Question:
I've heard a number of conflicting things about the future of
dentistry. On the positive side I've heard that there will be a
tremendous demand for dentists in the future. I've been told that there
are 2000 more dentists retiring each year than are being graduated from
dental school. I've heard that by 2010 there will be a federal shortage
of dentists in the United States due to the aforementioned and the fact
that the population is aging. I've heard that as people live longer
they tend to value their smiles and desire to hold on to their teeth for
longer periods of time. I've heard that as the affluence of Americans
rises so does their expenditure on their oral health (although I feel
the rich getting richer and the poor...). 87% of the population will
suffer from some sort of Periodontis.
On the downside, there is no doubt that the fluoridation of water has
decreased the incidence of caries. Sealants are protecting the teeth of
young childrens. Increasing awareness of oral health has led to a
decrease in complications. The gov't report on jobs expects the field
to grow "slower than average" which contradicts the retirement
statement.
So what is going on? Where is this field going? Am I heading into a
field where I'm just going to be bleaching teeth and sending patients on
their way? Are there any disaster cases left? Will people still get
caries? There is no doubt in my mind that accidents occur and people
chip and break their teeth necessitating repair. Patients are no
doubtedly going to ignore my advice and not floss or brush properly. So
what kind of work can I expect to be doing? Will there be enough work
in the future? Nobody really seems to know.
Answer:
I think most dentists, including yourself, will still be quite busy for
many years to come. Those who were born in the early to mid sixties,
also known as the "forgotten generation", were the last group of
children to miss a most of the preventative treatments such as sealants
and flouride treatments. They are now in their thirties
now and have fillings which need to be replaced with newer materials.
I am of that generation (I'm 35). Ten years from now, most of us will
have full careers and lots of disposable income to spend on ceramic
inlays/onlays, crowns, veneers, implants, etc.
Those in their teens and twenties obviously have no or very few
cavities, but even some of them will eventually require restorations
for chipped, broken or knocked-out teeth.
Treatment of dental diseases will begin to take a more biological
approach in the near future. Since bone, gums and periodontal tissues
can be regenerated to a good extent, there is no technological reason
that hard tissues of the teeth will not be restored with their original
components. Already research is underway to regrow teeth in the jaw
using gene therapy. This probably won't come into fruition until 10-15
yrs from now, but expect a paradigm shift in your practice during your
lifetime.
Epidemiologically speaking, age has zero effect on tooth work-need.
Economics is 100% involved with it. I routinely see patients who are
70, 80 and older with pretty excellent teeth.
We devote most of our efforts to the "haves" who have generally decent
teeth and we ignore the "have-nots" who have missing front teeth!
Why? Why not prevent dental problems?
The cosmetics revolution was dreamed up to prevent dentists from
deep-sixing their careers and going to law school instead.
Never, never. Dental trauma prevention will come from a public health
perspective. That involves legislation, not the good will of fairly
greedy people.
The Future of Dentistry...Affordable Dentures grows by about 20% per
year. I'm pretty convinced that they have a pretty good handle on where
the future lies...BTW, it's NOT in $800 bleaching kits!
