The tooth is out there


433226main_Misti_ComaCluster_PPHow will dentistry look in 2020? What challenges and opportunities will the future hold? Chris Sheedy speaks with industry experts to find out

When he walks into a successful dental surgery in 2020, Phillip Palmer expects to simply feel better. He will be welcomed into the surgery in a more friendly and professional fashion. He will be communicated with in a more effective and personalised way. He will be dealing with engaged staff who have been well trained and are experts in their field and who know the value of high service levels. And that is all before he even meets the dentist.

“The profession is becoming more professional and in the new environment in which it will be operating, it will have to be,” Palmer, the founder and co-managing director of Prime Practice, says. “Everyone can tell you a horror story about when they went to see a medical specialist and the receptionist didn’t even look up at them. Some dentists were like this 10 years ago because they didn’t need to care. Now they do need to care.”

Why the sudden need for an increase in service levels? It is a simple matter of mathematics, Palmer says. Five or six years ago universities were producing around 250 newly qualified dentists each year. Added together with a smattering of dentists coming in from overseas, this meant there was a healthy balance in the marketplace of those entering and those leaving. But today we are seeing around 600 graduates annually and another couple of hundred from overseas, meaning there is an over-supply of dentists, he says.

“The over-supply will continue and if anything, it will gather pace,” says Palmer. “That is one of the biggest things that is happening to the profession. It means there will be less work for every dentist, meaning marketing and management will become extremely important. Those who are not strong in the field of marketing or in people-management will face a serious problem.”

Another near-future challenge will come from the constantly increasing corporatisation of dentistry. The change in ownership of a practice may not make a noticeable difference in the industry, but when the new owner is a major insurance provider that markets heavily to its own members, pushing them toward the company-owned dental surgeries, the difference will be noticeable, indeed.

Fortunately, the breadth of work being conducted by dental practitioners is likely to be increased by 2020, says award-winning academic Professor Lakshman Samaranayake, head of the University of Queensland’s School of Dentistry and professor of oral microbiomics and infection.

Prof Samaranayake says dentists will adapt to fill the role of oral physicians. For example, they may become experts in the use of saliva as a diagnostic fluid, he says. Or they may be called in to help work with various diseases and infections such as diabetes and HIV.

Palmer agrees, saying the growth currently being seen in such areas as aesthetic dentistry, orthodontic work and sleep dentistry (to help treat such issues as sleep apnoea) is an exciting sign of things to come.

Prof Samaranayake says the idea of inter-professionalism will become increasingly relevant for dentists, who should find themselves working with physicians, surgeons, psychologists and many other health science specialists. “By 2020 this inter-professionalism should be much more developed,” he says.

“Dentistry has an important role to play in systemic health. For example, for people staying in hospital, in intensive care or on respirators, etc, there are quite a lot of infections related to or originating in the mouth. A lot of studies indicate that if you have chronic gum disease then you may be subject to other types of disease as well. So, for the doctors and physicians working in this area, access to dentistry is valuable. Even the American Heart Association says to have a healthy heart, you need to have a clean mouth.”

There are large parts of the population that continue to face barriers to accessing regular dental care and who, as a result, experience poor oral health outcomes, says Andrew McAuliffe, Australian Healthcare and Hospitals Association’s executive director—policy program. “To address this, oral health practitioners must engage with the broader health workforce to promote early identification and referral of at-risk clients and to support better coordination of care for those with complex medical conditions,” he says. “The oral health sector needs to be fully integrated into the broader health system, not just an extra tacked on the side.”

Within the dental profession itself, implant dentistry will increase, Prof Samaranayake says. We’re currently witnessing a shift from dentures to implants and by 2020 the currently high cost of implants should be on the way down as more dentists offer the service and manufacturers of implant materials improve their systems and processes. It shouldn’t be too long, the academic says, before dentures are seen as a thing of the past.

Demand for such services should increase as the population ages over the coming years and decades, McAuliffe says. “The affordability of care will influence how this demand is spread across the public and private sectors. Appropriately using the skills of the whole oral health workforce will be a key to addressing this demand. The increasing involvement of the Australian Government in funding dental services should be encouraged and directed to addressing the needs of those with the highest need,” he says.

In summary, while workforce projections are indicating that we will see an over-supply of dentists, McAuliffe suggests that more needs to be done to address the relative under-supply in regional and rural areas. But we will also witness a broadening in the number and types of services that dentists will be offering, although not enough to make up for the over-supply of dental specialists, Palmer says. Dentists should be working more closely with other types of medical specialists as their specific skills make them more valuable in other areas. And most importantly for a clinic’s patients and staff, service and engagement levels should rise as successful practices work harder to retain staff.

“In the end, success will be about how patients are made to feel when they walk into a practice, and that is connected to how well trained and engaged the staff happen to be,” Palmer says. “Patients generally don’t know the skill levels of the dentist, but they do know how they’re treated. That is what controls whether they come back or not.”

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