Free Download Dental Hygiene Theory Practice 3rd Edition Programs

Free (and advertising-free) quizzes with pre-test study pages for students ages K through 12, and dental assisting programs.

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We've developed a number of online quizzes that teachers can feel free to use as a classroom activity when educating their students about dentistry, teeth and the oral cavity.

You can browse through our collection by ..

1. Scrolling on down this page to where we've grouped our quizzes according to specific subject and skill level needed.
2. Or you can start off by choosing from one of these broad quiz categories (each link goes to that activity's page).
   • Types of teeth, tooth identification and numbering.
     
   • Tooth and dental anatomy.
     
   • Facial anatomy.
     
   • Oral and tongue anatomy.
     

Graphic from Parts of a Tooth quiz (basic level).

1. Dental health quizzes - arranged by subject.
   
   1. Mouth / Face / Tongue Anatomy.
      
2. Dental health quizzes - arranged by skill level.
   
   1. Basic(Young children, lower elementary school grades)
   2. Intermediate(Upper elementary school grades, junior high.)
   3. Advanced(Junior high, high school, post-high school job training, dental assisting programs.)

I) Dental quizzes / Lesson graphics - arranged by subject.

A) The dental office / At-home dental care.

1) The Dentist's Office Quiz. - Basic level.

A quiz that teaches a child about the tools and equipment found in a dentist's office.
The Dentist's Office Quiz - Lesson graphic, terms and definitions.

2) The Dental Check-Up Quiz. - Basic level.

A quiz that tests the student's knowledge about tools and equipment used during a dental check-up.
The Dental Check-Up Quiz - Lesson graphic, terms and definitions.

3) The Cavity Prevention Quiz. - Basic level.

A quiz that tests the student's knowledge about at-home dental items that help to prevent tooth decay.
The Cavity Prevention Quiz - Lesson graphic, terms and definitions.

B) Permanent teeth - Identification and classification.

1) Tooth Numbering Quiz - Part I - Intermediate level.
2) Tooth Numbering Quiz - Part II - Intermediate level.
3) Tooth Numbering Quiz - Part III - Intermediate level.

A quiz that tests students about identifying teeth using the Universal Tooth Numbering System.
The Tooth Numbering Quizzes - Lesson graphics, terms and definitions.

Graphic from Parts of the Mouth quiz (basic level).

4) Which Type of Tooth is This? Quiz. - Intermediate level.

A quiz that tests the student about the basic categories of permanent teeth.
The Which Type of Tooth is This? Quiz - Lesson graphic, terms and definitions.

5) Kinds of Teeth Quiz. - Intermediate level.

A quiz that tests the student about the basic kinds of permanent teeth.
The Kinds of Teeth Quiz - Lesson graphic, terms and definitions.

6) Name That Tooth Quiz. - Intermediate level.

A quiz that asks the student to identify the different types of permanent teeth.
The Name That Tooth Quiz - Lesson graphics, terms and definitions.

7) Tooth Types Quiz. - Intermediate level.

This quiz asks you to name the different types of permanent teeth.
The Tooth Types Quiz - Lesson graphics, terms and definitions.

C) Deciduous Teeth - Identification and classification.

1) Which Type of Baby Tooth is This? Quiz. - Basic level.

A quiz that tests the student about the basic types of deciduous teeth (baby teeth).
The Which Type of Baby Tooth is This? Quiz - Lesson graphic, terms and definitions.

2) Name The Deciduous Tooth Quiz. - Intermediate level.

A quiz that covers the different types of deciduous teeth (baby teeth).

D) Dental and tooth anatomy.

1) Parts of a Tooth Quiz - Basic level.

An introductory quiz that teaches kids about teeth and the tissues that surround them.
Parts of a Tooth Quiz - Lesson graphic, terms and definitions.

2) Dental Anatomy Quiz - Intermediate level.

A quiz that teaches about teeth and the tissues that surround them.
The Dental Anatomy Quiz - Lesson graphic, terms and definitions.

E) Mouth / face / tongue anatomy.

1) Parts of the Mouth Quiz - Basic level.

An introductory quiz that teaches about the parts of the mouth.
The Parts of the Mouth Quiz - Lesson graphic, terms and definitions.

2) Oral Anatomy Quiz - Part I - Advanced level.
3) Oral Anatomy Quiz - Part II - Advanced level.

Our quizzes that test about structures and landmarks found in and around the mouth.
The Oral Anatomy Quizzes - Lesson graphics, terms and definitions.

4) Tongue Anatomy Quiz - Advanced level.

A quiz that tests about the major regions of and landmarks on the tongue.
The Tongue Anatomy Quiz - Lesson graphic, terms and definitions.

5) Parts of the Face Quiz - Basic level.

An introductory quiz for children that teaches about the parts of the face that are near the mouth.
The Parts of the Face Quiz - Lesson graphic, terms and definitions.

6) Facial Anatomy Quiz - Part I - Advanced level.
7) Facial Anatomy Quiz - Part II - Advanced level.

Quizzes that teach about the landmarks and portions of the face that lie near the mouth.
The Facial Anatomy Quizzes - Lesson graphics, terms and definitions.

II) Dental quizzes / Lesson graphics - arranged by skill level.

Don't let the way we've chosen to categorize of our quizzes below influence your decision about how to implement them. We know teeth and dentistry, we don't know the ability or needs of your students. Please explore all of our quizzes and evaluate their use independently.

A) Basic skill level quizzes - (Young children, lower grade school levels).

Graphic from Dentist's Office quiz.

1) The Dentist's Office Quiz. - Basic level.

A quiz that teaches a child about the tools and equipment found in a dentist's office.
The Dentist's Office Quiz - Lesson graphic, terms and definitions.

2) The Dental Check-Up Quiz. - Basic level.

A quiz that tests the student's knowledge about tools and equipment used during a dental check-up.
The Dental Check-Up Quiz - Lesson graphic, terms and definitions.

3) The Cavity Prevention Quiz. - Basic level.

A quiz that tests the student's knowledge about at-home dental items that help to prevent tooth decay.
The Cavity Prevention Quiz - Lesson graphic, terms and definitions.

4) Parts of the Mouth Quiz - Basic level.

An introductory quiz that teaches about the parts of the mouth.
The Parts of the Mouth Quiz - Lesson graphic, terms and definitions.

5) Parts of the Face Quiz - Basic level.

An introductory quiz for children that teaches about the parts of the face that are near the mouth.
The Parts of the Face Quiz - Lesson graphic, terms and definitions.

6) Parts of a Tooth Quiz - Basic level.

A introductory quiz that teaches kids about teeth and the tissues that surround them.
Parts of a Tooth Quiz - Lesson graphic, terms and definitions.

7) Which Type of Baby Tooth is This? Quiz. - Basic level.

A quiz that tests the student about the basic types of deciduous teeth (baby teeth).
The Which Type of Baby Tooth is This? Quiz - Lesson graphic, terms and definitions.

B) Intermediate skill level quizzes - (Upper grade school levels, junior high).

1) Name That Tooth Quiz. - Intermediate level.

A quiz that asks the student to identify the different types of permanent teeth.
The Name That Tooth Quiz - Lesson graphic, terms and definitions.

2) Dental Anatomy Quiz - Intermediate level.

A quiz that teaches about teeth and the tissues that surround them.
The Dental Anatomy Quiz - Lesson graphic, terms and definitions.

Graphic from Tongue Anatomy quiz.

3) Name The Deciduous Tooth Quiz. - Intermediate level.

A quiz that tests about the different types of deciduous teeth (baby teeth).

4) Tooth Types Quiz. - Intermediate level.

This quiz asks you to name the different types of permanent teeth.
The Tooth Types Quiz - Lesson graphic, terms and definitions.

5) Which Type of Tooth is This? Quiz. - Intermediate level.

A quiz that tests the student about the basic categories of permanent teeth.
The Which Type of Tooth is This? Quiz - Lesson graphic, terms and definitions.

6) Kinds of Teeth Quiz. - Intermediate level.

A quiz that tests the student about the basic kinds of permanent teeth.
The Kinds of Teeth Quiz - Lesson graphic, terms and definitions.

7) Tooth Numbering Quiz - Part I - Intermediate level.
8) Tooth Numbering Quiz - Part II - Intermediate level.
9) Tooth Numbering Quiz - Part III - Intermediate level.

A quiz that tests students about identifying teeth using the Universal Tooth Numbering System.
The Tooth Numbering Quizzes - Lesson graphic, terms and definitions.

C) Advanced skill level quizzes - (Junior high, high school, post-high school training).

1) Oral Anatomy Quiz - Part I - Advanced level.
2) Oral Anatomy Quiz - Part II - Advanced level.

Our quizzes that test about structures and landmarks found in and around the mouth.
The Oral Anatomy Quizzes - Lesson graphic, terms and definitions.

3) Tongue Anatomy Quiz - Advanced level.

A quiz that tests about the major regions of and landmarks on the tongue.
The Tongue Anatomy Quiz - Lesson graphic, terms and definitions.

4) Facial Anatomy Quiz - Part I - Advanced level.
5) Facial Anatomy Quiz - Part II - Advanced level.

Quizzes that teach about the landmarks and portions of the face that lie near the mouth.
The Facial Anatomy Quizzes - Lesson graphic, terms and definitions.

• Dental quizzes
  
  • Complete listing of all of our quizzes by subject and student skill level.
  • Teeth quizzes - Types of teeth, tooth identification and teeth numbering.
  • Anatomy quizzes - Tooth, Oral and tongue, Facial
  • Introductory dental quizzes for young children.
• Award Badges - Congratulatory graphics that can be emailed to students after taking quizzes.
• Infographics -
  
  • Toothpaste - An infographic explaining what to look for when picking out toothpaste.
  • Dental Sealants - An infographic about tooth sealant use in the USA.
  • Fluoridation - An infographic about city fluoridation of tap water in the USA.
• Animated-Teeth.com - full index of topics.

While the connections between oral health and overall health and well-being have been long established, oral health care and general health care are provided in almost entirely separate systems. Oral health is separated from overall health in terms of education and training, financing, workforce, service delivery, accreditation, and licensure. In the United States, medical and dental education and practice have been separated since the establishment of the first dental school in Baltimore in 1840 (University of Maryland, 2010). The financing of oral health care is characterized by a similar divide.

For example, private health plans typically do not cover oral health care, and the benefits package for Medicare excludes oral health care almost entirely. These separations contribute to obstacles that impede the coordination of care for patients.This chapter provides an overview of the oral health care system in America today—where services are provided, how those services are paid for, who delivers the services, how the workforce is educated and trained to provide these services, and how the workforce is regulated. The role of the U.S. Department of Health and Human Services (HHS) in oral health education and training, as well as in supporting the delivery of oral health care services, will be addressed in of this report.

Detailed examination of the role HHS plays in overseeing safety net providers such as Federally Qualified Health Centers (FQHCs) was charged to the concurrent Institute of Medicine (IOM) Committee on Oral Health Access toA Federally Qualified Health Center (FQHC) is any health center that receives a grant established by section 330 of the Public Health Service Act (42 U.S.C. Therefore, this committee limited its examination of the safety net in this current report.The current oral health care system is composed of two basic parts—the private delivery system and the safety net—and there is little integration of either sector with wider health care services. The two systems function almost completely separately; they use different financing systems, serve different clientele, and provide care in different settings. In the private delivery system, care is usually provided in small, private dental offices and financed primarily through employer-based or privately purchased dental plans and out-of-pocket payments. This model of care has remained relatively unchanged throughout the history of dentistry. The safety net, in contrast, is made up of a diverse and fragmented group of providers who are financed primarily through Medicaid and the Children’s Health Insurance Program (CHIP), other government programs, private grants, as well as out-of-pocket payments.In addition, some oral health care, especially for young children, has begun to be supplied by nondental providers in settings such as physicians’ offices, which is discussed later in this chapter.

This section gives a brief overview of the basic settings of oral health care by dental professionals—namely, dentists, dental hygienists, and dental assistants. The professionals themselves will be discussed later in this chapter.The Private Practice ModelThe structure of private practice provides dentists with considerable autonomy in their practice decisions (Wendling, 2010). Private practices tend to be located in areas that have the population to support them; thus, there are more practices located in urban areas than in rural, and more practices in high-income than in low-income areas (ADA, 2009b; Solomon, 2007; Wall and Brown, 2007). About 92 percent of professionally active dentists work in the private practice model (ADA, 2009d) (see for definitions of types of dentists). Among all active private practice dentists (whose primary occupation was private practice), about 84 percent are independent dentists, 13 percent are employed dentists, and 3 percent are independent contractors (ADA, 2009d).

About 60 percent of private practice dentists are solo dentists (Wendling, 2010). In addition, 80 percent of all active private practitioners and 83 percent of new active private practitioners are in general practice, while the remainder work in one of many specialty areas (see ).Dentists in the private practice setting see a variety of patients. BOX 3-1Types of DentistsA professionally active dentist is primarily or secondarily occupied in a private practice, dental school faculty/staff, armed forces, or other federal service (e.g., Veterans Administration, U.S. Als (Bailit et al., 2006; HHS, 2000). While there is a perception that the care provided in safety net settings is somehow inferior to the care provided in the private practice setting, there are no data to support this assumption.

In fact, there are very little data regarding the quality of oral health care provided in any setting (see later in this chapter for more on quality assessment in the oral health care system).Common types of safety net providers include FQHCs, FQHC look-alikes, non-FQHC community health centers, dental schools, school-based clinics, state and local health departments, and community hospitals. Each type of provider offers some type of oral health care, but the extent of the services provided and the number of patients served varies widely and the safety net cannot care for everyone who needs it (Bailit et al., 2006; Edelstein, 2010a).

Private sector efforts to supplement the safety net include the organization of single-day events to provide free dental care. In 2003, the ADA established the annual Give Kids a Smile Day; in 2011, the ADA estimated the event would involve about 45,000 volunteers providing care to nearly 400,000 children (ADA, 2011a). Another example includes the Missions of Mercy, which are often organized by state dental societies or private foundations. At these events, thousands of individuals have waited in lines for hours to receive care (Dickinson, 2010). English to hindi dictionary free download for samsung mobile wave 525 2017. These types of single-day events provide temporary relief to the access problem for some people, but they do not provide a regular source of care for people in need.Multiple challenges exist in the financing of oral health care in the United States, including state budget crises, the relative lack of dental coverage, a payment system (like in general health care) that rewards treatment procedures rather than health promotion and disease prevention, and the high cost of dental services.

Expenditures for dental services in the United States in 2009 were $102.2 billion, less than 5 percent of total spending on health care, a proportion that has remained fairly constant for the last two decades (CMS, 2011c).Demand for dental care may vary with the economic climate of the country (Guay, 2005; Wendling, 2010). For example, the recent recession was identified as a key factor contributing to 2009 having the slowest rate of growth in health spending (4 percent) in the last 50 years (Martin et al., 2011). Notably, expenditures on dental services had a negative rate ofFQHC look-alikes must meet all of the statutory requirements of FQHCs, but they do not receive grant funding under section 330 and are eligible for many, but not all, of the benefits extended to FQHCs.

Growth (–0.1 percent) in 2009, down from a positive rate of growth of 5.1 percent in 2008.Typical sources of health care insurance—Medicare, Medicaid, CHIP, and employers of all sizes—often do not include dental coverage, especially for adults. Employment status of adults ages 51–64 is a strong predictor of dental coverage (Manski et al., 2010c), and “routine dental care” is specifically excluded from the traditional Medicare benefits package. High-income older adults are more likely to have dental coverage than are other older adults (Manski et al., 2010c). In any case, individuals with dental coverage often incur high out-of-pocket costs for oral health care (Bailit and Beazoglou, 2008).

Estimates regarding the severity of uninsurance for dental care include the following:. In 2000, the surgeon general’s report estimated that 108 million people (about 35 percent of the population) lacked dental coverage (HHS, 2000). A recent estimate based on enrollment in private dental plans found 130 million U.S. Adults and children lack dental coverage (NADP, 2009). In 2004, 34 percent of adults ages 21–64 and about 70 percent of adults ages 65 and older lacked dental coverage (Manski and Brown, 2007). Nearly 25 percent of people who have private health insurance lack dental coverage (Bloom and Cohen, 2010).Overall, rates of uninsurance for oral health care are almost three times the rates of uninsurance for medical care—34.6 percent (Manski and Brown, 2007) versus 14.7 percent (CDC, 2009).Financing of oral health care greatly influences where and whether individuals receive care. For example, the national Medical Expenditure Panel Survey (MEPS) data show that in 2004, 57 percent of individuals with private dental coverage had at least one dental visit, compared to 32 percent of those with public dental coverage and 27 percent of uninsured individuals (Manski and Brown, 2007).

At the individual level, insurance coverage and socioeconomic factors play a significant role in access to oral health care (Flores and Tomany-Korman, 2008; GAO, 2008; Isong et al., 2010; Liu et al., 2007). Financing also has an effect on providers’ practice patterns, in part due to the low reimbursement rates of public insurers.

Previous studies have shown that like in medicine, dentists’ practice patterns are associated with financial incentives (Atchison and Schoen, 1990; Naegele et al., 2010; Porter et al., 1999). The following sections give a general overview of how care is financed in the United States.

Private SourcesAs shown in, dental care is financed primarily through private sources, including individual out-of-pocket payments and private dental plans.In 2008, dental services accounted for 22 percent of all out-of-pocket health care expenditures, ranking second only to prescription drug expenditures (see ).Employers can add a separate oral health product to their overall coverage package, but often they do not. In 2006, 56 percent of all employers offered health insurance, but only 35 percent offered dental insurance (Manski and Cooper, 2010). The availability of dental coverage through one’s employer is associated with the size of the establishment; that is, the larger the number of employees overall, the higher the incidence of stand-alone dental plans available to employees (Barsky, 2004; Ford, 2009). Higher-paid workers are also more likely to have access to and participate in stand-alone dental plans (Barsky, 2004; Ford, 2009). FIGURE 3-1Out-of-pocket health care expenditures, 2008.SOURCE: BLS, 2010a.Public SourcesOf the $102.2 billion in dental expenditures, nearly 91 percent came from private funds (e.g., private insurance and out-of-pocket payments), and only 9 percent came from public funds (e.g., state and federal funds) (CMS, 2011b). In comparison, public funds account for about one-third of physician and clinical services (see ).

However, the reported national expenditure levels likely undercount the total public funds spent on improving oral health, because that total represents only the costs associated with direct services delivered by dentists (to the exclusion of the broader definition of oral health) and does not account for care provided in settings such as hospitals and nursing homes. While a much lower percentage of funds for dental services come from public sources as compared to the funding of many other services, the government may, in fact, have a very important role to play for those who cannot afford to pay for care.Public sources are an important source of coverage for many vulnerable and underserved populations, but a recent report from the U.S. Government Accountability Office (GAO) found that finding providers to care for Medicaid populations “remains a challenge” (GAO, 2010).

Low reimbursement by public programs is often cited as a disincentive for providers’ to participate in publicly funded programs (Damiano et al., 1990; GAO, 2000; Lang and Weintraub, 1986; McKnight-Hanes et al., 1992; Venezie et al., 1997). Studies have shown, though, that in order to significantly increase participation rates, increased reimbursement is necessary but often. Requires additional efforts such as decreasing the administrative burdens of participation; changing provider perceptions of participating; and fostering relationships among state Medicaid staff, the state dental association, and local dentists (Borchgrevink et al., 2008; GAO, 2000; Greenberg et al., 2008; Wysen et al., 2004).Medicaid and CHIPDental coverage is required for all Medicaid-enrolled children under age 21 (CMS, 2011a). This is a comprehensive benefit, including preventive, diagnostic, and treatment services. According to data from the Kaiser Family Foundation, Medicaid provides health care coverage to nearly 30 million children while CHIP covers an additional 6 million (KFF, 2011). Further, they note that together, Medicaid and CHIP provide health care coverage for one-third of children and over half (59 percent) of low-income children.

However, exact documentation of these numbers may be challenging due to how enrollees are counted (e.g., at a point in time versus at any time in a given period).Regarding the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program, by law, states must cover any Medicaid-covered service that would reasonably be considered medically necessary to prevent, correct, or ameliorate children’s physical (including oral) and mental conditions. In contrast, Medicaid dental benefits are not required for adults, and even among those states that offer dental coverage for adult Medicaid recipients, the benefits are often limited to emergency care (ASTDD, 2011c). In FY2008, Medicaid spending on dental services accounted for 1.3 percent of all Medicaid payments (CMS, 2010b).CHIP is a federally funded grant program that provides resources to states to expand health coverage to uninsured, low-income children. Millions of children have received coverage for medical care, and a portion of those have also been covered for dental care (Brach et al., 2003).

The Children’s Health Insurance Program Reauthorization Act (CHIPRA) enacted in February 2009 requires all states to provide dental coverage to children (but not including their parents) covered under CHIP.MedicareAs increasing numbers of baby boomers become eligible for Medicare, considerable attention is being paid to how these aging adults will pay for42 U.S.C. §1396d(r)(3).Children’s Health Insurance Program Reauthorization Act of 2009, Public Law 3, 111th Cong., 1st sess.

(February 4, 2009). And obtain oral health care (Ferguson et al., 2010; Manski et al., 2010a,b,c; Moeller et al., 2010). In the year 2000, almost 77 percent of dental care for older adults was paid by out-of-pocket expenditures, and 0.4 percent was covered by Medicaid (Brown and Manski, 2004). Medicare explicitly excludes coverage for routine dental care, specifically “for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting the teeth.”In the initial Medicare program, “routine” physical checkups and routine foot care were excluded; comparatively, all dental services were excluded, not just “routine” dental services (CMS, 2010a). In 1980, Congress made an exception for “inpatient hospital services when the dental procedure itself made hospitalization necessary” (CMS, 2010a). Delineates the extent of the exclusion of oral health care from the Medicare program.Federal Systems of CareIn addition to the public programs noted above, the federal government both directly provides and pays for the oral health care of several distinct segments of the U.S.

This includes care provided both in public and private settings through the various branches of the military, the Bureau of Prisons, the Department of Homeland Security, and the Veterans Administration. Netgear wgr614v7 firmware s. The role of the federal government in providing care is discussed more fully in.Impact of Health Care ReformBetween now and 2014, several provisions of the Patient Protection and Affordable Care Act (ACA) will affect dental coverage. For example, provisions address coverage of oral health services for children and the expansion of Medicaid eligibility. Table 4-4 in highlights some of the key provisions that will affect dental coverage.Traditionally, a combination of dentists, dental hygienists, and dental assistants directly provide oral health care. Dental laboratory technicians create bridges, dentures, and other dental prosthetics. In addition, new and evolving types of dental professionals (e.g., dental therapists) are being pro-Social Security Act, §1862(a)(12).Patient Protection and Affordable Care Act, Public Law 148, 111th Cong., 2nd sess. (March 23, 2010).

And ethnic diversity, as well as the role of new and emerging members of the dental team. Later sections in this chapter will describe the roles and skills of other types of health care professionals (e.g., nurses, physicians) in the provision of oral health care.Basic DemographicsThe adequacy of the current supply of oral health professionals, both in terms of its numbers and skills, is difficult to assess for a variety of reasons related to changes in employment status, differing measures (e.g., licensed vs. Active professionals), the holding of more than one position per worker, part-time employment, and the presence of multiple job titles. Predicting the need for specific types of practitioners is always difficult because many factors can affect the need and demand for oral health care (Brown, 2005; Guthrie et al., 2009). For example, improvements in oral health of the population might limit future demand for restorative care.While it is debatable whether the number of professionals is adequate, it is more certain that the oral health workforce is not well distributed, with distinct areas showing significant needs (Hart-Hester and Thomas, 2003; Mertz and Grumbach, 2001; Saman et al., 2010). Even with a sufficient supply, geographic maldistribution could still persist (Wall and Brown, 2007).

For example, even with financial incentives such as loan repayment, dentists willing to locate in rural areas might be unable to sustain a practice in these locations (Allison and Manski, 2007). More attention may be needed to where students are recruited from, as 57 percent of graduates report plans to return to work in their home states after graduation (Okwuje et al., 2010).Job growth during the next decade is projected to be above average for all the dental professions, particularly for dental hygienists and dental assistants (see ). In fact, dental hygienists rank twelfth on the list of the fastest-growing occupations (of all occupations) and fifth among occupations directly related to health care (see ). Dental assistants rank fourteenth on the list of the fastest-growing occupations and sixth among occupations directly related to health care.DentistsEstimates of the number of dentists in the workforce vary significantly, likely due to how they are counted. As shown in, the Bureau of Labor Statistics (BLS) estimates that dentists held approximately 141,900 jobs in 2008, 85 percent of which were in general dentistry. However, in 2007, the American Dental Association (ADA) estimated that there were 181,725 professionally active dentists; 79 percent were general dentists. TABLE 3-3Employment of Dental Occupations, 2008 and Projected 2018OccupationNumber of JobsPercent Increase In Growth (%)20082018Dentists141,96General dentists120,25Dental hygienists174,16Dental assistants295,36Dental laboratory technicians46,4aThe Bureau of Labor Statistics calculates replacement needs based on estimates of job openings due to retirement or other reasons for permanently leaving an occupation.bTotal job openings represent new positions due to both growth and replacement needs.

Totals may not add precisely due to rounding.SOURCES: BLS, 2010d,e,f,g.(ADA, 2009d). The dentist-to-population ratio has remained relatively constant for nearly 20 years (about 60 dentists per 100,000 population) and is expected to decline in the coming decades (Wendling, 2010).Among independent dentists in private practice, 43 percent are age 55 or older (ADA, 2009b). Like many other health care professions, concerns arise about replacement needs as these individuals retire. While most dentists are male, the proportion of female dentists is on the rise owing to the increased proportion of female dentists among younger dentists (see ).

However, while dentistry is becoming increasingly gender diverse, the racial and ethnic profile of dentists has shown little change (see later in this section for a discussion of the racial and ethnic diversity of dental professions). Dentists’ income can vary depending on the type of employment, ranging from an average total net income of about $114,000 for new employed dentists to over $350,000 for independent specialists (ADA, 2009c).As discussed previously, professionally active dentists overwhelmingly work in the private practice setting (92 percent). Among the remaining dentists, occupations includeDoes not total 100 percent due to rounding. FIGURE 3-2Percentage distribution of dentists by gender.SOURCES: ADA, 2009d, 2010a.Dental HygienistsThe dental hygiene profession began almost a century ago when a dentist trained his assistant to assist in preventive dental services (University of Bridgeport, 1998). Since then, dental hygiene has evolved to a licensed health care profession; dental hygienists, in concert with dentists, provide “preventive, educational, and therapeutic services supporting total health for the control of oral diseases and the promotion of oral health” (ADHA, 2010). In private dental practice, dental hygienists’ work is generally billed under the dentist’s provider number.Dental hygienists are virtually all female (99 percent) (ADHA, 2009b).

This is not changing dramatically: in 2008, only 2.8 percent of graduates of dental hygiene programs were male (ADA, 2009a). The mean age of dental hygienists is about 44 years of age (ADHA, 2009b), which, like dentists, may lend to concerns about the numbers nearing retirement. Dental hygienists are primarily employed in private dental practices but may also work in educational institutions and in public health settings such as school-based clinics, prisons, long-term care, and other institutional care facilities (ADHA, 2009b). In 2008, dental hygienists held about 174,100 jobs, with a median annual wage of about $66,500 (BLS, 2010e). Nearly 30 percent of dental hygienists do not receive any benefits (ADHA, 2009b).In spite of BLS projections for a 36 percent growth in the employment of dental hygienists between 2008 and 2018 (see ), the dental hygiene workforce may also be experiencing challenges due to geographic maldistribution. For example, a 2009 survey of dental hygienists showed that 68 percent of respondents reported finding employment was somewhat or very difficult in their geographic area (up from 31 percent in 2007), andBecause dental hygienists may hold more than one job, this is an overestimate of the number of practicing dental hygienists. Of these, 80 percent felt that there were too many hygienists living in the area (ADHA, 2009a,b).Dental AssistantsDental assistants primarily work in a clinical capacity, but other roles include administrative positions, practice management, and education (McDonough, 2007).

Most dental assistants work in private practices and as assistants to general dentists, but many dental assistants work in specialty practices. Across the country, there are different job titles and categories for dental assistants in different states (ADAA/DANB Alliance, 2005). The BLS estimates that dental assistants held 295,000 jobs in 2008, with a median annual wage of about $32,000 (BLS, 2010d). Like dental hygienists, dental assistants are nearly all female (McDonough, 2007).

Expanded function dental assistants (EFDAs) may perform some limited restorative functions under the supervision of a dentist (Skillman et al., 2010). Both the U.S. Army Dental Command and the Indian Health Service have programs to train and employ EFDAs (IHS, 2011; Luciano et al., 2006). While the title of EFDA is commonly used to describe all dental assistants who can perform extended duties, there are many other titles given to dental assistants with expanded duties (e.g., expanded duties dental assistant, advanced dental assistant, registered restorative assistant in extended functions), and many states permit dental assistants to perform specific extended functions (e.g., coronal polishing, administration or monitoring of sedation, pit and fissure sealants) (DANB, 2007). In fact, some states permit certified dental assistants to act at the level of an EFDA, even though titles such as certified dental assistant or registered dental assistant are used (DANB, 2007).

As stated by the Dental Assistant National Board, “without a single, nationally-accepted set of guidelines that govern the practice of dental assisting in the country, it is difficult to execute a concise overview” of the profession (DANB, 2007).Dental Laboratory TechniciansIn 2008, dental laboratory technicians (or “dental technicians”) held about 46,000 jobs in 2008 with a median annual wage of about $34,000 (BLS, 2010g). Dental technicians work in a variety of settings, including dentists’ offices, their own private businesses, or small privately owned offices. Among all students enrolled during the 2008–2009 academic year, 40 percent were age 23 and younger and slightly more than half were female (ADA, 2009a). Education and TrainingPrior to the 20th century, dental and allied dental education occurred through apprenticeships and training in proprietary schools (Haden et al., 2001). The education of dental professionals evolved and formalized over time to take place in a variety of locations, including dental schools, 4-year colleges and universities, community colleges, and technical schools. The ADA’s Commission on Dental Accreditation (CODA) accredits predoctoral dental education programs; programs for dental hygienists, dental assistants, and dental laboratory technicians; and advanced dental educational programs (i.e., residencies) (Department of Education, 2010). While the number of programs is increasing, faculty recruitment, especially for dental schools and dental hygiene programs, is a persistent problem; this is often due to low salary (ADHA, 2006; Chmar et al., 2008; Walker et al., 2008).

In addition, several efforts have emphasized the need to revise the way that dental students are educated and trained, including the need to provide care in a more patient-centered fashion, as well as for students to gain more clinical experiences in the community setting (Cohen et al., 1985; Formicola et al., 1999, 2006; HHS, 2010; IOM, 1995; Lamster et al., 2008). More effort is also needed to improve the health literacy and cultural competency of students.The sections below provide some highlights as to the overall education and training of the dental professions. Provides more information on the role of HHS in education and training.DentistsU.S. Dental schools typically offer a 4-year curriculum; students take 2 years of predominantly basic science classes followed by 2 years of predominantly clinical experience, after which they are awarded either a Doctor of Dental Medicine (DMD), or a Doctor of Dental Surgery (DDS). The number of dental schools in the United States is increasing, and more dentists are being produced. In 2009, there were 57 dental schools, of which 37 were public, 16 were private, and 4 were private, state-related institutions (ADA, 2010a).

At that time, 8 new dental schools were in various stages of development (Guthrie et al., 2009). About 4,800 dentists graduate each year (ADA, 2010a). In 1999, there were 55 dental schools that graduated about 4,100 dentists annually (ADA, 2010a.)The cost of dental education is a barrier to entry, especially for low-income and underrepresented minority students (IOM, 2004; Sullivan Commission, 2004; Walker et al., 2008). In 2008–2009, the average annual tuition for dental schools was $27,961 for state residents and $41,561 for nonresidents, similar to the tuition for medical students (AAMC, 2011. ADA, 2010a); the difference is significant considering that many states do not have a single dental school. As this problem exists for several professions, the Western Interstate Commission for Higher Education created the Professional Student Exchange Program in which students from certain states may receive assistance to attend health professional schools (including dental schools) in other states (WICHE, 2011).

There is also great variation between public and private institutions.In 2009, average dental education debt was $164,000, and 77 percent of graduates had at least $100,000 in debt (Okwuje et al., 2010). Comparatively, the average educational debt for medical school graduates in 2009 was approximately $156,000, and 79 percent of graduates had at least $100,000 in debt (AMA, 2011). Debt among dental graduates varies widely; those with higher levels of debt are more likely to enter private practice immediately upon graduation and less likely to pursue advanced education as compared to those with no debt (Okwuje et al., 2010).Dentists have the option of postgraduate education that provides further training in general dentistry or one of the nine recognized specialty areas. In 2008–2009, there were 723 specialty and postdoctoral general dentistry programs in the United States, including dental residencies and fellowship programs (ADA, 2010b). Currently, about 30 percent of graduating dental students plan to pursue postgraduate training (Okwuje et al., 2010). In the 2008–2009 academic year, there were nearly more than 44,500 applications for residency programs slots and about 3,000 first-year enrollees (ADA, 2010b).Dental HygienistsIn the 2008–2009 academic year, there were 301 dental hygiene education programs accredited by CODA (ADA, 2009a). Most of these programs award associate degrees (82 percent), but others award baccalaureate degrees, diplomas, and certificates (ADA, 2009a).

In 2008, there were about 6,700 dental hygiene graduates. In the early years of the profession, dental hygiene education programs were often colocated with dental education programs in schools of dentistry (Haden et al., 2001). Today, about two-thirds of dental hygiene education programs are located in community, junior, and technical colleges (ADHA, 2006), which may decrease the amount of interaction between dentists and dental hygienists during their training, and therefore not prepare them to work as a team. Annual tuition can vary widely.

For example, community colleges have an average annual tuition of $3,154, while the average annual tuition for programs colocated with dentals schools is $12,659 (ADA, 2009a). While the educational admissionsThis reflects the number of applications and not the unique number of applicants. Requirements for dental hygiene education programs vary widely, more than 80 percent of first-year students have completed at least 2 years of college (ADA, 2009a). Faculty in dental hygiene education programs are mostly dental hygienists (76 percent), and 21 percent are dentists (ADA, 2009a).Dental AssistantsDental assistants are trained on the job or in formal education programs. Education programs in dental assisting may be located in postsecondary institutions that are accredited by CODA, postsecondary institutions that are not accredited, high schools, vocational programs, and technical schools (ADAA/DANB Alliance, 2005). Dental assistants may also be trained on the job by their employers.

Considering the numerous alternate pathways to working in dental assisting and the variability in state licensure and certification practices, as described previously, it is difficult to generalize a description of the workforce as a whole or to assess the impact of the various training alternatives (ADAA/DANB Alliance, 2005; Neumann, 2004). Little is known about the wide variety of programs that are not accredited by CODA.In 2008–2009, CODA accredited 273 dental assisting programs, almost all of which (87 percent) were in public institutions (ADA, 2009a). Average cost for tuition and fees in a CODA-accredited dental assisting program in the 2008–2009 academic year for in-district students was $6,791 (ADA, 2009a).

Among students enrolled in CODA-accredited dental assisting programs in the 2008–2009 academic year, 63 percent were age 23 and under, and less than 5 percent were male. In 2008, there were 6,110 graduates from CODA-accredited programs (ADA, 2009a).Virtually all CODA-accredited programs require a high school diploma (or even higher level of education) for admission (ADA, 2009a). Most CODA-accredited programs are 1 year in length leading to a certificate or diploma. However, a few have a 2-year curriculum resulting in an associate degree. About 14 percent of faculty in CODA-accredited programs are dentists, 70 percent are dental assistants, and 28 percent are dental hygienists (ADA, 2009a).Dental Laboratory TechniciansThere are no formal education or training requirements for dental technicians, and most learn required skills through on-the-job training; however, some formal programs exist in universities, community and juniorSome faculty members reported more than one discipline, so these numbers do not total 100 percent. Colleges, vocational schools, and the military (BLS, 2010g).

In the 2008– 2009 academic year, there were 20 CODA-accredited programs (ADA, 2009a). Virtually all faculty (91 percent) are dental laboratory technicians (ADA, 2009a). Most accredited programs last 2 years, and 13 confer an associate’s degree.

In the 5-year period from 2004–2009, applications to these programs decreased by nearly 13 percent (ADA, 2009a). Average total tuition and fees range from $7,838 for in-district students to $18,214 for out-of-state students (ADA, 2009a). In 2008, there were 234 total graduates from accredited dental laboratory technology programs (ADA, 2009a).Racial and Ethnic DiversityThe racial and ethnic profile of the dental workforce is not representative of the overall population (see ).

While diversity among the dental professions students has increased in the previous decade (see ), the numbers still are not significantly different. Evidence shows that a diverse health professions workforce (including race and ethnicity, gender, and geographic distribution) leads to improved access for underserved populations, greater patient satisfaction, and better communication (HRSA, 2006; IOM, 2004). Health care professionals from underrepresented minority (URM) populations, in part due to patient preference, often account for a disproportionate amount of the services provided to underserved populations (including both URM and low-income populations) (Brown et al., 2000; HRSA, 2006; IOM, 2003; Mitchell and Lassiter, 2006).

For example, a 1996 survey by the ADA revealed that nearly 77 percent of white den-TABLE 3-5Dental Professions by Percentage of Race and Hispanic Ethnicity, 2000General PopulationDentistsDental HygienistsDental AssistantsWhite75.182.890.975.8Black or African American12.33.32.35.6Asian3.68.82.03.6Hispanic or Latino Origin12.53.63.712.6Category excludes Hispanic origin.SOURCES: U.S. Census Bureau, 2000, 2002. TABLE 3-6Percentage of Dental Professions School and Program Enrollment by Race and Hispanic Ethnicity, 2000–2001 and 2008–2009Enrolled Dental StudentsEnrolled Dental Hygiene StudentsEnrolled Dental Assistant Students a208–200200–200White63.459.982.378.668.460.2Black4.85.84.24.412.515.1Asian24.823.44.67.02.94.8Hispanic5.36.25.77.39.711.1aIncludes only dental assistant students enrolled in CODA-approved programs. Racial and ethnic diversity of entire dental assistant workforce may be different.SOURCES: ADA, 2002, 2009a, 2010a.tists’ patients were white, while 62 percent of African American dentists’ patients were African American and 27 percent were white (ADA, 1998). More recently, among dental students graduating in 2008, 80 percent of African American students and 75 percent of Hispanic students expected at least one-quarter of their patients would be from underserved racial and ethnic populations; nearly 37 percent of the African American students and 27 percent of the Hispanic students expected at least half their practice would come from these populations (Okwuje et al., 2009).

In comparison, only 43.5 percent of white students expected at least one-quarter of their patients to come from underserved racial and ethnic populations, and only 6.5 percent expected at least half of their practice to be comprised from these populations (Okwuje et al., 2009).