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Dr. Dan Crofton

A message from the 2018-2019 CFDDA President,
Dr. Daniel J. Crofton:

You Say You Want a Revolution

Fifty years ago, this year in 1968, the Beatles released their song “Revolution.” This song was inspired by the political protests and upheaval of the 1960’s. Their song challenged the methods of destructive change to bring about reforms.

Our field of dentistry is changing, and the pace of change may seem dramatic. Not all of the changes we are witnessing are positive and some present challenges to our profession.

One challenge our profession is facing is from third party interference to the doctor-patient relationship. A recent survey done by Dr. Gordon Christenson found that the greatest concern of the 1,500 dentists surveyed was third party limitations on fees. These fee limitations are frustrating for dentists and affects their income.

Another challenge affecting dentistry is increasing student debt. As of 2016, the average student debt of dental graduates was over $260,000. Dental practices are capital intensive. Large student loans can affect the paths many young dentists pursue. Many starting dentists are choosing to join large corporate or group practices instead of starting their own practice or buying an established dental practice. In a recent edition of the ADA News, Marko Vujicic, Ph.D. who is the chief economist of the ADA Health Policy Institute said, “the percent of dentists who are owners of their practice is declining over time.” He went on to say that the gap in earnings between dentists who own their practice and dentists who are employees in a practice is shrinking.

The rising numbers of mid-level dental providers are creating another challenge. Mid-level providers include dental hygienists and a newer mid-level provider called a dental therapist. The U.S. Bureau of Labor Statistics predicts the employment growth percentage for dental hygienists to grow by 19 percent through 2024. Dental therapists are being promoted as a solution to the access to care issue and a way for dentists to increase their revenues by hiring dental therapists at lower cost to perform some dental procedures. Many dentists feel threatened by these groups.

 Do-it-yourself (DIY) dentistry is being promoted as a way for the public to treat themselves while saving money. The American Dental Association (ADA) is launching a public awareness campaign encouraging citizens to avoid do-it-yourself (DIY) dentistry, such as teeth straightening, veneers and bruxing devices, which if used improperly can negatively impact the gums, bone, ligaments or even the teeth themselves. When some of these DIY treatments go wrong there can be irreversible damage to the teeth.

Other challenges include an aging population with an increased risk of oral cancer. Many older patients have Medicare coverage that does not cover many dental related expenses. As a result of lack of insurance coverage, many of these older patients on fixed incomes delay or neglect dental care.

We are also seeing a more diverse population. A Proctor and Gamble study found that in the growing Hispanic population, 45 percent of Hispanics lack private dental coverage. Some of these uninsured people seek sporadic care in community dental clinics. Dentists need to be able to communicate, reach out, educate, and treat affordably such patients who may not be reachable with traditional methods. These are only some of the challenges facing dentistry today. Other challenges include offshore dental labs and opioid addiction, but dentistry has always faced challenges and overcome them. Gone are the days of the tooth worm, the bow drill, and extractions without anesthesia. Research, innovation, and improvements by dental pioneers like Pierre Fauchard, the Father of Modern Dentistry and Charles Goodyear (Vulcanite) and the use of X-rays, anesthesia, water fluoridation, dental implants, esthetic dentistry, and much more have allowed dentistry to overcome the challenges of the past.

Before you start losing sleep or become overly concerned that the last patient has entered your practice, remember that dental diseases and problems that can only be treated with the skill and expertise of a licensed dentist have not been eliminated. Tooth decay, periodontal disease, crooked teeth, impacted wisdom teeth, and dental trauma will be with us throughout our careers. Dr. Jeffrey Cole, ADA president-elect, says, “the future of our profession is bright.” Dr. Cole goes on to say that the solutions to our challenges lie in innovation and data-driven decision making to respond to and to stay ahead of changes. Dentistry has never rested on its laurels.

The solutions to our problems will come from large organizations, such as the ADA and other organized dentistry associations, dental schools, state dental boards, dental clinics, research institutions, and from individual dentists.

Organized dentistry will have to find new and better ways to recruit and engage members, volunteers, and staff in order to remain a viable resource to members. Dental schools will need to introduce dental students to the dental profession and to the business profession, insist on maintaining high standards and prepare students for the ever-changing needs of their patients. Dental boards will have to continue to protect the public with rigorous licensing and regulatory standards. Ongoing dental research and the development of new products, procedures and inventions will be paramount.

There is a lot of misinformation out there that is confusing to both practitioners and to patients. Practitioners should seek reliable information from recent peer-reviewed journals. The best information and treatment for a dental patient comes from their dentist who has performed a thorough clinical and radiographic exam and not from a mid-level provider or from the internet. Dentists will have to continue to focus on providing high-quality service, building relationships with patients, educating patients and managing efficient offices.

The growth of corporate dentistry and any perceived threat should be kept in perspective. Corporate dentistry will most likely continue to gain market share over the coming years, but eventually such gains should plateau. Trees do not grow to the sky. Over time, all dental offices will inevitably have to become more efficient without sacrificing quality. Only the highest quality dental care should be provided to patients regardless of the dental practice model. Quality dental care should always be provided to patients and by all dentists.

The problems that dentistry is confronting are not revolutionary, but evolutionary. This is all part of an ebb and flow within our profession, but our challenges must be addressed and not ignored. If we confront these challenges as a united profession, then we should be able to overcome these challenges like we have in the past. Take solace in the lyrics of the Beatles song “Revolution” that goes on to say, “You tell me that it’s evolution … Don’t you know it’s gonna be all right.”


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