Something I have been hearing and seeing a lot of lately is how traditional dentistry is on its way out. Whether it is the decline of private and fee-for-service dental practices, with the exception of a few standout superstars, or other portents of gloom and doom, like many other things, it is very popular to say that traditional anything or long standing career paths are on their way out.  “Traditional” dentistry is far from dead, but the days of truly old fashioned dentistry will be coming to a close in the next several decades.

Now, why is this happening you might ask? Hold on to that question and let’s discuss what many people see as traditional dentistry first. Until the past thirty or so years, dentistries were generally small operations with one to five dentists working either alone or in a partnership at a single location, or perhaps two, if they were successful enough within a local area. Think of shows like “Happy Days” or “Leave It To Beaver”, which emulated middle and small town America. While seen as cliche by many today, the experience of the single dentist has become a fading memory for many families as corporate dentistry and boutique dentistry and dental spa have gained a foothold in many communities and smaller communities are seeing their dentists leave for better opportunities. Very few dentists can survive if they have continuing attrition of patients due to age, lifestyle changes, or opportunities appearing elsewhere. Sometimes dentists themselves get old, retire, or quit practicing dentistry. If they were the last dentist in their community, that area may not have another dentist for years. This leaves large portions of the United States either unserved or underserved.

This has left traditional, single office dentistry dwindling in many parts of the United States. The advent and popularity of cosmetic and esthetic dentistry has also done a bit to push the old-fashioned general dentist to the wayside. Why has this happened? Demand. Consumer demand and our own professional demands to meet consumer demand have made it less appealing to go into straight general dentistry. As a Beverly Hills cosmetic dentist myself, I have done my best to integrate both aspects of dentistry into my practice. This actually has had great results for nearly all my patients. When a patient comes to me, looking for cosmetic improvements, I take a look at their whole mouth and identify problem areas before we are even allowed to think about the cosmetic procedure. I cannot force treatment onto anyone, but I always make the necessary recommendations to my patients when they come in to see me.

For example, if a patient comes into my office looking for whitening and veneers and their teeth show significant decay, I will try to address this issue first. While it is not common, there are some dentists who will go ahead and do the cosmetic procedure without addressing the underlying foundation and health of said procedure. This results in repeat visits which not only require the cosmetic aspects to be completely redone after the teeth are further damaged by decay or other processes that were not properly addressed. I don’t like it when that happens, because it means extra and often costly work that would not have been done if it was performed correctly the first time. The health of my patients is a major concern of mine, because there is truly no better alternative than your real teeth. This is the foundation of my practice, despite my specializations in both reconstructive and cosmetic dentistry. If I can save a tooth, I will.

I have gone off on a tangent, given that we are talking about the single office dentist. One of the biggest problems facing dentists today, especially single or small partnership practitioners, is the day to day running of the office. I have a full staff that handles many of the things I either cannot or do not have the time to work on. At my office, I have hired a social media, copywriter, and SEO & web development specialist, a sales specialist, an engineer, an appliance technician, two dental assistants, a hygienist, and have several people up front to handle patients and incoming calls. Combine this with the cost of equipment and other overhead, you can imagine that sometimes it can get a bit tight. But this is why old-fashioned dentistry is starting to fade away. When a dentist tries to do all of this by himself — advertising, office management, sales, etc. — he cannot focus on his dentistry and the quality of his care begins to suffer. There are numerous dental chains out there, which have their pros and cons, but they serve their purpose and free up the dentists and staff to perform their functions without interruption. I am fortunate enough that my practice is large and stable enough to remain private and have the normal corporate accouterments in-house.

It used to be when people were looking for a dentist, they went to the phone book or got a referral from a friend or neighbor. Local dentists always had a steady stream of new patients, given there were births, people moving into the community, and other factors. Given the rapid advancement of communication, transit, and social media in the past decade, it has gotten harder for dentists to rely on the local soak to get new patients. Advertising and presence-making has become an entire production, requiring hours of writing, interaction with patients, clients, and businesses, requiring both an in-house specialist and occasionally talking to contractors and consultants to help make sure everything gets done.

Relying on referrals also doesn’t necessarily work, at least for local patients. We have patients that drive up to an hour or more to come in. For the most part, it used to be that your dentist was within two to five miles of where you lived. Now, your dentist can be across town or even in another city! This has also put a major dent in the ‘traditional’ or ‘old-fashioned’ dentistry and required many private or solo practices to diversify their skill portfolio to attract patients. Thanks to things like Facebook, Twitter, and even Pinterest and Instagram, the days of phone-book and neighbor dentistry are past us. A young man in Torrance with a friend in Silver Lake who raves about her dentist may very well go see the practitioner in Silver Lake/Downtown Los Angeles, rather than see the local dentist in his neighborhood. This presents a unique challenge, especially for dentists who need to do outside referrals.

While we’ve always done as much as we can in-house, many other dentists have to do outside referrals because they either cannot perform the procedure themselves or are not qualified to practice certain forms of dentistry. This results in “Team-Dentistry”, which leads to uneven results and dissatisfied patients. The problem is lessened in partnerships, but still exists.

Herein lies the problem: old fashioned dentistry usually had a dentist that specialized only in a specific area. You went to the dentist to get your teeth cleaned, cavities and root canals fixed, and sometimes have a bridge or implant placed and that was it, if they were capable of it. However, as the field of dentistry has grown, so has the demand for dentists to be multidisciplinary and the stress of private practices increased. I am fortunate enough to have a private practice that has survived, but even I realize the reality of our situation.

Other dentists who run private practices offer what are called dental spas, which are locations that focus primarily on cosmetic and limited reconstructive dentistry. These are perfectly legitimate practices, and I offer many of the same luxuries in my office. You can also have your general dentistry done at these locations, but you probably are better off finding a more traditional dental office to have your groundwork and more advanced needs taken care of. True dental spas, are rare though, so I would recommend doing your research before you commit to appointments.

I’ve also seen talk about how the advancement of laser technology, the use of stem cells, and other emergent technologies will cure cavities and make fillings and root canals redundant meaning the end of the traditional dentist. I would beg to differ — until these technologies become widespread and are affordable for the average consumer, there will always be work for a dentist to do root canals and fillings. Even after that, our place as craftspeople, and yes, dentists are craftspeople, will remain. What will change is how we apply our craft. Instead of making a prosthesis, we will either craft augments or perfect replicas of your teeth. The ability to completely remold your teeth may only be a few decades away, without procedures that require us to shave away part of the enamel, such as veneers. Even then, the need for dentists who observe, care about, and assist with your oral health will be there. Someone will always have to look for oral cancer, identify gum disease, find cavities, provide cleanings, and prescribe treatments. The only real change is how we perform our craft.

An advantage of chain and corporate offices, is they can pool resources to get technologies and amenities, which are often the lifeblood of our offices (outside of our patients, of course), more quickly. The private practitioner has to pay their own way, out of their pocket, to keep up with their competitors. When the technology to repair a cavity without a filling, needles, or other things that are seen as unpleasant at the dentist become an affordable reality, I can almost guarantee that patients will flood to that office. This is why corporate and high-end boutique dentistry is seeing such an upsurge and more “old-fashioned” single practitioners are finding it difficult to survive in the market in many places. While the single or partnership office will probably never completely disappear, there will be increasing specialization and changes as dentistry evolves. And while I see certain things happening, I am not prognosticator and cannot see into the future. For all we know, “old-fashioned” and traditional dentistry may make a resurgence due to backlash or people deciding to stay closer to home due to fuel prices and time commitments. I simply wanted to air a few things I have noticed and where I see the field of dentistry going in the next few decades. But will traditional dentistry die or is it dead? Most likely not. We just have adjust and change with the times.