Services. Therefore, this committee limited its examination of the safety net in this current report.


The current oral health care system is composed of two basic parts—the private delivery system and the safety net—and there is little integration of either sector with wider health care services. The two systems function almost completely separately; they use different financing systems, serve different clientele, and provide care in different settings. In the private delivery system, care is usually provided in small, private dental offices and financed primarily through employer-based or privately purchased dental plans and out-of-pocket payments. This model of care has remained relatively unchanged throughout the history of dentistry. The safety net, in contrast, is made up of a diverse and fragmented group of providers who are financed primarily through Medicaid and the Children’s Health Insurance Program (CHIP), other government programs, private grants, as well as out-of-pocket payments.

In addition, some oral health care, especially for young children, has begun to be supplied by nondental providers in settings such as physicians’ offices, which is discussed later in this chapter. This section gives a brief overview of the basic settings of oral health care by dental professionals—namely, dentists, dental hygienists, and dental assistants. The professionals themselves will be discussed later in this chapter.

The Private Practice Model

The structure of private practice provides dentists with considerable autonomy in their practice decisions (Wendling, 2010). Private practices tend to be located in areas that have the population to support them; thus, there are more practices located in urban areas than in rural, and more practices in high-income than in low-income areas (ADA, 2009b; Solomon, 2007; Wall and Brown, 2007). About 92 percent of professionally active dentists work in the private practice model (ADA, 2009d) (see Box 3-1 for definitions of types of dentists). Among all active private practice dentists (whose primary occupation was private practice), about 84 percent are independent dentists, 13 percent are employed dentists, and 3 percent are independent contractors (ADA, 2009d). About 60 percent of private practice dentists are solo dentists (Wendling, 2010). In addition, 80 percent of all active private practitioners and 83 percent of new active private practitioners are in general practice, while the remainder work in one of many specialty areas (see Table 3-1).

Dentists in the private practice setting see a variety of patients. The

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