Message Boards
Today's Active Topics Today's Active Cases Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

Second Opinion: Pedonomics and the Affordable Care Act: Emerging Economic Impacts That Can Propel .. by Roger G. Sanger, DDS, MS

View Comments (8) More by this author (1)
Second Opinion Header

Second opinions are common in health care, whether a doctor is sorting out a difficult case or a patient is not sure what to do next. In the context of our magazine, the first opinion will always belong to the reader. This feature will allow fellow dental professionals to share their opinions on various topics, providing you with a "second opinion." Perhaps some of these observations will change your mind, while others will solidify your position. In the end, our goal is to create discussion and debate to enrich our profession. — Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine


Forget the rhetoric of the debates on the Affordable Care Act (ACA). Children and their dental benefits can, and should, have a long-lasting and significant impact in your practice. So put aside your political opinions for the moment and let's look at some facts.

What you might know
Baby boomers (currently the largest segment in our population) have significantly impacted the success of many dental practices with their desire and need for cosmetic rehabilitation, implants, adult orthodontics, nonsurgical periodontal therapy, sedation and more. Where once there were few dentists trained in offering these services, now it seems that there is an oversupply. Competition for these clinical procedures is becoming very prevalent. Do a Google search for "cosmetic dental rehabilitation" in your area and see for yourself.

In addition, advances in dental technology have multiplied at such a rapid pace that continuing education is no longer sought after just for re-licensure. It is now necessary in order to be competitive. New patients (and your current ones) are well educated and more discerning in choosing dental-health options thanks to advertising, Google searches, social media, and the baby boomers' increased desire to hold on to a youthful appearance.

As a result, the successful paradigm shift that allowed dental practices to fulfill these baby boomer needs with advanced dental technologies has leveled off.

What you need to know
Our birth rate is steady at four million per year, with millennial parents accounting for 80 percent of these births.

These parents (who are having their children later in life) are often "drone parents" who self-educate through their social networks and extensive Internet research. They have less inherent trust in the health-care system and their health-care providers, and as such have strong opinions regarding dental care for their children.

They are more demanding of their child's dentist, while often actually exerting less control and oversight over their kids. They also have a keen interest in technology, especially biocompatible, nontoxic, no-pain (or at least no-memory) dentistry. With the millennial generation, peer recommendation and social-media marketing are essential to effectively reach this audience.

Second, the caries rate in children has reached epidemic proportions, regardless of ethnicity, culture, and socioeconomic status. Dental caries prevention techniques have declined, while cariogenic diets have increased.

Centers for Disease Control and Prevention (CDC) studies show that 28 percent of preschoolers have untreated caries, compared to 14 percent of school-aged children. Approximately 4.5 million children are estimated to suffer from early-childhood caries. By the time they leave high school, an estimated 80 percent of students have untreated caries.

According to the ADA, from 2014 to 2018 the ACA will add more than 8.7 million children to the existing pediatric population already covered by some dental benefit plan. Expansion will be split among Medicaid (3.2 million), health-insurance exchanges or marketplaces (3 million) and employer-sponsored insurance (2.5 million).

Importantly, the number of children without dental benefits could be reduced by approximately 55 percent with this addition. All of this—on top of the impetus to add more children to non-ACA plans because of the nationwide push for all children to have a dental home—will cause an unprecedented increase in the demand for dentistry for children in this country.

The dental workforce treating children has changed dramatically. While the number of new pediatric dentists has increased to about 350 each year from the approximately 80 postdoctoral programs, the overall supply in the U.S. for practicing pediatric dentists remains at about 6,000—less than 5 percent of the total number of practicing general dentists.

Beyond the numbers
Today, pediatric dentistry is the most popular specialty, and many general dentists who aren't accepted into or choose not to apply to a specialty training program are practicing with a greater emphasis on treating children. Many general dentists have recognized this opportunity and ethically limit their practice by marketing themselves as general dentists for children.

With rapid technological advances, dental schools today are incorporating new subjects that were never taught 20 or more years ago, but are forced to do so in a smaller amount of time (either three or four years). This squeezes out the clinical hands-on time in the pediatric dental curriculum. The result: new graduates often enter a corporate or private employee associateship with deficient clinical skills. On-the-job training becomes the norm, and this is often, unfortunately, with outdated technology.

Advances in adult dental technology are now catching up in pediatric dentistry.

New game changers in pediatric dentistry include digital radiography and transillumination for caries diagnosis, caries management by risk assessment (CAMBRA) for treatment planning, needleless local anesthesia, and more. General dentists—and even some pediatric dentists—will need to improve their skill set in these areas. Just as adult zirconia crowns, implants, ortho, and other procedures require didactic and simlab training, so do these new technologies in pediatric dentistry. It ain't kiddy dentistry anymore!

So you have the facts.
Now what?
By 2020 it is estimated that the pediatric population (0-18) will be the largest segment of the U.S. population, and their caries will remain an epidemic.

As dental practices previously shifted to the baby-boomer paradigm, younger practitioners in practice for fewer years who were at the end of this shift have experienced greater competition. It's smart to analyze the demographics of the area where your practice is located. Many dentists today are opening additional practices in areas with a heavy concentration of both children and caries.

If you are a more seasoned practitioner, consider the addition of an associate who might add a pediatric component to your adult-oriented practice. Or if you feel secure in the adult paradigm and do not care to enter the pediatric paradigm, at least you did some analysis and made a plan to keep your practice geared toward adult rehabilitation. But regardless, make a decision now. Then plan for action.

Changing the game plan
If you have decided to make pediatrics the next paradigm shift in your practice, then you need to evaluate your practice technology and the skill set that you and your staff possess in the new game changers in pediatric dentistry. My guess is that you and your staff (remember that a practice's best asset is the staff) will need to improve your diagnostic, treatment planning, and clinical skills, incorporating at least some of the new game changers described above. You would not expect to go to a didactic course on implants and then go back to your practice and do one on a live patient (I guess you could, but I would hate to be that patient). Instead you would find a course that offered didactic instruction and simlab hands-on, or possibly an over-the-shoulder live experience. Well, the same is true for pediatric game changers like cosmetic primary crowns, for example. Or MTA-treated pulpotomies. You get the point!

If you decide to shift your practice into the pediatric paradigm and you acquire the necessary skills, then the next thing you need to apply in your practice is pedonomics. Pedonomics, or the economics of pediatric dentistry, is simple but powerful. You need to practice better dentistry (quality and proficiency) in less time (faster and more efficiently) and more easily (less stress with new technology helping you and your staff).

Dentists tend to be "dinkers." They equate quality with time. The more time they spend on a procedure, the greater the quality—or at least they think. This couldn't be further from the truth.

For example, I can do a quadrant of primary teeth requiring pulpotomies and crowns with the same chair time—30 minutes or less—that I use to do multi-surface restorations. Other dentists might take one hour or even longer. How can I do this? I have great skills (pardon my immodesty), use the best equipment, incorporate the latest and best technology, and invest in the very best staff.

But don't get me wrong. I don't advocate over-treatment. I do advocate doing appropriate treatment with CAMBRA risk analysis in the best, fastest and easiest way possible. I see too many dentists today apply the minimally invasive multiple-surface restoration plan on a primary tooth that should have had pulp therapy and a crown. They don't follow AAPD best-practice guidelines because they are undertrained and poorly equipped. Then the child returns with either more decay on that same tooth and/or a failed restoration. This leads to an unhappy child, an unhappy parent, and retreatment that's not covered by the dental plan. Now you're left with lost revenue and a blow to your staff's morale. Luckily, this can all be avoided.

Because I apply time economics to pedonomics, I can also accept children who are on dental plans paying less than 100 percent of my UCR fees. Plus, if these children have advanced caries because the child is new to a dental plan and hasn't been treated for a long time—or maybe ever—then this time, economics works as a win for the practice and a win for the child.

Making an investment in your education and new technology will get you to better, faster and easier pediatric dentistry and you will see your production increase and your profitability enhanced.




Dentaltown Magazine
October 2025
Dentaltown Magazine October 2025 Read Current Issue Read Archived Issues
Sponsors
Townie Perks
Townie® Poll
Do you place implants in your practice?
  
Site Menu
Message Boards Magazine Continuing Education Podcasts Blogs Classifieds Dental News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
The Dentaltown Team, Farran Media Support
Phone: +1-480-445-9710
Email: support@dentaltown.com
©2025 Dentaltown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450