Position Statement on Dental Service Capacity

Goal: To facilitate access to affordable quality dental care for all Americans by assuring a sufficient supply of dental professionals.

Background

The US Surgeon General’s 2000 report, “Oral Health in America,” links overall health with oral health. It further documents that oral health is improved by dental care but that the top barrier to dental care is cost. As people with dental benefits/insurance are more likely to access dental care than those without benefits, dental benefits are shown to overcome the cost barrier and facilitate access to dental care.

The 2004 Dental Benefits Joint Report: Enrollment Model, published by NADP and DDPA predicts a 6.74% increase in dental benefit enrollment between 2003 and 2007. As dental benefit penetration is tracking slightly ahead of population growth and Americans with dental benefits are 20% more likely to seek care, this expansion of Americans with dental benefits will put a higher demand on dental service capacity.

But as the private market for dental benefits expands, public programs providing dental care are constricting. Both Medicaid and Children’s Health Insurance Program coverage for dental in the states have been reduced since 2000. As a result, access to dental care in population groups that are dentally underserved is decreasing. There are some reports that this decline in access is being reflected in an increase of patients with dental needs in hospital emergency facilities.

While there were dental school closings from the mid 1980s to 2001, there have been three schools that have opened in recent years. ADEA indicates that dental school graduates have steadily increased since 1987. This increase is not sufficient to offset retirement of dentists and the increase in population, thus the decline in dentist to population ratio.

The American Dental Association as well as federal agencies project a declining ratio of dentists to population from the current level of .6 per thousand to .54 per thousand in 2020, there is no agreement as to an adequate number of aggregate dentists to population.

A general population to dentist ratio of 5000 to 1 (4000 to 1 for high need populations) is used by HRSA to designate a Dental Health Provider Shortage Area, with attendant grossly inadequate service availability. HRSA documents that the number of D-HPSAs has increased to 2,477 encompassing over 41,936,484 people. It is estimated that 8,591 dentists are needed to achieve a ratio of 3000 patients per dentist in D-HPSAs.

Oral Health America’s National Grading Project for Oral Health graded access to dental care in the US at “C-“ based on the following rankings:

The experience of NADP’s member plans is that a general dentist that has been in practice for more than 3 years that see patients 35 to 36 hours a week can support a patient load of 1,750 to 2,000 patients. Based on the ADA’s 2001 Workforce Model of Active Private Practitioners, if there was a perfect distribution of dentists in relation to the population, the number of general dentists approximately supports the current utilization of dental services. 

To expand the number of Americans that access dental care on an annual basis, additional capacity is needed. .

Conclusion: As the dental care needs and demands of the U.S. population increase, methods to increase capacity and access must be developed so that oral health as well as the overall health of the population will not be negatively impacted.

NADP Position:  The U.S. Surgeon General’s 2000 report, “Oral Health in America” brought national attention to the issues attendant to access to dental care and the importance of dental care to overall health, “The nation’s capacity to provide care that is accessible and acceptable to address the oral health needs and wants of Americans in the next century is challenged….” That report also recommended use of “public-private” partnerships to address these important issues.

NADP supports the principle of public-private partnerships and commits to (and its member organizations) both dialogue and partnership with organized dentistry, dental education, government agencies, and organizations representing allied dental personnel to examine and implement a mix of responses to improve the nation’s capacity to provide oral health care.

NADP believes that targeted activities to increase the capacity of the dental profession to meet current and future demand are limited only by the imagination and innovation of these key participants and suggests initial examination of the following mix of responses:

• Expansion of dental school classes as soon as possible.
• Expansion of education and awareness for current and emerging members of the dental profession on ways to increase productivity of the dental workforce, particularly through the use of allied dental personnel.
• Enhancement practice mobility between states, reciprocity between state licensure, and simplification of the licensure process on a national basis.
• Expansion of delegated duties to qualified allied dental personnel where allowed by local laws and supported by education and accountability.
• Incentives for:
  a) Increased availability of education and training for allied dental personnel, to insure that delegated duties are delivered without diminished quality.
  b) Allied dental personnel to seek that continuing education, with the goal of increased productivity and enhanced career satisfaction.
  c) Qualified applicants to enter dental schools, obtain relief of student debt, and assistance in the formation of new practice opportunities.
  d) Dentists to remain in the workforce as long as they can contribute, rather than opting for full retirement. e) Quality faculty candidates to seek affiliation with dental schools.
  f) Research for evidence-based dentistry which can identify ways to intervene in the dental disease process before major restoration is required.
  g) The development of technology that increases the productivity of a dentist in his or her practice.
  

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