Dental legislation and policy significantly lags behind how dentistry is actually practiced today, creating friction for providers and often failing to address significant health needs when they arise.
Insurance reimbursements and annual maximums have not seen any meaningful increase in years, legislation is still being written for analog dentistry and public health and insurer policies do not always prioritize long-term dental health for patients.
These dentists and dental executives recently connected with Becker’s to share the largest gaps for dental legislation and how they are operating.
Note: Responses were lightly edited for clarity and length.
Question: Where do you see the biggest disconnect between dental policy decisions and day-to-day clinical reality?
Sara Mahmood, DDS. Founder and CEO of brush365 Dental Group (Dallas): One of the biggest disconnects between dental policy decisions and day-to-day clinical reality is how much administrative burden is created by policies that haven’t kept pace with digital dentistry. Practices are being asked to provide more documentation, more narratives and more justification — often for care that is already clinically obvious — while simultaneously investing in technology that is designed to make care more efficient and predictable.
At the same time, many policies are still written for an analog model of dentistry. Digital impressions, same-day crowns, CBCT-guided procedures and AI-assisted diagnostics are now routine in modern practices, yet policy frameworks frequently fail to recognize or reimburse these workflows appropriately. This creates a paradox where technology improves outcomes and efficiency for patients, but increases friction on the administrative side for providers.
The result is that clinicians and teams spend a disproportionate amount of time managing paperwork instead of delivering care, and practices are forced to absorb the cost of innovation without policy alignment. Until policy evolves to reflect how dentistry is actually practiced today, that gap will continue to strain both providers and the patient experience.
Frank Semo. COO of Oakwood Dental (New York City): Dental policy must be written with the patient at its core — expanding access to care while ensuring providers have the resources necessary to operate financially sustainable practices and serve their local communities without fear of revenue loss per visit.
Since the COVID-19 pandemic, dental practices have faced dramatic increases in labor and overhead costs. At the same time, insurance reimbursement rates have continued to decline, and claims payment timelines have increasingly exceeded mandatory reimbursement windows. These delays and reductions inhibit providers’ ability to deliver consistent, high-quality care and maintain sustainable profit margins needed to serve broader patient populations.
Compounding this issue, major insurance payors are now reducing fee schedules for practices that elect to participate in lower-reimbursing local or state plans. These plans often reimburse at rates below those of traditional PPOs, effectively lowering a practice’s overall reimbursement against UCR (Usual, Customary and Reasonable) fees. While the importance of fair-market auditing and payer cost control is understood, this approach ultimately harms the very patients these plans are intended to serve. Reduced reimbursements force many providers to reconsider in-network participation, which in turn limits patient access to care.
Additionally, employer groups and the insurance carriers they select must allow for more comprehensive coverage of preventive and soft-tissue management services. Patients frequently decline necessary periodontal care, whether in-network or out-of-network, due to significant out-of-pocket costs. Expanding coverage for services such as periodontal maintenance and scaling in the presence of gingival inflammation reduces the need for extensive restorative procedures and typically results in net savings across both dental and medical expenditures.
Patients should not be burdened with the emotional and financial consequences of delayed or deferred care when preventive treatment could improve outcomes, lower long-term costs and preserve access to essential oral health services.
James Willis, DDS. Founder and CEO of Willis & Associates Family Dentistry (Fishersville, Va.): One of the biggest disconnects between dental policy and clinical reality is that dental insurance has moved away from its original purpose of protecting against catastrophic health risk. Annual maximums, often still around $1,000 to $1,500, have not meaningfully changed in decades, despite inflation, advances in care and rising expectations for outcomes.
From the perspective of a growing, dentist-led organization, this is a clear policy choice with real clinical consequences. Patients regularly present with active disease but are constrained by outdated benefit caps that limit their ability to complete appropriate treatment. As a result, care is delayed, fragmented or compromised, not because of clinical judgment, but because of benefit design.
Dental policy today prioritizes cost containment and administrative simplicity over long-term oral health. If we want better access, better outcomes and lower downstream costs, policy must realign with how dentistry is actually practiced and with the original intent of insurance: enabling patients to address significant health needs when they arise.
