Yesterday I watched with intent and concern a local news channel’s investigative report about bad dentistry in Maine. To say the least, the piece was marred with incomplete information and accusations about poor dentistry in Maine. Yes, even I extracted two teeth on my last patient and didn’t place any “stitches.” Why?, she didn’t need them! Throughout my 30-year career I have spent a great amount of time participating in and teaching continual education to dentists from all over the country. As a profession, you would be impressed by the amount of time, cost, energy and effort put forth by dentists to try to be the best they can be. Unfortunately, as with any occupation there will always be a group who are indifferent to their careers. I have found these individuals usually filter themselves out of a job. But in general, Maine should be very proud of its high level of skill and expertise throughout the medical field, especially dentistry. Dentistry is a very complex and difficult science and art.

A true crises looming in dentistry (and all the professional occupations) is the high debt the graduates are leaving college with. Many of the recent dental graduates have student loan debt between $400,000 and $500,000. And to be frank, they will never be able to pull themselves out from under this debt load. This has a very negative effect on the dental profession and more importantly, the public. Some of these issues are:

1. When you graduate from dental school your education is merely an outline from which you are able to build upon. The recent graduates will not be able to afford quality continuing education to improve their skill set.
2. Due to the extremely high cash flow needed to pay back these student loans, future dentists will be unable to invest in advancing technologies within their private offices to stay current and up to date.
3. Few dentists will be able to afford to buy or maintain private practices and will be controlled by corporate dentistry and insurance companies. This leads to “bottom line” sales and not necessarily what treatment option is best for the patient. People should be treated, not mouths.
4. Unfortunately, the high cost of student loan repayment and practice overhead may influence treatment decisions, which could negatively impact the patient.
5. As the cost of medical/dental treatment continues to be a major concern, cost of services will need to rise to keep cash flow at a sustainable level.
6. Finally, when the reality of the cost/return on investment becomes clearer to our young students, few will take the plunge into the profession and we will see a significant shortage of qualified caregivers.

It would take a long discussion to place blame on why this is happening, but I point toward the dental schools, our national student loan programs, and the decisions of the students and their parents to assume these huge financial risks. To add to the just plain frightful nature of the direction of dentistry in Maine, our legislature is committed to approving the “mid-level providers” who will have minimal dental education or supervision. Dentistry is a skill level that takes a significant amount of time to develop. It is procedural oriented, a combination of medical evaluation and surgery. Soon one of our state legislatures may find out the hard way that there is no such thing as a “simple extraction or simple filling.” It will be interesting to watch the future “investigative pieces” that our news programs do on these  issues. Stay tuned!