Although some of you who practice 35 to 40 hours a week at chairside and then spend another 35 to 40 hours a week wading through employee reviews and payroll changes, purchase orders, and insurance forms, pre-authorizations, and denials of payment may disagree with my characterization, I think you should think about how far you and your profession have come and the impact you've had on other healthcare professions and on the public in the past ten to 15 years.

Think about it. In the early 1980s when I began working at Dental Products Report, fewer than 50% of dentists ever wore gloves for patient treatment. Of those who purchased and wore gloves, less than 10% wore them for treatment of each and every patient. Within five years, 100% of dentists who responded to surveys conducted by Dental Products Report wore gloves for treatment of virtually every patient and wore them for all instances requiring contact with patient blood, saliva, or crevicular fluid. Okay, this was after the death of one of my favorite actors from AIDS. The public panicked: How can this fatal disease be transmitted? If Rock could have it, who else does? Despite the fact that hepatitis B had long been a documented occupational hazard in dentistry (along with herpetic whitlow on the fingers), it took a media- generated shake-up to change habits in the dental profession.

Yet while dentists were putting on gloves, masks, face shields, and protective glasses, ER physicians and medical surgeons were still wearing blood-splattered scrubs and damp masks pulled below their chins outside the operating and emergency rooms. Television interviews with these "healthcare cowboys," as I dubbed them, revealed that they thought the protective garb and equipment were for the less "manly," the less-serious physicians, and the female surgeons of childbearing age.

Dentistry actually has been the leader in infection control among all healthcare professions. Whether it was because dentists finally began listening to or reading the reports about hepatitis transmission in dentistry and then assessing their own risks is unknown and highly idiosyncratic, but dentists and their staffs, in spite of the grumbling that accompanied the expense and the inconvenience, adapted to social and epidemiological changes more rapidly than did other healthcare workers. Instruments came out of the "blue stuff" more often than once a day and got bagged and sterilized. Sterilizers were monitored. Patient chairs, light handles, x-ray heads, curing-light tips, and instrument tubing were wrapped in plastic.

Think about it. Does your medical-care provider have wrapped environmental surfaces (yes, they have those crinkled, white-paper covered things you get to lie down or sit on) in all those little rooms? Well, you may answer, they don't use handpieces, scalers, or air-abrasion systems. No, they don't, but they often have waiting rooms full of people coughing and sneezing. Tuberculosis, caused by a hardy "benchmark" organism that should be killed in order for disinfection to be successful, is spread through respiratory secretions. The tuberculosis bacterium can survive on surfaces for a much longer time than can HIV. Tuberculosis infection has been shown to be on the increase throughout the world and, in fact, is indigenous to certain regions from which North America draws a large number of immigrants. As our communities grow more diverse and our lives enriched by greater cultural exposure, our medical-care providers seem to be overlooking an important vector in disease transmission. Yet we don't have the media swarming physicians' offices like they did dentists' offices when the "handpiece story" broke loose.

We can sit with our sick children in typically very crowded pediatricians' offices--with babies drooling on the furniture, toddlers sneezing and coughing without hands over their mouths or tissues nearby, and kindergartners still wiping their noses on their sleeves (or yours, if you happen to be sitting next to them)--and we don't ask the pediatrician or their staff if anyone has disinfected the furniture in the past hour. We may see a nurse pull up a new strip of the white crinkled paper while we wait with a squirming child to see the doctor, but we don't ask them if they sterilize their instruments. So why are dentists, who have demonstrated outstanding progress and leadership in infection control, still on the firing line? Is it the still-unresolved (at least to most people) Acer-Bergalis case? Is it the fact that the attention of broadcast media was grabbed by a few dentists who blamed handpieces for disease transmission? Was it the relatively slow and some not-quite-believable responses by components of organized dentistry and the poor media coverage these responses received?

We should expect another media rumble over the contaminated dental-unit waterline issue. Fortunately, after the Acer-Bergalis case and the handpiece reports, organized dentistry, the dental industry, and the research community have become much more proactive in addressing the potential (and probable) media crisis, which most probably will be generated by the fact that dentists demonstrate a comparatively high rate of exposure (as determined by blood tests) to legionella, a common resident of dental-unit waterlines and the causative agent of Legionnaire's Disease.

Yet what about proactivity on the part of Dr. Jo/Joe Dentist, DDS? What are dentists in communities just like yours doing to change patient perceptions of dentistry, dentists, and dental treatment? What are they doing to further the health of their patients? What are they doing to make the dental experience more educational, more enjoyable, and more rewarding for the patient? What are they doing to make their own tasks and profession more enjoyable and less stressful for them?

As I implied, I have the chance to observe, largely indirectly, changes in the dental scene. With more than 1,800 new, improved, redesigned, and/or repackaged items introduced each year in the editorial columns of Dental Products Report, I have the opportunity to monitor reader inquiry activity on each item and on particular groups of items. The number of reader inquiries for particular categories of products and for specific products within those categories via the publication's Product Information Card varies from year to year. Since mid-1996, desensitization agents, temporary restorative materials, simplified bonding systems, new restorative materials (new concentrations of flowable composites, ultra-versatile hybrid composites, ceramic/polymer combinations, new mixtures of glass ionomer and resins, and new ceramic and porcelain materials), accelerated bleaching systems, and bone and tissue regeneration and repair materials have ranked very high among readers' selections for more information, as have digital, digitizing, and electronic devices; digital still and video cameras and software to enhance their applications; software packages that can combine management and clinical functions; and, of course, the hallmarks of more evidence of dentistry's leadership among healthcare providers: toothbrushes, dental floss, tongue scrapers, dentifrice, and an array of other home-care preventive items.

A common thread that runs through the most inquired-after items or product categories is that each of the products enhances patient care, at chairside by the professional or at home by the patient, in some fashion - making it faster, easier, less expensive, more reliable - or serves to make the business of dentistry - running a practice, administering personnel and payroll, marketing services, developing treatment plans, billing patients, facilitating insurance reimbursement - less of a burden.

On the basis of reader inquiry figures compiled during the year, our editorial and research departments develop and issue a series of topic-specific surveys (i.e., directed toward assessing product choices and techniques employed in particular areas of patient care or dental practice), questioning between 20,000 and 40,000 general and specialized dental practitioners annually. From the data collected during the year, we're able to see just how proactive the dental profession is. Examine the following and then look at what you do:

By the summer of 1997, virtually 40% of U.S. general dental practitioners have purchased an intraoral video camera, an increase of more than 500% since 1991.

More than eight (and almost nine) out of ten U.S. dental practices now incorporate computers, using them for an array of purposes, including patient records, billing, insurance predetermination, word processing, and scheduling as well as clinical applications. For the most part, however, dental practice computer functions such as appointment scheduling, tracking of appointment failures and cancellations, electronic claims submission, referral tracking, and patient recall systems are seriously underutilized.

Computer peripherals such as CD-ROM drives and modems are growing in popularity, as is dentists' use of computers to access on-line information related to their professional needs.

The use of digital radiography in general practices has increased by 500% since 1994. In addition, currently 20% of endodontists utilize digital/filmless x-rays, and other specialties are finding the technology of value to their specific needs as well.

More than 90% of dentists surveyed provide take-home bleaching systems for their patients, and the majority believe that bleaching provides a viable means of practice building.

More than 50% of general dental practices now are equipped with more than one operating sterilizer, facilitating rapid instrument turn-around.

Dentists' installation of CD-i (CD-interactive) systems for patient and staff education continues to accelerate at a very rapid pace as more programs become available. The use of interactive (CD-based) patient-education programs for cosmetic dentistry has increased by more than 80% in the past 2 years, and the use of ready-made patient education videos on cosmetic dentistry has climbed by a whopping 190% since 1994.

One fourth of dentists who purchased new equipment over the last year report that they did so to help market their practices and patient services.

The rate of laser acquisition, although stagnant for a few years, is increasing, with approximately 5-6% of general dentists surveyed reporting laser ownership.

Unfortunately, a down-side to all the enthusiasm happens to show itself when we ask about professional satisfaction:

87% of active dental practitioners told us they enjoy the practice of dentistry. More than a handful of these added their own comments that all focused on a single theme: "I like dentistry; I dislike the paperwork and fighting insurance companies and managed care." This figure, the most recent now available (winter 1996), represents a drop of 10 percentage points since 1993.