Consumer Survey: Barriers to Accessing Oral Health Services in New York State (Report)
This report highlights major access barriers to oral health services for adults in New York. By examining the unique challenges New Yorkers face in obtaining necessary oral health services, the report provides evidence-based insights for policymakers and stakeholders to develop strategies that reduce oral health disparities and improve access to care, particularly for historically underserved populations.
Oral Health Needs Assessment for New York State, 2024 (Report)
The 2024 oral health needs assessment aims to improve access to oral health (OH) services in New York State (NYS) by identifying areas with the highest OH needs and addressing access barriers, particularly for underserved and vulnerable populations.
Identifying Strategies to Improve Oral Health Workforce Resilience (Report)
This report describes the levels of burnout experienced by oral health providers in the safety-net during the COVID-19 pandemic including contributing factors and strategies used to increase workforce resilience.
Teledentistry Adoption and Use During the COVID-19 Pandemic (Report)
This report describes the impact of the COVID-19 pandemic on the delivery of oral health services in the dental safety-net using teledentistry to consult with patients.
This report describes the immediate and longer-term impacts of the COVID-19 pandemic on 4 domains of the oral health care system: care delivery, regulation, education, and finance.
Implications of COVID-19 on Safety-net Oral Health Services (Report)
This report examines COVID-19 pandemic impacts on Federally Qualified Health Centers (FQHCs) and other safety-net dental providers. Researchers describe the unique challenges posed by the COVID-19 pandemic on the ability of safety-net providers to deliver care to underserved communities as well as potential future implications related to oral health workforce shortages and provision of care for patients. The report also examines pandemic impacts on safety-net providers that offer oral health services through mobile and portable programs.
Teledentistry Trends in the United States During the COVID-19 Pandemic (Report)
This report reviews the use of teledentistry following the COVID-19 pandemic in 4 states—California, Maine, Pennsylvania, and Wisconsin—and the supports needed to enhance dental care in a post-COVID-19 world. States were selected for case studies based on the following parameters: existence of teledentistry regulation, Medicaid reimbursement of telehealth (including teledentistry), payment parity, state Medicaid expansion, Medicaid dental benefits for adults, and direct access for dental hygienists and/or dental assistants.
Provider and Patient Satisfaction With the Dental Therapy Workforce at Apple Tree Dental (Report)
This study describes the satisfaction of clinical providers, organizational administrators, and patients with the dental therapy workforce at Apple Tree Dental in Minnesota, the first US state to authorize dental therapy practice statewide.
This report describes the results from 2 surveys. The first assessed clinician and administration satisfaction with the dental therapy workforce at Apple Tree Dental’s centers and programs. The second describes the satisfaction of patients with their clinical providers at Apple Tree Dental, making comparisons across provider type.
The Changing Role of Post-baccalaureate Programs in Dental Education (Report)
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 aim of this study was to examine changing trends in post-baccalaureate programs available to pre-dental students and to assess the role these programs play in improving oral health workforce diversity.
Evaluating the Impact of Dentists’ Personal Characteristics on Workforce Participation (Report)
This study expands upon previous work by the OHWRC discussing gender diversification in dentistry. The study uses 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 evaluates 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.
A Comparison of Opioid Prescribing Patterns by Dentists in New York and Oregon, 2014-2016 (Report)
Dentists are 1 of the top 5 opioid analgesic prescribers among health care professionals in the US. However, most of these prescriptions remain unused after dental surgery, with upwards of 100 million opioid analgesic pills estimated to be left unused. This OHWRC report describes dentists’ prescribing patterns in 2 very different states—Oregon and New York—prior to the implementation of prescribing guidelines. This establishes a baseline to understand prescribing trends before and after the implementation of guidelines for Medicaid patients.
How Evidence-based Is US Dental Workforce Policy for Rural Communities? (Report)
The OHWRC completed a study to examine 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.
Dental therapy is a new workforce model in which the clinician is trained to perform preventive and basic restorative dental services (positioned as a mid-level provider in dentistry). The OHWRC completed a study to evaluate how the dental therapy workforce has affected access to oral health services and oral health outcomes for patients at Apple Tree Dental in Minnesota as well as the impact of the workforce on practice configurations, team productivity, and practice efficiency.
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. The OHWRC collaborated 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.
The OHWRC completed a study to evaluate the attitudes and willingness of general and specialty dentists to treat people with special needs and to identify the barriers to greater participation by dentists in the care of these patients. 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, source of training, and geography.
Consumer Survey Focused on Parents’ Experiences Accessing Oral Health Services for Their Children (Report)
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 collaborated 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 report highlights unique access barriers for specific high-need children (racial/ethnic minorities, low-income parents, uninsured families, Medicaid beneficiaries, rural individuals) or geographic regions.
Compendium of Innovations in Oral Health Service Delivery
Oral health providers across the country that work in the safety net have used 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 compendium summarizes best practices in innovative oral health service delivery programs drawn from over 40 case studies conducted by the OHWRC in recent years. Organizations included were early initiators of service integration, mobile/portable dentistry, and/or teledentistry. Brief summaries of each organization include infographics as well as detail the problem, solution, facilitators, barriers, and benefits that the organization encountered in its efforts to expand access to care for underserved populations.
The Health Resources and Service Administration (HRSA) mission is “To improve health outcomes and address health disparities through access to quality services, a skilled health workforce, and innovative, high-value programs.” To support this mission, HRSA supports primary care postgraduate dental (PGD) training programs through competitive grant funding. Primary dental care fields include Advanced Education in General Dentistry (AEGD), General Practice Residency (GPR), Pediatrics, and Dental Public Health (DPH). Researchers at OHWRC assessed the impacts of this HRSA-funded training experience on current practice patterns of completers of these programs, and subsequent patient access to care. This study also aims to measure the long-term impact of these programs on improving the capacity of dentists to meet the needs of the underserved.
Demographic changes within the dental profession including aging and gender distribution are affecting dental practice characteristics and practice locations. 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.
Consumer Survey of Barriers to and Facilitators of Access to Oral Health Services (Report)
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.
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 will conduct 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.
Trends in the Provision of Oral Health Services by Federally Qualified Health Centers (Report)
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 examines factors that 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.
The Evolving Pipeline of Hispanic Dentists in the United States: Practice and Policy Implications (Report)
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.
An Assessment of Mobile and Portable Dentistry Programs to Improve Population Oral Health (Report)
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.
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 examines the variety of DSO models, who they serve, their workforce needs and practices, career pathways provided, and evolving models of workforce deployment.
Determinants of Oral Health Assessment and Screening in Physician Assistant Clinical Practice (Report)
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 Academy 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.
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.
Utilization of Oral Health Services by Medicaid-Insured Adults in New York, 2012-2013 (Report)
OHWRC analyzed and summarized their findings of Medicaid dental claims over a 2-year period in New York State, which has 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.
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. The report also explores the impact of residencies in ambulatory care settings, particularly for FQHCs, on service capacity and access for patients.
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.
Development of a New Dental Hygiene Professional Practice Index by State, 2016 (Report)
As part of its Year 1 research projects, staff at OHWRC conducted an extensive review of state legislation and regulation governing RDHs in order to describe the current regulatory environment and quantify it using the 2001 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 has diminished. In 2016, OHWRC updated and modified the DHPPI scale by adding new variables to better quantify current practice for RDHs and allow comparisons of change over time for dental hygiene practice in each state.
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.
Dental Hygiene Professional Practice Index by State, 2014 (Report)
OHWRC updated the scope of practice index for registered dental hygienists (RDHs) that was originally created in 2001. This report provides an objective quantification of current practices for RDHs and a comparison of changes over time for dental hygiene practice in each state.
Evolving Delivery Models for Dental Care Services in Long-Term Care Settings: 4 State Case Studies (Report)
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 report describes the findings from case studies conducted for the project.
Utilization of Oral Health Services by Medicaid-Insured Adults in Oklahoma, 2012-2013 (Report)
OHWRC analyzed and summarized their findings of Medicaid dental claims over a 2-year period in Oklahoma, where the Medicaid program provides only a limited emergency dental benefit for eligible adults. The objective of this research is to understand the impact of Medicaid dental benefits and availability of providers on utilization of dental services.
The Dental Assistant Workforce in the United States, 2015 (Report)
OHWRC conducted a comprehensive examination of the dental assisting profession to understand the contributions of dental assistants to oral health services. This study discusses demographic and educational characteristics of dental assistants and identifies gaps in data about this workforce that should be addressed.
Case Studies of 8 Federally Qualified Health Centers: Strategies to Integrate Oral Health with Primary Care (Report)
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 is to better understand the use of new or alternative workforce models in oral health services delivery and to understand their contributions to patient care.