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Background: While management service organizations are new to dentistry, they have existed in medicine for many years. The author examined why they developed and what happened to three of them during 1998 to provide dentistry with insights into the future of dental management service organizations, or DMSOs., Methods: The author identified and examined the three largest physician practice management firms, or PPMs, as of early 1998. He monitored their stock prices and fiscal changes through 1998. He also tracked all publicly traded DMSOs for growth and evaluated their stock price changes., Results and Conclusions: Economic pressures to control the cost of health care led to the development of organizational structures designed to increase the cost effectiveness of, and to control more variables associated with, health care delivery. The lure of vertical integration of health care delivery with the resultant control of multiple variables-including primary and specialty care, pharmaceuticals and hospitals-promoted the development of many PPMs and DMSOs, although many variables differ for dentistry., Practice Implications: The realities associated with the loss of control in the corporate model, the lack of sufficient operating margins to support investor expectations and plummeting stock prices call into question the wisdom of universally embracing similar models for dentistry.

The purpose of this study was to conduct a survey of Colorado pediatric and general dentists concerning attitudes toward and use of sealants. The survey results indicated that sealants were used in the following manner by pediatric vs. general dentists, respectively: 1) Routinely 73.4% vs. 40.1%; 2) Occasionally 15.6% vs. 32.6%; 3) Seldom 6.6% vs. 10.0%; 4) Do Not Use 4.4% vs. 17.3%. Reasons for limited or non-utilization of sealants by both groups included: 1) Not covered by insurance; 2) Inadvertent sealing in caries; 3) Do not last; 4) Not cost effective. Delegation of primary responsibility for sealant placement differed as follows between pediatric and general dentists, respectively: 1) Dentist 73.3% vs. 64.8%; 2) Hygienist 0% vs. 17.8%; 3) Assistant 26.7% vs. 17.4%. Continuing education courses on sealants had been attended by 62% of pediatric dentists and 16.9% of their auxiliaries and by 29.1% of general dentists and 6.3% of their auxiliaries. Approximately 50% of pediatric and general dentists expressed an interest in attending sealant courses. This study indicates that: 1) Colorado dentists report a relatively high sealant utilization rate. 2) Pediatric dentists place sealants more frequently than general dentists. 3) The most frequent reason for restricting sealant placement was lack of insurance coverage. 4) A need for continuing education of dentists and auxiliaries exists.

The purpose of this study was to conduct a survey of Colorado general dentists regarding the use of and attitudes toward pit and fissure sealants. The survey consisted of a questionnaire to determine the utilization levels of sealants by general dentists, reasons for limited placement or non-utilization of sealants, whether sealant placement was delegated to dental auxiliaries or not, and if continuing education courses on sealants had been attended by the dentists and/or their dental auxiliaries. A total of 544 completed questionnaires were available for study. The results indicated that sealants were used by 82.7% of the dentists. Approximately 70% of the practitioners reported that they utilized sealants either routinely or occasionally. Reasons for limited placement or non-utilization of sealants were, in descending order: 1) Not covered by insurance; 2) Inadvertent sealing in of caries; 3) Sealants do not last; 4) Sealants too expensive; 5) Not familiar with sealant technique; 6) Sealants not effective. Placement of sealants was delegated as follows: 1) Dentists, 64.8%; 2) Hygienists, 17.8%; 3) Assistants, 17.4%. Continuing education courses had been attended by 29.1% of the dentists surveyed. Only 6.6% of the dentists indicated that their staff had attended continuing education courses on sealant placement. A relatively high percentage of Colorado dentists are utilizing sealants on a frequent basis. Major reasons for limited usage or non-utilization of sealants relates to lack of insurance coverage and concern regarding sealing in of caries. A need for continuing education courses on sealants appears to exist.

For the past six years, 78 dental students have worked with 25 rural dentists to provide over 31,000 dental health services to migrant patients for all of Colorado's agricultural communities. In 1977, each of 19 dental students averaged over $538 per week in value of comprehensive dental services, including preventive and peridontal services (36 per cent, N=3,006); restorative services (46 per cent, N = 3,904); surgical services (8 per cent, N = 705); services in pulp therapy (5 per cent, N = 413); and an additional 5 per cent (N = 412) in miscellaneous services. A unique combination of federal resources from the Departments of Labor, and of Health, Education and Welfare, were combined through the Colorado State Health Department and the University of Colorado Medical Censtrated by: 1) a relatively low extraction to restoration ratio (1 to 5) when compared to reported studies (1 to 2); 2) a relatively low extract to root canal therapy (10 to 1) when compared to reported studies (400 to 1); 3) no statistical difference between students and rural practitioners in the quality of services as determined by peer review study. This dental program is an integrated component of a comprehensive program combining student and professional services in medicine, nursing, nutrition, and health education.

Since the migrant farmworker family is a marginal issue among competing priorities for public health services, the logical strategy ought to be the pooling of limited resources at the state and local level to provide maximum benefit for the dollar and the client. A program planning model in inter-agency migrant health services delivery has been developed in Colorado. The model includes tangible evidence of cooperation by front-line service agencies. A task force approach for joint agency programming was initiated at state and local levels, and a structure for accountability was established which was carried out with performance contracts.

A 1984 study of dental disease in 534 children (aged 6-15) of migrant farm workers in Colorado found that the prevalence of disease for this population continues to exceed the national and regional average. The mean DMFS was 3.56 with only 23 per cent caries free compared to a regional non-migrant DMFS mean of 2.50 with 44.7 per cent caries free. Results indicate that the children of migrant farm workers should remain a priority in preventive and restorative dental care programs.

While dental decay has decreased significantly during the last decade because of community fluoridation and other factors, children of low-income families have not benefited as greatly as others from this decrease and still remain at significant risk for dental disease. Published reports of dental disease among low-income families and data from the 1986 National Health Interview Survey indicate that children from low-income families have (1) higher dental disease rates, (2) higher percentages of unmet dental need, and (3) significantly lower utilization rates for dental care services, especially preventive activities. Even with the rapid growth of dental insurance, children of low-income families still experience barriers, having both a lower rate of dental insurance and lower use of dental services even with insurance. Notwithstanding these difficulties, there is much the medical care delivery system can do to decrease the effect of poverty on the dental health of children. Health care professionals can assist in identifying a source of dental care, encourage early dental visits for children, promote preventive dental procedures including routine visits and sealants, and increase parents' awareness of dental disease and the importance of dental health.

Population-to-practitioner ratios have long been the primary index in the designation of health manpower shortage areas. This paper documents that application of the widely used population-to-dentist index results in understatement of the need for dental health manpower in rural areas. Through the analysis of utilization data collected from a statewide health screening program in Colorado, the practice of sole reliance on the population-to-dentist indices as an indicator of need was tested. Another measure, the area-(square miles) to-dentist ratio was formulated, examined, and found to be a more useful referent of the need for additional health manpower in rural areas. Utilization of dental services in sparsely settled rural counties of Colorado was unrelated to population-to-dentist ratios. A strong, statistically significant association of utilization with land area-to-dentist ratios was found. The findings of this analysis suggest a need for reevaluation of needs assessment methodologies used in the designation of health manpower shortage areas. Indices more sensitive to consumer circumstance than to the number of health care providers available must be considered.