Demand for dental implants is growing despite economic challenges facing patients, according to Richard Hall, the president and CEO of U.S. Oral Surgery Management.
USOSM is a management services organization supporting oral surgery practices in 29 states.
Mr. Hall recently spoke with Becker’s to discuss challenges facing oral surgeons, and where the oral surgery field is headed.
Editor’s note: These responses were lightly edited for length and clarity.
Question: What are some of the bigger challenges you’ve seen facing oral surgeons so far this year?
Richard Hall: What we’re seeing so far this year is a continuation of the market being a little softer. Coming out of last year, we saw the market being soft, and I think that’s continuing in 2025. Last year, it was pretty well known that general dentistry was only slightly up and orthodontia was flat or down. We’re a 90% referral-based specialty, so we rely on patients going to general dentists and other specialists and ultimately being referred to us for the oral surgery care they need. So, we’re continuing to see some softness in the market in that regard. Implants are actually up a little bit from the prior year. So, that’s kind of a contradictory trend when you think about the overall macro market conditions in the economy in general. You would think that implants, which tend to be a little bit more discretionary by nature, would be the first affected, but that doesn’t appear to be the case thus far this year.
Q: What might be causing implantology to be seeing more growth this year in comparison to other specialties?
RH: I don’t know for sure. I think implants are becoming the standard of care for tooth replacement overall. If you do have a need to replace a tooth, many people are opting to go with the more permanent solution of an implant versus crown and bridge. The other thing is, depending on where the implant is, if it’s a front tooth or one that’s going to be seen, it’s a cosmetic decision in addition to a treatment decision. So, I think those are the two things that are driving it more than anything else.
Q: What changes have you seen with patient expectations?
RH: With patients being consumers, I think they’re continuing to ratchet up their expectations around their total service experience, and that starts taking place the minute they walk into an office until the time they leave, and what kind of care they received and the quality outcome they expected. It also includes how they were scheduled, how their appointment setting went, were they offered financing, were they communicated with clearly and followed up with? All those things that make up a good patient experience are becoming more and more important. They’ve always been important, but I think today’s consumers have a higher expectation than perhaps they did even two or three years ago. Slowly but surely, patients are becoming more aware of how their oral health directly impacts their systemic health. Many times patients look at their oral health and their overall health in two different silos, but I think the bridge is starting to be built more strongly between the two, and more people are beginning to understand that.
Q: How are some of the macroeconomic challenges affecting the oral surgery field, and how are oral surgeons responding?
RH: When I think about our practices, some of the costs are going up, so we’re trying to do what we can to offset those cost increases by increasing fee schedules where possible, modestly, but still covering the increased costs. It’s not just about the labor expense and compensation anymore. When you’re competing with a workforce that is still largely remote, you have to make sure your culture at the office is one that they want to be a part of and want to continue to support, so training and other fringe benefits not covered in compensation, are being implemented at some of our practices, and that’s to deal with the ever-increasing needs of the labor market.
Q: What do you see as being the next frontier for innovation in oral and maxillofacial surgery?
RH: There are a number of them. Obviously, on the technology side, you have robotics, AI [and] 3D printing of prosthetics. The expansion overall of in-office laboratories I think is something we’ll continue to see develop within our specialty. I think we’ll see more cosmetic work being done. Board-certified oral and maxillofacial surgeons are capable of doing cosmetic surgery above the clavicle. They really are the experts when it comes to facial reconstruction, so I think we’ll see an evolution toward more of that work [and] med spa-type treatments, etc. In certain markets, I think you’ll see a growing orthognathic practice. Most of that is done in the hospital today, but it can certainly be done in outpatient surgery centers as well. Last but not least, we started OMS Centers of Excellence with third-party accreditation to really differentiate certain OMS practices from others with a Centers of Excellence designation that should be important to their referral sources, to patients and even payers over time.
Q: What are some trends in oral and maxillofacial surgery that people aren’t talking about enough?
RH: There are two. One I mentioned already with consumer education around how your oral health directly impacts your overall systemic health. I’d love to see more focus on that. Secondly, educating the consumer about the difference in expertise, skill and quality between a board-certified oral surgeon and a general dentist. In many states, if not most states, a general dentist can do extractions. They can do implants. They don’t necessarily have the same level of training and expertise as an oral surgeon, and they’re not going to do it under general deep sedation in their office as an oral surgeon does, but they can do that work. In most cases, the consumer doesn’t always understand the difference between a general dentist and an oral surgeon and what that means relative to the experience they may have.
Q: What is making you both nervous and excited about the OMS field right now?
RH: The thing that makes me excited about it is that we’re in a unique specialty. A large percentage of our doctors are double degrees, so they went to both dental school and medical school. They have one foot in dentistry and one foot in general medicine, so that makes things unique. As a result of that, and the skill set they bring along with them, there is going to be a continued need for the type of work they do that nobody else can do. The demand is going to continue to be there for well qualified oral surgeons. The other thing I’m concerned about is the scarcity of talent. There are only 230 or so oral surgeons exiting residency programs each year. They’re in short supply. They’re in very high demand, and companies like ours that continue to grow at an accelerated pace rely heavily on our ability to be able to recruit them. We’re investing heavily in surgeon recruitment, and we’re doing well there today, but it’s an area that continues to be a challenge and a concern for us.
Q: What do you think is causing the short supply of oral surgeons?
RH: We’ve talked with all of the residency programs. There are about 90 or so residency programs around the country. Increasing capacity is a significant challenge for them because they don’t have qualified training in most cases, or they don’t have the budget to expand those programs. So, the number of residents they’re able to train per year is relatively stagnant. I think the last statistic I saw was that the specialty was only projected to grow about 1% as it relates to the number of surgeons over the next decade. So OMS is going to be relatively stagnant as it relates to the number of surgeons, but when you look at the enrollments of dental school students and orthodontia and other specialties, they’re growing significantly more. So … you have referral sources that are significantly expanding and that are going to be referring to a fairly stagnant base of oral surgeons. That tells you that the demand is going to be extremely strong for those types of services.