Index
A
Academic health centers, 4, 33
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
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
current status of schools, 233, 235
curriculum guidelines and, 93-94
of dental hygiene programs, 237
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
student performance trends and, 234-235
survey team, 233
Active learning techniques, 12
problem-based learning, 98-100
Advanced dental education
accreditation, 231
costs, 118
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
oral health complications, 64
service needs in, 74-75
socioeconomic factors, 65
Allied dental personnel
dental team productivity, 272-273, 293
in dentist training, 13
expanded role for, 111
practice regulation and, 4, 18, 253
professional development, 274
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
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
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
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
practice guidelines, 72, 73, 76-78, 86-87
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
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
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
sources of data for analysis of, 91
variations in instructional allocation, 92-93
D
Data needs
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
quality of care in dental schools, 185-186, 290-291
Defense, Department of, 115
Deformities, dentofacial, 62
Demand for care
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
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
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
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
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
time line, 35-37
university affiliation, 199-201
Examinations. See Testing
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
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
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
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
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
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
G
Government
in dental education, 29
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
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
computer simulations in, 249-250
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
recommendations for, 18, 252-253
responsibility for, 244-245
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
Medical education
accreditation of, 231-232
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
nurse practitioners, 80-81
revenue sources, 207
sharing of basic science faculty, 13, 97
Medical management, 70-71
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
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
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
development of epidemiological research, 53-55
emergent interventions/technologies, 70-72, 283
Healthy People 2000 initiatives, 75-76
in loss of work days, 66
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
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
reimbursements, 175, 178, 188-190
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
dental work force issues, 10-11, 293-294
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
university dental schools, 8-9, 291
Regionalization, 216-218
Research in dentistry
accreditation standards, 145
advanced specialty preparation, 117
alternative models, 30-31
collaborations in, 7-8, 15, 144, 172, 290
cost of care and, 56
current status, 144-145
dental education and, 170-171
development of dentist scientists, 162-165
epidemiological research in oral health, 53-55
faculty role, 14, 128, 147-148, 162, 165
focus, 151-156
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
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
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 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
status of students in, 131
strategic planning in, 15-16
See also Curriculum;
Faculty;
University-affiliated dental schools
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
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
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
U
Universities
academic health centers in, 31-32
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
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
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