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COVIDonomics in dentistry

May 1, 2021
COVID-19 has had an impact on the bottom line of all dental practices, but has it impacted them all equally? Let’s take a look at the stats and how some practices were more COVID-proof than others.

I have always been a huge advocate of organized dentistry, and never before in my 40-plus-year career has it been more important. The American Dental Association (ADA), with all of its state and local affiliates, has recently helped dentists secure personal protective equipment (PPE), advocated for paycheck protection program and other funds for dental practices, worked with local health boards to make sure dentists are prioritized to receive the vaccine and approved to administer vaccinations, and so much more.

Another important service from the ADA is the ADA Health Policy Institute (HPI), which is under the direction of the very talented Dr. Marko Vujicic. According to the ADA website, HPI aims to be a thought leader and trusted source for critical policy knowledge related to the US dental care system. HPI achieves this by generating, synthesizing, and disseminating innovative research on a variety of topics that are relevant to policymakers, health-care advocates, and providers. The key issues that HPI focuses on include health policy reform, access to care, the workforce, care utilization and benefits, education, and oral health outcomes.

Follow the science

HPI launched an ongoing study during the pandemic titled COVID-19: Economic Impact on Dental Practices. This study has been measuring
certain parameters week by week throughout the pandemic. Let’s take a look at the latest report, as of this writing, which includes results from the week of February 15.1 I encourage you to look at the entire report, but for now, let’s take a look at some specific parameters, which I hope will help solo practices specifically take action now. Let’s also compare solo private practices with DSO practices to give some perspective and better understand how pandemic economic trends are affecting these entities.

Clearly, DSO practices are doing a better job at attracting patients during the pandemic (figure 1). Solo practices should look to improve their social media presence and investigate other cost-effective ways to reengage existing patients and attract new ones. Get on the phone, let your patients know that your office is among the safest environment to visit right now and they should stop putting off needed care.

Dental offices made some significant financial decisions in 2020, which seemed to be fairly consistent across different types of offices, especially in the area of raising fees. It will be interesting to see how the combination of increased fees and decreased patient volume will play out.

COVID clenching

I find these to be the most interesting statistics of all, as this has a direct
impact on every dental practice. Due to the pandemic and increased stress that everyone is experiencing, there has been a massive increase of what I have termed “COVID clenching,” which results in the need for every dental office to integrate TMD and orofacial pain trigger point therapy (figure 3).2

Data-driven dentistry

Let’s contrast some of the statistics in figure 2 with findings from an internal American Academy of Facial Esthetics (AAFE) member study that
was updated February 28, 2021. More than 94% of dentists who had integrated Botox, dermal fillers, and PDO threads into their practice before the pandemic ended the year 2020 with equal or more profitability year over year, even taking into account closure for two months. For the first two months of 2021, the average AAFE member’s office had an average increase of 22% compared to January and February of 2020, which were pre-COVID. Only 1% of AAFE dentists had downsized their dental team, and none had reduced the team’s pay. These dentists report an increase of bruxism, TMD, and orofacial pain treatment with Botox therapy being up nearly 20% compared to last year.3

It’s time to follow the numbers to build your practice. The continuing comparative data clearly shows the need, especially for solo practices, to add highly profitable, elective, recession-proof services in order to increase patient volume and practice production. Additionally, with the dramatic increase of bruxism, TMD, and orofacial pain, there will be a need for effective trigger-point therapy and therapeutic Botox treatment for years to come.  


  1. COVID-19: Economic impact on dental practices. Week of February 15 results. https://surveys.ada.org/reports/RC/public/YWRhc3VydmV5cy02MDJiZTU1N2M1MDZhNDAwMTFkNzgwMmUtVVJfM3BaeGhzWm12TnNMdjB4
  2. Malcmacher L. ‘COVID clenching’ patients and your practice. Dental Economics. December 1, 2020. https://www.dentaleconomics.com/practice/article/14189625/covid-clenching-patients-and-your-practice
  3. AAFE Member internal study, February 2021. American Academy of Facial Esthetics. https://www.facialesthetics.org/
LOUIS MALCMACHER, DDS, MAGD, is a practicing general dentist and an internationally known lecturer and author. Dr. Malcmacher is president of the American Academy of Facial Esthetics (AAFE). You can contact him at (800) 952-0521 or email [email protected]. Find information about live patient Botox and dermal fillers training, solid filler PDO threadlifts, frontline TMD/orofacial pain training, dental sleep medicine, bruxism therapy, and sign up for a free monthly e-newsletter at FacialEsthetics.org.
About the Author

Louis Malcmacher, DDS, MAGD

Louis Malcmacher, DDS, MAGD, is a practicing general dentist and an internationally known lecturer and author. He is the president of the American Academy of Facial Esthetics (AAFE). You can contact him at (800) 952-0521 or [email protected]. Go to facialesthetics.org for information about live-patient Botox and dermal fillers training, solid-filler PDO thread lifts, frontline TMJ and orofacial pain training, dental sleep medicine, bruxism therapy and medical insurance, and to sign up for a free monthly e-newsletter.

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