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Public attitudes regarding dentures. VII
REPORTS O F C O U N C IL S A N D B U R E A U S . . . V O L U M E ¿3, O C T O BER 1961 • 93/531
Survey of public attitudes regarding dentures VII. Summary
B U R E A U O F E C O N O M IC R E S E A R C H A N D S T A T IS T IC S
There is widespread opinion that the vol ume of denture service provided by dental laboratory technicians directly to the pub lic, contrary to the dental practice laws, has increased substantially in recent years. The Board of Trustees of the Association authorized a survey to illuminate this problem by obtaining information on the public’ s attitudes, knowledge and prac tices with respect to the acquisition of dentures. The survey was conducted by mail, and survey panels maintained by National Family Opinion, Inc., Toledo, Ohio, were utilized. These panels are closely repre sentative of the general population of the United States. Returns were received from 6,861 adults or more than 80 per cent of the families receiving question naires. Husbands and wives were asked to fill out their questionnaires independ ently. K N O W L E D G E O F T E C H N IC IA N ’ S R O L E
Survey participants were asked how many months or years of training beyond high school they thought dental technicians had. A similar question was asked regard ing dentists. Most people underestimated the training of dentists and overestimated that of technicians. The average number of years of training estimated for dentists was 4.5, compared to 2.6 for technicians.
Respondents with no formal schooling es timated that dental technicians had 3.8 years of formal training, whereas actually most technicians have had less than a year of formal instruction in the craft. This misconception may be the reason why some people obtain their dentures from technicians. One out o f five respondents answered affirmatively the question “D o you know anything about the kind of work that is performed by a dental laboratory tech nician?” The percentage checking “yes” ranged from 12.3 per cent in the South west to 25.6 per cent in the Far West, and from 3.6 per cent of respondents with family income of less than $ 1,000 to 31.6 per cent with family income of $ 10 ,000 and more. Those who checked “ yes” were asked to describe the work of the technician. Nearly all wrote that the tech nician made or repaired dentures or bridges, but relatively few added that this work was done for dentists. Prob ably most respondents knew this fact but assumed that it would be taken for granted. Only 11.6 per cent replied affirmatively to the question “ Are you acquainted with the working relationship between the den tist and the dental laboratory techni cian?” O f those who described this working relationship, the majority did so correctly.
94/532 • T H E JO U R N A L O F THE A M E R IC A N DENTAL A S S O C IA T IO N
T o the question “ Are any persons other than dentists allowed by law in your state to provide false teeth directly to the pub lic?” about 70 per cent answered that they didn’t know, 25 per cent checked “ no” and 4.3 per cent checked “ yes.” “ Has a dentist ever sent you to a den tal laboratory?” The percentage answer ing this question affirmatively was 4.1 per cent nationally, with a regional range from 2.3 per cent in the Southeast to 7.2 per cent in the Far West. Next to the Far West, the highest figure was in New Eng land (4.5 per cent). SOURCE OF DEN TU RES A N D D E N T U R E R E PA IR S
The percentage of respondents wearing dentures and bridges increased with age from 22.4 per cent for people 20 to 29 years of age to 78.3 per cent for people 60 and older, the figure for all respond ents being 49.1 per cent. At each age level, more of the women than o f the men reported wearing dentures or bridges. Regionally, the percentage o f respondents wearing dentures or bridges ranged from 40.5 per cent in the Southwest to 52.5 per cent in New England. Nearly one third of all respondents wore a complete upper and nearly one fourth a complete lower denture. Among people 60 and older, 62.5 per cent wore a complete upper and 50.0 per cent a com plete lower denture. Respondents wearing complete or par tial dentures were asked whether their dentures had been obtained from a den tist or from a dental laboratory techni cian. “ Dentists” was the answer checked by 93.7 per cent, “ dental laboratory tech nicians” by 2.1 per cent and the remain ing 4.2 per cent did not reply to this question. The percentage of respondents admit ting they had received their dentures di rectly from technicians ranged from 2.8 per cent in the Middle East and 2.7 per cent in the Far West to a low of 1.3 per
cent in the Northwest. By population density, the range was from 3.7 per cent in the central cities in metropolitan areas o f 2,000,000 or more, to 1.4 per cent in rural areas. A considerably larger per centage of men ( 2.8 per cent) than of women ( 1.6 per cent) indicated they had received dentures from technicians. Denture wearers were asked why they chose a dentist or a dental laboratory technician. One third of the respondents who had patronized a technician gave “ price” as the reason. A similar percent age o f this group indicated the technician had a good reputation or was known to be skilled in making dentures. Based on figures received from people who had acquired complete dentures dur ing the preceding 12 months, the average cost of complete uppers obtained from dentists was $104.21, compared to $82.50 for those obtained from technicians. Comparable averages for complete lower dentures were $ 100.00 and $71.88. In reply to a question directed to re spondents wearing one or two complete dentures, only one respondent answered that extractions were performed by a dental technician. O f the 65 respondents who had ob tained dentures from technicians, 47 re plied that they had found out about the technician from a “ friend,” and the re mainder were scattered among miscella neous sources of information such as newspapers, physicians and dentists. A little more than one fourth of the people wearing complete dentures indi cated dentures currently worn were re placements. O f this group, slightly over 1 per cent indicated, in reply to a question, that their first complete dentures had been obtained from a dental technician. A similar number declined to answer the question, and about 98 per cent checked “ dentist.” All respondents were asked where they would obtain their dentures in the future — in the event it were necessary. Tw o per cent indicated the dentures would be
REPORTS O f C O U N C IL S A N D B U R E A U S . . .V O L U M E 63, O C T O BER 1961 • 95/533
obtained from technicians, 1.2 per cent wrote in “ undecided,” 4.0 per cent did not answer and 92.8 per cent checked “ dentist.” These percentages are about the same as the percentages for source of dentures currently worn. Eighteen per cent of all denture or bridge wearers indicated they had re ceived repairs from dentists or dental laboratory technicians. O f this group, 6.3 per cent reported they had received the repairs directly from a technician and 93.7 per cent from dentists. The percent age of people going to a technician for re pairs was more than twice as high for ages 40 and older as for ages under 40. The percentage going to a technician for re pairs was particularly high in metropoli tan areas, and higher in the central cities than in the suburbs. There was no discernible trend in the statistics on source of either dentures or denture repairs according to family in come. A N O P IN IO N S C A LE
The questionnaire listed nine statements about dentistry, and respondents were asked to indicate whether they agreed or disagreed with each statement. The state ment “ In general, fees of dentists are reasonable” was agreed with by a major ity of respondents; yet, the majority also agreed with the two statements to the effect that dentists charged too much for fillings and dentures. M ore of the young people than of the older people agreed that dentists’ fees, in general, were rea sonable. Three fourths of the survey par ticipants agreed that “ A person should always go to a dentist to get false teeth that are satisfactory,” but 13.5 per cent agreed with the contradictory statement, “ A person can get false teeth that are satisfactory directly from a dental labora tory technician.” When asked whether they agreed that it was necessary to go to a dentist ( 1 ) for repair of broken “ plates” and ( 2 ) to
have “ plates” relined, between three and four times as many respondents agreed as disagreed. “For people with two full plates, regu lar visits to the dentist are not necessary.” A little more than one third agreed with this statement, a similar number declined to opine and about one fourth disagreed. Highest agreement was with the state ment “ Most dentists have a high degree o f skill and knowledge,” with which 85.9 per cent agreed. F R E Q U E N C Y O F V IS IT S T O T H E D E N T IS T
Information was elicited on length of time since last visit to a dentist and in tended future frequency of dental visits. It was obvious from comparisons with other sources of data that respondents in this survey underestimated the length of time since they last visited a dentist. As shown in many other surveys, on the av erage, women had seen their dentist more recently than had men. There was a high correlation between length of time since last visit to a dentist and ( 1 ) educational level and ( 2 ) family income. Less than one fourth of the respond ents intended to go to the dentist as often as every six months in the future, and only two out of five as often as every year. “ As need arises” was the most fre quently checked answer. “ Never” was the reply of 3.7 per cent. “ Every six months” was checked by only 18.1 per cent of the men, compared to 26.3 per cent o f the women. This reply was given by about 28 per cent of all respondents under 40; the percentage declined with each higher age group to 11.2 per cent of those 60 and older. The variation in replies to this question according to educational level and family income was striking. C O N C L U S IO N S
O f people wearing complete or partial dentures, 2.1 per cent admitted obtaining
96/534 • T H E JO U R N A L O F T H E A M E R IC A N DENTAL A S S O C IA T IO N
their dentures directly from a dental laboratory technician, and 4.2 per cent did not answer the question on source of dentures. The median percentage of “ no answers” to nonopinion questions in this survey was approximately 2 per cent. It seems likely that nearly half of those who did not answer the question on source of dentures actually obtained their dentures from technicians but preferred not to divulge this information. Thus, it is esti mated that a total of 4 per cent of the denture wearers obtained their dentures from technicians. Based on responses in this survey, it was estimated that the population 20 and older received 5.5 million complete den tures during the year ending in April 1960. Limitations of data were such that a second upper or second lower denture received during the course of the year was not counted. In other words, no more than one complete upper or one complete lower denture was counted for any one individual. Had the survey included peo ple under 20 and more than one denture of a given type received during the year, the estimate would have been slightly higher than 5.5 million. In another survey conducted by the Bureau o f Economic Research and Sta tistics, The 1959 Survey of Dental Prac tice, data were obtained from dentists on the number of complete dentures in serted. Based on the 1959 survey, it was estimated that dentists supplied 5.6 mil lion dentures to the civilian population during 1959. Although the coverage in these two surveys was not identical, it was very similar. The two estimates of complete dentures received or provided (5.5 mil lion and 5.6 million) are almost identical and provide evidence that the number of complete dentures obtained directly
from dental laboratory technicians is rela tively small. In The 1959 Survey of Dental Prac tice it was determined, from data on 25,901 patient visits, that complete upper dentures were provided at 1.4 per cent of the visits and complete lower dentures at .9 per cent of the visits. In a similar survey of dentists conducted by the Bu reau nine years earlier, the 1950 Survey of the Dental Profession, data were ob tained on services rendered at 34,010 sittings. In the 1950 survey, the percent ages were exactly the same as in the 1959 survey— 1.4 per cent for complete upper' dentures and .9 per cent for complete lower dentures. These statistics provide strong evidence that the proportion of complete dentures that had been received by the public directly from technicians did not increase during the period from 1950 to 1959. Although these statistics do not indi cate an increase in the illegal provision of dentures during the past decade, the problem remains of sufficient dimension to warrant close attention. If technicians provided directly to the public 4 per cent of the 5.6 million complete dentures in 1959, the number provided was approxi mately 225,000. There is some indication in the survey results that the problem may increase in the future. It is true that the percentage o f people indicating future dentures would be obtained from technicians was practically the same as the percentage of denture wearers who had patronized technicians in the past. It should be noted, however, that 13.5 per cent of the re spondents agreed with the statement that satisfactory dentures could be obtained directly from a dental laboratory tech nician, and only 22.5 per cent disagreed with this statement.
Survey of public attitudes regarding dentures VII. Summary
B U R E A U O F E C O N O M IC R E S E A R C H A N D S T A T IS T IC S
There is widespread opinion that the vol ume of denture service provided by dental laboratory technicians directly to the pub lic, contrary to the dental practice laws, has increased substantially in recent years. The Board of Trustees of the Association authorized a survey to illuminate this problem by obtaining information on the public’ s attitudes, knowledge and prac tices with respect to the acquisition of dentures. The survey was conducted by mail, and survey panels maintained by National Family Opinion, Inc., Toledo, Ohio, were utilized. These panels are closely repre sentative of the general population of the United States. Returns were received from 6,861 adults or more than 80 per cent of the families receiving question naires. Husbands and wives were asked to fill out their questionnaires independ ently. K N O W L E D G E O F T E C H N IC IA N ’ S R O L E
Survey participants were asked how many months or years of training beyond high school they thought dental technicians had. A similar question was asked regard ing dentists. Most people underestimated the training of dentists and overestimated that of technicians. The average number of years of training estimated for dentists was 4.5, compared to 2.6 for technicians.
Respondents with no formal schooling es timated that dental technicians had 3.8 years of formal training, whereas actually most technicians have had less than a year of formal instruction in the craft. This misconception may be the reason why some people obtain their dentures from technicians. One out o f five respondents answered affirmatively the question “D o you know anything about the kind of work that is performed by a dental laboratory tech nician?” The percentage checking “yes” ranged from 12.3 per cent in the South west to 25.6 per cent in the Far West, and from 3.6 per cent of respondents with family income of less than $ 1,000 to 31.6 per cent with family income of $ 10 ,000 and more. Those who checked “ yes” were asked to describe the work of the technician. Nearly all wrote that the tech nician made or repaired dentures or bridges, but relatively few added that this work was done for dentists. Prob ably most respondents knew this fact but assumed that it would be taken for granted. Only 11.6 per cent replied affirmatively to the question “ Are you acquainted with the working relationship between the den tist and the dental laboratory techni cian?” O f those who described this working relationship, the majority did so correctly.
94/532 • T H E JO U R N A L O F THE A M E R IC A N DENTAL A S S O C IA T IO N
T o the question “ Are any persons other than dentists allowed by law in your state to provide false teeth directly to the pub lic?” about 70 per cent answered that they didn’t know, 25 per cent checked “ no” and 4.3 per cent checked “ yes.” “ Has a dentist ever sent you to a den tal laboratory?” The percentage answer ing this question affirmatively was 4.1 per cent nationally, with a regional range from 2.3 per cent in the Southeast to 7.2 per cent in the Far West. Next to the Far West, the highest figure was in New Eng land (4.5 per cent). SOURCE OF DEN TU RES A N D D E N T U R E R E PA IR S
The percentage of respondents wearing dentures and bridges increased with age from 22.4 per cent for people 20 to 29 years of age to 78.3 per cent for people 60 and older, the figure for all respond ents being 49.1 per cent. At each age level, more of the women than o f the men reported wearing dentures or bridges. Regionally, the percentage o f respondents wearing dentures or bridges ranged from 40.5 per cent in the Southwest to 52.5 per cent in New England. Nearly one third of all respondents wore a complete upper and nearly one fourth a complete lower denture. Among people 60 and older, 62.5 per cent wore a complete upper and 50.0 per cent a com plete lower denture. Respondents wearing complete or par tial dentures were asked whether their dentures had been obtained from a den tist or from a dental laboratory techni cian. “ Dentists” was the answer checked by 93.7 per cent, “ dental laboratory tech nicians” by 2.1 per cent and the remain ing 4.2 per cent did not reply to this question. The percentage of respondents admit ting they had received their dentures di rectly from technicians ranged from 2.8 per cent in the Middle East and 2.7 per cent in the Far West to a low of 1.3 per
cent in the Northwest. By population density, the range was from 3.7 per cent in the central cities in metropolitan areas o f 2,000,000 or more, to 1.4 per cent in rural areas. A considerably larger per centage of men ( 2.8 per cent) than of women ( 1.6 per cent) indicated they had received dentures from technicians. Denture wearers were asked why they chose a dentist or a dental laboratory technician. One third of the respondents who had patronized a technician gave “ price” as the reason. A similar percent age o f this group indicated the technician had a good reputation or was known to be skilled in making dentures. Based on figures received from people who had acquired complete dentures dur ing the preceding 12 months, the average cost of complete uppers obtained from dentists was $104.21, compared to $82.50 for those obtained from technicians. Comparable averages for complete lower dentures were $ 100.00 and $71.88. In reply to a question directed to re spondents wearing one or two complete dentures, only one respondent answered that extractions were performed by a dental technician. O f the 65 respondents who had ob tained dentures from technicians, 47 re plied that they had found out about the technician from a “ friend,” and the re mainder were scattered among miscella neous sources of information such as newspapers, physicians and dentists. A little more than one fourth of the people wearing complete dentures indi cated dentures currently worn were re placements. O f this group, slightly over 1 per cent indicated, in reply to a question, that their first complete dentures had been obtained from a dental technician. A similar number declined to answer the question, and about 98 per cent checked “ dentist.” All respondents were asked where they would obtain their dentures in the future — in the event it were necessary. Tw o per cent indicated the dentures would be
REPORTS O f C O U N C IL S A N D B U R E A U S . . .V O L U M E 63, O C T O BER 1961 • 95/533
obtained from technicians, 1.2 per cent wrote in “ undecided,” 4.0 per cent did not answer and 92.8 per cent checked “ dentist.” These percentages are about the same as the percentages for source of dentures currently worn. Eighteen per cent of all denture or bridge wearers indicated they had re ceived repairs from dentists or dental laboratory technicians. O f this group, 6.3 per cent reported they had received the repairs directly from a technician and 93.7 per cent from dentists. The percent age of people going to a technician for re pairs was more than twice as high for ages 40 and older as for ages under 40. The percentage going to a technician for re pairs was particularly high in metropoli tan areas, and higher in the central cities than in the suburbs. There was no discernible trend in the statistics on source of either dentures or denture repairs according to family in come. A N O P IN IO N S C A LE
The questionnaire listed nine statements about dentistry, and respondents were asked to indicate whether they agreed or disagreed with each statement. The state ment “ In general, fees of dentists are reasonable” was agreed with by a major ity of respondents; yet, the majority also agreed with the two statements to the effect that dentists charged too much for fillings and dentures. M ore of the young people than of the older people agreed that dentists’ fees, in general, were rea sonable. Three fourths of the survey par ticipants agreed that “ A person should always go to a dentist to get false teeth that are satisfactory,” but 13.5 per cent agreed with the contradictory statement, “ A person can get false teeth that are satisfactory directly from a dental labora tory technician.” When asked whether they agreed that it was necessary to go to a dentist ( 1 ) for repair of broken “ plates” and ( 2 ) to
have “ plates” relined, between three and four times as many respondents agreed as disagreed. “For people with two full plates, regu lar visits to the dentist are not necessary.” A little more than one third agreed with this statement, a similar number declined to opine and about one fourth disagreed. Highest agreement was with the state ment “ Most dentists have a high degree o f skill and knowledge,” with which 85.9 per cent agreed. F R E Q U E N C Y O F V IS IT S T O T H E D E N T IS T
Information was elicited on length of time since last visit to a dentist and in tended future frequency of dental visits. It was obvious from comparisons with other sources of data that respondents in this survey underestimated the length of time since they last visited a dentist. As shown in many other surveys, on the av erage, women had seen their dentist more recently than had men. There was a high correlation between length of time since last visit to a dentist and ( 1 ) educational level and ( 2 ) family income. Less than one fourth of the respond ents intended to go to the dentist as often as every six months in the future, and only two out of five as often as every year. “ As need arises” was the most fre quently checked answer. “ Never” was the reply of 3.7 per cent. “ Every six months” was checked by only 18.1 per cent of the men, compared to 26.3 per cent o f the women. This reply was given by about 28 per cent of all respondents under 40; the percentage declined with each higher age group to 11.2 per cent of those 60 and older. The variation in replies to this question according to educational level and family income was striking. C O N C L U S IO N S
O f people wearing complete or partial dentures, 2.1 per cent admitted obtaining
96/534 • T H E JO U R N A L O F T H E A M E R IC A N DENTAL A S S O C IA T IO N
their dentures directly from a dental laboratory technician, and 4.2 per cent did not answer the question on source of dentures. The median percentage of “ no answers” to nonopinion questions in this survey was approximately 2 per cent. It seems likely that nearly half of those who did not answer the question on source of dentures actually obtained their dentures from technicians but preferred not to divulge this information. Thus, it is esti mated that a total of 4 per cent of the denture wearers obtained their dentures from technicians. Based on responses in this survey, it was estimated that the population 20 and older received 5.5 million complete den tures during the year ending in April 1960. Limitations of data were such that a second upper or second lower denture received during the course of the year was not counted. In other words, no more than one complete upper or one complete lower denture was counted for any one individual. Had the survey included peo ple under 20 and more than one denture of a given type received during the year, the estimate would have been slightly higher than 5.5 million. In another survey conducted by the Bureau o f Economic Research and Sta tistics, The 1959 Survey of Dental Prac tice, data were obtained from dentists on the number of complete dentures in serted. Based on the 1959 survey, it was estimated that dentists supplied 5.6 mil lion dentures to the civilian population during 1959. Although the coverage in these two surveys was not identical, it was very similar. The two estimates of complete dentures received or provided (5.5 mil lion and 5.6 million) are almost identical and provide evidence that the number of complete dentures obtained directly
from dental laboratory technicians is rela tively small. In The 1959 Survey of Dental Prac tice it was determined, from data on 25,901 patient visits, that complete upper dentures were provided at 1.4 per cent of the visits and complete lower dentures at .9 per cent of the visits. In a similar survey of dentists conducted by the Bu reau nine years earlier, the 1950 Survey of the Dental Profession, data were ob tained on services rendered at 34,010 sittings. In the 1950 survey, the percent ages were exactly the same as in the 1959 survey— 1.4 per cent for complete upper' dentures and .9 per cent for complete lower dentures. These statistics provide strong evidence that the proportion of complete dentures that had been received by the public directly from technicians did not increase during the period from 1950 to 1959. Although these statistics do not indi cate an increase in the illegal provision of dentures during the past decade, the problem remains of sufficient dimension to warrant close attention. If technicians provided directly to the public 4 per cent of the 5.6 million complete dentures in 1959, the number provided was approxi mately 225,000. There is some indication in the survey results that the problem may increase in the future. It is true that the percentage o f people indicating future dentures would be obtained from technicians was practically the same as the percentage of denture wearers who had patronized technicians in the past. It should be noted, however, that 13.5 per cent of the re spondents agreed with the statement that satisfactory dentures could be obtained directly from a dental laboratory tech nician, and only 22.5 per cent disagreed with this statement.