Optimizing the dental delivery system.

This paper examines the application of information and principles derived from social science research to increasing the effectiveness and efficiency of the dental care delivery system. Four major delivery system attributes are considered: the availability, accessibility, appropriateness and acceptability of care. The dentist to population ratio is a major determinant of the availability of dental care and many factors have to be considered in deciding on the appropriate number of dentists needed in a population. Optimum size of dental practices is another aspect of availability. The evidence suggests that practices with 2 or 3 dentists are more efficient than solo practices. However, large group practices appear only to be of equal or even less efficiency than small group practices. The accessibility of dental care is influenced by the geographical location of practices, the convenience of obtaining care during non-working hours, the reduction and dissemination of information on dental fees and, most importantly, the beliefs of people concerning their oral health status. The appropriateness of care concerns the impact of different services on improving oral health. Relatively little clinical research has been published on the costs and benefits of different dental services. The acceptability of dental care concerns both patients who visit the dentist and the larger society. Studies show that patients who visit the dentist are generally satisfied with the care they receive. Societal attitudes about the dental care system have not received much attention. Although social science research on the dental care delivery system is at an early stage of development, some data exist which are relevant to optimizing the practice of dentistry.