I am writing regarding Dr. Timothy Brown and colleagues’ January JADA article, "How Do We Measure Shortages of Dental Hygienists and Dental Assistants?: Evidence From California: 1997–2005" (
JADA 2007;138[1]:94–100
).
I’m no economist, but the divergences in the slopes of inflation-adjusted wages for dental hygienists versus dental assistants between 1997 and 2004 suggest what may be a permanent decrease in per capita demand for hygiene services in California. In contrast, the relatively stable wages for dental assistants over the same interval suggest little or no change in demand for the clinical services typically provided by California dentists. If accurate, a logical question is: What is behind this apparent per capita decrease in demand for dental hygiene services in California?
Because almost all dental hygiene services in California are prescribed by a dentist (rather than the dental hygienist offering his or her services directly to the public), dental hygienists are somewhat isolated from consumer demand. In this light, these data suggest to me that dentists themselves are providing more dental hygiene services, referring their patients to dental hygienists less often and/or that the efficiency of delivery of dental hygiene services has jumped. If so, why?
Additional studies that relate such changing clinical dynamics to treatment outcomes, overall patient wellness, insurance coverages and patients’ out-of-pocket costs may produce valuable public health information that could lead to more efficient and more effective utilization of dental and dental hygiene services.
