dentists in a post-cavity era

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A

arkenstone

With all the research interest in our microbiome and the composition of biofilms, it's not inconceivable that sometime in the next hundred years tooth decay could be combatted with some effervescent mouthwash of enzymes/cultures/bacteriophage. (I happen to believe that it will always require some form of manual abrasion and dietary control to prevent tooth decay, but anything it possible.)

So, hypothetically, let's say it happens. Let's say there's a news conference on CNN, and five years later insurance companies are paying for this treatment and six-month checkups become two-year checkups. What happens to dentists? A rush to saturate the cosmetic, orthodontic, and surgical markets -- while the rest go find something else to do with their lives?

I feel foolish for entertaining the idea, but as I'm planning to dedicate the rest of my twenties and several hundred thousand dollars on this path, I'm intrigued.

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I think is is a great post. Great Title too -- "post-cavity era".

I'm actually praying for this "post-cavity" era to begin. I feel like filling cavities is something dental therapists should handle. Real dentists should not derive most of their income from: drillin-fillin-n'billin. These pedo-mills have given our profession a black-eye, and killed our respectability. Hell.. even our MD counterparts don't view us as doctors.

The "S" in DDS stands for "surgery". And in the post-cavity era, earning a DDS will mean you must be a competent surgeon. Which means dentists in the future will make a living placing implant retained prosthesis for the aging baby boomer population.
 
I've always thought that if this happened clinical dentistry would look a lot more like other non surgeon physicians in practice where they're treating diseases of the jaws, occlusion, soft tissues, etc while applying these newer non-procedure therapies to patients' teeth. For example my dermatologist rarely cuts but there is certainly a lot for them to do.

However, I don't think this will happen within my career or possibly even lifetime.
 
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I did a google scholar search for fusobacterium nucleatum and emailed maybe 5 random researchers in dental-related pathology, asking them whether they thought such treatments were years away or decades away. I'll post any responses I get (but I usually don't have much success when I email random academics like this).

I can see this going one of two ways

1) As yappy points out, perhaps such treatments will require individual calibration -- giving dentists more pathology-like work to do. This would also make the treatment inconvenient enough to NOT be the miracle cure that reaches every corner of the world, meaning there'd still be plenty of crowns, fillings, and periodontal work. I see this as the most likely route, especially during the nascent stages of such treatments.

2) Or the treatments are so broadly effective that they can be mass-produced and sit on the shelves at Walgreens. This would be the sea change scenario. No more rotting teeth. Endodontics and periodontics slowly disappear. Prosthodontics is limited to cosmetic motivations. And maybe the treatment is so straightforward that there's no pathology work to do either. Orthodontists with business sense would make a killing on CE programs for a decade or so. Oral surgery would be relatively safe since you can't just create true residency programs out of thin air . . . although there may be more extraction-related CE activity.

If it seems like I'm pulling this out of my ass, you're right.
 
A short and sweet response from a lady named Shailja Chatterjee (recent publication) when I asked her about such treatments and continuing on a dental path:

"It shall take years of research to do so. So go ahead and take the leap."
 
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I think is is a great post. Great Title too -- "post-cavity era".

I'm actually praying for this "post-cavity" era to begin. I feel like filling cavities is something dental therapists should handle. Real dentists should not derive most of their income from: drillin-fillin-n'billin. These pedo-mills have given our profession a black-eye, and killed our respectability. Hell.. even our MD counterparts don't view us as doctors.

The "S" in DDS stands for "surgery". And in the post-cavity era, earning a DDS will mean you must be a competent surgeon. Which means dentists in the future will make a living placing implant retained prosthesis for the aging baby boomer population.

Guess us DMDs are screwed. But seriously, we all know there's more to dentistry than surgery.

There's plenty of dentistry to be done, and not just clinically. Drilling and filling is a very myopic way of thinking. That's why this is a wonderful field -- numerous opportunities to use your training!
 
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how will dentist's fair in a post-apocalyptic era?

We're already in the post-apocalypse area. 2008 was the year the bomb went off.

--Unfortunately most Americans don't realize the radiation from the aftermath is far worse than the detonation itself, and the landscape is forever changed.

My advice for dentists is -- " lean. startup. Be small, flexible, adaptable -- be like water, my friend."
 
It is nice to worry about what dentistry is likely to be in 100 years, although none of us presently on sdn will be around to watch CNN at that point in time. The profession is and will continue to evolve. The introduction of fluoride and the significant reduction of caries in the general population has not adversely affected dentistry, just as eradicating smallpox, polio, and the virtual elimination of others has had little effect on medicine.
 
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how will dentist's fair in a post-apocalyptic era?

I've thought about this from time to time - I imagine that dentists will use their skills to keep themselves out of the work-camps; escaping the scourge of whatever dominant power that has taken hold. They may even prosper as they could trade much needed dental treatment for chickens, toilet paper, etc.
 
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Ahh, this topic again ;)

Two KEY real world things to remember about this topic.

#1 IF, they do come up with a true, 100% effective caries "vaccine" you'll still have a generation of people, with literally hundreds of millions, if not BILLIONS of existing restorations, the majority of which at sometime will reach the end of their functional lifespan and need replacement, and that doesn't even get into the countless numbers of fractured cusps, incisal edges, etc around these restorations that will need to be restored. Restorative dentistry will have plenty of work for the careers of all those currently in practice and in dental school now and likely for years to come. If you think that all restorations have an infinite lifespan, then you'll be in for a BIG surprise in the future when you've been practicing restorative dentistry in the same place on the same basic patient pool for 5 or so years and longer :wideyed:

#2 Let's talk about the reality of how an insurance company decides if it will or won't cover a procedure, since for many patients deciding if they do or don't want to do something comes down to the age old question "Does my insurance cover it?" :bang: Let's say that the caries "vaccine" is going to cost $200 a year per patient (who knows what the actual number would be and what it's annual dosing frequency would be?) Any insurance company has a huge amount of data as to what the annual restorative cost they pay per client per year. The reality is that if the annual average amount they pay client for restorative services per year is less than the cost of the caries "vaccine" would be, then they, the insurance company, is likely based on the economics of the situation to NOT cover it, and as a result, you'll see a far less than 100% utilization of the caries "vaccine" by the general population

Lastly, this doesn't even get into the concept that you'll run into with some paranoid patients about having to put some likely "foreign" bacteria or chemical compound in their mouths, or even worse the mouths of their kids!! See the anti amalgam. anti fluoride, anti Triclosan movement BS for an example :diebanana:

Restorative dentistry, based on REAL WORLD realities, as opposed to real world fantasies, will be around for a LONG time, in basically the same form (less a few new materials I'm sure) as it is now and has been for a century
 
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well... who do you think will be the ones that apply the treatment that prevents all the cavities? if everyone needs that treatment done, I know what im going to tell my grand children to specialize in
 
Ahh, this topic again ;)

Two KEY real world things to remember about this topic.

#1 IF, they do come up with a true, 100% effective caries "vaccine" you'll still have a generation of people, with literally hundreds of millions, if not BILLIONS of existing restorations, the majority of which at sometime will reach the end of their functional lifespan and need replacement, and that doesn't even get into the countless numbers of fractured cusps, incisal edges, etc around these restorations that will need to be restored. Restorative dentistry will have plenty of work for the careers of all those currently in practice and in dental school now and likely for years to come. If you think that all restorations have an infinite lifespan, then you'll be in for a BIG surprise in the future when you've been practicing restorative dentistry in the same place on the same basic patient pool for 5 or so years and longer :wideyed:

#2 Let's talk about the reality of how an insurance company decides if it will or won't cover a procedure, since for many patients deciding if they do or don't want to do something comes down to the age old question "Does my insurance cover it?" :bang: Let's say that the caries "vaccine" is going to cost $200 a year per patient (who knows what the actual number would be and what it's annual dosing frequency would be?) Any insurance company has a huge amount of data as to what the annual restorative cost they pay per client per year. The reality is that if the annual average amount they pay client for restorative services per year is less than the cost of the caries "vaccine" would be, then they, the insurance company, is likely based on the economics of the situation to NOT cover it, and as a result, you'll see a far less than 100% utilization of the caries "vaccine" by the general population

Lastly, this doesn't even get into the concept that you'll run into with some paranoid patients about having to put some likely "foreign" bacteria or chemical compound in their mouths, or even worse the mouths of their kids!! See the anti amalgam. anti fluoride, anti Triclosan movement BS for an example :diebanana:

Restorative dentistry, based on REAL WORLD realities, as opposed to real world fantasies, will be around for a LONG time, in basically the same form (less a few new materials I'm sure) as it is now and has been for a century

^
Also, I want to emphasize the idea that this could take a LONG time....
My dentist heard the same claims about a caries vaccine when she was in dental school. 20 years later, nothing has actually happened yet.
 
I thought we already had a caries vaccine? Its called toothbrush, toothpaste and floss... The issue in my eyes is the perceived threat of dental caries. People can totally avoid caries if they kept to their oral healthcare (with some exceptions). The fact is, if this comes out, people will still have to use it, and remember to use it... while brushing. Sadly, I really dont see it changing much.
 
I'm not too worried.

That being said, that drug they developed will not be a vaccine. It will be a toothpaste addative or something similar. Very effective so far. Can you imagine a patient only needing to be so compliant that he/she brushes a couple times a week and still have little to no incidence of caries?

I'd say we're going to have a "busyness" problem like they did in the 80s (though not just because of this). I think we'll still have jobs though.

I just hope that 10 years from now I'm not pissed at myself for not going into medicine.
 
With all the research interest in our microbiome and the composition of biofilms, it's not inconceivable that sometime in the next hundred years tooth decay could be combatted with some effervescent mouthwash of enzymes/cultures/bacteriophage. (I happen to believe that it will always require some form of manual abrasion and dietary control to prevent tooth decay, but anything it possible.)

So, hypothetically, let's say it happens. Let's say there's a news conference on CNN, and five years later insurance companies are paying for this treatment and six-month checkups become two-year checkups. What happens to dentists? A rush to saturate the cosmetic, orthodontic, and surgical markets -- while the rest go find something else to do with their lives?

I feel foolish for entertaining the idea, but as I'm planning to dedicate the rest of my twenties and several hundred thousand dollars on this path, I'm intrigued.

Like Bereno said, caries can be reduced with a simple toothbrush, toothpaste, and floss, but so many people are too lazy to do simple hygiene. If a caries vaccine is effective, people will still need to do their home care, so you're relying nearly 100% on patient compliance. Even if there is a "caries vaccine," I'm still not worried about the future of dentistry.

Even if caries is somehow 100% eliminated, there will be plenty of work to do. Here are just a few examples. Tooth loss due to periodontal disease or trauma will require dentures, partials, bridges or implants. Old restorations will constantly need replaced. People's teeth will wear down and they will want them built back up. People will still want their teeth to look better, so we will do plenty of bleaching, Invisalign/ortho, and veneers.

Yes, plenty of work indeed.
 
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