Some of the challenges holding the dentistry industry back from advancing further include rising costs, student loan debt and insurance reimbursements, according to those in the industry.
Six dentists recently spoke with Becker’s to discuss how these issues are affecting practitioners.
Editor’s note: Responses are lightly edited for length and clarity.
Question: What factors are holding dentistry back from further growth and innovation?
Mike Davis, DDS. Dentist at Smiles of Sante Fe (Albuquerque, N.M.): Growth and innovation are stifled in an environment of uncertainty and fear. Two major factors are contributing to this unfortunate situation.
Firstly, outrageous levels of student loan debt are weeding out a broader base of professional applicants. I am not talking about gender or race. I mean self-reliant risk takers. Such persons come from multiple backgrounds, and today are less likely to seek dentistry as a career. The risk-to-reward ratio is less favorable than previous times.
Secondly, the insurance industry has placed the breaks on earnings potentials in many demographics. Digital advancements are beneficial to patients and practitioners alike. Unfortunately, in an insurance-focused dental business model, many positive innovations are cost prohibitive.
Bradley Dykstra, DDS. Founder, CEO and Clinical Director of MI Smiles Dental Group (Hudsonville, Mich.): I believe there are a few possible factors holding dentistry back from further growth. The uncertainty of the economy right now, will there be a recession, what will the tariffs be and how will that affect our costs, will people cut back on spending, etc. The higher cost of capital and escalating wage pressure also have an effect on the decision-making process.
Louis Malcmacher, DDS. President of the American Academy of Facial Esthetics: One of the biggest factors holding dentistry back from greater growth and innovation is its heavy reliance on insurance reimbursements, which often undervalue services and limit the adoption of advanced procedures. It is hard to believe that many dental insurances still have a $1,000 per year limit.
Many practices are caught in a cycle of high-volume, low-margin care just to stay profitable, leaving little room for investment in new technologies or expanded services available to patients.
Dental school debt discourages many young dentists from taking entrepreneurial risks or adopting innovative business models early in their careers.
The lack of business and marketing training leaves many dentists unprepared to pivot their practices toward emerging high-demand, fee-for-service areas.
Dentists can turn this around by investing in advanced training for these high demand, self-pay patient treatments like Botox and fillers, which their patients are already paying for and getting elsewhere. The American Academy of Facial Esthetics has trained thousands of dental professionals who have integrated Botox and fillers into their practices. On average, this can add an additional $32,500 per month of injectable services on top of their current monthly production, according to an AAFE member survey from June 2024.
The bottom line is the biggest factor holding dentistry back is dentists. Dentists can control their own future by investing in themselves by learning elective esthetic treatments like Botox and fillers that patients want. Once a dentist controls their own future, nothing will hold them back.
Patrick McGann, DDS. McGann Family Dental (Lake Elmo, Minn.): Finances. Inflation is still a problem, staff salaries keep rising (especially for hygienists due to the continuing shortage), and the costs of materials and equipment continue to climb. I’m afraid even if the tariff situation resolves, the cost of products will not revert back to pre-tariff levels. That just seems to be the nature of marketplace dynamics. Dental school tuition and costs keep setting new records, and new graduates are spending the bulk of their careers just servicing their debt. Meanwhile, insurance companies continue to offer meager incremental gains in reimbursement. Dental manufacturers can offer the greatest products and most innovative devices, but if nobody can afford them, then growth and innovation will stagnate.
This financial squeeze has led to a consolidation in dentistry — fewer privately-owned practices and more large-group practices. The large-group practices tend to not invest in the more innovative equipment due to the high cost and the need to cater to every dentist equally in the system. Not every dentist in a large group is comfortable offering in-office crowns. Not every dentist in a large group is comfortable reading CBCT images. The management of these groups is therefore not going to spend millions of dollars to outfit every location with equipment such as this if their providers aren’t going to grant them universal acceptance.
Todd Sarubin, DDS. Dentist at Sarubin Family Dental (Pikesville, Md.): As a three-generation dental practice in Baltimore for over 65 years, I have seen all the ups and downs in the practice of dentistry. I still believe it is the best profession and we do very well in helping our patients attain beautiful healthy smiles.
The biggest issue that we have that permeates our life on a constant basis is dental insurance. The joke is that they call themselves insurance companies. They are not at all insurance companies. Medical insurance, as bad as it is, truly is insurance. Dental insurance is just a small maximum amount of dollars provided to patients per year without concern for their well-being. Many procedures are denied, paid at a lower rate or not covered. They try to dictate the services we provide and make it hard to invest in new equipment or hiring and keeping good staff.
If we could get a handle on these companies, especially the PPOs, then we could provide more services, better services and grow our practices so that we can help everyone, even those who are downtrodden and can’t afford dental care.
Stacey Verkler, DDS. Knellinger Dental Excellence (Palm Harbor, Fla.): One of the biggest factors holding dentistry back from further growth and innovation is the excessive amount of time wasted dealing with insurance companies. These companies often operate without accountability, engaging in anti-competitive practices that harm both providers and patients. They delay reimbursements, deny necessary treatments and impose arbitrary rules that interfere with clinical decisions. This puts a significant strain on small dental businesses, making it harder for them to compete, thrive or invest in innovative technologies and patient care improvements.
