The changing face of dentistry: Part I

Ah, the allure of entrepreneurship: Be your own boss. Set your own hours. Make a decent living and help people in need.

Surprisingly, despite dentistry being one of the most attractive small-business ventures around, in recent years there has been a shortage of dentists in the U.S. -- due in large part to a "generation gap" between retiring and incoming dentists, with not enough of the latter to replace the former. But now this trend is shifting, and with it the face of dentistry.

According to the American Dental Education Association (ADEA), the peak year for new dentists was 1983, when 5,756 dental students graduated. In 2005, total graduates only numbered 4,478, a 23% decrease.

"Those nearing retirement age were part of a big surge of graduating students in the mid-1970s to late 1980s, so actually too many dentists were being produced for the need," said Laura Neumann, ADA's senior vice president of education and professional affairs. "Now things have equalized and once again there's an increase in dental school applicants."

In fact, the ADA expects the number of dentists to increase by 8% between now and 2025, with many more women and minorities stepping into the lead role. In 2005, 12,287 students applied to dental school.

There still aren't enough seats for all the dental school applicants. In addition to a decline in the number of dental schools (56 in 2005, down from 60 in the 1980s), the capacity of those schools is restricted, said John Williams, D.D.S., dean at the University of North Carolina at Chapel Hill School of Dentistry.

"It's not like undergraduate schools where they only need to provide instructors and space," he said. "Huge infrastructure is needed for a new dental school, like labs and clinic spaces. So the small increases we're seeing in dental school enrollment is primarily due to new schools opening up."

But help may be on the way. Three new schools have opened in the past decade, and a new one in Virginia is under way.

The reasons why more people are opting to enter dental school these days vary, but the key seems to be the promise of independence and entrepreneurship. In 2006, when the ADEA polled people about to enter dental school and asked them why they chose that profession, more than 80% listed the top reasons as "ability to control my work time," "self-employment," "income potential," and "service to others."

The values of this generation coincide with dentistry, according to Anne Wells, ADEA's associate executive director for Education Pathways. "They value lifestyle. Income is important but not only the thing; they want control over their practice. It's much more significant to them to develop a meaningful philosophy in life."

Those are the reasons Rhett Raum, a 28-year-old senior at the University of Alabama School of Dentistry in Birmingham and vice president of the American Student Dental Association, went into dentistry. "I have a degree in business management and I used to run a B&B, so I have an entrepreneurial background. What drew me to dentistry was the ability to be a small-business owner, be my own boss, and have financial flexibility."

Raum is an anomaly of sorts, however, because he is purchasing a practice in a small Tennessee town with a population of 4,000. Most dental school graduates are opting to go to urban and suburban areas where there are already plenty of dentists, leaving sizable portions of the U.S. without access to oral care.

"It's less of a shortage and more of a maldistribution," Neumann said. That means dentists in inner cities, rural areas, and small towns who are planning to retire will have a harder time finding their replacements.

Some young people are being lured away from medical school when they hear about equally lucrative and less hectic careers in dentistry. In 2004, general practitioners earned an annual average of $186,000, while specialists averaged $315,000, according to the ADA.

"My physician friends send their kids to dental school because they don't like what's going on with the laws in their industry, whereas the dental industry has not been nearly as encumbered," said Paul Gruber, a 64-year-old dentist in Sheboygan, WI.

Who’s signing up

What will the next generation of dentists look like? In terms of demographics, one population that is taking off is women, who now account for 44% of all dental school graduates and 19% of all dentists, according to the ADEA.

While these numbers are expected to continue to increase, however, another trend is worth noting: a growing number of female dentists will work part time to balance career and family. According to the ADA, 14% of dentists now work part time; this number is expected to reach 19% by 2025, with most being female dentists.

Jack Dillenberg, D.D.S., dean of the University Arizona School of Dentistry & Oral Health, worries about that figure. "Women make up half our class and they are great dentists, but they don't work as long and therefore won't be as productive overall."

But others argue that the flexible hours of dentistry will allow women to be at least as productive as men. That's the opinion of Laura Rammer, a 29-year-old general dentistry student who graduated from Marquette University Dental School in Milwaukee last summer. She mentored with Dr. Gruber in Sheboygan, and is considering taking over his practice when he retires.

"It's now an option for the woman to be a full-time worker and the husband a stay-at-home parent," she said. "I'm going to keep going to the office. Besides, I work four days, from 7 a.m. to 5 p.m. That's accommodating for families."

The flexibility of dental work is also attracting many women to become hygienists. The number of dental hygiene programs has steadily increased during the past decade, numbering 270 with 7,200 graduates in 2004. That's nearly twice the amount of dental school graduates -- and the education is half the cost of dental school.

Dental hygiene is the fifth fastest growing profession in the U.S., said Jean Connor, president of the American Dental Hygienists' Association (ADHA). "They are mostly women, often because hygienists stay licensed for their life cycle, so it's good for women who want to have kids and a flexible or part-time career. It's a good-pay salary. And you can be a healthcare professional, but unlike nursing you don't have to work nights or weekends."

Hygienists are expected to be on the front lines of expanding oral care to underserved populations. The ADHA is developing a curriculum to create a master's degree for advanced dental hygiene practitioner. Graduates would be able to do many services a dentist does -- such as cavity prep, extractions, and prescriptions -- and without a dentist's supervision. The goal is to have them serve in lieu of dentists in underserved areas.

"They can be a long arm reaching out to people in need," Connor said. "They'll be important because they can provide dental services and get people on the learning curve of oral health."

Serving the underserved

While the number of female dentists is on the rise, minority enrollment is lagging. More Asians are enrolling, which accounts for the vast majority of minority applicants. However, blacks and Hispanics currently comprise less than 10% of U.S. dentists, far below their numbers in the U.S. population.

This is where targeted minority recruitment of dental students and mentoring can play a key role. The ADEA found that dentists of an ethnic minority background, especially Asians and Hispanics, often chose the career because they wanted to serve their ethnic group or a low-income population in general.

"It's a priority for dental schools as well as for organized dentistry to raise those numbers," Neumann said. "It's a concern about our ability to meet the needs of the public because people want to go to a health provider that comes from their own background and speaks the same language."

In its numerous programs to boost minority representation, the ADEA is working with the Association of American Medical Colleges on the Summer Medical and Dental Education Program that identifies college freshmen and sophomores interested in dentistry and give them a summer-school education.

"This can enhance their chances to do well in both undergrad and dental school," Wells said. Nearly 1,000 students currently participate, along with 12 medical and dental schools.

In part II of this series on the future of dentistry, author Vanessa Richardson tells how dental education is changing, from revised dental school curriculums to targeted recruitment and mentoring.