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Biomedical subjects

L Jackson Brown

Publications and source records attributed to L Jackson Brown.

At least 19 recordsLinked to original sources
PubMed2006

The endodontic workforce.

The amount of endodontic care provided in the US requires an understanding of the supply and demand for such care. The supply side includes the number and location of endodontists, type of provider, and productivity. The demand side consists of the changing demographics of the age groups that endodontists predominantly treat along with changes in their dental health. To address these issues, we have compiled and analyzed data from American Dental Association (ADA) with other sources such as US government census data and the National Health and Nutrition Examination Surveys (NHANES). From 1982 to 2002, the supply of endodontists increased at a rate greater than that observed with general practitioners or the other specialty areas. The growth of endodontists in relation to general practitioners is important. The latter are co-providers of endodontic care as well as a primary source for referral of patients to endodontists. Demographic and disease changes are likely to impact the need and demand for endodontic services. Endodontists' patients are generally between the ages of 25 and 64 yrs. Currently, the majority of endodontists' patients are members of the large baby boom generation who in 2000 ranged in age from their late 30s to their late 50s. During the next 20 yrs the Baby Boom generation will be replaced by the numerically smaller Generation-X cohort. This generation has experienced substantially less total caries than baby-boomers and they most likely will have fewer endodontic sequela as they age. A moderating factor that could partially offset the predicted decline in numbers of patients is the increased number of teeth that Generation-Xers are likely to retain. A flexible endodontic workforce strategy must assess the impending demographic and disease trends in relation to future growth rates of both endodontists and general practitioners.

Adult↗
PubMed2006

U.S. State-supported dental schools: financial projections and implications.

This article examines the impact of financial trends in state-supported dental schools on full-time clinical faculty; the diversity of dental students and their career choices; investments in physical facilities; and the place of dentistry in research universities. The findings of our study are the following: the number of students per full-time clinical faculty member increased; the three schools with the lowest revenue increases lost a third of their full-time clinical faculty; more students are from wealthier families; most schools are not able to adequately invest in their physical plant; and more than half of schools have substantial NIH-funded research programs. If current trends continue, the term "crisis" will describe the situation faced by most dental schools. Now is the time to build the political consensus needed to develop new and more effective strategies to educate the next generation of American dentists and to keep dental education primarily based in research universities. The future of the dental profession and the oral health of the American people depend on it.

Capital Financing↗
PubMed2005

A look at allied dental education in the United States.

BACKGROUND: The American Dental Association conducts surveys of educational programs in dental assisting, dental hygiene and dental laboratory technology. The 2002-2003 survey included questions about enrollment, graduates, program information and trends. METHODS: The ADA Survey Center mailed the Survey of Allied Dental Education to 548 program directors of dental assisting, dental hygiene and dental laboratory technology educational programs. They also sent several follow-up notices as a reminder to complete the survey. A 100 percent response rate is mandatory for continued accreditation by the Commission on Dental Accreditation. Association staff members resolved inconsistencies in the data and analyzed them before producing a final report. RESULTS: The number of applications to, first-year enrollment in and number of graduates in dental hygiene and dental assisting educational programs have increased during the last five years. During the same period, the number of applications to, and graduates of, dental laboratory technology educational programs decreased, but first-year enrollment increased slightly. CONCLUSIONS: Results from these surveys help address the concerns of the public and the profession regarding allied dental manpower levels. They also provide information for those interested in applying to individual allied dental educational programs. PRACTICE IMPLICATIONS: Private dental practices employ the majority of graduates of allied dental educational programs. Recent graduates of dental assisting and hygiene programs continue to supply the office staff members needed to support the delivery of dental care.

American Dental Association↗
PubMed2005

Improving the oral health of Alaska Natives.

There is a high prevalence of oral disease in the Alaska Native population, much of which goes untreated, creating a large discrepancy between the level of their oral health and that of the general population. The causes of this discrepancy are multiple--a major cause being the lack of access to care, especially in remote Alaska Native villages. Improving the oral health status of Alaska Natives will require treatment of current disease and initiation of an effective program to prevent oral disease. Cooperation between the Alaska Native organizations, dental health aides, the dental profession, and the government will be important. A strategy that combines addressing the disease currently present and preventing the occurrence of disease in the long run is the only strategy that offers a sustainable solution.

Adolescent↗
PubMed2004

Predictors of tooth loss in two US adult populations.

OBJECTIVES: This study determines tooth loss rate over a 10-year period and identifies predictors of tooth loss in two separate US adult longitudinal study populations. METHODS: Subjects from the Baltimore Longitudinal Study of Aging (BLSA), consisting of 47 men and 47 women, ages ranging from 30 to 69 years, were compared to subjects from the VA Dental Longitudinal Study (VADLS) in Boston, MA, consisting of 481 men in the same age range. Baseline and follow-up examinations were performed on each cohort over a 10-year period. Using multivariate regression models, significant predictors of tooth loss were identified. RESULTS: A mean rate of tooth loss of 1.5 teeth lost per 10 years was noted in the VADLS cohort compared to 0.6 teeth lost per 10 years in the BLSA (P < .001). Combining subjects from both populations, significant predictors of tooth loss were baseline values of: percent of teeth with restorations, mean probing pocket depth score, age, tobacco use, alcohol consumption, number of teeth present, and male sex. However, the set of significant predictor variables differed between the two populations and sexes. In BLSA men, number of teeth present, percent of teeth with restorations, mean probing pocket depth score, and alcohol consumption, but not age, were significant, while in BLSA women, only age was a significant predictor. CONCLUSIONS: Over a 10-year period, the incidence of tooth loss, the rates of tooth loss, and the predictors of tooth loss were found to vary by population and by sex. These results illustrate the limits of generalizing tooth loss findings across different study cohorts and indicate that there may exist important differences in risk factors for tooth loss among US adult populations.

Adult↗
PubMed2004

Self-reported satisfaction of enrollees in capitated and fee-for-service dental benefit plans.

BACKGROUND: This article examines the impact of capitated, or CAP, and fee-for-service, or FFS, dental benefit plans on the enrollees' satisfaction with their plans and their satisfaction with their dentists. METHODS: The authors selected four dental markets: California, New Jersey, Michigan and North Carolina. Eight Fortune 500 companies participated. Enrollees were selected randomly and interviewed about their experiences with their dental plans. The sample consisted of 2,340 respondents, of whom 42.3 percent were enrolled in CAP plans and 57.7 percent in FFS plans. RESULTS: The major findings were that those enrolled in FFS plans were four times more likely to be very satisfied than dissatisfied with their dental plans than were those in CAP plans. The FFS plan enrollees were 16 times more likely to be very satisfied than dissatisfied with their dentists than were those in CAP plans. CONCLUSION: Enrollees generally were satisfied with their plans and their dentists but those in FFS plans were the most satisfied. The higher the premium paid, the higher the level of satisfaction. PRACTICE IMPLICATIONS: Enrollees with perceived unmet needs were less satisfied with their dental benefit plans and dentists. Taking care of needs is the most significant thing dentists can do to affect patients' satisfaction.

Analysis of Variance↗
PubMed2004

Self-reported oral health of enrollees in capitated and fee-for-service dental benefit plans.

BACKGROUND: This article examines the impact of different dental plan types, dental markets, premiums, out-of-pocket costs and enrollee demographics on the enrollees' perceived oral health status. METHODS: The authors randomly sampled enrollees in dental benefit plans offered by eight Fortune 500 companies and interviewed them regarding their experiences with their plans, including perceived oral health status. The sample consisted of 2,340 respondents, of whom 42.3 percent were enrolled in capitation, or CAP, plans, and 57.7 percent were enrolled in fee-for-service, or FFS, plans. RESULTS: The authors used chi2 tests, analysis of variance and multinomial logistic regression. They set significance at P < .05. Results indicate that nonwhites, CAP-plan enrollees and those with higher out-of-pocket cost were less likely to rate their oral health "good," "very good" or "excellent" compared with whites, FFS-plan enrollees and those with lower out-of-pocket costs, respectively. CONCLUSIONS: CAP-plan enrollees rated their oral health more poorly than did FFS-plan enrollees. Further studies are necessary to determine if adverse selection occurs and if CAP plans provide inferior quality of care. PRACTICE IMPLICATIONS: Practitioners' awareness of and willingness to address the variety of factors that influence perceived oral health status may improve their patients' perceived oral health status and satisfaction with care.

Analysis of Variance↗
PubMed2004

The economic impact of dentistry.

BACKGROUND: The goal of the authors' research was to determine the national economic impact of expenditures arising from the provision of dental services. METHODS: The authors used a well-known and accepted methodology in economics known as input-output analysis to measure the economic impact. These models describe--among other things--the interrelationships between businesses, government, households and the foreign sector with regard to where inputs come from and where outputs go. RESULTS: For 2000, national expenditures attributable to the provision of dental services were calculated at dollar 203.6 billion. Dentistry accounted for more than two million jobs nationwide. Taxes generated directly or indirectly from dental activity totaled more than dollar 33 billion. The annual impact of one additional dentist on the economy was estimated at dollar 1,278,253. CONCLUSIONS: Dentistry provides substantial local and national economic benefits, including increased economic activity, employment and tax revenues. For small counties, an additional dentist provides a significant boost to the local economy.

Dental Care↗
PubMed2004

Dental visits among Hispanics in the United States, 1999.

BACKGROUND: This article describes dental visits among Hispanics and Hispanic subgroups in the United States. METHODS: This study is based on an analysis of data regarding dental visits among Hispanics two years of age and older from the National Health Interview Survey of 1999. The authors compared the 1999 data with a combined sample from 1978 through 1980. RESULTS: Although the level of dental visits for all Hispanic subgroups increased between the period of 1978 through 1980 and 1999, the level of dental visits was lowest among Mexican-Americans. For Mexican-Americans born outside the United States, the longer they had lived in the United States, the more likely they were to have visited a dentist. CONCLUSIONS: Increases in the utilization of dental services among Hispanics provide some optimism for reductions in the level of untreated oral disease among Hispanics in the future. However, if increases in dental care utilization among Mexican-Americans fail to keep pace with those among other segments of the U.S. population, this population group risks falling further behind. PRACTICE IMPLICATIONS: Hispanic patients will make up a greater percentage of all dental patients in the future. The impact of this growth will vary greatly by state.

Adolescent↗
PubMed2004

The American Dental Association's oral cancer campaign: the impact on consumers and dentists.

BACKGROUND: The ADA conducted a public service campaign in late 2001 to raise awareness of oral cancer and of the dentist's role in early detection. METHODS: To gather information about the impact of this campaign, the ADA undertook two surveys. A telephone survey was conducted among 1,270 adult consumers, and a second survey was mailed to a national sample of 2,500 dentists. RESULTS: The majority of the consumers did not recognize the fact that dentists are responsible for examining their patients for oral cancer and that oral cancer claims more lives than melanoma or cervical cancer. The majority of dentists was aware of the ADA campaign and agreed that it helped raise the public's awareness of oral cancer and the importance of early detection. As a result, more dentists said that they are likely to educate their patients about early detection, adjust their own practice routines to include discussion about the disease, and look more closely for small oral lesions and test them with the brush biopsy test. CONCLUSIONS: The results of the survey of dentists demonstrated that the oral cancer awareness initiative sponsored by the ADA resulted in positive behavioral changes targeted toward the early detection of oral cancer. CLINICAL IMPLICATIONS: Continued efforts to provide health education and health promotion interventions aimed at consumers and dentists invariably will result in the detection of oral cancers at early and curable stages.

Adult↗
PubMed2003

Recent trends in dental visits and private dental insurance, 1989 and 1999.

BACKGROUND: This article describes recent trends in dental visits and private dental insurance in the United States. METHODS: This study is based on the analyses of data regarding dental visits and private dental insurance among the population 2 years of age or older from the 1989 and 1999 National Health Interview Surveys. RESULTS: Overall, the percentage of the population with a dental visit rose from 57.2 percent in 1989 to 64.1 percent in 1999, while the percentage with private dental insurance fell from 40.5 percent to 35.2 percent. CONCLUSIONS: Although a higher percentage of people with private dental insurance reported having a dental visit than did those without private dental insurance in both years, the increase from 1989 to 1999 in the percentage of those with a visit was larger among the uninsured. PRACTICE IMPLICATIONS: If this trend persists, a smaller portion of practicing dentist's clientele will be insured. This may affect demand for services, as well as front office operations.

Adolescent↗
PubMed2002

Private practicing endodontists: production of endodontic services and implications for workforce policy.

The methods and techniques used by private practicing endodontists to provide patient care are at the core of endodontic workforce policy. Productivity influences both the amount of care provided and the required number of practicing endodontists in the future. Data was collected from practicing endodontists in order to characterize the technical methods of producing endodontic services. This data was then used to develop a statistical model for use in assessing the national endodontic workforce conditions in the United States. A survey was mailed to a random sample of 2,075 private practicing endodontists in the United States based on membership files from the American Association of Endodontists and the American Dental Association. The overall survey consisted of three means of data collection: (1) a survey about the endodontic practice as a whole; (2) a survey about the endodontist; and (3) patient encounter forms used when collecting detailed endodontic procedure data for a single day in the practice. The model was used to obtain a projection of 4,016 endodontists in the year 2005 and 4,671 practicing endodontists in 2010 required to meet the projected demand for endodontic care. The model and survey data provide valuable information to practicing endodontists for use in identifying critical elements used to render care, how the elements are combined in the practice of endodontics, and the minimum number of endodontists required to provide a given volume of endodontic care.

Adult↗
PubMed2002

The importance of productivity in estimating need for dentists.

BACKGROUND: Although the number of dentists is an important determinant of supply, other factors also contribute. Technological advancements and well-trained and managed auxiliary personnel affect supply by allowing dentists to produce more dental services per unit of time. METHODS: This article examines trends in dental output, productivity, number of dentists and dental care utilization from 1960 through 1998. The authors estimated growth rates for the entire period and selected subperiods using regression analysis. Growth rates for dentist productivity and per capita utilization are important to estimate the number of active dentists needed in the year 2020. RESULTS: Based on ADA practice survey data, the annual growth rate in dentists' productivity was 1.41 percent from 1960 through 1998. However, productivity grew at different rates during this period. It increased 3.95 percent per year from 1960 to 1974. There was a decline in productivity of 0.13 percent annually from 1974 to 1991. From 1991 to 1998, productivity grew 1.05 percent annually. CONCLUSIONS: Accurate estimates of changes in dentist productivity are important in evaluating the adequacy of the number of dentists to meet the demand for dental services. PRACTICE IMPLICATIONS. Since productivity generally increases over time, failure to account for changes in productivity can lead to an overestimation of the number of dentists required for any given level of demand for dental services.

Dental Auxiliaries↗
PubMed2002

The funding of dental services among U.S. children 2 to 17 years old: recent trends in expenditures and sources of funding.

BACKGROUND: This article is the first of two that focus on recent changes in the funding of dental services in the United States. METHODS: This study is based on analyses of data regarding dental expenditures among children 2 to 17 years of age from the 1987 National Medical Expenditure Survey and the 1996 Medical Expenditure Panel Survey. Both of these surveys were designed to produce national estimates of annual medical expenditures in the United States. RESULTS: Overall, real per capita dental expenditures among 2- to 17-year-old children who had had a dental visit fell from $578.05 in 1987 to $498.57 in 1996. Large increases per patient were reported for the poorest children, while decreases were reported for children from families with higher incomes. CONCLUSIONS: Much of the increase from 1987 to 1996 in dental expenditures among economically disadvantaged children who had had a dental visit was due to an increase in care provided by dentists that was not reimbursed. PRACTICE IMPLICATIONS: More needs to be done to increase the number of economically disadvantaged children who visit a dentist. All segments of society must cooperate to achieve this result.

Adolescent↗
PubMed2002

The funding of dental services among U.S. adults aged 18 years and older: recent trends in expenditures and sources of funding.

BACKGROUND: This article is the second in a series of two that focus on recent changes in the funding of dental services in the United States. METHODS: This study is based on the analyses of data regarding dental expenditures among adults aged 18 years and older from the 1987 National Medical Expenditure Survey and the 1996 Medical Expenditure Panel Survey. Both of these surveys were designed to produce national estimates of annual medical expenditures in the United States. RESULTS: Overall, real per-patient dental expenditures among adults aged 18 years and older who had had a dental visit fell from $529.93 in 1987 to $467.29 in 1996. CONCLUSIONS: Recent decreases in dental expenditures may be related to a shift from restorative to diagnostic and preventive services. PRACTICE IMPLICATIONS: In the future, dentists' gross revenues may grow more from an increase in the number of patients seen than from an increase in the average revenue per patient.

Adolescent↗
PubMed2002

Trends in caries among adults 18 to 45 years old.

BACKGROUND: This article focuses on changes in the caries status of adults 18 to 45 years old in the United States during the periods of 1971-1974 (the First National Health and Nutrition Examination Survey, or NHANES I) and 1988-1994 (the Third National Health and Nutrition Examination Survey, or NHANES III). METHODS: Using data from NHANES I and NHANES III, the authors based this study on analyses of data regarding the trends in total caries, untreated caries and filled caries among adults 18 to 45 years old. RESULTS: There was a decrease of 27.26 percent in the total number of carious surfaces among adults aged 18 to 45 years, or a decline from 38.30 surfaces in NHANES I to 27.86 surfaces in NHANES III. The number of untreated caries also declined from 3.64 to 1.82, a decrease of 50.0 percent. CONCLUSIONS: These caries improvements may be associated with birth cohort effects. Young adults 18 to 25 years old in NHANES I grew up before widespread fluoridation, while people the same age in NHANES III grew up when fluoridation and preventive dentistry were more widely available. Practice Implications. The reduction in caries previously demonstrated in children has extended to adults. The impact is a decline in the need for restorative dentistry.

Adolescent↗