My Five-Year Future View of Dentistry

I want to make a prediction about the next five years of dentistry. Let’s see how things play out by 2025. I think it will eventually be generally good for all of us -- but not the way you think:

History shows that only about half of Americans visit the dentist regularly. With the COVID19 crisis, it is estimated that about 40+ % of the regular patients are planning to avoid the dentist, gyms, concerts, for about 4 to 6 months.

Furthermore, dental offices are now required to follow strict and rigorous rules for infection control which include making patients wait outside the office, or in their vehicles so as to control social distancing. In addition, dentists cannot "bounce" back and forth between rooms and have multiple chairs going simultaneously. PPE will need to be changed between each patient, which will add at least 10 minutes to each appointment time, and that will also involve numerous hand-washings just to don and doff each set of PPE.

The result of all this will be severely restricted patient-flow, dramatically increased times for dental visits, skyrocketing overhead from increased supplies of disposables and trash pickup, etc., which will boil down to rising dental costs and insurances fighting to limit payments as usual. There will be substantial increases in dental fees as soon as dentists can submit new fees, which means patients will end up paying even more for dentistry, and there will be more consumer complaints about lack of access to affordable care. Dentists may not want to send their lab work overseas anymore for fear of patients finding out and switching dentists. Dentists may either need to pay American dental labs, which will increase fees even more, or they will switch to 3D milling or printing of dental restorations, which carries its own set of additional costs and problems. Dentists will try to drop insurances and set up concierge dental programs for patients, which will also cost patients even more money for no measurable improvement in treatment.

Meanwhile, there will likely be a few more waves of virus attacks and I'm sure a few cases will be traced to dental offices, since dental offices are nearly the highest risk places to create some of the most infectious aerosols. These events will add up and many private small dentists will give up and sell their offices or patient bases to large clinics with business/investors and deep pocket funding.

I believe insurers and large dental service providers will collaborate and eventually form something like insurance/investor/business operated dental "hospitals". At this point, most of the dentists will be like worker-bee drones out of dental school with tremendous educational debt and the only way they can repay their loans will be to work for these "hospitals" which will pay for their malpractice insurance, continuing education, and give them vacations. This will be more economically feasible for the new dentist drones because they will not have to buy offices, hire staff, learn to run businesses, etc., so their leftover money will be able to pay off their student loans in 15 to 20 years, while living a half-decent life.

The dental "hospitals" will try to make extra money by selling elective services not covered by insurances. They may also sell ancillary products which may include special home care kits, supplements, etc. And at that point, maybe true dental prevention will become possible.

I say all the above because this COVID19 has shown us that it will probably be unprofitable to practice traditional drill/fill/bill dentistry due to the extensive, infective aerosol production that requires such high maintenance and extra operations. Sure, there will be improved vacuum systems, air management, filters, etc. However, after a year or two, it just won't seem worth it for dentists to look forward to doing a mouthful of crowns and bridges and dealing with all the infectious and expensive aftermath. I think that aerosol procedures will soon be seen as necessary evils to be avoided and it will be a lot better to try to prevent problems in the first place, so that the least possible dental drilling will be necessary. This will also pertain to ultrasonic cleanings for periodontal patients. Ultrasonics create copious infective aerosols. It will be much better if patients will be trained to take better care of themselves.

The dental "hospitals" and their investor/business managers will quickly realize that it will be more beneficial and cost-effective to actually try to prevent dental problems than to waste a lot of time, money, PPE, and employee health risk on treating problems -- especially dental problems that are 80% preventable in the first place. Besides, there are just two main dental diseases that cause most of the problems anyway: cavities and gum disease. And if we can’t prevent just two diseases that are 80% preventable in the first place, then what the heck good is dentistry doing after all? Dental hospitals may soon start prevention departments like Dr. Michael Roizen did with the Cleveland Clinic''s Department of Wellness and Preventive Medicine.

COVID19 has shown us that many of the worst-affected victims are people with pre-existing chronic problems: diabetes, obesity, heart disease, etc. Even many young people nowadays have underlying cardiovascular problems and pre-diabetes. And gum disease is a chronic disease that is linked to diabetes, heart disease, and other systemic problems. Thus, COVID19 has brought chronic disease to the acute phase. Diseases that used to kill us in slow motion over a long time, have suddenly advanced into real-time and are putting people at higher risk for serious complications from COVID19.

Pretty soon it won’t pay to be sick because the treatments carry too much overhead and risk for the treaters. Now more than ever, and certainly in the next five years, it will become blatantly obvious that prevention is truly the best medicine.

I also think that within a couple of years it will become mainstream to use dental probiotics, and especially our unique strips, Breathific.