Millions of people can’t afford dental care, and the consequences are devastating for consumers and dental practices alike.

According to the United States Census Bureau, “Adults ages 19 to 34 had the highest uninsured rates of any age group in the United States.” In part, this explains why more than a quarter of adults aged 20-44 live with untreated dental caries, and 35 percent of adults over 18 haven’t visited a dentist in the past year.

Meanwhile, according to an Accenture healthcare consumer survey, younger people are less likely to find value in traditional healthcare models than their contemporaries. Interestingly, this isn’t just a young person’s problem. Nearly 50 percent of Americans over 65 lack traditional dental insurance and haven’t visited the dentist in the past year.

With dental practice revenues expected to drop by 20 percent in 2021, new dental solutions can cater to these consumers, helping practices thrive even in a challenging environment. Specifically, providing dental consumers with transparent pricing, compelling payment models, and personalized patient insights can drive revenues and improve dental outcomes.

#1 Pricing Transparency

The healthcare sector is experiencing a reckoning with pricing with profound implications for dental practices. 

For instance, a novel federal law brought pricing transparency to hospital patients, requiring hospitals to post the prices negotiated with insurance companies. This reflects shifting consumer sentiment that views healthcare as a consumer good subject to the same price efficiencies that drive other sectors, making products and services more affordable for more people.

Dental practices can attract and retain consumers by getting ahead of this trend, offering unparalleled pricing transparency that allows more people to select and pursue the services they want or need.

As one industry professional explains, “Diversifying who you do business with can help grow a dental practice too. Diversifying supplier options has a few great benefits to dental practices, but first and foremost is transparency.”

Embracing price transparency cultivates trust within patient communities, and, when paired with novel payment structures, allows consumers to choose the procedures that matter most to their oral health.

#2 Subscription-based Payment Options 

Subscription-based payment options, powered by a round of tech startups, allow dental practices to couple pricing transparency with unique payment models that cater to younger and older generations unable to attain employer-sponsored healthcare or Medicare, respectively. That’s why several large dental service organizations, including Heartland Dental, Smile Brands Inc., MB2 Dental, NADG, and many more offer dental subscription plans to their patients.

Subscription-based payment options don’t have to replace existing insurance payment models, but they can supplement these offerings, allowing dental practices to reach more patients on their terms.

In addition, practices can consider offering professionally administered membership plans with exclusive member pricing arrangements, earned rewards, and other financial incentives that encourage people to regularly invest in their oral health.

While the particular member fees and discounts will look different for each dental practice, membership plans create uniquely personal and financial connections between dental practices and consumers, encouraging loyalty and enhancing profitability.

#3 Personalized Consumer Experience

Today’s consumers expect a personal and connected experience in every context, and dental providers should work to meet those expectations with their digital platforms. 

For starters, create member dashboards that provide patients with easy access to their dental care priorities while allowing them to self-schedule or communicate with a team member using live chat functionality. Meanwhile, practices can capitalize on consumers’ mobile-first mentality, providing push notifications and other features that increase engagement and drive revenue growth.

Most importantly, a personalized consumer experience is about communication, which undergirds any thriving dental practices. As the American Dental Association (ADA) reminds practices, “Your ability to communicate with patients impacts their perception of your practice. Managing that perception is critical to providing patients with ethical, personalized, high-quality care that maintains, or improves, their oral health and their overall health and well-being.”

Digital platforms provide an easy and accessible way for practices to personalize the consumer experience, enhancing communication and patient outcome along the way.

Conclusion

Last year, dental practice revenue declined by six percent as millions of people lost their employer-sponsored health insurance, delayed semi-annual appointments, and reprioritized dental procedures as part of their overall healthcare spending. Now, dental practices can provide a compelling opportunity to re-engage with these consumers while simultaneously appealing to a new generation and an older cohort of dental consumers ready for new solutions. 

ABOUT THE AUTHOR

Eric Johnson is the founder and CEO of membersy, a digital health company democratizing access to quality, affordable dental care through subscription-based dentistry. While building his career in the dental care space, Eric founded membersy in 2015 with the mission of helping dental professionals take back the dental care narrative from big insurance companies through pricing transparency and a personalized membership experience for patients. For more information, please visit membersy.com.

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An innovative article published today in the British Dental Journal defends the permissibility of biological human enhancement to fall within to proper domain of dentistry, exploring topics that have never been discussed in the dental science literature before.

The natural norm of human dentition is to produce only two sets of teeth that will be lost over time. Oral diseases such as dental caries and periodontitis are widely prevalent in the human species, therefore it could be argued that there is still no consensus on what the natural state of human oral health biology is. The article discusses a growing interest in the development of novel biological interventions that might, in the future used to prevent the onset, or even cure these conditions.

Caries and periodontitis develop as a result of a gene-environmental interaction. Incidence of these diseases have increased over the years because of the modification of human diet (environment). As a response, adaptation to human behaviour (oral hygiene habits) have been implemented to control the environmental factors contributing to the development of these diseases. However, the “gene” part of it, has not been well explored on the pursue to oral health and managing these diseases.

Lead author Dr Vitor Neves from King’s College London explains: “Since untreated carious lesions and periodontitis are, still, amongst the top six most common diseases that affects humans worldwide, it is important to further explore other permissible ways to eradicate these conditions.”

In the opinion piece, “Beyond oral hygiene, are capacity-altering biologically based interventions within the moral domain of dentistry?”, the authors discuss the ethical issues regarding the use of biological human enhancement as a tool to contribute to eliminating these common oral diseases.

The authors argue that dentistry should seek the prevention and cure of dental caries and periodontitis using novel, biological capacity-altering interventions, in view of considerations of wellbeing and consistency with accepted dental practices.

The paper can be viewed here: https://www.nature.com/articles/s41415-021-3335-y

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Children with limited exposure to fluoridated water and a high sugar intake are 70% more likely to develop cavities in their permanent teeth, according to a team of Australian researchers.

The study of 24,664 Australian children raised particular concerns, said Loc Do, PhD, professor in dental public health and research chair at the University of Queensland School of Dentistry.

“The coverage of water fluoridation in Queensland is the lowest in the country, while our intake of free sugars is among the highest,” Do said.

“We hope these results will convince policymakers in jurisdictions without fluoridated water to implement this effective and cost-saving community measure,” he continued.

“We also hope to see the promotion of healthy behaviors like reducing the intake of sugars, which would both improve dental health and help prevent other conditions such as obesity,” he said.

More than half of the 5- to 14-year-olds in the study were considered to have either low exposure to fluoridation (less than 25 of their life) or medium exposure (between 25% and 75% of their life).

Also, approximately 60% of the children analyzed consumed four or more daily servings of food or drinks high in free sugars.

Those who consumed more than four daily servings of high-sugar food or drinks but with high exposure to fluoridation were 40% less likely to develop cavities in their baby teeth than those with low or medium fluoridation.

Those with a diet rich in sugars but with high exposure to fluoridation were 50% less likely to develop cavities in adult teeth than those with lower levels of fluoridation.

It was well known that dental cavities are largely preventable, water fluoridation was effective, and high free-sugar intake was detrimental to child dental health, said lead author Diep Ha, PhD, a research fellow at the University of Queensland School of Dentistry.

“These facts are not surprising or new, but the results from almost 25,000 young people in this study show there is still a need to address these issues to improve child dental health in Australia,” said Ha.

“To achieve maximum prevention of dental decay, lack of exposure to fluoridated water and high intake of sugars should be targeted,” said Ha.

The research used data collected in the National Child Oral Health Study 2012-14, funded by a National Health and Medical Research Council Partnership Grant to the University of Adelaide and a collaboration with state/territory dental health services.

The study, “Excess Risk of Dental Caries from Higher Free Sugars Intake Combined with Low Exposure to Water Fluoridation,” was published by the Journal of Dental Research.

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The Australian Dental Association’s New South Wales (ADA NSW) chapter said it supports the Australian Medical Association’s call for a tax on sugary drinks to help safeguard the oral health and overall well-being of millions of Australians.

“Tooth decay is one of the most common chronic diseases in Australia and worldwide and is the second most costly diet-related disease in Australia. Consuming too much sugar is one of the main factors causing tooth decay and other oral health issues,” said ADA NSW president Dr. Kathleen Matthews.

According to the ADA NSW, 26% of all children and adults between the ages of 5 and 64 experience untreated tooth decay in one or more of their teeth. Spending on dental services accounts for approximately 20% of total health expenditures by individuals. Also, dental conditions account for the highest number of potentially preventable hospitalizations in children between the ages of 5 and 9.

“Almost one in two Australian adults and more than two-thirds of Australian children are consuming too much free sugar. Sugar-sweetened beverages (SSBs) are the largest source of added sugars in the Australian diet. Drinking a can of soft drink each day will significantly increase the risk of tooth decay and dental erosion,” said Matthews.

“There can be as much as 17 teaspoons of sugar in an energy drink. You wouldn’t dream of consuming that much sugar in one go. Why drink it?” Matthews said.

Young Australians consume particularly high numbers of SSBs, the ADA NSW said, especially males between the ages of 12 and 24. The prevalence of SSB consumption is higher among lower socioeconomic groups, with availability, price, and marketing all having a significant influence.

“ADA NSW has previously called for a tax on SSBs as part of a comprehensive program aimed at educating the public to limit their consumption of such drinks,” she said.

“A price increase from a 20% levy could provide an additional $400 million in government revenue and could help fund a public education campaign informing healthier purchasing and dietary habits, especially aimed at children,” she said.

“A levy would reduce consumption of SSBs and help lead to sustained reductions in the incidence of diabetes, cardiovascular diseases, and some cancers, resulting in thousands of healthy life years and millions of dollars saved in healthcare costs,” she said.

“ADA NSW welcomes the AMA’s proposals for a sugar tax and calls on the federal government to follow the example of dozens of countries across the globe and implement a sugar tax to help improve health outcomes for all Australians,” she said.

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As June marks National Migraine and Headache Awareness Month, DentalPlans.com said that oral health plays a role in migraines and headaches and is encouraging people to take care of their head, smile, and overall health.

Migraines and headaches are different, DentalPlans.com said, both can be triggered by some of the same things, including but not limited to stress, alcohol, overindulgence or withdrawal from caffeine, bright sunlight, dehydration, blood sugar fluctuations, and weather changes.

Oral health issues that can be treated by dentists also can impact migraines and headaches, DentalPlans.com said, including:

• Loose, missing, or misaligned teeth: These conditions force jaw muscles to work harder to bring teeth together, swallow, and even keep the mouth closed. This can lead to persistent muscle inflammation that can trigger a migraine or headache.
• Tooth grinding and jaw clenching: This can cause muscle and gum inflammation, triggering migraines and headaches. While tooth grinding often is related to stress, a “bad bite,” or teeth that aren’t properly aligned, also can result in tooth grinding.
• Tooth decay: A throbbing toothache can trigger a migraine or headache.
• Temporomandibular disorders (TMDs): It is unclear whether TMDs cause migraines or whether migraines are what triggers pain in the jaw and teeth of those with TMD issues. Either way, research shows that treating such underlying oral health issues can reduce the frequency and severity of the associated headaches and migraines.

Dentists can treat all of these conditions, but people who experience frequent, severe, or new head pain should speak with their primary doctor as soon as possible, DentalPlans.com said. Primary doctors can work with patients to understand the cause of the pain and develop a plan to manage it. If oral health plays a role in the pain, doctors can refer patients to a dentist who specializes in head pain.

“Research continues to show that dental health plays an important role in overall health, including having the power to cause or worsen headaches and migraines,” said Jenn Stoll, chief commercial officer at DentalPlans.com.

“While dentists can certainly treat oral health issues causing headaches/migraines after the fact, preventive care such as regular dental checkups can help uncover those issues earlier and treat them before they start to cause pain in your mouth or head,” Stoll said. “Preventive care is so important, so be sure you don’t skip those appointments.”

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The American Association of Endodontists (AAE) has released a new position statement in support of vital pulp therapy, which preserves the vitality and function of the dental pulp after injury resulting from trauma, caries, or restorative procedures.

These procedures already have been widely accepted as an option for treating injured pulps in adult teeth that do not yet have fully formed roots, the AAE said.

The AAE supports vital pulp therapy as a treatment option that providers may offer their patients for adult teeth with injured pulps and fully formed roots. Previously, only root canal therapy or extraction may have been considered for these teeth.

Notably, the AAE said, the statement supports complete caries removal, with the feasibility of vital pulp therapy determined by direct inspection of the exposed dental pulp. It also address, among other considerations, the selection of biomaterials and permanent restoration.

In developing its position statement, the AAE said that a dedicated special committee based its recommendations on many recent studies demonstrating a high rate of success for these procedures in properly selected cases.

While the statement is presented from the perspective of the specialty of endodontics, the AAE said, its recommendations may be useful to any practitioner in assessing his or her ability to provide vital pulp therapy for the benefit of patients.

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The University of the Pacific Arthur A. Dugoni School of Dentistry has launched a San Francisco Bay Area public service ad campaign to raise awareness that dental care is an essential part of overall health.

“The mouth is a window into the health of the body, and research continues to show the connections between oral health and overall health,” said Dr. Nader A. Nadershahi, dean of the school.

“For example, a growing set of evidence has linked oral conditions, particularly periodontal (gum) disease, to several chronic diseases, including diabetes, heart disease, and stroke,” Nadershahi said.

“Preventive dental care can reduce the complications of other diseases and prevent more serious and costly dental and medical conditions down the road,” he continued.

“As the Bay Area continues to reopen, we want to encourage people to get back on track with ongoing care and visit their oral healthcare professionals,” he said.

The initial theme of the public messages is the importance of children’s oral health, pointing out that dental cavities are the number one chronic disease among California’s children.

Posters were installed across San Francisco’s Muni and San Mateo County’s SamTrans public transit systems to run during the summer.

As ridership starts to increase with the local economy reopening, the school said, the posters will be a visible reminder about keeping mouths healthy and about the school’s dental clinics, which serve the public.

Each year, nearly 18,000 patients of all ages receive care at the clinics, which are located in downtown San Francisco, the school said. 

Dugoni’s marketing and communications team worked to secure advertising space at no cost to the school thanks to the transit agencies’ pro bono PSA program for nonprofit organizations.

The school also is working on additional messaging opportunities to run across online, local television, and other Bay Area media outlets this summer and fall.

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As we begin to approach herd immunity from the COVID-19 pandemic, more and more dental offices across the United States are reporting that practice volume is starting to return to normal. In a March 15 poll by the ADA Health Policy Institute (ADA HPI), approximately 60% of practices said they were open for business as usual, but reported lower volumes than before the pandemic.

As patients become vaccinated, the fear of going to the dental office should diminish. There is a significant proportion of Americans who have delayed needed dental treatment since the pandemic started, creating a backlog of needed dental care that will need to be scheduled in the near future.

Moreover, USA Today has reported a dramatic uptick in stress-related dental conditions during the pandemic, which has significantly increased the numbers of fractured teeth due to stress and increased bruxism.

Coupled with the persistent increase in unemployment in some sectors of the economy, and the loss of dental insurance coverage or budgetary constraints, it will take the dental profession some considerable time to return to pre-pandemic levels of patient care.

The Need for Phased Treatment Planning

To help patients with their dental needs from a restorative and economic perspective, the application of phased treatment planning is a good approach to patient care for someone who hasn’t been in for over a year, or possibly even longer.  

From a periodontal health point of view, most patients who have not been in the office for more than a year will need more than a prophy. Using the D4346 or D4355 ADA CDT code may be appropriate for them.

Re-establishing periodontal health in your patients of record is the ideal place to start when they return. This in effect will help them understand that oral health is essential health and that preventive maintenance in the long run is less costly than sporadic care.

For a new patient who may or may not have had any significant dental work in previous years, a phased treatment plan approach is the rational mode of treatment, prioritizing dental treatment in the following manner:

• Treatment of teeth causing pain, swelling, and/or infection on an immediate or emergency basis with extractions or endodontic treatment depending on restorability and patient finances.
• Caries control by treating restorations that are deepest first and that may result in immediate or future endodontic treatment. Less severe or incipient caries can then be treated after periodontal therapy if a comprehensive exam is done at this time, and sequencing of restorative and periodontal treatment can be established at this time using the existing dental software the office uses.
• A comprehensive periodontal exam, followed by a periodontal evaluation, and diagnosis of the current periodontal condition as mentioned above, with recommended treatment appointments and future preventive maintenance visits pre-appointed.
• Completion of more comprehensive dental treatment such as crowns and/or implants after the patient has shown satisfactory improvements in their oral hygiene regimen.

Because of the pandemic, some patients might not accept immediate treatment, or they may slow treatment down due to finances. These financing limits must be considered. The phased treatment plan gives you the flexibility to take care of the most urgent needs first and then follow up with more comprehensive treatment as the financial position of the patient improves.

According to a new survey from Bankrate.com, just 39% of Americans can afford a $1,000 unexpected expense. In 2020, 41% of respondents said they could afford an unexpected $1,000 bill, while 40% said the same in 2019.

By judicious use of healthcare financing through third parties, the phased treatment plan can assist with payments over the time of treatment. Patients appreciate that you have their best interests in mind when you recognize that the pandemic may have caused financial hardship and/or loss of dental benefits due to workforce layoffs or elimination of jobs in the marketplace.

As we return to more normal living due to vaccinations and herd immunity, patients will return to dental offices, and they will be most satisfied with offices that empathize with their current financial condition. This will help guide them to better oral health by utilizing a phased treatment approach that is formulated for each individual’s needs and budget.

Dr. Huot is the founder of Beachside Dental Consultants. He has lectured on topics such as leadership issues, transitioning to an insurance-free practice, common sense office design, proper insurance coding, financial planning, and buying and selling dental practices. His articles have been featured in Dentistry Today, ADA News, and other dental journals. He retired from the US Air Force Reserve Dental Corps after 30 years of military duty. He also served on active duty from 1982 to 1985. He was a private practice owner from 1985 to 2008 and still practices clinical dentistry. Also, he has been a member of multiple dental organizations, serving in many leadership positions, including vice president of the ADA. Dr. Huot is a Fellow in the American College of Dentists, the International College of Dentists, the Academy of General Dentistry, and the Pierre Fauchard Academy as well. He can be reached at drhuot@militarydentist.com.

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A dental survey of three-year-olds in England has revealed drastic inequalities, according to the Oral Health Foundation (OHF), which believes that community water fluoridation is essential to bridging the gap and is calling on the government to act.

The Public Health England survey investigated nearly 20,000 three-year-olds from across the country and found that 10.7% of them already have tooth decay. On average, each child had three decayed teeth.

Also, the survey highlights regional differences. Three-year-olds living in the Yorkshire and Humber area are more than twice as likely to experience tooth decay (14.7%) as children living in the east of England (6.7%).

OHF president Dr. Ben Atkins believes these statistics highlight an urgent need to address the oral health of children in the country and would like the government to do more.

“These statistics are worrying indeed, especially when looking at the stark regional differences. The last survey of this nature was carried out in 2013, and since then very little progress has been made,” Atkins said.

“This stagnation is due to a lack of action and clear direction from government, both at a local and national level, when it comes to addressing oral health inequalities in the UK,” he said.

“As a charity, we believe that community water fluoridation holds the key to improving the oral health of children up and down the country,” he said.

“Under new NHS reform plans announced earlier this year, the government pledged to take back control of community water fluoridation in order to make the process of implementing schemes both more efficient and less costly,” he said.

“We need to hold the government accountable for this and hope that in years to come, we will see more and more community water fluoridation schemes,” he said.

Fluoride has been researched extensively for decades now and has been found time and time again to be very effective in protecting teeth from decay and erosion, the OHF said.

When added into the water supply, studies have shown that community water fluoridation can reduce tooth decay but up to 35%, the OHF continued.

The OHF believes that water fluoridation would be especially effective for those living in more deprived areas where access to dental care may be limited.

The report also revealed that children living in the most deprived areas of the country were almost three times as likely (16.6%) to experience tooth decay as those living in the least deprived areas (5.9%).

Atkins said that while the nation waits to see improvements made, everyone can take steps to improve their oral health by following a strong oral health routine at home.

“There is still a lot of work to be done when it comes to addressing oral health inequalities in this country,” he said.

“However, while we strive towards that goal, we would encourage everyone, including children, to brush their teeth with a fluoride toothpaste for two minutes twice a day,” he said.

“This, along with cleaning in between your teeth daily, can set you and your children up with a healthy smile for life,” he said.

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More than 45 million British adults are at an increased risk of tooth decay, according to the Oral Health Foundation (OHF) and Colgate-Palmolive Dental Caries Awareness Survey, which found that 84% of all adults in the United Kingdom fall into groups that put them at higher risk of the disease.

Additionally, the survey found that 21% of Brits have moderate to high sugar diets, 21% have not visited the dentist in the last two years, and 19% do not brush their teeth twice a day, all of which increase their changes of developing tooth decay, which can lead to expensive fillings, root canal treatment, or tooth extractions.

Meanwhile, the OHF notes that the latest data from National Health Service (NHS) Digital shows there are 9.7 million band-two treatments in England each year, including fillings, tooth canal work, and extractions.

Dr. Nigel Carter, OBE, chief executive of the OHF, said that tooth decay can have a devastating effect on a person’s quality of life and more must be done to reduce the number of people affected by the disease.

“Tooth decay remains the most common chronic disease in the UK, yet it is entirely preventable. Anybody can suffer from tooth decay, but there are a few things that can increase the risk,” Carter said.

“Tooth decay is caused by poor oral hygiene, as well as eating or drinking too much sugar too often. It is also linked with not having regular dental checkups,” Carter said.

“Those on medications containing sugar or that cause dry mouth can also put a person at greater risk. We also know that diabetics and orthodontic patients are also more likely to have tooth decay. Together, these make up a significant proportion of the population,” said Carter.

“In its early stages, tooth decay can cause mild pain, but in extreme cases it can have a debilitating impact on a person’s life. For a better quality of life, it is critical to know how to identify tooth decay in the early stages or prevent it from happening at all,” he said.

Toothache and tooth sensitivity to sweet things are two of the most likely signs of tooth decay. Dark spots on the surfaces of the teeth and an unpleasant taste in the mouth are further signs to look out for, the OHF said.

“If anybody falls into one of the high-risk groups or notices the early signs of tooth decay, they should book an appointment with their dental team for an assessment,” said Carter. “They will be able to help somebody lower their risk and offer a range of different options for preventing and treating tooth decay at home or while at work, one of which may be prescribing a high-fluoride toothpaste.”

In the United Kingdom, approximately eight in 10 adults have one or more teeth with decay, that are filled, or have been pulled out due to decay, according to the Office for National Statistics Adult Dental Health Survey. It also is extremely common in children, with more than one in five showing signs of tooth decay.

To help more people identify their risk of tooth decay and how to spot the early warning signs, the OHF has partnered with Colgate-Palmolive to launch “The Truth About Tooth Decay,” which provides advice for preventing the disease.

“The best way to prevent tooth decay is by brushing the teeth thoroughly last thing at night and at least one other time during the day, with a 1,450-ppm fluoride toothpaste. This should take around two minutes,” said Emanuele Cotroneo, scientific affairs project manager at Colgate.

“When brushing, make sure the inner, outer, and biting surfaces of the teeth are brushed carefully, and remember to brush along the gumline. Using interdental brushes, or dental floss or tap, also helps to remove plaque and food from between the teeth. These are areas an ordinary toothbrush can’t reach. Daily use of a fluoride mouthwash in between brushing can also help,” Cotroneo said.

The OHF also offers its Dental Helpline, which provides free advice by phone at 01788 539780 and by email at helpline@dentalhealth.org.

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