PROSTHODONTICS - American College of Prosthodontists

Changes in Scope of PracticeThe American College of Prosthodontists9. Highlight recent epidemiological data or studies that establish the incidence and/orprevalence of major conditions routinely diagnosed and/or treated by practitioners in thespecialty. Please provide overview comments on how these changes have affected the practiceof the specialty and the future practice of the specialty. (suggested response - up to fivepages)The data presented will show there is greater need for prosthodontic services, includingcomplex prosthodontics over the next 25 years. The needs for these services will continue toincrease with the growth in the adult population which is the fastest growing segment of the U.S.population. With these factors, the demand for complex prosthodontic services to be providedat the specialty level will also grow dramatically.According to Oral Health–Healthy People 2010: Objectives for Improving Health, 26% ofthe US population between the ages of 65 and 74 are completely edentulous. Other data showsthe prevalence of persons who are edentulous increases with age from 0% of the 18 to 24 yearolds; to 12% of the 50 to 54 year olds; 24% of the 60 to 64 year olds; and 43.9% of those 75and older (Marcus, et al., 1994). The rate of edentulism is estimated at 30% for African-Americans, American Indian, or Alaska Native for this age group, 26% for Caucasians, and 24%for Hispanics. Low-income adults aged 65 and older had the highest rate of edentulism (48% in1993), and there were dramatic differences between similar populations in the fifty states (13%in Hawaii to 47% in Kentucky are edentulous). Low education levels have been found to havethe highest and most consistent correlation with tooth loss. Early loss of teeth has shown to be asignificant factor leading to complete edentulism, with 7.4% of dentate Americans experiencingearly tooth loss becoming edentulous within the next decade. And, while reports indicate a 6%reduction in total edentulism between 1988 and 2002, significant growth in the US populationalong with possible declining access to dental care, shows a tendency for growth of edentulismin one or more dental arches over the next two decades. Based on the multiple factors,edentulous patients will need or demand an increase of approximately 230,000 units ofcomplete dentures per year.When considering complex prosthodontics in a partially dentate or dentate patient, acomplicating factor is the condition of the remaining dentition. The percent of treated anduntreated root caries increases markedly with age (Miller, et al., 1987). Approximately 7% ofdentate adults age 18 to 19 had at least one decayed or filled root surface, whereas, 54.4% of60 to 64 year olds had at least one decayed or filled root surface. Among seniors, 62.6% had atleast one decayed or filled root surface with 38% of these due to untreated decay (White, et al.,1995). Overall, 22.5% of dentate persons had root caries in 1988 -91. Mean root caries scoresincreased with age in every demographic group (Winn, et al., 1996).The data related to tooth loss and tooth retention will have a significant impact on thespecialty of prosthodontics. Based on the data related to edentulism, tooth loss and thecondition of remaining teeth, as well as other factors such as abrasion, attrition, erosion, and theneed for esthetic improvement (Douglass, 1992) coupled with the increase in the adultpopulation, there is an increased need for complex prosthodontics services.On review of three basic demographic trends occurring in the U.S.:(1) the population is getting larger,(2) the population is getting older,(3) the population is becoming more culturally diverse,The combination of these three trends, has a positive impact on the need for prosthodonticservices. Within 20 years the U.S. population is expected to exceed 325 million people. Thetotal U.S. population will therefore increase by 30% from 240 million in 1989 to more than 325million in 2020. Although there will be the same number of young people under age 20 years old(approximately 2 million at each level), they will represent a smaller proportion of the populationbecause of the increased number of older and senior adults. By the year 2020, it is projectedthat approximately 14% of the population will be less than 9 years old, 13% will be 10 to 19Prosthodontics - 172010 CDEL Re-recognition of the Specialty Report 17 of 279