Over time, different trends have emerged in the types of services provided in dental offices across the United States, as well as in other parts of the world. These changes can transform the image of dentistry and inspire and promote innovations affecting the scope of dental practice.

Occasionally, therefore, it is pertinent to appraise the types of services offered and how dental offices integrate new and different ideas into the delivery of care to their patients.

Traditionally, general dentists have offered an array of dental treatments, ranging from general dental check-ups to complicated oral surgical procedures, while specialists limited their practices to their particular areas of expertise and usually took care of the most challenging cases. Today, this distinction is blurred. Some general dentists limit their practices to specific areas not officially recognized as specialties, such as orofacial pain or esthetic dentistry. Also today, both general dentists and specialists provide many of the same types of services, such as implants or orthodontics.

A number of external forces are stimulating this reshuffling of boundaries. These forces include demographic trends, technological advances, and economic and political developments, all of which enable oral health care professionals to explore and adjust their services and, by default, their practices to narrower or broader areas of expertise.

Associated with these trends are various advantages and disadvantages for dental patients. It is reasonable to assume that a provider who limits his or her work to a particular discipline will become more proficient, will be more up-to-date on new techniques and materials and will refer patients to other oral health care professionals when the patients’ needs go beyond the provider’s own narrow scope of practice.

With a set referral arrangement, a network of providers will emerge, each aware of and comfortable with his or her colleagues’ skills and work patterns. This type of collaboration sometimes results in the establishment of multispecialty practice settings in which general dentists and specialists practice within the same office. This arrangement could benefit patients, who then would be able to get immediate second opinions, or chairside consults, from multiple providers with diverse areas of expertise.

But the patient also would need to be comfortable with all of the different practitioners within the multispecialty office. Concerns and problems could arise for patients who choose to seek help from practitioners not directly associated with their primary oral health care provider. Another possible problem: dentists outside the practice may hesitate to refer a patient to a specialist who practices with general dentists. They may fear losing the patient to the multispecialty office. Such an office would transform the traditional dental landscape from the single provider who did it all to the single practice that does it all.

Is it possible to differentiate between the provider and the services the provider is offering? Or is one a reflection of the other? New types of dental practices are emerging that offer many services not normally associated with dental care: facials, paraffin wax hand treatment, reflexology, micro-dermabrasion, massage therapy, and even Botox and Restylane treatment.

These types of services, and many other pampering, therapeutic and rejuvenating offerings, often are referred to as "spa dentistry." It is possible that one in every 20 dental offices in the United States actually offers, to some extent, some of these types of services to their patients. Obviously, this type of practice setting is not an endorsement of the dentistry that will be provided, but it may reflect on a professional with concern for more than a patient’s oral health. A more pragmatic view would argue that whatever brings a patient in for oral health care should be justified as long as it is not detrimental to the patient’s health.

Another category of dental practice of the future may be the health-oriented dental office, in which patients are offered a variety of services related to screening for and monitoring systemic diseases. These services might include noninvasive oral fluid diagnostics, blood pressure measurements or more invasive tests for cholesterol or glucose requiring blood samples. The utilization of nontraditional health care settings for these purposes is a growing trend that may have a dramatic impact on the overall health of our patients. While spa dental settings may employ estheticians and massage therapists, the health-oriented dental office might include registered nurses or physician assistants.

The art and science of dentistry is not static, and we should embrace this facet of our profession. Not all new ideas are better than old ones, but I believe the bad ones eventually will fade away and the good ones will prevail. If the added value gained from spa dentistry or health-oriented dental offices would benefit the patient, then this should be tried. Obviously, the reimbursement issue still needs to be resolved! But, as the scope of services provided in the offices of oral health care professionals change, today’s options may be the mandate of tomorrow. Let’s be bold and accept something new today.