Laura Dorr is the former executive editor of DPR's Modern Dental Network and a regular contributing author.

Laura Dorr

Competing with the Corporate Dental Chains. Photo courtesy of rudall30/stock.adobe.com. 


Chain dentistry, the bane of the independent dentist’s existence. Just say the words “corporate dentistry” and you’re bound to get an eye roll or a scowl from many independent practitioners, who find themselves competing with these mega-chains. These low-fee, high-volume practices that attract patients with the promise of low costs have taken the dental world by storm and popped up on seemingly every corner, with new practices opening practically every day.

While that may seem like an exaggeration (and perhaps it is a bit melodramatic), there’s no denying the corporate-dentistry trend is growing. As of July 2018, dental chains with over 100 locations comprised between seven and 12 percent of dental practices in the United States, while practices with three to 100 locations made up an additional approximate 12 percent.

 And this trend is likely to continue as younger dentists join the field; one American Dental Association Health Policy Institute study found that while 7.4 percent of practicing dentists in the U.S. were affiliated with a dental service organization, the number jumped to 16.3 percent for newer dentists ages 21 to 34.

 And the pandemic did independent practices no favors: Many dentists, put under significant pressure, decided to sell their practices.

So, while corporate chains are often seen as the greedy overlords, devouring individual practices and posing a threat to the traditional standard of independent practices, they clearly hold an attraction—or at least offer valuable solutions—to some dentists. Part of this appeal stems from the benefits they can provide for clinicians, particularly those starting out.

“There seems to be an almost unlimited amount of money available to the corporate entities funded by private equity,” Michael Goldberg, DDS, chief strategist for Practice Perfect Systems, says. “This gives the corporates the upper hand, because they can offer sign-on bonuses or some loan repayment plans. So, employment through a corporate entity can be a lot more enticing financially for newer dentists than with a smaller fee-for-service or independent practice, which can’t afford to offer those bonuses.”

In addition to offering financial benefits to dentists looking to pay off student loans, corporate dentistry presents dentists with the opportunity to focus on what they do best: Dentistry. Many dentists, Dr Goldberg says, aren’t entrepreneurs, while corporate entities focus on the bottom line.

“The promise of the corporate world is ‘doctor, you want to do dentistry. You’re not a businessman. We’re going to allow you to do what you want to do’,” Dr Goldberg says. “And different corporations fulfill that promise in different ways. Some doctors are happy with the arrangements, some are not.”

While this provides a good solution for some doctors, it puts the ones interested in maintaining ownership of their own practice in a bit of a bind. In order to compete, these doctors need to focus on the business approach, including things like marketing, practice management, and patient retention. This poses challenges for many dentists who have, until now, primarily focused on dentistry rather than entrepreneurship. So, how can independent dentists survive?

It starts with identifying your target market.

“A big concern for private practice is the added competition to acquire and retain patients,” Greg Pellegrom, cofounder and chief executive officer of SmileSnap says. “The reality is though, there are plenty of people out there wanting and needing dental services but don’t pursue treatment for a variety of reasons. Private practices just need to evaluate who they want their target market to be within their geographic area and focus on that audience.

“You need to know who your patient avatar is,” he says. “You need to define what your unique selling proposition or unique value proposition is so you can answer the question of why a patient should come to you rather than going to another dental practice. Those need to be really, really, well-defined, solidified, and communicated appropriately through your marketing.”

One way to convince patients to come to you over a competitor is to offer something the competitor cannot. This means finding a niche in your area that hasn’t already been filled, such as offering specialized services or care that the big chains don’t.

“One of the keys if you're looking to compete with somebody is go where they can't,” Dr Goldberg explains. He recommends looking into incorporating specialty care such as dental sleep medicine, TMJ, oral-systemic therapies, or even same-day treatments into a general practice.

“Things like TMJ or dental-sleep medicine are things that, in general, the big corporate practices don't do well—at least not across the entire spectrum of their offices or their practices,” Dr Goldberg says. “So, these become areas where private practices can compete with corporate.”

The bottom line is that small practices simply can’t compete with the marketing budgets of corporate chains, so competing for the same patients through traditional marketing may be a waste of money and energy.

“You can't hope to outspend an Aspen or Heartland Dental,” Dr Goldberg says. “But you can compete, if you look at these smaller niches and smaller problems, and focus on marketing around that.”

Once you’ve acquired patients, the next step is to retain them.

Focus on keeping the patients that you have,” Dr Goldberg says. “One of the fears is that people are going to leave your practice to go to the big new shiny corporate office on the block. And I think it's imperative for doctors today to do better internal marketing so they retain the patients that they have.”

The first step in effective internal marketing is to identify what your patients are looking for, and how you can provide services that appeals to them. Private practices can offer a more familiar, personalized patient experience than corporate chains that often have high dentist turnover rates since many dentists don’t have ownership stakes in the office. Patients looking to have a relationship with their clinician will shy away from corporate chains, which opens the door for the private practice. This may mean personalized, trust-based communications, like an email newsletter exploring timely topics with a personal touch, or being easily accessible to patients and ensuring the patient experience is streamlined and simple.

“For me, it’s all about the patient experience,” Pellegrom says. “Provide effective communication through text messaging, utilize digital forms with e-signatures, offer virtual consultations and visits where applicable—in other words, respect [the patient’s] time and don’t over complicate their life. Remember, Amazon patented the 1-click button and not the 2-click button.”

Once you’ve solidified relationships with your current patients, use their loyalty to your advantage. While it may seem awkward to encourage referrals, a satisfied patient is a great tool for practice promotion. Ensure your patients know you are accepting new patients, and encourage them to let their friends and family know about your practice.

“Our practice thrives because we get new patients referred by existing patients,” Dr Goldberg says. “You should be asking your patients for referrals. It sounds basic, but I think it's something dentists sometimes just don't feel comfortable doing—and they need to.”

When it comes to referrals, patients aren’t the only resources. Building solid relationships with colleagues in the dental and medical communities can increase referrals and bring new patients to your chair. Offering niche services or partnering with a medical professional for oral-systemic health issues can open the door for industry referrals.

“I would say a good portion of my non-internal referrals came from physician referrals,” Dr Goldberg says. “I became known as sort of the go-to person for anyone that had any kind of medical issues. These referrals were great for no-cost patient acquisition. It’s something I think is valuable enough that we (Practice Perfect Systems) actually teach dentists how to implement the physician-referral program.”

In addition to referrals, practices should also work on converting leads. While this sounds like a headache, technology is making it easier than ever. Online portals for scheduling, teledentistry options, and automated communications ensure that patients can easily and conveniently connect with your practice, making them more likely to actually end up in your chair.

“The easiest way to provide greater access for new patients is having a way for them to engage with you from anywhere at any time,” Pellegrom says. “Offering a virtual consultation component on your website is the perfect solution for any consumer to begin the discovery process to a new dentist or dental service they are interested in.”

Virtual consultation platforms such as SmileSnap allow practices to conduct virtual appointments, which can help translate online consumers to actual patients, increasing case-acceptance rates and successfully converting leads. Patients need a simple and quick way to engage, Pellegrom says, and online platforms can connect patients to your practice wherever they are and whenever they want.

“This can also save doctors time and frustration, by delivering patients that are qualified, informed, and ready to accept treatment,” he says. “It’s a win-win scenario.”

While connecting with patients is critical, it will all be for naught without a plan for capitalizing on that growth. This is where a consultant or business coach can come in handy. Clinicians should identify where their strengths and weaknesses lie, and then work with someone to make a plan for future practice growth and maintenance.

“I think it's invaluable today to work with someone more business-minded who can point dentists in the right direction,” Dr Goldberg says. “You want to wake up in the morning and enjoy going to work. So, you need to figure out what that enjoyment looks like. And then strategize as to what tactics you might need to employ to get you to where you want to go. And that's again where I think somebody who has a broader vision and experience like a coach or consultant has a place, because they can help with the strategizing.”

While face of the future dental market is still unclear, private practices shouldn’t give up just yet. The playing field is vast, and with good patient care, strategic marketing, and quality practice management, there’s no reason smaller practices offering high-level care can’t compete with low-fee giants. After all, Pellegrom says, there are plenty of fish in the sea, looking for different things.

“The real question is, how do we tap into the tens of millions of Americans that don’t regularly see a dentist,” Pellegrom says. “The top 3 reasons people don’t see a dentist are cost, time, and fear. As an industry we need to find ways to overcome these barriers by being more transparent on fees, providing greater convenience, and educating the public on the advancements in dental technology. Together, we can grow the size of the pie, as a whole rather than continuing to compete over the same size pie, and that is how everyone wins.

1. Dental Practice Transitions: Consolidation vs. Sole Proprietors.” Henry Schein, 17 July 2018, dentalpracticetransitions.henryschein.com/blog-dental-practice-transitions-consolidation-vs-solo-practitioners.

2. Garvin J. HPI: 7.4 percent of U.S. dentists are affiliated with dental service organizations. 

. March 07, 2017. https://www.ada.org/en/publications/ada-news/2017-archive/march/hpi-7-4-percent-of-us-dentists-are-affiliated-with-dental-service-organizations

Articles

How corporate chains are getting into dentistry and what it means for individual practices.

Competing with the Corporate Dental Chains

Flex patient communication software is a collection of tools that are designed to simplify practice workflow and improve the patient experience. It is said to eliminate complicated interfaces and integrations, helping to modernize patient communication, reduce workloads, increase treatment acceptance, and more. Flex features treatment planning, paperless forms, phone integrations, online scheduling, patient payments, and more.

Dentistry is generally straightforward—practice management, sometimes, not so much. With so many options for practice management software—many of which don’t play nice with others—it can be hard to find solutions that integrate seamlessly into your practice workflow.

Austin Vetter, DDS, found himself in this boat. He tried numerous practice management software platforms but couldn’t find one that met all his practice’s needs. In fall 2020, he converted to Open Dental and was immediately impressed. “I saw the efficiencies I was missing with other software,” Dr Vetter says. “The fact that Flex was heavily integrated was a huge reason as well.”

Easily customizable, Flex’s tools pair seamlessly and are fully integrated with Open Dental. Features like treatment planning, patient communication, intake and medical history forms, and payment integration gives practices the ability to control all aspects of their workflow from 1 platform.

“From online scheduling and paperless forms and consents to paperless treatment plans with automatic posting of the accounts, Flex has created this efficient workflow that requires very little auditing,” Dr Vetter says. “The program does the heavy lifting.”

After what he cites as a minimal learning curve for him and his team, Dr Vetter found that some of the features simplified his workflow. Treatment plans can be created in just a few clicks, and once a plan is saved in Open Dental, it is immediately available in Flex. This allows clinicians to easily show patients the detailed breakdown of their treatment, from appointment schedules to insurance information.

Customizable payment options and plans can also be created on the spot. Once a patient selects their preferred payment option, Flex can create a payment plan, tokenize the patient’s credit card, and auto set up the payment so a team member doesn’t have to babysit financial transactions.

“The treatment planning and financials really stand out to me,” Dr Vetter says. “[Since incorporating the software], I have found that my team is much more willing to talk about financials. I don’t think there’s a single software doing it this easily and in this fashion. A brand-new employee can truly walk through complete financing with a patient. Even my hygienists are discussing crown appointments and collecting down payments.”

This flexibility means that if team members are busy with other patients or front office tasks, any team member can collect co-pays, allowing appointments to move forward and ensuring practice efficiency doesn’t suffer. Plus, payments can be collected straight from the chair from any wireless terminal with the FlexPay feature.

“I have patients every day saying, ‘I can check out in the chair? I don’t have to go to the front desk? That’s awesome!’” Dr Vetter says. “This feature alone has caused my practice to grow in ways I never dreamed of.”

In addition to treatment planning and payment support, Flex also simplifies patient communication and scheduling through FlexBook. This real-time online appointment scheduling saves time for front desk staff and makes scheduling simple for patients, as they can make appointments straight from their mobile devices. Mobile apps are also available on the practice side: Flex Mobile keeps clinicians connected to their practice wherever they are, allowing them to reply to messages, monitor for issues, evaluate schedules, and make real-time adjustments. Dr Vetter also appreciates that Flex is browser-based, eliminating update times or syncing lags.

By eliminating lag times everywhere from syncing to treatment planning, to payment scheduling, Dr Vetter has found Flex software to be extremely beneficial to his practice workflow.

“If I get into the practice management conversation with other clinicians, I first ask, ‘Why are you not on Open Dental?’” Dr Vetter says. “Once on Open Dental, your world suddenly becomes open, and you now have the opportunity to use Flex as your efficiency software. I would bet most clinicians don’t even realize software like this exists. Many dentists are worried about what milling machine they should buy or what laser to buy, when in reality they should be converting to Open Dental and onboarding with Flex.”

Flex software completely altered how one practice measures practice efficiency.

Integrating Flexibility Into Your Practice

Clinicians Have Growing Need for Implant Experts. Photo Courtesy of Krishnacreations/stock.adobe.com. 

he dental implant industry is booming and your laboratory’s business could follow suit. It sounds like an over-the-top marketing tagline, but the rapid growth of implant dentistry (and the burgeoning work it gives labs) is indisputable. According to the American Dental Association, over 5 million implants are placed annually in the United States.

 The American College of Prosthodontists says 2.3 million implant-supported crowns are fabricated annually.

 And these numbers are growing every year.

Although dentures and bridges once were the treatment of choice, the rising popularity of implants means any lab not offering them is squandering opportunities, some professionals say. “The true pioneers in implants made it mainstream in the 2000s,” says Conrad Rensburg, owner and head of the Dental Implant Division for Absolute Dental Services in Durham, North Carolina. “Obviously we did implants before then, but that’s when it really became commercialized. It was a little easier in those early days to get into the space. But today, if you haven’t offered it, you’ve got a lot of catching up to do. And you need to be offering it.”

So how can a lab become the go-to for implants? In a competitive market, a lab must stand out. You need to put in some work, do research, become a resource, and understand—and meet—the demands of clinicians.

“Dentists are looking for lots of things in a lab when it comes to implants,” says Chris Bormes, MICOI, president of Preat, a company in Santa Maria, California, offering dental implant components. “They want treatment planning skills. They want to see knowledge of multiple systems and restoration types. They want their lab to have the ability to problem solve and think outside the box. And of course, they want reliable quality and timely communication.”

As with any industry, good connections are essential. Building relationships can make the difference between a successful and long-lasting or not-so-successful and fleeting partnership. With so many options available to clinicians, having a solid relationship can set a lab apart.

For example, when clinicians attend a trade show, they are looking at 400 vendors, all saying their products are the best. This can be overwhelming. Instead of the dentist wading through endless options, the lab can—and should—be a resource.

“I think the lab should be who the dentist calls when they are looking for advice about a product or company,” Rensburg says. “A lab can be a true resource, provided they are going to speak up and not play favorites but instead say, ‘Hey, here are the advantages of X over Y,’ regardless of any existing relationships with companies. Being transparent and honest is going to instill trust in dentists.” This means labs must research what options are available on the market and what dentists are looking for in a product or service.

“You need to understand your [clinician], what is being promoted to them, and their pain points,” Bormes says. “In 2017, dental school graduates listed implant dentistry as the key area they are not sufficiently prepared for. This is an opportunity to provide additional value other than just your product.”

Understanding what a clinician is looking for is key. Ask questions like “How can I create more efficiency for your practice? How can I help boost your revenue? How can I support your staff?” Then, Bormes says, the next step is to show them what your lab value proposition is. Whether that involves demonstrating how you can save them chairside time or investing in your relationship via an experience together (such as attending continuing education as a team), building that sense of a partnership is important. Helping clinicians increase their knowledge (and therefore confidence) leads to less stress, higher patient acceptance rates, and, ultimately, more revenue for all parties. “And remember to support the entire dental team, not just the dentist,” he adds. “Make sure your value proposition includes the hygienists, assistants, and front desk staff.”

“Become a resource and invest in your relationship, whether it be providing lunch-and-learns or continuing education to your dentists,” Bormes recommends. “Attend [the] Pankey [Institute], Spear [Education], or Kois [Center LLC] with your [clinicians]. Attend the same study clubs. Be the ‘technicians that know implants’ to these key prospective [clinicians]. You will increase respect and likely pick up new [clinicians] simply by being ‘the resource’ and sharing what they don’t know, whether that be material choice or technology.”

If your lab has the ability and resources, providing free continuing education to dental professionals can also attract attention. This positions the lab as a reliable resource for clinicians. Becoming heavily involved in treatment planning and case troubleshooting generates trust, building a closer relationship.

“It’s critical to provide complex and simple treatment planning,” Bormes says. “You need to be able to help choose the right framework, restorative components, and materials to provide the optimal solution for each patient. Dentists want lab advice on material options, restoration choices, and treatment planning. Understand the [clinician’s] experience level with each implant case and make the level of communication appropriate to provide peace of mind.”

Ultimately, providing support and accessibility is paramount to success. “We identify hundreds of implants and attachments each day,” Bormes says. “People trust us for their difficult cases, so the same professionals will trust our multiplatform prosthetics for their patients. We also strive to be ‘easy to do business with’ via extended hours, multiple ways to connect with us, and a senior technician on staff at all times.”

To provide what a clinician needs, the lab must be expert on the available offerings. This means staying up-to-date and educated on the latest materials, techniques, products, and technology. Otherwise, Rensburg says, a lab becomes obsolete.

“It’s my job to know what kind of zirconia is out there,” he says. “It’s my job to know what kind of implants or restorative options are out there. And the way you do this job is by constantly educating yourself.”

This means the workday doesn’t end at 5 pm. For Rensburg, clocking out of the office means spending time reading articles or sitting in continuing education—for both technical and clinical sessions. Rensburg says he probably spends more time in clinical courses than technical, because it is important to understand what happens on the clinician’s side. For example, if a lab technician has never been chairside with a guided-surgery case, they cannot know what could go wrong and do not see a patient’s discomfort, or understand how making a mistake at the bench relates back to the chair.

“I think a lot of lab techs like to limit themselves to just technical, because of course that’s what you’re going to be doing, but you have to understand what a clinician is dealing with to be able to help them,” Rensburg says. “If you learn from clinicians, you can be a resource to other clinicians.” Rensburg and Bormes agree that you cannot gain this knowledge without participating in continuing education events, classes, or conferences.

“Attending education events is very important,” Bormes emphasizes. “Ideally, a noncommercial course will provide ideas, tips, or techniques, and is a great way to remain current and motivated.”

This is critical in the rapidly evolving world of implant fabrication. New technologies and improvements are frequent, so it is important for labs to stay current. For example, Bormes says, in the 1980s the biggest development in implant fabrication was the angled tissue extension abutment. More recently, it has been the angled access channel. Both developments allow the patient to have a reasonably priced, esthetic, retrievable, and strong screw-retained restoration, often eliminating the need for painful, expensive bone augmentation and lowering the risk of peri-implantitis from cement. Although this technology is now common, not understanding it (or other improvements that hit the market) can hurt a lab. This makes knowledge and flexibility imperative.

“We all strive to have each surgery be prosthetic-driven, but often the surgeon must place where bone is,” Bormes says. “These combined technologies allow for fixed or removable cases with up to 60º of angle correction.”

Continuing education is not only a chance for technicians to learn; it presents a good marketing opportunity as well. “I recommend technicians who come back from a course send a note to their dentists informing them of the course they attended, what they learned, and inviting them to a lunch or meeting to discuss,” Bormes says. “It all goes back to being that invaluable resource.”

To be that all-encompassing resource, labs need information about companies, products, and materials. Being limited to a single company or product line can limit a lab’s capabilities and hurt its ability to offer a range of services. Although you may have companies you work more closely with, keeping an impartial and open mind about which offerings are the most effective for a specific indication is important. Not only will this allow a lab to provide superior services, but it will also build faith with clinicians who will trust that you are recommending the best product and not just promoting a company with which you may have ties.

“You will obviously build closer relationships with some companies over others,” Rensburg reiterates. “But a clinician needs to trust that when they ask you a question or what you think about a product, you will speak your mind truthfully and not play favorites just because you have a relationship with a company or rep. Instead, you should be honest and say, ‘Hey, these are the advantages, this is what I like or don’t like, and this is what I think you should do.’ This will build trust while also providing the best restorations.”

“Don’t be a ‘Brand X only’ lab,” Bormes agrees. “Learn multiple platforms. The value implant segment is the fastest growing in the United States. For example, in Europe, the value segment is expected to account for 60% of units placed by 2024. You never know when the surgeon is going to change brands, or a new patient presents with a system the doctor is not familiar with. It’s the same as with restoration types (ie, not every crown should be cemented porcelain fused metal or screw-retained ceramic): Be familiar with the indications and contraindications for many restoration types to be that resource for your clients.”

Labs can provide multiplatform prosthetic offerings by branching into multiple brands and restoration types. A lab that is a 1-stop shop can provide the widest selection of implant parts and attachment solutions for fixed and removable restorations. Because not all patients are the same, not being tied to 1 implant brand allows labs to provide clients with the best restorative parts for each patient. “In the end, an implant is an implant,” Bormes says. “The patient only cares about the restoration.”

In-lab technology can also increase a lab’s appeal to dentists. When the return on investment warrants it, Bormes recommends that labs have a scanner. Until it makes financial sense to bring printing or milling in-house, labs should outsource their work. Technology can be a huge driver for labs—and for implant companies—so both need to constantly innovate and not fall behind the other available options.

But technology alone will not market a lab. Although having the latest in technology may seem like a huge value add, it may not matter if the lab is lacking elsewhere. Even if the lab has the latest, greatest gadgets, it will not be cutting edge without reliability and knowledge.

One example is digital dentures. When they emerged, many in the industry were skeptical and did not believe they could be high quality. Many clinicians were hesitant to trust in the new technology, even though digital dentures can be esthetic, functional, and stronger than those made by hand. From the lab standpoint, digital dentures are faster and cheaper but still deliver a better product, saving time and money. But none of that really matters if the clinician does not have the information to trust in the technology—information the lab should be able to provide.

“I think it really doesn’t matter what technology a lab uses,” Rensburg says. “I think what gives labs a marketing ability is understanding the technology. If a dentist hears about a new material, he should feel confident that he can call me because he trusts I will already know about it. Yes, if a lab doesn’t embrace new technology, it will eventually become obsolete—but only if you are scared of it instead of immersing yourself in the knowledge and understanding of it. You do have to continually innovate to drive your company forward, because otherwise you can’t offer the latest innovations. But you need to know what you’re doing.”

The quickest way to destroy a lab’s relationships—and credibility—is to turn out a subpar finished product. Good relationships with clinicians and reps will not matter if you cannot produce a quality restoration. This means knowing your lab’s capabilities, strengths, and weaknesses, and realizing when a case is not feasible.

“It’s OK to say no to a case,” Rensburg says. “It’s crucial to be able to do that, because if you don’t, you’ll end up looking like a fool. Not all money is worth making—because if it’s a bad case, you’re not really making money anyway, since you’re going to be doing the case 2 or 3 times and wasting bench time.”

Not only can taking the wrong cases waste time and money, but it can hurt reputations. “At the end of the day, the clinician that was trying to take a shortcut or force a case that couldn’t be done will stand up at a dental meeting and tell people how bad the case was and what a bad job you did, even though you initially told him, ‘I don’t think this is going to work,’ ” Rensburg says. “It’s much better to say, ‘Doctor, with all due respect, I’m not going to accept this case because it’s not going to work.’ Otherwise, you will become the villain.”

Although rejecting cases can be difficult for smaller labs with only a few customers, it could make a huge difference in potential growth. When saying no to a case that simply will not work, a lab is not being difficult; it is being smart. In the long run, turning down jobs could lead to more work in the future, because a lab will build a stronger reputation for producing impeccable, high-quality work.

“Ask yourself 2 questions with every case,” Bormes says. “First, would I recommend this to my mom? Second, can I service this restoration in 10 years? It is becoming more important to provide life cycle support for implants.”

Providing life cycle support is a big value add. This ensures that clinicians know your lab can help troubleshoot for the life of the restoration and through all phases of prosthesis life, whether that be a reline, rebase, jump, or simply replacing attachments or screws. Ultimately, this means a longer life cycle for the restoration, a higher-quality restoration, and a happier patient.

“The continued excellence and quality of all implants on the market is one of the greatest developments in implant fabrication,” Bormes says. “With high osseointegration rates, now we can focus on what truly matters to the patient: the restoration. When is the last time you saw implant patients talking about what type of implant they have? As I mentioned, an implant is an implant to patients. Patients care about the quality, esthetics, and functionality of the restoration. They want the confidence of looking good, feeling good, and returning to as much of a normal quality of life as possible.”

When it all boils down, marketing is all about building relationships. In addition to building relationships, making connections with company representatives and implant reps can rapidly expand a lab’s business. Rensburg says it’s been his biggest business driver over the last 20 years.

“Build relationships with your company reps,” Rensburg says. “I’ll be the first one to admit that my relationships with my clinical implant reps have driven more business to me than any marketing or any speaking engagement because those guys are in the field. They can say to a doctor, ‘Hey, you’ve got an implant case, send it to this lab, this lab knows what it’s doing.’”

To build these relationships, Rensburg recommends getting the representative into the lab and talking about how you can collaborate and support each other. This opens the doors to not only a good relationship with a company representative, but a good relationship with someone who already trusts that representative. Although this does involve some selectiveness in the representatives you work with, he still emphasizes the importance of working with multiple companies and not becoming tied to a single brand.

When it comes to marketing to clinicians, traditional marketing can be ineffective. Unless you are a large lab with a big marketing budget or a brand-name chain, most referrals are going to come through community connections. However, there are ways to build your reputation as an implant resource that will not break the bank.

Bormes cites several primary steps for marketing a lab as a go-to for implant cases. He reemphasizes the importance of being a resource to dentists, completing continuing education, and adds several other tips including the following:

Highlight your best—and toughest—cases on social media.

Show clinicians how you can save them money, but be sure you are making money as well. Don’t be worried about being the lowest price; rather, make sure clinicians understand your value proposition and keep your focus on quality, turnaround time, and partnership. Offer multiple-tier pricing to make services more accessible and appealing. “You should have different price levels for different types of [clinicians] and patients,” Bormes says. For example, one can be using all OEM parts, and the other can be a value price using “multiplatform” (non-OEM) parts. “Many labs have increased profitability by offering tiered pricing,” he says.

Source referrals and testimonials that can promote growth for your lab. Ask a few of your favorite clinicians for a referral to “other dentists like them.” Eighty-six percent of dentists look for another dentist’s recommendation when choosing a lab. Testimonials from current clinicians are important to have on the lab website to highlight your value proposition.

Because there are so many moving pieces and parts, building a lab’s business—and maintaining that business—is no easy feat. Getting those components to move in synchronicity will have positive results.

“What we do is hard,” Rensburg says. “We have to build relationships, we have to be marketers, we have to create a product, we have to control the quality, and then we have to deliver on time. So we really capture every facet of almost every industry out there. It’s a one-of-a-kind industry.”

1. Dental implants. American Dental Association. Accessed 9 September 2021. http://www.ada.org/~/media/ADA/Publications/Files/ADA_PatientSmart_Implants.ashx

2. Dye B, Thornton-Evans G, Li X, Iafolla T. Dental caries and tooth loss in adults in the United States, 2011-2012. NCHS Data Brief. 2015;197:197.

It is vital for dental laboratories to have dental implant experts to expand implant business.

Clinicians Have Growing Need for Implant Experts

Patients no longer have to grin and bear it when it comes to edentulism. These days, there are many options when it comes to replacing dentition, from bridges and dentures to dental implants that are virtually indistinguishable from natural teeth.

Although implants may look like the real deal, the care and upkeep of dental implants—and the patients who have them—can differ greatly from that of natural dentition. In terms of ensuring the longevity of an implant, this is critical to remember.

“When an implant is placed, we tell patients, ‘It functions like a natural tooth. It feels like a natural tooth. You can floss it like a natural tooth,’” says Katrina Sanders, RDH, BSDH, M.Ed, RF. “And I think after enough times of saying that, we begin to believe that we can instruct our patients to care for dental implants just like they would their natural teeth. The difference is that if you do this, dental implant failure can occur, and I think people forget this.”

So what does it take for hygienists and patients alike to properly care for dental implants? Understanding how implants behave, knowing the risk factors for periimplantitis, and the ability to identify red flags for possible complications are critical.

“There is a science caring for implants, and you have to know the steps of assessment and…how to do implant maintenance,” says Susan Wingrove, RDH, BS, author of 

Peri-Implant Therapy for the Dental Hygienist

. “Research is constantly being done. For instance, we now have new ceramic implants, and we have to know how to maintain and home care for those as well. You have to know how to assess the situation.”

A hygienist can’t provide proper care for an implant until they know what condition it is in. This is where a thorough assessment comes in.

“Patients have invested in their oral health with dental implants,” says Theresa Biernat, RDH, BS, MBA, a project manager at HuFriedyGroup. “The maintenance and support of their investment is critical, and clinical implant assessment is the cornerstone of sustained success. In performing an intraoral implant assessment, clinicians must take a multifactorial approach.”

To ensure this approach is followed—and that hygienists don’t skip any critical steps or miss any important warning signs—Wingrove created a 5-step assessment.



The first step of the 5-step assessment is the same as what you would do with natural teeth: Look at the tissues around the implant and examine it for signs of inflammation. Inflammation is a clear indicator there could be a problem.





Probing and palpating are good ways to identify any potential problem areas. Wingrove recommends palpating the implant to see if any exudate or bleeding happens. Palpate the area by putting 1 finger on each side (buccal and lingual) of the implant and milking up toward the crown (or, on the upper, press down toward the crown). “If there’s bleeding around an implant, you have to get to the bottom of it as soon as possible,” says Wingrove. “If that inflammation cascade continues, you’ll have a chance of losing bone.”





Residue can signal the death knell for implants. Residue (such as that from calculus, instrument shavings, or cement) can stick on the implant and trigger an inflammatory response. To identify any residue, the clinician needs to properly and carefully floss the implant.

Wingrove emphasizes that flossing the crown correctly takes several steps. “It’s mesial, distal, cross in front, then you have to shoeshine so that it meets where the abutment meets the implant—that’s the sweet spot,” she says. “Go back and forth a few times, then remove it out of the mesial and the distal—you don’t want to pull it through.”

Proper flossing is exceptionally important because, if done incorrectly, the floss can inadvertently leave behind more residue instead of removing it. It is now only recommended for single implants with no thread exposure and by clinicians as an assessment tool.

“You have to be really careful about what is exposed on the implant,” Sanders says. “If there is exposure of the threads of the implant, floss can shred. Shredded floss can essentially create a bacteria trap, creating nodules for additional bacteria to form in the area.”





Although natural teeth have a little mobility and flexibility, implants should not. Because implants are rooted into the bone and aren’t supported by ligaments like natural teeth, there shouldn’t be any give.

“Implants are like putting it in cement,” says Wingrove. “It shouldn’t move. With no ligament attachments, it should be solid. If you’ve got movement, the doctor needs to assess for multiple causes, and a radiograph [should be] taken.”





Because the implant is screwed into bone, bone loss could potentially trigger implant failure. To assess bone condition, radiographs should be taken annually. Vertical bitewings or periapical radiographs are typically the most accurate. These radiographs should be compared with the baseline radiographs from 1-year postrestoration.

“A radiograph will tell you if the implant is healthy or not,” says Wingrove. “Bone loss around the implant is the assessment for the health of the implant.”

Because implants aren’t natural teeth, they shouldn’t be treated with the same tools. Having an implant changes which products should be used (both in the operatory and at home) and hygienists and patients need to adjust accordingly. According to the American College of Physicians Clinical Practice Guidelines, instruments should only be used that are “compatible with the type and material of the implants, abutments, and restorations.”

“We’re understanding a lot more about how implants need to be maintained and cleaned differently than our traditional teeth,” says Debbie Durako, director of StellaLife Inc. “That’s very important to remember to aid in the prevention of periimplantitis.”

Wingrove agrees. “Because it’s a medical device, it’s not the same as a natural tooth,” she says. “If people have even 1 implant in their mouth, it changes what they can do, what products they can use, and what instruments hygienists can use for the maintenance visit.”

Identifying the proper instruments is the first step. Although stainless steel instruments might be the go-to for natural teeth, they shouldn’t be used on implants. Instead, hygienists should turn to titanium scalers.

But it’s not only stainless-steel instruments that should be avoided. Although many people were taught in dental school that plastic scalers should be used on implants because they are softer and less likely to scratch the implant, they may not be getting the job done properly and could be causing more harm than good. Sanders references periimplantitis cases she’s seen where curls of plastic were found among the threads of the implants once the doctor opened the flap.

“Clearly a hygienist was once trying to clean that area, and pieces of plastic started to peel off and were then embedded into the threaded area,” she says. “Of course, this then created other niches for bacteria to be able to form, and it’s a difficult thing for the tissue to heal. The good news is that there are a lot of other amazing tools out there.”

Some of the tools Sanders turns to are implant scalers that have a change in the hardness level without the risk of curling of plastic, as well as PDT Wingrove scalers. “These are just 2 examples of hand instruments that are available that are shaped completely different to allow for efficiency of the subgingival space.”

“You can’t be using your plastics, graphite, or stainless steel that you’ve been using in the past,” Wingrove says. “The concern is you can leave residue behind if you’re using the wrong instrument, because residue stuck on the implant will build up over time, and you could lose the implant if the wrong instruments are used on debriding the implants. You need to have a set of titanium scalers. You need to have the proper tool set.”

In addition to titanium scalers, there are plenty of tools that can be used to provide proper implant care. Technology like subgingival air polishers, powder streaming devices designed to gently remove biofilm without causing damage to implants or associated components. It can also aid in the reduction of inflammation and the prevention of related diseases, such as gingivitis and periodontitis/periimplantitis.

Scalers and other tools aren’t the only risk for implants. Using the wrong clinical products or recommending the wrong home care products can also be problematic. As 1 example, avoiding high fluoride products is critical, as high fluoride with a low pH could possibly remove the oxide layer on a titanium implant. Wingrove recommends only using products with a neutral pH that are safe for both pre- and post-procedural rinses. These products include chlorine dioxide rinses from CloSYS, OraCare, OxyFresh, and StellaLife, which she considers to be the top 4 for pre- and postsurgical procedures, as well as pre-and postmaintenance visits.

“The first step in care is preparing the patient for surgery or maintenance,” Durako says. “You’ve got to do a good job of being able to prepare the tissue and oral microbiome for surgery. That’s where StellaLife comes in with our 3-3-3 program.”

The 3-3-3 program is a combination of 3 all-natural products (an antimicrobial rinse, sublingual spray, and topical gel) used 3 times a day for 3 days prior to implant surgery and implant placement. These products reduce the anaerobic bacteria in the oral cavity and kills 

. In conjunction, the tissue is being saturated with anti-inflammatories.

“Once the patient gets prepared for surgery, you’re already in a better position to have a better postoperative outcome,” Durako says. “Patients can use the products for 7 days after, which helps control bacteria (thereby hastening wound healing) and also reduce inflammation.”

Postprocedural rinses are just 1 way that patients can improve their implant home care after they leave the operatory. But patient compliance can be a tricky thing, and hygienists need to find ways to provide effective options that simplify oral care. Although proper monitoring and maintenance are essential to preserving the health of a dental implant, the long-term success of an implant is fundamentally dependent on the dental team’s administration of professional prophylaxis procedures and the efficacy of the patient’s home care.

“How do we teach patients that, [although] they have all these beautiful implants, there is a level of maintenance that has to occur?” Durako says. “[Although] that includes visits to have the implants checked and cleaned, care has to continue at home. If we can make it easy for them, we will see compliance rise. Things like the Philips Sonicare or the Waterpik Sonic-Fusion are brilliant, because it’s a one-stop shop; I don’t have to whip out another tool, I can do it in 1 fell swoop.”

Biofilm research has found that, for optimal oral health, 80% to 85% of biofilm should be removed twice daily.

 The easiest way to accomplish this is to use an electric toothbrush and/or a water flosser. A water flosser becomes even more important as trends shift toward discouraging patients from flossing around implants because of the risk of residue and the resulting complications. Water flossers are also handy when implant threads are exposed, as water flossers create effective lavage to flush out any bacteria that may live within the embedded threads of the dental implant.

“It’s important for us to acknowledge that the tools we send our patients out with are what they are going to maintain their health with for 361 or 363 days out of the year when we aren’t seeing them in recare,” Sanders says. “Water flossers are truly the unsung heroes of keeping a lot of our implant patients in a state of stability. [Most of] our patients that have these dental implants have periodontal disease and are oftentimes experiencing other comorbidity challenges where dexterity and their ability to clean the area could be a challenge. Putting an auto flosser or a water flosser in our patients’ hands helps them to keep the area far cleaner.”

Ultimately, in addition to simplifying home care, patient education is key.

“You can have the most beautiful implant or natural tooth restoration, but if the patient doesn’t know how to care for it at home and doesn’t come back for maintenance, how long is it going to last?” Wingrove says.

A combination of accurate assessment, proper hygiene protocol, good home care, and plentiful patient (and hygienist!) education is the key to implant success. Without any 1 of these facets, patients face higher risks of periimplantitis and other implant complications. Hygienists should stay abreast of the latest research, materials, and tools; without this knowledge, they will be unable to effectively communicate information and instructions to patients.

“Our hygiene teams need support and a lot of education, because we have to maintain implant patients now,” Durako says. “This is not a short-term condition that patients are never going to have to think about again. The investments are large for [patients], so it’s important we help them maintain oral health so they aren’t in a situation where they may have to redo an implant or struggle with wound healing.”

Biernat agrees that hygienist education is critical.

“The field of dental implant maintenance is constantly evolving as new materials, techniques, and protocols are developed,” she says. “Keeping current with evidence-based research and updating treatment protocols as they become available is the best way to ensure cutting-edge optimal treatment.”

Wingrove agrees that implant science is evolving and is releasing an updated version of her 2013 book in 2022 to reflect the latest trends and research. When it comes to implant science, change is good, but it means that both hygienist and patient education are lifelong commitments.

“We have the opportunity to guide our patients through this,” Sanders says. “Just because I’m loading this implant doesn’t mean we’re gone. Just like periodontal disease, after you perform active perio therapy, that patient is in maintenance for life. They’re in remission, we’ve got to keep them there, and dental implants are the same way.”

Peri-Implant Therapy for the Dental Hygienist: A Clinical Guide to Implant Maintenance & Disease Complications

Bidra A, Daubert DM, Garcia LT, et al. Clinical practice guidelines for recall and maintenance of patients with tooth-borne and implant-borne dental restorations. 

. 2016;25 Suppl 1:S32-S40. doi:10.1111/jopr.12416

 Advancing antimicrobial strategies for managing oral biofilm infections. 

. 2019;11(3):28. doi:10.1038/s41368-019-0062-1

Caring for Patients with Implants in the Hygiene Operatory

Ratcheting Up Your Practice’s Implant Business


In 2000, the dental implant business was not exceptionally lucrative for general-practice dentists. According to a study published in 2016 by the National Institutes of Health (NIH), the prevalence of dental implants at the turn of the century was estimated to be around 0.7 percent—small enough to be easily handled by specialists, and not be worth the time or money for a general clinician.

That landscape has changed. The NIH found that in 2016, that number had risen to 5.7 percent—and is expected to keep climbing. Increased availability of implants and improved technology are making implants more attractive to patients who want to regain as close to natural feel, look, and function as possible.1 Given how common tooth loss is (a reported 69 percent of adults ages 35-44 have lost at least one tooth) his rising demand means that adding implant services to a general practice could be very profitable indeed.

But before a practice jumps on the implant train, there are several things to consider. Will it increase revenue? What investments will the clinician need to make? And, eventually, how in the world do you go about getting the word out that you are offering implant dentistry?

The first step to figuring out if you should expand to offer specialty care like implants in your practice is to know if you have the volume to make it worthwhile. Identifying how much work you’re currently referring out will let you determine if bringing those offerings in house makes sense financially. If the lost revenue isn’t substantial, it may not be worth the investment necessary to increase implant offerings.

Crunching these numbers can seem like a headache, but there are ways to simplify the process. Refera, a dental referral management program, offers clinicians a simple dashboard that outlines how many patients were referred to external specialists, allowing the clinician to easily extrapolate what they are referring out and how many. In the future, says Sam Ahani, DDS, a private-practice clinician in California and founder and owner of Refera, the company also hopes to add referrals by specialty types and track how many dollars a practitioner is referring, so they can make more informed decisions.

“Refera’s online platform keeps track of all your referrals in one place,” he explains. “You can quickly see how much production you have referred to specialists. This information wasn’t available when we did paper referrals.”

When it comes to spending money to make money, the level of financial investment in increasing implant offerings depends on how involved you want to be in the process. If you want to do the surgical aspect of the implants, Brian J. Jackson, DDS, diplomat of the American Board of Oral Implantology and fellow and president-elect of the American Association of Implant Dentistry (AAID), says clinicians can expect to shell out some big numbers on an extensive surgical setup.

“Upfront you’ll need things like CBCT and surgical kits, and then as you mature, you’re going to want to add other things like maybe Versa units,” he says. “These different, more specialized aspects of surgical instrumentation are going to be more expensive. And then of course you’re going to have to buy a lot of materials like bone graft material and barriers and implants themselves and all the parts and pieces, so it’s a pretty significant investment if you want to do the surgery.”

And these tools and materials aren’t optional. You’ll need them to provide appropriate care. For example, Dr Ahani says, you’ll need to have a CBCT so that you can properly diagnose. “Remember,” he says, “you will be held to the same standard of care as specialists, so you need the right tools.”

These costs are a big reason why Dr Jackson says clinicians can’t just “dabble” in implants—it’s simply not practical (and you can’t provide the best possible care). However, if dentists are only interested in taking on the restorative end of implant cases, it’s a smaller investment. You’ll still need to purchase a handful of tools for particular systems, but you leave the bigger purchases to the surgical specialist.

Making the determination about expansion is just the first step before you can begin building increased implant business. Before you can promote your offerings, you need to figure out what you’re doing. The bottom line: Education is key.

“The number one thing is that you need to get training,” Dr Jackson says. “You can't just talk to talk; you have to walk the walk. Before you decide that you want to get into the field of implant dentistry, you have to commit yourself to the fact that it's going to be a lifelong learning, and that you're going to have to commit a certain amount of time to some serious education in order to meet patient expectations and be able to have successful outcomes.”

This lifelong-learning process means staying abreast of the latest technology, honing your skills, committing to ongoing continuing education, and perpetually practicing—a commitment that’s probably too great for clinicians who just have dollar signs in their eyes.

“It’s not a field where you’re going to be a dabbler,” Dr Jackson says. “If you decide that you want to be an implant dentist, you're going to have to get education, you're going to need to get training—it's going to require a tremendous amount of time on your part in order to be proficient at it. If practitioners want to be involved in implants and do it at a very serious level that they need to get educated.”

And the education doesn’t stop at the clinician. Hygienists, dental assistants and even the front-desk staff need to understand what increased implant business entails.

“It’s not just you that has to be educated,” Dr Ahani says. “It’s everyone in the office. This will automatically increase your cases going forward.”

If a clinician is serious about ratcheting up their implant business—and skills—the AAID is a good place to start. Established with education in mind, the association is still based in non-biased education. Through maxi courses, annual meetings, and endless other continuing education opportunities, clinicians can develop a framework for implant dentistry. And the education doesn’t stop at the conference door: The AAID mentorship program connects clinicians with specialists for additional support.

“If you’re a dentist that practices in New York and you want to learn how to do implant dentistry, you can go to the AAID and call a member dentist and say, ‘can I come and watch you do implant surgery,’ or ‘can you look over my shoulder and help me with this case?’” Dr Jackson says. “It’s a very welcoming and supportive academy, and I think that’s a great opportunity for those who are just starting out.”

The relationships clinicians can build through AAID aren’t the only ones that will be beneficial when increasing implant offerings. To build a successful implant practice, you need to develop industry relationships with other implant dentists, specialists, and of course, your lab.

“You have to have a great relationship with your lab because, again, these are highly sophisticated prostheses we’re talking about, and they require a great deal of sophisticates on every end—in the surgery, restorative, and laboratory aspects,” Dr Jackson says. “So, your relationship with your lab is critical and so you have to be able to trust that everybody is on the same page as to what is expected.”

In addition to being critical to case success, labs are a valuable resource for implant questions. Many labs work with multiple brands or systems of prostheses, and can give advice on which is best for a particular case. Lean on your lab partners for information and recommendations, and build that relationship; relying on their technical knowledge frees you up to focus on the clinical aspects instead of wading through product marketing materials and spec guides.

Another key component is case selection, and knowing when to call in a specialist. Having a good relationship with a local specialist can help you produce better outcomes for tricky cases.

“You’ll need to decide if you are going to do the care or if you are going to bring in a specialist,” says Dr Ahani. “If you want to do it, you have to get some great education and learn how to pick very, very easy cases—not do just any case—and still refer the hard ones out. This will keep you out of trouble and also leave your relationship with your specialist intact in cases where you may need their help.”

“If you’re bringing specialists in house, you’ll obviously want to make sure they’re a good one, and figure out a way to have them review cases before they come in to do them,” Dr Ahani adds. “One issue that often arises is that they don’t have enough information before coming in.

Just because a clinician knows how to do implants, doesn’t mean they always do them as thoroughly as they should. This can be catastrophic both for the patient and the practice. One area where Dr Jackson sees problems arise is pressure to finish cases more quickly.

“There's a tendency for our patients to want everything done very quickly,” he says. “As a result, there’s a competition in the marketplace where you know, the guy next door does it in 3 visits instead of 5.”

This, Dr Jackson says, creates a “speed-it-up” mentality for a lot of dentists, which results in cutting corners. Maybe they start to reconstruct on implants that aren’t fully integrated, or perhaps they say, “yeah that's not that important, I think I can go right to the final prostheses rather than having a prototype made.” It could even be as simple as not understanding—or taking the time to understand—some of the more sophisticated approaches on how to take impressions. There are a lot of potential aspects with this that can go wrong, and the dentists who succeed are the ones that progress through all steps of the implant process with care.

“I think the dentists that are the best are very strict to their protocols and they do things a very, very specific way, all the time,” Dr Jackson says. “You have to avoid the compulsion to just do things to finish cases faster. If you do, you’re going to have setbacks.”

Once a clinician starts a case, in many ways they are married to it, so it benefits everyone for them to do it well the first time. If thing don’t go well—especially very early on—then patients expect the clinician to correct things—and usually for free. “This takes implant dentistry from becoming a profitable aspect of your practice, from a business point of view, to a very, very non-profitable aspect very quickly,” Dr Jackson says.

This means that doing things right the first time and not having to correct things or perform revisions is certainly a win-win all the way all around, both in terms of time, patient confidence, and revenue, as you won’t be forced to redo things at no cost.

The aforementioned patient confidence becomes even more critical when you consider marketing. When it comes to marketing your implant offerings, traditional methods may not be the most effective. Unless you are a corporate practice where you’re doing a lot of scattershot advertising on radio or television, rave patient reviews are your most powerful marketing tool. While increased target marketing—like pay-per-click advertising—for implant care may bring in a little new business, it most likely will cost way more than a practice will be willing to pay.

“Most practices build by word of mouth,” Dr Jackson says. “Whether you live in a big city or a small town, you’ll have a ‘small community’ of patients. And within that community, your patients will tell their friends about their experience at your practice and that can make or break your business.”

This makes providing exceptional patient care and a consistently successful end product equivalent to the best marketing campaign that could ever run—but once again, it means putting in the time.

“It comes back to the time commitment,” Dr Jackson says. “If you’re serious about upping your implant abilities, you’ve got to commit to it and do it right. There’s a great sense of responsibility to our patients; implants are not inexpensive and are not something to take lightly. If we’re going to take their money and provide a service, you can’t be guessing about what you’re doing. You need to know how to do it.”

At the end of the day, building implant cases in your practice can’t be a spur-of-the-moment decision. It’s going to take time, money, dedication, and a lot of happy patients to truly expand your business.

“In deciding to increase your implant business, make sure you factor the added costs of marketing, education, equipment, specialists, and tools into the equation,” Dr Ahani summarizes. “A lot of people will just think about what they will get per case, or how much they’ll have to pay the specialist, and not the investments you’re making just to get each case.”

Ratcheting Up Your Practice’s Implant Business

Naturally, dentists want to ensure that patients have the most pain-free experience possible when receiving dental care. Traditionally, that has meant pulling out the prescription pad.

That’s not true anymore. The opioid epidemic has forever changed the way clinicians approach pain management. Opioid overdoses led to the deaths of nearly 50,000 individuals in the United States in 2019, a 600% increase since 1999. Of those 50,000 overdose deaths, more than 14,000 were confirmed to have been caused directly by prescription opioids—a number that doesn’t take into account individuals who became addicted to prescription drugs and then transitioned to heroin or synthetic opioids.

These numbers are staggering and frightening to both clinicians and patients. Although dentists are just 1 piece in the opioid-prescription puzzle, they play an important role in the opioid epidemic. Dentists are the top prescribers of opioid prescriptions (12%) after family physicians (15%). Historically, they have often written opioid prescriptions before considering other options.

“While dentistry doesn’t contribute the largest number of opioid-based narcotics, I think dentists are interested in continuing to reduce the use of opioid-based prescription medication,” says Debbie Durako, director of StellaLife, Inc., a biotech company with all-natural products. “As awareness of how dangerous these drugs can be has grown, and the crisis of people dying from opioid addiction and overdoses has skyrocketed, clinicians feel it’s better just not to dispense that at all, so they’re turning to alternatives.”

This awareness is reflected in the decrease in opioid prescriptions coming from dental practitioners. In 2018, the American Dental Association became the first professional health organization to mandate limits on opioid prescriptions and publicly urge clinicians to consider alternative options as the first line of defense in pain management—and dentists listened. From 2014 to 2019, dentists wrote nearly half a million fewer opioid prescriptions.

Nonopioid remedies are changing the landscape in dentistry. 