Most dental water’s so dirty, no wonder they tell you to spit," cried the Newsweek ad for the "20/20" exposé on dental office waterlines, which first aired Feb. 18. Promising to tell all about dentistry’s "dirty secret," the actual program fell far short of its prebroadcast hype.

Hindering the TV muckraking was the fact that the ADA had been publicly seeking and promoting solutions to this problem for years. So much for the secret, which proved to be not so "dirty" and hardly "secret."

But dentistry does have an authentic secret of its own. Don’t expect to see it on any TV exposé. It doesn’t have the necessary emotional pull. But if ignored, it could cause irreparable harm to the dental profession and its members.

Few dentists have knowledge of this internal time bomb. Indeed, my own awareness of it came only after observing this year’s commencement activities for the University of Colorado’s 34 dental graduates.

The dental school dean had invited immediate relatives of the graduates who were dentists to participate in the hooding process. It was this ceremony that gave me the first inkling that dentistry had its own "family" secret. As each dental student came forward to receive his or her hood, I marveled at the large number of dental relatives. Fifteen fathers, two brothers, three husbands and one grandfather hooded their sons, daughters, grandsons or significant others. That’s more than 60 percent of the class.

Remember not that long ago when dentists were saying, "I’d never want a child of mine to go into dentistry"?

What’s changed?

For many dentists, it’s the economics. After suffering for decades with negative or minimal real increases in their income, dentists are now seeing incomes that exceed those of many of their physician counterparts. Don’t think dentists haven’t passed that message on to their children or relatives.

The paradox is that, except for those connected to dental families, there has been a drop, rather than the expected increase, in applications for dental school.

According to the widely accepted economic formula of "rate of return"—which factors time, cost of education and lost income against anticipated future earnings—the recent increases in dentists’ income should have translated into increased dental school applications. Not so! In fact, the opposite is occurring.

The number of applications for dental school has dropped significantly in each of the last three years. There may be an even more precipitous drop in the next few years, as judged by the unexpected reduction in prospective dental students taking the dental aptitude test, or DAT. Consider these figures: five years ago, 11,314 took the DAT; last year, only 6,645 did so.

What’s going on?

– Demographers would say this is simply a birthrate issue. With fewer 18-year-olds presently available in the cohort of those who might select college and professional careers, dentistry’s percentage drops accordingly.

– Characteristically, dentistry has served as an upwardly mobile profession, offering those who enjoy working with their hands an opportunity to become health professionals. The present tight job market is drawing many of these prospective dental students into immediately high-paying work opportunities in the trades.

– The economic return of other professions offers shorter time in school for immediate high returns. This is especially true for minority and underserved people whose families may not have had experience with paying long-term debt in hopes of eventual high returns.

– There are insufficient scholarships and low-interest loans to lessen the cost of a dental education.

– The health professions have experienced a drop in status. For the first time in decades, dentistry has fallen out of the top five in the annual "Honesty and Ethics in Professions" poll conducted by The Gallup Organization.¹

– There is no major recruitment effort promoting the dental profession as a desirable career path.

The good news is that even with these unexpected reductions in dental school and DAT applicants, the grade point averages of those entering dental school continue to increase, as do their DAT scores.

So for the present, we’re doing OK with less. But what about the future?

The ADA’s Dental Workforce Model: 1996-2020² predicts a modest increase—less than one-half percent—in the number of dentists. This is well below the projected growth rate for the U.S. population during the same period. Will the dental education system continue to find sufficient qualified applicants to meet the dental needs offered by the ADA projections? If not, practicing dentists can expect increased difficulties in hiring associates and even greater problems in finding buyers for their practices.

On a national level, those who believe that a dentist shortage already exists will use any weakness in the number and quality of new dental graduates as evidence that the government should provide incentives to increase the availability of dental services. That might include pressure to add duties to segments of the dental auxiliary work force, especially to those looking for nonsupervised practice opportunities.

We’ve seen the results of that strategy before.

Sharing dentistry’s secret can prevent the problem. The biggest and best group of recruiters for dentistry is dentists themselves. It’s time for them to get dentistry’s "good-news" message out to their patients and friends.

Consider this: if only 10 percent of all ADA members were able to recruit just one person a year to become a candidate for dental school, the number of applicants would be almost triple the present number. That’s just one prospective student every 10 years for each ADA member—surely not an insurmountable task.

It’s time that dentistry’s "other secret" remains a secret no longer.