Terri Lively

Providing Restorative Care for People in Need. Image credit: © InsideCreativeHouse - stock.adobe.com

As the surgeon general said in 2000, you can't be healthy without good oral health. Nevertheless, many patients try to do just that for various reasons. However, some patients would like to get the oral healthcare they need but don't have access to care, again, for a variety of reasons.

We look at what the industry believes about access to care, why some patients don't have access to care, the problems that can lead to, and some successful programs that get patients the care they need.

Oral Health Care is Essential to Overall Health

The research established links between oral health and other systemic conditions. So, 3 years ago, the American Dental Association (ADA) passed Resolution 84H-2020, emphasizing dentistry's essential role in public health, particularly during the COVID-19 pandemic. The World Dental Federation (FDI) echoed this message in 2021, advocating for oral health's recognition as an integral part of overall well-being.

The surgeon general agrees. The 2021 update to the Surgeon General's report builds on the original 2000 report, emphasizing social and behavioral disparities that limit access to oral care. It calls for collaborative efforts among policymakers, health care professionals, and communities to integrate oral, medical, and behavioral healthcare and address systemic inequities affecting oral health behaviors and access to care.

Low-Income Adult Patients Don't Have Access, But Do Have Consequences

One of the reasons patients who want oral health care but don't have access to it is affordability. Medicaid, the primary healthcare program for low-income individuals, offers an extensive and mandatory benefit package for children, which covers oral health screening, diagnosis, and treatment services. Over the last decade, through combined efforts at the federal and state levels, Medicaid and the Children's Health Insurance Program (CHIP) have significantly improved access to dental care for low-income children, increasing their utilization of preventive and primary dental services.

In addition, the American Dental Association (ADA) has its charitable branch called the ADA Foundation. It manages programs like Give Kids A Smile® (GKAS), along with associated programs such as Tiny Smiles and Give Veterans A Smile. Since 2003, GKAS has given free oral health care to children. Every year, around 6500 dentists and 30,000 dental teams volunteer at GKAS events, providing screenings, preventative and restorative treatment, and oral health care education to over 300,000 kids.

However, fewer programs exist for low-income adults. Without dental benefits, there is a significant cost barrier for these patients. Also, a long-term lack of access to dental care or connection with providers can lead to low-income adults having low expectations regarding oral health or delaying seeking dental care until something hurts.

Unfortunately, not getting care when they need it can have a lot of adverse effects on these patients' lives, including:

Changes in appetite and the ability to eat

Tooth loss, which can cause nutrition problems

Chronic pain impacting speaking and sleeping

Work-related problems: i.e., employed adults lose over 164 million work hours annually due to oral health problems or dental visits, and people who do not have professional positions lose more of those than those who do

Negative effects on job prospects due to damaged teeth or tooth loss.

Some states have responded to these needs. For example, the California Department of Health Care Services (DHCS) has Medi-Cal Dental. They encourage their members to call them for help finding a provider and for dentists to register their practices with the program. The program treats patients for things like:

Periodontal maintenance, scaling, and root planing

Orthodontics for kids who qualify for it.

People with Special Needs Also Struggle with Access to Care

Another patient population that suffers from access to care is those patients who have special needs. People with developmental disabilities like autism, cerebral palsy, Down syndrome, or other conditions face challenges in taking care of themselves, especially their oral health. For example, the following can interfere with their ability to take care of their teeth:

might make it difficult to understand and follow instructions at the dentist or home.

 contribute to patients feeling anxious, making dental treatment uncomfortable.

 make getting in and out of the dental chair harder, and appointments might take longer.

 can interfere with the patient's ability to eat or swallow.

 can make it challenging to get dental care safely.

 might require antibiotics before the patients receive dental treatment.

 can have symptoms that affect their teeth.

can happen, which can harm their teeth or mouth.

 can make it hard to communicate during dental visits.

 are more common in these populations, too.

This population often has problems with their oral health, like tooth decay and gum disease, because of problems with their home care. They also sometimes have harmful habits, like bruxism, food pouching, mouth breathing, and tongue thrusting. In some cases, children with developmental disabilities experience late tooth growth. Other people can suffer mouth injuries from falls, accidents, or seizures. Sometimes, the medication these patients take for their conditions can cause dry mouth or other issues that lead to problems with oral health care.

Penn Dental Medicine Care Center for People with Disabilities at the University of Pennsylvania treats people with disabilities who don't get proper dental care. They're also training students, dentists, and caregivers worldwide to improve the care for people with disabilities.

The Care Center has been running for 2 years, and it's getting busier. From September 2021 to September 2022, they had 1793 patients and almost 9000 appointments. The dental school also uses telemedicine to help patients, sharing their knowledge at conferences, teaching practicing dentists, and opening new places to treat people with disabilities and others in the community

DSOs Help Provide Restorative Care for People in Need in Many Ways

Despite the challenges, some patients who need (and want) access to care get it from dental professionals. Dental Support Organizations (DSOs) have many organized programs that give back to their communities.

For example, Aspen Dental opened the TAG Oral Care Center for Excellence (OCC) to treat low-income patients in the Chicago area, free of charge. The 25,000 sq. ft. clinic opened in July 2022 and has 16 dental care rooms, including 14 operatories and 2 surgical suites. The TAG OCC is a global center of excellence for continuing dental education while providing comprehensive quality care to those in need, including veterans and other underserved populations. The TAG OCC has donated over $4 million in free dental care to over 500 patients, with another 500 on a waitlist.

Julie Frantsve-Hawley, PhD, CAE, Executive Director of the TAG Oral Care Center for Excellence, describes it as the next evolution of the charitable giving Aspen calls the Healthy Mouth Movement, which they started in 2014. The TAG OCC is the year-round program serving Aspen's overall mission to break down barriers to quality care and bring better care to more people.

"We developed a strong partnership with the state of Illinois to help us provide this free dental care. A team of dentists and support staff provide care at the TAG Oral Care Center for Excellence who are wonderful, compassionate people who think and live our mission," Frantsve-Hawley says.

Aspen also uses the TAG OCC to train their team on their technology for 3D printed dentures and advances in implant placements. During this training, their teams provide access to care with the latest technology, which can give patients a new outlook on life, Frantsve-Hawley says.

"It's been inspiring and touching when we see many of our patients come to us in a state of despair and fear and shame and leave with a new smile and courage and a great outlook on life," Frantsve-Hawley says. "It's not just changing their teeth and smile, but it's changing their lives."

The combination of the efforts on behalf of the Healthy Mouth Movement, which also includes Aspen Dental’s Dental Service Day, where many of the practices nationwide provide free dental care to Veterans and their families, and the Overseas Outreach Program, which Frantsve-Hawley also leads, have led to over $23 Million in donated dentistry since 2017.

Heartland Dental established the Heartland Dental Foundation in 2018 with the vision to “

give supported doctors, team members, support professionals and the communities they serve more reasons to smile through passionate, thoughtful, and generous assistance

.” The Foundation raises money through various fundraising efforts and applies those funds to individuals in the Heartland support network experiencing hardship.

Heartland Dental also partners with the Heartland Dental Foundation on programs that reach outside the United States borders. Over the last 2 years, Heartland Dental has partnered with Mission Lazarus in several areas of Honduras to provide much needed dental care to the communities. This population, through no fault of their own, has zero access to the level of care that the Heartland supported team can provide, he says. David Foster, DDS, practices near Nashville at Gallatin Dental Care as a Heartland-supported doctor has participated in mission trips with the Heartland Dental Foundation.

"We have had 3 groups travel down to provide care, including our CEO, Pat Bauer," Dr Foster says. "Our goal is to provide more than extractions, which is the typical model of humanitarian work. We want to save teeth and provide consistent care so that our patients in Honduras can keep their teeth and their dignity long-term. So, in addition to extractions, we are placing fillings, providing cleanings, and even performing root canal therapy. The results are better than expected so far."

In 2023, 25 Heartland Dental supported doctors, delivered over $230,000 in dental care across two trips to Mission Lazarus. The teams provided 325 exams, 399 extractions, 170 fillings, and 18 root canals. These treatments likely would not have happened otherwise, Dr Foster says.

"Remember, our patients in Honduras must decide between paying for dental care or putting food on their tables. They always choose food, but because of Heartland Dental, Mission Lazarus, and our supply partners Henry Schein, they do not have to make that choice," Dr Foster explains, adding that the benefits to the Heartland team are significant, too. "I am always blown away by the quality of character our Heartland Dental doctors have on these trips. While serving others, we are developing life-long relationships and sharing dental knowledge. We are growing together as an organization while making the world a better place."

In 2024, Heartland Dental and the Foundation have additional mission trips planned, both to Mission Lazarus and to serve underserved areas in Appalachia.

Heartland Dental supported offices also participate in Free Dentistry Day, an initiative that has provided over $14 million in free dental care to patients over the years. This year, supported doctors have provided care for 5233 patients, resulting in $2,122,122 in donated dentistry, which is even more than they had the year previous. Many Heartland Dental supported doctors also participate in community outreach and local events, giving back to the communities they serve.

At Pacific Dental Services, they recognize the vital role they play as leaders in the health care industry within the communities they serve, says Carli Casey, Senior Manager of Corporate Social Responsibility and Service.

"Providing donated restorative dental care to those in need is one of the primary ways we choose to serve," Casey says.

Pacific Dental Services established several key initiatives and partnerships to address the critical needs of underserved populations, which include:

 Since 2011, they have actively participated in Smile Generation Serve Day, a nationwide campaign of giving that focuses on providing donated dentistry to underserved patients.

 Collaborating with local nonprofits and community health centers ensures their services reach individuals who may face challenges accessing dental care.

 Their clinicians regularly participate in community events and health fairs, offering free consultations and educating individuals on the importance of maintaining oral health.

 Their international service program takes their clinicians and team members to countries like Guatemala, where residents have limited access to dental care. There, team members generously volunteer their time and skills, providing donated dental care, education, and community service.

"Since our first international service trip in 2010, PDS team members have traveled to countries like Guatemala, Ethiopia, and Fiji, providing over $11 million in dental care and positively impacting the lives of thousands of patients," Casey explains.

our participation in Smile Generation Serve Day over the past 13 years has allowed us to make a significant impact on underserved communities here in the U.S. We've provided over $57 million in donated dental care, encompassing essential procedures like cleanings, fillings, extractions, and more complex treatments, such as root canals and dental implants, on that annual day of service alone," Casey says.

Pacific Dental Services' most recent Serve Day was a remarkable success, Casey says, resulting in over $10.6 million in care for those who need it most, serving over 3500 patients nationwide.

“And through meaningful partnerships we’ve made with dental laboratories and other organizations, patients receive 100% pro-bono care, further amplifying our impact."

These projects have impacts on the organization as well. Casey says serving those in need brings substantial benefits, not only to the patients they serve but also to their team members providing the service. Research shows that the act of giving boosts the production of 3 brain chemicals–dopamine, serotonin, and oxytocin, often referred to as the "happiness trifecta."

 This increase in brain chemicals improves the overall mood and well-being of those serving others, Casey explains.

"Engaging in acts of giving through their core competencies enriches our team members' lives, providing them with a profound sense of purpose and fulfillment," Casey says. "This transformation in their daily routines enhances their dedication to their work throughout the year, creating a win-win situation for everyone involved."

Oral Systemic Health. American Dental Association. Published 2023. Accessed October 25, 2023. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/oral-systemic-health

Hinton, E. and Paradise, J. Access to Dental Care in Medicaid: Spotlight on Nonelderly Adults. KFF. Published 2016. Accessed October 25, 2023. https://www.kff.org/medicaid/issue-brief/access-to-dental-care-in-medicaid-spotlight-on-nonelderly-adults/

About Give Kids a Smile. About Give Kids a Smile | ADA Foundation. Accessed November 2, 2023. https://www.adafoundation.org/give-kids-a-smile/about-give-kids-a-smile

. Accessed October 31, 2023. https://www.dhcs.ca.gov/services/Pages/MediCalDental.aspx

"Developmental Disabilities & Oral Health” 

National Institute of Dental and Craniofacial Research

. U.S. Department of Health and Human Services. Published 2023. Accessed October 31, 2023. https://www.nidcr.nih.gov/health-info/developmental-disabilities

Unger Baillie, K. "A growing focus on equitable oral care for people with disabilities." Penn Today | The University of Pennsylvania. Published 2022. Accessed October 31, 2023. https://penntoday.upenn.edu/news/penn-dental-medicine-growing-focus-equitable-oral-care-people-disabilities

The power of a smile: what helping others does for you. Benefits of Helping Others|Why Should I Help Others|Grin! Magazine. Accessed November 3, 2023. https://www.grinmag.com/archive/en/ddpa/2020/spring/wellness/what-helping-others-does-for-you/

Articles

We look at what the industry believes about access to care, what are some reasons that patients don't have access to care and the problems that can lead to, and some successful programs that get patients the care they need. 

Providing Restorative Care for People In Need

Strategies for Reducing Material Waste | Image Credit: © Summit Art Creations - stock.adobe.com

In daily dentistry, practices produce waste. If not properly disposed of, some of this waste can have adverse effects on the environment.

Waste takes other forms. What you order and how much produces waste. How the materials you use are packaged produces waste, too. Even the light bulbs you choose or the paper you recycle (or do not) produces waste. This article looks at problems with material waste in dentistry, ways of employing green policies, and strategies for reducing waste in your practice this year.

Taking advantage of purchasing deals on materials you use often makes sense for your bottom line. However, for products with an expiration date, buying more than you can use before that date can backfire. You probably have thrown out some of that product you got for “free” before you could use it; if not, you probably know someone who has. Avoiding that problem starts with how much you order and when.

Another area where material waste occurs is package sizing. Sometimes leftover material in these larger packages or tubes goes unused and is thrown out. The American Dental Association (ADA) recommends buying sealants, adhesives, and other restorative materials in package sizes that ensure use of all the product during the procedure to avoid this problem.

One of the most significant areas of concern regarding dental material waste is dental amalgam. Dental amalgam contains mercury, a toxic and bioaccumulative material. Therefore, it is essential to manage dental amalgam waste properly. A European journal had the following suggestions for dental practices:

Reduce waste by limiting the amount of dental amalgam used in procedures. Consider alternative materials like resin, ceramic, or other metal alloys when suitable.

If you do need to employ amalgam material, use precapsulated dental amalgam to avoid spills and clinic contamination from liquid mercury.

Install chairside filtration devices and secondary filters in vacuum pumps to trap larger amalgam particles and prevent contamination. Chairside traps remove around 68% of amalgam particles, whereas vacuum filters are around 40% effective.

Use these filtration devices to separate fine particles generated during procedures, preventing their release into wastewater.

Treat collected mercury and amalgam waste as hazardous waste, ensure staff are trained in disposing of it, and use protective gear. Store contact and noncontact amalgam waste separately.

Collect waste storage containers for reclamation by a registered agency, aiming for recycling, although not all agencies can do this.

Avoid flushing contaminated wastewater down sinks, rinsing chairside traps or vacuum filters in sinks, or disposing of amalgam material in general waste. These practices release mercury into the environment, undermining efforts to reduce mercury contamination.

Material waste occurs when using traditional x-rays and related chemicals. There are concerns regarding silver and lead pollution. Silver can get into the water system with improper disposal of dental x-ray fixer and into landfills through disposal of undeveloped film. When thrown into the general waste system, the lead foil around the x-ray film can leach lead into the landfills. In both cases, using an approved waste carrier or switching to digital x-rays can avoid these problems.

In addition to the risks with silver and lead, the constant exposure to radiographic developer and fixer solutions in dental settings can pose potential health risks to dental personnel. These solutions contain chemicals like hydroquinone, acetic acid, and glutaraldehyde, known for their volatile and irritating properties. Continuous exposure to these chemicals, as mentioned in the Material Safety Data Sheets, may lead to respiratory tract irritation and aggravate preexisting asthma conditions. Additionally, some components, like hydroquinone, are linked to chromosome breakage, although the human risk is uncertain. Furthermore, the incompatibility warnings, such as the release of sulfur dioxide or ammonia when in contact with acids or bases, respectively, raise concerns.

These chemicals, which operate together in the same x-ray developer apparatus, are poured in and out of containers. Given the small, confined spaces of x-ray developer rooms, repeated exposure, even with proper ventilation, may pose long-term health risks over a span of 20 years. The cumulative effects of exposure to these volatile and potentially harmful chemicals warrant careful consideration for the safety and health of dental personnel—and perhaps switching to a digital radiography option.

Problematic areas also include energy waste and chemical waste. There are other ways in which a dental practice can create waste, such as multiple shipments from the same supplier in a given week or not recycling products when appropriate.

, a dental monitoring app company that allows dentists to monitor their patients remotely, had the following suggestions for reducing waste in your dental practice:

Use a dimmer system for lights to save energy. It adjusts light based on how much natural light is already in the room. Add motion detectors and timers to turn off lights when no one is around.

Instead of chemicals, use steam to clean and sterilize items.

Dental offices produce lots of trash with single-use products. Try using stainless steel trays and reusable items like glass irrigation syringes and cloth bags. Use disposable barriers only when necessary.

Switch to a vacuum without water and with a special trap for amalgam.

Ask suppliers to pack orders together to make fewer delivery trips. Reuse the boxes.

Look into aligners made from reusable plastic. Some companies reshape them so they can be used 3 times.

Recycle as much paper, aluminum, and plastic as possible using bins. Some services recycle shredded medical paper.

Try going paperless. Use software to manage appointments, bill patients, and keep records without printing anything.

In addition, there are things your staff can do to reduce waste and conserve energy in a dental practice, including the following:

Use reusable plastic containers for cleaning and disinfecting solutions to reduce waste.

Opt for products made from recycled or partly recycled materials like cotton or wool rolls, and paper towels.

Install energy-efficient lighting to reduce energy consumption.

Regulate office temperature effectively to conserve energy.

Old equipment is another area of opportunity regarding waste in a dental practice. When you replace a broken or aging dental equipment component, it can be tempting to dump the old one. However, instrument company

encourages dental practices to recycle (ie, pass on) old equipment instead.

For example, outdated dental equipment, like an x-ray machine, does not have to end up in a landfill. Explore programs that accept old equipment and repurpose it to set up dental clinics in developing nations, like 

, or experts in dental equipment recycling and decommissioning, like 

By partnering with such initiatives, you can dispose of your outdated machine responsibly while giving it a new life to serve communities in need. This allows your office to upgrade to modern equipment and reduces landfill waste. Moreover, when you donate functioning equipment that the organization can ship to a clinic that needs it, your contribution aids in providing essential oral care to vulnerable populations worldwide.

Surprising Facts Regarding Recycled Paper

These suggestions might seem like small things and many are. However, small does not mean insignificant. Small changes accumulate into big impacts.

For example, it might seem like a small thing to have those blue bins for recycling paper. But the impact the cumulative contents of those bins can have might surprise you. Recycling 1 ton of paper saves trees, conserves resources like water and oil, reduces air pollution, and prevents landfill space consumption. It also saves

This represents a 64% energy savings, 58% water savings, and reduces 60 lb of air pollution.

Moreover, the 17 saved trees can collectively absorb 250 lb of carbon dioxide from the air annually. By contrast, burning a ton of paper releases approximately 1500 lb of carbon dioxide.

There are a few things you can do to reduce paper usage in the practice, 

. Ask to stop receiving unwanted office mail. Choose recyclable options for letterhead, envelopes, fax paper, and business cards and send appointment reminders via email or text message. Also, consider going paperless by using a virtual system for patient records, billing, and x-rays. In addition, reduce the number of printers in the practice and print double-sided when feasible. Reuse shredded paper as packaging material.

1. 80 ways to make your dental practice green. American Dental Association. Accessed December 7, 2023. https://www.ada.org/en/resources/practice/practice-management/office-design/80-ways-to-make-your-dental-practice-green

2. Muhamedagic B, Muhamedagic L, Masic I. Dental office waste - public health and ecological risk. 

. 2009;21(1):35-38. doi:10.5455/msm.2009.21.35-38

3. Farahani A, Suchak M. Eco-Friendly Dentistry: The Environmentally-Responsible Dental Practice. University of Waterloo. April 3, 2007. Accessed December 7, 2023. https://ecodentistry.org/wp-content/uploads/2014/12/eco-friendly_dentistry_jcda.pdf

4. 10 tips to help your dental practice produce less waste. In Hand Dental. June 29, 2023. Accessed December 7, 2023. https://inhanddental.com/10-tips-to-help-your-dental-practice-produce-less-waste/

Tackling Dental Office Waste and Recycling

. Available at: https://prodentusa.com/tackling-dental-office-waste-and-recycling/ (Accessed: 8 December 2023).

The dental industry cannot avoid producing its share of material waste, but steps can be taken to employ green policies in your practice this year. 

Strategies for Reducing Material Waste

What 2023 Taught Me for 2024 | Image Credit: © Jenn Miranda – stock.adobe.com

As the new year settles into its normal tempo, it is a good time to reflect on the experiences of the past year. We spoke to 3 of our editorial board clinicians about what they learned this past year and how that will affect their dental practice in 2024.

John Flucke, DDS, chief dental editor and technology editor at 

, predicted last January that 2023 would be the year of artificial intelligence (AI) in dentistry, and it was. Going into 2024, he thinks its applications will continue to develop and grow, and not just in dentistry. AI is everywhere.

“It reminds me of science fiction where the killer plant puts all these roots underground, and no one realizes it, and all of a sudden, one day, these things sprout up everywhere,” Dr Flucke says. “Artificial intelligence is so embedded in many things we do now that it can accelerate change quickly. We saw huge growth regarding AI in 2023, and I look for that to continue to grow exponentially in the next few years.”

For example, Pearl AI assists dentists by analyzing radiographs and applying algorithms that look for caries, infections, and periodontal disease. Dr Flucke says as these systems get more data, Pearl AI will identify more areas for clinicians to examine. Comparing the technology to a second set of eyes, he emphasizes that AI doesn’t make decisions; it provides more data points.

“It doesn’t decide what to do any more than an x-ray tells you what to do,” Dr Flucke says.

AI also impacts the clear aligner market. Dr Flucke began working with Candid, which has functionalities enhanced by AI. Candid has a tool that attaches to a mobile phone, which the patient uses along with the app to take a video of their mouth. Once uploaded, AI monitoring can determine when the patient should change aligners. Also, it can detect when something is not working as it should and notify the patient and practice that they should meet to make adjustments. 

“You get all…this info every time they scan, and the patient doesn’t have to take off work and come in for a 20-minute appointment where I look and go, ‘yep, everything looks great! See you in another 4 weeks when you take another day off work,’” Dr Flucke says.

He also likes the polymer chemistry of CandidPro’s material, which provides continual slight pressure movements. Therefore, the teeth do not get as sore as they do with other plastics.

“Now the trays stabilize the pressure so your body can get used to it,” Dr Flucke says.

In-office mills design software that will also soon have enhancements provided by AI, he says. Maybe as early as 2024, an AI system can design the indirect restorations needed from the intraoral scan taken in the office. 

“Then you can download the file and mill it, and it will take 5 minutes to create all that for you,” Dr Flucke says. “That’s a game changer, too. Artificial intelligence is slowly permeating everything.”

Delving Deeper Into Digital Dentistry and Marketing, and Working on Balance

Speaker and educator Jeffrey Lineberry, DDS, AAACD, FAGD, FICOI,has a private practice in North Carolina that has delved deeper into the digital side of dentistry this past year. He recommends that clinicians follow suit, particularly those on the fence about taking on a digital workflow. Digital dentistry is not a fad that is going away, he says. Plus, digital scanners are getting a lot more affordable.

“Printing is another huge part of what we do. It’s getting to the point now where I don’t remember the last time we poured up a model in our office. That’s interesting when you don’t hear the model trimmer going anymore,” Dr Lineberry says.

In addition to models, Dr Lineberry prints surgical guides in-office, which has been more cost-effective and predictable. With files available for download to print in-house, his team appreciates not having to wait for the guides to be shipped.

The most significant change while incorporating 3D printing is creating a digital workflow that is practice specific. Dr Lineberry’s staff has taken on this responsibility, particularly regarding the practice’s printer setup. Moreover, it is essential to mention that using a 3D printer in the dental practice is not as easy as using a printer to print a Word doc.

“But once they figured that there were more steps to it, it [was] like everything else,” Dr Lineberry says, comparing the implementation phase to figuring out a new cell phone for the first time. “When you start using the phone, it’s time-consuming and makes you want to pull your hair out. But once you get used to doing it that way, you forget how you used to do it otherwise.”

In addition to investing in the digital workflow for his practice, he thinks that 2023 confirmed for him the critical nature of constantly refining the elements of practice management. He thinks the days of riding out the status quo are gone.

For example, ongoing marketing is a necessity today and it was not in the past. In some cases, advertising dental practices used to be taboo.

“There was a time here in North Carolina [when] we weren’t allowed to advertise other than making announcements [such as] we opened a practice or [were] accepting new patients,” Dr Lineberry explains. “Marketing was very much frowned upon. Now it’s very much mainstream. It’s a different thought process, especially [for] dentists like me who have been doing it for 20 years.”

Dr Lineberry has been marketing more in 2023 and letting his marketing dollars gravitate away from the traditional channels and toward digital marketing and social media. Keeping up to date on these types of changes is vital, he notes.

“You may not want to embrace the whole digital marketing thing, but it is a viable channel and an integral piece of how we market today,” he says.

Consistency is key with marketing. Getting busy and letting marketing efforts slide will lead to a schedule that waxes and wanes between very busy and not so much, Dr Lineberry says.

Plus, having an online presence is essential to a dental practice. Many patients find their dentists online, using reviews and other online feedback to narrow their choices. Dr Lineberry thinks the time of giving a referral and expecting the patient to go to that referred clinician is also past.

“Patients are much more involved with making some of these decisions, and some of those are made online,” Dr Lineberry says. “Marketing, the internet, and an online presence are very much a driving force in making selections in health care nowadays.”

He also thinks that dentists should focus on self-care in 2024. Self-care should be an ongoing priority for clinicians.

“No matter how busy you get in your practice, you should always take time to take care of yourself,…mentally and physically…. [Carve] out time specifically for yourself and your family, working on your work-life balance,” Dr Lineberry advises.

The benefits of this effort are improved performance in the practice and an abundance of positive energy. The pitfalls of ignoring self-care are the opposite.

“If you come in like, ‘Oh my gosh, why am I here today? Somebody please shoot me,’ that’s not going to be very healthy for your practice or your patients,” Dr Lineberry says.

Working Smarter as Well as Harder to Manage Shrinking Margins

Jason H. Goodchild, DMD, vice president of clinical affairs at Premier Dental Products Company, says because new technology and materials come out all the time, clinicians should always learn new techniques for whatever pathway they choose for their practice. He describes this type of lesson as table stakes. Learning these new techniques is essential, whether through live events, webinars, podcasts, or journal articles. 

In addition to new techniques for the services dentists already provide in their practice, Dr Goodchild thinks an eye toward the efficient and effective expansion of services is also critical. Part of this consideration is recognizing how to acquire new skills and the technology accompanying the service while managing the shrinking margins in dentistry to increase revenue.

“We can’t just do more and expect to make a better profit. That’s the fallacy many dentists fall into, which is, ‘I’m going to work more hours or pick up a Saturday here and there, and I will make more money,’” Dr Goodchild says. “But unless you do the other things to increase the profit margin, you’re just killing yourself for no particular reason.”

The revenue associated with more activity should produce a profit after the costs of the increased activity. Dr Goodchild explains that if you spend more to acquire that revenue, with things such as workforce costs, you can end up spinning your wheels from the perspective of bottom-line success. Dentists should have a keen eye for efficiency with their time and an understanding of what they spend to get to more production to protect their profitability.

“Unless you do the things underneath the top line to protect and increase [the] margin, it won’t work,” he says. “That’s why one of the things I’m involved with is how to do things more efficiently.”

Dr Goodchild has a unique clinician perspective because he also works on the manufacturing side. Both viewpoints value doing things better, safer, and faster. However, on the clinician side, there is also the element of doing it more cheaply without compromising care.

“What they want to do is minimize,” Dr Goodchild explains from the practice-owner perspective. “They want to look for great deals on equipment, supplies, and consumables.”

One way to find deals that increase the margin without sacrificing quality of care is to look for areas where a private label can perform as well as a brand name. Dr Goodchild discourages clinicians from buying a brand name at a higher price when it does not provide specific value in the present environment.

“[For] paper products, gloves, cotton rolls, distilled water, and other highly commoditized products, I’m always looking for the best deals. When it comes to products like burs, composite, bonding agents, cements, and [prophylaxis] paste, I still look for the deals, but also still feel like branded products will handle and perform the way I want,” he says. “Everything is getting so expensive, and dental products are no exception. There’s at least 1 price increase every year, probably more—and you can’t say the same for your reimbursement from insurance.”

Another area that Dr Goodchild thinks he learned a lot from in 2023 was managing the cost of the acquisition of talent. It’s not a secret that acquiring and keeping the right team was a challenge this past year, and it is only getting more complicated, he says. With all the competition, dental assistants and hygienists are commanding more per hour and getting it. In some cases, hygienists are doubling their hourly rates. Dr Goodchild says this area significantly challenges a dentist’s bottom line.

Digital workflow components press the margins, too, he says. When one compares the price of their digital technology to that of their more affordable analog counterparts, such as film and processors or alginate, it compounds the growing costs associated with running a dental practice. Plus, it is harder to control production when the workflow depends on the internet, which can fail, or a server or image management programs that can glitch. Dr Goodchild says these are all practice killers.

“They grind us to a halt, and we still need to keep going with the schedule,” he explains, adding that he worries the growing pressure with overhead expenses could influence the treatment planning of young dentists. “Are they prescribing things on the borderline because they need the revenue? I hope that they resist that urge.”

Per Dr Goodchild, a solution-based approach to procedures is a powerful way to move forward into the new year. For example, clinicians do not require 5 different bonding agents and composites, nor do they need an assortment of approaches to procedures. One system for Class II composite filings or crown placements can streamline things.

“This approach becomes important when there are multiple doctors in a practice because every doctor wants a different thing and does things their way. But suppose there are systems in place and solution-based approaches for better outcomes. In that case, that’s a powerful way of looking at it because then you don’t have tons of different materials in the practice [or] lots of extra stock that you don’t need,” Dr Goodchild explains.

He also favors the just-in-time approach to managing inventory. Rather than carrying thousands of dollars’ worth of inventory in the practice’s storage closet, have only the items used consistently and reorder often. If the inventory budget is 6% of the gross revenue, why not reduce that by 1% in 2024?

“If I cut that 1%, then [those dollars flow] right back into my pocket as the owner,” Dr Goodchild explains.

In general, Dr Goodchild would encourage clinicians to look at the bigger picture regarding the margins in the business. However, it is also critical to remember to plan for taxes. In the first year of his practice, he worked hard and didn’t spend any money on capital improvements or equipment. His practice revenue was significant, but his tax bill killed his profit. However, this hard lesson drove home the idea that you can work harder, but working smarter is also crucial. He thinks clinicians should remember this going into the new year.

“In the days of everything getting so expensive so fast, it’s even more in focus,” Dr Goodchild says. “It has to be."

It’s that time when we look back as we move into the new year. Three editorial board clinicians share their thoughts on what 2023 taught them and how these lessons will play a role in how they approach their practice in 2024.

What 2023 Taught Me for 2024

Flexible partial dentures are a versatile and affordable option for tooth replacement. Like all the restorative options, they have their pros and cons. We look at both and what you should consider regarding case selection.

Dental implants are an excellent restorative option for patients with missing teeth. However, not every patient can tolerate or afford dental implants. Therefore, every dental practice must have other, more affordable alternatives to restore missing teeth.

Partial dentures are an affordable way to replace a missing tooth or teeth. Traditionally, these are made with a plastic or metal base with clasps that attach to surrounding teeth to hold the replacement tooth in place.

By contrast, flexible partial dentures have a non-rigid base. Many patients find them more comfortable to wear than a traditional partial denture.

 Made of thin thermoplastic, such as nylon or a vinyl composite, flexible partials bend to fit the patients' oral cavity. Flexible dentures are an excellent option for patients that have:

Tilted teeth, making it challenging to insert rigid dentures

Irregular bone ridges that cannot be corrected

The Materials Used for Flexible Partial Dentures

Many flexible partial dentures, including the early ones from the 1950s, were made of nylon-based materials, like Valplast. A couple of decades later, flexible partial dentures were made from a range of materials, including:

Acrylics (polymethylmethacrylate – PMMA)

Today's denture materials have continued to evolve. There are super flexible crystalline nylons and polyolefins. Choosing the material depends on the patient's needs. For example, crystalline nylon might be the better choice for patients with allergies.

These materials have many patient benefits. They are biocompatible and don't have BPAs. They are also stain and odor-resistant. Plus, they are comfortable to wear and eat with because the bases are thin, much thinner than traditional dentures. The flexibility means they are also less likely to irritate the oral cavity.

Partial dentures are great for patients with three or more missing teeth next to each other. They can also be helpful after extractions from trauma or disease, holding the surrounding teeth in place until the patient gets a more permanent option.

Flexible dentures retain better (no adhesive necessary) and are more difficult to break than traditional partials. Many think they are more comfortable than conventional partial dentures, too. Also, they are affordable, ranging from $700 to $3000, depending upon the case, and some insurance policies cover them up to 50 percent.

In addition, flexible partial dentures are more straightforward to custom design. The whole process requires less time for custom design than other restorative options and is far less invasive than dental implants. Moreover, flexible partials tend to fit appropriately with less fuss than other modalities.

While partial dentures are esthetic and affordable and help patients eat, smile, and talk, patients cannot always wear them. Also, flexible partial dentures need maintenance more than other permanent solutions. Patients often need replacements at five years, although some estimates put that at 8 years.

 Plus, the color can degrade as the patient wears them. Additionally, they are more expensive than traditional partial dentures, which might be a stumbling block for some patients.

Some patients want a low-maintenance and natural-feeling solution for their missing teeth. In those cases, flexible partial dentures, with their less-than-permanent feel, will not deliver the proper patient experience. Also, even though they don't break the same way traditional partials do, flexible partials are challenging to fix and often require a complete replacement if something breaks.

All restorative options have pros and cons. When reviewing the flexible partial denture for tooth replacement, we look at some key points to consider regarding case selection.