Forecasting the Dental Office of the Future
Advances in dental practice and patient care in the distant future could be difficult to imagine today, but some of the current trends in dentistry are hints as to the industry’s path forward. The COVID-19 pandemic has sent waves of change through the entire healthcare space, dentistry included. New technology is changing how dentists practice and interact with their patients. Multiple forces are molding the practice landscape, raising questions about the future of the dominant dental practice model. Experts weigh in on what the future of the dental office could look like in the next decade.
The Impact of the COVID-19 Pandemic
When shutdown orders rolled out around the country to combat the COVID-19 pandemic, dental offices were largely forced to close their doors except for emergency cases. As time wore on, the scientific community learned more about how the virus was spread. Dental offices were able to put in place mitigation strategies, many of which already fit like a glove.
Personal protective equipment (PPE), like gloves and masks, were already commonplace in dentistry. As more information came to light, offices were able to adopt specific kinds of PPE, such as N95 masks. Offices were also able to institute protocols to improve airflow and ventilation.
“We documented through our research1 from the American Dental Association (ADA) Science and Research Institute and Health Policy Institute that COVID-19 prevalence and test positivity rates were low among practicing U.S. dentists after practices adopted the strengthened recommendations around infection control,” said Krishna Aravamudhan, BDS, MS, senior director, Center for Dental Benefits, Coding and Quality, at the ADA Practice Institute.
As COVID cases continue to spike and recede, dental offices have the protocols to keep patients and staff safe. If a different pandemic hits in the future, the dental industry will have a solid foundation to manage and adapt to a new threat. “While each public health crisis will have distinct challenges and unanticipated, unimaginable bumps in the road, we have had a thorough refresher course on the basics of preparedness,” said Aravamudhan.
The COVID-19 pandemic has necessitated more time between patient cases. Some dentists have found that this scheduling approach has allowed them to spend more time with patients and build stronger relationships. “We get to know our patients on a more personal level, and I think that is something that’s going to be positive coming out of the pandemic,” said David K. Yang, DMD, a solo practitioner in Flagstaff, Arizona.
The pandemic has also caused a shift in labor dynamics for many dental offices. “Some dental practices are struggling significantly with staffing shortages, as are other sectors in healthcare and the labor market more generally,” said Aravamudhan. Practices with inadequate staffing have had to reduce capacity.
While offices may be struggling to find dental assistants and hygienists, more dentists are entering the industry,2 a significant number being women.3 However, the number of dentists 55 and older leaving the workforce increased sharply in 2021.4 Shifting labor dynamics and changes in the population of practicing dentists will likely change how practices operate for years to come.
New Technology
Technology is integral to how dentists practice, but new technology takes time to adopt, often due to cost constraints and sometimes resistance to change. Cone beam computed tomography (CBCT) first came onto the dental scene in 1988,5 but it has taken years for this imaging approach to become standard in the field.
When Angelique R. Freking, DDS, FAGD, a dentist practicing in New York, bought her practice, investing in CBCT was one of the first things she did. “I actually had in my business plan to upgrade the panoramic machine to a CBCT because I couldn’t work without it. I didn’t feel clinically responsible working without it,” she said.
It does take time to adopt new technology, but some trends are moving at a faster pace. “It took years, decades even, to go from the early CEREC [chairside economical restoration of esthetic ceramic] and in-office milling to what we have now,” said Marty Jablow, DMD, FAGD, a dentist practicing in Woodbridge, New Jersey. “Digital radiography still took decades to get to the majority of North American offices. Now, we’re starting to see intraoral scanning [adoption] going at a faster rate than either of those.”
Intraoral scanning gathers more information for dentists and gives them more control, according to Jablow. Those benefits, as well as increased efficiency, could be driving its adoption. “I think digital intraoral scanning is growing, and it is going to become just as mainstream as a handpiece at some point,” he said.
Cost is typically one of the factors that slows the introduction of new technology in dental offices. All practices need to perform a return-on-investment analysis, and, often, new technology is just too expensive to justify the cost. But one new technology making headway in dentistry has a relatively low point-of-entry cost: 3D printing. It’s showing significant promise in the industry. The price of milling is $43.18 per denture base, while the price for 3D printing one is $5.95.6
3D printing does have limitations compared to milling. Dentists can currently print night guards, diagnostic wax-ups and temporary crowns, but they cannot print permanent crowns yet. But Freking believes the technology is headed that way.
Dentists are currently purchasing 3D printers to use in-office, and they also have the option of outsourcing to third parties that have the technology. Depending on the type of 3D printer offices are using, fumes from the printing materials and space can be an issue. Once the product is printed, it needs to be washed, cured and polished. “It’s not as simple as printing it and putting it in the patient’s mouth,” said Jablow. Yet, the technology is making strides. New types of resin for printing are emerging at a rapid rate, making 3D printing more and more appealing for dental offices. “Those resins are what is going to change dentistry and make 3D printing easier,” Jablow said.
Artificial intelligence (AI), also known as augmented intelligence, is also shaping the dental office of the future. The technology will likely be used in treatment planning. AI will be able to spot decay in radiographs and help dentists make diagnostic and treatment decisions. The use of AI will be supported by insurance companies. Jablow expects insurance companies will employ AI to weed out fraud — recognizing if the same radiograph has been submitted for reimbursement more than once — and to drive more standardization in dental care.
The pandemic has also played a role in driving technological change in dentistry. “Dentistry has always been a rather technological specialty, but the post-pandemic era might bring more solutions into remote care,” said Bertalan Meskó, PhD, director of The Medical Futurist Institute. With widespread office shutdowns during the pandemic, teledentistry became a vital tool for reaching patients and keeping them out of already overcrowded emergency rooms. While some dental offices have wholeheartedly embraced teledentistry, its use has waned. From April 2020 to July 2020, the number of dentists using remote communication for patient evaluations dropped significantly.7
Dentistry remains a hands-on specialty. Most patient care must be done in the chair. But remote technology has shown promise for triaging patients, postoperative follow-ups and reaching underserved populations. “Teledentistry is perfect for those areas that are underserved where we can get patients in to see some kind of auxiliary, and they can become the eyes and ears while dentists can possibly make that diagnosis remotely,” said Jablow.
The continued use of teledentistry will also depend on how payers approach the technology. “We are seeing a number of third-party payers introduce teledentistry platforms to their beneficiaries and offer additional benefits. So, on the consumer side, this is catching attention, but it seems to be more for triaging emergencies and consults,” said Aravamudhan.
With more technology available, dentists could be empowered to do more work in-house, lessening their reliance on referrals. For example, advances in imaging, coupled with 3D printing that allows dentists to make night guards and temporary crowns, could mean a faster turnaround time for patients and no need to send them to a third party. But technology will only do so much. “The question of whether to refer or not will be a decision that each dentist will continue to make regardless of the technology that is available,” said Aravamudhan.
New technologies come with exciting possibilities, but implementation can be challenging, and not only from a cost perspective. Compatibility among technology is an important element of deciding what to invest in for dental offices. One piece of equipment may lock dentists into a specific brand for the foreseeable future. For example, certain aligner companies only accept scans from specific intraoral scanners. “A lot of the companies that fabricate and develop these technologies become very closed-loop,” said Freking. “How is your choice today going to open or close doors in the future?” She chose her CBCT machine because it was more open source.
In other ways, technology has opened the door wider than ever. Freking points to the role social media has in exposing dentists to new and exciting ideas every day. “I can follow many dentists who are active on social media. They’re sharing what they’re doing, and I think it’s starting to gel into a huge explosion of innovation, excitement and change in dentistry,” she said.
The endless availability of information online has also made it even easier to access new research in dentistry, helping dentists keep learning and honing how their office operates. “There is a significant increase in the number of peer-reviewed research publications coming out in dental materials and dental techniques that have challenged what we thought we knew even 10 years ago,” said Freking.
This proliferation of information is also available to patients, who are becoming increasingly empowered and involved in their healthcare. “Dentists will have to become guides for their patients in the jungle of information and technologies rather than being key holders to the ivory tower of medicine as before,” said Meskó.
The Practice Landscape
The question of investing in new technology and its costs becomes even stickier when dentists look at the future of reimbursement. “It’s very difficult to financially commit to modernization of dental offices when you are beholden to very low fee schedules from dental insurance companies,” said Freking.
This challenge could drive changes in the practice landscape. “Rather than increase fees to pay for more technology, even if reimbursements from insurers are not diminished, in many areas of the country solo dental practitioners will more likely aggregate into larger groups to achieve economies of scale,” said Burton L. Edelstein, MPH, DDS, professor emeritus and special lecturer of dental medicine and health policy and management at Columbia University Irving Medical Center.
The consolidation of dental practices further feeds into the growing trend of dental service organizations (DSOs). In 2019, 20.4% of dentists under the age of 35 were affiliated with a DSO, up from 16.3% of dentists in the same age group in 2015.8 On one hand, DSOs offer dentists the power of group purchasing and negotiation. Supplies and materials can be considerably less expensive for large group practices than for small or single-dentist offices. On the other hand, the DSO model comes without the individual control that independent practitioners can exercise.
The number of DSOs is expected to continue growing. More dentists entering the field could choose to begin their careers with DSOs, and older dentists deciding to retire could sell their practices to existing DSOs.
With the DSO model gaining even more traction, the future of small, independent practices is in question. When it is time for Yang to retire, he intends to pass his practice to another solo practitioner. He wants to see the model survive, and he sees a need for different models to coexist in dentistry. “We need a population of dentists who are going to take care of our Medicaid patients. We need a population of dentists who are going to take our PPO patients. We need a population of dentists who do fee-for-service,” said Yang.
Dental students and new dentists will have a significant hand in shaping the office model of the future. Those who went through training during the pandemic have had a significantly different experience than dentists who are already established. Depending on how their education was interrupted, they may be behind on clinical experience, which could influence how they decide to start their careers. While the pandemic is not without impact on new dentists, they will follow in the footsteps of their predecessors and continue to learn through residencies and the early years of practicing. “When it comes to my experience, the real start of my clinical training started when I graduated,” said Freking.
The pandemic isn’t the only factor influencing the decisions new dentists make when it comes to getting into the office. “Students are graduating now owing two to four times what some of us have paid in the past,” said Yang. In 2020, dental students graduated with an average of $304,824 in debt.9 Paying off those loans could make practicing at a DSO, at least initially, more attractive. The financial burden of student loans may make it more difficult to invest in opening or purchasing an independent practice or the technology to update an independent practice.
The payment landscape for dentistry also impacts practice decisions and the future of dental offices. Reimbursement pressure continues. Patient frustration with the cost of dental care could also drive down demand and utilization of dental services.
Additionally, the way payers reimburse dental providers for their services is likely to change. “While fee-for-service payment arrangements are likely to predominate well into the future, paying-for-performance can be expected to increase in dentistry,” said Edelstein. “This is already well underway in medicine and can be expected to impact the dental industry and individual dental practices as well.”
Edelstein anticipates that the rise of value-based care in dentistry could further drive growth of the DSO model. With value being tied to reimbursement, dentists will be expected to play a role in a more holistic approach to patient care. “DSOs can be expected to play ever-greater roles in providing wraparound and business services to dental practices, including access to nutritionists, health educators, social workers and community health workers to help address the full range of oral health determinants and enhance oral health outcomes,” he said.
This shift means dentists will not only be working within their own specialty. They will also begin to communicate more with other healthcare professionals. “Being cognizant of the medical state of the patient and interacting with the patient’s physician team will also be increasingly important,” said Aravamudhan.
Will that evolving environment leave room for solo practices and other smaller independent dental offices? The short answer is likely yes, but it will be a matter of where these practices fit into the dental industry. “[Solo practices and small group practices] will continue to be essential components of the U.S. dental care systems in small and rural locales. They can also be expected to continue in small numbers as concierge practices,” said Edelstein.
While the number of dentists practicing in metropolitan areas is growing, the number practicing in rural areas has remained the same, according to Aravamudhan. Population dynamics and patient preference will also be factors in determining where different office models are located. “Ultimately, the policy environment, preferences of the patient base and demographics of the dentist all contribute to the choice of the practice model,” she said.
How the dental office of the future will look is already being shaped by forces today: technology, payment and changing practice models. Technology will change how dentists perform patient care. New payment models will alter how they interact with patients and model their practices. The rise of DSOs will mean more dentists in group practices and will affect how those who want to remain independent do business. One thing remains certain: dental offices will still be an essential part of healthcare.
Carrie Pallardy is a freelance writer and editor based in Chicago. To comment on this article, email impact@agd.org.
References
1. Estrich, Cameron G., et al. “Estimating Covid-19 Prevalence and Infection Control Practices Among US Dentists.” The Journal of the American Dental Association, vol. 151, no. 11, 2020, pp. 815-824.
2. Munson, Bradley, and Marko Vujicic. “Projected Supply of Dentists in the United States, 2020 – 2040.” American Dental Association Health Policy Institute, ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/hpibrief_0521_1.pdf?rev=cc49e9d4967c4769bd7acb9b698051a0&hash=ABEBC5139499 FB738EC67F5ACD859BBE. Accessed 5 April 2022.
3. “The Dentist Workforce – Key Facts.” American Dental Association Health Policy Institute, February 2021, ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/hpigraphic_0221_1.pdf?rev=1829a4f788c14974a1ac89ff1e288c0f&hash=A27C6AD199EB6FCAB15DB069BAF0CC85. Accessed 5 April 2022.
4. “Dentist Retirement Increase.” American Dental Association Health Policy Institute, March 2022, ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/hpigraphic_dentist_retirements_increase.pdf?rev=5d53bb1d3e2f49a9bafc89f180e276bd&hash=B20737F023C98C81A1B3BDDC1CA7C322. Accessed 5 April 2022.
5. Mah, James. “The Genesis and Development of CBCT for Dentistry.” American Dental Association, dentalacademyofce.com/courses/1808/PDF/TheGenesisandDevelopment.pdf. Accessed 5 April 2022.
6. Rensburg, Conrad. “Printing vs Milling Dentures: Inside Dental Technology.” Inside Dental Technology, 1 Sept. 2020, aegisdentalnetwork.com/idt/2020/09/printing-vs-milling-dentures. Accessed 5 April 2022.
7. “Economic Impact of COVID-19 on the Dental Care Sector.” American Dental Association Health Policy Institute, ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/hpigraphic_dentist_retirements_increase.pdf?rev=5d53bb1d3e2f49a9bafc89f180e276bd&hash=B20737F023C98C81A1B3BDDC1CA7C322. Accessed 5 April 2022.
8. “HPI: Shifting Practice Patterns.” American Dental Association Health Policy Institute, 3 Dec. 2021, ada.org/publications/new-dentist-news/2021/december/hpi-shifting-practice-patterns. Accessed 5 April 2022.
9. Solana, Kimber. “Tackling Student Debt.” American Dental Association, 1 March 2022, ada.org/publications/new-dentist-news/2022/march/tackling-student-debt. Accessed 5 April 2022.
The Impact of the COVID-19 Pandemic
When shutdown orders rolled out around the country to combat the COVID-19 pandemic, dental offices were largely forced to close their doors except for emergency cases. As time wore on, the scientific community learned more about how the virus was spread. Dental offices were able to put in place mitigation strategies, many of which already fit like a glove.
Personal protective equipment (PPE), like gloves and masks, were already commonplace in dentistry. As more information came to light, offices were able to adopt specific kinds of PPE, such as N95 masks. Offices were also able to institute protocols to improve airflow and ventilation.
“We documented through our research1 from the American Dental Association (ADA) Science and Research Institute and Health Policy Institute that COVID-19 prevalence and test positivity rates were low among practicing U.S. dentists after practices adopted the strengthened recommendations around infection control,” said Krishna Aravamudhan, BDS, MS, senior director, Center for Dental Benefits, Coding and Quality, at the ADA Practice Institute.
As COVID cases continue to spike and recede, dental offices have the protocols to keep patients and staff safe. If a different pandemic hits in the future, the dental industry will have a solid foundation to manage and adapt to a new threat. “While each public health crisis will have distinct challenges and unanticipated, unimaginable bumps in the road, we have had a thorough refresher course on the basics of preparedness,” said Aravamudhan.
The COVID-19 pandemic has necessitated more time between patient cases. Some dentists have found that this scheduling approach has allowed them to spend more time with patients and build stronger relationships. “We get to know our patients on a more personal level, and I think that is something that’s going to be positive coming out of the pandemic,” said David K. Yang, DMD, a solo practitioner in Flagstaff, Arizona.
The pandemic has also caused a shift in labor dynamics for many dental offices. “Some dental practices are struggling significantly with staffing shortages, as are other sectors in healthcare and the labor market more generally,” said Aravamudhan. Practices with inadequate staffing have had to reduce capacity.
While offices may be struggling to find dental assistants and hygienists, more dentists are entering the industry,2 a significant number being women.3 However, the number of dentists 55 and older leaving the workforce increased sharply in 2021.4 Shifting labor dynamics and changes in the population of practicing dentists will likely change how practices operate for years to come.
New Technology
Technology is integral to how dentists practice, but new technology takes time to adopt, often due to cost constraints and sometimes resistance to change. Cone beam computed tomography (CBCT) first came onto the dental scene in 1988,5 but it has taken years for this imaging approach to become standard in the field.
When Angelique R. Freking, DDS, FAGD, a dentist practicing in New York, bought her practice, investing in CBCT was one of the first things she did. “I actually had in my business plan to upgrade the panoramic machine to a CBCT because I couldn’t work without it. I didn’t feel clinically responsible working without it,” she said.
It does take time to adopt new technology, but some trends are moving at a faster pace. “It took years, decades even, to go from the early CEREC [chairside economical restoration of esthetic ceramic] and in-office milling to what we have now,” said Marty Jablow, DMD, FAGD, a dentist practicing in Woodbridge, New Jersey. “Digital radiography still took decades to get to the majority of North American offices. Now, we’re starting to see intraoral scanning [adoption] going at a faster rate than either of those.”
Intraoral scanning gathers more information for dentists and gives them more control, according to Jablow. Those benefits, as well as increased efficiency, could be driving its adoption. “I think digital intraoral scanning is growing, and it is going to become just as mainstream as a handpiece at some point,” he said.
Cost is typically one of the factors that slows the introduction of new technology in dental offices. All practices need to perform a return-on-investment analysis, and, often, new technology is just too expensive to justify the cost. But one new technology making headway in dentistry has a relatively low point-of-entry cost: 3D printing. It’s showing significant promise in the industry. The price of milling is $43.18 per denture base, while the price for 3D printing one is $5.95.6
3D printing does have limitations compared to milling. Dentists can currently print night guards, diagnostic wax-ups and temporary crowns, but they cannot print permanent crowns yet. But Freking believes the technology is headed that way.
Dentists are currently purchasing 3D printers to use in-office, and they also have the option of outsourcing to third parties that have the technology. Depending on the type of 3D printer offices are using, fumes from the printing materials and space can be an issue. Once the product is printed, it needs to be washed, cured and polished. “It’s not as simple as printing it and putting it in the patient’s mouth,” said Jablow. Yet, the technology is making strides. New types of resin for printing are emerging at a rapid rate, making 3D printing more and more appealing for dental offices. “Those resins are what is going to change dentistry and make 3D printing easier,” Jablow said.
Artificial intelligence (AI), also known as augmented intelligence, is also shaping the dental office of the future. The technology will likely be used in treatment planning. AI will be able to spot decay in radiographs and help dentists make diagnostic and treatment decisions. The use of AI will be supported by insurance companies. Jablow expects insurance companies will employ AI to weed out fraud — recognizing if the same radiograph has been submitted for reimbursement more than once — and to drive more standardization in dental care.
The pandemic has also played a role in driving technological change in dentistry. “Dentistry has always been a rather technological specialty, but the post-pandemic era might bring more solutions into remote care,” said Bertalan Meskó, PhD, director of The Medical Futurist Institute. With widespread office shutdowns during the pandemic, teledentistry became a vital tool for reaching patients and keeping them out of already overcrowded emergency rooms. While some dental offices have wholeheartedly embraced teledentistry, its use has waned. From April 2020 to July 2020, the number of dentists using remote communication for patient evaluations dropped significantly.7
Dentistry remains a hands-on specialty. Most patient care must be done in the chair. But remote technology has shown promise for triaging patients, postoperative follow-ups and reaching underserved populations. “Teledentistry is perfect for those areas that are underserved where we can get patients in to see some kind of auxiliary, and they can become the eyes and ears while dentists can possibly make that diagnosis remotely,” said Jablow.
The continued use of teledentistry will also depend on how payers approach the technology. “We are seeing a number of third-party payers introduce teledentistry platforms to their beneficiaries and offer additional benefits. So, on the consumer side, this is catching attention, but it seems to be more for triaging emergencies and consults,” said Aravamudhan.
With more technology available, dentists could be empowered to do more work in-house, lessening their reliance on referrals. For example, advances in imaging, coupled with 3D printing that allows dentists to make night guards and temporary crowns, could mean a faster turnaround time for patients and no need to send them to a third party. But technology will only do so much. “The question of whether to refer or not will be a decision that each dentist will continue to make regardless of the technology that is available,” said Aravamudhan.
New technologies come with exciting possibilities, but implementation can be challenging, and not only from a cost perspective. Compatibility among technology is an important element of deciding what to invest in for dental offices. One piece of equipment may lock dentists into a specific brand for the foreseeable future. For example, certain aligner companies only accept scans from specific intraoral scanners. “A lot of the companies that fabricate and develop these technologies become very closed-loop,” said Freking. “How is your choice today going to open or close doors in the future?” She chose her CBCT machine because it was more open source.
In other ways, technology has opened the door wider than ever. Freking points to the role social media has in exposing dentists to new and exciting ideas every day. “I can follow many dentists who are active on social media. They’re sharing what they’re doing, and I think it’s starting to gel into a huge explosion of innovation, excitement and change in dentistry,” she said.
The endless availability of information online has also made it even easier to access new research in dentistry, helping dentists keep learning and honing how their office operates. “There is a significant increase in the number of peer-reviewed research publications coming out in dental materials and dental techniques that have challenged what we thought we knew even 10 years ago,” said Freking.
This proliferation of information is also available to patients, who are becoming increasingly empowered and involved in their healthcare. “Dentists will have to become guides for their patients in the jungle of information and technologies rather than being key holders to the ivory tower of medicine as before,” said Meskó.
The Practice Landscape
The question of investing in new technology and its costs becomes even stickier when dentists look at the future of reimbursement. “It’s very difficult to financially commit to modernization of dental offices when you are beholden to very low fee schedules from dental insurance companies,” said Freking.
This challenge could drive changes in the practice landscape. “Rather than increase fees to pay for more technology, even if reimbursements from insurers are not diminished, in many areas of the country solo dental practitioners will more likely aggregate into larger groups to achieve economies of scale,” said Burton L. Edelstein, MPH, DDS, professor emeritus and special lecturer of dental medicine and health policy and management at Columbia University Irving Medical Center.
The consolidation of dental practices further feeds into the growing trend of dental service organizations (DSOs). In 2019, 20.4% of dentists under the age of 35 were affiliated with a DSO, up from 16.3% of dentists in the same age group in 2015.8 On one hand, DSOs offer dentists the power of group purchasing and negotiation. Supplies and materials can be considerably less expensive for large group practices than for small or single-dentist offices. On the other hand, the DSO model comes without the individual control that independent practitioners can exercise.
The number of DSOs is expected to continue growing. More dentists entering the field could choose to begin their careers with DSOs, and older dentists deciding to retire could sell their practices to existing DSOs.
With the DSO model gaining even more traction, the future of small, independent practices is in question. When it is time for Yang to retire, he intends to pass his practice to another solo practitioner. He wants to see the model survive, and he sees a need for different models to coexist in dentistry. “We need a population of dentists who are going to take care of our Medicaid patients. We need a population of dentists who are going to take our PPO patients. We need a population of dentists who do fee-for-service,” said Yang.
Dental students and new dentists will have a significant hand in shaping the office model of the future. Those who went through training during the pandemic have had a significantly different experience than dentists who are already established. Depending on how their education was interrupted, they may be behind on clinical experience, which could influence how they decide to start their careers. While the pandemic is not without impact on new dentists, they will follow in the footsteps of their predecessors and continue to learn through residencies and the early years of practicing. “When it comes to my experience, the real start of my clinical training started when I graduated,” said Freking.
The pandemic isn’t the only factor influencing the decisions new dentists make when it comes to getting into the office. “Students are graduating now owing two to four times what some of us have paid in the past,” said Yang. In 2020, dental students graduated with an average of $304,824 in debt.9 Paying off those loans could make practicing at a DSO, at least initially, more attractive. The financial burden of student loans may make it more difficult to invest in opening or purchasing an independent practice or the technology to update an independent practice.
The payment landscape for dentistry also impacts practice decisions and the future of dental offices. Reimbursement pressure continues. Patient frustration with the cost of dental care could also drive down demand and utilization of dental services.
Additionally, the way payers reimburse dental providers for their services is likely to change. “While fee-for-service payment arrangements are likely to predominate well into the future, paying-for-performance can be expected to increase in dentistry,” said Edelstein. “This is already well underway in medicine and can be expected to impact the dental industry and individual dental practices as well.”
Edelstein anticipates that the rise of value-based care in dentistry could further drive growth of the DSO model. With value being tied to reimbursement, dentists will be expected to play a role in a more holistic approach to patient care. “DSOs can be expected to play ever-greater roles in providing wraparound and business services to dental practices, including access to nutritionists, health educators, social workers and community health workers to help address the full range of oral health determinants and enhance oral health outcomes,” he said.
This shift means dentists will not only be working within their own specialty. They will also begin to communicate more with other healthcare professionals. “Being cognizant of the medical state of the patient and interacting with the patient’s physician team will also be increasingly important,” said Aravamudhan.
Will that evolving environment leave room for solo practices and other smaller independent dental offices? The short answer is likely yes, but it will be a matter of where these practices fit into the dental industry. “[Solo practices and small group practices] will continue to be essential components of the U.S. dental care systems in small and rural locales. They can also be expected to continue in small numbers as concierge practices,” said Edelstein.
While the number of dentists practicing in metropolitan areas is growing, the number practicing in rural areas has remained the same, according to Aravamudhan. Population dynamics and patient preference will also be factors in determining where different office models are located. “Ultimately, the policy environment, preferences of the patient base and demographics of the dentist all contribute to the choice of the practice model,” she said.
How the dental office of the future will look is already being shaped by forces today: technology, payment and changing practice models. Technology will change how dentists perform patient care. New payment models will alter how they interact with patients and model their practices. The rise of DSOs will mean more dentists in group practices and will affect how those who want to remain independent do business. One thing remains certain: dental offices will still be an essential part of healthcare.
Carrie Pallardy is a freelance writer and editor based in Chicago. To comment on this article, email impact@agd.org.
References
1. Estrich, Cameron G., et al. “Estimating Covid-19 Prevalence and Infection Control Practices Among US Dentists.” The Journal of the American Dental Association, vol. 151, no. 11, 2020, pp. 815-824.
2. Munson, Bradley, and Marko Vujicic. “Projected Supply of Dentists in the United States, 2020 – 2040.” American Dental Association Health Policy Institute, ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/hpibrief_0521_1.pdf?rev=cc49e9d4967c4769bd7acb9b698051a0&hash=ABEBC5139499 FB738EC67F5ACD859BBE. Accessed 5 April 2022.
3. “The Dentist Workforce – Key Facts.” American Dental Association Health Policy Institute, February 2021, ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/hpigraphic_0221_1.pdf?rev=1829a4f788c14974a1ac89ff1e288c0f&hash=A27C6AD199EB6FCAB15DB069BAF0CC85. Accessed 5 April 2022.
4. “Dentist Retirement Increase.” American Dental Association Health Policy Institute, March 2022, ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/hpigraphic_dentist_retirements_increase.pdf?rev=5d53bb1d3e2f49a9bafc89f180e276bd&hash=B20737F023C98C81A1B3BDDC1CA7C322. Accessed 5 April 2022.
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