Catch The Wave by Roger G. Sanger, DDS, MS

Waving goodbye
After interviewing many senior dental students and recent graduates, and reading numerous blogs targeting this group, I think I have a pretty good sense of how many of you are envisioning your dream general practice (assuming you don’t specialize).

I suspect your vision might include phrases like spa practice, boutique practice, concierge practice, cosmetic practice, adult rehabilitation practice or implant practice.

When I look in telephone books—you remember those dinosaurs—or search online, I see these and similar phrases ... along with long lists of dentists who all seem to be trying to attract the same perfect patient: the middle-age-to-older adult with the need, desire and money to have that perfectly straight, white, no-missing-teeth smile.

But let’s face it—that market is flooded with thousands of general dentists, the oldest and most experienced of whom got into this arena decades ago by targeting baby boomers who wanted to look younger at all costs. That provided a nice living for the many dentists who got on their boards and rode that wave. Now, however, that perfect hidden surfing cove is so full of wannabes that you can barely even find a place on the beach to watch, let alone get out there and surf.

Despite this reality, too many dental students and recent graduates still focus on this paradigm—one that experienced its shift decades ago.

What continues to foster this retro desire by new dentists? Well, a lot of it can be attributed to dental schools, where the top-dog subjects are adult rehabilitation and implantology. As a result, most new dentists want to be the next Gordon Christensen. But there’s only one Gordon Christensen, and if he were a dental student or recent graduate today, I’m pretty sure he’d be focused on catching the next wave rather than watching one that’s already passed by.

The dawn patrol
Those of you who are smart—and I don’t mean book-smart, I mean entrepreneurially smart—will try to catch the next paradigm shift before it becomes so popular that the chance for success is all but gone. You don’t want to miss the train because you’re still buying a ticket when it leaves the station. This happens more than anyone cares to admit. What’s the next shift in dental care, and when will it start? Good questions. Short answer: pediatric patients. Let’s look at some sound demographic facts as part of the long answer.

• By 2020, the biggest segment of our population will be pediatrics (patients ages 0–18). In the U.S. approximately 4 million people are born every year, and 80 percent of those are born to millennial parents.
• Caries in the pediatric population has become a silent epidemic, and it isn’t expected to go away anytime soon. Preventive dentistry has failed to motivate most parents, and sugar consumption is at an all-time high.
• Dental workforce statistics show that the U.S. produces only about 350 new pediatric dentists each year. This is severely insufficient to meet the demand. Most pediatric dentists are solo practitioners in larger cities, leaving rural areas particularly vulnerable.
• Dental benefits for children are gaining popularity in both private and government programs. Children who are dentally uninsured are becoming more of an anomaly.

Market experts will tell you that the shift into the pediatric specialty by the current dental workforce has already started. Let’s look at two important workforce facts:

• Pediatric dentistry, as judged by the number of applicants applying for postdoctoral education programs, is now the most popular ADA specialty, beating out oral surgery and orthodontics for the top spot.
• Corporate dental groups and dental service organizations are opening children’s dental clinics across the U.S. and hiring pediatric dentists (if they can find them) or general dentists at a very high rate. Do they know something you don’t?

Now do I have your attention? Do you see opportunity? If so, what should you do if you want to capitalize on the shift to pediatric dentistry? (Let’s assume that you either don’t want or can’t get acceptance into a two-year postdoctoral pediatric specialty training program.)

As you know, most dental-school curriculums devote little time to pediatric dentistry. They may have a didactic seminar with a two-week clinical rotation, in which you do some exams and some work with prophies, sealants and fillings.

As a result, the average dental student graduate is ill-prepared to treat the myriad of dental problems that exist in children today. Regardless of whether the graduate or new dentist starts a new practice or gets an employment associateship, chances are high that the bulk of new patients treated will be children.

The old adage still applies: No matter where you start in dental practice, the odds are good that you will treat children until you get successful. Then, at that point, you could refer out children or give them to the new associate.

The question is, would it make sense to stop treating kids at that point just because you could? I’d argue that the answer is no.

By 2020, the biggest segment of our population will be pediatrics (patients ages 0-18). In the U.S. approximately 4 million people are born every year, and 80 percent of those are born to millennial parents.

Surf’s up
So if you’re going to treat kids—at least for the short term and ideally for the long term—where do you get the training in pediatric dentistry? Here are three options:

1. Try to get an associateship with a solo or group pediatric dental practice. Is that possible? Don’t pediatric dentists only hire pediatric dentists? Well, not all do. Some pediatric dentists who’ve had trouble finding pediatric dentists do hire general dentists to be associates. For ethical compliance, they must inform parents that the doctor is a “general dentist who treats children,” not a specialist. Sometimes the only available training is on-the-job training.
2. Try to get an associateship with a solo or group children’s dental practice that may be owned by general dentists. Although not pediatric dentists by training and experience, some of these “general dentists who treat children” are very experienced and can also offer that on-the-job training.
3. If the first two options are not possible, then consider a multiday, didactic, hands-on “SimLab” CE training program through an AGD- or ADA-accredited entity. One-hour circuit lectures are easier to find and much less expensive, but multiday, didactic, hands-on SimLab courses are far superior and well worth the extra investment. Without hands-on SimLab training, you won’t get the psychomotor skills to back up the cognitive learning.

Close out
Chances are high that you didn’t get didactic introduction to the new game changers in pediatric dentistry, because dental schools don’t often expose their students to the latest and greatest techniques and products.

Many dental schools and postdoctoral CE courses introduce you to the game changers in adult dentistry: dental imaging, cosmetic dentistry, rehabilitation CAD/CAM dentistry, implants, nonsurgical perio therapy, adult orthodontics and adult sedation.

I would bet, however, that most of you know little of the major players in pediatric dentistry: digital radiography and imaging, caries transillumination, CAMBRA diagnosis and treatment planning, advances in local anesthesia, oral conscious sedation, advances in isolation systems, MTA pulp therapy, cosmetic resin restorations, zirconia cosmetic premanufactured primary crowns, advances in immediate space maintainers, and other factors that are rarely taught in predoctoral dental education and hotel or dental society CE courses.

If you are to make the most of this shift by successfully treating children, you must perform pediatric dentistry that is better, faster and easier. If you can do that, by definition you’ll also be giving millennial parents the four C’s of pediatric dentistry for their child: care, comfort, convenience and cost.

Performing and marketing pediatric dentistry in a general practice can and will fill your chairs as you catch the pediatric dentistry wave. But to successfully ride this exciting wave, you will have to understand and provide the new services that today’s parents expect and tomorrow’s parents will demand.

References
census.gov/topics/population.html
ada.org/en/science-research/health-policy-institute/
ada.org/~/media/ADA/Science%20and%20Research/HPI/Oral
HealthCare-StateFacts/Oral-Health-Care-System-Full-Report.pdf
aapd.org/residency_program/
theadso.org.

Roger G. Sanger, DDS, MS, a pediatric dentist, co-founded one of the largest private pediatric dental groups in California. The group consists of pediatric and general dentists practicing in multiple offices, including two surgicenters and a hospital practice. He is a director at the Institute for Pediatric Dentistry and director of Pediatric Sedation Dentistry at DOCS Education.