It is difficult to make predictions about the future. However, it is relatively easy to look at current trends in dentistry and in others areas of endeavour and estimate if they will continue. In my opinion, there are numerous factors that continue to influence activity in dentistry, and each one has a potentially significant future influence on the profession.
This article states the factors that influence the future of dentistry, discusses each area of clinical dentistry and make predictions about the future. The predictions are based on current trends and my personal observations from presenting continuing education around the world for many years.
MAJOR FACTORS INFLUENCING THE FUTURE OF DENTISTRY
Some of the important factors influencing the future of dentistry are discussed in the following information. Undoubtedly, there are many more. Each factor will be discussed in relation to the obvious influencing trends, and predictions will be made for upcoming changes in each area.
PUBLIC INTEREST AND DEMAND
What have been the most obvious changes in public interest and demand in dentistry over the last several years? Is there any question? Esthetic concepts in the profession have dominated public interest. Most women’s magazines carry articles on cosmetic changes available by obtaining dental therapy. Esthetic improvements available from dentists are in the public eye on national television.
Bleaching teeth, veneers, tooth-colored inlays and onlays, orthodontic therapy, tooth recontouring, tooth-colored crowns, and numerous other esthetic procedures are in demand by patients who have been motivated by friends or information in the media.
It has been approximated that about 50% of the gross income in American general dentistry now comes from the previously mentioned and other esthetic therapies. This activity will continue as long as the economy is good in the country and the public continues to spend significant money on elective items.
It would be difficult to find an area of activity that has had or will continue to have more influence on American dentistry. All commercial items related to esthetic procedures will continue to be in high demand, and innovative products in esthetic dentistry will be welcomed by practitioners.
CHANGES IN THE DENTAL WORKFORCE
Approximations about the dental workforce in the future predict that the number of patients per dentist will increase over the next many years. A factor that is often overlooked is the increasing number of females coming into the profession. As this trend continues, the number of patients per dentists could increase even more, because of the reduced number of hours that are available for women to spend in practice.
From the standpoint of individual dentists, most predictions are that there will be more patients per dentist in the USA, and that to reduce the undersupply of dentists, either more dentists must be educated, or expanded function staff must be legalized, educational programs developed, and new staff graduated.
CHANGES IN ORAL DISEASE FREQUENCY
This topic has been presented in various confusing ways over my career. If I had believed all of the prognostications I have heard or read as stated by dental administrators, educators, public health officials, and miscellaneous other groups, I would have been influenced to escape from dentistry and go into another profession a long time ago. In observing the three major oral disease categories through the eyes of the practicing profession, it is easy to see that dentistry continues to have significant and increasing activity in all three areas.
Dental caries incidence has been predicted to be close to elimination at least three times during my career to date. Overall, that has not happened! The prognosticators were somewhat correct about caries in the young age range. When observing dental caries in children, there has been a reduction in caries in this group. However, when observing the incidence of dental caries in the mature population, there has been an enormous increase.
This increase is undoubtedly directly related to the increase in life expectancy over the past several decades. Is this trend likely to be reduced? On the contrary, the currently observable and predicted future increase in population over the age of 55 points to the fact that dental caries in the mature age group will increase.
Treatment of caries in mature people is more difficult and more time consuming than treatment of caries in the young age group. In my opinion, don’t look for any major decrease in overall dental caries in the foreseeable future.
Periodontal disease has also been predicted to be on the verge of elimination several times during my career.
Clinicians have observed many discussions about the upcoming elimination of periodontal disease, hundreds of optimistic research articles about the elimination of periodontal disease, and only minor influence on the disease itself as clinicians see it from day to day. Periodontal disease continues to be a significant dental challenge, but little has been accomplished to prevent or treat the disease with the exception of conventional scaling, polishing, and oral hygiene instruction.
In my opinion, periodontal disease will be around for a long time and prevention and treatment will be necessary. In surveys I have completed during continuing education for new and mature general dentists, I have found that these practitioners do not treat periodontal disease in a comprehensive manner.
Dental hygienists accomplish most of the periodontal therapy in typical general practices. The treatment provided by dental hygienists and the few periodontists in the USA still provides only a fraction of the therapy needed for periodontal disease... Unfortunately, because of the advent of implant dentistry; the attention of many periodontists has been diverted away from conventional periodontal therapy and redirected toward implant surgery. This trend has worsened the access of patients to periodontal treatment. I still await any major reductions in periodontal disease or motivation of patients to seek therapy. It is a significant and continuing challenge.
Treatment of malocclusion and occlusal pathogenic conditions are a significant part of dentistry. Orthodontic therapy for both young and old continues to increase. General practitioners are getting more involved with orthodontic treatment, because of simple procedures that have been introduced during the last few years.
Bruxism and clenching are present in up to one-third of the population, and continue to be relatively untreated by clinicians. Have clinicians observed significant advances in prevention of malocclusion conditions or other occlusal pathogenic conditions?
On the contrary, it is difficult to observe any notable reduction in these conditions, or the potential emergence of new concepts that will reduce the need for malocclusion therapy. Expect treatment of malocclusion and conditions such as bruxism and clenching to continue to increase.
In summary, it is apparent through the eyes of informed and observant clinicians and researchers that oral disease will not be decreased in the near future, but, on the contrary, the incidence of these diseases and conditions will increase significantly.
CHANGES IN DENTAL EDUCATION
Dental educators are faced with the formidable task of teaching all of the areas of dentistry in a short three or four years. When one considers the vast amount of information present in dentistry, it soon becomes evident that this task is impossible.
As a result, new dentists graduate with minimal information and technique ability to initiate their practices. Because of the lack of time for adequate inclusion of all of the necessary aspects of dentistry into the pre-doctoral curriculum, new practitioners must obtain continuing education from a variety of sources, including the excellent education provided by dental manufacturers, retailers, and sales representatives. There is a great need for pragmatic, technique and material oriented continuing education.
In my opinion, based on my observation of thousands of dentists in continuing education courses and my visits to dental schools and practices throughout the country, none of the major factors discussed will have a negative influence on the need for dentists.
FUTURE EXPECTATIONS FOR THE VARIOUS AREAS OF THE PROFESSION
Several factors have been discussed relative to their potential influence on the future of dentistry. What can I predict about the various specific areas of dentistry in the future?
Diagnostics-increased activity, because of aging population, affluence, and new concepts
Endodontics-increased activity, because of the aging population, and the retention of teeth instead of extracting them.
Esthetic dentistry—remarkable increases in demand for all esthetic procedures. This area of dentistry will dominate and exceed all other areas of activity.
Implant dentistry—both the surgical and prosthodontic areas of implants will have continued and increased growth as more practitioners incorporate one or both aspects into their practices.
Occlusion---still slow growth because of the complexity of the subject, but with continuing education, occlusal splints, occlusal equilibration and other techniques will increase. The need is there, but the demand needs to be stimulated.
Operative dentistry—unlike the prognosticators suggested, this area of dentistry continues to grow in need and demand.
Oral and maxillofacial radiography—this is the hottest CE subject at this time. The change to digital radiography and the expanded possibilities for complex treatment will make this area a significant growth area.
Oral and maxillofacial surgery—reduced extraction of teeth, with the exception of 3rd molars, but increased involvement of oral surgeons in more complex aspects of oral surgery and with dental implants.
Orthodontics—unprecedented growth with more simple techniques and involvement of more adult patients.
Pediatric dentistry—another prognosticator faux paus. There is continuing need and demand for pediatric dentistry. It will increase.
Periodontics—Slow growth, since most general practitioners will not involve themselves with this area. Potential is there, but significant advances are necessary to stimulate growth. Potential systemic interactions may be the stimulator.
Preventive dentistry— potential for preventive dentistry is high, with remineralizing concepts, more patient education, increased use of fluoride, but I predict that growth will be slow short of a major discovery.
Prosthodontics—another prognosticator incorrect prediction. Fixed prosthodontics is the single largest area of income for general dentists, and I see no reason it will not continue to be so.. Removable prosthodontic procedures are decreasing slightly, and implant procedures are increasing.
SUMMARY
Many factors influence the future of the dental profession. Several have been discussed, and, short of potential terrorist activities in the USA, none of the factors appear to have observable potential negative influences on the profession.
Each of the areas of dentistry has been discussed, and none of them are decreasing in activity. However, a few areas need significant stimulation to reach their potential.
In all, dentistry in the near future has high potential to serve the public better than ever before and to provide an exciting and stimulating profession for those fortunate enough to be a part of it.
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