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Early detection and treatment improve the prognosis for oral cancer. Delays from the onset of symptoms to clinical diagnosis are common. Our aim is to identify factors associated with this delay. Between 1995 and 1998, we interviewed 105 consecutive patients with histologically confirmed oral cancer in Greece. If 21 or more days elapsed from the time the patient noticed major symptoms to a definitive diagnosis, we called it a delay (52% of cases). We used logistic and linear regression to estimate odds ratios of delayed diagnosis and to identify correlates of length of delay, respectively. Former smokers had a 4.3 times greater risk of delayed diagnosis compared with current smokers (95% confidence interval: 1.1-17.1). The length of delay was greater among single patients, non-smokers, or those with stage IV tumors. Clinicians should be advised that delay in the diagnosis of oral cancer occurs frequently, even in individuals who do not smoke heavily.

This paper is an update on the issue of dental student debt and provides additional data and an exploration of continued trends which were outlined by Douglass and Fein in the 1995 IOM study of The Future of Dental Education. Dental school tuitions have continued to increase at rates at or above the consumer price index. These tuition bills are increasingly being met by debt financing on the part of the students. These trends are described and then related to recent data on the future plans of dental school seniors. The second part of the paper will provide new updated date on dentists' incomes and analyze the trend in dental fees versus the consumer price index. The final section provides a summary of pay back mechanisms currently being offered to students.

The erroneous claim that 50 percent of U.S. schoolchildren have never had a cavity has taken on the virtues of truth through frequent and widespread restatement. The 50-percent caries-free statement is an excessively optimistic misrepresentation by the media of the 1986-87 survey of oral health among schoolchildren by the National Institute of Dental Research because it only tells part of the story--it ignores dental disease in the primary dentition. This article documents that numerous public policy papers reflect failure to consider primary tooth caries data. Consequently, a significant disease burden has been overlooked. The article reviews the persistent underreporting of children's caries experience in policy documents and the dental literature, and reviews additional epidemiologic studies of caries reported in U.S. dental literature since 1985. Dental caries remains the single most common disease of childhood that is not self-limiting or amenable to a course of antibiotics. The popular statement that half of U.S. schoolchildren have never experienced tooth decay fails profoundly to reflect the extremity and severity of this still highly prevalent condition of childhood. At a time of extreme pressure on the Medicaid Early and Periodic Screening, Diagnosis, and Treatment budget this uncritically held belief is leading to inappropriate policy and funding decisions that can put the health of children at risk.

This paper explores the thesis that the changing medical needs of dental patients, advances in biomedical research, and the confluence of the financing of medical and dental care will result in closer linkages between the medical and dental care delivery systems during the next century. Five trends have been documented in support of this thesis: the increasing number of elderly and their retention of teeth means there is a greater need for restorative dental care than in previous generations; the elderly have chronic diseases and are taking more medications; younger patients are presenting more frequently with infectious, systemic diseases such as HIV/AIDS. New scientific discoveries are opening new possibilities for patient care, which generate even higher expectations on the part of future consumers of medical and dental services. The health and fitness trend is not a fad; new knowledge regarding diet, nutrition, and exercise is identifying systemic risk factors related to common oral pathologies. Medical and dental educators are paying increased attention to the application of basic sciences to patient care. HMOs are increasing their market share of medical care delivery and expanding their services with preventive care and total patient care, including dental services. Data are provided documenting that dentists see these trends occurring in their private practices. The paper concludes that the application of advances in science and technology to oral health will improve the quality of dentistry. However, only new, effective preventive agents will decrease the cost of care, while improved diagnostics and restorative technologies could increase dental care costs.(ABSTRACT TRUNCATED AT 250 WORDS)

Preventive regimens that have proven efficacy for older adults include topical fluoride rinses, brush-on gels, and antiplaque agents. The efficacy of patient education for both dental office and institutional patients is documented in this article. The use of a preventive and oral health maintenance plan for each patient can improve his or her quality of life even in the face of multiple chronic conditions.

The year covered in this review was marked with significant reports related to the prevalence and severity of periodontal disease in the United States and throughout the world. A series of well-conducted studies reported in peer-reviewed journals examined risk factors related to the high severity of periodontal disease as measured by progressive attachment loss. An interesting development during the year is the increased attention paid to collaborative international studies that document periodontal disease prevalence and severity in six different countries, thus providing a broader understanding of periodontal disease on a worldwide basis. Importantly, several papers discuss the policy implications of the periodontal literature for educational programs and clinical practice. These papers include major reports on national treatment needs in the United States, the use of statistical models and problems related to statistical analysis of periodontal data, and finally, a call for the use of epidemiologic data in program planning, implementation, and evaluation.

The personality traits of introversion/extraversion and neuroticism were investigated as determinants of the utilization of restorative dental care, controlling for socioeconomic status and restorative need. The VA Dental Longitudinal Study (DLS) provided information on the restorative treatment received by 593 healthy adult males during a 10-year period. Utilization of restorative services was measured by calculating the percentage of surfaces that needed and received treatment, as identified by the DLS examiners by clinical and radiographic examination. Oral examinations were initiated in 1969 with subsequent examinations occurring at approximately 3-year intervals. Personality measures for these individuals were obtained using the EPI-Q, a shortened form of the Eysenck Personality Inventory. A plot of neuroticism versus the utilization measure yielded a curvilinear relationship suggesting that participants seeking the most dental care scored moderately on the neuroticism scale while those scoring lowest and highest on this scale sought less treatment. In contrast, the introversion/extraversion scale showed no apparent relationship with dental care utilization. Results from the regression analysis suggest that dentition and socioeconomic status are strong determinants of utilization and that need for restorative treatment influences utilization.

Existing demographic and epidemiologic data are used to project the number of hours of operative dentistry treatment needed by all age groups in the year 2000. The findings suggest that calls to reduce the operative dentistry curriculum because of a decline in the need for single tooth restorative services may be premature, despite the recent caries decline in children and adolescents. The need for operative dentistry treatment is projected to increase until the 21st century, and the nature of this need has implications for the content of operative dentistry curricula.

Whether cost-efficiency in dental services production increases with firm size is investigated through application of an activity analysis production function methodology to data from a national survey of dental practices. Under this approach, service delivery in a dental practice is modeled as a linear programming problem that acknowledges distinct input-output relationships for each service. These service-specific relationships are then combined to yield projections of overall dental practice productivity, subject to technical and organizational constraints. The activity analysis reported here represents arguably the most detailed evaluation yet of the relationship between dental practice size and cost-efficiency, controlling for such confounding factors as fee and service-mix differences across firms. We conclude that cost-efficiency does increase with practice size, over the range from solo to four-dentist practices. Largely because of data limitations, we were unable to test satisfactorily for scale economies in practices with five or more dentists. Within their limits, our findings are generally consistent with results from the neoclassical production function literature. From the standpoint of consumer welfare, the critical question raised (but not resolved) here is whether these apparent production efficiencies of group practice are ultimately translated by the market into lower fees, shorter queues, or other nonprice benefits.

This study explores patterns of treatment for caries in adults. Data were collected as part of the Veterans Administration Dental Longitudinal Study. The 698 subjects received comprehensive dental examinations at three-year intervals for approximately ten years. The subjects were classified into three age groups and three dentition status categories. Total need for treatment was defined as the number of surfaces that initially had caries plus those developing caries over the three subsequent examinations. Analysis of variance was used to determine if there were significant associations between age or dentition status groups and the percent of total need that was treated by extraction, treated by restoration, or remained untreated. Significant associations were noted: (1) between age and the percent of carious surfaces extracted, (2) between dentition status and the percent of carious surfaces restored, and (3) between dentition status and the percent of surfaces extracted. These findings were interpreted to indicate that future cohorts of older patients with greater numbers of teeth are likely to seek operative treatment for diagnosed caries.

As the number of elderly Americans continues to grow in the United States, there is a subsequent shift in the need for dental services. This paper discusses the implications of demographic and disease pattern changes for the financing of dental services for the geriatric population.

This description of the supply of dental services in the United States addresses the number, kind, distribution, and training of dentists and dental auxiliaries, and the organizational factors that affect the production of dental services. Beginning with a brief historical review, the paper gives a general overview of the different types of dental personnel including the dentist, dental hygienist, dental assistant, and laboratory technician. The discussion of these categories of providers includes consideration of manpower planning as it has evolved over the past two decades, National manpower legislation is mentioned first as a reaction to the projected dentist shortage and then in response to the issues of geographic maldistribution and the effects of specialization. The second section of the paper discusses the dynamics of the dental care market. The distribution of the supply of services is identified and related to patterns of utilization and productivity. These factors are considered to be part of the set of dynamic relationships that help explain the current manpower problems of geographic and specialty maldistribution. A concluding section superficially discusses policy implications regarding the potential for increasing supply by: (1) increasing the number of dentists, (2) increasing the numbers and functions of auxiliaries, (3) increasing practice efficiency through group practice, and (4) reducing the restrictions that result from current state dental practice acts.

The declining incidence of caries in children and adolescents has caused speculation that there will soon be a great reduction in need for restorative services among adults. This study used recent dental epidemiological data, population estimates, and numerous alternative assumptions to calculate the hours of adult operative dentistry treatment need in the US in 1972, 1990, and 2030. According to those calculations, the total hours of need were about 125 million in 1972. In 1990 and 2030, the projected hours of need were determined to be about 150 million and 192 million, respectively.