Dental Practice 2001

When Dr. Gordon Christensen, co-founder and currently senior consultant of Clinical Research Associates in Provo, Utah, agreed to contribute material for a feature article in Dental Economics, he requested that I propose specific questions for him to answer.

Dr. Gordon Christensen answers six questions about what the new millennium will bring us

Dick Hale, Consulting Editor

When Dr. Gordon Christensen, co-founder and currently senior consultant of Clinical Research Associates in Provo, Utah, agreed to contribute material for a feature article in Dental Economics, he requested that I propose specific questions for him to answer.

Being charged with coming up with five or six questions to ask Dr. Christensen, who speaks to literally thousands of dentists each year, I wanted to ensure that the questions would accurately reflect current interests of the actively-practicing dentists who read Dental Economics each month. With this in mind, I sought the counsel of Drs. Bette Robin, Claremont, Calif.; Erich Heidenreich, Marshall, Mich.; Larry Cook, Marianna, Fla.; Charles Vogel, Springfield, Mo.; and Susan Holtrop, Holt, Mich.

The forward-looking questions on these pages were formulated:

Clinical Research Associates (CRA), which is mentioned several times in the interview with Dr. Christensen, can be contacted at 3707 N. Canyon Road, Suite 6, Provo, UT 84604; (801) 226-2121.

What steps does dental education need to take-which are not being taken-that will prepare young men and women for the future dental practice?

As a previous full-time educator and administrator, and currently a person constantly contacting schools and students throughout the world, I have the following thoughts on this question:

Dental education is doing a good job in the U.S., educating dental students in the basics of dentistry.

However, an experienced practitioner would agree that new graduates are underprepared in many areas of dental practice. The most glaring omission is practice administration. New graduates are hopelessly underprepared in that area.

Schools need to develop groups of successful practitioners who provide information to students on how to manage the financial affairs of their practices. It might even be well to involve dental students in a mini-program in business during their last year of dental school to prepare them for this woefully inadequate area of education.

Additionally, the new concepts in dentistry need to be addressed on a routine basis in dental schools. Since it is obvious that dental faculties do not want to teach the newest techniques because of the lack of assurance that the techniques will be adequate, I suggest that introductory courses in new concepts be added as mandatory courses in the dental-school curriculum.

It is amazing to note that many, new dental graduates have not accomplished a porcelain veneer, placed a Class II resin or accomplished add-on diastema closures, when such techniques are nearly mandatory the day they graduate to stay competitive with the rest of the dental marketplace. It is obvious that such techniques cannot be taught at a level of competence, but new graduates should at least have an introductory-level course in all areas of new technology.

I am not critical of dental education, knowing how little can be taught in the few years a person is in school.

It is the continuing education obtained after school that makes or breaks a clinical practitioner. Ten years after graduation, most of the information learned in school is outdated, but the concepts of service, honesty, professionalism, and continuing education remain.

To summarize, dental educators and schools need to be aware of the constantly changing new concepts, devices, materials, and techniques in the profession, and although they cannot teach them in detail, they should provide at least some information at the predoctoral level.

Should dentistry rebalance its fees to even out the dollars per hour we charge for our services?

Fees for dental services should be based on time involvement and difficulty. However, you cannot base fees entirely on time involvement, because some procedures are extremely difficult and others are very simple.

I believe strongly that fees in the U.S. are not equitable for patients or dentists. For example, amalgam is grossly undercharged, and procedures such as fixed prosthodontics and endodontics are much more expensive on a unit-time basis.

We need a group of experienced practitioners to develop a relative-value scale, without dollar-values attached, for all dental procedures, based on difficulty and time.

Such a relative-value scale would be useful immediately for practitioners when setting fees and for third-party payment companies, as they attempt to decide on fee scales.

What will be the primary restorative materials in 2001, and what will we not be using?

The year 2001 is a very short time away. Amalgam will remain the mainstay of restorative materials in America, although it is dying a very rapid and natural death in many other areas of the developed world.

Composite resins, both of the variety used today and of formulations being further developed, will provide a major part of the service for posterior restorations in the U.S. by 2001.

Already, nearly 10 percent of American dentists will not place amalgams, according to surveys we have conducted.

Tooth-colored inlays and onlays are becoming very popular in Western Europe and other parts of the world. They are growing in popularity in the U.S., but we still are much more accepting of amalgam than persons in other countries.

We are going to see a significant movement toward tooth-colored restorations of all types, including the new products, such as Artglass from Kulzer, Belleglass from Kerr, and the Targis System from Ivoclar.

What are the three questions that you most often are asked?

To answer your question, I have gone to the person with Clinical Research Associates who answers some 25,000 questions per year, Rella P. Christensen, PhD, director of CRA.

The most-often-asked question in the past few months has dealt with the selection of intraoral cameras. There are many intraoral cameras on the market, some of which are very good and some of which have limited application.

At this time, it is difficult to single out just a few. However, the newest intraoral camera, Concept 111 (NewImage Industries, Inc., (800) 634-7349),-which uses one lens for a full face, a dental arch, a quadrant, and a tooth,-provides an easily-used concept with a docking station that can be plugged into devices serving several operatories.

Additionally, there are three other cameras that have been rated very high in CRA evaluations: Easy Cam (Henry Schein, Inc., (800) 372-4346), VistaCam (Air Techniques, Inc., (516) 433-7676), and Reveal (Welch Allyn/Patterson, (800) 328-5536).

When selecting an intraoral camera, every practitioner has different views relative to what is desirable. CRA has accomplished extensive testing on these devices and that information may be obtained from CRA newsletters (Clinical Research Associates Newsletter, 20:10, p. 3, October 1996; and 20:2, pp. 2-3, February 1996).

The second most-common question received at CRA recently had to do with the selection of computer software. There are many computer software programs available for dental offices.

I suggest that dentists observe the most popular ones and select the program that best fits their needs.

A recent CRA newsletter carried an article on the Dentrix System, which has received very high ratings in CRA evaluations (Clinical Research Associates Newsletter 20:10, pp 1-2, October 1996). However, there are many other programs that are highly satisfactory as well.

A third commonly asked question has to do with the selection of cements, probably because of the major changes in cements over the past year.

Resin-reinforced, glass ionomer cements, namely, Advance (Caulk/Dentsply, (800) 532-2855), Fuji Plus (GC America, Inc., (800) 323-7063), and Vitremer (3M Dental Products (800) 634-2249) are becoming the predominant cements for metal and porcelain-fused-to-metal crowns.

Please remember that resin-reinforced glass io-nomer cements are not desirable for cementing all-ceramic crowns, because of their slight expansion.

What do you foresee for the dental laser and for visioradiography?

Lasers used in dentistry had a very frustrating beginning some years ago. The devices introduced early on were slow and expensive.

Subsequently, other lasers, including CO2 and argon, came on the marketplace and have been used with some success in soft-tissue surgery. Although practitioners and patients alike really like lasers for soft-tissue surgery, CRA`s basic science tests have not been as optimistic on the subject.

With refinements, I see lasers as an adjunct to soft-tissue surgical procedures. The most laser activity in dentistry is in the area of resin-curing with argon lasers. Resin-curing with lasers is faster and produces a more intense cure.

However, lasers for this purpose still are very expensive and will require revision over the next few years to occupy a place in a typical practice. In spite of the current controversy about them, I do think they have promise.

Visioradiography is widely used in Europe. It has ideal applications in the areas of implant surgery and endodontics. Those practitioners who have adopted visioradiography into their practices will not do without the concept.

However, it is expensive and dentists are reluctant to purchase such units, because of their lack of knowledge. I predict that this soon will be state-of-the-art.

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