Expanding scope-of-practice for dental hygienists, assistants and therapists, updating the dental insurance and reimbursement space and strengthening the dental workforce pipeline are just a few of the policy changes that dentists and dental service organization executives want to see implemented.
Dentistry has yet to build the allied health workforce infrastructure medicine created around physician assistants and nurse practitioners, leaving structural gaps in the dental workforce
Executives said that the current dental insurance system is still built for procedures over patients, and reimbursements haven’t kept pace with the cost of delivering care.
The 25 leaders featured in this article are speaking at Becker’s 2026 Fall Future of Dentistry Roundtable, set for Sept. 14-15 at the Hilton Chicago.
If you work at a DSO or dental practice and would like to be considered as a speaker, please contact Scott King at sking@beckershealthcare.com.
Note: Responses have been lightly edited for clarity and length.
Question: What is one policy or scope-of-practice change that would transform dental care delivery?
Hamza Asumah, MD. Director, Operations of Juniper Services (Sparks, Nev.): The single highest-leverage change would be the broad adoption and reimbursement of providers who can deliver routine restorative and preventive care under a dentist’s supervision, much as nurse practitioners and physician assistants do in medicine. Coming from a medical and public-health background, I’ve watched these types of providers dramatically expand access in underserved communities without compromising quality, and the dental evidence from the states and tribal programs that already use therapists points the same way. It would extend care into the rural and lower-income populations that dentists have never been able to reach economically, while freeing dentists to focus on the complex, higher-value procedures only they can perform. The workforce shortage we keep trying to hire our way out of is partly a scope problem: we’ve concentrated every clinical task in the most expensive, hardest-to-recruit provider. Expanding the team’s clinical ceiling, and for expanded-function assistants and hygienists — is how dentistry finally matches the access model medicine built decades ago.
Murat Ayik, DDS. Partner, Specialty1 Partners (Houston): The policy change with the greatest potential to transform dentistry is ending the artificial separation between oral health and overall health. Better integration would improve access to care, allow medical and dental providers to coordinate treatment more effectively and ensure oral healthcare is appropriately covered and reimbursed. Ultimately, that means getting patients to the right provider earlier and improving both oral and overall health outcomes.
Jeremy Behar. Founder and CEO of Canadian Dental Services (Toronto): If we could change one thing, it would be to expand the scope of practice for dental hygienists and other appropriately trained dental professionals, allowing them to deliver more care independently within a dentist-led clinical model.
Dentistry continues to face significant capacity constraints, yet too much of our delivery model still depends on the dentist performing — or directly overseeing — services that other highly trained clinicians could safely provide. At CDS, our strategy is to build team-based, multi-provider practices where every clinician operates at the highest level of their training and capability, supported by strong systems, technology and centralized infrastructure. Expanding scope would increase access, improve affordability, create more fulfilling career paths for dental professionals and allow dentists to concentrate their time on more complex clinical care. This would be very similar to the medical industry, where the advent of NPs and PAs has enabled the system to open up to cover more patients across communities.
Ultimately, it would help us achieve what we believe the future of dentistry requires: more productive, accessible and patient-centered practices that can care for significantly more people without compromising quality.
Aditya Desai, DDS. Chief Clinical Officer of Familia Dental (Clovis, N.M.): As we are increasingly aware, the disparity in access to healthcare continues to widen, particularly in underserved communities where patients have limited access to dental care. From the perspective of these communities, I believe several strategies could help address this challenge:
- Increase the dental workforce by expanding the number of dental schools and, importantly, finding ways to reduce the cost of dental education. Increasing the number of qualified providers is essential to meeting the growing demand for care.
- Improve state reimbursement for dental services. This does not necessarily have to result in a significant increase in taxpayer spending. A more strategic approach could involve improving reimbursement for high-impact procedures, reassessing certain coverage limitations and directing resources toward services that have the greatest impact on prevention and overall health. Where appropriate, expanding coverage to additional necessary procedures could also improve access.
- Consider a period of service in underserved communities. Students graduating from state-supported dental schools could be required (or strongly incentivized) to provide one to two years of service in underserved areas. Because these graduates often benefit from significantly lower tuition than students attending private institutions, a service commitment could provide a meaningful return to the communities that helped support their education. At the same time, new graduates would gain valuable clinical experience through higher patient volumes and exposure to a broader range of treatment needs.
- Create a more accessible pathway for internationally trained dentists. Given the shortage of healthcare professionals, including dentists, dental hygienists and dental assistants, there may be an opportunity to allow qualified internationally trained dentists to provide a limited scope of services under appropriate supervision and within clearly defined guidelines. This could be limited only in underserved areas and for a defined period, with appropriate training, credentialing and oversight.
I recognize that each of these proposals presents significant regulatory, financial, educational and political challenges. The fourth option is particularly complicated because of immigration and visa requirements. However, if our primary objective is truly to improve access to care, we may need to consider solutions that are outside the traditional framework. Sometimes leadership requires us to make difficult decisions and challenge the status quo. If we continue to approach the problem in the same way, the communities with the greatest need may continue to suffer the most.
Joseph Feldsien. Senior Vice President, Integrated Care of PDS Health (Henderson, Nev.): The big opportunity is for dentistry to continue to step into the medical integrated space. Billing medical for BP, A1C and saliva will make a massive impact on patient health and lowering costs of overall care. Dentistry is uniquely positioned as a “brick-and-mortar” healthcare solution. This is key as much of healthcare is moving remote. Dentistry holds a key to the successful change of health outcomes in this country.
Eva Frelix. COO of Krengel Dental (Bloomington, Minn.): One change that would meaningfully transform the health and dental care delivery system is allowing dentists to order sleep studies directly for patients presenting with clinical signs of obstructive sleep apnea.
Dentists are often the first clinicians to spot the warning signs of OSA, sometimes years before a patient ever raises the issue with a physician. Under current rules, most states require a physician to order the sleep study, even when the dentist is the one who initially recommended it. That handoff adds a referral, a separate appointment and often weeks of waiting. This is the time in which an already undiagnosed condition keeps doing damage to a patient’s systemic health.
Allowing dentists to order the test directly wouldn’t replace physician involvement in treatment; it would just close the gap between screening and diagnosis. It’s a natural extension of what dentists already do. The result would be fewer patients falling through the cracks between “your dentist is concerned” and “you finally got tested,” and a real dent in a condition that costs the U.S. healthcare system tens of billions of dollars a year.
Jay Glazer. Director, Business Development of DC Dental (Baltimore): Authorizing dental therapists through state scope-of-practice reform and direct Medicaid billing policies is one of the most transformative changes in oral healthcare.
Richard Hall. Chairman of the Board of US Oral Surgery Management (Irving, Texas): Establishing more universal regulations on scope of practice for general dentists. Consumers are confused as scope of practice is loosely defined and regulated by the states.
Sherry Hassler. COO and EOS Integrator of Today’s Dental Nebraska (Omaha): One major shift is the implementation of the Dentist & Dental Hygienist Compact, which simplifies out-of-state licensing and allows us to recruit and onboard clinicians much faster. Additionally, expanding the scope of practice for dental assistants and hygienists through expanded-function permits significantly helps dental teams increase chair-time efficiency and patient throughput.
Haim Haviv. CEO of Hudson Dental (New York City): Expanding and standardizing the scope of practice for properly trained expanded-function dental auxiliaries could materially transform dental care delivery. Dentists should remain responsible for diagnosis and treatment planning, but many routine, reversible procedures can safely be delegated to qualified team members under appropriate supervision. That would allow dentists to focus on higher-acuity care, increase the number of patients a practice can serve and make dental care more accessible without sacrificing quality. The current state-by-state patchwork unnecessarily limits that opportunity.
Geith Kallas. CEO of Smile Maker’s Dental Center (Tysons Corner, Va.): Ending state control of licensure is the single highest-leverage change in dentistry. Medicine figured this out. Nursing figured this out with the Interstate Medical Licensure Compact. Dentistry is the last holdout. Ending state control means one national license, like a medical board: licensed to practice anywhere in America.
Why this transforms delivery overnight: With national licensure, the shortage isn’t solved, but it is distributed. Surplus in one state fills the deficit in another within weeks, not years. It solves the reality of dentists practicing in two neighboring states or covering multiple locations across state lines. It also unlocks innovation. Teledentistry, mobile dentistry and AI diagnostics all require the dentist to be licensed where the patient is, not where the dentist is. How do you scale remote review of scans or a central specialist supporting 100 offices if that specialist needs 50 separate licenses?
If a national license replaced state licenses,then dental hygienist and dental assistant shortages become a logistics problem, not a terminal problem; DSOs and groups can finally staff to need; teledentistry and mobile models can actually scale; foreign-trained dentists only need one federal pathway, not 50 state fights; and freedom to move between states allows dentists to serve in shortage areas.
Eric Kukucka. Vice President, Clinical Removable Prosthetics and Design Technologies of The Aspen Group (Chicago): I’d love to see supervision requirements for digital scan quality review modernized to match the technology. Right now, inconsistent state-by-state rules on who can review and sign off on digital impressions and scans force a lot of workflows into slow, multi-day loops, even though real-time review is technically possible today but very limited in its efficacy. At Aspen Dental, we already combine AI-assisted scan review with dedicated clinical staff who confirm the findings, so we’ve seen firsthand that faster review doesn’t have to come at the expense of clinical judgment.
If qualified, calibrated reviewers and AI functionality could perform scan QC under general rather than direct supervision, we could catch errors before the patient ever leaves the chair instead of days later, cutting remakes, turnaround time and unnecessary second appointments. That single change wouldn’t reduce clinical oversight — it would enable the oversight to happen at the speed the technology already allows — which is where the real transformation in patient experience and access would come from.
Paul Kim. CEO of Planet Smile Partners (Hastings-On-Hudson, N.Y.): Employing dentist-led general supervision of advanced practice providers will transform care delivery and provide access to care across the country. I believe that this one scope-of practice change will lower costs and meet the demands of rural and urban dental needs. Although more dental schools are opening and expanding throughout the country, new dentists are not practicing in these areas of great need.
Alix Laurain. CEO of Viridian Dental Partners (Nashville, Tenn.): I’d fundamentally modernize the dental insurance model, which hasn’t kept pace with the cost or complexity of delivering care. Too often, insurance limitations dictate the scope or timing of treatment more than what is clinically appropriate for the patient. A model that functions more like true insurance — supporting prevention and early intervention while providing meaningful coverage when significant treatment is needed — would allow providers to deliver a broader, more comprehensive continuum of care. Better aligning reimbursement with clinical need could meaningfully improve both access and long-term outcomes.
Trevor Lines, DDS. Director of Specialty Integration of Platinum Dental (West Jordan, Utah): The biggest transformation to dental care delivery policy change could bring would be the creation of a new role that sits between hygienist and dental assistant to provide essentially healthy patients truly prophylactic care. Hygienists are healthcare providers specializing in periodontal therapy who currently often practice well below the top of their license. Elevating their status from tooth polisher to periodontal therapist would completely transform the public’s understanding of periodontal health and maintenance as well as the oral-systemic connection. This policy change would also allow the alleviation of the severe constriction in hygienist supply many markets have experienced since the pandemic.
Ian Miller. Strategic Growth Consultant of Cal Dental USA (Los Angeles): If I could change one thing in dental care delivery, it would be to make patient-centricity the operating standard — not the marketing slogan. We’re entering an era of AI, automation, staff shortages and enormous pressure to put the spreadsheet ahead of the patient. All good things … until the patient starts feeling like row 47 on that spreadsheet. We can automate texts, answer phones with AI and analyze 700 [key performance indicators] before breakfast, but here’s the inconvenient little detail: Mrs. Jones is still a human being. And humans buy from people and organizations they trust.
That’s why social proof has become so important. Companies like Birdeye helped practices understand the power of reviews and reputation. Newer platforms like Dentreel are taking it further with actual patient video testimonials. There’s a huge difference between your website saying, “We provide exceptional patient-centered care,” and an actual patient looking into a camera and saying, “These people changed my life.” One is marketing. The other is proof.
Use AI. Measure everything. Improve efficiency. But never forget who’s sitting in the chair. AI can start the conversation. Data can identify the opportunity. But trust closes the case. And last time I checked, trust still doesn’t have an API.
Jaleh Pourhamidi, DMD. COO of Today’s Dental Network (Tampa, Fla.): If I could change one thing, I would change the way we reimburse dental care. Our system still largely rewards procedures rather than prevention and long-term oral health outcomes. Imagine if the economics were better aligned around keeping patients healthy — preventing disease progression, improving periodontal health and intervening earlier — rather than primarily paying once treatment becomes necessary. That shift would change not only how we practice dentistry, but how we staff, use technology and engage patients over their lifetime.
Francesca Pregano. COO of Smile Makers Dental Center (Tysons Corner, Va.): If I could change one policy, it would be to standardize dental assistant training and expanded functions nationwide and make those credentials recognized across state lines.
Right now, dental assisting looks completely different depending on where you practice. Some states have very specific training and credentialing requirements, while others have very few requirements to enter the field. The functions an experienced, highly trained dental assistant can perform also vary significantly from state to state.
From an operational standpoint, I see this as one of the biggest workforce challenges facing dentistry. We talk a lot about the hygiene shortage, but I believe the dental assistant shortage is an even greater bottleneck. The issue isn’t that people aren’t interested in working in dentistry. We see the interest. The problem is that we don’t have enough properly trained people or a consistent pathway to develop them into skilled dental professionals.
I would like to see a national standard for dental assistant training, with additional certifications that allow assistants to perform expanded functions as they gain education, experience and competency. If someone has completed the appropriate training and demonstrated that they can safely perform those functions, those qualifications should be recognized across state lines.
This isn’t about lowering standards or simply allowing dental assistants to do more. It’s about raising the standard of training, creating consistency and building a real career pathway for the dental assistant workforce.
Dentistry is behind traditional medicine in this area. Medicine has created structured pathways for allied health professionals with different levels of training and responsibility. That allows physicians to delegate appropriately and focus their time where their expertise is most needed. Dentistry needs to build that same type of workforce infrastructure.
For a dental organization, having a stronger, better-trained assisting workforce directly impacts how efficiently we can deliver care, how effectively we can use our doctors’ time and ultimately how many patients we can serve.
If we standardize training, expand the functions qualified dental assistants can perform and recognize those qualifications across state lines, we aren’t just addressing a staffing shortage. We’re increasing the capacity of the dental workforce and improving access to quality care.
Hoss Said. CEO of Massoumi Dental Corporation (Chula Vista, Calif.): The greatest clinical value in dentistry is still the human relationship between the dentist, the dental team and the patient. Technology can give us better information, earlier detection and stronger preventive options, but ultimately the patient needs to feel that they are in the right hands. Transparency — taking the time to explain what we see, what the options are and why treatment may or may not be necessary — is what creates trust. When we combine that trust with modern technology and a strong focus on prevention, we are not simply treating dental problems; we are building long-term relationships and improving the patient’s overall experience and health.
Vilas Sastry, DMD. CEO of Teledentistry.com (Las Vegas): In the coming months to years, I foresee that we are going to experience a seismic shift in terms of how we attract patients to our offices. Traditional SEO and social media marketing are out, and we as healthcare professionals will have to contend with the AI-educated individual. The “google doctor” patients we used to encounter will now be replaced with “ChatGPT doctor” patients who will be better informed about their choices and the outcomes they want from their treatment. It’s on us as professionals to be able to deliver care in a way that is consistent with this evolving trend and meet the demands of society at large.
Kady Schloesser, DMD, Pediatric Dentist and Founder, Sprout Dental (Lake Ariel, Pa.): Expand dental therapist licensure nationwide, but limit their practice to designated underserved areas with a demonstrated shortage of dental providers. Dental therapists could provide preventive and basic restorative care within a defined scope of practice, while referring more complex treatment to dentists. This would expand the dental workforce and improve access to care in communities that need it most, without creating unnecessary competition with general dentists in areas that are already adequately served.
Alex Sharp, DDS. CEO of Shared Practices Group (Scottsdale, Ariz.): Over the years, I’ve developed a deep passion for dental education. Preparing the next generation of dental professionals to have an immense impact on their patients is mission-critical for our profession. But that impact is tough for most dentists to achieve in the midst of what I feel is an extreme challenge to our industry: the dire shortage of dental hygienists.
Most styles of dental practice revolve around the provision of dental hygiene services. Patients reliably visit their dentists twice per year for exams, X-rays and cleanings. As a result, these visits often serve as the cornerstone services provided by dental practices — both from the perspective of the patient (helped along by most dental insurances covering these services) and from the perspective of the dentist (since visits serve as recurring revenue and as built-in opportunities to present treatment needs).
But this long-standing set of norms exists on a faulty foundation. More dental schools open each year, yet dental hygiene programs aren’t keeping up with current market demand. Dental hygiene wages have skyrocketed post-COVID-19, largely due to the demand for dental hygienists far outpacing the supply. More dentists are performing hygiene procedures than has been the case in decades.
What’s the solution? Opening up more spots in hygiene programs would be the straightforward path. But why would these programs graduate more hygienists when they could make more revenue per student by graduating dentists?
My creative solution, then, is to expand the scope of practice for certified and registered dental assistants, allowing assistants to scale supragingivally while hygienists work subgingivally and perform SRP. If the shortage of hygienists continues, the industry will increasingly feel the strain of the unmet demand.
Bill Simon, DMD. Owner of City Smiles (Chicago): There is certainly more than one answer to that question. In my mind, the policy or scope-of-practice change that would perhaps transform dental care delivery the most is value-based care. While value-based care does exist today in limited applications, a broader permeation of that approach to reimbursement in our industry would create a paradigm shift whose implications at this point in time are not completely understood.
Curtis Swogger. CEO of North Pittsburgh Oral Surgery (Pittsburgh): Dental and medical insurance still operate as two separate gates to patient care. This continues to be the roadblock for access to care, especially in underserved communities. A patient referred out of a rural clinic for a specialty need hits the same wall the referring dentist did. Low reimbursement rates and the lack of coordinated care hinder provider expansion to these communities. While groups like PDS Health look to close that gap on the clinical side with the “mouth-body connection,” treating the mouth and the body as one patient instead of two systems, insurance hasn’t made that same move. That solves coordination, but not reimbursement. One example of policy change would be treating adult dental as an essential health benefit alongside medical coverage. A patient’s needs don’t stop when they become an adult. That kind of change from payers would help close the gap and move this issue from two gates to one.
Mariz Tanious, DDS. Chief Dental Officer of Affinity Dental Management (Holyoke, Mass.): Expand dental therapists’ scope and allow properly trained hygienists to diagnose within a dentist-led care model. That keeps patients with one team from screening and prevention through treatment and follow-up, rather than losing them in the referral process. Dentists can stay focused on complex planning and procedures, while the broader team delivers timely routine care. The payoff is simple: earlier intervention, fewer missed handoffs and better continuity of care.
At the Becker's 5th Annual Future of Dentistry Roundtable, taking place September 14-15 in Chicago, dental leaders and executives will gain insights into emerging technologies, practice growth strategies and the evolving landscape of dental care delivery, with a focus on innovation, patient experience and operational excellence. Apply for complimentary registration now.
