Basic standards of hospital dental service

reports of councils and bureaus

Basic sta n d a rd s of hospital dental service

COUNCIL ON HOSPITAL DENTAL SERVICE

T he purpose o f the “ Basic Standards” is to provide hospital administrators, chiefs o f dental service and dentists interested in the organization and conduct o f dental services in hospitals with standards that have been approved by the Am erican Dental Association for such a program. T h e C ouncil periodically reviews and recomm ends amendment o f the Basic Stand­ ards in light o f its experience in inspecting and accrediting hospital dental services. At the 1960 annual session in Los Angeles the House of Delegates approved am end­ ments to the Standards. Follow ing is the amended “ Basic Standards” under which inspections and ap­ provals o f dental services in hospitals are evaluated: INTRODUCTION

The dental profession knows that the health care it renders is an essential part of a total health service. It has long recognized, as well, that its services must be well integrated with those of the other health professions in order to provide this total health service for the individual patient. The modern hospital, marshalling as it does many professions, serv­ ices and facilities, provides a great challenge and opportunity for interprofessional coopera­ tion in the service of the individual patient. For these reasons, the American Dental Association has established the Council on

Hospital Dental Service to act on its behaii in the inspection and improvement of dental services in the hospital. The Council on Hos­ pital Dental Service examines dental services in hospitals and issues certificates of accredita­ tion in the name of the American Dental Association to hospitals which have dental services which meet certain standards. In establishing standards, the Council on Hospital Dental Service has kept in mind the need of relating them to prevailing standards in the field of hospital administration and practice. It has endeavored to establish only broad general principles within which the best interests of the patient are served.

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APPLICATION FOR APPROVAL OF A HOSPITAL DENTAL SERVICE

Application for the approval of a hospital dental service should be made to the Council on Hospital Dental Service, American Dental Association, 222 East Superior Street, Chicago 11, Illinois. Inspection of the dental service will be made without cost to the hospital and in full consultation with appropriate hospital authorities. NAME

The name of the dental service of a hospital should be similar to that of other services of the hospital. FUNCTIONS

A dental service of a hospital should be operated on the basis of four main functions: Administrative • to conduct the affairs of the dental service in accordance with the established administrative procedures of the hospital. Consultative • to act, through customary channels, in an advisory capacity on all prob­ lems related to the dental health of the pa­ tient. Included in consultations required under these standards are those required under the rules of the hospital staff. In all cases where the patient is not a good risk and in all cases in which diagnosis is obscure, or when there is doubt as to the best therapeutic measures to be utilized, consultation is appropriate. The consultation note, except in emergencies, shall be recorded prior to definitive treatment. Clinical • to render professional services to patients in accordance with the concepts of modern scientific dentistry and to evaluate these services periodically. Educational • to provide, where feasible, an educational program for dental interns, dental residents, dental hygienists, dental as­ sistants and nurses; to provide training for junior staff members; to engage, when facili­ ties permit, in the teaching of graduate and postgraduate students who are preparing themselves for the practice of one of the specialties o f dentistry. The “ Requirements for the Approval of Hospital Dental Internships and Residencies” of the Council on Dental Education of the American Dental Association may be useful

in establishing standards in these educational fields.

QUALIFICATIONS OF DENTISTS

All dentists privileged to practice in the hos­ pital should be: 1. Graduates of dental schools recognized at the time of matriculation or of graduation by the Council on Dental Education of the American Dental Association and legally licensed to practice dentistry in the state in which the hospital is established. 2. Members of the American Dental Asso­ ciation or the National Dental Association, or eligible for membership in these associa­ tions. 3. Worthy in personal character and in professional ethics as set forth in the Prin­ ciples of Ethics of the American Dental Asso­ ciation. All dentists who are appointed to the dental staff or are granted privileges to operate in a hospital should have qualifications based on experience, training and demonstrated com­ petence comparable to that of members of other services in the hospital. All dentists who are admitted to practice in the hospital should qualify for membership on the hospital staff in accordance with the customary local procedures. All dentists who engage in the practice of one of the recognized specialties in dentistry should, insofar as possible, meet the require­ ments established by the specialty board for such practice. ORGANIZATION AND OPERATION

In teaching hospitals and in larger hospitals, the functional division of the medical and dental staff into more than minimal depart­ ments or services is frequently desirable. In these instances, the organization of the depart­ ment of dentistry or dental department should be comparable to that of other departments of the hospital. The dental department should be organized into sections to conform to the areas of the recognized dental specialties consistent with available facilities and the needs of the com­ munity. The section on, oral surgery should be administered as a section of the department of dentistry coequal with the other specialties of surgery with full consultative and advisory relations with the department of surgery. In smaller hospitals, and in those hospitals where the principal activity of the dental de­ partment is oral surgery, this service may be

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organized as a section of the surgery depart­ ment coequal with the other surgical special­ ties. Chief of Dental Service • The chief of the dental service should be responsible for the dental service. He should be selected for his professional and executive ability. He should be designated by a title comparable to that of the chiefs of other services. He should have the same privileges regarding appointment to the medical board or executive committee as do the chiefs of the other services. Staff Conferences and Meetings • The mem­ bers of the dental service should attend and participate in general staff conferences. They should also hold regular departmental meet­ ings for the thorough review and analysis of their clinical activities. Appointments and Promotions • All appoint­ ments to the dental staff shall be made by the governing body upon recommendation of the executive committee and credentials com­ mittee which should have a dental member. The terms and procedures of the appointment as established for the medical staff shall apply to the dental staff. The number of appoint­ ments and grades in rank available to the dental service will vary with the size and type of the individual hospital. The classification of appointments according to rank should be made in accordance with the standard nomen­ clature and the custom of other services in the hospital. Promotion in rank should be made on a basis consistent with that established for the other services in the hospital. Admission and Discharge of Hospital Dental Patients • Dentists shall have the privilege of admitting and discharging patients for den­ tal treatment. Medical Survey of Dental Patients • An ade­ quate medical survey by a member of the medical staff shall be required on each patient before oral surgery. Indicated consultations with the medical staff shall be required in complicated cases. Oral Examination of Dental Patients • Den­ tal patients should have a complete oral examination by a member of the dental staff as soon after admission as conditions permit. Dental outpatients should be afforded the same service when possible. Availability of Hospital Beds • Hospital beds should be available to the dental service in

the same manner that they are available to other services of the hospital. Records • Careful records of all histories, diagnoses, therapeutic and operative pro­ cedures should be kept on charts in accordance with the standard procedure of the hospital. Special clinical records may be useful as an aid in clinical research. Relation to School of Nursing • If the hos­ pital maintains a school of nursing, it is de­ sirable for members of the dental service to participate in the training of student nurses in the fundamental principles and practical knowledge of dental health. Rules • The dental service should establish rules for the conduct of its program com­ parable to the rules established by other serv­ ices and not inconsistent with the rules of the hospital. The brochure, The Dental Service and the Dental Staff, of the Council on Hos­ pital Dental Service will be useful in estab­ lishing dental staff rules and regulations. Research • Research and investigation should be encouraged, and the hospital should make every effort to provide time for the investiga­ tors and such materials and assistance as may be needed. Library • An adequate selection of dental books and periodicals should be available in the hospital library. Physical Equipment • The space allotted to, the equipment, instruments and supplies of, the dental service should be adequate to carry out all services in accordance with generally accepted standards o f practice. The brochure, Planning the Hospital Dental Department, of the Council on Hospital Dental Service will be useful as a guide in establishing the extent of physical facilities necessary for the dental program. DENTAL SERVICES FOR HOSPITAL PATIENTS

The extent of dental care provided for the hospital patient will vary with the size of the hospital, the type of hospital and the type of service rendered by the hospital. For example, in hospitals for crippled children or for those suffering from tuberculosis and mental dis­ eases, a more comprehensive dental service is necessary. The recommended program for hospitalized patients, and for outpatients when facilities

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permit, will include an oral examination based on a complete series of dental roentgenograms. Vitality tests, transilluminations, bacteriologic, pathologic and other types of laboratory tests should be used where indicated. More specifically, the dental service should develop programs in the following areas in accordance with local needs and facilities: Dentistry for Children (Pedodontics) • In hospitals where children are hospitalized for an extended period of time, as in hospitals for crippled children and for those suffering from chronic diseases, a pedodontic service is highly desirable. Consultation and treatment in orthodontics should be available to all such hospital patients. Dental Roentgenology • In all hospitals there should be good facilities for dental roent­ genology. In hospitals where dental roentgeno­ grams are taken by another service, the dental service should be available for reading and interpretation of the films. Dental roentgeno­ grams should be made by persons specially trained in this technic under the supervision of the dental service. Technicians should be given complete instruction in safety precau­ tions. Oral Hygiene • In all hospitals there should be an oral hygiene program whereby practical measures of mouth cleanliness should be an item o f routine nursing. The volunteer and nurses aid programs in hospitals appear to be a ready source of personnel to bring to the patient an effective program of oral hygiene. Oral Pathology • In hospitals where it is feasible, an oral pathologist should be avail­ able to the dental service because of the specialized nature of the tissues of the oral cavity.

Oral Surgery • In all hospitals there should be adequate facilities for the provision of oral surgical diagnosis and treatment. The scope of the specialty of oral surgery shall include the diagnosis, surgical and adjunctive treat­ ment of the diseases, injuries and defects of the human jaws and associated structures within the limits of the professional qualifica­ tions and training of the individual practi­ tioner and within the limits of agreements made at the local level by the health team concerned with the total health care of the patient. An adequate medical survey, including physical examination, blood count, etc., shall be made for each patient before oral surgery, and the indicated consultations shall be held in complicated cases. Periodontics • In all hospitals, it is desirable that patients have consultation and therapy available from a dentist qualified in the field o f periodontics. Restorative Dentistry • In certain hospitals, such as those for patients suffering from tuberculosis and mental diseases, a restorative dental service is highly desirable.

AMENDMENT OF EXISTING RULES

In order to comply with these standards it may be necessary to amend the rules of the hospital in order to include the words “ den­ tist” and “ dental service” in appropriate sec­ tions and to include such additional provisions as are necessary to permit proper functioning of the dental service. When necessary, the rules of the medical board should also be amended to obtain the same objectives and to facilitate interprofessional cooperation.

National Civil Defense Conference

COUNCIL ON FEDERAL DENTAL SERVICES

T he Second National Dental Civil Defense Conference was held in Los Angeles on Saturday, O ctober 15, two days prior to the opening o f the 1960 annual session of the Association. M ore than 150 members and guests attended the conference, which was staged under the auspices o f the Council. T h e principal speakers on the three and one half hour program w ere: Congress­ m an C het H olifield o f M ontebello, C alif., D r. Carruth J. W agner, director o f the Division o f Health M obilization o f the U . S. Public Health Service, R ear Adm iral Curtiss W . Schantz, chief o f the Navy D ental Corps and Captain Herbert J. T ow le, head, department o f audiovisual training at the Navy Dental School. Charles H . Patton, then president-elect o f the Association, after w elcom ing the conference participants on behalf o f the officers and trustees o f the Association, stated that he believed it was singularly appropriate, in these perilous times, fo r the Am erican Dental Association to evidence publicly— through the m edium o f the co n ­ ference— its dedication to the cause o f maintaining a vital awareness o f the contribu­ tion w hich each mem ber o f the dental profession may be called upon to make, in emergency circumstances, to the preservation o f the health o f the Am erican people. A dm iral Schantz and Captain T ow le spoke extemporaneously on the instructional technics em ployed by the Navy Dental Corps in the presentation o f its Casualty Treatm ent Training Course. A num ber of slides and films were utilized to dem on­ strate the visual aid devices that can be used effectively in emergency m edical care training courses by civilian dental societies. Congressman H olifield and Dr. W agner delivered prepared addresses and these have been digested for publication in the text o f this report. T h e digest o f Dr. W agner’s paper appears below ; that o f M r. H olifield’s will be published in the February issue of t h e j o u r n a l . In a world where international discussion is on the level o f hydrogen bombs, it is im portant that we focus attention on our com m unity health services and personal survival. T h e only absolute protection we have against m odern warfare is to prevent its occurrence. H owever, as long as there exists in the world a political,

econom ic and social system that is dedicated to destroying our way o f life, we must devote considerable time and re­ sources to ensure our people a capability o f surviving disaster should it occur, T h e National Plan for Civil Defense and Defense M obilization, promulgated by the President in O ctober 1958, defines

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the mission o f nonmilitary defense as an integral part o f the total defense o f the nation. T his mission includes: (1 ) pro­ tection o f life and property by preparing for and carrying out nonmilitary functions to prevent, minimize, repair and recover from injury and damages; and (2) mobilization and management o f re­ sources and production. M u ch has been done by states and their local jurisdictions towards accomplish­ ment o f the first part o f this tw ofold, n on ­ military defense mission. T h e states, with encouragem ent, guidance and assistance from the Office o f Civil and Defense M obilization, have prepared and pu b­ lished comprehensive operational survival plans. Similar plans have been prepared by the separate counties and communities in most states. It has been proved under all conditions o f war and peace that people succeed best w h o form definite ideas o f what they are going to d o before they start to d o it. T o “ get something done” in civil defense, we must have an emergency operations sur­ vival plan which sets up an organization. Available health personnel are fitted within this organization in such a way as to utilize to the m axim um their par­ ticular skills. Training then must be p ro­ vided to increase and extend the technical skills o f assigned personnel and to teach them to operate in a coordinated manner. p r im a r y m i s s i o n ,

MAJOR PROBLEMS

T h e primary mission o f emergency health services is to: 1. M inim ize the effects o f natural or m an-m ade disaster, through such meas­ ures as mass casualty care, emergency preventative health measures and re­ habilitation. 2. M aintain the noncasualty popula­ tion in a state o f good health. 3. Restore essential com m unity health services.

T h e m ajor problems that will make the provision o f health services in case of enemy attack so difficult in clude: (1 ) the pronounced disparity that will exist be­ tween the resources that remain after at­ tack and the requirements for these re­ sources in casualty and noncasualty care, and (2 ) the radiation fallout that may interdict prom pt response and rescue as well as create additional casualties. T he use o f biological and chem ical warfare agents m ay pose additional problems. It is only within the organization created by our local civil defense plan that we can “ get something done.” Civil defense is basically government-in-anemergency. T o develop their capacity to perform their assigned jobs as professional health workers, dentists must assume responsi­ bilities and provide professional services which, to some extent, vary from the usual practice o f dentistry. T h e dentist will need training beyond that which he has received in dental school, tailored to fit the specific needs o f his assigned civil defense role rather than his categorical identification as a dentist. W hen members o f the dental profession have been given organizational assign­ ments at local levels, and training for specific assignments has been planned, local communities will be in a position to identify training needs that are com m on to each type o f assignment. These com ­ m on training needs can then be met by basic health mobilization training courses for dentists. These basic training courses can be included with other basic emer­ gency training in the dental school and be given to practicing dentists through such mediums as postgraduate courses at dental schools or state courses jointly sponsored by professional societies and the state civil defense director. In the actual situation, the civil defense team must be prepared to find that the ideal operation it had planned, rehearsed and practiced is impossible, either in part or as a whole. In spite o f all unplanned-

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for possibilities, the com m unity that has a plan, and has taken the necessary steps to develop a capability o f implementing the plan, will find itself well-prepared to adjust to varying conditions. Planning prepares us to make a wise alliance with circumstances. Health mobilization planning at all levels must emphasize the most efficient management and utilization o f resources

in order to ensure the greatest amount of health services to the greatest num ber of people in the event o f a civil defense disaster. I f we direct our attention to the opera­ tional survival plans o f our states and communities and work within the organi­ zation they provide, we will all make significant contributions to the welfare o f the country.

Revisions in G roup Life Insurance Program

COUNCIL ON INSURANCE

T h e Council is pleased to report that continued favorable loss experience under the Association’s G roup L ife Insurance Program has enabled the Council, with the cooperation o f the Great-W est L ife Assurance Com pany, to effect the a d o p ­ tion o f certain revisions in the program which will make it even m ore desirable from the standpoint o f the membership. These revisions, which becom e effective January 1, 1961, will accomplish the fo l­ lowing : 1. A reduction o f $20 in the annual premium charged members in the two lowest age groups insured under Schedule I V ($20,000 benefit). 2. T h e incorporation, without an in ­ crease in rate, o f a provision under which payment o f premiums will be waived for any insured mem ber w h o becomes per­ manently and totally disabled prior to his 60th birthday. 3. T h e incorporation on a permanent basis o f the heretofore experimental p rac­ tice o f issuing paid-up policies for $400 to members insured under Schedule II

($5,000 benefit) and for $500 to m em ­ bers insured under Schedule I I I ($10,000 benefit) or Schedule I V ($20,000 bene­ fit) upon attainment o f age 76. T h e revised schedule o f premiums, as o f January 1, 1961 is shown in the table. T h e Council, in justifying the selective reduction in premiums to the Board o f Trustees, stressed that the over-all favor­ able loss experience under the program had been due principally to excellent ex-

T a b le • R e vise d sc h e d u le o f prem ium s, a s o f J a n u a ry Ì, 1961 Y e a r ly prem ium Age*

$20 ,0 0 0 in s u r a n c e !

H a lf -y e a r ly premium $ 2 0 ,0 0 0 in s u r a n c e !

U p to 30

$ 40.00

31 to 4 0

8 0 .0 0

$ 22.00 42.00

41 to 5 0

160.00

8 2 .0 0

51 to 6 0

260.00

132.00

61 to 7 5 j

300.00

152.00

* A g e nearest birthday, tPlus $10,000 for accide ntal death. ^Renewal prem ium s only. The a g e ance o f risks is 60.

lim it for a c c e p t­

REPORTS OF C O U N C ILS A N D BUREAUS . . . VOLUME 42, JANUARY 1961 • 127/113

perience in the two lowest age groups; that, therefore, considerations o f equity would require that the members o f those groups be the beneficiaries o f any pre­ mium reduction. T h e C ouncil is con ­ fident that the incomparably low cost at which the protection afforded under the plan now can be purchased will induce even m ore young members to participate, thereby assuring a continuation o f the plan’s fine record. T h e Council does not believe that any student member or young active mem ber o f the Association can afford to ignore the extraordinary life insurance bargain available to him through the program. A n insured m em ber under age 60 who is totally disabled on January 1, 1961

m ay file a notice o f claim under the waiver-of-prem ium benefit despite the fact that the disability pre-existed the effective date o f the amendment o f the policy. P roof that the disability has con­ tinued uninterruptedly for at least six months must be given to the company within 60 days after (1 ) the date notice o f claim is given or (2 ) the end o f the six m onth period, if the notice was given during the first six months o f uninter­ rupted disability. U p on receipt o f proper proofs, the com pany will waive all pre­ miums falling due during the continuance o f the disability. A ll notices and proofs should be sent t o : G roup Claims D epart­ ment, T he Great-W est L ife Assurance Com pany, W innipeg, Canada.

A dditions to the Library

BUREAU OF LIBRARY AND INDEXING SERVICE

T h e books listed here have been added recently to the Bureau collection. R e ­ quests for this material, available on loan to all members o f the Association, should be addressed to the Bureau o f Library and Indexing Service. T here is n o charge for borrow ing books, but there is a m ini­ mal charge o f one dollar for each pack­ age library. Practically all the dental journals published in the w orld at pres­ ent are available to members on loan. Lists o f books and package libraries are available on request.

C o m m is s io n

on

th e

S u rvey

o f

D e n t is t r y

Dentistry in the United States; status, needs, and recom­ mendations. Summary report. B. S. Hollinshead, Director. Washington, American Council on Education, 1960. 66 p. $1. C u n h a , E. S. Historia da odontología no Brazil, 1500-1900. 2d ed. Rio, Editora Científica, 1952. 288 p. $4.25. D a l d e r u p , L . M. Nutrition and caries; a few observations in experimental animals. (Thesis— University of Amsterdam.) Am­ sterdam, 1959. 95 p. D e n t a l C lin ics o f N o r t h A m e r i c a , No­ vember, 1960. Symposium on controversies in dentistry. Philadelphia, Saunders, 1960. 328 p. in

th e

D enver BOOKS

U n it e d

Sum m er

van cem en t

S ta tes.

M e e t in g

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fo r

O r t h o d o n t ic

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Ad­

P r a c tic e

R esea rch . 22nd annual meeting, Writers’ Manor, Denver, Colorado, August 2-7, 1959. Denver, 1960. 341 p. $30. l l i s , R. G. The classification and treatment of injuries to the teeth of children; a reference manual for the dental student and the general practitioner. 4th ed. Chicago, Year Book Publishers, 1960. 250 p. $4.50. and

A k tu e lle

B e itr ä g e

zur

Z a h n m e d iz in ;

ausgewählte Vorträge aus den Fortbildungs­ lehrgängen für Zahnärzte 1957 in Dresden und in Leipzig. (Schriftenreihe der ärzt­ lichen Fortbildung No. 5.) Berlin, Volk und Gesundheit, 1959. 147 p. DM17.70. A m e r ic a n o f th e

C an cer

S o c ie ty .

S ta tis tic s

S u b c o m m itte e

Manual of coding. New

C o m m itte e .

tumor nomenclature and York, 1951. 119 p. $2.50. A m e r ic a n

D e n t a l A s s o c ia tio n . B u re a u

E c o n o m ic

R esea rch

and

D en ta l

A s s o c ia tio n .

C a lifo r n ia .

D en ta l

U n iv e r s it y . R e la tio n s .

I n s t it u t e

o f

In ­

C e c ilia

&

L ondoño,

Seminario de anatomía patológica sobre afecciones clinicas e histopatológicas de la pulpa dental. Bogotá, Pontificia Uni­ versidad Católica Javeriana, 1959. 153 p. rew e, H. E. Dringliche Chirurgie beim Säugling und Kind. Stuttgart, Thieme, 1959. 180 p. DM25.

I n te r n a tio n a l O ffic e f o r D e n t a l H e a lt h

S c h o o ls .

Prepaid dental care conference, April 29-30, 1960, at the Statler Hilton Hotel, Los Angeles, California. Los Angeles, 1960. 57 p. Mimeo. C h a v e s , M. M. Manual de odontologia sani­ taria. Vol. 1 : Teoria da odontologia sani­ taria. Säo Paulo, 1960. 391 p. d u s tr ia l

G

C o u n c il

Conference on utilization and training of dental as­ sistants, September 13-15, 1960. Chicago, 1960. 151 p. B l a c k m a n , S y d n e y . An atlas of dental and oral radiology. Bristol, Wright, 1959. 371 p. $15. o f

A g u ile r a ,

E d u ardo.

o f

o n D e n t a l E d u c a t io n & A m e r ic a n A s s o ­ c ia tio n

F a ja r d o

S ta tis tic s .

Facts about states for the dentist seeking a location. Chicago, 1960. 34 p. A m e r ic a n

E

In fo r m a tio n .

Cataloge.

Zurich,

1960.

36 p. W. W. The jaws and teeth of pri­ mates; photographs and commentaries. London, Pitman, 1960. 328 p. $21. a c i n t o s h , R. R. & B a n n i s t e r , F . B . Grund­ lagen der Allgemeinnarkose. Berlin, Volk und Gesundheit, 1960. 341 p. DM29.90.

Jam es,

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O r t h o d o n t ic

D ir e c t o r y

o f

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W o r ld .

20th ed. Edited by O. A. Oliver and W . H. Oliver. Nashville, Tenn., American Associa­ tion of Orthodontists, 1960. 272 p. Pe l t o n , W . J .; B o t h w e l l , R u t h

&

V avra,

H. M. The dental profession in the Mid­ west. (U . S. Public Health Service publica-

REPORTS OF C O U N C IL S A N D BUREAUS ... VOLUME 62, JANUARY 1961 • 129/115

tion No. 751.) Washington, Govt. Print. Off., 1960. 20 p. $0.15. P e l t o n , W. J. & R o w a n , J. C. Digest of prepaid dental care plans, 1960. (U. S. Public Health Service publication No. 585.) Washington, U. S. Public Health Service, 1960. 103 p. P o l l o c k , M. I. The assistant’s role i n the dental profession. Toronto, Canadian Na­ tional Refining Co., 1959. 45 p. $1.50. P o r t , T h e o d o r . Vademecum der Mundkrankenheiten. Munich, Pflaum, 1959. 135 p. $2. R a m m , J a c o b . Den Norske Tannlaegeforening gjennom 75 ár, 1884-1959. Oslo, 1959. 355 p. R o d r íg u e z

C a b r a le s ,

S e lm a ;

O s o r io

F er­

Las corrientes eléctricas y su aplicación en endodoncia. (Seminario para optar al título de doctores en odontología— Pontificia Univer­ sidad Católica Javeriana.) Bogotá, 1959. 49 p. n a n d e z , C e c ilia

R o d r íg u e z

& L la n o s , E n r iq u e .

G a r a v it o ,

A d e la

&

O th e rs.

Valor de la radiografía coronal en el diag­ nostico de las caries proximales incipientes. (Seminario para optar el título de doctores en odontología — Pontificia Universidad Católica Javeriana.) Bogotá, 1959. 93 p. R o j a s , A r m a n d o . Exámen y profilaxis en odontopediatría. (Thesis— Pontificia Uni­ versidad Católica Javeriana.) Bogotá, 1958. 64 p. S á n ch ez, C a r lo s & O th e rs. Trastornos causados por la exodoncia prematura de los dientes temporales. (Seminario de odontopediatría — Pontificia Universidad Católica Javeriana.) Bogotá, 1959. 71 p. S c h u e r m a n n , H a n s . Krankheiten der Mund­ schleimhaut und der Lippen. 2d ed. Munich, Urban & Schwarzenberg, 1958. 524 p. $22.50. S h a p ir o , R o b e r t & J a n z e n , A. H. The normal skull; a roentgen study. New York, Hoeber, 1960. 257 p. $18. S o r r i n , S i d n e y , ed. The practice of periodontia. New York, McGraw-Hill, 1960. 496 p. $19.50. S p r e n g , M a x . Allergie und Zahnmedizin; eine Einführung für Zahnärzte und Studierende. (Allergie- und Asthmaforschung, Band 2.) Leipzig, Barth, 1959. 137 p. $3.25. S t o c k f i s c h , H u g o . Die neuzeitliche kiefer­ orthopädische Praxis; ein kieferorthopä­ disches Vademecum. 2d ed. Heidelberg, Hüthig, 1959. 456 p. DM48. S to c k h o lm s T a n d lä k a r fö r e n in g . Jubileumsskrift, 1908-1958. Stockholm, 1958. 139 p.

R o m u a l d . Herstellung kieferortho­ pädischer Apparate. Berlin, Volk und Ge­ sundheit, 1960. 83 p. DM13.70.

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S. D e p a r t m e n t

o f

H e a lt h , E d u c a t io n ,

Health, education, and wel­ fare trends. Washington, Govt. Print. Öff., 1960. 90 p. $0.50. U. S . N a t i o n a l H e a l t h S u r v e y . Loss of teeth, United States, July 1957 - June 1958; statistics on persons who have lost all their permanent teeth, by age, sex, residence, ■ region, race, income, education, time inter­ val since last dental visit, and volume of dental visits. Based on data collected in household interviews during July 1957 June 1958. (Its Health statistics, ser. B22.) Washington, U. S. Public Health Service, 1960. 26 p. $0.25. U. S. N a v a l D e n t a l S c h o o l . Dental tech­ nician, general. (NAVPERS 10686-A.) Washington, Govt. Print. Off., 1958. 588 p. $2.25. U. S. N a v y D e n t a l C o r p s . Dental officer training programs. Prepared by the Dental Division, Bureau of Medicine and Surgery, Department of the Navy and the U. S. Naval Dental School, National Naval Medi­ cal Center. Bethesda, Md., 1960. 141 p. Mimeo. W a d e , A. B. Basic periodontology. Bristol, Wright, 1960. 303 p. $10. an d W e lfa r e .

W h ite

H ou se

C o n fe r e n c e

on

C h ild r e n

1960; conference proceedings, March 27-April 2, 1960. Washington, Golden Anniversary White House Confer­ ence on Children and Youth, Inc., 1960. 429 p. i e g e l , P a u l . Zahnärzte und Zahnbehand­ lung im alten Frankfurt am Main bis zum Jahre 1810. (Beiträge zur Geschichte der Zahnheilkunde, Heft 2.) Munich, Barth, 1957. 96 p. $5.

and Y o u th ,

W

PERIODICALS

DDA

R e fle c to r .

D e n ta l P rogress. J ou rn a l

o f

fe r e n c e s . Jou rn al

o f

(Denver) (Chicago)

C lin ic a l

S to m a to lo g y

C on­

(New York) th e

In d ia n

A cad em y

o f

D en­

D en ta l

S u r­

(Bombay)

t is t r y .

In fo rm a tio n s , geons

o f

C o lle g e th e

o f

P r o v in c e

o f

Q u ebec.

(Montreal) P r o te s is

D e n t a l.

S ou th ern g ie n is ts ’

Angeles)

(Madrid)

C a lifo r n ia

S ta te

A s s o c ia t io n

D en ta l

J o u r n a l.

H y-

(Los

130/114 • THE JO U R N A L OF THE A M E R IC A N DENTAL A SSO C IA TIO N

The 1959 survey of dental practice V III. N um ber of patients and patient visits; recall system s

BUREAU OF ECONOMIC RESEARCH AND STATISTICS

Self-em ployed dentists participating in this survey were asked to indicate, if pos­ sible, the num ber o f patients (in d i­ viduals) treated during 1958. T hey were also asked to record the num ber o f pa­ tient visits (sittings) and the num ber o f new patients during this same period. T h e relative difficulty experienced by dentists in answering these questions is reflected in the low rate o f response. R ough ly 60 per cent o f the respondents did not indicate the num ber o f patients treated and ap­ proximately half did not answer the ques­ tions relating to num ber o f patient visits and num ber o f new patients. T a b le 5 4 • P e r c e n ta g e d istribution d entists b y n um ber o f p a tie n ts in 195 8

of

n o n s a la r ie d

N um ber of p atients

P e r ce n t o f dentists

C u m u la tiv e p e r ce n t

99 1 0 0 - 199 2 0 0 - 299 3 0 0 - 3 99 4 0 0 - 4 99 5 0 0 - 5 99 6 0 0 - 6 99 7 0 0 - 7 99 8 0 0 - 8 99 9 0 0 - 9 99 1 ,0 00 -1,09 9 1 ,1 00 -1,19 9 1 ,2 00 -1,29 9 1 ,3 0 0 -1 ,3 9 9 1 ,4 00 -1,49 9 1 ,5 0 0 -1 ,5 9 9

1.6 3.9 4.2 7.2 6.8 6.9 7.8 6.0 5.3 4.0 10.1 2.5 5.9 1.1 1.6 4.5

1.6 5.5 9.7 16.9 23.7 30.6 38.4 44.4 49.7 53.7 63.8 66.3 72.2 73.3 74.9 79.4

1 ,6 0 0 -1 ,9 9 9 2 ,0 0 0 -2 ,3 9 9 2 ,4 0 0 -2 ,7 9 9 2 ,8 0 0 -3 ,1 9 9 3 ,2 0 0 -

4.4 5.3 3.2 3.0 4.7

83.8 89.1 92.3 95.3 100.0

T h e distribution o f nonsalaried dentists according to num ber o f patients treated is shown in T able 54. T h e outstanding characteristics o f this distribution are its extremely w ide spread and the tendency for each grouping o f num ber o f patients to be equally dense. Respondents tended to present the num ber o f patients in multiples o f 25 fo r less than 1,000 patients and in multiples o f 250 fo r 1,000 o r more patients. This clustering was absent in the distribution relating to num ber of patient visits (T a b le 5 5 ). Some o f the factors affecting the num­ ber o f patients are location o f practice, age o f the dentist, type o f practice arid certain aspects o f practice organization and management. H ow ever, it is apparent that these factors d o n ot account for all o f the total variation exhibited by the disT a b le 5 5 * P e r c e n t a g e d istrib u tio n o f n o n s a la rie d de ntists b y n um be r o f p a tie n t v isits d u rin g 1958 Num ber of pa tie n t visits

Per cent of

- 499 5 0 0 - 999 1 ,0 00 -1,49 9 1 ,5 00 -1,99 9 2 ,0 0 0 -2 ,4 9 9 2 ,5 0 0 -2 ,9 9 9 3 ,0 0 0 -3 ,4 9 9 3 ,5 0 0 -3 ,9 9 9 4 ,0 0 0 -4 ,4 9 9 4 ,5 0 0 -4 ,9 9 9 5 ,0 0 0 -5 ,4 9 9 5 ,5 0 0 -5 ,9 9 9 6 ,0 0 0 -6 ,4 9 9 6 ,5 0 0 -6 ,9 9 9 7 ,0 0 0 -

2.2 3.1 5.4 10.7 15.6 13.7 14.0 11.4 7.1 5.8 4.0 1.4 2.1 .9 2.6

de n tists

C u m u la tive p e r ce n t 2.2 5.3 10.7 21.4 37.0 50.7 64.7 76.1 83.2 89.0 93.0 94.4 96.5 97.4 100.0

REPORTS OF C O U N C ILS A N D BUREAUS ... VOLUME 62, JA N U A RY 1961 • 131/117

T a b le 5 6

• A ve rag e

n um be r o f patie n ts a n d

p a tie n t visits o f n o n s a la r ie d

dentists in

1958, b y r e g io n

R e g io n

A v e ra g e no. o f p a tie n ts

A v e r a g e n o. o f p a tie n t visits

M ean

M e d ia n

M ean

M e d ia n

N e w E n gla n d M id d le East S o u t h e a st S o u th w e st C e n t ra l N o rth w e st Far W e s t

1,061 1,047 1,448 1,353 1,123 1,471 1,227

798 700 1,070 1,001 853 1,001 8 99

3,300 3,147 3,356 2,744 2,926 3,158 3,371

3,300 2,998 3,014 2,607 2,646 2,718 2,7 50

U n ite d S ta te s

1,184

9 00

3,130

2,899

tribution shown in T able 54. A consider­ able amount o f the residual variation a p ­ pears to be due to an error factor. A clue to the nature o f the error factor is sup­ plied by the tendency to answer in multi­ ples o f 25 or 250, which indicates that the answers supplied are approximations and are not based on accurate accounting. For this reason, and because o f the rela­ tively high nonresponse, statistics on num ­ ber o f patients are regarded as being less reliable than most statistics presented in this survey. T h e distribution o f nonsalaried dentists according to num ber o f patient visits tends to show a response error consider­ ably less than for num ber o f patients (T a ble 5 5 ). A dentist can readily refer to his appointm ent book and actually count the number o f appointments for the year, or count the num ber o f appointments during a typical week and multiply that number by the total num ber o f weeks worked during the year. T h e m ean number o f patients reported by nonsalaried dentists was 1,184 and the median 900. R ough ly 25 per cent had 500 or less patients and another 25 per cent had 1,500 or m ore patients. O w in g to this wide variation, it is difficult to typify a dentist according to num ber o f patients. T h e m ean o f 1,184 patients represents an increase o f 27 per cent over the mean in 1949, 17 per cent over 1952 and 12 per cent over 1955.

T h e mean number o f patient visits dur­ ing 1958 was 3,130 and the m edian was 2,899. Accordingly, the m ean num ber o f visits per patient during 1958 was 2.6. This compares with 2.8 visits per patient during 1952 and 1955. Based on the mean o f 1,184 patients per nonsalaried dentist, it is estimated that 81,000,000 people, or 47 per cent o f the civilian population, saw the dentist during 1958. LOCATION

T able 56 presents the average num ber of patients and patient visits by region. As one would expect, regions with a rela­ tively high ratio o f population to dentists also had a relatively high average num­ ber o f patients per dentist. It is interesting to note the inverse re­ lationship between the number o f patients and the average num ber o f visits per pa­ tient. T here is a strong tendency for regions with a smaller number o f patients per dentist to have a higher average num­ ber o f visits per patient. N ew England re­ ported the highest average num ber o f visits per patient with 3.1, follow ed by 3.0 in the M id d le East, 2.7 in the Far W est, 2.6 in the Central region, 2.3 in the Southeast, 2.1 in the Northwest and 2.0 in the Southwest. T here are several possible reasons for variation in number o f visits per patient.

132/118 • THE JO U R N A L OF THE A M E R IC A N DENTAL A SSO C IA TIO N

Table 5 7 • A v e r a g e num ber o f p a tie n ts a n d p a tie n t visits o f n o n s a la r ie d de n tists in 1958, b y s iz e o f city a n d f o r f o u r la r g e cities A v e r a g e no. o f p a tie n ts

C it y s iz e o r city

M ean

M e d ia n

M ean

M e d ia n

U n d e r 1,000 1 ,0 00 -2,50 0 2 ,5 0 0 -5 ,0 0 0 5 ,0 0 0 -1 0 ,0 0 0 10,00 0 -2 5 ,0 00 2 5,0 0 0 -5 0 ,0 0 0 5 0 ,0 0 0 -1 0 0 ,0 0 0 1 0 0 ,0 0 0 -2 50 ,0 0 0 2 5 0 ,0 0 0 -5 0 0 ,0 0 0 5 0 0 ,0 0 0 -1 ,0 0 0 ,0 0 0 O v e r 1,000,000

1,047 1,281 1,260 1,262 1,343 1,354 1,219 991 1,134 1,173 937

7 00 1,004 1,005 1,001 9 98 901 9 99 801 970 7 59 597

2,645 2,838 2,819 3,441 3,227 3,017 3,243 3,219 3,248 2,805 3,236

2 ,0 35 2 ,8 00 2 ,8 33 2 ,9 50 3,032 2,8 00 3,018 3,020 2,958 2 ,5 2 5 2,9 60

A ll city s iz e s

1,184

9 00

3,130

2,899

N e w Y o rk

690 636 1,794 1,292

501 600 650 700

3,116 2,900 4,370 3,037

3 ,0 22 2 ,4 88 2 ,6 55 2,988

C h ic a g o Los A n g e le s P h ila d e lp h ia

Table 58 • A v e r a g e n u m b e r o f p a tie nts a n d pa tie n t visits o f n o n s a la r ie d dentists in 1958, b y a g e o f de n tist

A g e of dentist

A v e r a g e no. o f patients Mean

'

A v e r a g e no. o f pa tie n t visits

A v e r a g e no. o f p a tie n t visits

M e d ia n

M ean

M e d ia n

-2 9 3 0 -3 9 4 0 -4 9 5 0 -5 9 6 0 -6 9 70-

492 1,284 1,196 1,178 938 *

303 941 905 9 96 797 *

1,517 3 ,3 80 3,323 3,031 2,293 *

1,560 3,0 04 3 ,0 0 0 2 ,6 1 0 1,803 *

A ll a g e s

1,184

900

3,130

2,899

*T oo few replies fo r re liab le statistics.

T h e average need for dental care m ay be less in some areas than in others. M ore people may receive com plete care in some regions than in others. Variation in length o f appointm ent may be a large factor in the variation in ^umber o f visits per pa­ tient. T h e average number o f patients and patient visits by city size, and for four large cities, is shown in T a b le 57. A m on g places with a population o f less than 1,000 or m ore than 100,000, the m ean number o f patients was below the national mean o f 1,184.

Table 59 • A v e r a g e n um ber o f p a tie n ts a n d p a tie n t visits o f n o n s a la r ie d de ntists in 1958, b y ty p e o f p ra c t ic e •

T y p e o f p ra c t ic e

A v e r a g e n o. o f patie n ts

A v e r a g e no. o f pa tie n t visits

M ean

M e d ia n

M ean

M e d ia n

G e n e r a l p ra c titio n e r S p e c ia list O r a l s u rg e o n O r th o d o n t is t P e d o d o n tist O t h e r sp e c ia lists

1,191 1,053 2,507 323 1,263 1,137

900 515 2,500 200 1,013 800

3,082 3,757 3,844 4,336 4,044 2,601

2,8 58 3,675 3,500 4,7 50 3,609 2,5 50

A ll ty p e s o f p ra c tic e

1,184

900

3,130

2,899

REPORTS OF C O U N C ILS A N D BUREAUS .. .VO LU M E 62, JANUARY 1961 • 133/119

T a b le 6 0 • A v e r a g e n u m b e r o f p a tie n ts a n d p a tie n t visits o f n o n s a la r ie d de n tists in 1958 a c c o r d in g t o t y p e o f p r a c t ic e o r o r g a n iz a t io n

T y p e o f p ra c t ic e o r g a n iz a t io n

N o n s a la r ie d p r a c t ic e w ith o u t p a rtn e rs a n d w ith n o s h a r in g o f c o sts N o n s a la r ie d p r a c t ic e w ith o u t p a rtn e rs, but sh a rin g c o s t s o f o f fic e s o r assistants, etc. N o n s a la r ie d p r a c t ic e a s a p a rtn e r in a c o m ­ p le te p a rtn e rsh ip

T h e m ean num ber o f patients for the two largest cities, N ew Y ork and Chicago, was m uch lower than the national mean. T h e mean num ber o f visits per patient was also the largest for these two cities with 4.5 and 4.6 visits per patient respec­ tively. T h e mean num ber o f patients for Los Angeles and Philadelphia was m uch larger than the m edian, indicating that a few dentists from these cities reported an unusually large num ber o f patients.

A v e r a g e no. o f p a tie n ts

A v e r a g e no. o f p a tie n t visits

M ean

M ean

M e d ia n

M e d ia n

1,157

900

3,117

2,880

1,228

863

3,057

2,700

1,954

1,400

4,5 38

3,500

extreme variability in the num ber o f pa­ tients according to type o f practice with the oral surgeons having a mean o f 2,507 patients and orthodontists with a mean o f 323 patients. T h e average num ber of visits per patient varied from 13.4 for orthodontists to 1.5 for oral surgeons. Specialists as a group had 3.6 visits per patient; general practitioners had 2.6. PRACTICE ORGANIZATION AND MANAGEMENT

AGE; TYPE OF PRACTICE

T h e num ber o f patients and patient visits vary considerably according to the age o f the dentist (T able 5 8 ). Dentists under 30 averaged only 492 patients and 1,517 patient visits. T h e highest average num ­ ber o f patients (1,284) and patient visits (3,380) was reached by dentists in their 30’s. T h e decline was relatively small for dentists in their 40’s and 50’s but substan­ tial for dentists in their 60’ s. T h e peak in both num ber o f patients and incom e was reached by younger den­ tists in the current survey than in the 1956 survey. T h e average num ber o f visits per pa­ tient was highest am ong dentists under 30 (3.1 visits per patien t), was about equal to the over-all average o f 2.6 for dentists 30 through 59, and was lowest for dentists in their 60’s. T ype o f practice accounts for some o f the total variation in number o f patients shown in T able 54. T able 59 shows the

T h ere is surprising amount o f variation in the num ber o f patients and patient

T a b le 6 1 • M e a n n u m b e r o f patie nts a n d patient v isits o f n o n s a la r ie d dentists b y num ber o f e m p lo ye e s, 1 95 8 N u m b e r o f e m p lo y e e s M e a n no. o f patie n ts

M e a n no. o f pa tie n t visits

0 1 2

7 42 710 1,095

2,2 72 2,376 2,742

1 1 1

0 1 2

1,166 1,242 1,404

3,014 3,182 3,237

2 2

0 1

1,530 1,607

3,174 4,005

3

0

1,931

3,929

*

*

Full tim e f

Part t im e f

0 0 0

4 o r m o re

0

*T o o few replies fo r re liab le statistics. f ’FulI t im e " m eans full-tim e positions o ccupied^ all year, and " p a r t t im e " m eans either pa rt-tim e positions or positions filled only part o f the year.

134/120 • THE JO U R N A L OF THE A M E R IC A N DENTAL ASSO C IA TIO N

Table 62 • M e a n

n u m b e r o f p a tie n ts a n d patie nt visits o f n o n s a la rie d de ntists in 195 8 a c c o r d in g to n um b er o f d e n ta l c h a irs

N u m b e r o f c h a irs

M e a n no. o f p a tie n ts

M e a n no. o f pa tie n t visits

1 2 3 4 5 o r m ore

781 1,193 1,532 2,1 18 *

2,4 40 3,201 3,643 4,975 *

A ll n o n s a ia rie d dentists

1,184

3,130

*T o o few replies fo r re liab le statistics.

Table 63 * M e a n

n um b e r o f p a tie n ts a n d patient visits o f n o n s a ia rie d de ntists in 195 8 b y num be r o f d e n ta l units u se d

N u m b e r o f units

M e a n no. o f p a tie n ts

M e a n no. o f pa tie n t visits

1 2 3 4 o r m o re

848 1,207 1,471 3,0 59

2,479 3,223 3,7 55 5,581

A ll n o n s a ia rie d dentists

1,184

3,130

visits according to the way practice is organized (T a b le 6 0 ). Dentists in com ­ plete partnership reported a m ean num ­ ber o f patients o f 1,954 per dentist, 68.9 per cent m ore than dentists with solo practice with no sharing o f costs, and 59.1 per cent m ore than dentists in solo prac­ tice w ho shared costs. T h e ratio o f num ­

ber o f patient visits to num ber o f patients, however, was the lowest for dentists in com plete partnership, with 2.3 visits per patient. This compares with 2.7 visits per patient reported by dentists in solo prac­ tice with no sharing o f costs and 2.5 visits per patient by dentists in solo practice w ho shared costs. T able 61 shows the mean number of patients according to number o f em ­ ployees without regard to type o f em ­ ployee or num ber o f chairs and units. T h e m ean num ber o f patients increased from 742 for dentists with no employees to 1,166 for dentists with one full-time em­ ployee, 1,530 for dentists with two and 1,931 for dentists with three full-time em ­ ployees. A lthough the num ber o f patients and patient visits increases with num ber o f chairs and units (Tables 62 and 6 3 ), the ratio o f num ber o f patient visits to num ­ ber o f patients decreases from 3.1 for onechair offices to 2.7 for tw o-chair offices, 2.4 for three-chair offices and 2.3 for fourchair offices. A similar trend in the aver­ age visits per patient prevails according to num ber o f units. T h e average num ber o f patients and patient visits according to average wait for an appointm ent has an interesting pattern (T a b le 6 4 ). T h e mean num ber of patients increases steadily from 761 for one or tw o days o f waiting and reaches a

Table 64 • A v e r a g e n u m b e r o f p a tie nts a n d p a tie n t visits o f n o n s a la r ie d dentists a c c o r d ­ in g to average w a if f o r a n a p p o in tm e n t in 1958

A v e r a g e w a it

A v e r a g e no. o f patie n ts

A v e ra g e no. o f p a tie n t visits

M ean

M e d ia n

M ean

M e d ia n

O n e o r tw o days T h r e e to six d a y s O n e w eek T w o w eeks T h re e w eeks Four w eeks F iv e w e e k s S ix w e e k s o r m o re

761 1,180 1,028 1,351 1,470 1,477 1,591 1,420

497 708 802 1,000 1,050 1,200 1,485 1,013

2,3 18 2,841 3,119 3,449 3,729 3,655 3,209 3,767

2,000 2,500 2,880 3,000 3,490 3,475 2,818 3,600

A ll n o n s a ia rie d dentists

1,184

900

3,130

2,899

REPORTS OF C O U N C ILS A N D BUREAUS

. VO LUM E 62, JANUARY 1961 • 135/121

T a b le 6 5 • A v e r a g e n u m b e r o f p a tie n ts a n d p a tie n t visits o f n o n s a la r ie d de ntists in 1958, a c c o r d in g to d e s c r ip tio n o f p ra c t ic e

D e s c r ip tio n o f p ra c tic e

A v e r a g e no . o f p a tie n ts

A v e r a g e no. o f p a tie n t visits

M ean

M e d ia n

M ean

M e d ia n

1,476

1,104

3,541

3,390

1,467

999

3,834

3,500

1,056

801

2,921

2,600

659

4 97

2,027

1,900

1,184

900

3,130

2,899

B e c a u se o f the len gth o f y o u r a p p o in tm e n t list, s o m e p e r s o n s w h o c o n ta c t e d y o u f o r d e n ta l c a r e a c t u a lly o b t a in e d this c a r e from a n ­ o t h e r dentist Y o u p r o v id e d d e n ta l c a r e f o r a ll w h o re q u e ste d a p p o in tm e n ts, but y o u felt m o re rushed a n d w o r k e d m o re h o u rs than y o u w o u ld h a v e liked (you felt " o v e r w o r k e d " ) . Y o u p r o v id e d d e n ta l c a r e f o r all w h o re q u e ste d a p p o in tm e n ts, a n d d id n o t fee! " o v e r w o r k e d . ” Y o u d id n o t h a v e a s m a n y p a tie n ts a s y o u w o u ld h a v e liked. H o w m a n y m o re p a tie n ts w o u ld y o u h a v e lik e d ? A ll n o n s a la r ie d dentists

peak o f 1,591 patients at five week wait­ ing period. It then drops to 1,420 patients at waiting period o f six weeks or longer. T h e mean num ber o f patient visits, on the other hand, rises from 2,318 for one or two days o f waiting and reaches its m axi­ mum o f 3,729 at three weeks average wait. It then gradually declines to 3,209 at five weeks and takes a sudden jum p to 3,767 for dentists with average wait o f six weeks or longer. T h e medians display a

corresponding pattern. Both average wait for an appointm ent and average number o f patients vary greatly by type o f prac­ tice, which m ay som ehow account for this unusual pattern. Dentists were asked to check one of fou r statements describing varying de­ grees o f busyness during the year 1958. Those dentists w h o were unable to care for all patients seeking treatment, and those dentists w h o felt overworked in

T a b le 6 6 • A v e r a g e n um be r o f p a tie n ts a n d p a tie n t visits o f n o n s a la r ie d de ntists in 1958 a c c o r d in g to s p e e d n o rm a lly use d in o p e r a tin g a h a n d p ie c e

Speed

L ow In te rm e d ia te H ig h Super

A v e r a g e no. o f patients

A v e r a g e no. o f p a tie n t visits

Mean

M e d ia n

M ean

M e d ia n

1,032 1,040 1,263 1,261

8 75 825 1,027 1,001

2,5 35 2,908 3,156 3,407

2,300 2,650 2,880 3,000

L o w a n d in te rm e d ia te L o w a n d high Low a nd su pe r In te rm e d ia te a n d high In te rm e d ia te a n d s u p e r H ig h a n d s u p e r

835 *

6 50 *

2,751 *

2,650 *

1,100 *

990 *

2,894 *

2,552 *

1,329 1,233

850 900

2,9 45 2,936

2,900 3,000

A ll s p e e d s

1,184

9 00

3,130

2,8 99

u e T in iT io n s : l o w sp e e a — un a e r i u .u w rpm . im erm eai H ig h s p e e d — 30,000 rpm to 99,999 rpm. Su p e r s p e e d *T oo f e w replies fo r reliable statistics.

136/122 • THE JO U R N A L OF THE A M E R IC A N DENTAL A SSO C IA T IO N

Table 67 • A v e r a g e n um be r o f n e w p a tie nts o f n o n ­ s a la rie d dentists in 1958, b y r e g io n R e g io n

Mean

M e d ia n

N e w E n g la n d M id d le East S o u t h e a st S o u t h w e st C e n t ra l N o rth w e st Far W e s t

212 232 373 509 261 260 266

146 123 251 2 99 155 220 198

U n ite d S ta te s

278

175

T a b le 6 8 • A v e r a g e n u m b e r o f n e w p a tie n ts o f n o n ­ s a la rie d dentists in 1958, b y a g e o f dentist A g e o f dentist

M ean

M e d ia n

-2 9 3 0 -3 9 4 0 -4 9 5 0 -5 9 6 0 -6 9 70-

3 64 340 2 79 184 112 *

3 00 173 175 100 60 *

A ll a g e s

2 78

175

•Too few replies fo r re lia b le statistics.

T a b le 6 9 • M e a n n um ber o f n e w p a tie n ts a c c o r d in g to ty p e o f p r a c t ic e

Type of practice

G e n e r a l p ra c t it io n e r S p e c ia lis t O r a l su rg e o n O r t h o d o n t is t P e d o d o n t is t O t h e r sp e c ia lists

M e a n no. o f n e w patients 253 461 1,729 109 393 3 16

doing so, averaged about 1,470 patients, com pared to 1,184 for all nonsalaried dentists (T a b le 6 5 ). Dentists w h o cared for all w ould-be patients and did not feel overworked averaged 1,056 patients, g.nd dentists w h o said they d id n ot ha.ve enough patients averaged 659 patients. Dentists w ho used low and interme­ diate speed handpieces exclusively aver­ aged about 1,035 patients (T a b le 6 6 ). T hose w h o used high and super speed handpieces averaged 1,262 patients. Highest average num ber o f patients (1,329) was recorded by dentists using a com bination o f super and intermediate equipment.

Table 71 • P e r c e n ta g e o f n o n s a la r ie d de n tists w ith a re c a ll system , b y s iz e o f city a n d f o r s ix la r g e cities C it y s iz e

P e r ce n t

U n d e r 1,000 1 ,0 0 0 -2 ,5 0 0 2 ,5 0 0 -5 ,0 0 0 5 ,0 0 0 -1 0 ,0 0 0 1 0,0 0 0 -2 5 ,0 0 0 2 5 ,0 0 0 -5 0 ,0 0 0 5 0 ,0 0 0 -1 0 0 ,0 0 0 1 00 ,0 0 0 -2 5 0 ,0 0 0 2 5 0 ,0 0 0 -5 0 0 ,0 0 0 5 00 ,0 0 0 -1 ,0 0 0 ,0 0 0 O v e r 1,000,000

75.5 74.3 81.7 86.3 87.3 84.6 85.8 88.3 82.4 82.2 82.6

A ll c ity s iz e s

84.0

N e w Y o rk C h ic a g o Los A n g e le s P h ila d e lp h ia D e t ro it C le v e la n d

84.1 72.5 80.6 88.0 89.5 86.2

Table 7 0 • P e r c e n ta g e o f n o n s a la rie d dentists w ith a

Table 72 • P e r c e n ta g e o f n o n s a la r ie d dentists w ith a

re c a ll system , b y a g e o f de n tist

re c a ll system w h o in c lu d e d patie nts w ith t w o co m p le te d e n tu re s, b y a g e o f dentist

A g e o f dentist

P er cen t

-2 9 3 0 -3 9 4 0 -4 9 5 0 -5 9 6 0 -6 9 70-

96.6 92.0 84.1 77.2 68.8 47.1

A ll a g e s

84.0

A g e o f dentist -2 9 3 0 -3 9 4 0 -4 9 5 0 -5 9 6 0 -6 9 70A ll a g e s

P e r ce n t 4 2.0 2 8.3 24.5 22.4 26.3 34.4 26.8

REPORTS OF C O U N C ILS A N D BUREAUS .. .V O LU M E 62, JAN UARY 1961 • 137/123

T a b le 7 3 • P e r c e n ta g e o f n o n s a la r ie d dentists h a v in g a re c a ll system a n d in clud in g p a tie n ts w ith t w o co m p le te d e n tu re s w h o p r o v id e d sp e c ifie d ty p e s o f se rv ic e , b y a g e o f dentists Age T y p e o f se rv ic e

C le a n in g a n d p o lis h in g d e n tu re s O c c lu s a l e q u ilib ra tio n C h e c k f o r fit a n d adjustm ent O r a l e x a m in a tio n N o t e ls e w h e r e c la ssifie d

-2 9

3039

4049

5059

6069

74.5 51.1 25.5 17.0 .0

74.7 67.8 36.5 18.7 1.0

84.7 76.7 27.0 12.9 1.8

77.6 87.8 29.6 16.3 7.1

68.6 84.3 35.3 17.6 17.6

70-

A ll ages

* * * * *

77.1 73.0 31.9 16.5 4.4

*T o o few replies fo r re liab le statistics.

N E W PATIENTS IN

1958

T o the question “ Approxim ately how many new patients did you have in 1958?” the m ean reply was 278 and the median was 175 (T able 6 7 ). T h e mean reported by dentists in the Southwest (5 0 9 ) was far higher than in any other region. By age, young dentists, o f course, reported the greatest number o f new pa­ tients (T a b le 6 8 ). In fact, 75 per cent o f all 1958 patients reported by dentists under 30 were new patients. T w o groups o f specialists deviated markedly from the average in num ber o f new patients. O ral surgeons reported a mean o f 1,729 new patients in 1958 and orthodontists a mean o f 109 new patients (T a b le 6 9 ). THE RECALL SYSTEM

Nonsalaried dentists participating in the survey were asked if they had a recall sys­ tem to rem ind patients when it is time to com e to the office. Eighty-four per cent o f the respondents indicated they had a re­ call system. T h e m ean number o f patients reported by dentists with a recall system was 1,171 which compares with the mean o f 1,264 for dentists without recall system. T h e m ean num ber o f patient visits o f dentists with a recall system was 3,185, or 510 visits greater than for dentists without recall system. T h e percentages o f nonsalaried dentists having a recall system according to age

o f dentist and by city size and fo r six large cities are shown in T a b le 70 and Table 71, respectively. O ld er dentists and dentists in small towns were below average in use o f recall systems. T h e participating dentists were asked if their recall system included pa­ tients fo r w hom two com plete dentures had been provided. A bout one fourth o f dentists with recall systems included pa­ tients with tw o com plete dentures (T a b le 7 2 ). Dentists w h o included patients with tw o com plete dentures in their recall sys­ tem were asked to indicate the type of service(s) provided. T able 73 shows the type o f services provided according to the age o f dentist. It should be noted that the relatively low percentages for “ check for fit and adjustment” and “ oral examina­ tion” may result from the fact that these were “ write-in” replies whereas others were “ ch eck -off” replies. Dentists were also asked if they ac­ cepted patients o f all ages and if not, w hich age g ro u p (s) they excluded. A large m ajority o f nonsalaried dentists, 89.4 per cent, stated they accepted pa­ tients o f all ages. A total o f 4.8 per cent excluded children and 1.5 per cent ex­ cluded adults. A large proportion of dentists w ho excluded adults were special­ ists. T h e next article in this series will pre­ sent inform ation on “ dentist busyness” as perceived by the dentist himself, and on length o f wait for an appointment.

138/124 • THE JO U R N A L O F THE A M E R IC A N DENTAL A SSO C IA TIO N

Survey of hospital dental departm ents I. Introduction

BUREAU OF ECONOMIC RESEARCH AND STATISTICS

Between 1948 and 1958 the num ber o f hospitals with dental departments in­ creased from 1,806 to 2,352. D uring this period, there was, o f course, an increase in the total num ber o f hospitals, and the increase in the percentage o f hospitals having dental departments was m oder­ ate: from 29.3 per cent in 1948 to 34.5 per cent in 1958.1 W ith an average increase o f over 50 hospital dental departments per year, and. with growing realization that a hospital without a dental department is n ot p ro ­ viding a com plete health service, it was decided late in 1959 to con d uct a survey o f hospital dental departments. T h e pur­ pose o f the survey was to obtain statistical inform ation on the scope and character­ istics o f hospital dental service. Results o f the survey should provide new insight into the problem s o f hospital dental de­ partments and provide direction for im ­ provements and further study. T h e in for­ mation obtained in the survey will be particularly useful in the programs o f the C ouncil on Hospital D ental Service and the C ouncil on Dental Education. Questionnaires were sent to the chiefs o f the dental service o f 2,352 hospitals listed by the Am erican Hospital Asso­ ciation as having dental departments. Com pleted questionnaires were received from 1,004 hospitals with dental de­ partments, a return o f 42.7 per cent (T a b le 1 ). T h e results o f the survey will be m ore m eaningful if considered in the light o f statistics on the prevalence o f dental d e­ partments in the various types o f hos­

pitals. A lthough 34.5 per cent o f all hospitals had dental departments in 1958, this figure varied greatly according to ownership or control o f the hospital and other factors. O f all federal hospitals, 96.9 per cent had dental departments, com pared to 56.0 per cent o f all hospitals owned by state and local governments, 23.4 per cent o f voluntary (nonprofit) hospitals and only 10.8 per cent o f pro­ prietary hospitals. In psychiatric hos­ pitals, the percentage with dental de­ partments was 100 per cent for those operated by the federal government, 94.4 per cent for those operated by state, and local governments, 28.8 per cent for voluntary psychiatric hospitals and 12.2 per cent for proprietary psychiatric hos­ pitals. T here are large regional differences in the percentage o f hospitals having dental departments (T a b le 1 ). W here 57.5 per cent o f the hospitals in the M id d le East, and 51.3 per cent in N ew England, had dental departments, the percentages in the other five regions were m uch lower, ranging from 22.3 per cent in the N orth­ west to 32.6 per cent in the Central region. It has been shown that the per­ centage o f hospitals having dental depart­ ments varies substantially with ownership or control o f the hospital and with size o f the hospital. These factors m ay ac­ count fo r some, but certainly not all, o f the regional variation. T h e large m ajority o f hospitals are “ short-term” hospitals (average stay less than 30 days). A m on g the short-term nonfederal hospitals, dental departments

REPORTS OF C O U N C ILS A N D BUREAUS . .. VOLUME 62, JAN UARY 1961 • 139/125

Table 1 • D istrib u tio n o f h o s p ita ls w ith d e n ta l d e p a rtm e n ts a n d o f h o s p ita ls r e sp o n d in g in the su rv e y , b y re g io n a n d state H o s p it a ls w ith d e n ta l d e p a rtm e n ts

H o s p it a ls r e sp o n d in g in su rv e y Num ber

Num ber

P e r ce n t

221 47 17 119 11 16 11

51.3 66.2 28.8 57.2 28.9 69.6 34.4

99 19 8 52 7 8 5

44.8 40.4 47.1 43.7 63.6 50.0 45.5

M id d le East D e la w a r e District o f C o lu m b ia M a r y la n d N e w J e rse y N e w Y o rk P e n n sylv a n ia W e s t V irg in ia

678 11 15 48 105 255 220 24

57.5 68.8 65.2 60.0 69.1 52.6 65.9 26.7

270 5 11 19 38 98 87 12

39.8 45.5 73.3 40.0 36.2 38.4 39.5 50.0

S o u th e a st A la b a m a A rk a n sas Florid a G e o rg ia K e n tu c ky Louisia na M ississip p i N o r t h C a r o l in a S o u th C a r o l in a T e n n e s se e V irg in ia

369 28 20 41 39 40 43

26.3 21.9 24.1 25.9 27.7 30.3 32.1 14.3 21.3 20.8 29.3 38.3

144 9 5 20 17 21 18 5 12 5 14 18

39.0 32.1 2 5.0 48.8 43.6 52.5 41.9 33.3 32.4 31.3 31.8 39.1

S o u th w e st A r iz o n a N e w M e x ic o O k la h o m a Texas

193 23 19 34 117

24.2 32.9 37.3 26.6 2 1 .3

95 14 12 19 50

49.2 60.9 63.2 55.9 42.7

C e n t ra l Illinois In d ia n a Io w a M ic h ig a n M in n e so t a M is s o u r i O h io W is c o n s in

531 112 42 24 82 45 48 103 75

32.6 34.5 30.7 19.4 33.1 22.1 33.8 40.7 38.7

215 46 26 10 31 19 19 41 23

40.5 41.1 61.9 41.7 37.8 42.2 39.6 39.8 30.7

N o rth w e st C o lo r a d o Id a h o Ka nsa s M o n ta n a N e b raska N o r t h D a k o ta S o u t h D a k o ta Utah W y o m in g

149 24 6 33 16 26 8 19 10 7

22.3 25.0 12.0 21.6 26.2 23.4

63 8 2 14 7 10

42.3 33.3 33.3 42.4 43.8 38.5

12.7 28.8 27.8 22.6

5 11 4 2

62.5 57.9 40.0 28.6

Far W e s t A la s k a C a lif o r n ia H a w a ii N evada O re go n W a s h in g t o n

211 10 134 14 5 14 34

29.6 41.7 31.4 43.8 27.8 17.7 25.8

118 3 78 6 4 6 21

55.9 30.0 58.2 42.9 80.0 42.9 61.8

2,352

34.5

1,004

42.7

N e w En glan d C o n n e c t ic u t M a in e M a ss a c h u s e tt s N e w H a m p sh ire R h o d e Island V e rm o n t

U n ite d S ta te s

15 37 16 44 46

Per ce n t

;

140/126 • THE JO U R N A L OF THE A M E R IC A N DENTAL A SSO C IA TIO N

Table 2 • P e r c e n ta g e d istrib u tio n o f r e s p o n d in g h o s p ita ls a c c o r d in g to o w n e r sh ip o r c o n tro l, b y re g io n O w n e r s h ip o r c o n tro l R e g io n n o n fe d e ra l

G o vG e ronvm e nmtae l, e rn n ta l, V o lu n t a ry fe d e r a l (n o n profit!

A ll h o s p ita ls

P ro p rie ta ry

N e w E n g la n d M id d le East S o u t h e a st S o u t h w e st C e n tra l N o rth w e st Far W e s t

33.3 31.5 34.7 22.1 42.3 23.8 47.5

17.2 14.1 44.4 53.7 16.7 58.7 35.6

48.5 51.1 18.8 17.9 37.7 17.5 15.2

1.0 3.3 2.1 6.3 3.3 .0 1.7

100.0 100.0 100.0 100.0 100.0 100.0 100.0

U n ite d S t a t e s

34.9

28.4

3 3 .9

2.8

‘lOO.O

Table 3 • P e r c e n ta g e d istrib u tio n o f re sp o n d in g h o s p ita ls a c c o r d in g to ty p e o f h osp ita l, b y o w n e r s h ip o r c o n t r o l O w n e r s h ip o r c o n t r o l T y p e o f h o sp ita l

A ll G o v e rn m e n ta l, n on fe d e ra l

V o lu n t a ry (no nprofit)

h o sp ita ls

P ro p rie ta ry

2 8.8 38.8 17.4 .0 1.1 3.1 2.3

81.4 9.5 5.6 .0 .0 .4 .0

83.2 1.8 .9 ■ 3.8 3.2 3.8 2.4

78.5 14.3 .0 .0 3.6 .0 .0

63.5 17.2 8.0 1.3 1.6 2.5 1.6

8.5

3.1

.9

3.6

4.3

100.0

100.0

100.0

100.0

100.0

G e n e ra l P syc h ia tric T u b e r c u lo s is C h ild r e n 's O r t h o p e d ic C h r o n ic d ise a se O t h e r s p e c ia lty H o s p it a l d e p a rtm e n t o f a n institution T o tal

G o v e rn m e n ta l, fe d e r a l

Table 4 • P e rc e n ta g e d istrib u tio n o f r e sp o n d in g h o s p ita ls a c c o r d in g t o n um b e r o f b e d s, b y ty p e o f h o sp ita l Num ber of beds A ll

T y p e o f h o sp ita l

G e n e ra l P syc h ia tric T u b e r c u lo s is C h ild r e n 's O r t h o p e d ic C h r o n ic d is e a s e O t h e r s p e c ia lty H o s p it a l d e p a rtm e n t o f a n institution Per ce n t

5099

100199

200299

300499

500-

h o sp ita ls

7.8 1.2 1.2 7.7 12.5 8.0 15.4

15.8 4.6 16.3 7.7 50.0 12.0 23.1

15.5 5.2 25.0 46.1 25.0 20.0 30.7

17.9 2.9 16.3 23.1 12.5 20.0 7.7

20.9 2.3 21.2 15.4 .0 12.0 7.7

21.6 83.8 20.0 .0 .0 28.0 7.7

100.0 100.0 100.0 100.0 100.0 100.0 100.0

14.0

27.9

27.9

16.3

2.3

2.3

9.3

100.0

1.0

7.2

14.8

15.6

14.4

16.0

31.0 x

100.0

-2 4

2549

.5 .0 .0 .0 .0 .0 7.7

I

REPORTS OF C O U N C ILS A N D BUREAUS ... VOLUME ¿2, JANUARY 1961 • 141/127

existed in 25.9 per cent o f the voluntary hospitals, 24.4 per cent o f state and local governmental hospitals and 10.1 per cent o f proprietary hospitals. Dental departments existed in many m ore o f the larger than o f the smaller hospitals. A m ong voluntary, short-term hospitals, for example, the percentage with dental departments varied from 6.2 per cent o f those with less than 25 beds and 8.4 per cent o f those with 25 to 49 beds, to 61.4 per cent o f hospitals with 300 to 499 beds and 83.9 per cent of hospitals with 500 and m ore beds. O f all hospitals listed, 51.7 per cent (3,508) were voluntary, 26.6 per cent (1,805) were nonfederal-governmental, 15.2 per cent (1,034) were proprietary and 6.5 per cent (439) were federal. T here was not m uch regional varia­ tion in percentage of hospitals with den­ tal departments responding in the survey (T a ble 1 ). T h e greatest deviation from the national response o f 42.7 per cent was the Far West’s response o f 55.9 per cent. Certain types o f hospitals responded better than others in the survey. Whereas only 34.9 per cent o f the returns were from state and local governmental hos­ pitals, 42.5 per cent of all hospitals with dental departments fell in this category. C om parable figures for federal hospitals were 28.4 per cent o f the returns com ­ pared to 18.0 per cent o f the m ailing; voluntary hospitals, 33.9 per cent and 35.1 per cent, and proprietary hospitals, 2.8 per cent and 4.4 per cent. For each o f the four classifications of hospitals with respect to ownership or control, the percentage o f hospitals par­ ticipating in the survey varied a great deal according to region (T a b le 2 ) . F ed­ eral hospitals accounted for 58.7 per cent o f the returns from the Northwest and 53.7 per cent from the Southwest, co m ­ pared to only 14.1 per cent from the

M id d le East and 16.7 per cent from the Central region. V oluntary hospitals con­ stituted only 15.2 per cent o f the returns from the Far West, com pared to 51.1 per cent from the M iddle East. State and local governmental hospitals represented 47.5 per cent o f the returns from the Far West and 22.1 per cent from the South­ west. Although 6.3 per cent o f the returns from the Southwest were from proprie­ tary hospitals, no returns were received from proprietary hospitals in the N orth­ west. A bout four out o f five federal, volun­ tary and proprietary hospitals responding were general hospitals, com pared to only 28.8 per cent o f state and local govern­ mental hospitals (T a b le 3 ). A m on g the nonfederal governmental hospitals, 38.8 per cent were psychiatric hospitals, a far greater percentage than for any other ownership classification. T h e percentage o f tuberculosis hospitals, too, was larger am ong the nonfederal governmental hos­ pitals (17.4 per cent) than am ong the other ownership classifications. O f all hos­ pitals responding, nearly tw o thirds were general hospitals. O f all hospitals responding in the sur­ vey, 31.0 per cent had 500 or m ore beds, 30.4 per cent had between 200 and 500 beds and 38.6 had fewer than 200 beds (T a b le 4 ) . O f the psychiatric hospitals, however, 83.8 per cent had 500 or more beds. General hospitals varied widely in size, 21.6 per cent having 500 or more beds and 8.3 per cent having less than 50 beds. T h e next chapter in this series will pre­ sent inform ation on the staffing and other characteristics o f hospital dental depart­ ments.

I. Statistics on num ber o f hospitals and num ber hav­ in g dental dep artm ents are from the annual " G u id e Iss u e " o f H ospita ls, Jou rnal o f the A m e ric a n H osp ita l A ssocia tion .

142/128 • THE JO URNAL OF THE A M E R IC A N DENTAL A SSO C IA TIO N

Survey of public attitudes regarding dentures II. Know ledge o f the technician’s role

BUREAU OF ECONOMIC RESEARCH AND STATISTICS

T h e 6,861 adults participating in the survey were asked “ H o w many months or years o f training beyond high school d o you think most dentists h ave?” Else­ where on the questionnaire the same question was asked with respect to den­ tal laboratory technicians. M ost people underestimated the amount o f training received by dentists, and overestimated the training o f dental technicians. T h e average number o f years o f post-high school training as estimated by respond­ ents was 4.5 for dentists and 2.6 for technicians (Tables 5 and 6 ) . O n the average, then, people underestimated the training o f dentists by about 2.5 years, and overestimated the training o f technicians by at least two years. (M ost dental technicians have had less than a year o f form al instruction in the craft.)

In estimating the num ber o f years o f training beyond high school fo r the den­ tist, respondents from N ew England and the M id d le East came closest to the true figure (T a b le 5 ). T h e average fo r each o f these regions was 4.7 years, com pared to the other extreme o f 3.9 years for the Southeast region. T h e best estimates o f the amount o f education for the den­ tal technician were also received from N ew England and the M id d le East. H ow ever, regional variation in b oth o f these estimates was relatively small. T h e educational level o f the respond­ ent was reflected in his knowledge of the am ount o f training received by dentists and technicians (T a b le 6 ) . R e ­ spondents with no form al schooling es-

Table 6 * M e a n y e a r s o f tra in in g b e y o n d h ig h s c h o o l Table 5 • M e a n y e a r s o f train ing b e y o n d high s c h o o l fo r dentists a n d d e n ta l la b o r a t o r y te ch n icia n s estim ated b y s u r v e y re sp o n d e n ts, b y re g io n

as

fo r dentists a n d d e n ta l la b o r a t o r y t e c h n ic ia n s a s e stim ated b y su rv e y re sp o n d e n ts, b y e d u c a tio n a l le v e l o f s u r v e y re sp o n d e n ts Estim ated y e c rs o f tra in in g

Estim ated y e a r s o f train in g R e g io n

E d u c a tio n a l le ve l o f re sp o n d e n t

D entists

D e n ta l t e ch n icia n s

D entists

D e n ta l te ch n icia n s N o fo rm a l s c h o o lin g

4.4

3.8

N e w E n gla n d M id d le East S o u t h e a st S o u th w e st C e n t ra l N o rth w e st F ar W e s t

4.7 4.7 3.9 4.3 4.5 4.5 4.6

2.3 2.5 2.6 2.7 2.7 2.9 2.7

S o m e o r all o f e le m e n ta ry s c h o o l

4.1

3.0

S o m e o r a ll o f high s c h o o l

4.5

2.6

S o m e o r all o f c o lle g e

5.2

2.2

U nite d Sta te s

4.5

2.6

A ll re sp o n d e n ts

4 .5

2.6

REPORTS OF C O U N C ILS A N D BUREAUS

Table 7 • P e r c e n ta g e

distrib u tio n s o f re sp o n d e n ts a c c o r d in g t o re p lie s to the q u e stio n s " H o w m any m onths o r y e a r s o f tra in in g b e y o n d high s c h o o l d o y o u think m ost de ntists h o v e ? ” a n d " H o w m a n y m onths o r y e a r s o f tra in in g b e y o n d high s c h o o l d o y o u think m ost d e n ta l la b o r a t o r y te c h n ic ia n s h a v e ? ” Estim ated len gth o f tra in in g

D entists

D e n ta l te ch nicia n s

.9 5.7 5.9 30.2 9.1 23.6 6.5 7.8

10.5 27.7 7.8 21.2 2.9 4.7 .7 1.4

1.1 .2 5.2 3.8

.4 .1 13.3 9.3

100.0

100.0

O n e y e a r o r le ss O v e r ] y e a r to 2 y e a r s O v e r 2 y e a r s to 3 y e a r s O v e r 3 y e a r s to 4 y e a r s O v e r 4 y e a r s to 5 y e a r s O v e r 5 y e a r s to 6 y e a r s O v e r 6 y e a r s to 7 y e a r s O v e r 7 y e a rs to 8 y e a rs O v e r 8 ye a rs to 10 y e a r s O v e r 10 y e a r s M is c e lla n e o u s N o a n sw e r T o tal

timated that technicians had 3.8 years o f training beyond high school, almost as high a figure as their estimate for dentists (4.4 years). Even respondents w ho had gone to college underestimated the training o f dentists (5.2 years) and overestimated that o f technicians (2.2 years). T h e widespread m isconception o f the amount o f training received by dentists and technicians is well illustrated in T able 7. T h e most com m on amount o f

VO LUM E 62, JANUARY 1961 • 143/129

college training attributed to the den­ tist was fou r years. Evidently many peo­ ple are not aware o f predental college requirements. T h e com parable figure for technicians was tw o years, with four years also m entioned frequently. It is difficult to understand why people think most technicians have two or fou r years o f college or trade school training. A bout one in every five respondents checked “ yes” in reply to the question “ D o you know anything about the kind o f work that is perform ed by a dental laboratory technician?” (Tables 8, 9 and 1 0 ). R egionally, the percentage o f af­ firmative replies varied from 12.3 per cent in the Southwest to 25.6 per cent in the Far West. In general, knowledge o f the technician’s work was consider­ ably low er in the southern and central states than in either the eastern or west­ ern states. T here was a high degree o f correla­ tion between fam ily incom e o f the re­ spondent and knowledge o f the work o f the dental technician (T a b le 9 ) . O nly 3.6 per cent o f those with incom e under $1,000, and 5.9 per cent o f those with incom e between $1,000 and $2,000, claim ed knowledge o f the work o f the technician, com pared to 26.0 per cent o f the p eople with incom e between

Table 9 • P e r c e n ta g e Table 8 • P e r c e n ta g e

distrib u tio n o f re sp o n d e n ts a c c o r d in g to re p lie s to the q u e stio n " D o y o u k n o w a n yth in g a b o u t the kind o f w o r k that is p e rfo rm e d by a d e n ta l la b o r a t o r y t e c h n ic ia n ?” b y re g io n

Yes

No

R e sp o n se Fam ily In c o m e

R e sp o n se R e g io n

distribu tion o f re sp o n d e n ts a c c o r d in g to re p lie s to the q u e stio n " D o y o u k n o w a n yth in g a b o u t the kind o f w o r k that is p e rfo rm e d b y a d e n ta l la b o r a t o r y t e c h n ic ia n ?” b y family in co m e

No a n sw e r

N e w E n gla n d M id d le East S o u th e a st S o u t h w e st C e n t ra l N o rth w e st F ar W e s t

23.2 22.3 14.2 12.3 16.8 16.4 25.6

76.0 76.3 84.3 86.3 81.7 82.5 73.4

.8 1.4 1.5 1.4 1.5 1.1 1.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0

U n ite d Sta te s

19.4

79.3

1.3

100.0

A ll r e sp o n d e n ts

T o ta l

No

3.6 5.9 11.6 13.3 18.4 2 0.3 26.0 26.0 31.6

9 3.5 92.0 86.5 84.5 80.5 78.5 73.5 7 3.3 67.4

2.9 2.1 1.9 2.2 1.1 1.2 .5 .7 1.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

19.4

79.3

1.3

100.0

T o ta l U n d e r $ 1 ,0 0 0 $ 1 , 0 0 0 -$ !, 9 9 9 $ 2 ,0 0 0 -$ 2 ,9 9 9 $ 3 ,0 0 0 -$ 3 ,9 9 9 $ 4,00 0 —$ 4 ,99 9 $ 5 ,00 0 —$ 5 ,9 9 9 $ 6 ,0 0 0 -$ 6 ,9 9 9 $ 7 ,0 0 0 -$ 9 ,9 9 9 $ 1 0 ,0 0 0 a n d o v e r

No a n sw e r

Yes

144/130 • THE JO U R N A L OF THE A M E R IC A N DENTAL A SSO C IA T IO N

T a b le 1 0 • P e r c e n ta g e distrib u tio n o f re sp o n d e n ts a c c o r d in g to re p lie s to the q u e stio n " D o y o u k n o w a n y th in g a b o u t the kind o f w o r k that is p e rfo rm e d b y a d e n ta l la b o r a t o r y t e c h n ic ia n ?” b y e d u c a tio n a l le v e l o f re sp o n d e n ts R e s p o n se E d u c a tio n a l le ve l

T o ta l

No a n sw e r

Yes

No

N o fo rm a l s c h o o lin g S o m e o r a li o f e le m e n ta ry s c h o o l S o m e o r all o f high s c h o o l S o m e o r a ll o f c o lle g e

13.5 8.0 18.9 34.1

75.7 89.9 80.1 65.2

10.8 2.1 1.0 .7

100.0 100.0 100.0 100.0

A ll re sp o n d e n t s

19.4

79.3

1.3

100,0

$7,000 and $10,000 and 31.6 per cent o f those earning $10,000 and more. A m ong respondents w h o had gone to college, 34.1 per cent indicated they were familiar with the work o f the den­ tal technician, com pared to 13.5 per cent o f those with n o form al schooling and only 8.0 per cent o f those w ho had gone to elementary school only (T a b le iO ). Those respondents w ho indicated they had knowledge o f the work perform ed by dental laboratory technicians were asked to describe what they knew about

the technician’s work. Tables 11 and 12 show the percentage o f respondents giving the various descriptions o f the technician’s work, according to family incom e and educational level o f the respondent. O f the 18.9 per cent w ho entered a description o f the technician’s work, only a few answered incorrectly. H ow ever, the m ajority wrote that the technician m ade false teeth, dentures and bridges, w ithout indicating that this work was done for, and at the direction of, the dentist. O nly 11.6 per cent checked “ yes” in

T a b le 11 • P e r c e n ta g e o f re sp o n d e n t s g iv in g s p e c ifie d d e s c r ip tio n s o f w o r k p e rfo rm e d b y d e n ta l la b o r a t o r y technicians, b y fam ily in c o m e Fam ily in c o m e D e s c rip tio n

M a k e s fa lse teeth, d e n tu re s o r b r id g e s M a k e s fa lse teeth, d e n tu re s o r b r id g e s f o r dentists R e p a irs fa lse teeth, d e n tu re s o r b r id g e s R e p a irs fa lse teeth, d e n tu re s o r b r id g e s f o r dentists W o r k s w ith x -r a y s T a k e s im p re ssio n s O t h e r n o n te ch n icia n d e n ta l a ctiv itie s N o t e lse w h e re c la ssifie d N o a n sw e r

Under $ 1,00 0

$ 1 ,0 0 0 - $ 2 ,0 0 0 - $ 3 ,0 0 0 $ 1 ,99 9 $ 3,999 $ 2 ,99 9

$ 4 ,0 0 0 $ 4,99 9

$ 5 ,0 0 0 $ 5 ,99 9

$ 6 ,0 0 0 $ 6,99 9

$7,00 0 $ 1 0 ,0 0 0

$ 10 ,0 0 0 and ove r

A ll re sp o n d ­ ents

1.4

2.3

6.1

7.7

11.0

11.9

16.8

14.5

18.6

11.3

.7

1.7

2.1

2.9

4.9

5.5

5.9

7.1

8.1

4.9

.7

.6

2.3

2.1

1.5

2.4

3.0

2.1

2.4

2.1

.0 .7 .7

.2 1.5 .0

.6 1.5 .7

.1 1.4 .7

.3 1.8 .6

.3 1.2 .5

.1 2.0 .3

.7 1.3 .8

.5

.4

2.1 1.1

1.5 .6

.7

.8

.8

.6

1.2

1.7

1.1

1.9

2.4

1.3

.0

.8

.9

1.1

1.2

1.2

1.7

2.3

2.3

1.4

96.4

94.3

89.0

87.5

82.2

80.1

74.3

74.5

69.5

81.1

REPORTS OF C O U N C ILS A N D BUREAUS . .. VOLUME 62, JANUARY 1961 • 145/131

Table 12 • P e r c e n ta g e o f r e sp o n d e n ts g iv in g sp e c ifie d d e s c r ip tio n s o f w o r k p e rfo rm e d b y d e n ta l la b o r a t o r y te ch n icia n s, b y e d u c a tio n a l le v e l o f r e sp o n d e n t E d u c a tio n a l le ve l D e s c rip tio n

M a k e s fa lse teeth, d e n tu re s o r b r id g e s M a k e s fa lse teeth, d e n tu re s o r b r id g e s f o r dentists R e p a irs fa lse teeth, d e n tu re s o r b r id g e s R e p a irs fa lse teeth, d e n tu re s o r b r id g e s f o r dentists W o r k s w ith x - r a y s T a k e s im p re ssio n s O t h e r n o n te c h n ic ia n d e n ta l activitie s N o t e ls e w h e r e cla ssifie d N o a n sw e r

N o form a l s c h o o lin g

S o m e o r all S o m e o r all o f e le m e n ta ry o f h igh s c h o o l school

S o m e o r all o f c o lle g e

A ll re sp o n d e n t s

5.4

4.9

11.0

19.8

11.3

.0 2.7

1.3 1.1

4.9 2.1

8.9 2.9

4.9 2.1

.0 2.7 .0 2.7 .0

.1 .6 .3 .5 .7

.4 1.6 .5 1.2 1.3

.7 2.4 1.0 2.7 2.7

• 1.5 .6 1.3 14

86.5

92.4

81.6

66.8

81.1

response to the question “ Are you ac­ quainted with the working relationship between the dentist and the dental lab­ oratory technician?” (T ab le 13). Again, the percentage o f affirmative answers was higher in the western and eastern states than in the central and southern states. T h e percentage o f affirmative an­ swers varied greatly with family income, from 2.2 per cent for the “ under $1,000” category to 18.3 per cent where family incom e was over $10,000. A correlation o f similar degree prevailed between the “ working relationship” question and ed­ ucational level o f the respondent. Respondents w h o indicated they knew the working relationship between the dentist and the technician were asked to describe that working relationship. As shown in Tables 14 and 15, many o f the replies to this question were sim­ ilar to the replies to the question on the “ kind o f w ork” perform ed by the tech­ nician. A lthough not many respondents ventured to describe the working rela­ tionship, m ore than tw o thirds o f those w ho did stated that the technician made dentures and bridges for the dentist. Eighty-seven people (1.3 per cent) stated that the dentist and technician “ worked together” and 39 stated that the tech­ nician worked under supervision o f the

-

.4

dentist. T en stated that the dentist sent his patients to the laboratory. T h e m ajority o f respondents indicated they did not know the answer to the question “ Are any persons other than dentists allowed by law in your state to provide false teeth directly to the pub­ lic?” (Tables 16 and 17). Nationally, 4.3 per cent o f the respondents checked “ yes,” and this figure varied regionally from 2.0 per cent in the Southwest to 6.4 per cent in N ew England. T h e cor­ rect answer to this question, “ n o,” was given by 24.8 per cent o f the respond­ ents. This figure varied by educational

Table 13 • P e r c e n ta g e

distribution o f r e sp o n d e n ts a c c o r d in g to re p lie s to the q u e stio n “A r e y o u a c ­ q u a in te d w ith the w o r k in g r e la tio n sh ip b e tw e e n the d e n tist a n d the d e n ta l la b o r a t o r y t e c h n ic ia n ? " b y re g io n R e sp o n se R e g io n

No a n sw e r

T o ta l

Yes

No

N e w E n g la n d M id d le East S o u t h e a st S o u th w e st C e n t ra l N o rth w e st FarW e st

13.1 13.1 8.5 8.2 11.4 8.7 14.4

85.5 84.9 90.2 89.7 86.5 89.1 84.2

1.4 2.0 1.3 2.1 2.1 2.2 1.4

100.0 100.0 100.0 100.0 100.0 100.0 100.0

U n ite d S tate s

11.6

86.6

1.8

100.0

146/132 • THE JO U R N A L OF THE A M E R IC A N DENTAL A SSO C IA TIO N

Table 14 • P e r c e n ta g e d istrib u tio n o f r e sp o n d e n t s g iv in g s p e c ifie d e x p la n a tio n s o f the w o r k in g re la tio nsh ip b e tw e e n the dentist a n d the d e n ta l la b o r a t o r y te chn icia n, b y fam ily in c o m e Fam ily in c o m e E x p la n a tio n

Under $1,00 0

T e c h n ic ia n m akes d e nture s, b r id g e s etc. T e c h n ic ia n m akes d e n tu re s, b rid g e s, etc., fo r th e dentist T e c h n ic ia n re p a irs d e nture s, b r id g e s T e c h n ic ia n re p a irs d entures, b r id g e s fo r the dentist T e c h n ic ia n is u n d e r de n tist s u p e rv isio n T h e y w o r k t o g e th e r in m aking de ntures, b r id g e s, r e p a irs T h e y w o r k t o g e th e r Den tist se n d s p a tie n ts to the la b o r a t o r y N o t e ls e w h e r e c la ssifie d N o a n sw e r

$1,00 0 $ 1,999

$ 2 ,0 0 0 - $ 3 ,0 0 0 $2,999 $ 3 ,99 9

A ll

$ 4 ,0 0 0 - $ 5 ,0 0 0 $4,99 9 $ 5,99 9

$6 ,0 0 0 $ 6,99 9

$ 7 ,0 0 0 $ 9 ,99 9

$ 10 ,0 0 0 and over

re sp o n d ­ ents

.7

.6

.5

.7

.6

.5

.5

.4

.7

1.5

3.7

5.7

7.5

9.6

9.8

10.5

.0

.2

.2

.3

.2

.2

.3

.4

.2

.2

.0

.2

.2

.7

.4

.3

.8

.2

.3

.4

.7

.8

.2

.1

.3

.6

.5

.9

1.1

.6

.0 .0

.2 .4

.2 .3

.4 .8

.7 .4

.6 .9

.7 .8

.8 1.0

.5 1.1

.6 .7

.0

.0

.1

.0

.3

.2

.1

.2

.2

.1

.8

11.5

.6

7.7

.0

.8

1.0

1.0

1.7

.3

.8

1.5

2.8

1.2

97.8

95.6

93.9

91.3

89.0

87.2

86.7

85.4

82.5

88.8

Table 15 • P e r c e n ta g e distrib u tio n o f re sp o n d e n t s g iv in g sp e c ifie d e x p la n a tio n s o f th e w o r k in g re la tio n sh ip b e tw e e n the dentist a n d the d e n ta l la b o r a t o r y te ch n icia n , b y e d u c a tio n a l le v e l o f r e sp o n d e n t E d u c a tio n a l le ve l E x p la n a tio n

T e c h n ic ia n m a k e s d e ntures, b r id g e s, etc. T e c h n ic ia n m ake s d e ntures, b rid g e s, etc.. f o r th e dentist T e c h n ic ia n r e p a irs d e nture s, b r id g e s T e c h n ic ia n r e p a ir s d e nture s, b r id g e s f o r th e dentist T e c h n ic ia n is u n d e r dentist s u p e rv isio n T h e y w o r k t o g e th e r in m aking d e n tu re s, b rid g e s, r e p a ir s T h e y w o r k t o g e th e r D e n tist s e n d s p a tie nts to the la b o r a t o r y N o t e ls e w h e r e cla ssified N o a n sw e r

N o fo rm a l s c h o o lin g

S o m e o r all S o m e o r all o f e le m e n ta ry o f high s c h o o l sch ool

S o m e o r a ll o f c o lle g e

A ll r e sp o n d e n ts

2.7

.6

.7

.2

.6

.0 .0

2.6 .3

7.9 .2

13.0 .2

7.7 .2

.0 .0

.1 .2

.4 .4

.5 1.6

.4 .6

.0 .0 .0 2.7

.1 .5 .1 .5

.7 .7 .1 1.2

.7 1.1 .3 1.9

.6 .7 .1 1.2

94.6

95.6

88.5

81.4

88.8

level from 18.9 per cent o f respondents with n o form al schooling to 27.9 per cent o f respondents w ho had gone to college.

T o the question “ Has a dentist ever sent you to a dental laboratory?” 4.1 per cent answered in the affirmative (T a b le 18). T h e figure was relatively

REPORTS OF C O U N C ILS A N D BUREAUS . .. VOLUME 62, JAN UARY 1961 • 147/133

Table 16 • P e r c e n ta g e distrib u tion o f re sp o n d e n ts a c c o r d in g to re p lie s to the q u e s t io n “A r e a n y p e rso n s o t h e r than de n tists a llo w e d b y la w in y o u r state to p r o v id e fa lse te eth d ire c tly to the p u b lic ?” b y re g io n

Table 18 • P e r c e n ta g e distribution o f re sp o n d e n ts a c c o r d in g t o re p lie s to the q u e stio n “ H a s a dentist e v e r sent y o u to a d e n ta l la b o r a t o r y ? ” b y r e g io n ' ^ R e sp o n se

R espor se

R e g io n Yes

No

R e g io n

D o n ’t kn ow o r no a n sw e r

6.4 4.5 2.4 2.0 5.3 3.8 4.5

28.5 29.4 23.8 25.7 19.5 23.0 26.8

65.1 66.1 73.8 72.3 75.2 73.2 68.7

100.0 100.0 100.0 100.0 100.0 100.0 100.0

U nited S ta te s

4.3

24.8

70.9

100.0

N e w E n g la n d

Table 17 • P e r c e n ta g e d istribution o f re sp o n d e n ts a c c o r d in g t o re p lie s to the q u e stio n " A r e a n y p e r s o n s o th e r than d e n tists a llo w e d b y ia w in y o u r state to p r o v id e fa lse teeth d ire c tly to the p u b lic ?” b y e d u c a ­ tio n a l le v e l o f r e sp o n d e n t R e sp o n se

No

D o n 't know o r no a n sw e r

2.7

18.9

78.4

100.0

3.5

21.1

75.4

100.0

4.6

25.1

70.3

100.0

4.4

27.9

67.7

100.0

4.3

24.8

70.9

100.0

E d u c a tio n a l le v e l Yes

N o r fo rm a l s c h o o lin g S o m e o r a ll o f e le m e n ta ry s c h o o l S o m e o r all o f h igh s c h o o l S o m e o r all o f c o lle g e A ll r e sp o n d e n ts

T o ta l

low in the Southeast (2.3 per ce n t). In the Far W est, the figure was 7.2 per cent, considerably higher than in any other region. T h e statistics presented in this chap­ ter indicate a rather low level o f knowl­ edge o f the training and role o f the

T o tal

No

N e w E n gla n d M id d le East So u th e a st S o u t h w e st C entral N o rth w e st Far W e s t

4.5 3.9 2.3 3.4 3.3 2.7 7.2

92.7 93.3 94.1 94.1 92.9 96.7 90.3

2.8 2.8 3.6 2.5 3.8 .6 2.5

100.0 100.0 100.0 100.0 100.0 100.0 100.0

U n ite d S ta te s

4.1

92.9

3.0

100.0

T o ta l

M id d le East S o u th e a st S o u th w e st C e n tra l N o rth w e st F ar W e s t

No a n sw e r

Yes

dental laboratory technician. W hile over­ estimating the technician’s education, p eople underestimated that o f the den­ tist by an average o f about 2.5 years. O n ly one fifth o f the people knew any­ thing about the work perform ed by a dental technician and only about half this num ber were acquainted with the working relationship between the den­ tist and the technician. Seventy per cent o f the respondents did not know, or declined to answer, whether any per­ sons other than dentists were allowed by law in their state to provide dentures directly to the public. T here was a distinct correlation be­ tween econom ic-educational level and knowledge o f the role o f the dental technician. Even in the upper levels o f incom e and education, however, the m ajority o f respondents did not have the correct answers to the questions re­ lating to the role o f the dental tech­ nician. T h e next chapter in this series will present inform ation on the num ber of people wearing dentures and bridges and the source o f dentures.