Smiling through

An unsettled present is once again forcing the dental industry to sink its teeth into the future.

By Anne-Frances Hutchinson

As did the AIDS crisis, the COVID-19 pandemic has thrust the industry into transformation mode. While it’s almost impossible to imagine a time when dental professionals worked with bare hands, they weren’t required to wear gloves until 1989—and most dentists wanted nothing to do with them.

Despite the fact the OSHA mandate was created to protect practitioners and their patients from exposure to bloodborne pathogens such as HIV, which at the time was believed to be an automatic death sentence, dentists worried that the sight of them wearing protective gear would keep patients away. Three decades and a global pandemic later, many practices are struggling to obtain and finance the PPE patients expect them to wear and that they need to keep their doors open. It’s one of the many challenges fueling the breakneck pace of pandemic-influenced change.

In 2021, keeping the doors open hardly guarantees survival. Ninety-eight percent of the nation’s dental practices are open, but it’s far from business as usual. Only one third are serving their typical patient volumes, and that number has been on a steady downswing since the summer. “Rather than resuming normal service, this crisis presents an opportunity to rethink the future of dentistry and address system-level failures,” writes Richard Watt in The Lancet.

The pandemic shone light not only on systemic shortcomings in the healthcare industry at large, such as the inequality of care, but on the day-to-day dental industry business practices in need of reworking. For example, in the event that the pandemic becomes endemic, meaning that it never goes away and the world must adapt accordingly, the use of teledentistry will continue to strengthen.

According to the NIH, “Teledentistry can be incorporated into routine dental practice as it offers a wide range of applications such as remote triaging of the suspected COVID-19 patients for dental treatment and decreasing the unnecessary exposure of healthy or uninfected patients by decreasing their visits to already burdened dental offices and hospitals.”

The potential of teledentistry is but one aspect of reinvention that oral healthcare practices should consider. Watt posits that restrictions on procedures that generate aerosol sprays offer an opportunity to seek out less invasive techniques and encourage collaboration amongst dental teams to better manage the risks for oral and other non-communicable diseases. Taking advantage of these possibilities will mean refocusing on patient-centered outcomes, such as infection control, consistency of care, and building loyalty through more satisfying and effective interactions between staff and patients.

“The traumatic and collective experience of 2020 has demonstrated the potential for fundamental and revolutionary shifts in the dental delivery mode, from the training of dental workers, to the sourcing and inventory management of critical care equipment and PPE, to the optimal settings for care delivery and how it is reimbursed. The future success of dental professionals will be determined by our industry’s ability to remain hypervigilant, adjust to the new normal, deal with a specific set of new or accentuated challenges, and capture new opportunities at optimal speed,” said Farhad Attaie, co-founder of the New York City-based pediatric dental practice hellosmile.

Part of that future success, he stressed, will be new infrastructure technologies designed to make dental practices more efficient. “It’s worth noting that while representing only a minority of all dental practices, the number of practices with more than 10 employee dentists, as well as the number of practices contracting with (dental service organizations) to streamline business operations, has been rapidly expanding. Massive financial losses during the pandemic may hasten the consolidation of dental practices under new infrastructure models that can better weather financial uncertainty.”

Alongside technologies that are changing the way dentist offices operate, brand new technology allows for people to have more access to different types of clear aligners that can cater to their dental needs. Gone are the days when Invisalign was the only alternative to that of braces. Nowadays, there are so many different options besides braces and Invisalign, from at-home solutions to other in-office clear aligners. Thanks to these developments, the industry can adapt and deliver to various different people who have different wants, interests, and budgets.

Nacci, the social impact venture studio cofounded by Attaie, is a member of Oral Health United, “a modern community built for dental professionals, by dental professionals, in a pandemic-shifted world.” Incubated on social media as an informal discussion group, OHU launched in November 2020, and boasts a membership of 45,000 dental professionals and counting. The coalition of dental professionals and brands aims to redefine dentistry’s “business as usual.”

The collegial support offered by the group is rapidly becoming integral to the vitality of American dentistry. As founder Sarah Lawrence PDH explained, “As dental professionals, we must approach ourselves with renewed compassion, and ask: What needs to change in order for us to thrive in this industry? What do we need to feel whole? What do we need to feel fully equipped and empowered to deliver life-saving preventive care for our patients? We might not have all the answers now, but we can learn and iterate together—and to me, that’s a powerful beginning.” Unsurprisingly, Lawrence is a registered dental hygienist; these stalwart front-liners face a staggering 99.7% occupational risk of exposure to COVID-19.

OHU member companies are coming together to offer innovative solutions that enable dentists to build healthy, resilient practices now and in the pandemic’s aftermath. BlueIQ developed an industry-specific dashboard that enables small practices to employ data-driven decision-making to benefit their businesses.

The on-demand staffing platform developed by onDiem provides qualified and verified permanent and temporary pros, and handles each employee’s weekly payroll and payroll taxes, as well as their malpractice and workers compensation insurance. CEO Joe Fogg asked Attaie, “There are so many moving parts to this pandemic. Having one person or organization try to put their arms around all that and really know what they’re up against is impossible. How do we make this a safe environment for the teams? How do we make it efficient for them?”

Attaie noted, “The intersection of dentistry and modern education technology has allowed for streamlined learning.” In partnership with onDiem and mobile learning startup Higher Learning Technologies, OHU offers a Smart Safety COVID-19 course at no cost. Safety and compliance specialists BioShield Healthcare and medical device R&D innovator Forca Healthcare contribute to the course.

Supply expenses don’t drop when dentists’ chairs are empty, and these days that means 66.7% of the time. A new alternative to dealing directly with suppliers or working with buying groups, Dentira enables users to compare prices from most of the country’s major suppliers without sacrificing discounts and negotiated pricing, and simplifies procurement and inventory management. As practices struggle to obtain and afford PPE, the platform is a much-needed asset.

“Even before the pandemic,” said founder Vikas Gupta, “there was no price transparency. It was just a lot of time and research and hassle for dental staff, especially for practices. Now, during the pandemic, some people are selling N95 masks for $1—and some are selling them for $9. We’re helping people gain more transparency into these prices, so that they can avoid spending thousands more dollars than they need to per month.”

Tackling the ever-present pressure of billing, OHU partner Zentist uses AI and machine learning to offer end-to-end insurance claims processing. By removing the time and labor intensive work of filing and tracking claims, Zentist enables office staff to spend their time on more valuable and satisfying tasks that can help grow the practice.

To speak of growth as the industry shoulders the unprecedented burden of the pandemic’s brutal second wave may seem premature and even reckless to some, but in the words of The Lancet’s Watt, “Radical reform of oral health-care systems will require brave and bold decision-making from our political and professional leaders. The time however is ripe for change.”