Based on the preceding considerations, what
will the dental plans of the future look like? The vision
here involves what will be likely from the dental
perspective as well as the integration of health
systems and dentistry.
First, there will be a continued reduction in
disease penetration and increasing disease sequestration,
mandating that health systems be risk-based
at the level of the individual. Given the increasing
financial pressure on health care, we cannot afford
to treat all patients for diseases that many will never
have. This will mean that the health services provider
will use and be paid for validated diagnostics
and their own deductive and intuitive skills that assess
the patient’s current conditions and their risk of
future diseases. In all likelihood, this diagnosis will
include many other parameters besides those associated
with dental caries, periodontal diseases, and oral
cancer. Saliva, for example, is a rich diagnostic fluid
that will find many uses by health care systems.
A range of treatments will be preadjudicated
and paid for based on the patient’s risk profile and
the known therapeutic successes of preadjudicated
interventions when applied to that risk profile. Treatment
outside this range of treatments will either not
be reimbursed or will require separate approvals. This
reflects the health and cost-driven need to limit treatment
variation and the subsequent reduction of ineffective
strategies. This will be likely facilitated by
an expansion of the recent U.S. Supreme Court ruling
that draws the distinction between payment decisions
and treatment decisions. If extended beyond
the current narrow interpretation, this decision will
limit the liability of the payers who design and implement
these strategies.
Diagnosis and treatments for dentistry’s two
primary diseases will be delivered in a medical model
of care with fewer mechanical interventions. When
simple mechanical interventions are necessary, they
will be provided by service providers with less training
than dentists, leveraging the improvements in
materials. Complex treatments, including implants,
placement of their prostheses, trauma repair, oral
surgery, endodontics, and a number of other treat