Drilling for New Business

By Anastasia Toufexis

U.S. dentists find the cavities are in the chair, not the teeth

Dr. William Schmidt, 35, of San Jose, Calif., is a successful dentist. If that description conjures up nervous waits in a bland, Muzak-filled office and a white-coated figure poking fingers, drills or needles into the patient's mouth, with possibly a palliative lollipop or pat on the back afterward, forget it. Dr. Schmidt practices his profession in a red cape and bright blue tights. He calls himself "Plaque Invader." The cape outfit is only one of twelve costumes he dons to amuse young patients. At Christmas he may be dressed as Santa Claus, and around July 4 as Uncle Sam. Schmidt drives to and from work in a vehicle that he calls a "Plaquemobile," a white Volkswagen topped by a king-size Styrofoam molar.

Adults have their own treats at Schmidt's office: chances to win record albums, dinner at a local restaurant or a turkey. He offers a choice of wines in the waiting room. Patients can even try a relaxing soak in the office hot tub. Says Dr. Schmidt: "We've kept our name circulating in the community because of what we are doing. The more the name is mentioned in the community, the more likely we are to pick up a patient."

Picking up patients is a serious business for the nation's 130,226 tooth doctors. Lately they have been seeing more cavities in their chairs than in their patients' mouths. They face what for them is an alarming trend: the prospect of fewer patients and better teeth. In the late 1960s, a survey by the American Dental Association found that 14% of dentists "would like more patients." Ten years later, 21% of dentists had come to the same conclusion. Still the average annual net income of U.S. dentists is around $42,000.

In the past decade the number of dentists climbed 31%, while the country's population rose by less than 10%. Especially hard-hit demographically are the orthodontists. The prime candidates for high-priced teeth straightening are children between 7 and 19. The number of youngsters in this age bracket fell by 4 million. Dentists are quick to point out that fees have barely kept pace with inflation, but the stalled economy has kept people away from the chair.

Dentists are also victims of their own success. With improved equipment like high-speed drills, tooth capping and other repairs can be accomplished in a fraction of the time once needed. Preventive oral hygiene has also paid off in healthier teeth. The three-decades-old program of adding fluoride to drinking water has had dramatic impact on cavities--and so have fluoride toothpastes. An A.D.A. survey shows that a child who drinks fluoridated water from birth to age 14 develops 60% fewer cavities than a youngster who drinks unfluoridated water.

The outlook for dentists is not totally bleak. More and more companies are offering dental insurance as part of employee benefit programs. Seventy-five million people are now covered by insurance, more than twice as many as in 1975. Enrollment in the nation's 60 dental schools has peaked so that competition for patients may eventually ease off.

But dentists are tantalized by the fact that half the people in the U.S. still do not see a dentist regularly, if they go at all. To tap that great undrilled and uncapped market, the A.D.A. has run $2 million worth of print ads in national magazines and TV commercials in Buffalo, Cincinnati and Kansas City, featuring toothy models and the lines: "Dazzle. When your teeth have it, you have it. So go get some at your dentist's." The California Dental Association has supplemented "dazzle" with "doodle." Print, TV and billboards show a smiling woman or man whose front tooth has been blackened by a marking pencil. The warning: "Don't doodle around with your teeth." So far, the experimental ad campaigns have had only mixed results.

Like California's Dr. Schmidt, dentists around the country are consciously drilling for new business in unconventional ways. Dr. Allan Gutstein of Universal Dental Centers has installed dental chairs in several department stores in shopping malls on Long Island, N.Y. He and his colleagues drill, extract and cap in leased space, right alongside the ladies' lingerie and sporting-goods sections. In Worces ter, Mass., a soon-to-open shopping center dental office will provide parents with beepers so that they can browse and buy until they are signaled back to the office when junior is ready.

When it comes to bizarre ways of coming to grips with a shortage of profitably infected molars, nothing can top California. In addition to Dr. Schmidt, there is Dr. Terry Pratt of Alameda, who has taken an old bungalow and created a homey office complete with stained glass, eucalyptus-wood paneling, brass fixtures and white lace window curtains. Dr. Ronald Konopaski of San Francisco says that he has "tried to create an image similar to a beauty salon." The doctor's dental salon offers clients a rainbow-colored printed menu of services with fees. They can or der to taste -- anything from a brush and floss ($5) to an examination with X rays and consultation ($55). In Oakland, Dr. Ernie Lavorini will gladly tattoo a butterfly or a flower on caps being fitted (there is an extra charge for the artwork). So far Dr. Craig Rosenberg of Huntington Beach, Calif., has been more timid. "I'm still not used to a lot of it. Dressing up in costumes, wearing funny hats, is too much for me right now. Maybe it won't be some day. I could do dentistry in a funny hat as well as I can in a smock if it makes some one happy." And brings him in the office door.

--By Anastasia Toufexis. Reported by Cheryl Crooks/Los Angeles

With reporting by Cheryl Crooks/Los Angeles

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