ADA.org: Future of Dentistry Full Report

FUTURE OFDENTISTRY

oratory, and the dentist. For example, many manu-
facturers who have sold through distributors are
now creating websites and are selling products to
dentists and laboratories through the Internet.
The Internet also has the potential to globalize the
distribution of dental products. Traditionally, two-
thirds of the products manufactured in the United
States have been distributed to dentists through den-
tal supply houses. At the present time, there are
approximately 300 small- to medium-size urban
and regional distributors of dental supplies in the
United States. The volumes of their business gener-
ally range from $2 million to $20 million.
Additionally, there are several national chains
whose retail volumes might be between $750 mil-
lion and $1.5 billion. About one-third of the dental
manufacturers sell directly to the dentists, rather
than through distributors. Moreover, certain dental
manufacturers will sell products only to laboratories
(9,000 in the United States) through dental supply
houses, while other manufacturers will sell labora-
tory products only directly to laboratories.
Within the past few years, a new breed of dental
Internet company has come on the scene, some call-
ing themselves manufacturers, others calling them-
selves distributors. Some of these new companies
are located in the United States, but many are based
in Europe and Asia, and will be taking more and
more orders from United States dentists.

There may be risks involved in the broadening

Internet market: ignorance or avoidance of impor-

tant elements of public health, safety, and efficacy;

lack of quality assurance; and price dislocation,

among others. Many new Internet companies may

not have a background in public health, and may

not comply with FDA safety records and regula-

tions. For example, under the Dental Device Acts,

distributors must report to the FDA adverse events

that come to their attention through their

customers, the dentists. Moreover, product identifi-

cation may disappear, as several entrepreneurial

entities take title quickly from branded and

unbranded products, and resell these products to

others, who are selling them on the Internet. It is

important that the identification of the product be

very clear and that compliance with state and

federal laws occur.

Product Approval

Medical devices, including dental devices, must be

cleared by the Food and Drug Administration (FDA),

generally through the 510(k) process to be imported

into the United States. This requirement applies to

products manufactured throughout the world and

includes products manufactured in the United States

that are exported to international markets and subse-

quently imported back to the United States.

Global Oral Health

II. GLOBAL ORAL HEALTH IN THE FUTURE

FUTURE CHANGES IN ORAL HEALTH AND
DISEASES

Dental Caries

While it was reported at the first International
Conference on the Declining Prevalence of Dental
Caries (Glass, 1982) that dental caries experience
among children and young adults has decreased in
industrialized countries, dental caries may be rising
again in areas in which preventive interventions
have been neglected or removed. For example,
where water fluoridation has been stopped as a
result of political issues, the incidence of dental
caries has increased (Attwood and Blinkhorn, 1988;
and Kunzel and Fischer, 1997).
The prevalence of dental caries may increase as
urbanization increases, especially in developing

countries. Not only might populations in these coun-

tries adopt more cariogenic diets, but they might also be

affected by bacterial infection and the unknown effects

on the immunologic system associated with the stress of

rapid social and economic change.

Periodontal Diseases

Although reports from several countries indicate

a decrease in the prevalence of periodontal diseases,

the emerging association between periodontal dis-

eases and systemic conditions (Compendium, 1999)

will require continued monitoring of these diseases

and their health effects. Lifestyle, especially the wide-

spread use of tobacco, will ensure that periodontal

disease will continue to be a major oral disease. In

addition, as the economies of many nations improve,

there will be a greater demand for periodontal care.