Dentistry's environmental scan

Nov. 11, 2013
The American Dental Association (ADA) has just published an environmental scan that is titled A Profession in Transition: Key Forces Reshaping the Dental Landscape.1

By Christine Nathe, RDH, MS

The American Dental Association (ADA) has just published an environmental scan that is titled A Profession in Transition: Key Forces Reshaping the Dental Landscape.1 Earlier this year, an ADA-commissioned report by Diringer and Associates was published which assessed the dental landscape. Collectively, these reports provide an analysis of interesting findings, a view of the changing landscape in our dental care delivery systems, and pivotal thoughts regarding these findings.

The report published in May titled Critical Trends Affecting the Future of Dentistry: Assessing the Shifting Landscape discussed the ever-changing demographics present in our society which have resulted in changes in disease patterns, care-seeking behavior, and the ability to pay.2 The report further stated that payments for dental services are shifting from commercial dental insurance to public coverage and personal, out-of-pocket payments. Interestingly, the report highlighted additional changes that involve the mounting pressure for expanded dental team providers. Further, the report defined the increase in dental school graduates and the increasing student debt of graduating dentists. The impact of the changing demographics of dentists, in combination with these aforementioned factors, is altering the practice choices for new dentists.


Other articles by Nathe


The ADA environmental scan includes key findings and key takeaway points. The key findings present structural changes that have occurred in the dental care sector in recent years. They include:

  • The decline in the utilization rate of dental services among working-age adults, particularly the young and the poor, which apparently is a trend that is unrelated to the recent economic downturn.
  • Dental benefit coverage for adults has steadily eroded in the past decade.
  • More and more adults in all income groups are experiencing financial barriers to care.
  • Total dental spending in the U.S. slowed considerably in the early 2000s and has been flat since 2008.
  • Dental care utilization among children has increased steadily in the past decade, a trend driven entirely by gains among poor and near-poor children.
  • The percent of children who lack dental benefits has declined, driven by the expansion of public programs.
  • The average dentist's net income declined considerably beginning in the mid-2000s.
  • Two out of five dentists indicate they are not busy enough and can see more patients.

A few years ago, I highlighted the 2011 ADHA Environment Scan. This report, titled Dental Hygiene at the Crossroads of Change, focused on the premise that although many dental hygienists will continue to work as they always have, some will be drawn to become pioneers in moving the profession to new places. These collaborative leaders will engage people and groups to work toward common goals that rise above their traditional roles, disciplines, and past experience.3 The report also described the following concepts: although the job market would continue to be competitive for dental hygienists, new opportunities would emerge for dental hygienists in nontraditional settings; further, expanding access to oral health care may also be an influence on the dental hygiene job market.

The dental scan painted a picture of the changing landscape, economic realities, and infrastructure factors that will influence dental care delivery in the near future. Interestingly, the dental hygiene scan also addressed new opportunities for dental hygienists in these changing times. The dental hygiene field should keep these findings in mind when working to develop solutions for dental care delivery issues. Collaboration between dental hygiene and dentistry would be a good first step in developing sound, logical solutions to problems stemming from the changing times.

Source: Much of this information and more can be found at:

The key takeaways from the ADA environmental scan include the following:
  • A decline in dental care utilization is an important factor in the slowdown of the dental economy.
  • The decline in utilization is not being offset by an increase in per-patient expenditures.
  • The small but growing shift in the payer mix has likely contributed to the flattened growth in dental expenditures.

CHRISTINE NATHE, RDH, MS, is director at the University of New Mexico, Division of Dental Hygiene, in Albuquerque, N.M. She is also the author of "Dental Public Health Research" (, which is in its third edition with Pearson. She can be reached at [email protected] or (505)272-8147


(1) ADA. A Profession in Transition: Key Forces Reshaping the Dental Landscape. Chicago: American Dental Association, August 2013. Retrieved from on September 9, 2013.

(2) Diringer J, Phipps K, Carsel B. Critical Trends Affecting the Future of Dentistry: Assessing the Shifting Landscape. Prepared for the ADA. San Luis Obispo, CA: Diringer and Associates, May 2013. Retrieved from on September 9, 2013.


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