Year 8 Projects
Identifying Strategies to Improve Oral Health Workforce Resilience
This study examined the issues of stress and burnout among oral health providers during the COVID-19 pandemic. In collaboration with CareQuest (formerly DentaQuest), OHWRC researchers conducted surveys and/or interviews with key informants from major oral health provider organizations (ie, American Dental Association [ADA], American Dental Hygienists Association [ADHA], American Dental Assistants Association [ADAA], National Network of Oral Health Access [NNOHA], Association of Dental Support Organization [ADSO], among others) to learn more about the levels of and contributing factors to clinician burnout as well as the strategies used to promote resilience.This research resulted in a Report.
Impacts of State Policies on Provision of Teledentistry Services by Safety Net Providers
Prior to the COVID-19 pandemic, the use of teledentistry was limited; The utility of teledentistry was widely questioned in light of the predominately procedural nature of dentistry. Due to the closures of dental practices and organizations during the early months of the COVID-19 pandemic, teledentistry quickly became a useful tool for dental providers to connect with patients. OHWRC researchers 1) reviewed the enabling statutes and regulations for the provision of teledentisty services in each of the 51 regulatory jurisdictions in the US, and 2) explored themes that emerged from dental provider interviews on the use of teledentisty prior to, during, and subsequent to the COVID-19 pandemic. This research resulted in an Interactive Infographic and a Report.
Implications of COVID-19 on Safety Net Oral Health Services
The COVID-19 pandemic has significantly affected the oral health care system, particularly the workforce and care delivery at community health centers and other dental safety net providers. An ongoing poll of US dentists launched by the Health Policy Institute at the ADA shows that a majority of dental practices re-opened by July 2020, after closure in March, with 90% at pre-pandemic staffing levels and 70% at pre-pandemic patient volume levels. However, the trends on practice opening status, PPE supplies, patient volume, staffing, and other pandemic related impacts varied substantially between private practices and safety net providers.
Researchers at the OHWRC examined COVID-19 pandemic impacts on Federally Qualified Health Centers (FQHCs) and other safety-net dental providers. Researchers evaluated: 1) changes in the ability of safety net providers to offer dental services; 2) the recruitment and retention of staff (ie, dentists, dental hygienists, dental assistants, and dental therapists); 3) the number of dental facilities and sites operated by FQHCs; and 4) changes in the cost of providing care due to the precautions necessitated by the pandemic. The study describes unique challenges posed by the COVID-19 pandemic on the ability of safety net providers to deliver care to underserved communities as well as the potential future implications related to oral health workforce shortages and provision of care for patients. This study also examines pandemic impacts on safety net providers that offer oral health services through mobile and portable programs. This research resulted in a Report.
Year 7 Projects
COVID-19 Impact on Dental Service Delivery, Financing, Regulation and Education Systems: An Environmental Scan
The coronavirus pandemic has had a profound impact on all aspects of the dental care system. Oral health services were ‘paused’ in the early stages of the pandemic and the education and training of oral health students was postponed, jeopardizing progress in the educational pipeline. Patients, dental providers, regulators, educators, and students are all being asked to rapidly change how they work with almost no roadmap. Organizations, associations, and government agencies are all working on components of the problem in their respective areas of expertise yet often with little awareness of concurrent changes in interrelated systems. OHWRC will conduct a multi-part project that summarizes immediate and longer-term impacts of the COVID-19 pandemic on the following 4 domains: Care Delivery, Education, Financing, and Regulation. This research resulted in a COVID-19 webpage on the OHWRC website providing the most up-to-date information about COVID-19 impacts on oral health and a Report.
Teledentistry in a Post-COVID-19 World: Assessing Adoption, Integration, and Policy
Telehealth has been slower in uptake in the dental care sector than in medical or behavioral care and has been primarily used for screening and to extend care to areas where no in-person dental services are available. The COVID-19 pandemic has most dental services currently shuttered, and the high risk of dentistry as an aerosol-generating service presents huge barriers to reopening, as business cannot be “as usual.” Teledentistry has become a critical bridge for connecting patients and providers as services are brought back online. Assessing the rapidly evolving use of teledentistry and supports needed at the state and national policy level will be critical to enhancing use of these services to improve the safety and access to needed dental care in the post-COVID-19 world. This study reviewed policy changes and practices using interviews and policy reviews in 4 states. This research resulted in a Report.
A Survey of Oral Health Status and Access to Care for the General Population Related to COVID-19 Pandemic
The COVID-19 pandemic has significantly affected the US economy and health care system, including dental practices. The pandemic had an impact on both the dental workforce and patients, dramatically affecting the ability of dental professionals to deliver oral health care. Potential positive impacts could emerge as a result of the pandemic, as dental practices use less invasive procedures in treatment to avoid possible aerosol transmission of COVID-19 and place more emphasis on promoting the importance of oral disease prevention.
To identify and describe the factors that influenced access to oral health services for different population groups during the COVID-19 pandemic, researchers at the OHWRC designed a series of questions about people’s need for and utilization of oral health services in 2020 for inclusion in the biannual Consumer Survey of Health Care Access. This survey is conducted by the Health Workforce Research Center at the Association of American Medical Colleges (AAMC). This project built upon previous research conducted by the OHWRC that used this consumer survey to ask adults about the facilitators and barriers to their access to oral health services in 2018. This research resulted in a Manuscript which is pending publication.
Year 6 Projects
National Practice Patterns and Trends in Post-Graduate Trained Dentists
A 2017 review of graduate dental education described modern training programs but little is known about the composition and distribution of these trainees once in practice. This study expanded upon the prior study Practice Patterns of Post-Graduate Dental Residency Completers from Select HRSA-Funded Primary Dental Care Training Programs and examined the practice patterns of all post-graduate dental trainees utilizing the American Dental Association (ADA) Masterfile and associated databases. The project both provides the most updated information on this highly trained sector of the dental workforce, and assesses what data are required for a comprehensive policy-relevant monitoring the pipeline of providers beyond advanced training. This research resulted in 2 journal articles in a special edition of the Journal of Dental Education:
A Study of the Productivity and Effectiveness of Dental Therapists in a Large Dental Organization
This study built upon previous work by researchers at the OHWRC that describes the dental therapist (DT) workforce at Apple Tree Dental in Minnesota and evaluates the contributions of DTs to expanded access for underserved populations. This mixed methods study used interviews and surveys to describe integration of DTs into oral health care teams and patient experiences and satisfaction with the new model of care delivery. This research resulted in a Report.
The Changing Role of Post-Baccalaureate Programs in the Pipeline to Dental Education
A major focus of many post-baccalaureate (post-bac) programs is assisting underrepresented minority, economically or educationally disadvantaged students who have graduated from college and demonstrated potential to become competitive health professional education applicants. These programs have evolved and today many applicants participate in pre-health preparation programs, shifting the educational landscape, and adding additional educational debt to the pipeline. The OHWRC examined changing trends in post-bac programs with dental schools, and the role of these programs in a broader policy context. Detailed information on the current set of programs was collected, and key informant interviews were conducted with both dental school admissions staff and post-bac program administrators. This research resulted in a Report.
Evaluating the Impact of Personal Characteristics of Dentists on Workforce Participation
This study expanded upon previous work by the OHWRC discussing gender diversification in dentistry. The study used data from both the individual and household portions of the 2014-2018 American Community Survey (ACS) to assess variation in workforce participation patterns among dentists related to various personal variables that are not available elsewhere. This project will evaluated differences in employment/ownership status and hours worked across gender and age cohorts among dentists in the US, as well as the impact of commuting and location of work, disability status, income, marital status, spouse occupation and income, having children, age(s) of children, and other family characteristics. This research resulted in a Report.
Year 5 Projects
A Comparative Study of Dental Providers’ Prescriptive Patterns of Opioids Analgesics
With more than 100 opioid-related overdose deaths occurring daily and over 11 million people misusing prescription opioids, the opioid epidemic is estimated to cost the US $506 billion annually. Dentists’ are responsible for 12% of all immediate-release opioid prescriptions, making them one of the top 5 prescribers of opioids analgesics among healthcare professionals in the US and significant contributors to the prevailing opioid epidemic.
This research project conducted a comparative analysis of Oregon State and New York State Medicaid Claims data to examine opioid prescribing patterns of dental providers related to dental pain management. The ultimate goal of the project was to determine general capacity of dental professionals to implement protocols which aim to prevent opioid misuse. This research resulted in a Report and a Journal Article.
A Study of the Alignment of Rural Workforce Policy with Access to Oral Health Services in Rural Communities
Populations residing in rural America have lower rates of dental care utilization, higher rates of dental caries, less water fluoridation, and fewer dentists per capita when compared to those living in urban environments. Dental workforce shortages in rural communities are endemic, despite the research on best practices for enhancing the rural workforce.
This research project examined the alignment of policy and infrastructure with evidence-based workforce strategies to increase access to oral health services for rural populations. Research focused on best practices as well as the barriers and facilitators to effective implementation of workforce strategies to increase the availability of oral health services. This research resulted in a Report.
Curricular Content Used by Dental Schools to Teach Recognition and Management of Substance Use Disorders
During the height of the opioid epidemic, dentists and oral surgeons remain among the top prescribers of opioids for young people between the ages of 10-19, an age group inclined to abuse drugs and develop addictions. Consequently, it is important to understand how dental schools prepare these students for pain management, particularly as it relates to the potential for substance abuse. This research project was a collaboration with the American Dental Education Association (ADEA) to survey dental education programs in the US on curricular and clinical protocol content related to substance use disorders, including screening, intervention, and referral, in order to better understand the extent to which new oral health providers are prepared to address substance use among patient populations.
Contributions of General and Specialty Dentists to Provision of Oral Health Services for People With Special Needs
Families with special needs have identified oral health as the most common unmet health care need. While pediatric dentists are trained to provide special services to people with special needs, the supply of pediatric dental specialists is limited and the metropolitan locations of many of these specialty dental practices may limit access to their services. This research project was a collaboration with the Health Policy Institute at the American Dental Association (ADA) to examine the contributions of general and specialty dentists, especially pediatric dentists, to oral health care for people with special needs. Researchers focused on variations in the provision of oral health services by specialty, training experiences, and geography. This research resulted in a Report.
Consumer Survey Focused on Parents’ Experiences Accessing Oral Health Care Services for Their Children
Despite efforts to improve access to oral health services in the US, oral health disparities persist for many vulnerable population groups, including children. Children are especially vulnerable to not receiving health or oral health services because they are dependent on others to arrange appointments and provide transportation to services. Researchers at the OHWRC will collaborate with the Health Workforce Research Center at the Association of American Medical Colleges (AAMC) to survey parents about the factors that affect access to oral health services for their children. This research highlights unique access barriers for specific high-need children (racial/ethnic minorities, low-income parents, uninsured families, Medicaid beneficiaries, rural individuals) or geographic regions. This research resulted in a Report.
Compendium of Innovations in Oral Health Service Delivery
Oral health providers are using a variety of innovative strategies to expand access to oral health services in community-based settings, including federally qualified health centers, schools and nursing homes, among others. This compilation summarizes best practices in innovative oral health service delivery programs drawn from over 40 case studies conducted by the Oral Health Workforce Research Center (OHWRC). Each summary is presented in a standard 2-page format highlighting key program elements, with special attention to the organizations’ workforce strategies that have successfully expanded access to care for underserved populations. This research resulted in the Compendium.
Year 4 Projects
Impacts of Dental Post-Graduate Residency Training on Choice of Practice Setting
Post-graduate dental training programs result in quantifiable numbers of graduates and services to rural, underserved and vulnerable patients during training, and measurable programmatic capacity of the training to address community needs, but little is known about the longer term impact of the federal investment in these programs. Researchers at the OHWRC surveyed over 500 graduates of one such program to establish the impact of this investment. This research resulted in a Report, Policy Brief, and Abstract.
A National Study of the Practice Characteristics of Women in Dentistry and Potential Impacts on Access to Care for Underserved Communities
Demographic changes within the dental profession including aging and gender distribution are affecting dental practice characteristics and practice locations. For this study, OHWRC collaborated with the American Dental Association (ADA) to conduct secondary data analyses to assess the impact of demographic changes in dentistry on access to oral health services, particularly in rural areas and for underserved populations. This research resulted in a Report, Policy Brief, and Abstract.
Conducting a Consumer Survey Focused on Barriers and Facilitators of Access to Oral Health Services
Despite efforts over the past decade to improve access to oral health services in the US, oral health disparities persist for many high need populations. To better understand the factors that contribute to these disparities from the patient perspective, OHWRC partnered with the Workforce Studies unit at the Association of American Medical Colleges (AAMC) to include a series of questions on oral health care access in AAMC’s biannual Consumer Survey of Health Care Access. This research resulted in a Report, Policy Brief, and Abstract.
Conducting a Series of Case Studies to Identify Strategies Used by Federally Qualified Health Centers to Integrate Oral Health and Substance Abuse/Behavioral Health Services
There is growing recognition of the relationship between mental illness and behavioral health disorders with oral and physical health status. Safety net provider organizations are key to providing integrated care for many of their patients with mental health or substance use disorders. OHWRC conducted 6 case studies of Federally Qualified Health Centers or other safety net providers that have successfully integrated oral health and substance abuse/behavioral health services. This research resulted in a Report, Policy Brief, and Abstract.
Year 3 Projects
Trends in the Provision of Oral Health Services by FQHCs
Federally qualified health centers (FQHCs) are increasingly providing oral health services directly to patients in fixed clinics and mobile and portable oral health programs. However, some continue to offer only referrals or vouchers for services from community dentists. This study examined factors that might impact the decision of an FQHC to provide oral health services directly, including state Medicaid and reimbursement policies for oral health. The study used a variety of data sources including HRSA’s Uniform Data System and primary data. This research resulted in a Report, Policy Brief, and Abstract.
Exploring the Impact of a Teledentistry Program on Access to Services and Oral Health Outcomes in the Patient Population
In Year 2, the OHWRC conducted a series of case studies on the use of teledentistry applications in the delivery of oral health services. One of the FQHCs included in the research study, was an early innovator in teledentistry and has indicated a willingness to provide patient utilization data to better understand the impacts of the teledentistry program on access to care and oral health outcomes. The analysis of these data by OHWRC researchers will highlight the value of teledentistry applications, particularly for safety net providers and underserved populations. This research resulted in an article that was submitted to a peer-reviewed publication.
Assessing the Impact of DH Scope of Practice on Oral Health Outcomes
In Year 2, the OWHRC completed a study to update the state-specific Dental Hygiene Professional Practice Index (DHPPI) scores to reflect current dental hygiene scope of practice in 2016. The variables in the 2016 DHPPI were factor analyzed to determine validity. This project will use the 2016 data in multi-level regression analysis to examine the impact of state level scope of practice on oral health outcomes for low-income children. This research resulted in an Article published in Health Affairs.
The Evolving Pipeline of Hispanic Dentists in the US
The Hispanic/Latino (H/L) dentist population is disproportionately small compared to the rapidly growing and historically underserved H/L population in the US, and current enrollment will not meet the demand. Half of the H/L dentists in the US are foreign-born, and about 1 in 5 were trained outside the US. Changing licensure laws have limited the pathways for non US-trained providers. Using a nationally representative sample survey of H/L dentists and a policy review, this study elucidates trends and challenges in H/L dentists’ pathways to practice, examines the changing patterns of care delivery, and identifies access and care delivery goals for the H/L population. This research resulted in a Report, Policy Brief, and Abstract.
An Assessment of Mobile and Portable Dentistry Programs to Improve Population Oral Health: Practice and Policy Implications
Mobile and portable oral health service programs continue to gain the attention of policymakers and providers for their ability to bring oral health services into local communities and to reach patients with limited access to oral health services. This study consists of 7 case studies that describe the workforce in mobile dentistry programs, the structure and funding of programs, and the regulation of mobile and portable dentistry by states. This research resulted in a Report, Policy Brief, and Abstract.
Trends in the Development of the Dental Service Organization Model: Implications for the Oral Health Workforce and Access to Services
The fastest growing segment of the dental delivery system is Dental Service Organizations (DSOs). While DSOs take various forms, as large employers of dental providers, they are changing the landscape of oral health care delivery. OHWRC conducted a survey of a convenience sample of DSOs and compiled case studies of 6 dental support organizations delivering general or specialty dental services to patients. This mixed-methods study examined the variety of DSO models, who they serve, their workforce needs and practices, career pathways provided, and evolving models of workforce deployment. This research resulted in a Report, Policy Brief, and Abstract.
Developing a Graphic Visualization to Help Policy Makers Understand the Wide Variation in State-level Dental Hygiene Scope of Practice
There is substantial variation in dental hygiene (DH) scope of practice across states, but no user-friendly tools to help policymakers understand these differences. OHWRC produced an infographic on state-specific DH scope of practice. Researchers worked with key stakeholders in dental hygiene (representing education, practice, and research) to identify the variables to include in the graphic to accurately depict key DH responsibilities associated with scope of practice and to display state-to-state variation. This research resulted in an Infographic.
Further Study of State-Level Policies that Affect Access to Dental Services in LTC Settings
A Year 1 OHWRC project included a 4-state case study of delivery models for dental care services in long-term care (LTC) settings. Since then, a more comprehensive literature review was completed and additional information was compiled on key state-level policy factors that drive the organizational models cited in the study. OHWRC researchers conducted an in-depth analysis of policy factors that serve as barriers to and facilitators of access to dental services in long term care settings. Findings highlighted state level policy factors that influence access to needed services. This research resulted in an Article and a Report.
Generating State and Sub-State Maps of Oral Health Training Sites, Substance Abuse Treatment Centers, and FQHCs and Look-alike Clinics that Provide Comprehensive Oral Health Services
Researchers at the OHWRC used data and information provided by HRSA and the Substance Abuse and Mental Health Services Administration (SAMHSA) to produce a series of maps depicting the following: (1) oral health training and rotation sites, (2) substance abuse treatment centers, and (3) FQHCs and FQHC look-alike clinics (FQHC-LA) that provide comprehensive dental services. These maps integrated information on oral health and substance abuse treatment centers which could potentially encourage possible synergies and resource sharing.
Year 2 Projects
Determinants of Oral Health Assessment and Screening in Physician Assistant Clinical Practice
In 2013, a survey of directors of physician assistant education programs conducted by the Center for Health Workforce Studies (CHWS) found that more than 70% of respondent programs had integrated oral health topics into core content of their physician assistant (PA) curriculum. A 2014 HRSA-sponsored report described core oral health clinical competencies for frontline primary care clinicians, including PAs, and outlined strategies for implementing oral health training in primary care practice and safety net settings. However, whether training in oral health in PA education programs translates to actual screening and assessment of patients’ oral health status in clinical practice remains unclear. OHWRC in cooperation with the American Association of Physician Assistants (AAPA) fielded a survey to a sample of PAs across the US in 2016 to ascertain PA practice characteristics, to describe oral health screening activities for patients, to understand the extent and source of PA education in oral health, and to determine facilitators and barriers to the integration of oral health service in practice. This research resulted in a Report, Policy Brief, and Abstract.
Understanding the Impact of Dental Residents and Student Externs on Oral Health Service Delivery Capacity in the Safety Net
Demand for dental residency and dental student externship opportunities has grown in recent years, driven by the economy for dental employment and the desire of students for increased market competitiveness. In addition to specialty residencies, some states now also require that general dentists complete a year of advanced education in general dentistry before licensure. The Teaching Health Center program, a feature of the ACA, has contributed to increased capacity in dental residency programs, has impacted new dentist preparedness for practice, has increased opportunities for recruitment and retention of dentists in community clinics, and has increased access to oral health services for safety net populations. OHWRC examined trends in demand for advanced training by students and how this aligns with current policy supporting this training and practice. Researchers also explored the impact of residencies in ambulatory care settings, particularly for FQHCs, on service capacity and access for patients. This research resulted in a Report, Policy Brief, and Abstract.
Case Studies of 6 Innovative Oral Health Service Delivery Programs Using Teledentistry
Teledentistry is an emerging strategy with the potential to improve oral health outcomes for underserved populations, particularly those living in rural communities. OHWRC conducted 6 case studies of innovative oral health programs in different states that employed teledentistry. The case studies entailed site visits and in-depth interviews with both administrative, HIT, and clinical staff at selected sites where teledentistry services are provided. In addition, OHWRC reviewed current state statutes and regulations in dentistry with a specific focus on regulation of teledentistry and state-level reimbursement policies for oral health providers accepting Medicaid and/or commercial insurance for services provided using teledentistry. The findings provide a better understanding of teledentistry program applications, workforce strategies, impacts on access to care, the organizational structure in which services are provided, and the barriers and facilitators of teledentistry services. This research resulted in a Report, Policy Brief, and Abstract.
Development of a New Scope of Practice Index for Dental Hygienists
As part of its Year 1 research projects, staff at OHWRC conducted an extensive review of state legislation and regulation governing registered dental hygienists in order to describe the current regulatory environment and quantify it using the 2001 dental hygiene professional practice index (DHPPI). However, much has changed for the dental hygiene profession in the decade since the DHPPI was constructed and the utility of the 2001 DHPPI for analysis had diminished. In 2016, OHWRC updated and modified the DHPPI scale by adding new variables to better quantify current practice for dental hygienists and allow comparisons of change over time for dental hygiene practice in each state. This research resulted in a Report, Policy Brief, and Abstract.
Underrepresented Minority Dentists’ Contribution to Health Equity in the US
Black, Hispanic, and American Indian/Alaska Native dentists are substantially underrepresented relative to their proportion in the general population. HRSA has a strong commitment to improve health workforce diversity. OHWRC examined nationally representative sample survey data of underrepresented minority (URM) dentists in the US to determine the supply, distribution, and practice patterns of URM dentists, current contributions to dental care for minority populations, and future supply and impact on the access to care for minority populations based on cohort practice patterns and projected inflows through US schools as well as immigration flows over time. This research resulted in an Article published in Health Affairs, a Policy Brief, and Abstract.
Year 1 Projects
A Comparison of Medicaid Dental Claims Data in 2 States With Different Adult Dental Benefits, 2012-2013
OHWRC conducted a comparative analysis of Medicaid dental claims over a 2-year period in New York and Oklahoma. Oklahoma Medicaid provides only a limited dental benefit for adult enrollees 21 years of age and older, including emergency exams and extractions of diseased teeth. In contrast, adult Medicaid beneficiaries in New York State have a comprehensive dental benefit that includes preventive services, restorative services, periodontal services, dentures, and oral surgery services. The objective of this research was to understand the impact of Medicaid dental benefits and availability of providers on utilization of dental services. This research resulted in:
- A Comparison Report, Policy Brief, and Abstract;
- A Oklahoma-specific Report, Policy Brief, and Abstract; and
- A New York-specific Report, Policy Brief, and Abstract
Updating the Professional Practice Index for Dental Hygienists in the 50 US States and the District of Columbia
OHWRC updated the scope of practice index for registered dental hygienists (RDHs) that was originally created in 2001. Researchers provided an objective quantification of current practices for RDHs and a comparison of changes over time for dental hygiene practice in each state of the US. This research resulted in a Report, Policy Brief, Abstract, and an Article published in Health Affairs.
Case Studies of Oral Health Service Delivery Models Used in Long-Term Care Settings
OHWRC examined the current and changing practice models utilized in providing dental services in long-term care, residential care, and for homebound individuals through 4 state case studies. A secondary objective was to determine policy variables that may impact the availability of these services within a state or community and describe these impacts. This research resulted in a Report, Policy Brief, and Abstract.
A Study of the Dental Assistant Workforce in the United States
OHWRC conducted a comprehensive examination of the dental assisting profession to understand the contributions of dental assistants to oral health services. Researchers examined demographic and educational characteristics of dental assistants and identified gaps in data about this workforce that should be addressed. This research resulted in a Report, Policy Brief, Research Brief, and Abstract.
Case Studies of 8 Federally Qualified Health Centers to Describe Oral Health Services Delivery and Oral Health Workforce Innovation
OHWRC developed 8 case studies of federally qualified health centers (FQHCs) that use various oral health and/or medical workforce in their care delivery models to provide oral health services to high-need populations. One goal of the study was to better understand the use of new or alternative workforce models in oral health services delivery and to understand their contributions to patient care. This research resulted in a Report, Policy Brief, and Abstract.