Eight practicing dentists weigh in on the most important business and clinical trends impacting the dental field.
Leila Jahangiri, DMD, BDS, MMSC, Clinical Professor, Chairperson, Prosthodontics, New York College of Dentistry:
• Decay or cavities as a "transmittable disease." Very few people know this, but it is true.
• Esthetics and no preparation laminates, has some limitations.
• Salivary diagnostic tests, the research area, will be a very hot topic. In the current climate of infectious disease this could be of a high interest.
• Old age and dry mouth; multiple medications is a big cause.
Edita Outericka, DMD, Dynamic Dental (Mansfield, Mass.): There are some interesting changes and trends in dentistry that affect both
business and clinical treatment. With the advent of the Affordable Care Act, there are many new types of dental insurance available to patients. Because there is no standardization in dental fees or dental coverage, treatment is more difficult to financially plan for.
Oftentimes the insurance company representatives are confused by the plans. This can be frustrating for a patient and can delay treatment while waiting for pre-treatment estimates. It is advisable to take the time to fully understand the insurance prior to presenting a treatment plan. This can be time-consuming but understand, the patient is very unlikely to have any idea of how their insurance functions.
From a clinical perspective, treatment is delayed and if the provider does not follow up, care is less likely to be administered. Putting off treatment can lead to bigger issues such as added patient costs and patient annoyance. Understanding and explaining insurance coverage information to the patient or insured party is an important new role dental workers must learn to accept.
Justin Philipp, DMD, Centers for Family & Cosmetic Dentistry (Chandler, Ariz.): On the business side, I would say the decline in the number of insured [is the biggest issue]. It decreases every year so does the quality of the insurance. The insurance companies are harder to work with every year. They deny more claims that should be paid based on covered benefits. If the trend continues dental insurance will be a thing of the past. The rise of corporate dentistry [is also an issue]. These are for-profit chains driven by investor demand for a return. The quality of care and materials used are not in the control of the dentist who works at these chains. Profit is put before care. Some states have laws blocking these chains and some do not.
On the clinical side, we can replace missing teeth and return patients to health and function with dental implants. There have been other advancements as well in imaging: digital x-rays, and scanning technology faster and better fitting crowns. New crown material is nearly
impossible to break.
Oral cancer testing is here and it is reliable and affordable. It allows us to catch it in stage one and two, which will greatly increase survival rates. Currently oral cancer is seen with the naked eye in stage three and four; the survival rate is only five years. Oral cancer is not associated with traditional risk factors anyone over 30 should be tested once a year. It is four times more prevalent than cervical cancer, which of course almost every woman is tested for once a year.
Harvey S. Shiffman, DDS, Boynton Laser Dental Center (Boynton Beach, Fla.): Several issues are of prime importance to practicing 
dentists. These include the rapidly shrinking insurance reimbursements from both corporate and private policies. Dental maximums have not changed much in almost 40 years, while the cost of services, supplies, staff and lab costs have sky rocketed.
The rapidly changing technology such as lasers, 3-D printing and 3-D CT imaging causes a quandary for many practicing dentists. Should they follow the technology or keep the status quo? We have always personally followed the technology as it helps improve the patients' dental experience. New graduates are dealing with the highest levels of indebtedness ever and the cost of opening a new practice make it prohibitive. Corporate dentistry (chain clinics) hire over 10 percent of new grads because of this.
Maureen Raczka, DDS, and Timothy Raczka, DDS, Alliance Dentistry (Cary, N.C.): Dealing with insurance companies is a daily challenge for dentists. Whether it is explaining benefit coverage to patients or trying to collect payment from insurance carriers, it can often be quite frustrating. As healthcare providers, we are committed to diagnosing dental problems and offering the best treatment options to our patients. Unfortunately, ideal treatment is too frequently abandoned because insurance will pay only a small portion of the fee or not at all. Patients are discouraged when discovering that their 
coverage will pay more for the silver filling they do not want and less for the white filling that they do want.
Also troublesome is managing those with insurance plans and those without insurance. With PPOs, dentists are obligated to accept established fees for common procedures. Typically these fees are significantly lower than the normal fees charged, meaning uninsured patients are forced to pay more for the same procedure than those in preferred provider plans. Add to that the differences in fees paid to in-network versus out-of-network dentists, and you can be left with your head spinning.
Timothy Stirneman, DDS, All Smiles Dental (Algonquin, Ill.): The rise of corporate dentistry is one of the biggest issues facing dentists today. It's going to get harder and harder for smaller, single dentist offices to survive, the reason being that larger dental firms that are contracted with insurance companies as preferred providers are able to negotiate higher fee schedules than sole practitioners are able to.
Smaller dental offices also are typically not able to offer expanded hours and services like corporate offices can. Why is this important? Our culture is moving towards wanting the latest and greatest available as well as wanting it to be available immediately. If a dental practice only has two exam chairs and someone needs a crown done immediately the sole practitioner may not be able to accommodate that patient whereas the larger practice can.
Another major issue for dentists currently surrounds finding ways for patients to pay for their dental treatment. Being able to process insurance claims effectively and efficiently is going to continue to be increasingly important for patients as well as coming up with creative ways to help patients pay for whatever insurance plans don't cover. Two examples of these are in-office dental savings plans and third party financial services.
Mark S. Wolff, DDS, PhD, Professor and Chair, Associate Dean for Pre-Doctoral Clinical Education, Department of Cariology
and Comprehensive Care, New York University College of Dentistry: Two of the greatest healthcare/business challenges facing dentistry are very closely related. As new technologies and techniques emerge, ranging from new diagnostic and preventive techniques to the newest high tech materials and methods, dentistry faces the challenge of educating the public as to why these new technologies are to their advantage and educating third party payers as to the wisdom of covering these expenses.
Two examples are provided here:
Modern implant dentistry is nearly 40 years old at this time. It is well proven and successful clinically, yet many patients still do not understand its benefits over other tooth restoration techniques and even more important, third party coverage for these procedures is just starting to come in to the marketplace.
Preventive dentistry with fluorides, sealants and caries management by risk assessment has long been accepted in children's dental care. Yet, when the same exact principles of management are applied to the adult, particularly the elderly, utilizing fluoride varnishes, sealants and products to reverse early decay, third party payment is unavailable.
These same issues confront dentistry with such treatments as tooth colored restorations, partial coverage tooth restorations (rather than crowns), CAD/CAM, pharmacological management of periodontal conditions, tobacco cessation therapy and other technologies/treatments
The lack of a business model that includes third party payment for new technologies often leaves patients with the thought that these technologies are untested, unproven and experimental so in their mind they may not be worth the personal investment. Without a compensation model, dentists are resistant to including these time-, tooth- and life-saving therapies into their practice. This trend often interferes with a dentist's ability to improve oral health and general health outcomes for their patients.