 Wednesday, January 5, 2000
 
Dentists run out of cavities to fill
Thanks to fluoride, few kids have decay, boomers keep teeth
Clarence Tabb Jr.
/ The Detroit News
Dennis J. Fasbinder, U-M director of Advanced Education in General
Dentistry, works on Nancy Damberg with a device that makes a
porcelain restoration in one visit. |
By Sarah A. Webster / The Detroit News
ANN ARBOR -- Without
fluoride, an average American couple like Ann Arbor's Stephen and Sue
Eklund might have faced $3,200 in bills filling the cavities their
children Kate and David developed by age 18.
Then the
Eklunds would face middle age and the prospect of sinking more than
$3,000 each on full dentures to replace their own decayed teeth.
Five decades of fluoridated public water have, of
course, eliminated many of those expenses. Now most children have no
fillings and no tooth decay -- and never will. Baby boomer parents will
keep their teeth until they die, needing only to repair an occasional
cracked tooth.
But what's good news for families'
pocketbooks isn't so beneficial for dentists, whose numbers are
projected to swell through 2020, even as need for their services
declines.
To cope with the gap, many dentists are
starting to shift away from the cosmetic services -- such as teeth
whitening or bonding -- that produced plenty of new business since the
1980s. Increasingly, dentists are exploring new areas of opportunity,
such as treatment of gum disease, a condition that fluoride has not
helped and will become more prevalent as aging people keep their teeth
longer.
More than 2,000 dentists, nearly one-third of
those licensed in the state, are expected to discuss the changes facing
their field at a two-day seminar that begins today at the University of
Michigan.
"It doesn't mean dentists will have less to
do," said Dr. George Magulak, president-elect of the Macomb Dental
Society. "It just means we have different things to do,"
Other areas into which dentistry might expand include general
medicine. One idea scheduled for discussion is using the mouth as a
window to diagnose diabetes, heart disease and other ailments that show
early symptoms in the mouth.
"Dentistry is certainly
changing, and how it's going to turn out is anybody's guess," said
Stephen Eklund, a U-M dentist and public health researcher who gives
opening remarks at the conference. His research on the future of
dentistry was published last month in the Journal of the American Dental
Association.
Each generation, Eklund and other
dentists are observing, needs less traditional dental care than the one
before it. After four decades of use, it appears fluoride has a
surprising compounding effect: American teeth are getting increasingly
stronger.
Practice has changed
"Dentistry has made so much progress that we've
changed the way we practice," said Dr. Arnold Morawa, assistant dean of
alumni relations and continuing dental education for the U-M School of
Dentistry.
In the changing dental environment,
patients, who are still urged to have a twice-a-year dental exam, can
bank on one thing: "You'll have to go the dentist less often and have
less done each time you go," Eklund said.
Patients
also might consider second opinions in this environment, where some
dentists could suggest unnecessary work.
The state
Bureau of Health Services, which licenses dentists, reported complaints
against a scant 1 percent of the state's 7,364 licensed dentists in
Michigan. But in the current climate, "it's a reasonable speculation"
that dentists might try to do more dental work than is necessary in the
future, Eklund said.
"In most cases, dentists are
responding appropriately, doing less as less is needed."
Most patients give dental advances, which come with less pain
than ever, a thumbs-up.
Charles "Ed" Burley, 62, of
West Branch, for example, found out a few years ago that he wouldn't
have to get dentures, which he long dreaded, because of improvements in
dentistry. He got four implants instead.
"I am
thrilled," he said. "I just didn't want to put my teeth into little
jars."
Challenges ahead
While the practice of dentistry faces diminishing need
for services with every ensuing decade, need for dental work will hit
rock bottom in about 2030, when the last of the baby boomers turns 65,
Eklund said.
Dentistry will be challenged at that time
to ensure a smaller supply of new practitioners, who will be able to
handle more patients than ever before, Eklund said.
Dentist Richard Raad of Sterling Heights, who specializes in cosmetic
procedures, thinks dentistry must continue its decade-long trend of
serving mainly as a wants-based industry -- giving people pretty smiles
-- than a needs-based one of curing toothaches and filling holes.
For now, that appears to be true, Eklund said. For the
past 10 years or so, many general dentists have been diversifying their
practices as dental health improves, adding cosmetic and orthodontic
procedures to their list of services.
But the
unprecedented demand for aesthetic services "is not going to continue
indefinitely," Eklund said. In fact, it's expected to dwindle along with
the baby boomers, who begin turning 65 in 2011.
Quarter-century of change
While cavities and demand for cosmetic procedures like tooth-whitening
aren't expected to vanish, longtime dentist Robert Branch of Eastpointe
sees change on the horizon.
His practice has been in
constant flux since he was first licensed 25 years ago.
"When I started in 1974, I averaged four or five complete
dentures a month, or 60 a year," said Branch, who has an Eastpointe
office. "Last year, I did one for the whole year."
During that same period, the number of teeth he had to extract went from
150 to 20. He filled so many cavities for children in 1974 that he
couldn't recall how many. But last year that number was more memorable.
"I think I did two or three," Branch said.
Branch, who learned in a case review four years ago that 96
percent of his child patients never had a cavity, now advertises
cosmetic dentistry, a staple of his practice.
Already,
the 52-year-old dentist is focusing on geriatric patients, whose numbers
are expected to explode, with more demand for gum treatments and
implants to replace cracked or broken teeth, a consequence of keeping
teeth longer.
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