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The baby-boomer generation
Dental Implants Why implants succeed Background.—Dental implants are well-integrated into daily dental practice. When they are successful, the patient’s missing teeth are replaced by esthetically pleasing structures that restore full chewing ability. Success rates are between 95% and 98% for osseointegrated dental implants, which demonstrate both acceptable function and stability. Factors related to success and complications were documented. Reasons for Success.—The reasons for success of dental implants flow from the continuing research and development done by implant manufacturers as well as dedicated clinicians and researchers. These include refinement of implant surfaces, prosthetic components, and surgical protocols. Because these advances undergo careful clinical evaluation, only the best are incorporated into clinical protocols. The protocols established early in the course of implant development reflect stringent requirements that originally limited implant use to specialist oral surgeons, prosthodontists, and eventually periodontists. As the implants proved clinically successful, surgical and prosthetic protocols were simplified. Ultimately, through this process and extensive marketing, implant placement became part of general dental practice. Dental students not trained in implant care are seen as less competent and competitive than those who receive it. Complications.—Challenges have arisen with wider use of implants. As more implants are placed, higher numbers of complications are seen, but the percentage success rate has remained high. Safeguards must be observed to preserve a high success rate, including the requirements for appropriate training and for following established guidelines. As major implant,
oral surgery, prosthodontics, and periodontal specialist organizations publish new developments and information about new materials and protocols, these are added to the process to maintain the best outcomes. Only the materials and protocols supported by evidence-based research are considered for incorporation into implant therapy protocols. It is also important to understand our own limitations regarding implant placement. When the case is more demanding than our training can handle, we have a responsibility to refer the patient to an experienced clinician before treatment rather than during the course of care or after making significant compromises in patient care. Patients must also be educated about long-term maintenance requirements, which are critical to implant success.
Clinical Significance.—Worldwide, hundreds of thousands of dental implants are placed each year. The current implant dentistry marketplace is expected to double by 2018, so implants will continue to be an important part of the dentist’s armamentarium. It is essential that we keep before us the admonition to ensure implants are placed for the right reasons and in the patient’s best interests rather than ours.
Bartold PM: Dental implants—from experimental dreams to mainstream practice. Austral Dent J 60:1, 2015 Reprints not available
Dental Practice Future The baby-boomer generation Background.—Dental practice trends show that dental services have expanded significantly from past models. In addition, there have been demographic trends among patients and professionals that have affected practice patterns. The changes in workforce, economic issues, and
clinical practices have the potential to change the future of dentistry. Practice Trends.—The past 60 years have seen a change from a one dentist one assistant model to practices
Volume 60
Issue 5
2015
243
Fig 2.—Procedures completed in the dental office. *General dentists. (Courtesy of Solomon E: The future of dental practice: Demographics. Patients, professionals, and procedures. Dent Econ 105:16, 20, 22, 26, 2015.)
with many more staff members who offer diverse skills. About half of all dental personnel were dentists in 1950, but by 2012, they accounted for only about 20% of dental professionals. The highest rate of growth has been among personnel who are not involved in delivering direct clinical care. New personnel have been hired to accommodate the change in the range of services now offered in dental offices. Among the services provided are examinations; prophylaxis; restorations, including plastic restorations; and other specialty-type procedures, including prosthodontic, endodontic, periodontic, orthodontic, and surgical procedures (Fig 2). The focus has shifted from a disease-based
Fig 3.—Percent of population visiting the dentist within past 12 months. (Source: ADA News, vol 44 no. 6.) (Courtesy of Solomon E: The future of dental practice: Demographics. Patients, professionals, and procedures. Dent Econ 105:16, 20, 22, 26, 2015.)
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Dental Abstracts
model to one based on routine check-ups and health maintenance interventions. The change is largely attributable to the decline in childhood caries. Annual dental visits may be declining for some age groups (Fig 3), with the increase for children age birth to 3 years having leveled off. Much of this is due to governmental funding for childhood dental services. Adult visit numbers have declined since 2003, consistent with the decline in the incidence of dental disease among children. Dental spending data reveal that older adults have significantly higher dental expenditures per capita than other dental patients (Fig 4). Older patients also tend to
Fig 4.—Percentage of total dental expenses by age and year. (Source: Nasseh K, Vujicic M: http://www.ada.org/sections/profes sionalResources/pdfs/HPRCBrief_0813_1.pdf.) (Courtesy of Solomon E: The future of dental practice: Demographics. Patients, professionals, and procedures. Dent Econ 105:16, 20, 22, 26, 2015.)
visit the dentist more frequently than other age groups. Thus the aging population provides the core financial focus of dental practices and will continue to do so for the next 25 years. Expanding government programs will increase the number of children who make regular visits, but these visits have a low level of reimbursement. The group making the fewest visits and having the least dental disease will be young adults, age 20 to 39 years. Corporate Practice Model.—Ownership of a dental practice is the key determinant of the dentist’s freedom to choose the course of clinical management. Dental management service organizations (DMSOs) and corporate practices will continue to increase their presence in dentistry. Recent graduates with high debt levels will find them suitable as a place to work without incurring additional debt. Retiring dentists will be selling their practices to these corporate entities when younger dentists are unable to take on the responsibility. In addition, corporate practices offer advantages over traditional practices such as competitive pricing, multiple locations, provision of care to walk-in patients, acceptance of government insurance, and accessibility for underserved populations. Midlevel Practitioners’ Role.—Midlevel dental providers have been proposed as a way to assist in underserved areas. However, they must to be trained to perform procedures that only dentists now perform, or their usefulness will be limited. In preparation for this role, midlevel practitioners will incur high levels of debt and need to have jobs when they graduate. The most likely employers will be corporate entities, and midlevel practitioners could certainly provide an economic benefit to the corporation. They could free dentists to perform more complex procedures that are more highly compensated and perform less
skilled tasks, reducing labor costs. The underserved population, however, is not likely to see any benefit with this use of these practitioners. As outlined, the patient of the future will be older and have more complex dental needs and medical issues, including medication use. Proper treatment for these patients will include extensive knowledge of clinical science. Rather than train dental care providers at a lower level, more extensive training of dentists to meet more complex needs may be appropriate. Discussion.—It is likely that the dental market of the future will be more competitive. Changes will occur in the workforce, in the patterns of spending for dental services, and in the services provided in dental offices. How private dental practices are able to respond to these challenges will influence the future of dentistry.
Clinical Significance.—The baby-boom generation will greatly influence the dental marketplace, both in terms of their role as practitioners and as they seek care as patients. As things stand, it is likely that the dental marketplace will become more competitive and challenging.
Solomon E: The future of dental practice: Demographics. Patients, professionals, and procedures. Dent Econ 105:16, 20, 22, 26, 2015 Reprints not available
Economics Background.—Expenditures for dental services showed a greater than 50-fold increase between 1960 and 2012, mostly driven by a higher proportion of the population seeking care and increased dental service costs. However, between 2007 and 2012, dental expenditures grew only at a rate of 2.8% annually. The US Centers for Medicare and Medicaid Services estimates that dental expenditures will rise by an addition 53% by 2020, with annual increases averaging 6.7%. This view is regarded as overly optimistic, however, based on the recent slow growth. Signs indicate that the growth in dental service spending is becoming nearly stagnant, reflecting the extended, uneven recovery from the latest recession. Factors to be considered in the economic picture for
dentistry are shifts in expenditure sources, inflation, and dental income. Sources of Expenditures.—Although government sources for dental service payments were nearly nonexistent 50 years ago, they have grown slowly and now account for 9.6% of all expenditures. In contrast, 55.4% of all physician and clinical services are covered by government sources. Other sources for dental expenditures are private insurance and out-of-pocket expenses, which account for 48.1% and 42.3%, respectively. For the future, the US Centers for Medicare and Medicaid Services estimates that insurance payments will
Volume 60
Issue 5
2015
245
oral surgery, prosthodontics, and periodontal specialist organizations publish new developments and information about new materials and protocols, these are added to the process to maintain the best outcomes. Only the materials and protocols supported by evidence-based research are considered for incorporation into implant therapy protocols. It is also important to understand our own limitations regarding implant placement. When the case is more demanding than our training can handle, we have a responsibility to refer the patient to an experienced clinician before treatment rather than during the course of care or after making significant compromises in patient care. Patients must also be educated about long-term maintenance requirements, which are critical to implant success.
Clinical Significance.—Worldwide, hundreds of thousands of dental implants are placed each year. The current implant dentistry marketplace is expected to double by 2018, so implants will continue to be an important part of the dentist’s armamentarium. It is essential that we keep before us the admonition to ensure implants are placed for the right reasons and in the patient’s best interests rather than ours.
Bartold PM: Dental implants—from experimental dreams to mainstream practice. Austral Dent J 60:1, 2015 Reprints not available
Dental Practice Future The baby-boomer generation Background.—Dental practice trends show that dental services have expanded significantly from past models. In addition, there have been demographic trends among patients and professionals that have affected practice patterns. The changes in workforce, economic issues, and
clinical practices have the potential to change the future of dentistry. Practice Trends.—The past 60 years have seen a change from a one dentist one assistant model to practices
Volume 60
Issue 5
2015
243
Fig 2.—Procedures completed in the dental office. *General dentists. (Courtesy of Solomon E: The future of dental practice: Demographics. Patients, professionals, and procedures. Dent Econ 105:16, 20, 22, 26, 2015.)
with many more staff members who offer diverse skills. About half of all dental personnel were dentists in 1950, but by 2012, they accounted for only about 20% of dental professionals. The highest rate of growth has been among personnel who are not involved in delivering direct clinical care. New personnel have been hired to accommodate the change in the range of services now offered in dental offices. Among the services provided are examinations; prophylaxis; restorations, including plastic restorations; and other specialty-type procedures, including prosthodontic, endodontic, periodontic, orthodontic, and surgical procedures (Fig 2). The focus has shifted from a disease-based
Fig 3.—Percent of population visiting the dentist within past 12 months. (Source: ADA News, vol 44 no. 6.) (Courtesy of Solomon E: The future of dental practice: Demographics. Patients, professionals, and procedures. Dent Econ 105:16, 20, 22, 26, 2015.)
244
Dental Abstracts
model to one based on routine check-ups and health maintenance interventions. The change is largely attributable to the decline in childhood caries. Annual dental visits may be declining for some age groups (Fig 3), with the increase for children age birth to 3 years having leveled off. Much of this is due to governmental funding for childhood dental services. Adult visit numbers have declined since 2003, consistent with the decline in the incidence of dental disease among children. Dental spending data reveal that older adults have significantly higher dental expenditures per capita than other dental patients (Fig 4). Older patients also tend to
Fig 4.—Percentage of total dental expenses by age and year. (Source: Nasseh K, Vujicic M: http://www.ada.org/sections/profes sionalResources/pdfs/HPRCBrief_0813_1.pdf.) (Courtesy of Solomon E: The future of dental practice: Demographics. Patients, professionals, and procedures. Dent Econ 105:16, 20, 22, 26, 2015.)
visit the dentist more frequently than other age groups. Thus the aging population provides the core financial focus of dental practices and will continue to do so for the next 25 years. Expanding government programs will increase the number of children who make regular visits, but these visits have a low level of reimbursement. The group making the fewest visits and having the least dental disease will be young adults, age 20 to 39 years. Corporate Practice Model.—Ownership of a dental practice is the key determinant of the dentist’s freedom to choose the course of clinical management. Dental management service organizations (DMSOs) and corporate practices will continue to increase their presence in dentistry. Recent graduates with high debt levels will find them suitable as a place to work without incurring additional debt. Retiring dentists will be selling their practices to these corporate entities when younger dentists are unable to take on the responsibility. In addition, corporate practices offer advantages over traditional practices such as competitive pricing, multiple locations, provision of care to walk-in patients, acceptance of government insurance, and accessibility for underserved populations. Midlevel Practitioners’ Role.—Midlevel dental providers have been proposed as a way to assist in underserved areas. However, they must to be trained to perform procedures that only dentists now perform, or their usefulness will be limited. In preparation for this role, midlevel practitioners will incur high levels of debt and need to have jobs when they graduate. The most likely employers will be corporate entities, and midlevel practitioners could certainly provide an economic benefit to the corporation. They could free dentists to perform more complex procedures that are more highly compensated and perform less
skilled tasks, reducing labor costs. The underserved population, however, is not likely to see any benefit with this use of these practitioners. As outlined, the patient of the future will be older and have more complex dental needs and medical issues, including medication use. Proper treatment for these patients will include extensive knowledge of clinical science. Rather than train dental care providers at a lower level, more extensive training of dentists to meet more complex needs may be appropriate. Discussion.—It is likely that the dental market of the future will be more competitive. Changes will occur in the workforce, in the patterns of spending for dental services, and in the services provided in dental offices. How private dental practices are able to respond to these challenges will influence the future of dentistry.
Clinical Significance.—The baby-boom generation will greatly influence the dental marketplace, both in terms of their role as practitioners and as they seek care as patients. As things stand, it is likely that the dental marketplace will become more competitive and challenging.
Solomon E: The future of dental practice: Demographics. Patients, professionals, and procedures. Dent Econ 105:16, 20, 22, 26, 2015 Reprints not available
Economics Background.—Expenditures for dental services showed a greater than 50-fold increase between 1960 and 2012, mostly driven by a higher proportion of the population seeking care and increased dental service costs. However, between 2007 and 2012, dental expenditures grew only at a rate of 2.8% annually. The US Centers for Medicare and Medicaid Services estimates that dental expenditures will rise by an addition 53% by 2020, with annual increases averaging 6.7%. This view is regarded as overly optimistic, however, based on the recent slow growth. Signs indicate that the growth in dental service spending is becoming nearly stagnant, reflecting the extended, uneven recovery from the latest recession. Factors to be considered in the economic picture for
dentistry are shifts in expenditure sources, inflation, and dental income. Sources of Expenditures.—Although government sources for dental service payments were nearly nonexistent 50 years ago, they have grown slowly and now account for 9.6% of all expenditures. In contrast, 55.4% of all physician and clinical services are covered by government sources. Other sources for dental expenditures are private insurance and out-of-pocket expenses, which account for 48.1% and 42.3%, respectively. For the future, the US Centers for Medicare and Medicaid Services estimates that insurance payments will
Volume 60
Issue 5
2015
245