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Fewer adults visiting the dentist

HPRC research briefs focus on utilization

The numbers speak for themselves, and they can't hide what's really going on in dentistry.

Staff from the ADA Health Policy Resources Center has translated some complicated analysis from a number of different data sources into a few basic facts. For one, fewer adults, no matter their income level, are visiting the dentist—a trend that started well before the Great Recession.

This decrease in utilization is a key driving force behind a decline in dentists' income, one that's also been occurring since the mid-2000s—several years before the Great Recession.

The opposite is happening with children. More low-income children are visiting the dentist now than 10 years ago. Between 2000 and 2010, dental care utilization among low-income children increased in 47 states, according to HPRC.

Adult utilization is going one way while dental visits by children are going the other way, and dentists' incomes are struggling to keep pace. Meanwhile, the ADA is trying to help member dentists make sense of all the changes.

As a start, HPRC has published three research briefs analyzing patterns of dental care utilization and dentists' income: "Dental Care Utilization Declined Among Low-Income Adults, Increased Among Low-Income Children in Most States from 2000 to 2010," "Dental Care Utilization Declined for Adults, Increased for Children During the Past Decade in the United States," and "Dentist Incomes Slow to Recover."

HPRC staff believes this research taken together suggests that the coming years will see significant shifts in the dental landscape.

"Dentistry is at a crossroads. Changes in how dental practices are organized, reductions in adult dental benefits at the state level, increased financial barriers to care among adults, increased dental student debt level and improvements in oral health status for most segments of the population are some of the major forces bringing significant change to the profession," Marko Vujicic, Ph.D., managing vice president of the HPRC, and lead author of the briefs, wrote. "At the same time, the U.S. health care delivery system is on the verge of unprecedented reform, aimed at reducing costs and improving quality through better coordination of care delivery and significant change in how health care services are paid for."

The percentage of adults who went to the dentist in the past year has been on the decline since before the economic downturn, according to HPRC, dropping from 41 percent in 2003 to 37 percent in 2010. When broken down by age group, the largest decline in utilization among adults occurred in the 35-49 age group, dropping from 43 percent in 2003 to 38 percent in 2010. 

Looking at income, adult dental care utilization declined across the spectrum during the 2000s but was most pronounced among the poor. For middle income adults, utilization declined from 38 percent in 2003 to 34 percent in 2010. Utilization among higher income adults decreased from 54 percent to 51 percent in the same time frame.

Dr. Vujicic said that forthcoming work from his team shows that a significant driver of declining dental care utilization among adults is an increase in the share of adults who have no dental benefits. This, in turn, is driven by the fact that employers this past decade have been less and less likely to offer dental benefits and Medicaid programs, in general, have slimmed down dental benefits for adults. Low-income adults in particular face significant barriers to dental care, cost being the primary one.

Even if their parents aren't visiting the dentist, children seem to be going more often. The vast majority of states made progress in increasing dental care utilization among low-income children. Nationally, utilization in 2010 was 53 percent higher among low-income children relative to 2000, according to HPRC.

"For low-income children, many argue that increased advocacy efforts, enhanced financial resources, enactment of the Children's Health Insurance Program, expansion of the dental safety net and increased participation in Medicaid programs among dentists were key drivers (behind increased utilization)," Dr. Vujicic and co-authors Kamyar Nasseh, Ph.D., and Tom Wall wrote in a brief. "The expansion of new, lower cost dental care delivery models has also been put forth as an explanation. Many state-level analyses also point to the impact of improved dentists' reimbursement and streamlined administrative processes within Medicaid and CHIP initiatives as an important factor."

The newest data from HPRC shows that dentists' incomes have remained stagnant since 2009. The average general practice dentist's income in 2011 was $192,392. General practitioners' incomes peaked in 2006 at $219,501, which is adjusted for inflation to reflect 2011 dollars.

The ADA has a number of initiatives that may reassure dentists during this unsteady time and help them continue to succeed in their practices. This fall, the Association plans to launch the Center for Professional Success, which will be a Web-based portal to help dentists manage their careers, expand their knowledge and balance their lives. Dentists can visit the Center to find resources to help them solve practice management problems; engage in online executive management certificate programs; and learn more about managing their health and wellness while balancing work and life.

HPRC is currently researching dental care utilization and spending patterns among older adults—a key population for the coming decades—and is conducting major analyses on student debt and group practice. The ADA is also making a major push to address the access to dental care issue through the Board of Trustees' Call to Action for Oral Health. It includes frequently and consistently communicating dentistry's positive story and the contributions dentists make to oral health; providing care now by leveraging capacity in the current system so dentists can provide that care through innovative collaborations and working with other health care providers; working to prevent disease before it starts; and providing people with the knowledge that empowers them to be good stewards of their own oral health. 

"Now more than ever, it is crucial for dentists, the public, educators and policymakers to work together to reduce barriers to dental care to ensure all Americans have the opportunity to be mouth healthy for life," Dr. Vujicic and his team wrote.

To read the full research briefs, visit www.ada.org/1442.aspx.