Tomorrow’s Dentist

Understanding dentists’ wants, needs, and style is the baseline prerequisite to attain and retain clients. Understanding their background, perspective, and outlook is more obscure and significantly more difficult. Every laboratory wants to successfully meet their clients where they are at, but with four generations in the workforce, the variance in approach can at times feel drastic. Recent dental school graduates represent even more sweeping change. Dentists are launching their careers with higher debt, less dental laboratory training, and more technological and material choices than ever before. In 2022-2023, dentist school enrollees are more ethnically diverse with a higher rate of female students, and the number of advanced dental education programs and the interest in them continues to grow versus general dentistry. These elements all play a part in understanding the clients of today and more importantly, tomorrow.

The American Dental Education Association (ADEA) shared a recent report, ADEA Trends in Dental Education 2023-2024, which detailed the following.

DIVERSITY

HURE includes the following four race and ethnicity categories: non-Hispanic African American, Hispanic or Latino of all races, non-Hispanic American Indian or Alaska Native and non-Hispanic Native Hawaiian or Other Pacific Islander.

HURE students expanded their representation among predoctoral applicants. In 2023, this group represented 19 percent of applicants, a six percent increase from 2013.

HURE students represented 17 percent among first-time, first-year enrollees in 2023, an increase from 13 percent in 2013 (Table 1).

Entering classes in accredited allied dental education have diversified. Accredited allied dental programs expanded the most among Hispanic or Latino students (10 percent increase since 2013), followed by Asian (three percent increase). White first-year allied dental enrollees decreased over the last ten years from 65 percent to 51 percent.

The number of first-year enrollees in predoctoral programs who identified as women exceeded that of men in 2022-2023, a trend since 2018-2019. Allied dental first-year enrollees remained overwhelmingly female over this time (Table 2).

EDUCATION

Sixty-six percent of the senior predoctoral students of the Class of 2023 responding to the ADEA Senior Survey graduated with education debt. The average education debt was $296,500 in 2023 (Table 3).

While enrollment in accredited predoctoral dental, advanced dental, and hygiene programs rose, accredited dental assisting and dental laboratory technology programs saw drops of 25 percent and 20 percent, respectively (Table 4).

ADVANCED SPECIALTIES

More than half of the 15 disciplines of accredited advanced dental education programs added new programs and most of them received a significantly higher number of applications over the past decade. Endodontics and periodontics saw more than double the number of applicants and while the number of oral and maxillofacial surgery education programs decreased, the number of applicants increased by more than half between 2012 and 2022.

All 15 advanced dental education program disciplines analyzed registered larger or similarly sized entering classes in 2022-2023. Oral and maxillofacial radiology, dental public health, and clinical fellowship in orthodontics expanded their first-year classes by more than 40 percent but were still only a small number.

CAREER PLANS

Senior predoctoral students responding to the 2023 ADEA Senior Survey were more likely to join a private practice upon graduation (53%) than their 2013 counterparts (50%).

President and CEO of ADEA Karen P. West, DMD, MPH, commented that while students are still likely to go into private practice, as has been the case for the last ten years, the private practice setting has changed with more DSOs and group practices. Students now tend to first go where they can make financial capital until they have enough saved to go into private practice. This is not the only change, however, for dental students and graduates.

The dental world tends to be rather stable and somewhat slow to change, but COVID forced learning in new spaces and new ways. Testing mechanisms changed, with fewer patient-based exams, and now there is continued direction to eliminate patient-based exams altogether. There is also a significant change with the learners themselves in the utilization of technology; how they want to learn, and what they are comfortable with. Markedly, the dental industry in consciously moving forward to teach, ‘one health’; or oral health as part of general health.

“Technology will continue to play an important role in the evolution of dentistry,” said West.

Therefore, with ADEA Board approval, she established the ADEA Task Force – Envisioning and Transforming the Future of Oral Health & Education (ADEA TF-ETFOHE). The ADEA TFETFOHE consists of forward-thinking and innovation across not only the academic health profession but also oral health and health care. Additionally, the Task Force developed models of educating oral health students with a shared vision and understanding of the need for sustainable and meaningful change with an emphasis on technology.

“Dentists like to learn and are curious about the available technology,” said West. “Many have already embraced and implemented technology in their office, but first, they need to understand it before utilizing it. While some will adapt and move forward with new technology, others will be content to stay within their current modalities according to their comfort level. But new graduates will have a different mindset.”

West recognizes that there indeed has been a decline in required lab procedures for dental school students. If students do not have to do the lab processes, then they may not understand them. Today, most schools focus on teaching students to critically think, ask the right questions, diagnose, and follow the guidelines to know what their patient needs. At the end of the day, it is their obligation to write the script for the technology being utilized.

“Right now, we are at an in-between stage,” she said. “There is so much technology and at times, we don’t have to think as much as we used to; it’s easy to click a button. For the highly technological processes, however, students still must understand how it happens. They need to know how the lab technician utilizes what they send to them and then be able to critically analyze how the restoration fits the patient. Utilizing both technology and critical analyzation, they will be able to decipher what is needed, what the outcome should be, and how to get there.”

Utilizing both technology and critical analyzation, they will be able to decipher what is needed, what the outcome should be, and how to get there.” – Karen P. West, DMD, MPH

No matter what changes lie ahead, communication will always play an integral role in bridging the gap between the dentist and dental laboratory. While the partnership between the two has been strengthening the last few years, West encourages labs to talk to the dentists of tomorrow as well. She recommends reaching out to dental schools and offering lectures on dental laboratory technology. She also suggests attending the same CE courses that doctors attend.

West said, “Dentists will send their cases out to the lab that they love, that will continue, but technicians must be able to provide what the schools are teaching. Learn what is being taught so you know how to better partner together.”

The use of Artificial Intelligence (AI) will undoubtedly and expansively grow in the next few years. – Eric J. Mayuga, DDS, PA

Learning can best be done by listening.

Eric J. Mayuga, DDS, PA, owner of Imagine Dental, in Gardner, Kansa, shares his story.

Dr, Mayuga’s interest in dentistry began at an early age. He had congenitally missing teeth and his dentist was able to place direct composite veneers to close the diastema between his front incisors. It amazed him that such a simple procedure could make such a world of difference after only one appointment. He decided to pursue a career in dentistry so he could provide the same service and positive impact that his dentist had provided to him. After graduating from dental school in 1995, in 1997 he purchased a satellite dental practice on the outskirts of Kansas City. It was a small, two-chair office with a staff of three. Today, the population of Garnder has tripled, and the practice has grown to a two-dentist, eight-chair office with a staff of 10.

It was a massive undertaking to purchase a practice as a new graduate, and then to take the steps to grow. When Dr. Mayuga was in dental school, he learned the nuts and bolts of clinical dentistry and the use of materials, but only had one single-semester class on dentistry as a business. It was very basic and was taught by a part-time professor who owned a private dental office. Things have now changed in a positive direction, enabling more graduates to be prepared for private practice.

Mayuga said, “The associate dentist in my office is a recent dental school grad and shared with me that the school integrated more business-minded classes into the curriculum to help dentists better prepare to run a business. In addition, dental students today are being exposed to intraoral scanning, milling, and 3D print technologies. In the 1990s some of these technologies were still in their infancy, under development or not even imagined yet. Adhesive bonding and posterior composites were not encouraged over the old standby, amalgams. It is good to see that today’s dental school students are given hands-on exposure to the new digital technologies before they venture out into dental private practice.”

Even though dentists are provided training in digital technology, the use of Artificial Intelligence (AI) will undoubtedly and expansively grow in the next few years. AI is already part of most dental CAD/CAM design software programs commonly used for the design of crowns, bridges, and a wide variety of other dental applications in combination with a dental milling solution and/or a 3D printer. AI is also commonly used in treatment planning, scheduling, and imaging.

“Dentists should be excited about the possibilities AI can provide as an adjunct for quality patient care,” said Mayuga. “AI will not replace the need for dental professionals and the human touch, rather it will be a valuable resource to allow more efficiency and predictability in treating patients.”

Mayuga does not see the use of technology as an impediment to the partnership between his practice and the lab. For example, he considers an intraoral scanner as an indispensable tool to have in a dental office, much like digital x-rays. A scanner can be paired with an in-office milling solution to provide same-day chairside permanent restorations as well as for 3D-printed applications like occlusal guards, stents, surgical guides, and more. An intraoral scanner allows for flexibility and a customized workflow with the option to fabricate a restoration in-house or outsource the case to the dental laboratory and submit the digital impressions electronically.

“Most dental labs today actually prefer to receive digital impression files, and patients appreciate the quick turnarounds,” he said. “Digital impression submission is not only more efficient for all, but it also provides time and cost savings for the practice and dental laboratory alike.”

“I am no stranger to chairside milling. My first adventure began in 2004 with CEREC. I utilized the technology extensively for five or six years and then took a break to explore the wide array of new ceramics available through traditional dental laboratories as my options were limited with my closed, turn-key chairside solution. I took the time to research and explore the new restorative materials available as I wanted to ensure my patients were receiving the very best restorations with optimal strength, esthetics, and quality In early 2021, I decided to give chairside milling another shot and purchased a Roland DGA DGSHAPE DWX-42W Chairside Milling Solution. I did quite a bit of research before this purchase. It features an open architecture platform, which is important to being able to select the best materials for restorations and the DWX-42W is a solid, reliable chairside milling solution built by a great company.

“In order to appeal to the dentists of tomorrow, laboratories should accept that dental offices are incorporating and will continue to incorporate more in-house digital technologies like chairside milling for everyday posterior crowns. Dentists will still look to their trusted dental laboratories, however, to partner with them for all other cases including complex, cosmetic, and full-arch cases.”

Rita Acquafredda is the President of Global Dental Laboratory & Prosthetic Solutions at Zahn Dental. Throughout her career, she worked exclusively with dental laboratories and has seen many changes and evolutions in both dental labs and dental practices. Even through changes, the one constant element to successful partnerships is creating and maintaining personal connections with the patient at the forefront.

It is important to promote how dental laboratories are contributing to society. – Rita Acquafredda

“To adapt to the next generation of oral health professionals, dental laboratories should continue to strengthen their partnership with providers, helping to increase adoption of advanced workflows, technologies, and materials,” said Acquafredda. “As technology becomes stronger, oral health professionals will be more dependent on knowledge of laboratories. As more dental professionals look to harness the power of 3D printing and other technologies, dental labs that have integrated emerging innovations in materials, such as resins, will become more viable. Artificial Intelligence and machine learning to help optimize 3D printing capabilities are also on the horizon and can help dental labs further demonstrate their role in helping to improve clinicians’ digital workflows. On the flip side, while technology will always be important for many reasons, and will continue to evolve, dental professionals also want to engage industry peers who share common values, which often include having an impact on society. With a shared vision and commitment to support local communities, it’s important to promote how dental laboratories are contributing to society or creating unique opportunities that help providers deliver a unique patient experience, improving their overall quality of life. At Zahn Dental, we recognize that laboratories will be key to the successful adoption of new technology, helping the next generation of dentists deliver high quality care and operate successful practices. Together, we look forward to helping foster the continued collaboration and integration between dental practices and dental laboratories.”

 

This article was originally published in the June/July 2024 issue of the Journal of Dental Technology