This industry consists of offices and clinics of licensed practitioners of dentistry with the degree of D.M.D., D.D.S., or D.D.Sc. Included in this industry are the offices of dentists, dental surgeons, pediatric dentists, endodontists (root canal specialists), oral pathologists (specialists in mouth diseases), orthodontists (specialists in straightening the teeth), periodontists (gum specialists), and prosthodontists (artificial teeth and denture specialists).
Offices of Dentists
There were an estimated 119,032 offices and clinics of dentists in 2005, with a workforce of 702,566 dental professionals. The industry reported nearly $35 billion in revenues. On average, there were a total of six employees per office.
During much of the 1990s, the number of professionally active dentists was on the decline. By 2000 there were 154,459 professionally active dentists in the United States. Approximately 4,000 new dentists graduate in a typical year, whereas 6,000 retire. Throughout much of the 1980s, there was a perceived oversupply of dentists, which gave insurers the upper hand—providing patients for dentists in exchange for discounts. Due to the perceived decline in the number of dentists in the early 2000s, insurers had to compete for doctors with services and information they could provide. Approximately half of U.S. citizens had some form of dental coverage in 2001, steadily rising over the last two decades. Self-pay and private prepayment each accounted for about 47 percent of payments for dental care, with government-financed care making up 4 percent and other private funds accounting for 2 percent.
Employer funding of dental benefits is an area that is expected to experience major changes in the coming years. Medical costs will continue to rise, and health benefits will continue to compete with dental benefits for employer dollars. More employers will be expected to play a bigger role in cost sharing, and contribution programs will become more defined. These factors will affect dental services and the types of services provided. A growing number of patients are frustrated with increasing restrictions from their insurance companies, service limitations, larger co-payments, and annual caps on benefits. Some dentists are similarly frustrated with dealing with the bureaucracy and complicated paperwork of dental benefits companies and have been moving toward "insurance-free" services. If this trend continues, dental insurance could be negatively affected.
The dental profession is divided into eight types of practices carried out at dental offices and clinics: general dentistry, oral and maxillofacial surgery, endodontics, orthodontics, pediatric dentistry, periodontics, oral pathology, and dental public health.
Prior to the 1980s, establishments in this industry that were owned by self-employed dentists were operated by the dentist and a small staff. During the 1980s, dentists began running their offices like small businesses, employing the outside services of managerial consultants and dental office advisers. These organizational changes continued throughout the industry in the 1990s. With the health care industry moving toward managed care, dental maintenance organizations (DMOs) grew rapidly; at these organizations, participating dentists were paid fixed monthly rates. In 1989, only 10 percent of dentists worked with DMOs. By 1992, 15 percent of all dentists participated in these organizations, and analysts forecasted that 40 percent would be participating in such plans by the year 2000. Another reason that DMOs were seen as necessary was because the dental inflation rate had started to exceed the medical inflation rate in the mid-1990s. In 1995, approximately 18 percent of Americans were enrolled in a DMO. In fact, a total of 100 million people (including 52% of adults) were in a dental plan that covered part or all of their dental expenses.
Modern dentistry began in the sixteenth century with the European revival of arts and sciences. According to dental historians, dentistry was being practiced independently from general medicine and surgery as early as 1544. Dentistry and medicine had been united for centuries because both sciences were practiced by barbers. The sixteenth century saw the important developments of dental instruments designed for cleaning and filling teeth.
In the seventeenth century, dentistry developed into an area of scientific inquiry in the way medicine had for many centuries. In Europe and America, academic and scientific articles began to appear on dentistry topics. During this time, the occupation of the barber-dentist evolved into that of tooth puller, while a separate practice of dental surgeons began to develop. The practices of periodontics and dental pathology began to develop during the eighteenth century.
Dentistry saw tremendous growth in the twentieth century. Preventive dentistry and public education on the importance of dental health and hygiene paid off for this industry. The number of patient visits rose significantly, especially for preventive measures. Moreover, elderly patients, unlike previous generations, did not lose their teeth and therefore went to dentists regularly.
Advances in fluoride treatments and dental technology have decreased the number of cavities Americans have. In 1990 Americans had 151 million fillings, only half the number of fillings in 1959, even though the population had doubled during that time. The number of root canals, however, tripled.
Income levels play a significant role in the number of times a person visits the dentist. In 1997, approximately 59 percent of people with household incomes between $10,000 and $19,999 indicated they had visited a dentist within the past 12 months, whereas 84.9 percent of people with annual household incomes of $55,000 or more said they had been to a dentist.
The expansion of this industry during the twentieth century was also due to numerous technological advances. During the 1940s and 1950s, new methods of anesthetics greatly reduced pain during clinical procedures. The 1960s saw the development of bonding...