not include real patients) should, however, be developed for acceptance by each state.

The Dental Work Force

The dental community is characterized by much anxiety and disagreement about whether the nation faces a future shortage or oversupply of dental services. The committee found no compelling evidence that would allow it to predict either outcome with sufficient confidence to warrant recommendations that dental school enrollments be increased or decreased. On the one hand, the ratio of dentists to the general population is declining, and the coverage of dental services under expanded public or private health insurance could substantially increase the demand for such services, especially if additional efforts are made to reach people with significant unmet needs. On the other hand, scientific and technological developments could increase or reduce overall need and demand for dental services depending on whether they promoted prevention or expensive treatments. In addition, the current dental work force appears to have reserve capacity that could be mobilized through better use of allied dental personnel, improved identification and elimination of care with little or no demonstrated health benefit, and more efficient delivery systems.

In the face of uncertainty, the committee believes it is prudent to continue monitoring trends in the supply of dental personnel and developing a better understanding of their productivity, of the appropriateness of dental services, and of the factors that impede access to dental care. This course will require a more sustained investment in a comprehensive oral health data infrastructure than has been evident over the last decade.

Two persistent work force problems involve (1) parts of the country in which dental services are in short supply and (2) minority representation in the future. The National Health Service Corps (NHSC) and other federal or state programs link the provision of financial assistance to a commitment to practice in an underserved area for a specific period, and thus help both to overcome service shortages and the serious problem of high student debt. The shrinkage in dental positions in the NHSC should be reversed. Efforts to increase the cultural and ethnic representativeness of the dental work force encounter a limited pool of candidates for admission, stiff competition from other professional schools for those candidates, and disproportionate attrition among minority predoctoral students. Building a dental work force that



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