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Background: This paper deals with the economics of the independent dental hygiene practice., Methods: Using historical data from dental practices in Cincinnati, Ohio, we developed a business model for an independent hygiene practice. We tested the sensitivity of the model to variations in key assumptions (initial capitalization, interest, employee salary, and owner's draw). We described the profitability on the basis of the breakeven point., Results: Under the most permissive regulatory and financial environment, the practice would breakeven after 26 months. However, the owner would not equal the earnings of a salaried hygienist until the initial loan is paid off after 7 years. The model was not sensitive to 20 percent changes in the key assumptions., Conclusions: Under ideal circumstances, an independent hygiene practice could be profitable.

The opportunities for public health training have declined over the years while the need for public health skills is likely to increase. This paper reports the results of a project, sponsored by the Health Resources and Services Administration, which answers the question of "how best to invest in the dental public health education system so as to fulfill the profession's responsibilities to protect and improve the oral health of individuals and society." An information base on dental public health education, practice, and specialization was developed from an extensive review of the literature and a survey of dentists concerning employment and practice requirements for public health dentists. An advisory group considered this information, met to discuss the issues involved in dental public health training, and provided advice to the project staff. Based on the information gathered as part of the project, recommendations were made to: (1) develop a grant program to support advanced education in dental public health; (2) increase the competencies of dentists who are working in public health positions and not eligible for board certification via off-site residencies; (3) develop model programs in areas of great need, such as general public health, management, policy, prevention, environmental health and research, that in conjunction with a basic public health core, could satisfy the eligibility requirements of the American Board of Dental Public Health; (4) develop student loan forgiveness programs for dentists and dental hygienists working in public health; and (5) develop additional credential recognition programs for dental public health workers.

When used properly, sealants result in improved dental health. However, their use on all occlusal tooth surfaces for preventive reasons will result in wasted dental care resources. To optimize the preventive effects of sealants, a delivery model should be initiated that uses specially trained dental hygienists or dental assistants who visit schools to explain oral health-related issues, conduct visual inspections of clinical oral health status, identify patients at risk for dental caries, and generate a central database for program operation. When a high-risk patient is identified, auxiliary personnel could place sealants and recall the patient for a new visual inspection six months later. If caries is suspected at that time, the patient could be sent to a dentist for additional treatment. To offset the negative effects caused by overutilization of sealants, their usage should be divided into two categories. First, a preventive option should be available, and the fee for use of sealants in this option should be lower compared to the fees used today. By using specially trained auxiliary personnel to place such sealants, the fee could be kept reasonably low. Second, a sealant treatments option that targets treatments of incipient lesions also should be available. The fee for such a treatment should be close to that of the traditional occlusal restoration, and the application should be by a dentist. By using such a fee structure based on market forces, one would expect that sealant usage would increase among patients suffering from early carious lesions, while the usage of preventive sealants would remain the same or decline. This utilization pattern for dental sealants would contribute to improved efficiency of sealant usage in the treatment of dental caries, particularly at a time when caries frequency is declining. The improved efficiency could release dental care resources that should be used to target risk groups with improved education in dental health. By using such a strategy, the long-term effect would be not only the placement of fewer restorations, but an improvement in dental health among adolescents and adults.

Dental hygienists' contribution to total gross billings and production, measured in standard production minutes, was studied in 13 private practices that employed hygienists. Hygienists' treatment accounted for one fourth of total production and one eighth of all gross billings. These results, together with analyses of the use of available time, the range of procedures performed by hygienists, and the rate of return for these procedures, illustrate the utility of this type of information when assessing the possibility of changes in the dental hygiene profession. In the past five years, the literature concerning dental hygienists has included a number of contributions that focus on the status of and possible changes in the practice of dental hygiene. These contributions have discussed the general future of dental hygiene,1-3 and the specific issues of professionalism,4-6 advocacy,7-8 and legal and political activity and knowledge.9-11 In addition, several discussions of new forms of dental hygiene practice also have appeared in the hygiene literature, 12-17 as well as in the general dental literature.18-20 Finally, surveys of dental hygienists have been reported frequently.21-30 The content of this growing body of literature indicates that the profession of dental hygiene currently is undergoing an internal examination, and that several educators and practitioners are advocating the acceptance of increased responsibility by hygienists.(ABSTRACT TRUNCATED AT 250 WORDS)

Little is known concerning the employment characteristics of hygienists practicing in nontraditional settings. Respondents were identified through screening (n = 38,380) a listing of the entire population of hygienists licensed in the United States. The screening identified 1,301 hygienists practicing in nontraditional settings. These hygienists were mailed comprehensive questionnaires; completed questionnaires were returned by 84.3 percent of the hygienists. Data were collected describing hygienists' reasons for seeking employment in nontraditional settings, their sources of information concerning job opportunities in nontraditional settings, benefits, and job satisfaction. The main source of information concerning employment opportunities in nontraditional settings was "word of mouth." Hygienists were motivated to seek employment in nontraditional settings primarily by a desire for a more challenging position and personal satisfaction. The hygienists were overwhelmingly satisfied with all aspects of nontraditional employment except opportunities for advancement. Respondents were found to receive standard benefits similar to those of employees in other industries.