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Is this the dark, or golden age of dentistry?

Feb. 5, 2021
Do the nonstop hurdles of owning a practice make it feel like this is the dark age of dentistry? Don't let your mind go there.

By Brett Wells, DDS

I still vividly remember my final day of dental school, 14 years ago. I walked out, having completed my clinical requirements and knowing my entire career lay ahead of me. I was ready to get out there and begin my journey. It wasn't long before I opened my first practice.

Soon thereafter, the reality of our profession hit me.

Dentistry is difficult. It takes years of schooling and on-the-job training to become good. Opening a practice takes business savvy, marketing sense, human resources know-how, and financial acumen. It can seem overwhelming. Not a day goes by that I don't hear about the hurdles our profession is facing. I think of all of the challenges—dental insurance, dental school debt, corporate dentistry—and wonder, could we be in the dark age of dentistry?

Dental insurance—Insurance companies have become a large part of our practices, not necessarily for the better. With nearly 70% of the population covered by some type of plan, insurance companies know they have the upper hand. Reimbursement rates are staying stagnant at best and are often lowered. Our relationships with insurance companies are becoming more antagonistic as the companies focus more on their own bottom line than on patient care, and more on profit than their relationships with those who provide it. 

Dental school debt—Many of us have felt crippling student loan debt. Per the American Dental Association, the average dental school debt has nearly tripled the past 20 years to almost $300,000, with some of us more than $500,000 in the red. Dentists are riddled with some of the highest student loan debt of any profession, so much so that the idea of hanging your own shingle is a dream that far fewer of us are able to pursue. Which leads to . . .

Corporate (chain) dentistry—Enter the world of the dental service organizations (DSOs), or what many dentists consider corporate-backed “chain” dentistry. Many solo practitioners fear the competitive advantages that DSOs have—group buying power to lower equipment costs, centralized business services, co-op marketing, and more—and are concerned about stagnating salaries that these cost-cutting measures can bring.

For these and other reasons, many would say that we are in a dark age of dentistry. It’s too difficult, there are too many obstacles, and we pine for a long-gone era. I would argue, however, that we are in the golden age of our profession. We have access to powerful tools that our predecessors did not. Opportunities abound to provide more effective patient care through technology, payment flexibility, outsourcing, education, and organized dentistry. Change may be hard and a bit scary, but embracing progress is a surefire way to build the practice of your dreams.


From equipment to software, technology is changing the way we practice for the better. Technology allows us to become more efficient, lowers our costs, and allows us to provide more procedures in our offices.

CAD/CAM technology—This is perhaps the most rapidly evolving technology in our profession, giving us more control over care and lowering lab costs. With proper training we can easily perform cosmetic procedures, implants, and even full-mouth restorations using solutions in our offices. 

Digital radiography—Digital sensors and cone beam CT systems costs have come down to levels where many of us are able to have the technology in our practices. This results in significantly less time needed to make an image, which allows us to diagnose more dentistry and provide more, and ultimately better, care of our patients. 

Practice management software—The biggest technology bump, however, comes from the explosive growth of software solutions for dentistry. We now have the ability to manage and analyze our practices like never before. While not a new technology, the advancement of practice management software has opened the floodgates for integrated cloud-based tools to do so much. This amazing software technology simply wouldn't be possible if we were still using paper charts. 

Practice analytics—Do you know your KPIs? Key performance indicators are practice metrics that provide a snapshot of how your business is operating. Collections and new-patient numbers are some obvious ones, but to properly assess your operations, you should go further: hygiene reappointment rates, new-patient call conversion rates, treatment acceptance rates, patient attrition rates, and more. There are a number of practice analytics solutions that help you take a deep dive into your numbers, tracking them over time to show operational improvement. 

Automated patient engagement software—This can reliably confirm appointments via phone calls, emails, and texts, taking much of the burden off your front desk. Some also allow for online appointment scheduling. In my practice, this alone has been a huge source of new millennial patients. 

Payment flexibility

While patient financing is dominated by a select few providers, new players and new models are constantly jumping into the fray. This is a good thing. An effective financial presentation should offer patients several options, including pay-as-you-go, prepayment pay-in-full discounts, third-party financing, and in-house payment plans, all of which get patients to a “yes” much more easily, and that’s the goal. The more options you offer patients to help them pay for their care, the more dentistry you will do.

Insurance is getting more difficult to deal with. On top of that, more Americans are losing their dental insurance due to the overlapping factors of an increased older population, increase in gig economy workers, and layoffs and cutbacks from the pandemic.

In-house membership plans—These are an awesome solution for your uninsured patients. These plans increase cash flow, patient loyalty, recall frequency, and case acceptance, and decrease patient attrition. I know this because I’ve had membership plans in my practice for 10 years, and my fee-for-service patient base has more than doubled. I initially rolled out my own, but that became an administrative headache. Existing third-party platforms just didn’t cut it, so I created DentalHQ. Whether you use DentalHQ, another platform, or handle it on your own, there has never been a better time to reduce dependence on dental insurance and implement a membership plan. 


Dentists can outsource many administrative functions that allow us to grow without the financial burden of more full-time team members. We can use expertly trained teams at a fraction of the cost of doing the work in our office. Popular areas of outsourcing include insurance verification, insurance EOB submission/entry/resubmission, patient reactivation, insurance negotiation, and call centers (new-patient call overflow). Call centers significantly reduce the number of missed new-patient calls, increasing your new-patient numbers almost overnight.


The educational opportunities available today are far beyond anything we had even just 20 years ago. From advanced training in clinical areas to immersive training on the business side, the dental education bar has been raised to pole-vault levels. Better still, the rise of online courses, especially during the past year, has made these opportunities more accessible than ever. 

Organized dentistry

While organized dentistry at the city, state, and national levels have been around for years through the ADA, we have recently seen many new options pop up. There are countless Facebook groups with thousands of dental professionals discussing case stories, business advice, and products and companies, providing platforms to share what's working for us and what's not. 

We’ve also seen recent growth in the number of group purchasing organizations (GPOs), which use economies of scale by grouping large numbers of dental offices together to get better discounts from suppliers. These provide small practices with some of the benefits of the large DSOs while remaining independent.

The challenges we face as dentists are real. The previous generation didn't face them, and they aren't going away regardless of how much we complain or fight them. Taking the glass-half-empty approach, we could lead ourselves to believe that all the cards are stacked against us, and that these are the dark ages of dentistry.

However, if we view progress as an opportunity for growth, we can turn those challenges on their heads. Improvements and efficiencies provided by increased education, technology, and a systemized approach to running your practice can mitigate your dental school debt. And you can combat dental insurance overgrowth with in-house membership plans and practice analytics.

While we may be facing more challenges than our predecessors, we have by far many more opportunities available to us to improve, both with patients and our businesses. We have tools that give us superpowers—the power to reach more patients, provide better care, and turn our businesses into well-oiled machines. There’s never been a better time to be in this profession. That’s why I believe that this, my friends, is the golden age of dentistry.

BRETT WELLS, DDS, is the founder and CEO of DentalHQ. He’s a practicing dentist in Raleigh, North Carolina, and a frequent podcast guest star. A serial entrepreneur, foodie, and diehard Carolina Panthers fan, Dr. Wells started DentalHQ to help his fellow dentists increase patient care and case acceptance with in-house membership plans. Contact him at [email protected].