envisioning the future of oral health and dental practice 30 or more
years from now, the contributors to this feature— each a recognized
authority in his or her discipline—have displayed the imagination
and vision that one expects of respected clinicians and scientists.
We hope that their attempts to capsulize the future of dentistry will
provide you with substantial food for thought. But as one of our visionaries,
Dr. Irwin Mandel, cautions, “He who looks into a crystal ball is destined
to dine on ground glass.” We leave it to you to match your predictions
against those of our experts and to decide what’s credible and what’s
Boundaries imposed by state boards will be eliminated, making the
practice of medicine/dental medicine national in scope."
Dr. Dominick P. DePaola:
Dr. DePaola, a 1969 graduate of NYUCD, is president and CEO of The Forsyth
Institute. A past-president of the ADEA, a member of the National Advisory
Council of NIDCR, and a former dean of three dental schools, Dr. DePaola's
provocative points of view have enriched dental education, research, and
practice for decades.
- The dental profession will be totally integrated into the practice
of medicine. There will also be a reimbursement system for health care
that is not discriminatory just because the word dental precedes medicine.
- Geographic boundaries imposed by state boards will be eliminated,
making the practice of medicine/dental medicine national in scope.
- Rather than surgical and mechanical tissue manipulations to repair
or fill either soft or hard tissue defects, the appropriate use of genetic
tissue engineering will be the preferred approach and the basis for
continuing clinical practice.
- Minimally invasive technologies powered by advanced information systems
will greatly reduce unavoidable trauma, pain, and recovery time associated
with surgical protocols, relegating dental phobia to the historical
- We will see an integrated health professions education system, rather
than independent schools of medicine, dentistry, nursing, pharmacy,
and the like.
- The monoliths of medical/dental schools and libraries will be replaced
by distributed information systems and community-based clinical, educational,
and outreach “centers of excellence.”
Dr. Robert S. Ledley:
Dr. Ledley (NYUCD Class of 1948), a professor of physiology and biophysics
and of radiology at Georgetown University Medical Center, is best known
for developing the first whole-body computerized tomography (CT or CAT)
machine. In 1999, he received the NYU Distinguished Alumnus Award. He has
also been awarded the National Medal of Technology, the nation’s highest
honor for technological achievements.
- “Prediagnosis” based on genetic characteristics of individuals will
anticipate the possible occurrence of pathogenesis and enable individualized
- Molecular motors, set in motion by the dentist, will be used to perform
dental procedures and craniofacial reconstruction mechanics, including
reshaping mandibles and other facial structures.
- Research on stem cells will allow tissues to be grown to replace epithelial
structures, both of soft tissues, such as skin and mucous membrane,
and hard tissues, such as bones and teeth.
- With respect to bone, the dentist will be able to use a special camera
to take a stereo image of broken or deformed craniofacial bones and
then automatically compute the shape to be reconstructed. Using advanced
methods, the shape of the structural components will be reproduced in
a hard, porous matrix into which the replacement tissues will grow and
replace the matrix.
- Food additives will be developed that will entirely prevent decay
and periodontal disease, keep teeth white and shiny, keep the periodontal
membrane healthy, and keep the bone support of teeth strong and intact.
As a result, tooth loss will occur only through accidents.
Dr. Irwin D. Mandel:
Dr. Mandel is a professor emeritus at Columbia University School of Dental
and Oral Surgery and the first person to receive the Gold Medal for Research
awarded by the American Dental Association.
- Edible transgenic plants (bananas, potatoes, etc.) containing specifically
designed “plantabodies” against mutans streptococci will join increasingly
effective fluoride formulations plus remineralizing agents in a variety
of products to prevent virtually all dental caries.
- Specific antibacterial agents derived from the functional domains
of protective proteins in saliva and other mucosal fluids will prevent
the initiation of periodontal disease. Teeth will remain firmly rooted
- Gene therapy for restoring function for salivary glands incapacitated
by disease or radiation will be joined by “epithelial gene” therapy
for treatment of oral mucous membrane disease using genetically altered
cultured epithelial cells from host biopsies.
- Chemical sensors employing nano-technology will make it possible to
use a drop of saliva for diagnosis of oral and systemic diseases, risk
management, and genetic screening.
- Despite dental school efforts to integrate the restorative/aesthetic
and biological aspects of teaching programs, with a growing number of
dentists utilizing a broad array of diagnostic, preventive, regenerative,
and genetically related procedures, there will be increasing overlap
with medicine, and “turf wars” can be envisioned. Some things never
Dr. Richard F. Mascola:
Dr. Mascola (NYUCD Class of 1968) is immediate past-president of the
American Dental Association. He has been a pivotal force in energizing young
dentists about the value of organized dentistry and a stalwart in ensuring
that all treatment decisions remain the exclusive purview of the dentist
- The extent to which dental practice remains autonomous 25-50 years
into the future will depend upon what all of us in the profession do
now to uphold the sanctity of the doctor/patient relationship
and the ability of dentists to follow their best professional judgment.
- It is predictable that a high-quality reference genome sequence will
be completed by 2003 or sooner, bolstering our understanding of how
genetics influences disease development and leading to the discovery
of new dental treatments.
- The completion in 2001 of an intensive, two-year ADA-sponsored Future
of Dentistry study will provide a blueprint to ensure the continued
strength and effectiveness of the dental profession.
- The ADA will play a leadership role in providing members with information
technology tools to help them thrive and prosper in the electronic information
- The ADA’s Web site at www.ada.org
will become an increasingly strong and effective link with members.
The surge in usage will become especially dramatic as today’s dental
students enter practice and make the ADA Web site their leading source
for services and information.
- Full ethnic and racial diversity in the profession and in organized
dentistry remains a goal. The ADA will foster activities to achieve
nonclinical D.D.S. instruction will take place off-site using computer
generated educational materials."
Dr. Lawrence H. Meskin:
Dr. Meskin is a professor at the School of Dentistry of the University
of Colorado Health Sciences Center and editor of the Journal of the American
Dental Association. His perceptive, incisive editorials have constantly
challenged the profession.
- Mega dental education and research centers will supply the major
training and research requirements for the dental profession. The present
dental schools will cease to exist except as clinical sites for specialty
training of residents and as centers for referral and treatment of difficult
- Most nonclinical D.D.S. instruction will take place off-site using
computer-generated educational materials. The subsequent efficiencies
will eliminate student debt and prevent faculty shortages.
- As dentists assume major roles as diagnosticians and treatment planners,
they will provide primarily specialty care. The remainder of hands-on
treatment will be provided by technicians under the direction of these
- Microcomputer chips inserted in the periodontal sulcus will maintain
periodontal health, prevent dental caries, etc. These chips will activate
robots which, on command, will clean out the dental sulcus at predetermined
- Legislation providing dental care for the elderly, supported through
Medicare, will become a reality early in the 21st century, due to the
political clout brought to bear by the “baby boomer” generation.
- With the passage in 2015 of the Federal Right to Practice Anywhere
Act—following a successful class action suit brought by dentists—licensure,
state dental boards, and freedom of mobility will cease to be issues.
Dr. Diane Rekow:
Dr. Rekow is a professor and chair of the Department of Orthodontics
at the University of Medicine and Dentistry of New Jersey (UMDNJ) New Jersey
Dental School. Trained in engineering, dentistry, orthodontics, research,
and business, she also directs a major consortium on tissue engineering
in New Jersey.
- Tissue-engineered materials to regenerate hard and soft tissues will
- Current radiographic and MRI diagnostic imaging techniques will be
replaced with high resolution 3-D, noninvasive, nonhazardous systems
capable of imaging and recording both anatomy and function.
- Computational biology will provide computer-based models to replace
a major portion of the in vivo testing now required for product introduction.
- Saliva and crevicular fluid will be a diagnostic and health monitoring
fluid. Saliva could likely replace blood as a fluid reflecting the health
status of a person.
- Smart micropores will be engineered to perform specified functions
on command. For instance, selectively permeable membranes around pores
could attach to the teeth and release fluoride when bacterial levels
reach caries-causing thresholds.
- Genomics information will be used to establish which patients are
prone to various diseases, permitting clinicians to proactively treat
Dr. Sidney I. Silverman:
Dr. Silverman, a 1937 graduate of NYUCD, is a professor emeritus and
clinical professor of prosthodontics at NYUCD and a clinical professor of
neurology at the NYU School of Medicine. Dr. Silverman wishes to thank Dr.
Freeman Dyson, author of the recently published monograph “The Sun, the
Genome and the Internet” for inspiring his predictions.
- The development of a radiation beam of energy that can slice and/or
peel molecular layers of tissue will dramatically reduce the use of
the rotary diamond drill and bur, the endodontic broach and file, and
the scalpel and currette.
- The currently used metals, porcelains, and plastic resins for prosthodontic
treatment will be replaced by biochemically and genetically induced
orodental and facial tissues.
- Current and future generations of dentists nurtured on interactive
Internet technology will develop a genetically altered nervous system
derived from the neural plasticity inherent in all children’s brains
- Internet-adept dentists will boast genetically improved cognitive
components of human brain function with respect to decision making and
performing hand-eye skill procedures.
- The interactive Internet will instantaneously allow the brains of
two or more dentists to join their capabilities for abstract thinking
and judgment to exponentially enhance their collective decision making.
Dr. Harold C. Slavkin:
Dr. Slavkin is dean of the University of Southern California School
of Dentistry. He is also the former director of the National Institute of
Dental and Craniofacial Research, where he led a remarkable transformation
of the institute, making craniofacial health part of mainstream thinking
at the NIH.
- By 2020, more than 80 percent of the U.S. population will have access
to oral health care.
- Increased public awareness of the oral complications of systemic diseases
and of the relationship between oral infections and systemic diseases
will significantly impact “third party reimbursement” for oral aspects
of many systemic diseases, including cancers, diabetes, and cardiovascular
and pulmonary diseases.
- Academic health science centers will offer cross-disciplinary, multidisciplinary
education, training, and scientific research programs, resulting in
increased hybridizations among the health sciences—dentistry, medicine,
nursing, dental hygiene, pharmacy, and physical and speech therapy.
- A major shift in national priorities will lead to a new emphasis
on health promotion (making and maintaining healthy choices and practices)
and risk assessment to reduce disease burdens, especially as related
to the many health disparities among segments of the population.
- Biotechnology solutions to clinical problems will become mainstream,
including highly specific and sensitive noninvasive imaging, the use
of saliva as a diagnostic fluid, gene-mediated therapeutics for tissue
repair and regeneration, and individualized pharmacogenetics.
- Thanks to rapid progress of the Human Genome Project and functional
genomics, novel gene-gene and gene-environment understanding will occur,
bringing with it profound changes in the ability to assess and manage
chronic diseases and disorders.
graduate programs will include considerable training in general medicine
and, with time, most programs will offer an M.D. degree..."
Dr. Martha Somerman:
Dr. Somerman (NYUCD Class of 1975) is a professor and chair of the Department
of Periodontics/Prevention/Geriatrics at the University of Michigan School
of Dentistry and a highly respected scientist.
- Preventive and treatment protocols will be based, in part, on individual
genetic profiles that reflect information on disease susceptibility.
- Biomarkers, obtained from oral fluids and tissues, will be used to
identify patients at risk for certain oral and systemic diseases.
- Tooth loss will be minimized by the availability of more effective
agents and methods for regenerating/repairing tooth structure and supporting
soft and hard tissues.
- Drilling will become obsolete as lasers and less invasive techniques
- Annual oral/dental exams will be required for all children K–12.
This will address, in part, the disparities in oral health status among
various socioeconomic groups.
Dr. Dennis P. Tarnow:
Dr. Tarnow (NYUCD Class of 1972) is a professor and chair of the Ashman
Department of Implant Dentistry at NYUCD. His two-year training program
in implant dentistry has been attended by dentists from more than 25 countries.
- All grafting will be done using cloned cells from each patient. At
birth or soon after, a few cells of bone and connective tissue will
be harvested and cloned and then stored for use for the rest of the
- All fillings, if any are needed, will be made of the patient’s own
enamel which was cloned previously.
- A vaccine will be used to eradicate caries and periodontal disease.
- We will be able to add genetic modifiers to sockets, not only to make
them heal faster than normal but also to change the density of the bone
- All drilling for the placement of implants will be done by robotics.
- Any periodontal problems that occur will be treated by regeneration,
as opposed to repair of the defect. As a result, extractions will become
Dr. Ray C. Williams:
Dr. Williams is a professor and chair of the Department of Periodontology
at the University of North Carolina at Chapel Hill. He is one of the first
investigators to have proved that the progress of periodontal disease can
be mitigated pharmacologically.
- A specific periodontal risk profile will be created for each patient,
which will provide the therapist an appropriate algorithm for managing
that particular patient over the short and long terms.
- Rebuilding periodontal attachment structures—around teeth that have
periodontal disease—will be as simple as a prophylaxis.
- Placement of dental implants in all areas of the mouth, regardless
of amount and quality of bone, will be easy and facilitated by the use
of biological mediators/anabolic cytokines.
- Periodontal graduate programs will include considerable training
in general medicine and, with time, most programs will offer an M.D.
degree as part of the training program.
- Dentistry will become more and more a specialty of medicine. The
majority of dental training will include the M.D. degree, with increasing
numbers of dentists having dual degrees. Eventually the M.D. degree
will include the specialty of dentistry.