The Diversification of Dentistry Brings Opportunity

Terri Lively

Dental Products Report, Dental Products Report June 2021, Volume 55, Issue 6

From reaching populations with unmet needs to expanding clinical offerings, innovative, diverse practices can improve patient outcomes and boost profitability.

Dental professionals today face a diversifying industry in many ways, from treating patient populations with unmet needs to communicating through different marketing channels, as well as expanding clinical applications and products.

Treating Populations with Unmet Needs

Dental practices have always treated people from all walks of life, ethnicities, and backgrounds. Yet no matter who those patients are, they can’t be treated if they never walk through the practice doors.

Some clinicians are working to make it more comfortable for everyone to sit in the chair. Steve Perlman, DDS, is a clinical professor of pediatric dentistry at Boston University Goldman School of Dental Medicine in Massachusetts, and much of his practice focuses on treating people with physical and intellectual disabilities. Dr Perlman has also been the president of many of the academies that serve these populations. Dentistry is the most unmet health care need for this patient population; however, it is important to consider the context of the problem, he says.

“Prior to the new code of ethics of the dental profession and Commission on Dental Accreditation requirements, which is a step in the right direction, there was a severe lack of education in dental schools and dental hygiene schools regarding treating patients with disabilities due to a lack of resources,” Dr Perlman explains. “There is also the issue of inadequate reimbursement for dental professionals who are treating patients with disabilities.”

Most people with disabilities can and should be mainstreamed through a general practitioner’s office, Dr Perlman says, emphasizing that preventive dentistry is particularly critical for special needs patients.

“It’s important to consider that we use the mouth to breathe, eat, and communicate. Small children use it to discover the world, so the earlier you can start treating patients with disabilities, the better. It is recommended all children with special health care needs have a dental home by age 1,” he says.

Several organizations offer resources to help dentists treat special needs patients, according to Dr Perlman. The American Academy of Developmental Medicine and Dentistry (AADMD) is interdisciplinary and focuses on education, policy, and advocacy, with several chapters of the organizations within dental schools. Additionally, the Special Care Dentistry Association (SCDA), the Special Care Advocates in Dentistry, and the International Association for Disability and Oral Health offer help as well.

“All of these organizations offer helpful insight and resources for dentists,” Dr Perlman says.

Beyond education, it’s important to point out that sedation and general anesthesia are not the answer for treating patients with disabilities, Dr Perlman says. It requires that dentists step outside of their comfort zone and understanding that people with disabilities are just that—people.

“The more you treat them, the more comfortable you’ll be,” Dr Perlman says.

Maureen Perry, DDS, MPA, MAED, agrees, saying that clinicians will become more comfortable treating differently-abled patients the more they are in contact with these patient populations. Dr Perry is a professor of special care dentistry and the director of the Center for Advanced Oral Health at Arizona School of Dentistry and Oral Health (ASDOH) at A.T. Still University (ATSU) in Mesa, Arizona.

“It is important not to patronize people or speak baby talk. Speak simply and directly and allow the patient to ask questions. Even if the patient is nonverbal, speak to the patient and let him/her know what you are planning to do,” Dr Perry says.

Speaking is only one way to communicate with patients. Dentists should encourage the patient to participate as much as possible in their care by meeting the patient where they are at, Dr Perry says.

“Our eyes are the windows to the soul. Connect with the patient by eye contact or a gentle touch on the arm or shoulder,” she explains. “Create a supportive environment of acceptance and compassion.”

The first step to getting more comfortable with this patient population is earning continuing education (CE) in the subject, Dr Perry says. Many organizations offer CE for special care dentistry for free, including Henry Schein, ATSU-ASDOH, and the Pennsylvania Coalition for Oral Health. She also advises dental professionals to get familiar with the most common conditions they might see in practice, such as autism, Down syndrome, cerebral palsy, and physical disabilities. Once clinicians have some foundational knowledge, they become more familiar with managing these conditions, particularly after CE.

“Dentistry is very experiential,” Dr Perry explains. “We learn by doing, by jumping into the deep end and starting to treat people.”

The industry has invested in the effort of assisting general practitioners to expand care to patients with special needs, according to Jennifer Kim Field, vice president of Corporate Social Responsibility at Henry Schein, Inc, and executive director of the Henry Schein Cares Foundation. There have been advances in enhancing access to care for people with disabilities in recent years.

“Through public-private partnerships, we’ve seen meaningful actions taken to help equip and educate the dental community in disability competency, though there’s still much work to be done,” she says.

Field says that for more than a decade, Henry Schein has supported and advocated for individuals with disabilities around 5 key issues:

  1. Improving health literacy
  2. Expanding geographic location for care
  3. Ensuring Americans with Disabilities Act accessibility
  4. Teaching all health care providers cultural competency
  5. Developing appropriate financing and reimbursement rates for individuals with disabilities

“We strive to be catalysts and conveners for efforts to advance oral health for individuals with disabilities through our involvement with the AADMD, SCDA, Special Olympics, and patient advocacy groups,” she says. “We are also founding members of Project Accessible Oral Health, a global public-private partnership that brings together people with disabilities, the dental and medical communities, policymakers, industry members, educators, caregivers, and other stakeholders in pursuit of improved overall health through greater oral health awareness, education, improved reimbursement and coverage for quality oral health services and access to said quality services for people in the disabilities community.”

Henry Schein also signed a memorandum of understanding with the National Council on Disability, committing to coordinate efforts and better educate the professional dental community in disability competency to improve access to care for individuals with disabilities, Field says. It is also crucial that the dental education community takes concrete steps to educate providers—both current students and those already in practice—policymakers, third-party payers, and the public on this community’s specific attributes and needs, she adds.

“Finally, and fundamentally, we must evolve reimbursement models for providers treating patients with disabilities, as the current structure is woefully inadequate,” Field says. “Additional reimbursement for preventive care will redound exponential financial benefits to payers, along with vastly improving health outcomes for this population.

“We also need to continue engaging with clinicians and suppliers on this issue. In addition to achieving equal access to care, we must also consider the specialized equipment, education, and environments that are often necessary to treat patients with disabilities.”

Some dental schools have already initiated education efforts around this topic for dental students. In 2019, New York University College of Dentistry (NYU Dentistry) opened the NYU Dentistry Oral Health Center for People with Disabilities, which provides comprehensive dental care to people with physical, cognitive, and developmental disabilities in the tristate area. The center is designed to meet this population’s unique needs, according to Ron Kosinski, DMD, a clinical associate professor and director of Pediatric Sedation and Anesthesia at NYU Dentistry and the clinical director of the Oral Health Center for People with Disabilities.

“What we want to do here at NYU Dentistry is increase the number of providers who are treating the disabled community,” Dr Kosinski explains.

The center was designed to expose dental students in their third and fourth years to these patients through formal rotations, he says. The goal is to eliminate the fear of the unknown to make dental students feel comfortable treating these patients later instead of referring them to a sedation dentistry provider, he explains.

“We’re trying to make it easier for students to bond with this community of people because patients with disabilities deserve to be treated with dignity and respect,” Dr Kosinski says.

Dental students learn how to interact with patients with disabilities. The instructors show them how to approach the patient or speak to the aide who comes with them for a health history or other information. Some specialized assistants have experience working with the disabled population and help students create the environment necessary to provide care.

“Communicating with this patient population isn’t so difficult. It’s just a matter of eliminating the nervous nature these young dental students have,” Dr Kosinski says, adding that inexperienced dental students have nervous feelings about treating any patients, not only those with extra challenges. “We are trying to make the students understand that people are people. It’s a matter of approaching them with a smile and being kind and tolerant.”

Culturally diverse populations also face challenges getting the oral care they need. Several organizations came together under the umbrella of the Diverse Dental Society to address the unmet needs of underserved communities to increase access to care and oral health equity, including the Hispanic Dental Association, the Society of American Indian Dentists, and the National Dental Association.

“We realized our missions had many of the same goals and many of the same obstacles and challenges, so it made sense to group together and for the organization to help the diverse population. So that’s how everything started,” says Anna Munné, DDS, a co-founder and the president of the Diverse Dental Society and the former president of the Hispanic Dental Association.

Immigration has brought new populations, not just in the United States but also worldwide, increasing diversity in every country. A new country often means patients won’t get their dental needs met due to language barriers or cultural challenges. Populations coming from abroad feel more comfortable having a dentist who’s a part of their culture for many reasons, Dr Munné says. She would like to see more education programs in towns with diverse population concentrations to help dental practices be familiar with the different cultures, so patients feel more comfortable.

“Patients want people that understand them, understand their diet or their culture, or why they do the things they do. Maybe a dentist with the same background will understand why those patients grind their teeth or eat what they eat that causes wear or erosion in their teeth,” Dr Munné explains.

Another critical goal of the Diverse Dental Society is to recruit more diverse populations for dental schools. Dr Munné encourages more dentists to participate in outreach earlier, in high schools and other educational settings, to explain the rewards related to working in dentistry and improving people’s health to potential students of different backgrounds.

“The dental community is responsible for the health of the general community. Dentists need to understand that diversity is everyone’s issue and everyone’s problem to solve,” Dr Munné says. “It would be great if they would support organizations that have a focus on diversity and the challenges that diverse populations face every day.

“We need to open our minds and be ready to help in any way we can.”

Changing Communication

The ways that dentists communicate with patients and market to potential patients are changing. The content of the message may stay the same, but the methods used to deliver messaging may not.

Melissa Turner, BASDH, RDHEP, EFDA, chief hygiene officer for Cellerant Consulting Group, a highly specialized boutique consulting firm for dental companies, sees a shift in dentistry influenced by the patient population, technology advancements, and technique enhancements. These shifts will affect marketing too.

“With marketing and patient communication, we are not going to have to be intentional about the change in the message; it’s going to happen naturally. The dental practice owner will need to jump on board or be left behind,” Turner says.

Patients are a diverse population, and patients’ perception of their role in the dental relationship has changed. Turner says they want to be treated like a consumer.

“We have to honor that and shift power to our dental consumer patient. That includes social marketing, texting, and word of mouth. Once practice owners get on board, they will see the value of marketing through virtual and face-to-face technology,” Turner explains. “It is not just general patient marketing like we did in the past.”

Practice owners should also think about patient communications through the lens of inclusion, Turner says. The focus is not on how patients are different but, instead, on how the practice is here for them no matter their differences.

“Millennials, in particular, will be very responsive to that versus a message about what divides us,” Turner says.

Turner sees teledentistry and mobile dental health care models as new ways to market. When clinicians deliver care in a corporate lunchroom or a trailer in an office park, people notice, and it facilitates community involvement. During the COVID-19 shutdown, telehealth showed clinicians how to communicate and deliver dental care differently.

“When a dental practice owner can think outside the 4 walls of their dental practice, they can serve many more patients and not just 1 type of patient,” Turner says. “It’s one of the best forms of marketing out there.”

Flexibility in the delivery care model changes what is possible in dentistry. Turner has helped dentists who are recovering from surgery, who are “snowbirds” for the winter, or who are on maternity leave treat patients virtually.

She also sees the hours of care diversifying.

“This is my prediction, but once women become the majority leader in the dentist’s office, hours are going to change. They’re going to match the school day or maybe go into the evenings, but it’s going to shift traditional hours,” Turner says.

Broadening Marketing Channels

COVID-19 contributed a new way to segment the patient population: those who still had dental insurance and those who didn’t, according to David Means, director of marketing for Planet DDS, a company specializing in cloud-based dental software. Many people lost their job during the pandemic, and with it, their dental benefits, he says, but they still need dental care. Means says it’s crucial that communications let patients know you can still take care of them.

“Talk to that part of your audience that doesn’t have insurance and tell them, ‘Hey, I can still cost-effectively treat you,’” he suggests, adding that some practices could do what’s called a membership plan, giving members discounted rates on services.

Patients are also coming to treatment-plan discussions with a lot more information and questions than previously, he says.

“Patients are asking for the value dentists are providing. Dentists need to be prepared to show the value of what they are providing and the price [of the treatments],” Means says.

Dentists should be thinking of marketing communication as something more than a mailer they send out a couple times a year, he adds. Marketing is anything that is going to touch a potential patient, from referrals to the website and more. The message and images should reflect your practice and dentistry philosophy, even down to your chosen photos. Means recommends asking photogenic patients, friends, family, or staff to let you use their images in exchange for a discount or free whitening kit.

“Don’t use that stock stuff,” Means says of the royalty-free images available to dentists. “You can do things that are creative where you don’t have to spend a lot of money.”

Means also recommends being authentic in your messages and avoiding making unsubstantiated claims. In addition, he suggests that more dental practices communicate what makes them unique.

“Don’t let it be the cookie-cutter thing that everyone else says,” Means says.

He also notes that the dental experience is different than it was before COVID-19. As patients return to the practice, some might still be fearful, and it is critical to address those patients’ concerns in your communication with them.

“Part of it is communicating what the new experience is going to be when they come to see you and allaying their safety concerns. Tell them about everything you are doing to keep them healthy,” Means says.

There is also a dizzying array of things one can do in marketing today compared to 20 years ago, especially with all the components of digital marketing, according to Ted Teele, CEO of Kaleidoscope, a digital marketing company for orthodontic, dental, and medical practices. Also, market segmentation is more straightforward with digital channels, often offering the ability to target specific groups based on demographics or ethnicities.

Marketing diversification all begins with strategy, Teele says.

“The Kaleidoscope digital marketing platform is a one-stop-shop, so doctors and their practices can come to us for everything from analog to digital marketing,” he says. “Which ones you use depend upon your strategy.”

For example, one of Kaleidoscope’s orthodontic clients is a native Spanish speaker, and Teele says she doesn’t have a lot of competition in dental or orthodontics in her market area. So, the team decided to focus on getting more Spanish-speaking customers. This task is easy to do with the micro-segmentation available with some marketing channels, he says. It is also easier to measure results with digital marketing and media like Facebook.

“The diversity of the marketing mix has been increased due to the whole world making this evolution, certainly in dentistry and orthodontics, from analog to digital. The same thing is true in marketing,” Teele says.

Digitization also changes how you can go to market with a new service. For example, if an orthodontist wants to get more clear aligner patients in the teen and adult age range, digital marketing makes that audience segment easier to target.

“It becomes possible to do more of something you like doing with the marketing mix available today,” Teele says.

The goal of marketing is to put information in front of people who are interested in it at the right time, he says. The narrower the message for the interested people, the better. Google ads are an example of getting the information in front of the right people. Plus, Teele says, Google makes it easy to measure the results from your campaign.

“Marketing in the past has been a very blunt instrument,” Teele says. “But now it can be a much more finely tuned instrument [that enables you to go] after a particular group of people with a particular message. That is exactly what doctors need to do.”

Diversifying Suppliers

Diversifying who you do business with can help grow a dental practice too. Diversifying supplier options has a few great benefits to dental practices, but first and foremost is transparency, according to Sean Brewer, director of client success at Method Procurement, a company providing dental inventory management software.

“People have been told that they are getting a good price, good service, or good availability on the product that they need for their practice, but how do you really know?” Brewer says. “With online shopping gaining popularity and making it easy to compare prices, industries are moving into an environment of transparency. Buyers have the ability to compare prices and delivery times across suppliers with the click of a mouse.”

Another significant benefit of diversifying suppliers is availability and accessibility, Brewer says. Not all suppliers have everything you need all the time, so having multiple relationships ensures you can get what you need when you need it.

“If you are in rural Kansas or Oklahoma or somewhere, how many days it takes to get the product to you could also be important,” Brewer says. “You may want to have relationships with a couple of suppliers because if you find yourself needing something the next day, some may be able to accommodate it, while others may not.”

Having a relationship with a supplier who can suggest alternatives or present the newest technology and quality products is vital, Brewer says. Relationships with multiple suppliers could help maintain awareness of these types of developments.

“It’s good to have as many inroads as possible to the suppliers who can share that information with you, which could be a significant value the supplier provides to dentists and practitioners,” Brewer says.

Method Procurement’s platform makes these comparisons convenient by allowing dental professionals to access the site outside of regular business hours. This feature can change the way dental practices get their supplies. For example, Brewer says the internet has disrupted the car industry. Many car customers know the color and features of the car they want before stepping foot on the car lot or even talking to a salesperson. It isn’t any different for dental practices.

“We do all the shopping upfront,” Brewer says. “You are going to continue to see things like that happening in health care and dental because people who are now becoming dentists grew up with the comparison shopping online. It’s a pervasive mindset for the new generation coming into the mix.”

Expanding Technological and Clinical Offerings

Technology not only increases transparency, but it also provides alternatives to the ways you deliver patient care.

Agatha Bis, DDS, has devoted the past 20 years of her practice to working with patients who have had inadequate responses to conventional medical and dental treatments. She says dental practices that want to be on the leading edge should diversify the patient care they provide with technology. Communicating how diverse technology benefits patients is essential, she adds.

“Does any piece of new technology provide the visual of state of the art? Not on its own or if hidden behind closed doors. But if we communicate to patients about this technology and show them how they benefit from it, how it allows us to expand what we do—especially if we can do it faster, more accurately, and more efficiently—then it becomes an exciting aspect of our practice and puts us, as dental professionals, on a whole new level,” Dr Bis explains.

Dr Bis invested in Roland DGA’s DGSHAPE DWX-42W wet mill, which allows her to prep, digitally scan, design in 3D, mill the restoration, and place in 1 appointment. Her patients appreciate not having traditional impressions and find the creation of the restoration impressive, she says. Many patients post photos or short videos of the mill making their crowns on social media.

Dr Bis thinks having access to more materials she can use for many patients and their complicated functions and habits is crucial to providing more accurate, comfortable, and unique dentistry.

“The open architecture aspect of the DGSHAPE DWX-42W wet mill allows me to customize the restorative treatment that I provide to my patients based on their individual needs,” she says.

Patients don’t always understand what dentists do, and Dr Bis sees technology as a way to bring patients into the process and alleviate dental anxiety.

“By allowing them to experience the design process, showing them the detail, complexity, and sophistication of the design software, and then enabling them to witness the meticulous milling process, we can ensure patients have a better understanding of what we do,” Dr Bis explains. “By doing these things, my patients can see, without me even having to say a word, that I’ve invested money, time, energy, and passion into providing them something better and faster.”

Changing dental practice environments have changed how manufacturers support customers too. Carrie Nelson, director of marketing for SS White Dental, a dental manufacturing company founded in 1844, says the past year has forced the dental industry to rethink what they do and how they do it.

“Those that are successful and continue to thrive are the ones that were quick to adjust to the changing situation that we found ourselves in this last year,” Nelson says. “Hopefully, we all will come out of this much stronger.”

SS White Dental changed how they sold and marketed, Nelson says.

“We turned our focus to education and on providing value to our customers through webinars and other educational content. Once things started to open back up [and] they could start purchasing, we made it easier by opening up e-commerce and allowing them to buy online at their convenience,” Nelson says.

SS White is also focusing on how to help patients feel safe coming back into the office. In states that have granted an emergency exemption, SS White is distributing a new product— Grignard Pure™—that is designed to kill 98% of the SARS-CoV-2 virus in the air to address patients’ safety concerns. Nelson developed the digital marketing kit for patient communication and education, as well as materials to share with local press so that their communities can become aware of their new air treatment protocols.

“So it’s not just ‘continue to do what we do,’ but ‘What can we do to bring things back for our customers and the communities they serve?’” she says. “That’s what we as manufacturers need to be doing right now.”

Nelson encourages doctors to think outside of the usual to try new things. Manufacturers are continuously improving technology, techniques, and materials. The potential benefits are productivity gains and improved patient outcomes and experiences that lead to patient referrals and practice profitability.

“Sometimes, you get stuck in what you’re doing and how you’re doing it,” she says. “There’s always something new around the corner that could take you in a better direction and saves time.”

By diversifying care and taking measures to protect patients, practices have something to tell patients, Nelson says. Explain to patients new treatment options and the investments in infection control.

Minimally invasive dentistry is another important message because these treatments often produce fewer aerosols, she says.

“One of the core principles at SS White is conservation—as in doing everything you can to save tooth structure. Think of minimally invasive dentistry as another important treatment option, as these treatments often produce fewer aerosols while providing your patient a better patient outcome,” she says.

Imaging is another area of dental in which options are diversifying and provides patients with more treatment options. Patients like having multiple options for their care, according to Rob Gochoel, vice president of sales at PreXion, which specializes in medical imaging research and development. CBCT imaging provides an opportunity to diagnose issues earlier, potentially offering additional treatment options including minimally invasive ones. Dentists can also send CT scans to an oral maxillofacial radiologist for a second opinion if they see something unusual but are unable to make the diagnosis themselves.

Seeing more in the images provides better patient outcomes and more revenue for the practice, Gochoel says. And because early treatment tends to be less expensive, it can also be cost-effective for patients.

“There will be issues diagnosed that would have taken a long time to present on traditional 2D imaging x-rays—and potentially with other symptoms developing before a dental professional would find it,” Gochoel says, adding that for some endodontic cases, CBCT imaging can save a tooth. “Abscesses and infections tend to be caught much earlier.”

CBCT imaging also provides an opportunity to diversify the types of treatment dentists can offer, which is typically more complex, higher-margin dentistry. For example, a dentist getting into implants will find that adopting CBCT or 3D imaging will help sell dentist’s treatment plan with the level of detail it provides.

“It is about making the process easier and providing a more predictable outcome,” Gochoel says. “That also increases the doctor’s capacity to do more implants in the future.”

Additionally, imaging is helpful for dentists diversifying the care they provide by getting into airway analysis and sleep medicine. The PreXion 3D Explorer has a large panel field of view that captures the airway, which makes it especially helpful to aid in diagnosing and treating sleep apnea.

Gochoel says sleep medicine has a lot of potential for dentistry.

“The medical profession doesn’t have a lot of time with patients, unfortunately,” he says, adding that dentists are poised to take this issue into dental practices. “Cone-beam imaging is necessary to analyze the airway properly and put patients on the right path to treatment.”

Dental practices should take advantage of opportunities in dental sleep, especially with diverse populations, according to Alice Limkakeng, CEO of SleepArchiTx, a 360º turnkey solution for building a sleep practice. Obesity is a common correlation with obstructive sleep apnea (OSA). Ethnic groups with higher rates of obesity also tend to have higher rates of OSA. Moreover, some cranial facial structures have a greater tendency to inhibit the airway, which means some populations have a higher risk for OSA than others, even if obesity is not a factor.

“It’s important to provide a diversity of care because there are populations out there who need treatment, access to care, and education about the care they should receive,” Limkakeng says. “The dental practice also benefits from growing their patient base more widely.”

Working with a diverse selection of products and materials is another critical area for a dental practice, says Limkakeng, because patient anatomy differs. Therefore, a wide array of sleep appliance products and education materials is necessary to treat various patient conditions. For example, heavy bruxers need a different sleep appliance than patients with temporomandibular joint (TMJ) disorders, and partially or fully edentulous patients require a different sleep appliance as well.

“This is one of the biggest reasons that SleepArchiTx has a portfolio of over 17 FDA-cleared sleep appliances. One company’s appliance is not going to be right for every patient,” Limkakeng says.

She adds that one of SleepArchiTx’s goals is to provide this expertise to dentists. The team at SleepArchiTx maintains the sleep appliance portfolio and brings in new appliance designs as they emerge. The dentists who work with the company have a resource to find the right plan for the right patient and provide the best quality of care.

The added benefit of treating diverse communities is that some are incredibly tight-knit, contributing to practice growth, Limkakeng says. The practice could quickly become the dentist for the whole neighborhood.

“What we see is that sleep patients, once treated, tend to be so grateful because this is a lifesaving therapy. They bring so many referrals to that practice,” Limkakeng says. “For a general practitioner, it is fulfilling to know you are caring for your community, but it’s also a pretty amazing accomplishment to be able to provide access to care on these lifesaving therapies for patients.”

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