Journal Articles

Surdu S, Langelier M. Teledentistry: Increasing Utilisation of Oral-health Services for Children in Rural Areas. J Telemed Telecare. Published online October 18, 2020. doi: 10.1177/1357633X20965425.

The objective of this study was to evaluate factors influencing utilisation of follow-up oral-health services in general dentistry clinics among children subsequent to a teledentistry consultation and treatment with a paediatric dental specialist. The study found that case severity and compliance with treatment were predictors of utilisation of oral-health services in general dentistry clinics. An additional finding was that case-management interventions were important in facilitating specialty dental care.

Surdu S, Mertz E, Langelier M, Moore J. Dental Workforce Trends: A National Study of Gender Diversity and Practice Patterns. Med Care Res RevHealth Workforce Supplement. Published online August 28, 2020. doi: 10.1177/1077558720952667.

The dental workforce is increasingly gender diverse. This study analyzed gender differences in dental practice using the American Dental Association’s 2010-2016 Masterfile and the 2017 Survey of Dental Practice. Between 2010 and 2016, the proportion of women working in dentistry increased from 24.5% to 29.8%. Overall, female dentists were more racially/ethnically diverse, more likely to be foreign-trained, and more likely to work in pediatric dentistry than male dentists. The likelihood of female dentists working as employees, part-time, and/or in metropolitan areas was 1.2 to 4.2 times greater compared with male dentists. Female solo practitioners were 1.2 to 1.8 times more likely to provide services to children and patients covered by public insurance than male solo practitioners. Gender diversification in dentistry and other factors, including generational differences and changes in the dental service delivery system and public policy, will continue to reshape the delivery of oral health services.

Langelier M. Innovations in Scope of Practice. Dimens Dent Hyg. January 2020; 18(1):16-17.

Over the past decade, legislatures across the United States have grappled with scope of practice issues for health professions, including dental hygiene. Almost every state has provided new permissions or enabled conditions for broader practice in response to new technology, improved science, novel dental materials, or alternative methods for delivery of care. Downstream effects of these changes include opportunities for innovative dental hygiene practice. In addition, the fundamental shift in health care delivery away from the medical paradigm of identifying and treating existing disease toward early intervention in prevention of disease processes has had collateral effects on dentistry and dental hygiene. Dental hygienists’ competencies are grounded in patient education, motivational interviewing, and preventive and prophylactic clinical services. This expertise has positioned the profession to play a pivotal role in efforts to improve the oral health of the US population. Dental hygienists are now more commonly viewed as primary preventive oral health specialists with separate and critical responsibilities in the oral health care continuum of care.

Surdu S, Dall T, Langelier M, Forte G, Chakrabarti R, Reynolds RThe Pediatric Dental Workforce In 2016 and Beyond. JADA. July 2019; 150(7):609-617.

Supply and demand projections came from a health workforce tool that investigators have used to model the health care workforce for a wide variety of health occupations, including dentists.We provide a brief summary of the data, methods, and assumptions for modeling supply and demand, with additional information provided in a technical appendix (available online at the end of this article).

Walgama KWides C, Kottek A, Mertz E. Impact of Federal and State Policy on Oral Health Care Delivery in Long-Term Care SettingsJ Health Care Poor Underserved2018;29(4):1570-1586.

Residents of long-term care (LTC) facilities have a significantly higher risk of poor oral health status compared with those living independently; moreover, the provision of oral health services to LTC residents is often limited. This study identifies and classifies state-level policies and funding sources for dental services that are available to LTC residents. The research details variability in coverage levels, payment sources, workforce capacity, and care delivery configuration, finding little coherence between policy and the needs of patients or providers. Reforms to address the oral health care needs of vulnerable populations in LTC settings should start with defining a clearer standard of oral care required for this population. This will allow best practices in policy, practice, and accountability to be structured around care that improves patients’ oral health.

Moore J, Goodwin N. Expanding Access to Care with Scope of PracticeDimens Dent Hyg. 2019;17(3):12-14.

There has been longstanding concern about uneven access to oral health services, particularly for children, older adults, racial/ethnic minorities, and the economically disadvantaged. Stakeholders with an interest in expanding access to care and improving the oral health status of the underserved are driving efforts to identify and adopt innovative strategies to improve population oral health. Dental hygienists, who are considered experts in prevention education and services, often play important roles in programs that improve access to needed oral health services.

State-based laws and regulations define legal scopes of practice for health professionals within a state. This contributes to variation in what dental hygienists in different states are legally allowed to do. It is challenging to systematically describe these scope of practice differences, assess their impacts on population oral health, and translate this into policy-relevant information. With support from the United States Health Resources and Services Administration’s National Center for Health Workforce Analysis, researchers at the Oral Health Workforce Research Center, Center for Health Workforce Studies at the State University of New York at Albany developed a professional practice index to describe dental hygienists’ scope of practice across states and studied impacts of this variation on state oral health outcomes. Subsequently, researchers developed an infographic based on this work to depict state-level variation in dental hygienists’ scope of practice to help oral health advocacy groups, policy makers, and other stakeholders better understand these issues. 

Mertz E, Spetz J, Moore J. Pediatric Workforce IssuesDent Clin N Am. 2017;61(3):577-588.

According to the US Surgeon General, dental disease is among the most prevalent health conditions for children, and large disparities in oral health status and access to oral health services exist among children in the United States. In 2003, the National Call to Action to Promote Oral Health outlined the need to increase the diversity, capacity, and flexibility of the dental workforce in order to better meet children’s oral health needs and reduce disparities. Assessing progress toward the Call to Action, in 2009 the authors found only modest gains in workforce strategies focused on pediatric patients, and major challenges remaining. In 2009 the Institute of Medicine held a workshop on the sufficiency of the oral health workforce for the coming decade, which outlined the status of the dental workforce, and highlighted for the first time the multitude of new workforce models being proposed and tried. A special issue of the Journal of Public Health Dentistry entirely focused on the contributions of workforce innovations to delivery system redesign followed, with one of the key messages being that workforce design should be tied directly to meeting the patient care needs, with special attention to reducing disparities in oral health care, and in oral health. As 2017 begins, progress has been documented in children’s use of care primarily because of improvements in coverage through Medicaid, the Children’s Health Insurance Program (CHIP), and the Affordable Care Act (ACA). This article updates and synthesizes the evidence on clinical pediatric workforce models and discusses future directions and implications for health policy.

Langelier M, Surdu STop-of-License Dental Hygiene Practice. Dimens Dent Hyg. October 2017,4(10):18-21.

Dental hygiene scope of practice regulation significantly impacts oral health outcomes in state populations. A numerical scope of practice scale for dental hygienists, called the Dental Hygiene Professional Practice Index (DHPPI), scored numerous variables relevant to dental hygiene practice, including the regulatory environment, tasks permitted, levels of required supervision by setting, and reimbursement for services. This article describes the comparison of state DHPPI scores in each of 3 years (2001, 2014, and 2016) to evaluate the impact of scope of practice expansions on oral health outcomes.

Mertz E, Calvo J, Wides CThe Black Dentist Workforce In the United StatesJ Public Health Dent. 2017;77(2):136-147.

In the United States, blacks experience large disparities in both access to dental and oral health status. In addition, Black dentists are underrepresented within the overall dental workforce, and care for a disproportionate share of black patients. This article describes the black dentist workforce, the practice patterns of providers, and their contributions to dental health care for minorities and patients with limited access.

Mertz E, Wides C, Calvo J, Gates PThe Hispanic and Latino Dentist Workforce In the United StatesJ Public Health Dent. 2016;77(2):163-173.

Improving the racial and ethnic diversity of the nation’s dentists is critical in efforts to reduce disparities in access to care and health outcomes and to better address the oral health needs of an increasingly diverse US population. The Hispanic/Latino (H/L) dentist workforce, in particular, is disproportionately small compared with the rapidly growing and historically underserved H/L population. The objective of this paper is examine the Hispanic/Latino (H/L) dentist workforce, their practice patterns, and overall contribution to oral heal care for H/L and patients with limited access

Mertz E, Wides C, Gates PThe American Indian and Alaska Native Dentist Workforce In the United StatesJ Public Health Dent. 2016;77(2):125-135.

Improving the racial and ethnic diversity of the nation’s dentists is critical in efforts to reduce disparities in access to care and health outcomes and to better address the oral health needs of an increasingly diverse US population. The American Indian/ Alaska Native (AI/AN) dentist workforce, in particular, is disproportionately small compared to the overall dentistry workforce. This study describes the American Indian/Alaska Native (AI/AN) dentist workforce, examines the practice patterns of AI/AN dentists, and describes how these providers contribute to the oral health care of AI/AN and underserved populations.

Langelier M, Continelli T, Moore J, Baker B, Surdu S. Expanded Scopes of Practice for Dental Hygienists Associated With Improved Oral Health Outcomes for AdultsHealth Affairs. 2016;35(12):2207-2215.

Dental hygienists are important members of the oral health care team, providing preventive and prophylactic services and oral health education. However, scope-of-practice parameters in some states limit their ability to provide needed services effectively. In 2001 we developed the Dental Hygiene Professional Practice Index, a numerical tool to measure the state-level professional practice environment for dental hygienists. We used the index to score state-level scopes of practice in all fifty states and the District of Columbia in 2001 and 2014. The mean composite score on the index increased from 43.5 in 2001 to 57.6 in 2014, on a 100-point scale. We also analyzed the association of each state’s composite score with an oral health outcome: tooth extractions among the adult population because of decay or disease. After we controlled for individual- and state-level factors, we found in multilevel modeling that more autonomous dental hygienist scope of practice had a positive and significant association with population oral health in both 2001 and 2014.

Mertz E, Wides CD, Kottek AM, Calvo JM, Gates PE. Underrepresented Minority Dentists: Quantifying Their Numbers and Characterizing the Communities They Serve. Health Affairs. 2016;35(12):2190-2199.

The underrepresentation of Blacks, Hispanics or Latinos, and American Indians or Alaska Natives among dentists raises concerns about the diversity of the dental workforce, disparities in access to dental care and in oral health status, and social justice. We quantified the shortage of underrepresented minority dentists and examined these dentists’ practice patterns in relation to the characteristics of the communities they serve. The underrepresented minority dentist workforce is disproportionately smaller than, and unevenly distributed in relation to, minority populations in the United States. Members of minority groups represent larger shares of these dentists’ patient panels than of the populations in the communities where the dentists are located. Compared to counties with no underrepresented minority dentists, counties with one or more such dentists are more racially diverse and affluent but also have greater economic and social inequality. Current policy approaches to improve the diversity of the dental workforce are a critical first step, but more must be done to improve equity in dental health.