Dental Clinics of North America RSS feed: Current Issue. The Dental Clinics of North America updates you on the latest trends in patient management and the newest advances as well as provides a sound basis for choosing treatment options. Each issue focuses on a single topic in dentistry and is presented under the direction of an experienced guest editor.http://www.dental.theclinics.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Dental Clinics of North America0011-8532533July 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.dental.theclinics.com/article/PIIS0011853209000445/abstract?rss=yesContents10.1016/S0011-8532(09)00044-5Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0vviiihttp://www.dental.theclinics.com/article/PIIS0011853209000457/abstract?rss=yesForthcoming Issues10.1016/S0011-8532(09)00045-7Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0ixixhttp://www.dental.theclinics.com/article/PIIS0011853209000317/abstract?rss=yesDental access is a multifaceted problem and this issue of Dental Clinics of North America is equally multifaceted. Its contributors consider a wide range of issues: from ethical conundrums to logistic considerations, from private financing to national health policy, to informatics technology, and to workforce dynamics. Dr. Gary Colangelo, the Guest Editor for this issue, has approached the topic with a net as wide as the questions involved, engaging contributors who represent an equally wide range of philosophical and pragmatic perspectives.ForewordBurton L. Edelstein10.1016/j.cden.2009.03.013Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0xixiiihttp://www.dental.theclinics.com/article/PIIS0011853209000329/abstract?rss=yesDuring the twentieth century, the dental profession gained remarkable technological advances that improved the oral health of many Americans. Systemic and topical fluoridation, the air rotor hand piece, and local anesthesia dramatically prevented disease and made surgical care efficient and painless. Despite these advances, access to optimal oral health care is limited or nonexistent for at least 40% of Americans. If the goal for Americans is to improve their oral health, the means to reach this goal is to improve access. Oral health care access includes more than receiving appropriate professional care. Access to disease prevention interventions and oral health knowledge also are essential to reach the goal of optimal oral health.PrefaceGary A. Colangelo10.1016/j.cden.2009.03.014Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0xvxvihttp://www.dental.theclinics.com/article/PIIS0011853209000299/abstract?rss=yesOral health is associated with overall health, and lack of access to dental care has consequences that go far beyond aesthetics. Most oral diseases are preventable and are relatively easy and inexpensive to address at early stages. However, multiple barriers make dental care unreachable for a sizable portion of the United States population, who consequently has higher incidence and prevalence of disease. Achieving meaningful improvements in oral health status among these groups will require a revamping of the dental infrastructure, augmenting the productivity and skills of the dental workforce, and increasing the population's oral health literacy.How Dental Care Can Preserve and Improve Oral HealthClemencia M. Vargas, Oscar Arevalo10.1016/j.cden.2009.03.011Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0399420http://www.dental.theclinics.com/article/PIIS0011853209000263/abstract?rss=yesThe standard ethical arguments that prescribe dentistry's involvement in improving access to oral health care are based on the ethical principle of social justice. The authors underwrite this principle but argue that, as with other ethical principles, this principle alone will fail to have a practical impact. The authors show that the issue of access is a symptom of a more systemic problem in dentistry, namely the lack of connectedness that dentists feel between themselves and their profession, their community, and society at large. The second half of the article develops a plan for boosting “connectedness.” Successful implementation should help resolve many of the systemic problems that dentistry currently faces, including the issue of disparities in oral health.The Dilemma of Access to Care: Symptom of a Systemic ConditionJames T. Rule, Jos V.M. Welie10.1016/j.cden.2009.03.008Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0421433http://www.dental.theclinics.com/article/PIIS0011853209000305/abstract?rss=yesThe dental workforce refers to the number, distribution, and characteristics of dentists, dental auxiliaries, and other support staff involved in the provision of oral health care. This article reviews the changes in the dental workforce that have taken place, especially during the last 50 years, the present status of the workforce, and projections about the adequacy and composition of the dental workforce in the coming years.Dental WorkforceEric S. Solomon10.1016/j.cden.2009.03.012Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0435449http://www.dental.theclinics.com/article/PIIS0011853209000196/abstract?rss=yesThe disadvantaged suffer disproportionately from dental problems. These persons are more likely to have untreated oral health problems and associated pain, and also are more likely to forego dental treatment even when in pain. There has been increased emphasis on the potential role of physicians in alleviating oral health disparities, especially among children. In addition, many adults lacking access to traditional dental services seek care and consultation from hospital emergency departments, physicians, and pharmacists. The delivery of oral health care services by non-dental health professionals may assume increasing importance as the population continues to age and becomes more diverse. This is because, in general, the elderly and ethnic and racial minorities face significant economic barriers to accessing private dental services.The Role of Non-Dental Health Professionals in Providing Access to Dental Care for Low-Income and Minority PatientsLeonard A. Cohen10.1016/j.cden.2009.03.001Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0451468http://www.dental.theclinics.com/article/PIIS0011853209000251/abstract?rss=yesThis article documents the disparities in oral health among children, identifies barriers to access to care for children, describes the use of dental therapists internationally to improve access to care for children, documents previous efforts in the United States to train individuals other than dentists to care for children's teeth, describes the current status of the use of dental therapists in Alaska, justifies limiting the care given by dental therapists to children, suggests potential economic advantages of using dental therapists, and concludes by describing how dental therapists could be trained and deployed in the United States to improve access to care for children and reduce disparities in oral health.Improving Access to Oral Health Care for Children by Expanding the Dental Workforce to Include Dental TherapistsDavid A. Nash10.1016/j.cden.2009.03.007Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0469483http://www.dental.theclinics.com/article/PIIS0011853209000287/abstract?rss=yesDisparities remain among the United States population with regard to who receives dental treatment. This article assesses current programs designed to provide dental insurance coverage. This assessment examines person-level use and expenditures as a function of preferences, price, and the use of third-party coverage.Public Programs, Insurance, and Dental AccessRichard J. Manski10.1016/j.cden.2009.03.010Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0485503http://www.dental.theclinics.com/article/PIIS0011853209000226/abstract?rss=yesDental coverage provides a means to obtain oral care, which is an important component of overall health. This article discusses the common forms of dental health plans, the services usually covered, and their relative costs.Dental Benefits Improve Access to Oral CareRene Chapin10.1016/j.cden.2009.03.004Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0505509http://www.dental.theclinics.com/article/PIIS0011853209000172/abstract?rss=yesDentists and the dental health care industry have a renewed interest in clinical risk assessment, because they offer the potential to identify a patient's clinical needs for oral health care more specifically, to maximize prevention by early intervention, and to educate patients to become more informed consumers of oral health care and direct resources where they are most needed and can produce the greatest value. To realize this potential, risk assessment must be applied appropriately, and its indirect ramifications for access to care should be considered. Several ideas for the appropriate application of risk assessment are discussed and the ramifications for access to care are explored.Managing Clinical Risk: Right Person, Right Care, Right TimeFrank J. Graham, Council on Dental Practice, American Dental Association10.1016/j.cden.2009.03.015Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0511522http://www.dental.theclinics.com/article/PIIS0011853209000184/abstract?rss=yesDespite vast improvements in the oral health status of the United States population over the past 50 years, disparities in oral health status continue, with certain segments of the population carrying a disproportionate disease burden. This article attempts to describe the problem, discuss various frameworks for action, illustrate some solutions developed by the private sector, and present a vision for collaborative action to improve the health of the nation. No one sector of the health care system can resolve the problem. The private sector, the public sector, and the not-for-profit community must collaborate to improve the oral health of the nation.Private Sector Response to Improving Oral Health Care AccessLindsey A. Robinson, Council on Access, Prevention and Interprofessional Relations10.1016/j.cden.2009.03.016Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0523535http://www.dental.theclinics.com/article/PIIS0011853209000238/abstract?rss=yesTeledentistry is an exciting new area of dentistry that fuses electronic health records, telecommunications technology, digital imaging, and the Internet to link health providers in rural or remote communities. For the patient located in underserved or remote areas, teledentistry improves ready access to preventive dental care and teleconsultation with specialists. It allows the dentist in the nearby community to provide easier access to preventive care to a patient who, otherwise, probably will not seek care. It enables the specialist located many miles away to make a diagnosis and recommend treatment options and/or referral.Using Teledentistry to Improve Access to Dental Care for the UnderservedJames Fricton, Hong Chen10.1016/j.cden.2009.03.005Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0537548http://www.dental.theclinics.com/article/PIIS0011853209000214/abstract?rss=yesSocial work programs in dental schools and dental clinics have been operated successfully since the 1940s, and have been documented as contributing to patients' access to care and to dental education. However, unlike medical social work, with which it has much in common, social work in dentistry has failed to become a standard feature of dental schools and clinics. Few of the social work initiatives that have been implemented in dental schools have survived after initial grant funding ran out, or the institutional supporters of the program moved on. The authors hope that the CARES program serves as a model for the successful development of other programs at the intersection of social work and dentistry to the benefit of both dental patients and providers.Social Work in Dentistry: The CARES Model for Improving Patient Retention and Access to CareJoan M. Doris, Elaine Davis, Cynthia Du Pont, Britt Holdaway10.1016/j.cden.2009.03.003Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0549559http://www.dental.theclinics.com/article/PIIS0011853209000275/abstract?rss=yesOral health care reform is made up of several components, but access to care is central. Health care reform will occur in some fashion at some point, and how it will impact the entire dental sector is unclear. In the short term, there is likely to be a dental component during the reauthorization of State Children's Health Insurance Program in early 2009, and several federal oral health bills are expected to be reintroduced as well. Additional public funding for new programs and program expansions remains questionable, as federal funding will be tight. Fiscal conservancy will be occurring in the states as well; however, various proposals to expand dental hygienists' duties are likely, as are proposals related to student grants for dental schools. Regardless of one's political stance, the profile of oral health care has been elevated, offering countless opportunities for improvement in the oral health of the nation.An Introduction to Oral Health Care ReformKristen L. Hathaway10.1016/j.cden.2009.03.009Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0561572http://www.dental.theclinics.com/article/PIIS001185320900024X/abstract?rss=yesThe executive and legislative branches of state government have broad authority that provides the underpinning for the dental health care system. This article describes four principal areas in which policy makers' decisions can improve children's access to dental care: (1) providing and financing health care (ie, providing opportunities for shaping public insurance programs like Medicaid and SCHIP); (2) regulating health providers and facilities (ie, providing levers for policy change in dental practice acts); (3) ensuring the health of the public (ie, states' choices on population-based approaches and providing leadership in oral health); and (4) education and training of the health workforce (ie, state support of dental education that can ensure a dental workforce that meets the needs of the population).Why Public Policy Matters in Improving Access to Dental CareShelly Gehshan, Andrew Snyder10.1016/j.cden.2009.03.006Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0573589http://www.dental.theclinics.com/article/PIIS0011853209000202/abstract?rss=yesImproving access to oral health care requires an understanding of the social, cultural, political, financial, and manpower factors that influence access. Armed with this knowledge, individuals and organizations desiring to improve access can innovate to change public policy, garner resources, create clinical programs, and expand public health interventions as demonstrated by the examples in this article. This article highlights past and contemporary innovations that have improved access, or have the potential to improve access to oral health care. These innovations are grouped into six categories: the dental profession, public health, community-based care delivery, oral health care funding, dental education, and evidence-based dentistry.Innovations to Improve Oral Health Care AccessGary A. Colangelo10.1016/j.cden.2009.03.002Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0591608http://www.dental.theclinics.com/article/PIIS0011853209000469/abstract?rss=yesIndex10.1016/S0011-8532(09)00046-9Dental Clinics of North America 53, 3 (2009)2009-07-01Dental Clinics of North America2009-07-01533S0011-8532(09)X0003-0609615