I see a little card insert in my JADA (Question of the Month, December) asking for "one solid prediction" for the new millennium. Suffering as I do from a chronic case of logorrhea, naturally I cannot condense my prediction to a 4-by-6 card. Here’s what this 80-year-old thinks will happen. Encase this in a block of cement, surround it with stainless steel and dig it up Jan. 1, 3000, and we’ll see.
Now that the magical year 2000 has at last arrived and the attendant hoopla has subsided, sounding new depths of fatuity, it’s time to take stock. We’ve learned that although there are two "ems," two "ells," two "ens" and two eyes" in "millennium," the fun of spelling it never did match the third-grade feat of rattling off M-I-S-S-I-S-S-I-P-P-I with little or no provocation.
We have ultimately conceded to those righteous folks that, yes, the real millennium doesn’t begin until the year 2001, only on the condition we don’t have to hear anymore about it for 1,000 years. By that time, most of us, with the possible exception of Dick Clark, Carol Channing and Strom Thurman will be mercifully out of earshot.
Of transcendent importance right now is dentistry’s future. Many of us have survived a series of conflicts and sulphureous discourses over the years on a wide variety of subjects: managed care vs. fee for service, state boards vs. reciprocity, advertising vs. word of mouth, white bibs vs. pastels, and on and on. With the emergence of AIDS into our array of practice concerns, the leitmotiv for the moment and the foreseeable future is infection control. This riveting subject superceded the piquant katzenjammer foisted on us by external and internal marketing gurus of the 1980s.
For our part, lest we be accused of malfeasance and nourishing a viper in our bosom, we have sought to redouble our efforts to create a sterile environment in our offices, stopping just short of vasectomies and tubal ligations.
Some of the protocols seem to flout every dictate of common sense; for example, draping the entire operatory in acres of plastic and having the staff subjected to a hose-down by Haz-Mat teams between patients. Generally the results have been salutary; at least everybody knows where the fire escape route is. Unless there are late-breaking bulletins of which we are unaware, the incidence of infection directly attributable to dental procedures does not seem to be in the ascendancy; in fact, no worse than 50 years ago.
Naturally, dentists who couldn’t agree on a tooth-numbering system for 40 years have had some internecine disagreements over proper implementation of infection control. The Cross-Contamination Factions, caught up in the near-hysteria following the AIDS scare, came out foursquare for disposable items. Stumping around on their knuckles, they advocate, "One use, throw it away."
That made sense initially and was eagerly embraced by manufacturers who were quick to provide disposable long-sleeved gowns, prophy handpieces, gloves and plastic barriers of every size, shape and description. Unfortunately none of these items appears to be biodegradable, promising to remain intact until we are sucked into the Black Hole, which probably won’t occur for months. This pits the environmentalists against the anti-infection people, each impugning the other as dingbats. An uneasy truce was achieved just before it seemed that the penultimate solution was to have everything disposable including the provider who would provide once and then is retired before he or she could initiate any iatrogenic mischief.
An opposing faction in the profession, noting that office overhead has steadily climbed from about 55 percent to more than 75 percent, feels that recycling is the way to go, even if it means disassembling operatory components and sterilizing them until they fall victim to heat prostration. They can then be replaced as necessary after marinating 24 hours in an elixir of PineSol and Lysol. In as much as these procedures are largely labor-intensive, the reduction of overhead isn’t appreciable, although staff members consistently volunteer to reduce payroll costs by resigning en masse.
An informal survey taken on the departing patients sprinting for the exit reveals that, for the most part, they feel dentistry has improved over the last 30 years, citing the addition of wild cherry and piña colada flavors to the prophy paste as a major breakthrough. Still, there is room for improvement. Distilled to basics, patients would like the future to provide faster procedures, done painlessly and for no co-payment. This, they feel, is probably the best they could hope for, not ever having to appear at all being the ultimate answer.
For dentists, predictions for the future are a bit more realistic:
- – Cosmetic dentistry will continue to expand due to unrelenting advertising that insists on every individual’s right to "the perfect smile" whether he or she wants it or not.
- – In spite of smile-intensive advertising, a certain portion of the population will continue to exhibit butt-ugly anteriors and absentee premolar grins, completely ignoring the sensitivity of dental professionals.
- – Restorative and cosmetic dentists will try to understand why orthodontists have convinced insurance companies that esthetics is the furthest thing from their minds, a cosmetic result being only a minor consideration in their treatment.
- – Patients will continue to be a mixed bag of dedicated preservationists, couldn’t-care-less people, really nice people, really royal-pain-in-the-rear people, prompt payers, deadbeats, always-on-time people and habitually late people. On one of your occasional bad days you might expect to get a habitually late deadbeat person who is a really royal pain in the rear and couldn’t care less.
- – A vaccine for caries will be just around the corner where it has been lurking for 50 years.
- – The cost of dental education will continue to escalate until the only way to pay off student debt is to become indentured to the government for 20 years, explaining the advantages of multiple implants to impoverished transients.
- – A device widely hyped in the lay press to revolutionize dentistry by combining the salient features of intraoral cameras, imaging software, air-abrasive consoles and exotic gem lasers will go on sale for the customary introductory price of $40,000. The manufacturer suffused with the spurious excitement requisite in such enterprises promises rewards comparable to the Second Coming. Dentists won’t buy it. The company will seek relief in Chapter 11 and the device in various forms will rematerialize every 10 years.
- – The antiamalgam bunch will form a tenuous coalition with the anti-fluoridation gang and they will recruit new members based on the applicant’s affidavit that he or she is against something, even if it is only licensure by credentials.
- – January 2000 will be pretty much like January 1999 and the preceding Januaries back to January 1900. It will be late August before we become comfortable with writing "00" after the month and day.
- – It will not be too soon to consider the perilous implications of Y3K.
