training programs by dental educators. We also show how dental therapists might fit within a health care system that is being transformed.

Background Despite the increase in dental care utilization in the U.S., access to dental care is limited by many barriers, particularly financial ones. The aim of this study was to assess the relationship between the affordability of dental treatment and oral health outcomes. Methods This cross-sectional study utilized 2015–2018 National Health and Nutrition Examination Survey data (NHANES). The key outcomes measured included the number of decayed teeth, missed teeth due to caries, and filled teeth (DMFT), the number of untreated teeth with dental decay and missing teeth, the presence of root caries, and the affordability of dental care as the main predictor. Descriptive analyses, negative binomial analyses for count outcomes, and logistic regression for binary outcomes were conducted. The analyses were adjusted for the NHANES sampling weights. Results The study included 11,566 participants, 14.17% of whom reported being unable to afford dental treatment. Among those who could not afford dental treatment, the mean ratio was 3.27 (95% CI: 2.72–3.95; p  < 0.01) for untreated dental decay, along with a higher DMFT (mean ratio 1.24; 95% CI: 1.18–1.31; p  < 0.01) compared with those who could afford treatment. The odds of having root caries were significantly greater (odds ratio 4.46; 95% CI: 3.53–5.64; p  < 0.01) among those unable to afford dental care than among those who could afford treatment. Conclusion Individuals who cannot afford dental care experienced significantly higher ratios of untreated dental decay and other oral health outcomes. The findings highlight the necessity for targeted interventions to address financial barriers and improve access to dental services.

The most comprehensive study of US community water fluoridation program benefits and costs was published in 2001. This study provides updated estimates using an economic model that includes recent data on program costs, dental caries increments, and dental treatments. In 2013 more than 211 million people had access to fluoridated water through community water systems serving 1,000 or more people. Savings associated with dental caries averted in 2013 as a result of fluoridation were estimated to be$32.19 per capita for this population. Based on 2013 estimated costs ($ 324 million), net savings (savings minus costs) from fluoridation systems were estimated to be $6,469 million and the estimated return on investment, 20.0. While communities should assess their specific costs for continuing or implementing a fluoridation program, these updated findings indicate that program savings are likely to exceed costs.

Background To improve the oral health of low-income children, innovations in dental delivery systems are needed, including community-based care, the use of expanded duty auxiliary dental personnel, capitation payments, and global budgets. This paper describes the protocol for PREDICT (Population-centered Risk- and Evidence-based Dental Interprofessional Care Team), an evaluation project to test the effectiveness of new delivery and payment systems for improving dental care and oral health. Methods/Design This is a parallel-group cluster randomized controlled trial. Fourteen rural Oregon counties with a publicly insured (Medicaid) population of 82,000 children (0 to 21 years old) and pregnant women served by a managed dental care organization are randomized into test and control counties. In the test intervention (PREDICT), allied dental personnel provide screening and preventive services in community settings and case managers serve as patient navigators to arrange referrals of children who need dentist services. The delivery system intervention is paired with a compensation system for high performance (pay-for-performance) with efficient performance monitoring. PREDICT focuses on the following: 1) identifying eligible children and gaining caregiver consent for services in community settings (for example, schools); 2) providing risk-based preventive and caries stabilization services efficiently at these settings; 3) providing curative care in dental clinics; and 4) incentivizing local delivery teams to meet performance benchmarks. In the control intervention, care is delivered in dental offices without performance incentives. The primary outcome is the prevalence of untreated dental caries. Other outcomes are related to process, structure and cost. Data are collected through patient and staff surveys, clinical examinations, and the review of health and administrative records. Discussion If effective, PREDICT is expected to substantially reduce disparities in dental care and oral health. PREDICT can be disseminated to other care organizations as publicly insured clients are increasingly served by large practice organizations. Trial registration ClinicalTrials.gov NCT02312921 6 December 2014. The Robert Wood Johnson Foundation and Advantage Dental Services, LLC, are supporting the evaluation.

Dental coverage for adults is an elective benefit under Medicaid. As a result of budget constraints, California Medicaid eliminated its comprehensive adult dental coverage in July 2009. We examined the impact of this policy change on emergency department (ED) visits by Medicaid-enrolled adults for dental problems in the period 2006-11. We found that the policy change led to a significant and immediate increase in dental ED use, amounting to more than 1,800 additional dental ED visits per year. Young adults, members of racial/ethnic minority groups, and urban residents were disproportionately affected by the policy change. Average yearly costs associated with dental ED visits increased by 68 percent. The California experience provides evidence that eliminating Medicaid adult dental benefits shifts dental care to costly EDs that do not provide definitive dental care. The population affected by the Medicaid adult dental coverage policy is increasing as many states expand their Medicaid programs under the ACA. Hence, such evidence is critical to inform decisions regarding adult dental coverage for existing Medicaid enrollees and expansion populations.

Doctoral education, a key component of higher education in the United States, is performing well. It educates future professors, researchers, innovators, and entrepreneurs. It attracts students and scholars from all over the world and is being emulated globally. This success, however, should not engender complacency. A Data-Based Assessment of Research-Doctorate Programs in the United States provides an unparalleled dataset that can be used to assess the quality and effectiveness of doctoral programs based on measures important to faculty, students, administrators, funders, and other stakeholders. This report features analysis of selected findings across six broad fields: agricultural sciences, biological and health sciences, engineering, physical and mathematical sciences, social and behavioral sciences, and humanities, as well as a discussion of trends in doctoral education since the last assessment in 1995, and suggested uses of the data. It also includes a detailed explanation of the methodology used to collect data and calculate ranges of illustrative rankings.

Traditional Medicare still lacks dental coverage, which has contributed to inequities in pain, edentulism, and unmet need among lower-income people, people of color, and older adults. The federal government is now closer than ever to enacting a Medicare dental benefit.

Background Irregular dental visits due to cost-related delays contribute to poor oral health outcomes, dental needs, and emergency service utilization across the life course. The study investigated how predisposing, enabling, and needs factors are associated with cost-related delays in oral health care and postponed dental visits. Methods Using secondary data from the 2022 National Health Interview Survey for United States (U.S.) adults aged 18–64 years, the study conducted descriptive, bivariate, and multivariate data analyses. Separate multivariable logistic regressions were used to model cost-related delayed oral health care and postponed dental visits (no dental visit in the past 12 months) as a function of predisposing, enabling, and need factors ( n  = 17,513). Predictor variables included race, education, smoking status, age, gender and employment status (Predisposing factors), family income as a percentage of the Federal Poverty Level (FPL) and Health Service Deficit (HSD) variables (no health insurance, no usual medical primary care provider, > 12 months of last medical exam and delayed medical care due to cost) (Enabling factors), difficulty engaging in social activities and the presence of > 1 comorbidity (Need factors). Results The prevalence of cost-related delayed oral health care was 20.2%, and that of postponed dental visits was 36.4%. Strong predictors for cost-related delayed oral health care emerged from predisposing factors (smoking OR = 1.47, 95% CI, 1.33, 1.62), enabling factors (no health insurance OR = 2.96, 95% CI, 2.56, 3.42), and need factors (difficulty engaging in social activity OR = 1.59, 95% CI, 1.34, 1.88) at p  < 0.001. Enabling factors were the strongest predictors of postponed dental visits. The odds decreased with higher family income [> 400% FPL vs. < 100% FPL (OR, 0.50; 95% CI, 0.43, 0.58)], whereas the odds increased by 68%, 64%, 130%, and 57% for persons with no health insurance, no usual primary care provider, > 12 months of last medical exam, and delayed medical care due to cost, respectively. Conclusions Individual factors, including smoking, lack of health insurance, and difficulty engaging in social activity, were independently associated with cost-related delayed oral health care, and the strong links between postponed dental visits and HSDs provide a clear opportunity for advocating for medical and dental integration for patient-centered care.