two men talking

As dentists look to the future amid the inspirational annual Spear Summit, who better to talk about how we got here than Dr. Frank Spear? Here’s his take on five burning questions:

This year’s Summit theme is space exploration and innovation. What do you envision Spear dentists exploring and innovating in 2020 and beyond?

“A lot of the future of what Spear is going to look like is going to come out of the minds of our younger faculty. So, I view myself as less visionary of where we’re going in the future, but rather a guide as to how we take these new ideas and techniques and implement them so dentists can use them in their practices. At Spear, we’ll always be bringing in new concepts and questioning old concepts and ideas.

What I would like to see our dentists doing in 2020 is to continue to grow themselves clinically and make their practices run more efficiently so they can enjoy doing dentistry more. Will there be changes to how they do that in the practice? Sure, but nothing radical. I think it will still be some time before we start growing teeth in petri dishes.”

See these recent Digest articles for more on how Resident Faculty members are enhancing curricula in Spear’s learning ecosystem:

What are the most significant changes in dentistry over the past decade and how has that impacted independent practices?

“Over the past decade there are three major changes that have altered the face of dentistry, as far as independent practices in the U.S.

The first is student debt. When I graduated from dental school in 1979, my four years of dental school – in total, with books and instruments and everything – was $17,000. According to the ADA, in 2017 the average graduating dental student in the U.S. had a debt of $247,000. That changes the character of the stress you feel when you get out because you have to consider how you’re going to pay that off.

The impact of DSOs would definitely be another. If you talk to a dentist and ask them about the reach of DSOs or what percentage of dentists work for a DSO, they’ll guess about 40-50%. But if you look at the ADA data it suggests less. Independent practitioners have created this image in their minds of DSOs taking over dentistry.

At the moment, DSOs are not as big and powerful as we might consider them to be. But for graduates, they represent an opportunity to work immediately and begin to address that student debt. In addition to DSOs, there’s a decrease in independent solo practitioners who own their practices as some are grouping together, not with a DSO, but into independent group practices.

The third thing, besides debt and DSOs, is the decline in insurance reimbursement for dental procedures. Over time, insurance companies have provided less for many dental procedures, so that’s a model that’s concerning. But in some states, reimbursement rates have gone up, while in others they’ve gone down radically.

However, if you look in any community, there are dentists who are thriving. So, what are the characteristics of those doing exceptionally well? They’re committed to achieving Great Dentistry by providing exceptional customer service to patients and improving their clinical skills to generate more consistently predictable outcomes.”

How did you settle on your message for your Summit presentation, ‘The Future of Dentistry, for General Dentists, Dental Specialists, and Dental Technicians?’

“The national lab organization Cal-Lab invited me to be a keynote speaker on the future of dentistry and dental technology at their recent annual meeting. But they wanted to know about the future of dentistry and its impact on dental labs, which have dropped off by 22% between 2005-2017 – though some of that is attributed to larger labs’ acquisition of smaller labs. In addition, a big part of that decline in technician numbers is due to manual labor being replaced by in lab CAD/CAM technology. Large rooms full of model work and technicians performing wax-ups, have been replaced with scanners, computers, and milling machines.

As to my Summit message, the more I thought about it, I realized what has happened in the same 12-year period to dentists’ incomes would be a great topic for Summit. The average dentist income in the U.S. has dropped 11% over that same period. So, my presentation is addressing the background challenges on how five separate forces have influenced the changes in dentists’ incomes.

Dentistry is different than the laboratory model because technology doesn’t replace the dentist. It assists us to do things differently, but a machine isn’t going to be treating a patient anytime in the near future.”

What should general practitioners be focused on as they advance through an era where they are often ‘replacing the role of specialists?’

“When you’re not busy, sending something to the oral surgeon is like you’re sending money to them. For example, if I refer three or four extractions that I could have done myself when I wasn’t busy ... or if I send an implant to the periodontist, but I’m not as busy as I want to be, I would have gotten paid for it.

You’re seeing more restorative dentists do these procedures in their own practice to stay busier. But I don’t care how talented you are – if you’re not doing it every day, compared with someone who is, you’re not going to achieve the same results on difficult cases as a specialist who does it every day. Having said that, there are definitely very talented general practitioners who do a great job with many procedures that used to be considered the domain of the specialist. At Spear, we try to get general practitioners to recognize what is safe and predictable to produce in their own practice, and when it’s beneficial to refer.

What I believe is a major weakness of general practitioners not working with specialists, is how much they limit their diagnosis and treatment planning skills by missing out on the interdisciplinary interaction that occurs when multiple clinicians look at complex cases. That’s the whole focus of Spear Study Club – showing an interdisciplinary approach to complex cases. That always gets a better result than trying to do everything yourself, especially in treating more complex problems.

What should restorative doctors be doing today with CAD/CAM dentistry that most are not?

Eleven years ago, I didn’t have CAD/CAM in my office and didn’t use CBCT. We had the CEREC® division that was teaching CAD/CAM but it wasn’t yet part of the Spear curriculum. Now our faculty are using CAD/CAM constantly for diagnosis and treatment planning, so our CE has grown dramatically in those areas.

If you look in the U.S. in terms of CEREC® or chairside CAD/CAM users, there’s only about 18,000 dentists. But depending on whose numbers you read, there are upwards of 150,000 practicing dentists – so many are not using it yet.

I think we’ll see a continual increase as doctors seek to replace traditional impression techniques and integrate chairside milling technology into their practices. For me, being able to do restorations in office – to mill it and do it in one appointment, in select patients, provides a huge efficiency.


Commenter's Profile Image James C.
September 23rd, 2019
My concern for generalists doing procedures best provided by the specialists is the affects on patient trust. We should always decide on treatment on the basis of if it were ourselves having a need who would be our choice to fulfill that need. Patients deserve nothing less. On the laboratory front speed with Cad Cam is nice in concept, but I prefer to have a solid working relationship with my laboratories and take advantage of their talent. My best place is in the clinical not laboratory domain. Jim Craig DDS