As the dental industry undergoes rapid transformation each year, there are some trends dentists say could harm patient care and business operations.
Eight dentists recently spoke with Becker's to discuss what they think are the most dangerous trends in dentistry.
Editor's note: These responses were lightly edited for length and clarity.
Question: What are the most dangerous trends in dentistry today?
Robert Baskies, DMD (Phillipsburg, N.J.): Having worked for a few DSOs in the last 10 years, I fear the following: Private equity firms buy the private practices and in many cases streamline the business end of the practices by getting better contacts with dental labs and dental suppliers. This gives the profits that they need to make their investors happy. Private equity firms usually only hold their investments for five to six years and then they sell them to the next private equity firm. There is nothing less to streamline. The next private equity firm can only get profits by cutting ancillary staff, cutting salaries for all employees and/or cutting back on necessary supplies. The staff is unhappy, and they leave. Ultimately, patient care suffers and offices start to close.
Jeremy Burgin, DDS. Burgin Dentistry (Clovis, N.M.): There are a few trends circulating social media these days. In my personal opinion the answer is clear. The personal filing down of teeth with home products or devices is very dangerous, not to mention irreversible. People that file down their own teeth are subject to, but not limited to, infections, irreversible damage to teeth and surrounding structures, pulpal necrosis, constant sensitivity and/or pain to just name a few. This trend provides zero benefits. It would be very wise if this trend was eliminated altogether.
Michael Davis, DDS. Smiles of Santa Fe (N.M.): We are already positioned such that the fee schedules from many PPOs are below the overhead costs to deliver such services ethically and to standard of care. As such, numbers of ethical dental providers are dropping PPO participation. Others stay on the plans finding few other options considering their market demographics. This includes many in small business dentistry, as well as larger DSOs. The dark result can be high-pressure upselling of services, upcoding and unbundling of dental services, and overall cutting corners if not outright healthcare fraud.
Nels Ewoldsen, DDS (Davenport, Iowa): Each new layer of standards compliance places our patients farther away from the center of care. From signed consent forms to negotiated network language, to denied coverage or delays in authorization to treat, patients come after the lawyers, regulators and third-party payers. We speak of patient-centered care while we're ignoring patients' needs. We're delaying treatment until the lesser details are "worked out." When timely, appropriate dental care takes a back seat to system complexity, the patient is no longer in charge of their care and dentists are no longer in charge of their practices. That's a dangerous trend.
Kevin Nakagaki, DDS (St. Paul, Minn.): It appears the DSOs taking over the dental workplace are the biggest threat to the dental industry today. Profits over integrity is a poor trade.
Laurence Stone, DDS. Doylestown (Pa.) Dental Solutions: This is not an easy answer, because as per David W. Chambers report to The American College of Dentists, "Ethics Report: The New Professionalism," you can take your pick:
- Financially motivated overdiagnosis and overtreatment.
- The growing threat of commercialism from franchises, corporate entities, insurance companies and hedge funds, which is driving dentistry backward from a profession to a trade.
- Declining membership in the American Dental Association, which has also been documented in Robert Putnam's classic book "Bowling Alone," about the loss of social capital in this country. It was published 25 years ago but is just as relevant today as when it was published.
Eugene Santucci DDS. Associate Professor of Preventive and Restorative Dentistry at the University of the Pacific (Stockton, Calif.): Being involved with dental school education, I am concerned with [artificial intelligence] as the first and only use for dental treatment evaluation instead of traditional, clinical hands-on evaluation. Adjunctively is fine, as a replacement is not.
Reggie Thurston DDS. Ora Dental Studio (Chicago): If I had to identify one trend in the industry, it would be insurance reimbursement not keeping up with inflation and rising operating expenses. I am currently in the process of going out of network with almost all of my PPOs. I’ve been in dentistry for nearly 30 years and received better fees when I graduated. Insurance companies need to realize that this is not sustainable. Luckily, I have a very loyal patient base that values high-level, quality-driven dentistry, and the majority will not mind a slight fee increase.