A decision is a commitment of resources under conditions of risk in expectation of the best future outcome. The smart decision is always the strategy with the best overall expected value-the best combination of facts and values. Some of the special circumstances involved in decision making are discussed, including decisions where there are multiple goals, those where more than one person is involved in making the decision, using trigger points, framing decisions correctly, commitments to lost causes, and expert decision makers. A complex example of deciding about removal of asymptomatic third molars, with and without an EBD search, is discussed.
A decision is a commitment of resources under conditions of risk in expectation of the best future outcome. The smart decision is always the strategy with the best overall expected value-the best combination of facts and values. Some of the special circumstances involved in decision making are discussed, including decisions where there are multiple goals, those where more than one person is involved in making the decision, using trigger points, framing decisions correctly, commitments to lost causes, and expert decision makers. A complex example of deciding about removal of asymptomatic third molars, with and without an EBD search, is discussed.
This case study examines changes taking place in the Oregon dental care system. Data were obtained from interviews with senior executives from several delivery organizations. Conducted by the senior author (HB), the summarized interviews were reviewed by informants. Oregon Medicaid enrollees now receive medical! dental care in capitated managed care organizations. Several dental group practices that provide care to privately and publicly insured patients are growing rapidly.The largest local dental insurer has diversified into other health products, including management services for affiliated dental practices. The Oregon dental market is undergoing a major reorganization: (a) large dental group practices are expanding and solo practices are declining; (b) all Medicaid patients receive their care in state-regulated Coordinated Care Organizations and their contracted Dental Care Organizations; and (c) more dental graduates are seeking employment in group practices. Longer term, the dental group practice companies are expected to undergo some consolidation.Two key features of the Oregon dental market are the growth of large dental group practices and the reorganization of the dental Medicaid system.
This presentation is an interim report on the American College of Dentists Gies Ethics Project. Following the example of William Gies, our work has been grounded in empirical studies, with progress on the first 11 projects summarized here. The following general patterns are beginning to emerge: (a) the traditional model of individual dentists guided by abstract principles seems to exhibit some inadequacies; (b) ethical cases suggest that patients and dentists hold common views or what should be done and why in some areas but they diverge in others; (c) dentists place high value on technical excellence and income and relatively less on ethics and oral health outcomes; (d) ethics education in dental schools has not achieved the status of a discipline and is showing signs of receiving less attention than in recent years; (e) focus groups of both patients and dentists are concerned that private standards that differ across dentists as to what constitutes appropriate care are eroding trust in the profession, both among dentists and between dentists and patients; (f) recent economic trends highlight growing fragmentation within the profession; (g) practice is losing its direct relationship with patients as it becomes more commercial; (h) dentists are confused about their role in self-regulation and thus compromising public trust; (i) dentists seem to be willing to tolerate a significant number of their colleagues cutting corners; (j) educating individual dentists about ethical theory is unlikely to be effective in bringing about needed professional behavior. Based on this preliminary evidence, it may very well be the case that the ACD Gies Ethics Projects makes recommendations such as the following: (a) improving the ethical tone of the profession will require changes at the organizational as well as the individual level; (b) standards may be more effective if shared among dentists and with the public;
Disruptive innovation is a process whereby companies or industries that have succeeded in the past by producing ever more sophisticated and expensive products and services end up losing their customer base because eventually others enter to serve a market more in line with true consumer needs. The U.S. oral health system has followed this path and is now perfectly positioned for disruptive innovation. Among the innovations that are already disrupting the industry and will increasingly do so are consolidation of dental practices, bringing care to where people are through telehealth- health connected teams and Virtual Dental Homes, and payment systems that provide incentives for lowering costs and improving the health of the population.
Dentists justifiably bridle at having to compromise what they believe, based on evidence, is in the patients' best interests based on reimbursement rules of benefits providers. Benefits providers justifiably bridle at having to pay for services not contracted by those who purchase insurance. A particular case involving performing multiple quadrants of root planing at a single appointment is used as an example of this tension. One alternative is for the profession and the industry to seek to negotiate a win-win joint position. Another is for a few to game the system, which only makes it more difficult to reach ethical common ground.
The evolving demographics and economics of dental practice require consideration as the profession plans forfuture changes in the dental workforce, the makeup of the population and ongoing access to care crisis. This paper is a sampling of U.S. Census Bureau reports on demographics and an appraisal of JADA and ADA News statements regarding the economics of dental practice, as well as a review of historical developments of the profession's perceptions of dental education and government support for dental care. The trends in economics and population-based changes affecting U.S. dental practice indicate a general downturn in practice busyness, stagnation of expenditures for dental services, and a continuing increase in the proportion in minorities throughout the country and the limited ability to make changes in dental economics without altering some long-held views on the delivery of dental services. Customary populations which provided the bulwark of dental practices are being replaced by minorities.The economics of dental practices will be dependent upon (a) developing cultural and structural competence in the economics of the evolving shift in population demographics, (b) implementing changes in the economics of dental education and expansion of delivery models,
After 70 years of community water fluoridation in the United States, still over 100 million people do not have the benefits of dietary fluoride. The saturation level may have been reached. Salt fluoridation can be an adjunct method for improving children's dental health in noncommunity water fluoridation areas. It is used worldwide and the World Health Organization recommends it when water fluoridation is not feasible as it is equally effective in the prevention and control of dental caries. The author calls for a debate on this proposal by organized dentistry.
This investigation describes the factors associated with patients' initial decisions to seek dental care, including the corresponding number of visits and the types of services received during a dental visit episode. Data came from the nationally representative Medical Expenditure Panel Survey (MEPS). Episode-specific dental visits were further classified into three categories, based on type of services received: preventive, treatment-based, or a combination. Among individuals with a visit episode, 78% of the episodes consisted of a single visit. Within an episode, as the number of visits increased, the proportion of initial visits that were of the preventive type decreased.The findings showed that the primary driver of oral healthcare utilization in the United States is preventive care. As new health policy is developed, it is hoped that prevention will remain a central focus in dentistry and that all segments of the population will be able reap its benefits.
The literature is equivocal: dentists are either as susceptible to substance abuse or somewhat more susceptible than the general public. Most of us have suspected at one time that a colleague was troubled by excessive alcohol consumption or prescription pain medications. We often sit on the sidelines, waiting for an ideal opportunity to help, wary about offering unsolicited advice or invading the privacy of a colleague. When the problem is confronted and intervention begins, we hold our breath, yearning for a healthy outcome but dreading the worst. This brief memoir describes the first author's real-life attempts to support a colleague (with the help of a psychologist, the second author) at various intersections of treatment. The moral challenge of professional confrontation is explored. Suggestions on how to intervene with friends, colleagues, and loved ones are offered.
Most of us assume that what we do, and teach, is evidence-based. The challenge is to insure that this is indeed the case. More to the point, how can we readily find the credible evidence we need to guide practice and teaching? And, can we differentiate high-quality evidence from less trustworthy reports? This paper presents a basic, three-step process for querying the literature, identifying levels of evidence, evaluating the evidence, and summarizes the early experiences of three dental schools in developing a curriculum that incorporates EBD and critical thinking.
Ethics education has been a required part of accreditation standards for dental and dental hygiene programs since the 19lJs. The dominant approach uses a combination of lectures and small, case-based seminars to teach ethical principles and provide practice in decision-making procedures to reason through dilemmas where there are several "right" ways to act. Detail is provided about three such programs.
