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Background: In this study, the authors used observational data from 2014 to evaluate the association between the number of general dentists and several community characteristics., Methods: The authors collected community-level characteristics from secondary sources for all 947 Iowa incorporated communities to study their relationships with the mean number of general dentists per 1,000 population per square mile (population density), the dependent variable. The authors used zero-inflated negative binomial models to examine the association between the dependent and predictor variables., Results: Only 22.8% of communities had a dentist. Urban, young, well-educated, fluoridated communities with at least 1 elementary school had the highest estimated mean concentration of dentists. Isolated communities with older, less educated adults and lacking fluoridation and an elementary school had the fewest dentists., Conclusions: Although population is an important determinant for where a dentist practices, other variables such as urbanization, demographic characteristics, fluoridation status, and presence of at least 1 elementary school are also predictors of the number of dentists in a community., Practical Implications: These findings provide dental students and young practitioners useful information by highlighting community characteristics that are associated with office locations., (Copyright © 2018 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Objective: To examine the effects of distance to dentists and dentist supply on dental services use among children with Medicaid coverage in Iowa., Data Source: Iowa Medicaid claims for enrolled children between 2000 and 2009., Study Design: The study sample included 41,554 children (providing 158,942 child-year observations) who were born in Iowa between 2000 and 2006 and enrolled from birth in the Iowa Medicaid program. Children were followed through 2009. We used logistic regression to simultaneously examine the effects of distance (miles to nearest dentist) and county-level dentist supply on a broad range of dental services controlling for key confounders. Additional models only used within-child variation over time to remove unobservable time-invariant confounders., Principal Findings: Distance was related to lower utilization of comprehensive dental exams (2 percent lower odds per 1 mile increase in distance), an effect that also held in models using within-child variation only. Dentist supply was positively related to comprehensive exams and other preventive services and negatively related to major dental treatments; however, these associations became smaller and insignificant when examining within-child changes except for other preventive services., Conclusions: Longer distance to dentists is a barrier for use of comprehensive dental exams, conditional on dentist supply., (© Health Research and Educational Trust.)

Some U.S. states have more difficulty than others in recruiting or retaining dentists. Part of the problem is that often dental students are not aware of opportunities across geographic regions of either their home state or the state where they were educated. With student input, the University of Iowa College of Dentistry and Dental Clinics designed and launched an interactive website that provides basic demographic, economic, and other meaningful information to help dental students locate potential practice locations and identify current employment opportunities in Iowa. Although this website is not a recruitment or retention panacea, it provides an easy method for dental students to explore all or parts of the state as they go about making one of the most important decisions of their careers. The website also provides a showcase for current practitioners and communities to demonstrate what they have to offer as practice opportunities.

Objectives: Private practice dentists are the major source of care for the dental safety net; however, the proportion of dentists who participate in state Medicaid programs is low, often due to poor perceptions of the program's administration and patient population. Using a discrete choice experiment and a series of hypothetical scenarios, this study evaluated trade-offs dentists make when deciding to accept Medicaid patients., Methods: An online choice-based conjoint survey was sent to 272 general dentists in Iowa. Hypothetical scenarios presented factors at systematically varied levels. The primary determination was whether dentists would accept a new Medicaid patient in each scenario. Using an ecological model of behavior, determining factors were selected from the categories of policy, administration, community, and patient population to estimate dentists' relative preferences., Results: 62 percent of general dentists responded to the survey. The probability of accepting a new Medicaid patient was highest (81 percent) when reimbursement rates were 85 percent of the dentist's fees, patients never missed appointments, claims were approved on first submission, and no other practices in the area accepted Medicaid. Although dentists preferred higher reimbursement rates, 56 percent would still accept a new Medicaid patient when reimbursement decreased to 55 percent if they were told that the patient would never miss appointments and claims would be approved on initial submission., Conclusions: This study revealed trade-offs that dentists make when deciding to participate in Medicaid. Findings indicate that states can potentially improve Medicaid participation without changing reimbursement rates by making improvements in claims processing and care coordination to reduce missed appointments., (© 2015 American Association of Public Health Dentistry.)

Purpose: To evaluate the availability of general dentists who treat very young children with private insurance in the context of recommendations for age one dental visit., Methods: Administrative data from Delta Dental of Iowa were analyzed to identify general dentists providing care to children younger than 18 years old in 2005 and 2012. Characteristics of dentists providing care to children younger than two years old were compared, examining changes over time. Geographical distribution of dentists who treated children younger than two years old was examined., Results: The proportion of dentists treating children younger than two years old increased from six percent in 2005 to 18 percent in 2012. Younger dentists, females, graduates of The University of Iowa College of Dentistry, and those in metropolitan locations were significantly more likely to treat children younger than two years old. Fifty-one of 99 counties lacked any dentists who had provided care to privately insured children younger than two years old., Conclusions: The proportion of dentists in Iowa treating privately insured children younger than two years old has increased since 2005. However, relatively few general dentists provided care to very young children when compared to previous survey-based figures. Geographic distribution of providers supports the hypothesis that provider availability may pose a barrier to early dental visits.

The Institute of Medicine and the Commission on Dental Accreditation (CODA) have recommended that dental schools incorporate community-based dental education (CBDE) programs into their curricula. The expectation is that CBDE participation will help dental students gain the skills and motivation to treat vulnerable populations after graduation. The purpose of this study was to determine whether dentists' involvement with charitable dental care is associated with participation in CBDE as dental students. A questionnaire was mailed to private practice Iowa dentists (N=1,312); the response rate was 41.2 percent (n=541). Logistic regression analyses, controlling for age, gender, number of hours worked per week, graduation year, and alma mater, were conducted. A majority of the respondents provided charitable care: 85 percent in their offices, and 70 percent in the community. Seventy-nine percent had participated in CBDE as dental students. Respondents who reported being very satisfied/satisfied with their charitable care experiences were more likely to provide charitable care in their offices and the community than respondents who were not satisfied with their experiences. Respondents who participated in CBDE as dental students were more likely to provide charitable care in the community than respondents who did not participate in CBDE. The type of sites where dentists completed their CBDE experiences was associated with where they provide charitable care. This study suggests that participation in CBDE may be associated with dental students' providing charitable dental care after graduation.

Purpose: To examine whether there is a difference in the likelihood that a general dentist practices in a rural location based on individual characteristics, including dental school attended, birth state, practice arrangement, sex, and age., Methods: All private practice, general dentists in Iowa were included in this study. Data were extracted from the year 2010 version of the Iowa Dentist Tracking System, which monitors practice patterns of active dentists. Rurality of primary office location, categorized using Rural-Urban Commuting Area codes, served as the outcome variable. Chi-square tests and multivariable logistic regression were used to explain associations between rural practice location and dentist characteristics., Findings: Fifteen percent of the state's population resided in isolated small rural towns, but only 8% of general dentists practiced here. Approximately 17% of dentists in isolated small rural towns were age 40 or younger, compared to 32% of dentists in urban areas. Among male dentists, those who were born in Iowa (P = .002) were older (P = .020), and graduated from dental schools other than the University of Iowa (P = .009) were more likely to practice in rural areas than were their counterparts. Conversely, among female dentists, solo practice (P = .016) was the only variable significantly associated with rural practice location., Conclusions: The dentist workforce in rural areas of Iowa is dominated by older males who were born in Iowa. As this generation retires and increasing numbers of women enter the profession, state policy makers and planners will need to monitor changing trends in the rural workforce., (© 2013 National Rural Health Association.)

Objective: To study the association of having minor children and contribution to household income on weekly work hours of Iowa female dentists., Methods: A 28-question survey was mailed to all active Iowa dentists. This study represents female dentists who responded to the survey (n = 192; response rate = 63 percent). The dependent variable was whether dentists currently worked full- or part-time (≥ 32 versus <32 hours/week). The associations of having minor children and the percent women contributed toward their household income were then analyzed using stepwise logistic regression, controlling for covariates (alpha = 0.05)., Results: Of the respondents, 14.6 percent worked part-time. Females who had no minor children (40.1 percent) were 3.1 times as likely to work full-time (P = 0.0353), and those who contributed >60 percent to household income (57.8 percent) were 3.0 times as likely to work full-time (P = 0.0129). The final regression model indicated that those who contributed >60 percent to household income (P = 0.0096) and had no leave of absence longer than 45 consecutive days within the prior 2 years (P = 0.0483) were more likely to work full-time compared with their counterparts., Conclusion: Iowa female dentists who provided more than 60 percent to household income and had not taken a leave of absence during the past 2 years were more likely to work full-time. The inclusion of leave of absence as a predictor variable negates any additional influence of the presence or absence of minor children in the regression model, indicating that these variables are highly correlated for this population., (© 2013 American Association of Public Health Dentistry.)

Background: State dental boards maintain minimal demographic and practice characteristics about licensed dentists. The authors describe the creation and monitoring of an enhanced surveillance system concerning Iowa's dentists., Methods: The Iowa Dentist Tracking System (IDTS) was used to collect demographic, educational, practice arrangement, office location and work hour data for all active Iowa dentists beginning in 1997. IDTS staff members add newly licensed dentists to the system as practice locations become available. They also contact each dental office semiannually by telephone to update this information. The IDTS Advisory Committee meets annually to review these data and monitor trends., Results: The Iowa dentist workforce was relatively stable from 1997 through 2007; however, a large number of dentists are expected to retire during the next decade, which could create a shortage of providers, especially in rural areas. Although the percentage of male and female dentists who practice part time (< 32 hours per week) decreased between 1997 and 2007, young female dentists are more likely than young male dentists to practice part time., Conclusions: IDTS is a workforce tracking model that can be used to understand trends at the community, regional and state levels. An aging dentist workforce in Iowa could put a strain on the public's ability to access dental care, especially in rural counties., Practice Implications: In the development of workforce policy, workforce tracking systems such as IDTS provide additional information in considering the number of dentists, location, accessibility and potential productivity of a workforce.

The purpose of this project was to determine new dentists' comfort levels in treating traditionally underserved populations after participating in two consecutive five-week community-based clinical experiences while in dental school. A written survey was mailed to all known University of Iowa alumni (1992-2002; N=745). Respondents were asked to rank their comfort levels in treating twelve underserved populations on a five-point Likert type scale (5=no problem; 1=will not). Bivariate and logistic regression model analyses were performed to examine associations (p<0.05) among comfort and six predictor variables. Alumni (n=372) were most comfortable treating other ethnic, low-income, non-English-speaking, and HIV+/AIDS populations and least comfortable treating incarcerated and homebound populations. The following variables were significantly associated with comfort: 1) perception that the community experiences had great/much value; 2) practice located in larger communities; 3) non-solo practitioners; and 4) dentist's gender. As more dental schools utilize community-based clinical experiences to increase students' exposure to underserved populations, it is important that these experiences provide exposure to a variety of populations. Additionally, dental schools should continuously monitor the short- and long-term value of these programs for their students and recent graduates.

This study analyzed senior dental students' perceptions prior to extramural rotations for comfort and future willingness to treat patients with special needs and other vulnerable groups. The sample included 690 University of Iowa senior dental students who graduated from 1992 through 2004. These students completed a questionnaire concerning twelve vulnerable population groups. Logistic regression models were performed, using student comfort and future willingness to treat each group as the dependent variable. There was a wide percentage of range of comfort with these groups, yet there was no individual group that more than 60 percent of these students were willing to treat in their future practices. Generally, prior experience with the group had a positive impact on comfort level. When gender was included in the regression models, male students were more likely to express comfort. In all instances except one, experience had a positive influence on perceived future willingness to treat the associated group. However, younger graduates had a greater willingness to treat. When controlling for other variables within the future willingness to treat models, comfort was statistically significant only for HIV+/AIDS and non-English speaking groups. This study provides insight about comfort with and perceived future willingness to treat special needs and other vulnerable patient groups.