Why is Dentistry Expensive?

By FDA President David F. Boden, DDS, MS

Really, the question should be: Why is my dentistry expensive? To answer that, I will tell you a story about what happens in your mouth, and mine.

With few exceptions, we are born with the code for great oral health. Our teeth grow and form and eventually say, “Hello,” to the world, hugged nice and tight by healthy gums, ready to do their job for our bodies in helping condition food for digestion. Soon after, they make their premiere, they will be exposed to the enemy of any mammal: bacteria. Bacteria have one purpose: to feed on us and break us down. But they also get a free meal every time we eat. They form colonies of bacteria on our teeth we call plaque, just like they do on high school biology class petri dishes.

Some bacteria convert parts of that food into acids, which allow them to etch into a tooth’s nice, hard, pretty enamel. If they are there long enough, those acids will eat right through into the nerve in the center of that tooth. Our body senses that and registers it in the brain as pain, saying something is very wrong and needs attention. There are other bacteria that make their homes in gums. They feed on tissues, triggering our bodies to fight back with what doctors call an inflammatory reaction. This causes bleeding gums, but unfortunately, the signals sent to our brains are very weak and do not register until a lot of damage has already occurred.

Both cavities and gum disease can cause tooth loss. Unless, of course, you see a dentist. That dentist will attempt to repair tooth damage in numerous ways, depending on the extent of the damage. That can involve fillings, crowns or even root canal treatment. Gum problems — because they are so sneaky and quiet — often are overlooked. Repair can be pretty invasive, including surgery. In health terminology, we refer to reparative procedures as tertiary care. More on that in a moment.

All these repairs are costly because they involve work by a general dentist or dental specialist who has gone through time-consuming, intensive, and very expensive education to perform specialized types of hard-tissue (your teeth) or soft-tissue (your gums) microsurgical techniques using the very best instruments and materials in an extremely clean environment. And, of course, you would not have it any other way.

But it does not have to cost that much. No, I do not mean by getting dental insurance discounts on treatment. High quality dental treatment means a high overhead of costs for the ethical doctor. Deep discounts require cutting corners somewhere in your treatment, and I will let you guess what that means. Actually, it generally means more expense later.

Recall what was mentioned above. Tertiary care is reparative, and repairs are very costly. Why not do something that would avoid those repairs? We know bacteria are the cause of almost all dental problems. If we could only prevent those bacteria from collecting and setting up shop where they do damage, we could prevent the need for repairs!

Prevention is called primary care, and prevention is dirt cheap. Unfortunately, it also requires your dedication. The low-tech toothbrush is the single best invention for doing most of that by disrupting that bacterial plaque from causing trouble. But a brush only cleans half of each tooth. Floss must clean the other half. You must do both, because anywhere you miss cleaning, bacteria will set up shop, grow bigger, and eat and etch to their way to those costly repair procedures. Just insist you have great coaches to train you how to do it well and effectively — your dentist and dental hygienist.

So, why is your dentistry expensive? Because you did not clean off those bacteria. So, get cracking and break out that brush and doggone floss. Every. Single. Day. Because those bugs are sure hoping you’ll leave them alone to feed on you. And to borrow from Smokey the Bear: Remember, only YOU can prevent tooth decay.

Dr. Boden is the FDA president and can be reached dboden@bot.floridadental.org.

Oral Health Education for Kids

By Karen P. Buckenheimer, RN, BSN, Executive Director

Students are back in school! Well, hopefully. Faced with the ever-growing concerns of COVID-19, oral health may be the last thing on anyone’s mind. But tooth decay is the most common disease of childhood, according to the American Academy of Pediatrics. In fact, prior to the pandemic, tooth pain was the No. 1 reason children missed school.

For 30 years, I’ve had the honor to work for an amazing nonprofit, MORE HEALTH. Located in Tampa, we teach health and safety education lessons to students in grades K-12 throughout the Tampa Bay region. The first lesson we taught in 1989 was a dental health lesson for second grade students. Today, we offer 25 interactive lessons focused on providing valuable information to help kids and families stay safe and make healthy choices.

Teaching oral health is fun, rewarding, and sometimes surprising. Using an interactive kinesthetic style of teaching, we teach students how to brush their teeth, the importance of eating healthy foods and drinks, and encourage them to visit the dentist twice a year. Due to the pandemic, we transformed our in-person, hands-on lessons to high-energy virtual lessons. We now offer virtual oral health lessons throughout Florida and beyond.

Just last month, MORE HEALTH taught oral health to more than 1,100 adults and children attending the FDA Foundation’s Florida Mission of Mercy. Many of the patients did not know the basics. They asked questions such as how to brush their teeth, how cavities are formed and how often. Many were shocked to see the amount of sugar in a can of soda or sports drink. One even asked if they could use laundry bleach to whiten their teeth!

The dental visit is one of the most important teaching opportunities. Dentists are in a prime position to not only provide care to patients, but also reinforce the importance of oral health. Taking just a few minutes to talk with your patients about their hygiene habits can really make a difference. Most people are visual learners, so use a mouth model and toothbrush to show proper brushing. Another idea is to fill a jar with 10 teaspoons of sugar and hold next to a can of soda when you talk about drinking non-sugared drinks. Emphasize eating fruits and veggies and drinking fluoridated water. We use catchy phrases such as “just a dot, not a lot” when talking about fluoride toothpaste or remember the “2 + 2+ 2 rule” (brush two times a day, for two minutes and see your dentist twice a year). The few minutes you spend teaching your patients will definitely help them to be more compliant and have better oral health.

Even though this is basic information that you may feel everyone knows, hearing from the dental expert — you — means so much more. Teaching doesn’t stop in the office setting. Use every opportunity you can to reinforce the importance of oral health as it relates to overall health. Embrace teaching moments wherever you are — on the soccer field, on the golf course, at church or at the grocery store! Volunteer at the Great American Teach-in and visit your local schools and Boys and Girls Clubs. Enjoy getting involved in your community and take advantage of those teaching moments. Your expertise and advice will be appreciated and accepted. The kindness demonstrated that you truly care will help make you an integral and respected member in your community. It’s worth the effort.


MORE HEALTH, Inc., a nonprofit 501(c)3 organization, trains instructors to deliver interactive, exciting health education lessons to students, at no charge to school districts, through funding from local businesses, foundations, and state and federal grants. For more information, visit morehealthinc.org or call 813.287.5032.

How In-office Plans Can Help Free You from Insurance and Benefit Your Patients

By Landon Lemoine

If you’re a motivated dentist looking to separate your practice from mundane and outdated work brought by traditional insurance, incorporating in-office plans into your practice could well be the way to accomplish this — as well as bring in new patients and increase your income.

Even better, their subscription-based model not only benefits the practice, but also its patients. Here’s how.

How Patients Benefit

Provides the Uninsured Financial Options

Roughly one-third of the adult population has no dental insurance. According to the American Dental Association, almost two-thirds of uninsured patients have no plans to go to the dentist in the next 12 months.[1] Unemployment brought on by the pandemic greatly increased the number of people who have no coverage.

Without coverage, the idea of paying upfront for the needed work can be financially daunting, and in some cases, impossible. Membership plans equip practices with tools to provide financial options to their patients that enable to pay for and receive the care they need.

Patients needing expensive treatment can sign up for a monthly or yearly payment plan that allows practices to break up the cost of treatment for the patient into manageable monthly amounts. This is a better alternative to credit agencies with high interest rates or insurance companies with lofty coverage.

More Cost-effective than Traditional Insurance

More Americans are leaving traditional dental insurance behind and are looking for more cost-effective alternatives. In-office plans can help your practice keep these patients and keep them away from phony discount cards and inadequate insurance plans.

Because in-office plans are easily customizable, they can provide a better, more personalized treatment plan for a patient. Patients can avoid paying for coverage they may never use, because these plans enable them to pay a manageable monthly cost for the services they need.

How Practices Benefit

Creates Recurring Revenue

Converting uninsured cash patients to an in-office plan generates more recurring revenue for a practice and can bring uninsured patients in the door more often. In-office plan members also are far more likely to show up for their second visit, knowing they’re getting the care they need without taking on a large and immediate financial risk.

Creates the Ability to Work with Local Businesses

In-office plans allow practices to go beyond working with individual patients by enabling them to work with local small businesses. While practices can increase their patient base by working with these businesses, they’ll also be helping by enabling them to provide true benefits for their employees without the cost and hassle of working with a traditional insurance plan.

Decreases Admin Work

As a practice increases its in-office plan membership, the practice’s admin work will decrease. This is because the more individual and uninsured patients purchase the in-office plans, the less pre-authorizations and claims it will need to deal with.

In short, in-office plans provide a real benefit to a practice’s existing patients, can drive new ones in the door, and help free dental offices from haggling and battling with traditional insurance companies.

[1]https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1114_1.ashx


The FDA knows the frustration its members have with third-party payers. That’s why we’ve partnered with Bento to support adoption of a dental benefits administration technology that allows dentists and patients to remove artificial barriers to care and reduce administrative costs while improving oral health. Bento is a modern alternative to traditional dental insurance by enabling employers, groups and individuals access to comprehensive dental coverage through an advanced AI-based digital platform. Unlike traditional insurance companies, Bento works directly with dentists and provides solutions for practices, patients and employers. When creating in-office plans powered by Bento’s tech-enabled platform, dentists have complete control from plan design, pricing, and Bento even provides the tools needed to start selling plans to patients. Creating a plan powered by Bento is completely free, only takes minutes and FDA members receive a discount on administration. Visit floridadental.org/bento for more information.

Opinion: Dental Insurance Next Industry That Badly Needs Reform

By Yaël Ossowski, Consumer Choice Center Deputy Director

In the last decade, most debate and discussion on reforms related to health care have focused on Americans’ general health insurance plans and costs. And for good reason.

And though our health system is convoluted and complicated, it gets even more complex when we examine what is happening with dental care.

The intersection of hefty insurance premiums, confusing government benefits and a red tape bonanza keep many Americans from ever visiting a dentist’s office.

Even though 80% of Americans have access to dental benefits, nearly 35% of American adults didn’t visit a dentist in 2019, according to the National Association of Dental Plans.

The reason so many neglect getting their teeth checked is clear in the data: the mounting cost. And modern dental insurance, coupled with myriad various government programs, is a big reason for that.

Unlike most health care plans, dental plans have low caps on the number of benefits they will pay out, anywhere between $1,000-$1,500 a year. Premiums average $30-$50 per month depending on the plan and the number of people covered.

Because patients use dental insurance to cover all aspects of their care, rather than emergencies, this adds to an inflation of the price of rudimentary care, a phenomenon dubbed the “social consequences problem” by economists.

That problem gets even more complicated considering that nearly all dental patients don’t choose their plans themselves.

At present, 93% of privately insured dental patients receive coverage from their employers, meaning there is little incentive to innovate direct-to-consumer options that would offer competition.

This incentive problem, along with a relatively opaque dental insurance market, means costs will continue to rise unless we can agree on simple reforms to increase competition and transparency in the dental insurance market.

To do so, state legislatures and Congress should first look to encourage patients who choose membership programs as dental plans, rather than traditional insurance. Using health savings accounts to buy these memberships, as well as pay for care, would be a huge improvement that would empower patients to contract their own care.

This would be similar to the movement of direct primary care doctors, who offer direct monthly subscriptions to patients and don’t accept insurance. Removing the insurance middleman means less bureaucracy, less red tape and more time with patients. As a plus, prices are transparent and fair. That alone would provide better competition and prices for patients in need.

This would lead to a larger decoupling of health and dental insurance from employers, allowing patients and consumers to choose the plan that works best for them and their families.

On the note of transparency, state legislatures should hold the dental insurance industry accountable with simple reforms that empower patients when choosing their dentists.

Assignment of benefits laws, already passed in states like Colorado and Illinois, allow patients to choose whether they want insurance companies to directly pay dental clinics, freeing patients from having to pay upfront and negotiate with insurance companies for reimbursement.

Similarly, network leasing regulations, allowing dental clinics to revise and opt-in to insurance networks rather than being automatically forced into them, would keep prices low and transparent, not to mention predictable before you even step into the dentist’s chair.

As legislatures look to reform health care, we should also keep in mind the growing dental bills facing Americans every day, and hope lawmakers understand the need for more competition and transparency to better improve dental care in our country.

Encouraging competition to traditional dental insurance, while promoting simple regulations to promote financial transparency, will serve to empower consumers and lower the costs of care.

That would be bold and revolutionary for patients and would help encourage innovation in a sector where it has not always been the most welcome.

Reprinted with permission from the Boston Herald. This op-ed was originally posted on July 14, 2021 at bit.ly/3CzGRfI.


The FDA thanks the Consumer Choice Center for bringing attention to these important issues. The dental insurance industry needs important reforms to protect transparency and competition for patients. We’re glad to see this additional momentum behind the work of the National Council of Insurance Legislators to reform dental insurance and protect patients.