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Is this the Dark Age of Dentistry? Or is it the Golden Age?

March 1, 2021
Dental insurance, dental school debt, a pandemic—there are many challenges in dentistry today. But there are also lots of tools to stay ahead.

I still vividly remember my final day of dental school, nearly 14 years ago. I walked out the front door knowing I had the entire world ahead of me. I was ready to get out there and begin my dental journey. But soon thereafter, the realities of our profession set in.

Dentistry is difficult. It takes years of schooling and years of on-the-job training until you’re good at it. And then when you open a practice, it takes business savvy, marketing sense, human resources know-how, and financial acumen to make it all work.

It can seem overwhelming.

There isn’t a day that goes by that I don’t hear about the major hurdles our profession is currently facing. I think of all the challenges—dental insurance, dental school debt, a global pandemic—and wonder, could we be in the Dark Age of Dentistry?

Dental insurance

Insurance companies have become a much larger part of our practices, and not necessarily for the better. With nearly 70% of the population covered under some sort of plan,1 the insurance companies know they have the upper hand. Our relationships with them are becoming more and more antagonistic as they 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

Just about all of us have felt the result of crippling student loan debt. According to the American Dental Association (ADA), the average dental school debt has nearly tripled over the past 20 years to almost $300,000, with some of us more than $500,000 in the red.2 Dentists are now riddled with some of the highest student loan debt of any profession3—so much so that the idea of hanging out one’s own shingle is a dream that far fewer of us are able to pursue. And this leads us to . . . the pandemic.

Global pandemic

We all remember that day back in March 2020. We closed our businesses due to the outbreak of COVID-19 without knowing how or when our doors would reopen. Luckily, the overwhelming majority of offices are now open for business and patients have returned, but ADA surveys show over half of us still reporting lower patient volumes than we had before the pandemic began.4 Additionally, we are being challenged daily with COVID-19 exposures, illness of patients and team members, volatile patient management, and the ever-evolving regulatory changes.

Dark Age or Golden Age?

For these reasons and others, many of you might say that we are in the Dark Age of Dentistry; it’s too difficult, there are too many obstacles in the way, and you pine for a long-gone era.

I would argue, however, that we are living in the Golden Age of our profession. We have access to powerful tools that our predecessors simply did not. Opportunities abound to provide more efficient and effective patient care by leveraging 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 absolutely changing the way we practice for the better. Touching all aspects of our practices, tech innovation is allowing us to become more efficient, lowering our costs, and enabling us to provide more procedures in our offices.

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

The costs of digital radiography: Digital sensors and cone beam CT systems have become more affordable to where many of us can have the technology in our private practices. This results in significantly less time to make an image, allowing us to diagnose more dentistry and provide more, and ultimately better, care for our patients. 

The biggest technology bump, however, comes from the explosive growth of software solutions for the profession. Whether they’re locally hosted or cloud-based, we now have the ability to manage and analyze our practices like never before. Advancements in practice management software (PMS) have opened the floodgates for integrated cloud-based tools to do everything else. Much of the amazing software technology available to us today simply wouldn’t be possible if we still were using paper charts. 

Practice analytics: Do you know your key performance indicators (KPIs)? KPIs are metrics that your practice identifies to give you a snapshot of how your business is operating: collections, new-patient numbers, hygiene reappointment rates, call conversion rates, treatment acceptance rates, patient attrition rates, etc. Many of these metrics aren’t easily calculated with just your PMS, but 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. 

Confirming appointments can be a full-time job. Automated patient engagement software can reliably confirm appointments via phone calls, emails, and text, which takes much of the burden off your front desk. Some even 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 even in-house payment plans, all of which get patients to say yes to treatment much easier, and that’s the goal. The more options you offer your patients to help them pay for the cost of dental care, the more dentistry you will do.

Insurance is getting more and more difficult to deal with. On top of that, more and more Americans are losing their employer-funded dental insurance due to the overlapping factors of an increased older population (roughly 10,000 baby boomers are entering retirement every day5), increase in gig economy workers, and more layoffs and cutbacks as a result of the COVID-19 pandemic.

In-house membership plans are an awesome solution for providing care for uninsured patients. These plans increase cash flow, increase patient loyalty, increase recall frequency, increase case acceptance, and decrease patient attrition. I know this firsthand because I’ve had membership plans in my practice for 10 years, during which time my fee-for-service patient base has more than doubled. At first, I rolled out my own plans, but that grew into 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. 


Today, we are able to outsource many administrative functions that allow us to grow without the financial burden of bringing on more full-time team members. These services allow us to utilize expertly trained teams at a fraction of the cost of doing the work in our office.

Popular areas of outsourcing include:

  • Insurance verification and negotiation
  • Insurance EOB submission/entry/resubmission
  • Patient reactivation
  • Call centers (new-patient call overflow), which significantly reduce the number of missed calls from potential patients and increase your new-patient numbers almost overnight


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

Organized dentistry

While organized dentistry at the city, state, and national levels has been around for years, we have recently seen many new options pop up. There are countless Facebook groups comprised of thousands of dental professionals discussing case stories, business advice, and product/company reviews—all providing a platform to share what’s working for us and what’s not. 

We have 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 smaller practices with some of the benefits of larger DSOs, all the while remaining independent.

The challenges we face are real. The generation before us didn’t face these obstacles, 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 . . . that this is the Dark Age 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, adoption of technology, and taking a systemized approach to running your practice can mitigate your dental school debt. In-house membership plans and practice analytics can help you combat dental insurance overgrowth.

While we may be facing more challenges than our predecessors, we have—by far—many more opportunities available to us to improve, both with our patients and businesses. We have tools that give us superpowers: to reach more patients, provide better care for our patients, and turn our business into a well-oiled machine. There’s never been a better time to be in this profession, and this, my friends, is the Golden Age of Dentistry.  


  1. Who has dental benefits today? National Association of Dental Plans. https://www.nadp.org/Dental_Benefits_Basics/Dental_BB_1.aspx
  2. Education debt. American Dental Education Association GoDental. https://www.adea.org/godental/money_matters/educational_debt.aspx 
  3. Luthi B. Is dental school worth it? Bankrate. December 9, 2020. https://www.bankrate.com/loans/student-loans/average-dental-school-debt/ 
  4. COVID-19: economic impact on dental practices week of January 18 results. American Dental Association. Health Policy Institute. https://surveys.ada.org/reports/RC/public/YWRhc3VydmV5cy02MDA2ZWQ5MjEyZmU5NjAwMTBjZjdlMzktVVJfM3BaeGhzWm12TnNMdjB4 
  5. America Counts Staff. 2020 census will help policymakers prepare for the incoming wave of aging boomers. US Census Bureau. December 10, 2019. Updated August 18, 2020. https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html 
BRETT WELLS, DDS, is the founder and CEO of DentalHQ, a practicing dentist in Raleigh, North Carolina, and a frequent podcast guest star. A serial entrepreneur, foodie, and die-hard Carolina Panthers fan, he started DentalHQ to help his fellow dentists increase patient care and case acceptance with in-house membership plans. Contact him at [email protected].
About the Author

Brett Wells, DDS

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

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