Dental and orthodontics industry

Industry Snapshot

GENERAL INDUSTRY: Health Science

CAREER CLUSTER: Health Science

SUBCATEGORY INDUSTRIES: Dental Hygienists’ Offices; Dental Laboratories; Denturists’ Offices; Offices of Dental Surgeons and Doctors of Dental Medicine; Offices of Dentists; Offices of Oral Pathologists; Offices of Orthodontists; Offices of Periodontists; Offices of Prosthodontists; Orthodontic Appliance Makers

RELATED INDUSTRIES: Medicine and Health Care Industry; Pharmaceuticals and Medications Industry; Public Health Services; Scientific, Medical, and Health Equipment and Supplies Industry; Veterinary Industry

ANNUAL DOMESTIC REVENUES: US$171.7 billion (dentists; IBISWorld, July 2023); US$24.9 billion (orthodontists; IBISWorld, Sept. 2023); US$5.6 billion (cosmetic dentists; IBISWorld, Oct. 2023)

NAICS NUMBERS: 621210, 339116, 621399

Summary

Dentistry is defined by the American Dental Association as the evaluation, diagnosis, prevention, and surgical or nonsurgical treatment of diseases, disorders, and conditions of the oral cavity, maxillofacial area, and the adjacent and associated structures and of the effects of those conditions on the human body. It is a branch of medicine that addresses oral health, including the appearance and function of the teeth, gums, tongue, palate, and jaws. Dental professionals treat oral infections, cancers, malformations, malfunctions, and traumatic injuries that may affect a person’s ability to eat, drink, talk, breathe, and sleep, thus affecting overall health.

History of the Industry

Perhaps the earliest known written dental text is a Sumerian cuneiform document from 5000 B.C.E. that attributes tooth decay to “tooth worms.” Egyptians described dentistry in the Ebers Papyrus (wr. about 1550 B.C.E., found 1872). This papyrus listed toothache remedies made from common ingredients such as incense, cloves, and fennel. In the fifth century B.C.E., the Greeks Hippocrates and Aristotle wrote about dentistry in a more scientific fashion, noting the eruption pattern of teeth, the extraction of teeth with forceps, and the use of wires to stabilize loose teeth and broken jaws. Also about this time, the Greek physician Diocles instructed people to rub their teeth and gums with crushed mint leaves to remove food remains and freshen breath.

In the tenth century C.E., the Islamic Moor surgeon Abulcasis of Cordova provided illustrations of numerous crude dental instruments, including scalers, elevators, and forceps. In 1530, the anonymous German book Artzney Buchlein der kreutter (also known as The Little Medicinal Book for All Kinds of Diseases and Infirmities of the Teeth) devoted its forty-four pages exclusively to dentistry. It was written for barbers and surgeons and covered such topics as oral hygiene and methods for filling dental cavities. In 1563, Italian anatomist Bertolomeo Eustachi published Libellus de dentibus (A Little Treatise on the Teeth, 1999), the first accurate dental anatomy textbook. In 1575, French barber-surgeon Ambroise Paré, known as the father of modern surgery, published Les Oeuvres de M. Ambroise Paré, conseiller et premier chirurgien du roy (26 vols.), a practical handbook written in French vernacular. It explained his surgical techniques, including extracting teeth and repairing jaw fractures. Paré was interested in providing artificial body parts to soldiers and designed individual gold and silver replacement teeth.

In the seventeenth century, a new profession arose, known as “operators for the teeth.” Members of this professonion did more than extract teeth; they built artificial teeth and concocted dentifrices for keeping teeth clean and white. One such operator in London, Charles Allen, wrote the first dental book in English, The Operator for the Teeth (1685).

In 1728, French physician Pierre Fauchard, known as the father of modern dentistry, published Le Chirurgien dentiste (The Surgeon Dentist: Or, Treatise on the Teeth, 1946), a two-volume treatise on dentistry. In it, he described pyorrhea and tartar, an extraction instrument called a pelican, replacing missing teeth with dental prostheses, and straightening teeth with tension using linen, silk, or fine gold-wire threads.

In 1780, in England, William Addis began mass-producing toothbrushes fashioned from pig or badger bristles glued into small holes drilled into animal bone. Within sixty years, toothbrushes were being produced in England, France, Germany, and Japan. Mass production in the United States began in 1885.

In the nineteenth century, dental chairs that reclined and could be otherwise adjusted were designed by James Snell in London in 1832 and American dentist James Beall Morrison in 1867. Morrison also invented the foot-treadle drill, which allowed dentists to remove dental caries more efficiently. Anaesthetics were developed from nitrous oxide, ether, and cocaine; their use in dentistry was controversial. In 1839, American inventor Charles Goodyear discovered a process for hardening rubber with sulphur and heat, called vulcanization. The resulting product, called vulcanite, became popular as a moldable, durable, and inexpensive base for dentures.

The twentieth century brought more advancements in the dental industry, such as the use of dental x-rays, novocaine as a local anaesthetic, high-speed handpieces, and amalgam fillings. Daily tooth brushing came into practice during World War II, first with toothbrushes made from synthetic bristles (which were more hygienic than animal bristles) and then, decades later, with electric toothbrushes. Public health services studied the effects of fluoride on tooth decay, and by 1960, most public drinking-water supplies in the United States were fluoridated, and many toothpastes contained fluoride.

The Industry Today

Dentists are no longer barbers or trade apprentices. Their present profession has evolved as an accredited, independent specialty of surgery and medicine. Modern dental schools confer the degrees of doctor of dental surgery (DDS) and doctor of dental medicine (DDM). The first dental school anywhere was the Baltimore College of Dental Surgery, established in November, 1840. Today’s dentists typically spend four years in college and then four years in dental school. Once they graduate, they must pass a board exam to receive a license to practice. While most begin to practice general dentistry, some choose to pursue a dental specialty, such as endodontics (diseases of the dental pulp), periodontics (diseases of the gums), orthodontics (the straightening of teeth), and prosthodontics (the replacement of teeth). Such pursuits require several more years of specialized training. Dentists work in private practices, hospitals, public health clinics, and universities. Other than caring for patients, some dentists teach, conduct research, or promote the profession.

Dentists look after the oral health of their patients. This begins with a thorough examination of the oral cavity, including the teeth, gums, and tongue. Dentists are trained to identify pathological conditions such as dental caries (tooth decay), gum disease, and oral cancers. They use diagnostic tools such as radiographs, disclosing solutions, and articulating paper. They probe the relationship between the teeth and gums, the surfaces of the teeth, and the conditions of the oral mucosa.

To maintain a patient’s oral and overall health, along with the abilities to eat, swallow, talk, and breathe, dentists treat the appearance and function of the teeth, gums, tongue, palate, and jaws. They practice preventive dentistry by methods including fluoride treatments, placing sealants over vulnerable areas of teeth, conducting regular oral exams, and recommending professional cleanings every six months. They practice ameliorative dentistry by prescribing antibiotics and analgesics for painful conditions, extracting badly decayed or impacted teeth, and performing root canal procedures to remove exposed nerves. They practice restorative dentistry by placing fillings, crowns, and bridges after removing compromising tooth decay and in patients without teeth, they fit dentures. Dentists also adjust occlusion so that the teeth and jaws meet in proper alignment. Orthodontics, a dental specialty, is the practice of straightening teeth, reshaping the palate, and realigning the jaws using tension appliances to create a more functional oral cavity as well as a more attractive smile. Cosmetic dentistry, another specialty, compensates for unattractive and misshapen teeth and gums with procedures such as bleaching, gum surgery, and bonding or veneers.

As dental procedures became more complex and time-sensitive, dentists began training dental assistants to work with them, passing instruments to the dentist and keeping the patient’s oral field dry and free from debris with water, air, and suction lines. This teamwork is often referred to as “four-handed dentistry.” Dental assistants may also set up procedure trays, prepare immediate-use dental materials, and sterilize instruments.

A subprofession of dentistry arose in the late 1800s: Dental hygienists (once called dental nurses) were trained in oral health and the prevention of oral disease. Health care providers had come to realize that dental pain and destruction could be avoided by maintaining a clean mouth. Dental hygienists work under the supervision of a dentist to professionally clean and polish patients’ teeth, examine and chart the depth of the pockets between the gums and the teeth and bring to the dentist’s attention any unusual conditions that may require further treatment, such as cavities, broken teeth, bleeding gums, or sores. They also provide patient education on the techniques and importance of brushing and flossing.

The twentieth century saw an increased understanding of infectious diseases, especially viral diseases such as hepatitis and human immunodeficiency virus (HIV). Because such diseases may be transmitted in bodily fluids such as blood and saliva and because such fluids are present and even aerosolized during dental procedures, dental personnel now wear eye shields, as well as disposable masks and gloves. Many wear uniforms that are made to withstand tough washing, and those uniforms often remain in the office to avoid introducing potential pathogens into the car and home. Stringent health precautions, such as hand-washing, disinfecting countertops, sterilizing instruments, and using disposable supplies for each patient are followed to protect patients and dental personnel alike.

Dentists work in conjunction with physicians and pharmacists. Dentists have learned the importance of taking a complete medical history, not only to learn about any patient conditions that may potentially complicate dental treatment and results but also to find out what medications a patient is taking or is allergic to and thus avoid negative interactions. Patients with joint or heart-valve replacements may be told to take penicillin before and after dental treatment because such treatment releases bacteria from the mouth into the bloodstream and these patients are more susceptible to infections. Resistance to antibiotics is increasing in the population, so prescribers must be conscious of which antibiotic is appropriate and how long the course of treatment must be to be effective without encouraging resistance. Bisphosphonates used in cancer therapy and the treatment of osteoporosis have been linked to impaired wound healing after tooth extraction or periodontal surgery due to bone death. Dentists began reporting cases of this complication in the professional literature, and in 2005 the US Food and Drug Administration (FDA) issued a statement that osteonecrosis of the jaw was a recognized complication of bisphosphonate treatment.

Dentists also work closely with dental laboratories, which manufacture crowns, bridges, dental implants, dentures, and other custom oral appliances in accordance with dentists’ models and specifications. These products are regulated by the FDA as medical devices and thus must meet federal manufacturing and quality standards. The communication of specifications has become more timely with the use of digital photography and radiography that may be transmitted online and has become more precise with the use of three-dimensional imaging technology.

Industry Outlook

Overview

The outlook for this industry shows it to be on the rise. The US Bureau of Labor Statistics (BLS) projects that the number of dental positions will grow by 4 percent between 2022 and 2032, an average growth rate. Growth for dental hygienists and dental assistants is projected to increase by about 7 percent during the same period, making these among the fastest-growing occupations. Additionally, positions as orthodontists were also expected to grow at a faster-than-average rate.

Employment opportunities should continue to be readily available, as a large number of dentists reach retirement age. Older dentists who do not leave the profession are reducing their work hours and no longer accepting new patients, so they are also creating opportunities for new dentists. In 2022, there were 72 dental schools in the United States, the District of Columbia, and Puerto Rico, producing nearly 7,000 graduates per year. However, even this high number of graduates is not enough to keep up with the growing demand for dental services.

The need for dental care is continuing to grow because people are living longer, taking better care of themselves, recognizing the importance of dental care, and keeping their teeth longer. Because people are living longer, there are more patients to serve. As people take better care of themselves, they often improve their diets, which not only strengthens teeth but also increases the importance of oral function for chewing whole, unprocessed foods. People have begun to appreciate the value of dental care and are no longer requesting dentures for their convenience. They are choosing to invest in their mouths and spending discretionary funds. Because they want to keep their teeth longer, they are considering restorative procedures rather than settling for extractions without further treatment.

Although water fluoridation and fluoride toothpastes have reduced the incidence of dental caries, teeth still break, gums still recede, and jaws may not align properly. People still care about the appearance of their smiles; increasing numbers of adults are getting braces and bleaching their teeth. New intraoral appliances have been designed to reduce sleep apnea and relieve jaw pain from bruxism (tooth grinding). The need for dentistry is not waning.

As dentists become busier, more responsibilities and expanded skills will fall to dental hygienists and dental assistants. Colleges and universities are beginning to train dental personnel to become “expanded function dental auxiliaries,” licensed positions based on education rather than years of experience. This license allows someone other than a dentist to apply sealants; take impressions; place temporary fillings, crowns, and bridges; and place and carve direct restoration materials. In addition, workforce studies have recommended that dental hygienists have expanded responsibilities with less direct supervision to care for underprivileged children and underserved populations away from a traditional dental office.

Medicine and dentistry are continuing to overlap. An emerging field of common interest is called neuromuscular dentistry, which studies the nerves and muscles of the head and neck to determine their relationship to migraines, neuropathic pain (persistent overstimulation of nerves in response to a medical condition, with a burning or electric sensation), and nociceptive pain (time-limited, localized, and constant pain in response to irritation or injury). Dentists are seeking to find and treat the underlying causes of headaches, temporomandibular joint pain, and myofascial pain and are developing new injection techniques to deliver nerve blocks as well as intraoral appliances to balance muscle stress and bring relief. Dentists are also studying the relationship between jaw position and sleep apnea and fabricating intraoral devices to open airways and avert snoring. Such novel scientific pursuits and treatments will give patients new reasons to seek dental care.

Employment Advantages

In a 2008 survey of graduating dentists, five important reasons for going into dentistry as a profession were listed: control of time, service to others, self-employment, income potential, and working with one’s hands. Additional reasons reported by practicing dentists were the flexibility to balance family and career, the satisfaction of patient education and fostering change, the significance of disease detection, opportunities for using creativity and problem-solving skills, and the respect accorded the profession. New dentists are able to begin generating meaningful income directly after graduation and licensing and thus may begin to pay back student loans more quickly than new physicians, who must complete internships and residencies at minimal pay before establishing medical practices. As a profession, dentists earn more income than physicians, with more independence and less bureaucracy. However, because dental fees are often paid directly by patients, in some cases assisted by private insurance companies, in times of economic difficulty, the demand for dental services may be reduced. However, according to a survey conducted by the American Dental Education Association (ADEA) in 2021, about 60 percent of dental school graduates reported changing their immediate plans or pursuing a different path because of the COVID-19 global pandemic. About 39 percent reported pursuing advanced education instead of seeking a job upon graduation.

Dental assistants and dental hygienists may work full time or part time, allowing them to balance work with home and children. They often report satisfaction from working closely with patients, especially in the areas of oral health education and reducing anxiety about dental treatment.

Annual Earnings

According to a 2022 IBISWorld report, the annual domestic revenue for the general US dental industry was estimated at $171.7 billion. According to the BLS, dentists earned a mean annual wage of $159,530 in 2022, while orthodontists earned a mean annual wage of $216,320.

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