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"We were overworked until eight years ago," said Dr. Larry Anderson, a dentist in Prince George, B.C. "Now nobody’s overworked."
In greater Toronto, the ratio is one for 1,200, the highest concentration in Canada. In 1995, a dozen Toronto dentists went bankrupt, compared with zero in the previous decade, according to Dr. Edward Philips, a former member of the executive council of the Ontario Dental Association.
Not surprisingly, dentists almost everywhere have become really nice to patients. Gone are the days when they’d ask a question, then jam instruments into your mouth before you could reply. Now some take the Sistine Chapel approach to customer relations.
In British Columbia, Dr. Anderson offers 20-channel cable television, installed in the ceiling. In Ottawa, Dr. Sam Lewinshtein plasters his ceiling with a vast collection of funny buttons.
Children in Toronto awaiting Dr. Henry Ross get Polaroid snapshots and play Nintendo. Nervous types, adults included, are tucked into dental chairs with hand-crocheted blankets. And patients are welcome to toss their jewelry into the ultrasonic sterilizer, normally used to prerinse dental instruments. "People are just thrilled," said Helane Fischburg, his office administrator. "It polishes diamonds."
To be sure, it’s still great to be a dentist in, say, North Sydney, N.S., where there are only three dentists for 10,000 people. Dr. Colleen LaPierre laughed when asked whether she does anything special. "You don’t even have to be polite," she joked. "We just open up. People come."
That was standard fare 20 years ago, when patients everywhere might wait six months for an appointment. Children invariably had seven or eight cavities. "Even with emergencies, patients had to wait two weeks," recalled Dr. Edward Sonley, director of clinics at the University of Toronto’s faculty of dentistry.
To cope with the crush, provinces founded their own dental schools. Enrolment expanded. Burned-out dentists backed fluoridation, with few envisioning how this simple measure would end the golden age of dentistry.
A decade ago, dental schools began trimming enrolment, but the impact was neutralized by the influx of foreign dentists and by Canadians who, failing to get in, attended U.S. schools and returned home to set up practice.
Now, in these hard economic times, companies have drilled away at dental plans and some workers have lost their benefits entirely. "It’s funny," Dr. Gordan Markic said, sardonically. "People would rather put food on the table than see a dentist."
Banks, which once automatically gave dentists a loan, now demand business plans. And while dental fees have tracked inflation over the past 15 years, overhead has jumped to 64 per cent of gross billing from 45, according to the Ontario Dental Association. Said the U of T’s Dr. Sonley, 64: "I was taught that business was a dirty word. But God help you today if you don’t run it as a business."
Make no mistake, the pain is relative. Dentists enjoy the second-highest incomes in Canada, after medical doctors. In 1992, the most recent year for which information is available, they averaged $103,000, according to Statistics Canada.
The ineluctable law of supply and demand and a 1990 Supreme Court decision permitting dentists to advertise have sparked an unseemly scramble for market share. The Toronto Yellow Pages is filled with dental ads that blare "New Patients Welcome," announce payment by Visa and offer service in Italian, Hebrew, Cantonese, Tamil, Macedonian or Croatian. Many ads openly tout "senior citizen discounts." While dentists are reluctant to discuss discounting because two-tiered pricing – higher for insured customers and lower for uninsured – is considered unethical, many confirm the practice exists.
Dental advertising remains regulated, but now the restrictions aren’t much different from, say, those governing used-car salesmen. "Most of the complaints we get with respect to advertising come from other dentists," said Dr. Roger Ellis, registrar of the Royal college of Dental Surgeons of Ontario, which regulates advertising. "They keep sending us stuff and saying, ‘Is this legal?’ And, most of the time, it is."
As dentistry has gone from boom to bust, dentists have tried to cope. In Toronto, Dr. Donald Chong, who once stopped accepting new patients during the fat years, spent $20,000 (U.S.) on a dental-management course in Portland, Ore., when times turned lean.
Some dentists have fired their hygienists and clean teeth themselves. Others perform root canals, instead of passing the work to a specialist. "If our regular dentist isn’t as busy, he’s less likely to refer as quickly," said Dr. Douglas Pettigrew, an Edmonton periodontist. "There’s a ripple effect. It’s hurt all of us."
A normally morose bunch – U.S. studies indicate dentists have the highest suicide rate of any profession – some are trying to lighten up. Many wear designer dental garb by, say, Simon Chang. Others eschew whites entirely, especially those touting cosmetic dentistry. Many have spruced up once drab waiting rooms with waterfalls, juice bars and two-metre- long fish tanks. Cosmopolitan and Gourmet have replaced dog-eared copies of Reader’s Digest.
A once proud profession has been humbled. "I know patients don’t like to be kept waiting," Dr. Pettigrew said. "Their time is valuable." Indeed, waiting times at many offices have shrunk to five minutes or less, so short that some patients complain they don’t have a chance to peruse the latest issue of Vanity Fair.
Nowadays, you don’t call them; they call you to set an appointment and even send reminder postcards with cavorting toothbrushes. Same-day appointments are possible. And many dentists are also stocking up on the latest toys to soothe patients. –
In Toronto, Dr. Edward Philips, dressed in a collarless dark print shirt, black pants and lace-up leather boots, offers a choice of music, laughing gas or something called Relax Man, in which patients close their eyes and strap on goggles that flash tiny white lights and supposedly cause the kind of rapid-eye movement that induces relaxation. For those who would still rather be somewhere else, he offers virtual-reality goggles with scenes of Hawaiian beaches.
Some offer acupuncture. Others supply Walkmans or compact discs to drown out the whine of the drill. Across town, Dr. Allan Reiss uses needle-free electronic anesthesia. He also throws in free subway tokens or reimburses parking chits. "I figured: Make it that much easier for them."
Unlike medical doctors, pinched by a dwindling government treasury, dentists work as long as they want. A 7 a.m. start isn’t uncommon. Others open at night and on weekends to accommodate patients who can no longer take time off work. In their office in a strip mall in Mississauga, Dr. Gordan Markic and his wife, Dr. Susan Belavich-Markic, work until 7 p.m. every weeknight and all day on Saturday.
Like a number of competitors, they bought an intraoral camera so patients can see their teeth magnified on a television screen. They also promote services on laser discs and mail newsletters, supplied by a company that lets them customize part of the text. Called Word of Mouth, their latest issue includes flossing jokes, crossword puzzles with a dental theme and a snapshot of their infant son clutching a toothbrush.
Referrals merit thank-you notes and lottery tickets. At least two customers have won several thousand dollars. "It’s a thoughtful gesture for a thoughtful gesture," said Dr. Markic, 35.
Since taking the management course, Dr. Chong, 60, tracks referrals on a computer. When he notices a patient has sent him five or six new customers, he sends flowers. "Always to the office," he said, "because when it gets there, it generates more word-of-mouth business."
Some dentists target niches, such as children, seniors, even welfare recipients, who, until recent government cutbacks, had adequate dental plans. Dr. Kenneth Montague, who practices in Toronto’s hip Annex neighbourhood, goes after the Generation X crowd. He plays Alanis Morissette recordings and has furbished his waiting room in "Caribbean style" colors of sea green and terra cotta. "My personal view is that people equate techno-cyber stuff with the drill."
Other dentists try to lure customers with new services. Dr. Philips, of the virtual-reality goggles, offers "breath disorder" treatment. Patients who fear they have halitosis blow into a Halimeter, which measures volatile sulphur compounds. Dr. Philips then sells topical creams and mouthwash of chlorine dioxide to neutralize the sulphur dioxide chemically. But he and many other dentists see a lucrative future in cosmetics – whitening, bonding, implants and glued-on fakes called veneers.
Dr. Sol Weiss, who looks vaguely like Michael Douglas, recently posed in a magazine ad wearing a wool blazer, tie-less black shirt and khaki pants. He never wears dentist whites and has named his cosmetic practice Art of Dentistry.
"I see my dentistry as art work," said Dr. Weiss, who deemed his native Winnipeg too conservative for cosmetic dentistry and moved to Toronto in 1988. Dr. Weiss, who has his own World Wide Web site, offers his predominantly female clientele a choice of orange blossom, lilac, peppermint or bergamot aroma therapy. He also uses computer imaging to show them how beautiful they will look if they spend, say, $10,000 on a set of veneers.
In these uncertain economic times, will consumers make the switch from insured non-elective care to elective cosmetic dentistry? Some dentists fear not. But they console themselves with the thought that as baby boomers age, there is always gum disease. And the controversy lingers over replacing old fillings with new, mercury-free ones.
"Now dentists are all dying for someone to prove that silver amalgam fillings are bad for you," Dr. Chong said. "Then we’ll all be in business again."
Fluoride works
Three decades of fluoridated water and toothpaste, a glut of graduates and a nineties erosion of welfare and corporate benefits have taken a big bite out of the dental profession.
Dentists lose
Two decades ago, a dentist could survive with 1,000 patients. But these days, with nearly half of all youngsters growing into cavity-free adulthood, a dentist with fewer than 2,000 low-maintenance patients is in trouble. Only half the population normally sees a dentist regularly. In Alberta, there is roughly one dentist for every 1,800 residents, in Ontario one for 1,700 and in B.C. one for 1,600.
Patients get popcorn
Not surprisingly, dentists almost everywhere have become really nice to patients. They call you for an appointment. Waiting times are down to five minutes or less. And they ply you with free popcorn, coffee, hot finger towels and Polaroids of your children. To distract you in the chair, there’s Mozart or Morissette, virtual-reality goggles and aroma therapy.
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