Favorable dental economics could belie coming crisis

In the 1990s, the general economy, as well as the economics of dental practice, were favorable. Should there be an extended period of economic downturn, three factors could be cause for economic concern; the wide ranges in spending for dental services in different parts of the country, the reliance on out-of-pocket spending for dental care, and the minimal level of government spending for these services.

Low birthweight babies grow older, but there could be many problems

An increasing number of low birthweight babies are surviving into their teen years and beyond, but with lifelong problems- including physical, intellectual and behavior difficulties. In the past, the indicators and measures used to evaluate health outcome have been selected from the perspective of the health care provider. There have been considerable skepticism as to the ability of parents to provide data about the development of their children. But practitioners often must rely upon the parent/guardian of children (particularly children with developmental and /or emotional disabilities) for significant input. This input is essential, but should be considered within the context of raising a child with special health care needs.

A quarter of a million dollars to raise a child born in 2000: and if the child is disabled

Raising children in the year 2000 and beyond will be expensive. A review of actual costs by expense categories and a variety of family demographic characteristics provides practitioners with an appreciation of the competitive financial realities faced by many families. An added review of the costs of raising children with disabilities adds further dimension to the financial pressures placed on many families.

Children with both mental retardation and mental illnesses live in our communities and need dental care

Children with mental retardation may also suffer from the dual condition of mental health problems. As a result of deinstitutionalization and mainstreaming of many of these youngsters, an increasing number reside in our communities and are dependent upon local dentists for services. A review of the complicating realities of these comorbidities is presented.

Pockets of childhood poverty persisted despite a strong economy in the late 1990s: impact in special cases

Governmental and private agency reports provide varying views on childhood poverty levels during the final years of the 1990s. A review of these reports reveals that significant levels of childhood poverty continue, particularly in single parent households. The impact on children with special health care needs is considered.

Dental education for New York State residents in the 1990s and beyond

There was a continuing decrease in the 1990s in the number of New Yorkers admitted to out-of-state dental schools, with particular dependence on two out-of-state schools.

Cultural diversity: caring for minority children with mental retardation and other disabilities

Providing services for minority group children with mental retardation and other disabilities can challenge the abilities of any dental practitioner. The added challenge, however, is for the practitioner to recognize and understand the different cultures which can and do affect the relationships between the practitioner, the patient, the family, and the care that is provided. An introduction is provided to these complex and diverse minority group family settings which increasingly are becoming a component of our communities.

New York State--dental establishments--keep getting larger

Bureau of the Census data, through the end of the 1990s, indicate a continuing increase in the size of dental establishments. A review at the national, state and county levels document these developments for New York State.

In 1999, the number of children (and adults) without health insurance decreased, but

The Census Bureau announced in mid 2000 that, between 1989 and 1999, the number of children (and adults) without health insurance decreased. The continued lack of health insurance in many population groups and the limitations of Medicaid (the primary third party coverage for one-in-five children) are explored.

Community-based dental services for patients with special needs

Deinstitutionalization of individuals with mental retardation and developmental disabilities has increased the demand for dental services for these patients by community practitioners. There are numerous difficulties associated with the delivery of care to this population with special needs. Nevertheless, a county-by-county review for New York State indicates that in most instances, if all dentists are willing to help, there would be a relatively small number of these patients per dental practitioner.

1,304,594 births to unmarried women in 1999

The National Center for Health Statistics reported that out-of-wedlock child-bearing has leveled off or slowed down in 1999. But in almost every single year between 1940 and 1999 the number of births to unmarried women increased. In 1999, more than 1.3 million children were born to unmarried women. A review is provided of these developments through the end of the 1990s, together with 1) the economics of single parenthood,2) the reality that increasing numbers of these new mothers ar in the general workforce and 3) the added impact of youngsters with mental retardation and other disabilities on single parent families.

NYSDA Membership Survey. How the components stack up

There are many similarities and differences between the demographic characteristics of dentists, their practice arrangements, business activities, income and other factors, which do not follow the purported "downstate-upstate" dichotomy. In each district society, most respondents are sole proprietors, and 26+ years is the most frequently reported period of time in practice. A great majority of dentists in most component societies work 32+ hours per week, and average 50 to 56 scheduled and six to nine emergency visits per week. $175,000+ was reported most frequently as the net income of dentists in eight component societies. A small percent of practitioners belong to IPAs and capitation plans. A small percent accepts Medicaid patients. A somewhat larger percent belongs to DR plans. A much greater percent belongs to PPO arrangements. Approximately 25% of respondents expect that their primary occupation will change in the next 10 years, with the vast majority anticipating no longer being in dental practice.

Would you believe that during the 1990s, applications to pediatric dental training programs more than doubled?

A review of application to (and enrollment in) pediatric dental programs indicates increasing dental student graduate interest (particularly by female graduates) in this specialty. Except for black student representation, enrollment in pediatric dentistry training programs increasingly represents the ethnic and racial distribution of the general population.

NYSDA Membership Survey provides insight into the composition of the dental profession in New York State

How are dentists in New York State doing? How does their experience compare with that of dental practitioners throughout the country? Are there differences between the way male and female, minority and nonminority, younger and older dentists practice? These are but a few of the questions that the NYSDA 1999 Member Survey sought to answer. What follows are some of the findings.

Deinstitutionalization of children with mental retardation: what of dental services?

During the past thirty years there has been marked deinstitutionalization from large state facilities for youngsters and adults with mental retardation and developmental disabilities. In the past, dental (and general medical) services were provided in the institutions by an in-house staff. Increased numbers of former residents now live in small community units. These local residents must now rely on community dental practitioners for needed preventive and restorative services. The current status of these services (or lack there of) is reviewed, together with relevant concerns.

Providing general dentistry for people with disabilities: a demographic review

In the mid-1990s, approximately 54 million American people had some level of disability, including 26 million who had a severe disability. In addition, more than three-quarters of individuals with mental retardation/developmental disabilities were deinstitutionalized during the past 30 years and now reside in our communities, relying upon community practitioners for needed services. This review is provided to make dental practitioners aware of the magnitude and dimensions of the situations in which persons with special needs require their services.

Orthodontics and the population with special needs

During the past 30 years, more than three quarters of individuals with mental retardation/developmental disabilities have been deinstitutionalized and now reside in our communities, relying on community physicians and dentists (even orthodontists) for needed services. A presentation is made to increase orthodontic practitioner awareness of the magnitude and dimension of the increasing numbers of youngsters and adults with special needs who now reside in their communities and require their services, and to provide some insight and response for the query, "Why orthodontics?"

You may be treating children with mental retardation and attention deficit hyperactive disorder in your dental practice

Providing dental services for children with mental retardation is complicated further for those youngsters with the comorbidity of attention deficit hyperactivity disorder. A general introduction into these conditions is presented in an effort to extend practitioner awareness and ability to provide needed care.

Children with mental retardation and epilepsy: demographics and general concerns

Epilepsy is the most frequent additional handicap in children with mental retardation, with a reported prevalence between 5 and 50 percent. Demographics, issues of control of epilepsy and general attitudes to the care of these youngsters are considered in an effort to increase the availability of needed dental services.

Dental establishment business activity in New York State counties

Bureau of the Census reports for 1997 were used to develop business data for "average" dental establishments in each of the countries in New York State. On average, during the mid-1990s, when compared to nationwide information, the number of New York State dental establishments increased at a slower rate, had a smaller resident population per establishment, reported lower gross receipts, had fewer employees and paid lower salaries to employees.

Fewer people are on welfare rolls: does that mean that more children will receive dental care?

The number of welfare cases has been halved during this latest period of financial improvement. Can children who are "no longer poor" get dental care? A review of the complex interplay between welfare, Medicaid and dental services is provided.

And you thought the nation's economy was doing well--children remain in poverty: Part II

In an extended period of favorable economic indicators, improvements in child, poverty have slowed. In the late 1990s, almost one in five children continues to live in poverty at progressively lower financial levels. In addition, despite government safety net programs, significant number of children lack adequate health insurance and needed dental care.

An increasing number of your pediatric patients may have asthma: the demographics of asthma

In light of the growing prevalence of children with asthma, dental practitioners should increase their awareness of the demographic characteristics of the disease and the associated use of health services. A review is provided of 1) the distribution of the disease in the pediatric and general populations, 2) the number of physician visits, 3) emergency room and hospital usage, and 4) mortality patterns.

More than "just" food: what are our youngsters eating?

More than one in ten children in poor families experience hunger. The vast majority of children of all ages and family incomes do not have a good diet. A review of these realities is provided in an effort to alert dentists to the magnitude of these problems.

Use of pediatric dental services in the 1990s: some continuing difficulties

Despite continuing need for dental services, the use of dental services has not increased uniformly throughout the population of children. Minority group children, children in families with other than two parents present, children in lower income families and families without insurance, and children with special needs, receive reduced levels of dental services than their counterparts in the general population.

Baby fat is cute, but chubby kids may be in danger

An increasing percent of children are overweight. A review of the prevalence of overweight children in different demographic groups is provided in an effort to alert dentists to the role they could play in preventing medical complications.

Are we reaching very young children with needed dental services?

Recommendations by the Academy of Pediatric Dentistry urging a dental/oral examination of all infants before one year of age, have had limited impact on the profession and the general public. Significant numbers of pediatric dentistry specialists and general practitioners who provide care for children, disagree with the recommendations. Between the mid 1970s and 1990's, there has been no change in the percent of children less than six years of age who were reported to have visited a dentist in the past year. A review is provided of the dental disease needs and dental service patterns of very young children in the various demographic populations in an attempt to 1) increase practitioner awareness of the continuing needs for services and 2) develop a dialogue between the organizations of the profession and the dentists in practice, regarding directions to be taken in the future.

Why not Medicaid dentistry?

Charitable dental services and Medicaid dentistry are two components of services provided to patients with limited financial resources. An approach to making the case for improvements in Medicaid dentistry may best be made by increasing the public's awareness of the charitable services provided by individual dentists.

Children with mental retardation: stigma and stereotype images are hard to change

Societal attitudes and perceptions of children with mental retardation have stigmatized and stereotyped generations of youngsters. Deinstitutionalization and mainstreaming most of these children in our schools and general communities require that we recognize and reevaluate many long-held beliefs and how they serve as obstacles to implementing and ensuring needed health and social services. The background and current status of these attitudes are reviewed in an effort to 1) increase practitioner understanding of the population of youngsters with mental retardation that increasingly will be seeking the services of community dentists and 2) encourage legislative efforts and grass-root initiatives (such as the Special Olympics) to change/improve attitudes relative to children with mental retardation.

Sexuality and youngsters with mental retardation

Pediatric and general dentists provide services at a time when children with (and without) mental retardation experience their first stirrings of sexuality. A review of some of the realities of sexual behavior of children with mental retardation is provided.

New York State Medicaid dentistry in the 1990s

Medicaid dental expenditure data for the 1990s are reviewed in light of current legal efforts to improve free schedules in New York State.

Children with mental retardation grow older

In an effort to encourage dental practitioners to provide needed services for children with mental retardation as they grow older, a review is provided of the ongoing difficulties faced by families and their children--including attitudes, residence, sibling and older parent dilemmas, cost of care and the realities of sexuality.

Treating children with disabilities and their families

Increased numbers of dental students and practitioners are necessary to provide services for children with disabilities. In many instances, the technical aspects of treatment are complicated by the interaction between the dentists, patient and the family. The stresses and strains in a family with a child with disabilities can and do impact on both the office visit and in the home setting. A review of the literature is provided in an effort to familiarize practitioners with these realities.

Children with disabilities: more than just numbers

Listing of the numbers of children with disabilities provide little to no insight in the difficulties faced by children with disabilities and their families. A review is provided of the emotional and psychological hurdles that need to be considered as pediatric dentists continue to provide the necessary services.

A "dirty secret": the abuse of children with disabilities

The media and professional and lay literature are replete with the tragic stories of the abuse and neglect of children. Limited references, however, are made to the even more unbelievable reality that children with disabilities are maltreated at a rate that may be as great as four to ten times that of children without disabilities. The characteristics that make children with disabilities more vulnerable to abuse, the nature of the abuse, the variation by gender, the financial costs of abuse and the reality that this abuse may occur in the "best of families" are reviewed in an effort to increase practitioner awareness of the "dirty secret."

Some factors that endodontists may consider when selecting a practice location

The distribution of endodontists per population is considered in terms of the ranking of states by the availability of a graduate endodontic training program and selected population demographic characteristics. Statistically significant positive relationships were found for the endodontist to population ratios, and (i) overall health and social conditions, (ii) per capita income, (iii) per capita spending for health care, and (iv) percentage of the population that is Hispanic and Asian-American. Negative relationships were found for (i) increases in the population that is underserved by dentists, (ii) higher levels of out-of-pocket spending for health care, and (iii) increases in the population below the poverty level. Further analysis at the local level (and for individual practitioners) is needed to better understand the decision process in the selection of a practice site.

Health insurance for children: a new federal initiative and opportunity

In 1997, Congress enacted the State Children's Health Insurance Program to extend health insurance coverage to low-income children who are ineligible for other insurance, including Medicaid. The program is reviewed and considered in terms of children's access to health care and their health status.

When mom is out working: dads do take care of the kids

The mothers of more than nine million children less than five years of age are employed. Fathers provide child care services for 16 percent of these children during the mother's working hours. Recent reports by Bureau of the Census are reviewed to provide practitioners with an overview of the fathers who will be bringing their preschoolers to dental offices for services.

Selecting a practice location: factors that periodontists may consider

BACKGROUND

The decision to locate a periodontal practice is based upon a complex series of interrelated variables. An understanding of this process is essential if planning for the distribution of periodontists is to be considered.

METHODS

Non-parametric statistical tests were used to determine the relationships between the rankings of states by periodontist-to-population ratios and 1) the availability of a periodontal training program, and 2) selected population demographic characteristics.

RESULTS

A statistically significant positive relationship was found between the ranking of states by periodontist-to-population ratios and 1) the availability of a periodontal training program; 2) per capita income; 3) per capita spending for health services; 4) availability of health insurance; and 5) the percentage of the population that is African-American, Hispanic, and Asian-American.

CONCLUSIONS

This study provides a broad analysis of some of the factors in the practice location decision process. Further analysis at the local level (and for individual practitioners) is needed to better understand the decision process in the selection of a practice site.

Managed (not to) care: Medicaid and children with disabilities

The emphasis that managed care programs place on cost containment complicates further the already complex setting for Medicaid health services for children with disabilities by adding an additional barrier to access care to those that already exist. A review considers the attitudes toward and working of Medicaid managed care arrangements for children in general and children with disabilities in particular.

Changing number and distribution of endodontists: a continuing imbalance--1987-1995

A review of the 1995 and past American Dental Association studies on the distribution of dentists provides specific information on the evolving numbers of endodontists at the national, regional, and state levels. Despite an increase in numbers of endodontists, major differences continue in practitioner-to-population ratios in different geographic areas.

The evolving demographic makeup of dental graduates

The gender, racial and ethnic makeup of dental school graduates and advanced dental education program students is undergoing changes that to some extent mirror the developments in the general population. There have been marked decreases in the ratio of white dental school graduates to the white population, but limited changes in the ratio of minority group graduates to their respective national populations. Compared to their representation in dental schools, women and minority group graduates are under-represented in specialty training programs, with wide variations by specialty fields. There have been marked decreases in the proportion of dental school graduates whose immediate plans include self-employment practice and increases in the proportion anticipating some form of employment.

Dental care for children with mental retardation: thoughts about the Americans with Disabilities Act

The Americans with Disabilities Act bars discrimination in public accommodations, housing, employment and health care for people with disabilities. Efforts to "mainstream" (in housing and education) many of the individuals with mental retardation have altered the setting for dental services and place demands for services by dental practitioners in the community. These developments should be considered within the jurisdiction of this new legislation. Demographic characteristics and dental needs of children with mental retardation are reviewed to provide a background for this discussion.