The implications of changing patterns in oral health for the general practice of dentistry

Recent reports from several developed countries have shown reductions in caries prevalence, especially amongst children. As a result of these changes, dental practice surveys show that dentists now work fewer hours at the chairside and see fewer patients. There has been a decline in the time patients have to wait for appointments. There is anxiety amongst general dental practitioners that their income is reducing. The school dental service in the developed countries would be the first casualty of the caries-free society, and the reduction in demand for the services of school dental nurses has led to the closure of some training institutions. If the caries decline persists, the volume of restorative work will fall and there will be a shift of emphasis to periodontal care and geriatric dentistry. A change of attitude to the utilization of dental auxiliaries is predicted. In the developing countries, a restorative strategy is no answer to the increasing prevalence of dental caries, as most developing countries cannot afford the armamentarium required or its maintenance. The use of dental auxiliaries, especially dental hygienists, may not cope with the worsening picture of oral disease. It is proposed that volunteers recruited from the urban and rural areas be trained as lay health advisors. The prospects for the dentist in most developing countries are those of excessive work load, high cost of dental services and the continued neglect of preventive dental care.