KDA Today

KDA Today

For Immediate Release

Date: Feb 16th, 2017
Contact: Dr. Beverly A. Largent
Phone: 800-292-1855
Email: info@kyda.org

Trends in Dentistrythe More Things Change, the More they Stay the Same

Dentists in America in 2017 have little in common with the Egyptians who practiced dentistry as early as 2900 BC. There was no prevention, only relief of pain which is evident from the small holes drilled in the jaw bone of skulls of that date. It is thought that these holes represented an effort to relieve abscesses of the teeth. Many dentists today do not identify with the Chinese who used a form of amalgam for restorative dentistry as early as 200 BC, yet Michael Buonocore first described an acid etch technique as recently as 1955, which has led to bonded composite restorations, a staple in the modern dental practice. Throughout the 19th and 20th centuries in the United States, there have been rapid changes in technology, education, and diversity in the dental community, so that dentistry as our grandfathers knew it no longer exists. These changes have been so rapid that the statement is true for the millennials as well as for the baby boomers. Opportunities, as well as regulations, have led to the brave new world of modern dentistry and new technology and trends can cause questioning of our identity as health care providers.

Modern dentistry can be traced to Pierre Fauchard, a Frenchman who was the first to publish a collection of articles and papers about the practice of dentistry in 1728. He is credited as the one who separated dentistry from medicine. Before Fauchard’s time, dentistry was practiced in Europe by barber-surgeons who removed teeth for the relief of pain. As knowledge and technology improved, many in the field defined themselves as surgeons, dropping the first part of the title. These surgeons primarily extracted teeth, but there was greater emphasis on learning about anatomy, and offering preventive services such as tooth cleaning. Henry VIII gave these surgeons a charter, which through the years evolved into the Royal College of Surgeons. Barber-surgeons came with the early settlers to the Massachusetts Bay colonies. The first American born Dentist was Isaac Greenwood who began practicing in 1779. His six sons also became dentists, one becoming George Washington’s dentist. Another famous dentist was Paul Revere who practiced in Boston for seven years.

During the 19th century the United States was the center of dental developments. There were three events that cemented dentistry as a profession. The American Journal of Dental Science was established in 1839, followed in 1840 by the opening of the Baltimore College of Dental Surgery, the first dental school. The first dental association, the American Society of Dental Surgery was established in 1840 in New York. Other developments came fast and furious, changing forever the practice of dentistry. Horace Wells discovered Nitrous Oxide, and ether anesthesia in 1844 and 1846. In 1864 vulcanized rubber was introduced making dentures more affordable, and in 1871 James Beall Morrison a Missouri dentist developed the foot-treadle drill. In a time span of approximately 30 years, the face of dentistry was changed forever. During this 30 years, the American Dental Association was established.(1859) The 19th century also saw the discovery of x-rays, the entry of women into dental school, the graduation of African-American men and women from dental school, and the establishment of Orthodontics as a dental specialty.

The 20th century marked more familiar developments. Perhaps the most prominent and long lasting contribution was made by Greene Vardiman Black. G.V. Black more than any other person has influenced the practice of dentistry. In 1908 Black published his two volume work Operative Dentistry, which remained the essential text book in clinical dentistry for the next 50 years. A Dental Hygiene school was established by Alfred Fones, in Connecticut, and the term dental hygienist was coined. Water fluoridation began in many states, nylon toothbrushes and fluoride toothpaste was introduced. The foundations for bonded dental restorations were developed, the laser was introduced for soft tissue, and four handed dentistry was established.

In the 21st century we have seen the increased use and development of the laser in dentistry. Patient comfort is in the forefront. Dental implants have become commonplace. Restorative dentistry has placed the dentist arm in arm with his/her computer, from digital x-rays to impressions. The trend toward large group practices is increasing.


Research and advances in technology have changed the practice of dentistry, but there have been other factors influencing the profession. The entrance of the Millennial generation into the profession has the potential to bring the greatest impact in the 21st century. Millennials are the generation from ages 22 to 34. (Generation X are aged 35-51 years, Baby Boomers are aged 52-70 and Traditionalist are aged 71 years and older.) Wikipedia defines Millennials as self-confident, tech savvy, collaborative and team oriented, socially and globally oriented, and well connected. They value family time, and a good work/life balance. The Pew Research center defines this generation as one who likes to think for themselves, who don’t like to take advice, are detached from organizations, favoring networking with friends. This generation is upbeat, and has a more favorable view of the future than older generations. They are the first in the modern era to enter practice with a higher student loan debt. This diverse generation values meaningful work, growth potential, high pay and a sense of accomplishment.

The tech savvy individuals eschew organized dentistry for networking, and information via the internet. This has left dental organizations scrambling for their membership. The satisfaction the Traditionalist obtained from organized meetings, and connecting with old friends, has been replaced with instant information and social media.
Millennials graduate dental school with more debt than any other generation. The American Dental Education Association reports the average debt of a dental school graduate to be $240,277 for the four of five students who have debt. Over 30% of dental school graduates with student loans reported debt in excess of $300,000. ADEA also reports that 45% of graduates plan to enter private practice immediately after graduation, and 28.3% of these graduates plan to enter corporate group practice, an increasing trend. It is generally accepted that this trend is due in part to the need to repay educational debt.

From the Academy of General Dentistry Practice Models Task Force in 2013 we learn: “Ultimately, the growth of corporate models may vary based upon the priorities of up-and-coming generations of dental school graduates, as well as the effects of the Patient Protection and Affordable Care Act of 2010 and the varying and continually changing structures and contracts of DSOs. While some economists expect continued growth of large group practices, including models of corporate dentistry, others predict that the market share of corporate models has reached a plateau or will reach a plateau at or about 20-25 percent of all practice modalities.”

Interfaced with the emergence of the Millennials is the feminization of the profession. In 1866 one woman, Lucy Hobbs Taylor graduated from The Ohio College of Dental Surgery. In 2017, 60% of the dental students are women, and 25% of practicing dentists in the United States are women. Before 1970 fewer than 3% of practicing dentists were women, by far the lowest number in the Western World. By the year 2000, 40% of dental students were women, calumniating in the 60% today. There are sociological changes in the U.S. which have precipitated the gender shift in dentistry. The women’s movement in the late 60’s and early 70’s helped shape the view of women’s roles. In 1972 Title IX was passed, outlawing discrimination in education. Later, there were Federal Funds grants available to support women in professional education. Birth control was one of the most profound biological and social changes of the 20th century, giving women the option of planning the births of their children.
(www.spiritofcaring.com)

The American Dental Association and many other dental organizations are dealing with the current trends in the profession of dentistry through continuing education, efforts to maintain membership, and providing assistance in student loan repayment. Dental educators as well are dealing with a new generation, and added responsibilities in preparing young practitioners. A look back suggests that the current trends are no more tumultuous than those of the past. Be it women, men, Millennials, Baby Boomers, practice owners or employee dentists, the relationship between patient and practitioner remain the same.

 

 

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