Year : 2014 | Volume
: 5 | Issue : 2 | Page : 33--34
Threats and opportunities for a profession in transition
Edward F Rossomando
Department of Craniofacial Sciences, University of Connecticut School of Dental Medicine, Farmington, USA
Edward F Rossomando
263 Farmington, Ave, Farmington, CT 06030
|How to cite this article:|
Rossomando EF. Threats and opportunities for a profession in transition.Dent Hypotheses 2014;5:33-34
|How to cite this URL:|
Rossomando EF. Threats and opportunities for a profession in transition. Dent Hypotheses [serial online] 2014 [cited 2021 Jun 21 ];5:33-34
Available from: http://www.dentalhypotheses.com/text.asp?2014/5/2/33/133419
The American Dental Association (ADA) Defines the Problem
The ADA's Health Policy Resources Center (HPRC) develops and promulgates policies to inform members. A case in point is the recent editorial published in the February issue of the Journal of the ADA.  The article titled "A Profession in Transition" was prepared to assist the 2015-2020 strategic planning process underway at the ADA.
From data presented by the HPRC, the authors conclude working age adult Americans (ages 18-64) did not visit the dentist in 2011 as much as they did in 2000-2004.  Why might that be? Because the decline in dental visits began before the drop in income associated with the Great Recession (2007-2008) and has not rebounded since the recession ended, the authors suggest the decline is probably due to something other than income. In the remainder of the editorial they discuss alternative forces including changes in private and governmental insurance coverage.
Another Look at the ADA Data
While I agree with the authors that there is probably no single explanation for the decline in dental visits, to dismiss income as a factor suggests the authors are unaware of, or ignoring, the post-recovery hardships that continue to linger even into 2014. Although many working adults found employment, many of these jobs did not provide dental coverage and many of the jobs offered lower salaries or were part time. And it is likely that dental fees increased during these years making it even more difficult for adult workers to afford dental care. Why go to the dentist if you cannot afford the treatment?
Another possibility for the decline in dental visits for those in the 18-64 age groups is fewer cavities because of the success of fluoridation and of the ADA's educational programs to encourage both reductions in dietary sugar and increased oral hygiene. Why the authors have chosen to ignore these explanations as possibilities is unclear. Perhaps it is because the number of dental emergency room (ER) visits has doubled from 2000 to 2010 indicating a need for dental care.  Why these patients did not visit a dentist is not discussed but likely explanations would be they could not get an appointment, they had no insurance, and/or they could not afford the private practice fee. Also not discussed is why the HPRC did not count the ER visits when compiling these data. If counted, dental visits would be higher than reported.
Given that the authors' incomplete reporting on the decline in dental visits, it would appear disingenuous for them to conclude that the reason for the decline is not financial. What is clearly financial, however, is these authors' report of the decline in dentists' net income. The editorial reports HPRC data showing that average net income of dentists slowed in 2000-2001 and declined from 2006 through 2009.  Although these data also show stabilization since 2009, dentists' income has not rebounded to pre 2000 values. As these data apply to dentists in solo practice, and this group makes up at least 90% of ADA members, it should come as no surprise that these authors should chose to focus on the decline in dentists' income.
Having presented data to support the claim of a decline in dental visits and the decline in income, the authors look forward to see if the situation might change. What they see are trends that represent continued threats to dentists in solo practice and of course ADA members. The threats the authors' enumerate include provider consolidations and large multisite practices. Another threat is the emerging group of non-doctoral providers often referred to as midlevel providers. The threats also come from insurers who either will require improvements in practice management or from the patient who will seek additional value for the fees charged. ,
From Threats Emerge Opportunities
But where some see threats from change, others see opportunities. Many other professions, including medicine and psychology, when faced with loss of market share have acquired new skills. Dentists need to acquire new diagnostic and treatment skills that will enable them to provide dental care that multisite practices and midlevel providers cannot provide. They need to find something else to do. For dentistry this should not be a problem. During the past several decades, dental research has provided many opportunities for acquisition of new skills. Where the profession might have a problem is developing and accepting an educational model for incorporation of new paradigms for diagnosis and treatment using bio-based discoveries emerging from the research laboratories since the start of the 21 st century.
Changing the Paradigm for 21 st Century Dental Practice
In previous publications, I have referred to the current paradigm for treatment as xenodontics because treatment includes restoring and replacing teeth using nonbiological materials - metals, plastic, and at one time even bone, ivory, and rubber.  A new paradigm for treatment using bio-based materials such as bio-scaffolds and stem cells I have referred to as biodontics. 
Although the xenodontic paradigm for dental practice cannot be abandoned overnight, the profession must be willing to move forward. As noted by the authors of the editorial, we are indeed a profession in transition. But the transition should be seen as an opportunity to move forward from a xenodontic to a biodontic paradigm for dental treatment. Implementing this paradigm shift will be the challenge for our profession but necessary to insure our survival in the 21 st century.
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