The major problem in dentistry is still access to care. It’s not debt- Dental students have a tremendous return on investment when they start earning. It’s not Mid-level providers – Dental Therapists do not position themselves to be our (dentists’) competition. They have not had the training that we had and could be our partners if we would only let them. It’s not group practices (pg69 of hyperlink) – many group practice models are better for the patient and the provider than the traditional solo- and small-practice models in dentistry. The major problem is access. Even with Medicaid expansion through the Affordable Care Act, dental insurance is not mandated and many have chosen not to take advantage. The most vulnerable populations have the least knowledge and health literacy to make a wise decision about whether to take the dental insurance or not.
There are, currently, 336 clinical trials (with known status) being conducted about dental prevention. At the same time there are over 1,000 clinical trials on implants, dental materials, dental lasers, dental tissue regeneration, tissue grafting, digital impressions, digital xrays, Isolite and computer aided design and computer aided manufacture in dentistry. The bottom line is that a lot more resources like money, expert researchers and time are directed toward “high end” dentistry with little for the “low end.” But the problem is at the low end! We need more effective preventive techniques, we need better restorations so that the natural progression from restoration to crown to implant stops.
Most people know there is controversy about dental amalgam and the mercury component -at this moment there are 14 clinical trials on dental amalgam. However, much less rumor and concern surrounds dental composites even though it contains a material known to be associated with cardiovascular disease and may contribute to childhood obesity! Though the literature isn’t strong for either amalgam or composite being toxic to patients, the fact remains that we don’t have a perfect restorative material. When this fundamental issue isn’t resolved, why do we pour millions of dollars into perfecting the implant?
The answer, unfortunately, is profit. Clinical trial funders are more willing to fund trials that could turn profitable for them. Moreover, implant companies and dental laser companies are wealthy enough to support these trials themselves. Motivational interviewing, fluoridation and fluoride varnish are less sexy interventions that do not seem to attract the funding they need. Government support needs to prioritize prevention programs and solving issues of motivation and compliance for dental patients. Otherwise, dentistry risks becoming a luxury item like Rolex watches and Hermès handbags.