Trends in Dentistry
A look at priorities through the eyes of practitioners at different career stages
Allison M. DiMatteo, BA, MPS
Inside Dentistry spoke with dentists from each demographic “decade” of practice to learn what they really think about the major issues in achieving their vision of dental care at these points in their careers. The dental student, primed for graduation, all the world ahead, eager for as much hands-on experience with as many novel techniques and materials as possible, stands opposite the soldier with four decades of practice in the rear-view mirror, looking to optimize a practice for transition as the timeline to retirement compresses exponentially. Between these wayposts, a young dentist just beginning practice navigates debt and the disconnect between “real-world” clinical lessons and what was learned in school as he works to build a patient base emphasizing fully focused care, while the dentist with a few years’ more experience works to grow that base and strengthen patient loyalty to secure the practice’s future. Careful balance between life in and out of the office finds its way to the fore in the next practice decade, while a need to change and grow to keep a well-established practice fresh and profitable is a 50-something practitioner’s challenge.
In all these conversations, priorities and priority shifts were as varied as the demographics, but one thread ran through all phases of practice life: embracing innovation, technology, and continuing education plays a key role in realizing success.
The Dental Student
As Madelyn Stumpos approaches graduation in 2017 at the University of Michigan School of Dentistry, she’s realized very quickly that she still has a lot to learn about practicing dentistry. “Now entering my fourth year, I’m becoming more aware of the many techniques and materials used in dentistry, and the scope of the methods we’ve been exposed to are not all-encompassing. I still have a lot to learn,” Stumpos admits. “It is always concerning to try a new technique or material, so staying current with the standard-of-care techniques and materials is important.”
The current trends in dental material development and their introduction to the marketplace have already made an impression on Stumpos. In fact, she says the popularity of composite restorations, all-ceramic crowns, and implants has had an impact on her treatment planning decisions in the dental school clinic. “We are exposed to amalgam and PFMs very early on as an introduction to restoratives and restorations, but once working with patients in the clinic, most request ‘metal-free’ treatment options,” Stumpos says, adding that she enjoys working with many materials to gain experience with them prior to graduation.
In fact, coursework engages Stumpos and her peers to explore current trends and present them to classmates. As she and fellow students transition into the clinic, they participate in workshops that allow them to use various dental technologies and their respective techniques. “As students, we have opportunities to utilize digital impressions and CAD/CAM technology with specific faculty for certain cases,” Stumpos explains, adding that she also has had opportunities to visit a dental laboratory, observe scanning devices and 3D printers, and work with multiple materials.
“I often have interesting discussions with faculty and my peers about certain cases and how we’ve utilized different dental technologies for diagnosis, treatment planning, and treatment. I find myself discussing dental materials, techniques, treatment plans, continuing education courses, and other topics with family members and classmates,” says Stumpos, who comes from a family of dentists. “Right now, my biggest priority is to absorb as much information as I can while I have such ample resources available at the University of Michigan.”
What's your preferred method of obtaining dental information? Websites
The 20-Something Dentist
The list of top priorities for most new dentists might include paying down dental school student loan debt, landing a top-paying associate position, and growing a steady base of patients, according to Matt E. Koepke, DDS, an oral and maxillofacial surgeon falling into that 20-something dentist demographic. While he might well have some of those issues on his mind, they are not his top priorities. “My biggest priority right now is to be a patient advocate and help create an environment in which our patients, who are in a vulnerable state, are truly the focus of our respectful attention and action.”
Making that priority a reality involves closing the gap that Koepke sees between what dental students are trained to do and the incongruence in private practice. “There is a huge disconnect, and much of what I know now I learned on my own in my free time as a surgical resident—visiting cosmetic dentists in Beverly Hills and watching them as they taught me soft-tissue grafting and how to place dental implants for predictable success,” Koepke explains. “We need to be actively learning.”
Consider the integration of digital dental technologies, for example. Koepke’s attendance at a technology-related symposium opened his eyes to how 3D scanning, CBCTs, virtual planning software, and surgical guides are used. Previously, he hadn’t been exposed to those possibilities, but he realized very quickly that the impeccable accuracy that could be achieved would help eliminate certain types of implant failures.
As he moves forward in his career, Koepke will continue to broaden his own awareness, preferably by talking to various different specialists to garner a collective expertise. He takes all of the input and, in an analytical way, synthesizes it into what makes sense for his particular case.
“I’m proactive and I don’t just accept what I was taught,” Koepke admits. “Treatment should theoretically be universal, so I have become a better surgeon because I’ve sought out people and asked, ‘Why?’ You can get one answer, but with different approaches, so it’s important to ask why we do this, and why we use this material instead of that one.”
What's your preferred method of obtaining dental information? Talk to specialists in the field of interest
The 30-Something Dentist
Dean E. Kois, DMD, MSD, is a 30-something dentist specializing in prosthodontics. Practicing in Seattle, Washington, he’s like most young dentists his age—his practice-related challenges involve fighting the uphill battle of cultivating a loyalty-based practice that is built to last. “In my experience, a trust referral will have less of a concern about cost than a patient entering the practice based on convenience factors, such as location, hours, etc.,” Kois observes.
Still a young enough dentist, he’s not yet identified trends in practice management that are having an effect on him versus what’s just new to him personally. The trends he has observed, however, are those involving dental technologies and the manner in which they have made it easier to practice dentistry more efficiently and, in some cases, more predictably. Likewise, when it comes to the development of dental materials and the introduction of new products, Kois says he’s always looking to improve patient outcomes.
“Dental technology advances are helping to reduce failures by minimizing material failure. In addition, technologies that provide better diagnostic metrics allow clinicians to move towards ‘precision medicine,’ which will create a more predictable dental healthcare model,” Kois says. “However, I will never be an early adopter of any trend without good science to support change in my practice.”
A graduate of Nova Southeastern University, College of Dental Medicine, Kois went on to specialize in prosthodontics and received a Certificate in Prosthodontics with a Master of Science degree from the University of Washington School of Dentistry. He then completed a two-year surgical Implant Fellowship at New York University College of Dentistry. Although still in the early years of his own career, Kois stresses to 20-something dentists the need to invest the most in their own personal growth, and to remember that learning must be continuous. He utilizes multiple avenues for learning, but prefers traditional continuing education environments, in which he feels it is easier to be engaged with the content.
“The joy of dental practice increases as your confidence, knowledge, and understanding of dentistry increases,” Kois adds.
What's your preferred method of obtaining dental information? Traditional CE environment
The 40-Something Dentist
When you have a vision for your practice—to provide comprehensive esthetic dentistry—formulating that vision, and striving to find and maintain the right balance to make it a reality, is all part of being today’s 40-something dentist. “Perfection is not possible, so I’m striving to be my best self personally and my best self as a dentist,” explains Andrea Robbins Margeas, DDS, who practices in Port Huron, Michigan. “In life and in practice, it’s about balance.”
In this stage of her career, balance has never been more important. Like many of her 40-something colleagues, Robbins Margeas juggles the responsibilities of being a wife and a mother with her everyday practice. In addition, Robbins Margeas, who has been leasing her current dental practice space for 11 years, is in the process of building a new dental office. “This is a wonderful time to make changes in how we run our practice and treat our patients, and current trends in materials and technology will definitely make it easier and more enjoyable to practice dentistry.”
Digital technology will play a big role, not just for patient care benefits, but to help Robbins Margeas realize logistical and operational advantages, also. Digital scanners will eliminate mess and reduce storage requirements. Digital radiography will produce less radiation for patients. CBCT technology will enable better diagnosis and treatment planning. Combined, all of this will enhance the patient experience.
“This definitely makes it easier and better for patients during a very thorough new patient examination,” Robbins Margeas says, which is important particularly when dental insurance and reimbursements can impact whether or not patients proceed with necessary treatment.
Everything Robbins Margeas has learned since starting her own practice from scratch in 2005—both successes and failures—has ultimately made her a better dentist and team leader, she says. Her experiences have also endowed her with some words of wisdom for fellow dentists in their 20s and 30s. “Find someone you trust—a mentor—whom you would like to emulate,” she encourages. “Always be curious, invest in yourself, and you’ll see that dentistry is an absolutely wonderful career, and you’ll never get bored.”
What's your preferred method of obtaining dental information? Events/conferences and live seminars
The 50-Something Dentist
At this stage in his career, Brian K. Schroder, DDS, finds keeping up with changes in the profession and remaining dynamic enough to recognize the need to be different as his biggest priorities. “You need to accept the disruption of change in order to continually get better at what you do and take better care of your patients,” says Schroder, who practices in San Antonio, Texas. “The most significant challenge is just keeping up with it all.”
All—for Schroder and other 50-something dentists—encompasses technology, new materials, and new ways of approaching patient diagnostics and delivery of care.
“I have completely embraced computers in restorative dentistry and believe they belong there, and for many reasons,” Schroder explains. “They do the exact same thing every single time you use them. They’re accurate, efficient, and precise, which is what we are trying to accomplish.”
Although a positive disruption, technology-based approaches to care are disruptions nonetheless, and ones that need to be capitalized by the dental practice business. At a time when Schroder is also looking ahead to the day when he’ll transition his practice, that can become as significant as possibly embracing a different business model than he’s been accustomed to for the past 35 years. “Trying to maintain a relationship-based practice when the profession is moving toward consolidation is a challenge as far as business models are concerned,” he says.
Schroder asserts that adhering to principles of quality and ethics, and accepting and embracing changes, will be essential for his ongoing success, as well as for the success of his younger colleagues. “What I’ve seen happening is a commoditization of the dental profession, and many have fallen victims to believing that we sell procedures to patients, rather than provide care to patients. This challenges the relationship and quality of comprehensive care people receive,” Schroder says. “So, it’s important to be a perpetual student, understand why you’re doing what you’re doing, and once you’re aware of why you do it, then the how and what you do follows. Maintaining your integrity and trying to be excellent in every way that you can are my recommendations.”
What's your preferred method of obtaining dental information? Events/conferences and live seminars
The 60-Something Dentist
Over the years, David A. Burt, DDS, a dentist practicing in Allentown, Pennsylvania, has seen many changes affect the dental profession. He admits it takes a lot of effort to stay abreast of what he needs to know to not only survive, but thrive.“My biggest challenges are trying to grow my practice as fast as I can to where I can have it grossing in the top 5%, and have an associate to help and eventually take over,” says Burt, a 60-something dentist now in his third practice venture. “The timeframe for reaching this goal has compressed from 19 years, to 10 years, and now finally five years because of my age.”
Technology figures largely in helping him achieve this end. Digital radiography, practice management software, digital scanning, CBCT and guided surgery, lasers, digital caries diagnostics, and CAD/CAM chairside milling are all in his office. He can safely say they allow him to do the best dentistry of his career while being efficient and conservative in his approach to patient care.
He’s also witnessed the fast-changing realm of dental materials, with options available that make his life so much easier for achieving both needed function and excellent esthetics. However, a potential rub of some new materials is the cost, particularly considering some insurance companies’ reimbursements, Burt says. “Finding affordable solutions for patients’ dental needs is difficult, but it can be done, creating a win-win for the doctor and patient.”
The introduction of software to closely monitor all financial aspects of a practice can help, but practice management overall has become much more complicated, Burt observes. “I now see how dentistry is definitely as much a business as it is a profession, and I’m afraid of where that kind of thinking will take us,” Burt cautions. “We are still a healing art and must keep that in our minds and hearts. Patient expectations are higher than ever and sometimes unrealistic. Physically changing a person, whether with a smile makeover or simple composite restoration, is not always accepted as we would want. Take a deep breath, fix it to the patient’s liking, and you will sleep well at night.”
What's your preferred method of obtaining dental information? Events/conferences and live seminars
