Wednesday, September 30th, 2009

The Great Dentist Crisis! Is It?

SCAREDSlate claims that no one wants to be a dentist anymore, and that everyone hates them because of the movies. (There may be some truth in that! But I think people hated them first. Mostly people hate them because people hate dental work and are suspect of anyone who would do it all day!) Says Slate: "during the 20th century's final decades, a dwindling number of Americans chose to become dentists. In the early 1980s, U.S. dental schools produced about 5,750 new graduates per year. In 2007, with a population that's nearly one-third larger, there were about 4,700." And that: "In 1980, the United States had 60 dental schools; today there are 58, and class sizes are smaller." That is one way to look at the history of dentists! But let's pull some teeth here.

Well. From 1989 to 1997, the number of dental school applications actually doubled. And from 1989 to 2001, the number of dental school students actually increased, though it never quite got up to its early 80s peak.

What has happened to advanced dentistry in the last ten years? "In the last ten years, first-year predoctoral enrollment has risen an average of 1.2% annually," says the ADA.

What has happened over the last sixty years? From 1950 to 2009, the population of the U.S. almost exactly doubled. So did, quite nearly, the number of people enrolled in dental school.

What happened to dentists' income? As of 2004, their "average net income has increased 117% since 1990," according to the American Dental Education Association.

So actually we have the same ratio of dentists to Americans now that we had in 1950. Except they just make a heck of a lot more money now.

The ratio of dentists to Americans peaked in 1990. And yeah, the absolute number of dentists is predicted to decline: "81,000 dentists will enter the workforce between the years 2000 and 2020, but 85,000 will leave it," is the way one researcher put it. But the decline in dentists projected to the year 2025 still, at the end, still keeps the ratio of Americans to dentists at well above the low 1960s numbers.

But guess what? We don't need as many dentists, due to prevention and better oral hygiene. More than half of children and teens have no dental decay now, amazingly. So when Slate says that "about 600-800 more dentists enter the profession than retire from it each year," it's hard, even taking into account what will happen when all the baby boomers start to retire (the year 2023 looks a little rough!), to worry about what they call "the disappearing dentist." Will the dental lobby stop at nothing to convince of their plight?

29 Comments / Post A Comment

mathnet (#27)

Dental: Damned

It's all Corbin Benson's fault.

Abe Sauer (#148)

Needs more Marathon Man

sox (#652)

I find it sheerly amazing that someone would wan to make a living scraping tartar off of people's teeth.

Baboleen (#1,430)

At least you see the fruits of your labor.

garge (#736)

The hygienist does most of the scraping. The Dentist gets paid the big bucks to drill, paint fluoride on kids' teeth, and prescribe the fun stuff. Also, every dental student I asked "why .." has said it is All About the Benjamins, duh.

cherrispryte (#444)

I think the great Dentist crisis revolves more around the fact that 1)Most dental implements are fucking mideval looking and pain-inducing and 2) Going to the dentist is one of the least-fun things in the world. Can't we get the technology to catch up and make this shit less painful?

Oh also 3) Dental Insurance doesn't pay for anything.

mathnet (#27)

Balk, when's your doctor's appointment again? I should go to the dentist. YOU HAVE INSPIRED ME.

It's just that whenever I do go, I'm praised for all the flossing I'm (not actually ever) doing. You're idiots, dentists. I think my teeth are OK.

atipofthehat (#797)

Great oral history, Choire.

Flashman (#418)

A biting critique.

La Cieca (#1,110)


Abe Sauer (#148)

That's what she said! Boooyah!

HiredGoons (#603)

Frankly my misanthropic nature wouldn't allow me to trust anyone not to bite my fingers off.

sox (#652)

i accidentally bit the dentist! two weeks ago! i was mortified to say the least, but he hit this funny ticklish spot i didn't even know was there.

BoHan (#29)

Sorry man. I love the dentist. Because it is almost impossible for anyone involved in the enterprise, patient or employee, to use their fucking cellphones. It's like my yoga. I go twice a week.

johnpseudonym (#1,452)

My sister is a dentist. I hate her.

HiredGoons (#603)

which came first?

johnpseudonym (#1,452)

The egg, of course!

jfruh (#713)

I've often wondered why dentists are treated completely differently from other kinds of medica professionals, both in terms of their licensing and in terms of insurance. The latter is even true in countries that have universal health care; in Canada the gov't won't pay for your teeth problems. I mean, if I had some kind of weeping abcess in just about anyplace on my body, I'd go to a doctor; so why if I have some kind weeping abcess in my mouth, would I go to a dentist? And also my insurance wouldn't pay for it?

Bored (#1,111)

When the NHS was created in Britain the dentists managed somehow to weasel out of having to be a part of it. The consequences are, of course, well known

garge (#736)

This is also problematic–coverage-wise–because that old adage about your oral health being related to your overall health is actually very true. Infections can go to your heart, etc. So while you can be lenient with your eyeglasses and skin whateverissues, try not to let the mouth pain get out of control.

wiilliiaamm (#225)

I stopped going to my dentist once I lost all my teeth. Thanks Crystal Meth!!

johnpseudonym (#1,452)

Hmmmm. Now I want some Crystal Pepsi. I pine for the clear soda phase of the early 90s.

HiredGoons (#603)

Now I want clarity.

johnpseudonym (#1,452)

"Perfect clarity would profit the intellect but damage the will." ~ Blaise Pascal.

"Dare to be Stupid" ~ Weird Al Yankovic.

bshep (#746)

I don't hate dentists because I hate dental work; most medical procedures are unpleasant and I don't hate my doctor. I hate dentists because they (the ones I've gone to at least) are more used car salesman than health professional. Think about it- when discussing a course of treatment with a doctor, you usually discuss a couple of options, and doing nothing is often on the table as well. But ever try asking a dentist if there's a cheaper alternative to the $10,000 treatment he insists you need immediately? Or if it could wait another few years? I have, and trust me, you do not want to be on the other end of the look of pure contempt and rage you will receive. Especially if you are lying flat on that chair with sharp instruments pointed at you.

Art Yucko (#1,321)

Haha. I actually work at a dental college… here's some observations about the student body, the drillers and fillers of the future:

- Many of them are in it for the money, doye! Faculty members make no bones about telling them of their riches to come if they pursue this or that specialty. It's also sort of hard to ignore when part-time faculty (with the lucrative PPs) roll up in the parking lot in their brand new Benz/Beem/Escalade.
When they graduate, they can expect average salaries of $250k a year. They'll need it: Their student loans are horrific, maintaining a private practice is crazy expensive (and let's not touch the subject of buying or establishing one.) They'll also need to spend the rest of their career taking CE courses.

- Many of them are in it for Family: as in their entire family are dental professionals- Dad, Grandad, Mom, Uncle, Aunt, Siblings, etc. These families own the Practices and want the legacy intact. You frequently see multiple generations of Alumni like you would at any elite school… you start recognizing a lot of the same names. The Grandads and Dads are always big donors and VIPs, with clinics, scholarships named after them and so on.

- They're a decidedly upbeat, rather conservative bunch. Most of them were definitely the popular/rich kids at their small-town/suburban high schools… with good grades, so they didn't have to go into Marketing. Many of them come into school already married despite being in their mid-twenties. They love all the fraternal organizations and they love their sports and golf.

- They're also overwhelmingly white… despite much effort to recruit economically disadvantaged minorities. This is changing somewhat, but very, very gradually.

- There's no shortage of incoming students or applicants. There are more and more every year.
They turn away hundreds of applicants.

Gene (#1,580)

"Suspect of"?

June Thomas (#1,775)

As a longtime admirer of y’awl, it’s a dream to be fisked by Choire.

That said–and despite that "I don’t really believe the dental lobby is behind this" tag–it’s you that’s spouting the dental lobby’s talking points. The American Dental Association denies that there’s a shortage of dentistsâ€"though they will cop to a maldistribution (as anyone who lives outside a major population center will attest)â€"which is why they’ve pushed back against new dental schools opening up; why they oppose any relaxation of the licensing regulations that prevent foreign-qualified dentists from practicing here without years of expensive extra schooling; and why they’ve gone all out to fight efforts to allow non-dentists to provide basic dental care, even in places where patients face terrible problems finding a dentist (I’m think of programs like Alaska’s dental health aide therapist program and the new one in Minnesota).

You’re right that prevention and oral hygiene have had a positive effect, and that’s a great tribute to the profession (though dental cavities are still the most common chronic childhood disease). But don’t forget that we’re keeping our teeth longerâ€"partly because of prevention and fluoride and partly because of nifty options like implants as an alternative to denturesâ€"so more older people have a need to visit the dentist than was true four decades ago. There’s may be less dental decay, but there is more gum disease (which can hurt like a mofo, believe me). Throw in the fact that more dentists are working part-time (and that some are filling their appointment books with procedures like teeth-whitening), those baby-boomer dentists retiring, and the growing population, and I stand by my view that America faces a shortage of dentists in the next decade or so.

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