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For your enjoyment we have placed the slide program presented before the Pacific Coast Society of Prosthodontists(1998), the Academy of Prosthodontics(1999), and the American College of Prosthodontists(2000)on this site.
This is a 86 slide presentation which will require approximately 45 min. of viewing time.
Click on the - INTRODUCTION - link below and follow the arrow( > ) above the first picture for your own private show.
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Introduction
During the past several years there have been many manuscripts published documenting the results of a number of epidemiologic and demographic studies, most notably in the Journal of Prosthodontics, International Journal of Prosthodontics, and Journal of Prosthetic Dentistry. This data may provide insight into the future of prosthetic and restorative dentistry.
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Timeliness
In 1996 & 1999 the JADA dedicated issues to the demographics of dentistry.The entire Winter 1998 issue of the Journal of the American Collage of Dentists was devoted to the Demogaphics of Dentistry.
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Categorization
The information contained in these studies maybe categorized into three areas.Let's begin with the changing number of dentists.
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Historical Perspective
By reviewing data and surveys from approximately ten years ago an historical perspective may be developed.
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1989 Projections
In 1989 Waldman published demographic projections which have been recently updated and confirmed.
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Summary of Data
The information contained in these references may be summarized.
Between 1970 and 1978 there was a 95% increase in the entry places in U.S. dental schools.
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Summary of Data
By 1978 the U.S. experienced a record dentist to population ratio.
During this time private practitioners of dentistry began to experience a "Busyness Problem" which was perceived to be related to the overproduction of dentists.
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Summary of Data
Between 1978 and 1988 there was a 33% decrease in the entry places in U.S. dental schools.
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Summary of Data
By 1988 ( for the first time in history ) there was a decrease in the dentist to population ratio.
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Summary of Data
By 1989 the ratio of entry places to population was below that of 1950.
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Summary of Data
By 1996 the ratio of entry places to population was projected to be 50% of that of 1980.It is clear that organized dentistry did respond to what was perceived as an overproduction of dentists in 1980.
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Confirmation of Data
Last year Waldman updated and confirmed the data and projections originally published nearly 10 years ago.
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Waldman,B.,1998
Between 1980 and 1996 the number of dental school graduates decreased by 29%. During this period the number of graduates per million population decreased by 36%.
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U.C.S.F. Newsletter 1993
The number of dentists per 100,000 population which reached a peak of 56.6 in 1987 will continue to decrease to 43.5 by the year 2020 (matching the level of the 1910-1915 era) according to Waldman.
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Editorial,J.Am.Col.Dent.,1996
By 1997 there was an actual decrease in the number of dentists practicing in the U.S. due to the declining number of dental school graduates and the increasing number of dentists reaching retirement age.
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Dental Education
Dental education, unlike medical education, has undergone downsizing...resulting in a 37% decline in undergraduate enrollments.
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Categorization
The second category involves the level of prosthodontic training being provided through U.S. dental schools.
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Education Reference
About 20% fewer curriculum hours are presently spent in the area of removable prosthodontics compared with 30 years ago.
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Education Reference
At most dental schools there has been a general de-emphasis of removable prosthodontics over the years and a concomitant loss of time in the curriculum.
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Education Reference
Dr. Laney's conclusion of 1996. -A 1992 FPO newsletter stated that 91% of the directors of Grad.Pros., AEGD, and GPR programs feel there are deficiencies in undergraduate prosthodontic education.-
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Education Reference
78% of dental schools reported a decline in didactic time dedicated to fixed prosthodontic lecture as compared to earlier surveys reported by the ADA (1996) and Preston (1989).
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Education Reference
Complete denture prosthodontics offers the best and often the only context to reach dental students about such basic concepts as evaluation of vertical dimension, placement of teeth in space, centric relation, cusp height and angulation, occlusal plane, condular guidance and incisal guidance.
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Educational Reference
The clinical skills required to deliver exellent complete denture care are also paramount to successful implant prosthodontics and esthetic dentistry. Even so, the opportunities to develop these skills appear to be decreasing at the same time that the need is projected to increase.
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Laboratory Survey
Only 8% of the work authorizations requesting a fully balanced complete denture set-up were accompanied by a facebow orientation or came articulated on an instrument. This indicates a significant lack of understanding of the basic concepts which influence occlusion and articulation by over 9 out of 10 dentists involved in this survey.
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Atkinson,R. & Elliot,R. Survey
More than 50% of the dental school graduates could not design a removable denture framework that could be successfully made by a dental technician and worn by a patient.
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ACP Committee Report
Prosthodontic curriculum time has already undergone reduction over time...In the case of a realistic document, the skill level of dental graduates for complete dentures should be downgraded from competency to exposure.
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Implant Education
Only 17% of schools require some form of undergraduate clinical implant dentistry exposure.
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Education Reference
Dental schools apparently have attempted to meet the demand for less instruction in the details of removable prosthodontic laboratory procedures by teaching students about laboratory procedures by more observation and less direct involvement.
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1999 Survey
In January, 1999 I conducted a survey of the 55 U.S.dental schools to determine the clinical requirements for graduation in the disciplines of prosthetic and restorative dentistry. I recieved 39 responces (71% compliance). Four of the 39 schools reported no numerical requirements citing comprehensive care programs and competency based evaluations. These four schools were deleted from the data.
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1999 Survey
Clinical requirements for receipt of a D.D.S. or D.M.D. degree were reported for each of these procedures in terms of the numbers of prostheses completed per student.
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add slide 2.jpg
The average number of complete dentures required by dental school graduates in 1998 was 6.1.
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1999 Survey
The average number of removable partial dentures incorporating a metal framework required by dental school graduates in 1998 was 3.7.
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1999 Survey
The average number of metal ceramic or all metal fixed bridges required by dental school graduates in 1998 was 2.2.
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1999 Survey
None of the 39 dental schools in the survey required completion of an implant assisted prostheses in 1998 for graduation.
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1999 Survey
Two schools indicated that some of their students graduated in 1998 without having completed a single complete denture (class size indicated in the right column).
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1999 Survey
Three schools indicated that some of their students graduated in 1998 without having completed a single metal based removable partial denture (class size indicated in the right column).
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1999 Survey
Four schools indicated that some of their students graduated in 1998 without having completed a single all metal or metal ceramic fixed bridge (class size indicated in the right column).
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Postdoctoral Education
Apparently interest in postdoctoral education in prosthetic and restorative dentisty is also limited.
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Categorization
The third category involves the projected need for prosthodontic services during the next 10 to 30 years.
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Demographics of Edentulism
The number of edentulous patients in the U.S. is projected to remain unchanged for the foreseeable future.
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U.C.S.F. Newsletter 1993
In 1993 40% of those over age 65 were edentulous. This bar graph indicates that percent edentulism is correlated to socioeconomic level.
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1997 Editorial
...there will be an estimated reduction of the rate of edentulism in the elderly from about 35% now to 15% in 2020...in the U.S. the number of edentulous people will be the same in 2020 as it is now. A SMALLER PERCENTAGE OF A LARGER NUMBER IS THE SAME NUMBER.
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Demographics of Edentulism
In spite of an expected decline in the percentage of edentulous Americans during the next decade, increased longevity and the maturing of the large "baby-boom" generation will yield more edentulous patients.
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Population Demographics
It is estimated that each day approximately 4000 persons in the U.S. turn 65 years of age, approximately 3000 persons over 65 years of age die daily, and therefore approximately 1000 persons enter the geriatric population daily
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Population Demographics
The population over 65 years old will grow from 27 million to 64 million in the U.S. alone by the year 2020.
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Implications for Prosthodontics
It is likely that to the extent that the mix of specialties reflects the needs of specific age groups, shifts towards the growing segments of the population may be necessary.
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Implications for Prosthodontics
Demographics seem to be considered mainly with respect to marketing or business plans, in predictions about future demand for services by specific population groups.
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Text by Dent,H.,1993
Think about the effects of the "baby-boom" generation. This largest generation of births in our history is far from its peak in earning and spending. As it approaches this peak, it will have a dramatic impact on the economy creating the greatest boom in our history.
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Sacramento Bee Newspaper, 1998
A recent newspaper article describes the challenges facing the medical profession in teaching physicians to manage the health care needs unique to the aging population.
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Facing the Challenges
Preventive dentistry has been extremely effective at reducing the rate of tooth loss resulting from caries and periodontal disease. However, factoring in the demographics of our aging population, it is clear that the future need for prosthodontic services will remain substantial and perhaps increase.
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Prosthodontic Need
The classic 1988 study by Douglas,C., Gamman,M., ,and Atwood,D., published in the J.P.D. projected an increased need and effective demand for prosthodontic services between 1974 and the year 2000. This graph demonstrates this trend.
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Prosthodontic Need
The Pew Commission projects an increase in the need and demand for dental services for the elderly for the next two decades.
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Prosthodontic Need
Treatment of edentulous patients will continue to be a challenge for the dental profession; therefore, dental schools must provide adequate dental education and training in complete denture prosthodontics for the foreseable future.
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Prosthodontic Need
...one can extrapolate from current life expectancy messures that every general dentist in North America could have responsibility well into the next century for about 200 elderly patients, each with one or two edentulous jaws.
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ADA Services Rendered Survey
The number of RPD's and complete dentures placed was higher in 1990 than in 1980 for all age groups above 40 and 50 respectively. 42 million Americans wore RPD's in 1996.
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Demographics of RPD's
This 10 year research project showed that the number of removable partial dentures was increasing.
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Demographics of RPD's
...about one in five persons 18 to 74 years of age wears a removable prosthodontic appliance of some type.
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Demographics of RPD's
Most older adults today have retained some or most of their natural dentition. In fact, 46.3% of adults 70 years of age or older have an average of 20.5 teeth.
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Demographics of RPD's
...the number of hours dedicated to teaching removable prosthodontics in dental schools has been reduced...this finding may seem surprising in that the population of the U.S. is aging and thereby producing more people who require RPD's.
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Increasing Complexity
Treatment planning options are exponentially more complex than they were even a decade ago (Preston,J.,Editorial,Int.J.Prosth.,1994).
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Re-Restoration
Recent scientific manuscripts by Meskin,L.(JADA,1990), McComb,D.(JPD,1994), and Lloyd,D.(JPD,1994) have discussed the significant challenges of re-restoration. Today re-treatment accounts for more treatment and expenditure than the original treatment itself.
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Re-Restoration
A recent issue of the Journal of the California Dental Association was dedicated entirely to the current challanges of re-treatment.
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Increasing Complexity
Hoad-Reddick,G. reviewed the complex treatment demands of the older patient in an article published in the JPD in 1995.
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Increasing Complexity
In 1998 in the J.Am. College of Dent, Sinkford,J. discussed issues and trends related to dental education and the demands of the aging patient population.
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Challenges - Edentulism
Clinicians today faced with treating patients demonstrating severely compromised residual ridge height and conformation must be even more knowledgeable with regard to the biomechanics, anatomy, and physiology of the denture bearing area. The risks and benefits of ridge augmentation and ridge extension procedures must be understood as well as options involving dental implants.
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Challenges - Partial Edentulism
Today partially edentulous patients often present for restorative treatment following definitive periodontal therapy. These patients may demonstrate increased clinical crown height, exposed root surfaces, compromised gingival embrasure form, furcation involvements, hemisections, root resections, and hypermobility. Some patients require solutions to problems resulting from erosion, attrition, abrasion, and abfractions often associated with reduced interridge distance and compromised vertical dimension.
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Challenges - Partial Edentulism
Patients such as this require decisions that provide a rational for such features as splinting, non-rigid connectors, telescopic copings, and/or osseointegrated implant abutments. Dentists must have a scientific basis for the selection of materials and instrumentation. Even the incorporation of contingency planning is important in these complex restorative treatment plans.
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Implant Prosthodontics
Today it is necessary to present the risks and benefits associated with dental implants to partially and completely edentulous patients who are potential recipients of such treatment.
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Conventional Prosthodontics
However, implant dentistry may not be recommended for a significent number of adults because of medical, psychological and/or financial constraints...conventional therapy will remain an important and essential tool for the foreseeable future.
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Practicing Prosthodontists
Recently the ratio of professionally active prosthodontists to 100,000 persons has decreased from 1.8 to 1.6.
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Prosthodontic Residency Enrollment
The 1997-98 ADA Survey of Advanced Dental Education demonstrates a decline in applications and enrollments in prosthodontic residences.
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Summary
This presentation has reviewed the information and bibliography related to the demographics of prosthodontics. Although there is cause for concern regarding the de-emphasis of prosthodontic education in our dental schools, the future is exiting and challenging for those of us dedicated to the field.
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Closing Quotation
The professional of 2010 will be challenged to apply knowledge-based decision making...THE PROSPECT OF THE 21st CENTURY CAN BE A TIME TO CELEBRATE THE POSSIBILITIES.
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