Dental education will also be affected by changes in the university environment. Financial pressures on educational institutions undoubtedly will persist, although their severity may vary over time and across schools. Universities—and government policymakers—will continue to reevaluate their programs—adding, deleting, and restructuring them. Procedural changes in areas such as financial management, information systems, tenure, evaluation of educational outcomes, and accreditation may make life more difficult for educators in some ways and easier in others. Academic health centers will be under stress from the same changes in health care organization and financing that will affect dental schools, and in some respects, the impact of these changes may be more traumatic for medical schools and university hospitals than for dental schools. Overall, the world of higher education is likely to become less stable and thus more unpredictable and stressful for its constituent parts.

The implications of these trends and prospects for dental practice and dental education are clearer in some areas than in others. Dental schools and the dental community generally will see continued demands for greater professional accountability and evidence of effectiveness from public and university officials, institutional purchasers of dental services, managed care organizations, organized consumer or patient groups, and students. Relatedly, traditional practice and education will be challenged by a renewed focus on the dental practice team, multidisciplinary health care, and practice beyond the office setting. Dental practitioners will be relying more on medical management of a broad range of oral health problems, treating more patients who have chronic or complex medical problems, and undertaking a greater proportion of complex surgical and restorative services. For the majority of the population, however, the emphasis will continue to be on individual and community-based preventive and primary care services.

Much less clear is how changes in technology, demography, public policy, and health care organization will interact to affect the supply, demand, and need for oral health services. Although educators have no choice but to plan for the future and make choices that may affect the supply of dental services, this planning must account for uncertainty and consider alternative futures.

Further, although oral health status will continue to improve, it is not clear whether the society will commit the resources needed to reduce disparities in oral health status. Even if relatively inexpensive new preventive strategies were to emerge in the next few years, the problems—untreated caries, periodontal disease, and tooth loss—that now characterize disadvantaged groups



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