Index

A

Academic health centers, 4, 33

  challenges for, 200-202, 284

  collaborative research in, 7, 15

  in competitive markets, 105

  consolidation of programs in, 216

  contribution of dental schools to, 4, 30, 287

  dental research in, 158

  dental school clinics in, 196

  historical development, 31-32

  mission of, 31-32

  patient care in, 8, 174-175

  strategic planning in, 16, 192, 226

  See also Patient care in dental schools;

  University-affiliated dental schools

Academy of General Dentistry, 121

Access to care

  average wait time, 262

  care-seeking behaviors, 67

  dental insurance and, 25-26, 56

  in dental school clinics, 197-198

  geographic distribution of dentists and, 10, 276

  licensure requirements and, 247

  National Health Service Corps and, 56-57

  opportunities for improvement, 73-76

  supply of practitioners and, 56, 139

  underserved populations, 11-12, 75, 189, 190

Accreditation

  ambulatory care programs, 16, 186, 196, 197

  categories of, 233

  concerns about, 9, 229, 234-237

  confidentiality in, 233, 236, 251

  in continuing education, 120-122

  cost of, 233, 235

  current status of schools, 233, 235

  curriculum guidelines and, 93-94

  of dental hygiene programs, 237



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--> Index A Academic health centers, 4, 33   challenges for, 200-202, 284   collaborative research in, 7, 15   in competitive markets, 105   consolidation of programs in, 216   contribution of dental schools to, 4, 30, 287   dental research in, 158   dental school clinics in, 196   historical development, 31-32   mission of, 31-32   patient care in, 8, 174-175   strategic planning in, 16, 192, 226   See also Patient care in dental schools;   University-affiliated dental schools Academy of General Dentistry, 121 Access to care   average wait time, 262   care-seeking behaviors, 67   dental insurance and, 25-26, 56   in dental school clinics, 197-198   geographic distribution of dentists and, 10, 276   licensure requirements and, 247   National Health Service Corps and, 56-57   opportunities for improvement, 73-76   supply of practitioners and, 56, 139   underserved populations, 11-12, 75, 189, 190 Accreditation   ambulatory care programs, 16, 186, 196, 197   categories of, 233   concerns about, 9, 229, 234-237   confidentiality in, 233, 236, 251   in continuing education, 120-122   cost of, 233, 235   current status of schools, 233, 235   curriculum guidelines and, 93-94   of dental hygiene programs, 237

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-->   in evolution of dentistry, 42, 43, 49-50   medical vs. dental, 231-232   opportunities for improvement, 4, 291-292   organizational structure for, 230-231   patient care in schools and, 186, 195-196, 197   postgraduate training, 112   process; 231-233   professional interests in, 236-237   program innovation and, 236   recommendations for, 16, 17-18, 250-252   research standards, 145   role of, 228, 229   student performance trends and, 234-235   survey team, 233 Active learning techniques, 12   problem-based learning, 98-100 Advanced dental education   access to, 114, 115, 116   accreditation, 231   costs, 118   current status, 91, 115   dental-medical integration, 107   in dental specialties, 116-118   educational debt and, 137-138   for faculty, 100-101   in general dentistry, 112-116   licensure, 250   options, 111-112   patient care activities, 176   recommendations, 4, 14, 142-143, 289   in research, 117 African Americans   children, oral health of, 64-65   in dental work force, 260, 277, 278   enrollment trends, 132, 260, 277   oral cancer rate, 65 Aging of population, 4, 25   oral health complications, 64   oral health trends, 62, 63-64   service needs in, 74-75   socioeconomic factors, 65 AIDS, 64, 175 Allied dental personnel   accreditation, 231-232, 237   dental team productivity, 272-273, 293   in dentist training, 13   expanded role for, 111   practice regulation and, 4, 18, 253   professional development, 274   supply, 256-257, 263   training of, 19   See also Hygienists Alternative models of practice, 4, 30-31 Ambulatory care, accreditation for, 16, 186, 196, 197 American Association of Dental Examiners, 18, 121, 252 American Association of Dental Research, 157 American Association of Dental Schools, 16, 18, 43, 47, 48, 49-50, 89, 93-94, 112, 197, 252   on accreditation, 234 American Dental Association, 49, 51, 52, 53, 54, 73, 91, 230   on continuing education, 121   origins of, 41 American Dental Hygienists' Association, 43, 263 Asian Americans, 277 B Basic science   clinical practice and, 7, 12, 289   clinical science integration, 94-100, 216   current curriculum, 92-93   dental-medical integration, 13, 97, 108, 142, 166, 216   in dental research, 14, 79   recommendations, 12, 14, 141

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--> Behavioral sciences, 92-93, 147 Biomaterials development, 70 Bureau of Health Professionals, 261, 263 C CAD/CAM technology, 71 Cancer, oral-pharyngeal, 64, 65 Care-seeking behaviors, 67 Caries   epidemiological research, 54   prevalence in children, 63   in senior citizens, 63-64   vaccine for, 71-72, 268 Carnegie Commission on Higher Education, 57-58, 216 Carnegie Foundation for Advancement of Teaching, 43, 44, 49 Children   access to care, 74   caries prevalence, 63   minority, 64-65   oral health trends, 64-65   permanent tooth loss in, 62   sealant utilization, 67, 69   utilization patterns, 68 Cleft palate, 62 Clinical practice models, 4, 5, 30-31, 194-195, 287 Clinical science   basic science integration, 94-100, 216   comprehensive care model, 102-104   current curriculum, 92-93   educational costs, 208-209   faculty, 124-125, 128   practice guidelines, 72, 73, 76-78, 86-87   recommendations, 12, 141   research, 147, 151-156, 163-165, 168-169 Clinical science, faculty exposure, 101-102, 108, 127-128 Clinical services. See Patient care in dental schools Commission on Dental Accreditation, 16, 17, 50, 93, 145, 197, 229   activities of, 230-237 Commission on Recognition of Postsecondary Accreditation, 231 Committee on Postsecondary Accreditation, 231 Committee on the Costs of Medical Care, 56 Compensation, faculty, 128-129, 212, 213 Competition   academic health centers and, 189, 190   dental school clinics and, 55-56, 190, 290   distribution of dental work force and, 275   health care delivery trends and, 8, 290 Comprehensive patient care, 102-104, 114 Consolidation. See Regionalization Continuing education, 90   accreditation, 120-121   evaluation, 121, 247   importance of, 118-119   options for, 119-120   research role, 148   state requirements for, 122, 247 Continuous quality improvement, 193-194 Cost of care   in academic health centers, 188-189   in dental schools, 175, 178, 188-190   dentistry as medical specialty and, 110-111   early research, 56   insurance payment for, 67-68   out-of-pocket payment for, 67   trends, 23, 282

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--> Council on Dental Education, 47, 49-50, 121 Curriculum   accreditation and, 93-94   active learning in, 12   comprehensive patient care model, 102-104   content, 12   current criticisms, 94   dental-medical integration, 108-109, 216   dentistry as medical specialty in, 110-111   financial considerations in, 214   historical evolution, 46-47, 89-91   integration of basic and clinical sciences in, 94-98, 216   intensity of, 105-106   length, 91-92   licensure requirements and, 246   obstacles to change, 100-102, 289   postgraduate general dentistry, 114-116   practice relevance, 100-102   practice-relevant research model, 148   preclinical laboratory work in, 97   problem-based learning in, 98-100   recommendations, 12, 141-142   reform timetable, 7, 12   sources of data for analysis of, 91   variations in instructional allocation, 92-93 D Data needs   curriculum analysis, 106, 289   dental work force, 10   epidemiological research, 60-61   in financial planning, 211-212   monitoring dental care supply and demand, 5, 10, 18-19, 278, 293   oral health assessment, 80, 81   outcomes analysis, 72-73, 102   quality of care in dental schools, 185-186, 290-291 Defense, Department of, 115 Deformities, dentofacial, 62 Demand for care   contingency planning, 31, 284   forecasting models, 261, 267-269   in health care reform, 10, 26, 269   monitoring, 5, 10, 18-19, 278, 293 Dental assistants. See Allied dental personnel Dental education   current status, 1, 21, 143, 285-286   dental practice and, 5, 26   integration into health care system, 3-4, 26, 28, 29-30, 107, 286-287   medical education and, 7, 13, 29-30, 81, 106-111, 289   models of clinical practice, 4, 30-31   opportunities for improvement, 6-7, 140-141, 289   role of, 31-32, 33, 88   social trends and, 23-24, 282-285   See also Advanced dental education;   Evolution of dental education and dentistry Dental floss, 69-70 Dental Interactive Simulations Corporation, 249 Dental work force   allied personnel, 263   composition, 257-260   concerns about, 10-11, 254-255, 280, 284, 293-294

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-->   current numbers, 255   demand/need estimates, 267-269   dental educators as, 5, 26, 55-56   in dental research, 7, 156-157, 162, 255   dental school faculty in, 127-128   estimated requirements, 261-263, 266   forecasting of requirements, 18-19, 263-270   minority populations in, 10-11, 19, 29, 260, 276-278, 279, 293-294   monitoring supply and demand in, 5, 10, 18-19, 278, 279, 293   practice trends, 80-81   productivity of, 272-274   prospects for balanced supply, 275   prospects for oversupply, 270-271   prospects for undersupply, 271-275   recommendations, 18-19, 278-280   regional variation, 10, 58, 139, 257, 262-263, 275-276, 279   statistical trends, 255-257   supply issues, 4-5, 10, 18-19, 26, 57-58, 139, 254, 256-257, 261-263   team strategy, 272-273   work load, 262   See also Hygienists Disadvantaged populations   access to care, 6, 11-12, 56, 79, 81, 284-285   care in dental schools for, 197-198   in dental work force, 10-11, 19, 29, 260, 276-279, 293-294   oral health, 24, 64-66, 284-285, 288   utilization rates, 67 Disciplinary action, 238 E Education, Department of, 231 Effectiveness of dental services. See Outcomes research; Quality of care Enrollment trends, 1, 26, 57-58, 131-134, 179, 255-256   allied dental personnel, 263, 273   demographic, 257-260   projections, 267   prospects for undersupply of practitioners, 271-272   quality of applicants, 134-135   recommendations, 18-19 Epidemiological research   current assessment, 63-64   data sources for current oral health assessment, 59-60   data trends, 61-63   goals, 147   historical development, 53-55   obstacles to, 60-61 Evolution of dental education and dentistry   in ancient world, 38   curriculum development, 89-91   demographic trends, 257-260   dental hygiene education in, 42-43   early institutions, 39-41   enrollment trends, 57-58, 179   postgraduate training, 112-114   pre-modern Europe, 38-39   professionalization in, 41, 48-50   proprietary schools in, 42, 43, 46   reform efforts, 43-48   relations with medical schools in, 40   research base, 51-55   specialty programs, 116   standards development, 48-50   themes in, 35, 281-282   time line, 35-37   university affiliation, 199-201 Examinations. See Testing

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--> F Faculty   accountability, 142, 188, 192, 194-195   in accreditation process, 233   basic science, 97   compensation, 128-129, 212, 213   in comprehensive care programs, 104   diversity, 125   isolation of, 122-123, 166   organizational structure, 123, 166   practice plans, 127-128, 129, 176, 183, 194-195, 212-213   recommendations for, 14, 142, 143   research role, 14, 128, 147-148, 156-157, 162, 165   resistance to change in, 100-102, 223-224   as role models, 108, 127-128   specialization in, 118   statistical profile, 124-125   tenure, 129-131 Faculty development, 125-127   clinical practice skills, 101-102, 127, 128   licensure requirements and, 246   obstacles to, 126-127   problems in, 7   recommendations for, 14   for research, 162, 165-166 Fauchard, 39 Financial management   challenges for dental schools, 4, 9, 26, 203-209, 291   cost analysis, 211-212   cost of advanced specialty education, 118   cost of care research, 56   current statistical profile, 204-208   curriculum changes in, 214   economics of dental research, 149-151   economics of research, 159-162   expenditures per student, 204-207   faculty compensation, 128-129   faculty practice plans, 212-213   organizational consolidation, 216-218   philanthropic contributions, 215-216   policy constraints in, 218-219   public vs. private schools, 204-207, 220   recommendations for dental schools, 16-17, 266-227   revenue sources, 204, 207   in school clinics, 178, 180, 181, 208-209, 213-214   simple research designs, 166-170   sponsored research as revenue, 215   strategic opportunities, 209-211   student educational debt load, 135-139   tuition in, 214-215   in universities, 200-201 Flexner Report, 43, 46 Fluoridation, 55, 62, 69 Fluorosis, 54 Forecasting models, 263-270   recommendations, 18-19 Foreign schools, 135 Free care, 175 Future of dental education and dentistry   access to care issues, 73-75   choices in, 1-2   development of interventions/technologies, 69-72   opportunities for improvement, 286-287   patient care in dental schools, 175-176, 184, 191, 192-197   research opportunities, 144   social context, 282-285   See also Reform of dental education and dentistry

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--> G Gies Report, 44-45, 46-47 Gingivitis, 54, 61-69, 63 Government   in accreditation, 234, 251   in dental education, 29   in dental research, 52, 53   in growth of dental school enrollments, 57-58   Healthy People 2000 initiative, 75-76, 82-84   in influencing geographic distribution of dentists, 276   in postgraduate general dentistry, 114, 115-116   research spending, 149-150   school funding, 204   state licensure, 238-241, 244-245   state university policies, 219 Group practice, 107 Guidelines. see Practice guidelines H Health and Human Services, Department of, 79, 80 Health care system   dental school clinics in, 184, 188-189, 190, 191   evolution of dental education in, 40   integration of dentistry in, 3-4, 26, 28, 29-30, 107, 286-287   projecting supply requirements, 268-269   See also Restructuring of health care system Health insurance. See Insurance/health plans Healthy People 2000, 75-76, 82-84 Hispanic Americans, 65, 132, 260, 277 Hygienists   accreditation concerns, 237   in dental team productivity, 272-273   educational programs, 207-208, 273   evolution of educational programs, 42-43   licensing issues, 248   professional development, 273, 274   supply, 263, 273 I Information management   in financial management, 211-212   in patient care, 194, 195, 283 Informed consent, 188 Insurance/health plans   access to care and, 23, 73-74, 76   dental coverage trends, 25-26, 56   health care reform and, 77   patient care context, 174-175   quality of care and, 185   sources of, 68   student clinics and, 184, 185, 191, 197   utilization and, 67-68, 269, 275 International Association for Dental Research, 47 J Joint Commission on the Accreditation of Health Care Organizations , 186 Josiah Macy, Jr., Foundation, 205 L Leadership, in medical and dental education, 221-224 Licensure   access to care and, 247   clinical examination in, 237-238, 242-244, 245, 246, 249, 252-253

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-->   computer simulations in, 249-250   concerns about, 9-10, 241-242   continued competency, 247, 250   curriculum design and, 246   of dental hygienists, 248   disciplinary action, 238   evidence of competency in, 242-244   in evolution of dentistry, 42, 43   failure rate, 243-244   opportunities for improvement, 4, 248-250, 291, 292   out-of-state credentialing, 50, 240, 247, 250, 253, 260   postgraduate training, 116   process, 238-240   professional interests in, 244-245, 248   reciprocity in, 50, 240   recommendations for, 18, 252-253   responsibility for, 244-245   role of, 228, 237   for specialty practice, 240-242   standardization in, 18, 240, 253, 292, 293   student performance trends, 134-135, 234-235 M Managed care, 8, 177, 188, 191, 283 Medicaid, 68, 178, 185 Medical education   accreditation of, 231-232   dental clinic in, 189, 196   dental education in evolution of, 40   dental-medical integration, 13, 29-30, 81, 106-111, 142, 166, 216, 289   dentistry as specialty in, 44, 110-111, 216   Flexner report on, 43, 46   nurse practitioners, 80-81   revenue sources, 207   sharing of basic science faculty, 13, 97 Medical management, 70-71 Medical technologies, 25, 107   computer simulations for licensure, 249-250   dental-medical integration, 29-30   existing dental technologies, 69-70, 283   new dental technologies, 70-72, 283   in projecting supply requirements, 268   research, 146-147   technology transfer, 147-148 Medicare, 56, 68, 75 N National Academy of Sciences, 130 National Association of Dental Examiners, 48, 49 National Association of Dental Faculties, 48-49 National Board of Dental Examiners, 50 National Health and Nutrition Examination Survey, 53-54, 59-60 National Health Interview Study, 60 National Health Service Corps, 10, 56-57, 74, 139, 247, 276, 293   recommendations for, 12, 143, 279   tuition repayment and, 138 National Institute for Dental Research, 47, 52-53, 60, 145   recommendations for, 15   research spending, 150, 152-156, 159, 162-163 National Institutes of Health, 52, 53

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--> National Research Council, 2, 23, 51   Office of Scientific and Engineering Personnel, 162, 171 Native Americans, 64, 260, 277 Nurse practitioners, 80 O Oral health   access to care and, 73-75   comorbid conditions, 64   current assessment, 63-64   data sources in assessment of, 59-61   demographic trends, 24, 25   development of epidemiological research, 53-55   emergent interventions/technologies, 70-72, 283   goals, 5-6, 11, 28, 78   Healthy People 2000 initiatives, 75-76   in loss of work days, 66   monitoring of, 11, 79-80   outcomes research, 17-18, 28, 72-73, 77-78, 102, 286, 288-289   preventive efforts, 6, 69-70, 75-76, 78, 85, 285, 288   public support for programs, 288   recommendations for improving, 78-81, 288-289   role of dental education in, 79, 288   socioeconomic disparities, 6, 64-66, 284-285, 288   technology access/utilization, 69-70, 147-148, 283   in total health care management, 28, 110, 285   trends, 24, 61-63   See also Patient care in dental schools Oral Health 2000, 75, 78, 82-84 Orofacial pain, 63 Outcomes research   clinical practice guidelines and, 77-78   dental education, 9, 17-18, 251, 252, 292   need for, 28, 72-73, 102, 286, 288   problem-based learning, 98-99   recommendations, 17-18, 288-289 P Patient care in dental schools   academic health centers and, 32, 196   access issues, 197-198   accountability in, 188, 194-195   accreditation, 186, 195-196, 197   administration, 195   challenges in, 175-176, 182, 184, 196-197, 198, 208-209   community service efforts, 190-191   competition issues, 188-190, 286   conflicting needs in, 174-175   continuous quality improvement in, 193-194   efficiency of care in, 182-184   faculty in, 127-128, 129, 176, 183, 194-195, 212-213   financing of, 178, 180, 181, 208-209, 212-214   individual differences in, 180-181, 191   informed consent issues in, 188   opportunities for improvement, 192, 290-291   organization of, 177   providers of, 176   quality assurance programs, 185-186, 193-194   quality of care, 181-182, 184-186   recommendations for, 196-198

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-->   reimbursements, 175, 178, 188-190   as revenue source, 181, 212   settings for, 176-177   shortage of teaching patients, 188-190   statistical profile, 178-181   strategic planning in, 192-193, 197   student enrollment trends and, 179   utilization, 179-180 Patient-oriented care, 8   in comprehensive patient care model, 102-104   in dental schools, 31-32, 174-175, 196-197, 198, 290-291   recommendations for, 13, 15, 142   research topics, 15 Periodontal disease, 60, 62-63, 71-72 Pew National Dental Education Program, 90-91 Philanthropic contributions, 215-216 Physician, role in oral health, 80-81, 274 Practice guidelines, 72-73, 76-78, 86-87, 194-195 Prevention, 69-70, 75-76, 78, 85 Primary care   in academic health centers, 188-189   oral health in, 78 Private dental schools, 1, 21, 181, 202, 204-207, 220   See also Schools of Dental Education Problem-based learning, 98-100 Provider Recognition Program, 121 Q Quality of care   accreditation/licensure and, 228, 234-235, 291   allied dental personnel and, 111, 272, 273   definition, 184   in dental school clinics, 181-182, 184-186, 193-196   documentation of, 8   future of dentistry, 283   overcare in, 184-185   quality assurance, 185-186, 193-194 R RAND Health Insurance Experiment, 60 Randomized clinical trials, 167 Reform of dental. education and dentistry   accreditation and licensure issues, 9-10, 250-253   challenges in, 2, 21-22   dental work force issues, 10-11, 293-294   educational mission, 6-7, 289   historical developments, 43-48   implementation of recommendations, 294-295   oral health objectives, 5-6, 68, 75-76, 78-81, 288-289   patient care issues, 8, 290-291   policy and strategic principles, 3-5, 28-29, 282   recommendations, 11-19   research practice, 7-8, 289-290   timetable, 5, 7, 12   university dental schools, 8-9, 291 Regionalization, 216-218 Research in dentistry   accreditation standards, 145   advanced specialty preparation, 117   alternative models, 30-31   benefits of, 7, 289-290   collaborations in, 7-8, 15, 144, 172, 290   cost of care and, 56

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-->   current status, 144-145   dental education and, 170-171   development of dentist scientists, 162-165   economics, 149-151, 159-162   epidemiological research in oral health, 53-55   faculty role, 14, 128, 147-148, 162, 165   focus, 151-156   goals, 7-8, 28-29, 145-149   historical development, 51-55   as interdisciplinary activity, 146-147   modeling of practitioner supply, 263-270   new interventions/technologies, 70-72   obstacles to, 157-159, 165-166, 171-172, 286   opportunities for improving, 44, 166-170   oral health, 6, 79-80   outcomes, 28, 72-73, 102, 288-289   patient care objectives in, 15   private sector funding, 156, 161   promotion of, 15   publishing and, 150-151   randomized clinical trials, 167   recommendations, 14-15, 80, 172-173   as revenue source, 150-151, 159, 215   role of schools in, 31-32, 289-290   training for, 148-149, 165   work force in, 7, 156-157, 162, 255, 290   See also Epidemiological research Residency training, 112-116, 262 Restructuring of health care system   academic health centers and, 188-189   demand for dental services, 10, 26   dental coverage in, 74, 79   dental school clinics and, 105, 184, 285   information management in, 195   physician training in, 219   reform of dentistry in, 5, 30, 283   reimbursement systems in, 10   service demand and supply forecasts, 268-269 Rural practice, 257 S Schools of dental education   accreditation/licensure, 4, 17-18   ambulatory care in, 16   clinical practice in, 55-56   closure, 1, 8, 21, 26, 58, 199, 202, 219, 220   collaborative research, 7, 144   continuing education programs, 120   dental hygiene programs, 207-208   expenditures per student, 204-207   financial management, 4, 9, 16-17, 26, 203-211   foreign schools, 135   geographic distribution, 58   inefficiencies in, 104-105   private institutions, 1, 21, 181, 202, 204-207, 220   recommendations for, 12, 16-18, 141-143   regionalization, 216-218   research in, 7-8, 51-52, 54-55, 144-150, 157-159, 165-166, 171-173   revenue sources, 204, 207   status of students in, 131   strategic planning in, 15-16   trends in, 1, 21, 31-32, 202   tuition, 135-138, 204-207, 214-215

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-->   See also Curriculum;   Faculty;   University-affiliated dental schools Sealants, 67, 69 Social trends, 23-24, 282-285   oral health monitoring, 79-80 Specialization   current status, 116-117   dentistry as medical specialty, 110-111, 216   early developments, 47   estimated requirements for, 261-262   licensure, 240-242   minimum clinical competency and, 94   postgraduate education, 117-118   postgraduate general dentistry and, 114   problems in, 117-118   research training in, 117   trends, 112, 116, 256 State practice acts, 42, 219, 238-241, 244-245   See also Government;   Licensure Strategic planning   in dental schools, 16   for patient care in dental schools, 192-193, 197   patient-centered objectives in, 15   role of, 192   in university-affiliated dental schools, 226 Students of dentistry   attitude of educators toward, 131   educational debt load, 135-139   as providers of care, 176, 178, 182-183, 194-195   quality of applicants, 134-135   quality of life issues, 139-140   school expenditures per student, 204-207   statistical profile, 131-134 T Technology transfer, 147 Tenure, 14, 129-131 Testing   general dentistry license, 237-239   national uniformity in, 4   recommendations for, 18 Tooth brushing, 69-70 Tuition   cost of education and, 204-207   dental hygiene education, 207   in financial management, 214-215   student choices and, 136-138   trends, 135-136, 200 U Universities   academic health centers in, 31-32   challenges for, 200-202, 284   current environment for, 24   Flexner report, 43 University-affiliated dental schools, 8-9, 16   collaborative research in, 7   consolidation strategies, 216-218   contributions of, 30, 199, 224-225, 226, 287, 291   dental school clinics and, 208-209   evolution, 44-48, 199-200   financial challenges, 203-209, 225-226   financial strategies, 209-218   leadership issues, 221-224   opportunities for strengthening, 220-225, 291   philanthropic contributions to, 215-216   policy constraints in financial management of, 218-219, 284

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-->   recommendations for, 225-227   risks for, 8-9, 26, 202-203, 225-226, 286   sponsored research in, 215 Utilization   age as factor in, 67   insurance coverage and, 67-68   models for estimating, 266-269   reducing, in undersupply of dentists, 274-275   in student clinics, 179-180   trends, 67 V Vaccines, 71-72 Variation in practice, 9, 72, 99 Veterans Affairs, Department of, 68 W women in dentistry, 257-260 Work force. See Dental work force