As 2025 gently comes to a close, I would like to look back at dentistry over the first quarter of this century. The world has moved on a great deal and dentistry has morphed quite considerably since the new millennium. Do you remember the run-up with all the hopes, expectations, and worries about would happen to technology as the computers rolled over from 1999 to 2000 and beyond? No chaos ever occurred and although I am unlikely to be on the planet for the next big date change, inevitably, the scaremongers will seek to dramatise and once again, potentially even profiteer from the next round of millennial uncertainty.
The Nokia 3310 'brick' mobile phone had just been released in 2000 and the mix-tape was running out of fashion as the 21st century unfolded. Manual dental charting and studious writing of clinical notes were on an obsessive par with aircraft engineer handover notes, along with a wide range of gooey dental impression materials providing stand-up comedians with plenty of anti-dentistry ammunition. Despite being an early adopter of technology, I had no real idea about the sheer range of digital developments that would take centre stage across dentistry. 3D-printed prosthetics, artificial intelligence (AI) and image-guided surgery were tomorrow’s world, quite literally if you watched the 38-year long series on BBC1. The evolution in technology, education delivery, global dental health, and indeed the roles of dental professionals have changed considerably, whilst increasing expectations and life expectancy for our patients continues to help dentistry evolve.
The early 2000’s witnessed the phasing out of film radiography in preference for digital radiographic images with consequent improvements in diagnostic speed and patient safety. Laser dentistry was in its infancy, and CAD-CAM entered the digital market for a range of dental uses. Computerised learning was starting to become mainstream too. The ‘2010s’ decade signalled rapid development of intraoral scanners to replace traditional impressions across orthodontics and prosthodontics accompanied by CAD/CAM technology becoming widespread for crowns, bridges, restorations implant-guided surgery and orthodontic aligners. The 2020s have so far not disappointed either. 3D printing has revolutionised implant surgery guides, orthodontics and prosthodontics with ‘increasing speed and precision of ‘in-office’ milling.
Artificial intelligence and machine learning have also been keeping pace with developments in dental hardware more recently this century. The growth of AI clinical diagnostic tools including software for the detection of caries, periodontal disease and even oral cancers has been nothing short of impressive. Measuring plaster dental models is rapidly becoming historical with at-home scanning on a mobile phone now being able to assess a range of occlusal parameters. AI algorithms are also rapidly becoming mainstream in various other aspects of treatment planning and treatment sequencing across the dental disciplines.
One of the most important developments in this century has been cone-beam CT (CBCT) imaging. With the development of 3D image reconstructions, CBCT became a reality for my patients in 2008, and I could not practice these days without it. From implantology to impacted teeth, cleft care, orthognathic planning and a myriad of other dental uses, CBCT provides unparalleled advantages over 2D radiographs in terms of 3D visualisation of teeth, bone and some soft-tissues. It is one of my favourite inventions of the century so far.
Teledentistry and electronic learning were given a turboboost in 2020 with the COVID-19 pandemic. Whilst the technology had been available long before then, meeting spider phones and dial-in teleconferences changed almost overnight as the pandemic unfolded with clinical teams using videocall technology for remote triage, new patient consultations and follow-up appointments, delivery of at-home care and both patient and dental team education. I for one have become a big fan of teledentistry and my patients tell me they are happy with elements of care being delivered remotely. I am also a big fan of blended learning and a regular user of the Faculty’s ProDentalCPD package. That’s a big win for the 21st century.
Sensibly, the care model has slowly been shifting from repair to prevention over the first quarter of the century with increasing emphasis on fluoride use, sugar counselling, smoking cessation, and oral hygiene education. Oral health promotion as part of overall general health and wellbeing is becoming more understood but there is much work still to be done. The renewed focus on non-invasive and micro-invasive dental techniques is welcome with the development of remineralising agents and bioactive materials. With silver diamine fluoride and resin infiltration cavity preparation can sometimes be avoided. At the same time, personalised preventive care programmes are gaining popularity with individual risk assessments using genetic, microbiome, and behavioural data for tailored preventive strategies.
Nobody saw the boom in aesthetic and ‘discretionary dentistry’ that arrived in the early 2000s. As a mainstream orthodontist, aligners did not exist when I was training and have risen from an aesthetic alternative to being exceptionally popular. Within our research team we have published about the need for a significant improvement in the evidence base for aligners, and it is my hope that the companies publish their data. The insatiable demand for tooth whitening, cosmetic composite bonding and even veneers has been partly driven by social media and the ‘uberisation’ culture. The growth in smile design and digital smile simulation tools to enhance patient engagement and case acceptance does need to be accompanied by simultaneous focus in delivering basic dentistry correctly though, something to ponder.
The linkages between oral and general health and the ongoing recognition of oral disease as a marker of cardiovascular disease, diabetes and poor pregnancy outcomes is helping both patients and the medical community recognise the oral-systemic health risk factors. Integration of dental screening protocols with those for general health screens along with the management of chronic disease is a major step forwards so far this century with more to come. However, more work needs to be done on sharing electronic health records, and in particular making use of big data biomarkers (eg periodontal microbiome levels, blood pressure, diabetic data) using unique patient identifiers to continue to develop the linkages between chronic disease markers to fully establish the overall importance of oral health in general health.
In the background over the last 25 years, there has also been a revolution within the workforce and education sector. There has been an expansion in both the number of dental professional roles and the duties that each can undertake through an ongoing extension of duties. Collaboration is good for expanding the overall totality of patient care, but role extensions need to be accompanied by simultaneous development of professional responsibility in order to protect patient safety.
During this century, there has been a gentle move from competency-based undergraduate and postgraduate training to outcome-based curricula and reflective practice, which is now morphing into the entrustable professional activities model of training. Whilst I am a strong supporter of pedagogic development, “dental practice” means that repeating the same technical task has a significant educational value as the non-technical elements of care are different for every patient encounter. This results in a substantial educational dividend and should not be forgotten.
Simulation in dentistry is another part of the overall development work that has been quietly going on for the last quarter of a century. Virtual reality and haptic feedback are used by many educational institutions for the teaching of technical skills which I support, but at the same time, the non-technical elements of care are rightly no longer viewed simply as ‘soft skills’ with communication, interaction, morals and ethics, cultural humility, humanism being a key part of the overall education and training portfolio.
In the first quarter of this century, oral health inequalities have been a continued focus for many in dentistry. There are continued challenges in equitable access to dental care in rural communities, low-income populations, medically vulnerable groups and whilst many governments have developed public dental health programs (supervised school tooth brushing, fluoride varnish, school dental screening, sugar tax policies) which have reduced inequalities, considerably more work needs to be done to improve overall public dental health.
Sustainability is by no means new, but the climate emergency has brought the need for environmental protocols into sharp focus since the world paused during 2020. There is rightly now increasing awareness of the environmental impact of everything we do in dentistry with single-use plastics, mercury waste, and high-energy use being significant issues. More does need to be done and promoting eco-friendly practices including digital records and digital impressions, reusable PPE and suction tips, energy-efficient equipment is a start, but we do need to tackle prevention as a key driver in reducing the carbon impact of dentistry. It is good that sustainability being embedded in training, policy, and procurement in many countries; there is more work to be done.
It has been a busy first quarter of the century and what is in store for the next quarter of the 21st century? Will we still use playlists and will the vinyl record revival continue? And what will dentistry be like in the future? Stay tuned for one of the early 2026 blogs. I won’t give much away at this point, but innovation, integration, sustainability and technology will be important drivers. We should also remember to learn from the lessons of the past 25 years in order to guide the next generation of oral health professionals toward a future that is not only technologically advanced but also compassionate, inclusive, and sustainable.
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