Second, demographic changes are affecting dental practice. In the future, the number and proportion of elderly patients, who tend to have more complicating medical conditions and are retaining more of their teeth, will grow (Figure 1.1). In addition, the oral health care needs of other patients with complex medical problems such as cancer and AIDS are becoming better appreciated.

Third, scientific and technological advances are reinforcing the medical aspects of dental practice as new or improved preventive, diagnostic, and pharmacological interventions challenge procedure-oriented dental education. Computer-based technologies are changing the nature of dental practice and providing new opportunities for evaluating and improving the outcomes of care.

Fourth, health plans that restrict patient access to a selected panel of dentists are moving beyond their historically small base. However, because more than half the population is not insured for dental services compared to less than one-fifth with no health insurance, the impact of health care restructuring has, so far, been relatively limited for many practitioners and patients. Overall, about 6 percent of all expenditures for personal health services

Figure 1.1

Trends in age distribution of U.S. population aged 65 and over, 1990-2030. 

Source: U.S. Department of Commerce, 1993.

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