Salierno Chris 2020

Overcoming the obstacle of affordability

Jan. 1, 2021
The main reason patients do not get necessary dental care is because they either believe they can’t afford it, or they actually, legitimately, cannot. Dr. Chris Salierno looks at possible solutions to help patients get the care they need
Chris Salierno, DDS, Chief Dental Officer, Tend

I have some sobering statistics for you.

In 2019, research from the American Dental Association’s Health Policy Institute1 found that the number one reason patients did not receive necessary dental care was because they could not afford the cost. The second most common reason cited was that insurance did not cover the procedure, and the third reason was that patients did not want to spend the money.

That same year, the Federal Reserve published its “Report on the Economic Well-Being of U.S. Households in 2018.”2 They found that only 61% of adults would be able to afford an unexpected expense of $400; the rest would have to borrow or sell something, or they would not be able to cover the expense at all. 

So, let’s face it—the biggest obstacle to case acceptance is not dental phobia or patients being too busy. It’s not even ignorance about oral health. The main reason our patients do not get necessary dental care, by a large margin, is because they either (1) believe they can’t afford it, or (2) they actually, legitimately, cannot. I’ll discuss the latter case first.

If patients truly cannot afford dental care, then perhaps you, like I, could consider discounting or donating our services on a case-by-case basis. We are fortunate that, as small business owners, we are able to choose to be charitable.

In the first case, however, patients may be able to afford care, but they believe that they cannot. I think it is in instances such as these that our front desk team can do the most good for our patients. Helping patients overcome their largest hurdle to oral health is a most noble endeavor; and we could probably be doing more to help them in that pursuit. We should be empowering our finance coordinators and office managers to find creative and fiscally responsible ways to tear down cost barriers. Our teams should have clear rules for offering solutions such as membership plans and third-party financing, but those rules should also be a bit flexible to account for patients’ individual circumstances. 

I encourage you to revisit your practice’s patient financing system. As the data from the Federal Reserve and the ADA shows, a significant portion of our patients may struggle to even make their coinsurance payment for a crown. Let’s find ways to help them confidently afford their care and say yes to treatment.


Chris Salierno, DDS
[email protected]


  1. Gupta N, Vujicic M. Main barriers to getting needed dental care all relate to affordability. Health Policy Institute Research Brief. American Dental Association. April 2019. Updated November 2019. 
  2. Report on the economic well-being of U.S. households in 2018. Board of Governors of the Federal Reserve System. May 2019. 

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