Dentistry of the future
Brief recap
In antiquity, dentistry was primarily practiced by practitioners or barber-surgeons. Rudimentary dental treatments existed in ancient Egypt and Greece, but without a scientific basis. Dental treatment was often limited to tooth extraction.
Pierre Fauchard (1678–1761), a French dentist, is often referred to as the “father of modern dentistry.” In 1728, he wrote the first scientific book on dentistry, titled “Le Chirurgien Dentiste” (The Surgeon Dentist). Fauchard introduced many fundamental techniques, such as the treatment of caries and the fitting of dentures. Fauchard had a significant influence on the development of dentistry in Europe, including Germany.
At the beginning of the 19th century, dentistry was increasingly recognized as an independent discipline in Germany. It began to be differentiated from general surgery and medicine.
In 1800, the first dental school was founded in Berlin, and in 1826, the first dental training program for aspiring dentists was established in Berlin. Dental prosthetics, the art of creating dental prostheses, continued to develop. The profession of dental technician emerged.
In 1830, the German ophthalmologist (!) Friedrich W. G. von Graefe used the first amalgam filling. Amalgam remains one of the most common materials in dentistry worldwide.
The introduction of X-rays (at the end of the 19th century) enabled more precise diagnosis of dental problems. The first dental X-rays were taken in Germany in 1920.
From 1922 onward, dentistry could be studied as an independent subject at universities, and the first university dental clinics were established. The study of dentistry became increasingly widespread.
The discovery of fluoride as an important means of preventing tooth decay was investigated by various scientists worldwide and also influenced dentistry in Germany.
In the 1950s and 1960s, the importance of dental hygiene was emphasized more strongly in Germany, and nationwide oral health campaigns were launched.
Until then, dentistry in Germany was world-class.
Numerus Clausus
For decades in Germany, the Numerus Clausus (NC) has been the sole selection criterion for admission to dental school in 99% of cases. There is no aptitude test. This has prevented many young people from studying dentistry, even though they possessed the right mindset. And this remains unchanged to this day. To put it somewhat bluntly, this means that top grades in art and history are crucial for admission. I believe this is unique worldwide.
Dentistry as a deficient service
When I took my state dental exams in 1980, it was already clear that a problem would arise after 2015: more dentists were retiring than were entering the profession, a situation we are witnessing today. In concrete terms, we are losing approximately half of all dentists and practices, something we can see everywhere: practices are constantly closing.
Furthermore, 70% to 80% of dental students today are female, with different lifestyles than we had back then. They want and need to care for children and families, making full-time work in a practice rarely possible.
Ultimately, I suspect that we will lose approximately two-thirds of the workforce in dentistry. From a public health perspective, this is a catastrophe, especially since it has been foreseeable for decades. Dental care will therefore become a scarce service.
A look into the crystal ball
We are facing increasing staffing shortages because the profession of dental assistant is becoming less and less attractive. This is due, in no small part, to dental colleagues who pay abysmally low wages and/or don’t value and mistreat their employees. As a result, our society will continue to lower the standards for training in this profession in order to find staff at all.
A similar situation will occur with dentists. Their training is deteriorating because it costs universities a great deal of money. This culminated in the following statement from my then-assistant dentist: “I learned more in my first month working in your practice than in five years of university.”
As the shortage of dentists becomes increasingly severe, politicians and other experts will come up with the idea of creating “low-level dentists” to meet the demand for dental treatment. The standard of care will continue to decline.
The costs of running a dental practice are rising, just like costs in other sectors. However, revenues are not keeping pace, as these revenues are politically controlled. The consequence of this is that patients have to bear an ever-increasing share of treatment costs themselves. I’m almost led to believe that dentistry is being deliberately excluded from the benefits package of statutory health insurance.
Up-to-date dentistry
Dentistry is making tremendous strides worldwide, advancements you, as a patient, often don’t notice. Here are a few examples of what’s possible today:
The central element of modern dentistry is professional prophylaxis. We implemented this consistently well over 35 years ago.
Amalgam has been banned in Europe since 2025. However, we haven’t used this material for decades.
New materials have made minimally invasive dentistry possible. Fillings are now bonded, so we only need to drill the tiniest cavities. This is complemented by digital X-rays for the early detection of incipient caries.
Cosmetic dentistry is the umbrella term for various services, such as bleaching (teeth whitening), orthodontics, aligners, veneers, etc. The common goal is to create or optimize an attractive smile.
While we used to need impressions for crowns, bridges, and dentures, today we scan your teeth and mouth. This creates an “optical impression.” Patients with choking reflexes especially appreciate this.
Previously, crowns and bridges had a framework made of a metal alloy. Today, we use all-ceramic eMAX and zirconia. Both materials are milled from a solid block after the crown or bridge has been designed on the computer. In many cases, the patient can have the crown or bridge fitted in the practice after a short wait.
Implants used to be made exclusively of titanium. Today, ceramic and zirconia implants are also available for patients with metal allergies.
I could continue this list indefinitely. But then it becomes increasingly specialized and difficult to read and understand. Let’s leave it at that!
Author: drw
We need to take care of this generation!