Editor’s note: In February 1970, a group of dental students met in Chicago to form an independent national dental student organization and named themselves the Student American Dental Association (SADA). The following year the ADA embraced this idea and organized a meeting of student representatives from each dental school in the country to help form a new organization called the American Student Dental Association (ASDA). Although scattered all overthe world, several of the founders and leaders of those two organizations planned on having a reunion this year in celebration of their 50th anniversary, but it was scuttled due to the COVID-19 pandemic. Instead, they decided to mark this auspicious occasion by writing and publishing a series of seven articles regarding the state of dentistry, dental education and health care in general from a retrospective perspective. The first two articles in the series were on licensure reform and were published July 14 and Aug. 24 in the New Dentist News. This is the third article of the series.
Our current health care system is very different than the one I entered over 50 years ago.
Back in the early '70s, dental care was all about the solo private practice of dentistry and the idea of “group practice” was an outlier. However, by 1999 things had significantly changed. One in three dentists were working in some kind of group setting. By 2019 , that percentage had increased to almost 50% of all dentists, and if we consider only dentists under the age of thirty-five, it increases to 75%. Clearly, this represents a dramatic and consequential shift.
Undoubtedly, the emergence of Dental Service Organizations (DSOs) in the late 1990s has had a significant impact on this group practice trend . For example, with regard to the prevalence of DSOs in the United States, “in 2012, 67 firms reported operations in more than 10 establishments, totaling 4,480 locations, an increase of 110% in the number of establishments reported by firms in this category” since 2002 .
The trend is obvious – we can safely predict that dentists in solo practice will soon be analogous to those folks that coveted their horse and buggy as Henry Ford started rolling out his Model Ts.
I think that it is reasonable to assume that the practice model of the 21st century will continue to favor intradisciplinary group dental practice inclusive of general and specialty care and a comprehensive team of dentists, hygienists, and traditional and expanded function (EFDA)/dental therapist (DT) auxiliaries.
Currently 14 states have legalized some form of EFDA/DT, and a number of others are considering similar changes to the dental statutes in their upcoming legislative sessions. The success of integrating these auxiliaries into dental practices will continue to grow as they demonstrate the ability to improve efficiency and access to care.
More broadly speaking, I foresee a future where a significant sector of dental care will alsobecome an integral component of a true interdisciplinary health care modality - inclusive of physicians, nurses, nurse practitioners, physician assistants, nutritionists, behavioral practitioners, and social workers such as we currently see in HRSA Health Centers throughout the country.
“Today, HRSA funds nearly 1,400 health centers operating almost 13,000 service delivery sites in every U.S. state, U.S. territory, and the District of Columbia. In 2019, there were more than 252,000 full-time health center providers and staff serving nearly 30 million patients. Health centers have more than tripled the number of patients served since 2000,” according to HRSA .
Such an environment provides an integration of providers to assure a holistic health care perspective in order to address the total needs of patients, including those who are elderly, those considered “at risk” with special needs, and the 58 million Americans with disabilities.
What kind of dentist would flourish in such an environment? Or, another way of putting it – what attributes must a dentist have to become a functional, successful, and respected contributor within such a system?
I envision a future where focusing on teeth and gums alone will no longer be appropriate as we move closer and closer to a value-based system of care and reimbursement. Dentists will need to be concerned about the person attached to the tooth, the family attached to the person, and ultimately, the community attached to the family.
You will have to function as a leader, not only in your relatively small clinical space, but also within your health care facility and in your community. You will undoubtedly appreciate how practicing with empathy and equity, what I call “compassionate leadership,” will broaden not only your own sense of success and satisfaction, but of your patients and staff as well. That’s the part of being a “doctor” that I want to underscore - the responsibility for helping others achieve health and wellness, and being someone on the front-lines; a trusted provider who may find themselves fielding questions and concerns outside the confines of dentistry.
You may be their only doctor andconfidante for sharing personal issues about general health care, drug abuse, domestic violence, and other family problems. Your scope of practice will likely extend way beyond matters of teeth to include social and personal issues that impact the overall health and wellbeing of your patients and their families. Your embrace of compassionate leadership will not only help build your practice, it will give you the opportunity to be a role model for your community and the evolving health care system.
Of equal importance is exercising leadership to address the inequities in access to care. It’s amazing to me, and sad, that almost one half of all Americans do not seek oral health care. The percent of adults aged 18 and over who had a dental exam or cleaning visit in 2019 was only 64.9%. This statistic includes individuals who have dental insurance, transportation, and a ready, willing, and able provider. Many of our citizens simply do not understand and appreciate the importance of good oral health – unless they are in pain. Poor oral health literacy by so many people needs to change, and can change. You can be a part of the process to educate the public about the importance of basic dental care and the linkages between oral disease and systemic disease – the importance of oral health to “whole person health.”
Equitable access also extends to certain individuals who are challenging to care for – a calling that has been a passion of mine for my entire career. My heart goes out tothose with intellectual or developmental disabilities, and those with medically complex conditions. These folks with special health care needs are typically “aged-out” or excluded from the dental benefits they need due to policies and laws that are insensitive to their conditions.
For example, in most states in America, a child who is autistic (or inflicted with another type of developmental disorder) typically loses their dental benefits when they reach the chronological age of 21 years, even though they have not grown out of their behavioral issues. This is unfair and intolerable. Inequities such as these beckon for health policy activism to right these wrongs and are a clarion call to compassionate leaders in our profession. In addition, I am suggesting in the strongest of terms, that our dental profession needs to continue to cultivate the core principles of altruism and volunteerism by participating in programs such as the ADA’s Give Kids A Smile program and by providing service to disenfranchised and neglected communities and those in need i.e. by participating in the Special Olympics; or volunteering your time in migrant, rural, or inner-city health clinics, after-school centers, etc.
In conclusion, I want to emphasize the vital role of dental education in this entire process. That is, the responsibility to teach and provide relevant field experiences which foster this holistic and humanitarian leadership approach. These noble goals have been a driving force in my entire professional life and were my primary focus when I became the inaugural dean of the Arizona School of Dentistry and Oral Health in 2002. This was our founding Mission:
“To educate compassionate, community-minded oral health providers to lead the profession and to make a positive difference in people’s lives and our communities; and to cultivate core values such as respect, integrity, diversity and inclusion; and a life-long commitment to public health principles and practice, social equity, and continued learning and excellence.”
Dr. Dillenberg graduated from New York University dental school in 1971 where he was class president all four years and was one of the “founding fathers” of the Student American Dental Association in 1970. He received his MPH from the Harvard University School of Public Health in 1978. Notable positions include dental director, assistant director of family health services, and health director of the Arizona Department of Health Services 1986-97. In 2002, he was chosen to be the inaugural dean of the Arizona School of Dentistry and Oral Health and was given the honor of dean emeritus when he retired in 2007. Currently he resides in Jerome, Arizona, where he serves as the mayor.