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Why Americans forgo dental work—and what dentists can do about it

July 11, 2022
Many dental patients need alternative means of financing beyond traditional debit and credits. Here's where BNPL 2.0 can come in and help more people get the care they need.

Poor dental hygiene has ramifications people often overlook until it’s too late. In fact, more than half of Americans delay dental care simply because they cannot afford it. The economic impact extends beyond patients, as dental providers risk losing business and the potential for new customers when solely providing traditional payment and financing options for care. Today, patients need more to rely on than insurance when paying for dental expenses. Closed-end financing may be the answer providers are searching for.

About 74 million Americans have no dental coverage—almost one-quarter, or 23%, of the population.1 Even those with coverage struggle to afford expensive procedures, especially when faced with an urgent, unplanned dental surgery. In theory, a practice could be turning away hundreds of patients a month due to high costs and limited financing options. However, some lenders are expanding on the buy now, pay later (BNPL) pay-in-four concept by providing fair, fixed-rate loans for dental providers to offer patients, helping reduce financial stress if a routine teeth cleaning turns into a root canal.

Enter BNPL 2.0

Patients need alternative means of financing beyond traditional debit and credits. In response to this genuine need, select BNPL companies have made a monumental change within the payments space. The financing these “BNPL 2.0” companies offer is a lifeline for many; the ability to spread out the costs over time at affordable, fixed, and fair rates is a welcome alternative to scrambling to find the cash to pay upfront.

Related reading: How practices can capitalize on digital payment trends

These BNPL 2.0 companies expand on the popular pay-in-four model, providing installment loans with fixed rates, no deferred interest, no back interest, and no rate recalculations. As a result, dental providers who offer fixed-rate closed-end financing can find enormous advantages for their practice and a source for fair, transparent funding for patients.

For many, a matter of priorities

For many families, the pandemic increased the need for health care. As a result, health spending increased by 9.7% from 2019 to 2020,2 much faster than the 4.3% increase from 2018 to 2019. However, people tend to spend their money based on their needs; unless essential, health-care costs often can’t compete against rent, groceries, and other basic, everyday necessities. “Elective” or preventive procedures, even dental cleanings, often aren’t prioritized.

While this seems reasonable and logical, prolonging such treatments may lead to more severe and complex ailments, resulting in potential financial setbacks. From tooth decay and nerve damage to debilitating infections, the consequences of missing crucial dental work can lead to more than just a depleted bank account.

I had a personal medical issue that was deemed a semielective surgery years ago. My doctor informed me that I needed surgery to remove a hernia. I had had reflux for 40 years. In addition to being uncomfortable, prolonged reflux can result in severe medical complications, such as cancer. In fact, a good friend of mine recently passed away from the same illness. This surgery changed my life; not only has the reflux been eliminated, but I no longer worry about the long-term consequences of putting off the procedure. I paid $1,600 out of pocket for a $90,000 operation. While I know now how beneficial the treatment was, many Americans faced with a $1,600 bill would have to opt out, feeling that they needed the money for food and living costs.

To avoid such situations, dental providers need to be educated on alternative financing and how to offer other means of payment. There are products, such as BNPL 2.0, that offer extended terms, up to 24 months, for larger amounts, in some cases up to $20,000.

Benefits for providers and patients

Installment loan financing offers several benefits to both providers and patients, but there needs to be substantial volume to create change. If the dental industry can adapt to providing alternative payment options, the future of health-care financing will offer Americans fair, reasonable, and transparent closed-end funding. Adopting new technologies and processes is a constant challenge for any business, as it has been for decades, but affordability comes with scale. As BNPL 2.0 continues to transform and emerge, providers will realize how exciting it is to be a part of this evolution in payments fintech.

Editor's note: This article appeared in the July 2022 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.


1. University of Illinois Chicago School of Dentistry. The many costs (financial and well-being) of poor oral health. https://dentistry.uic.edu/news-stories/the-many-costs-financial-and-well-being-of-poor-oral-health/

2. Kirani N, Ortaliza J, Wager E, Fox L, Amin K. How has US spending on healthcare changed over time? Peterson-KFF. https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#Contribution%20to%20change%20in%20total%20national%20health%20expenditures,%20from%202019-2020,%20by%20spending%20category

About the Author

Brian Shniderman

Brian Shniderman, US CEO & Global Chief Strategy Officer at Opy, is a 32-year veteran of the payments and fintech advisory industry. Brian is responsible for bringing the BNPL 2.0 model to the US market with the mission of offering a smarter way to budget and pay for life-changing purchases.

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