The coronavirus pandemic has devastated dental practices. Most have shut down completely or are only seeing emergency patients. Government mandates for paid leave are affecting many practices, though exemptions may apply. Guidelines from the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, the ADA, and other bodies are now guiding our clinical care, causing tremendous financial hardships.
The State of the Industry
While income revenue has plummeted, rent, equipment leases, salaries, and other expenses continue. Many dental offices are furloughing employees with no assurances of when they can or will return to work. Small Business Administration loans, unemployment insurance for employees, and maybe even rent or mortgage forgiveness will help.
There is no question that there will be an end to this pandemic and a return to business, but not business as usual. Millions will be affected by unemployment for extended periods, and many small businesses will close permanently. These factors will impact dental practice, and probably negatively.
When practices reopen, cashflow generation will be a major immediate issue. There will be less discretionary income. Dental spending, which has been flat since the recession of 2008, also will decrease. History shows us that there will be a practice rebound, but it will likely be slow and protracted.
We will face continued rising expenses, including enhanced infection control equipment and procedures, coupled with falling demand for elective dental treatment and reduced revenue. The cost of dental procedures also will continue to go up. Rent, equipment leases, and all other fixed and variable expenses will rise as well.
This is going to impact our bottom lines, and we need to have a plan to reverse these trends. We must look for ways to increase revenue at a level affordable to the patient, control our overhead, and maintain well-trained staffs.
New Revenue Streams
Dental practices will have to rebuild their patient bases. The loss of active patients can be devastating and needs to be addressed right away. It is time for dentists to reinvent themselves. Look for patient segments and procedures relevant to growing markets, including efficient and cost-effective procedures that can generate immediate cashflow.
For example, millions of people under the age of 65 are edentulous. Once the economy starts to recover, these people will want to be employed, and their lack of teeth will be a serious obstacle in finding a job. They will need access to quality and affordable dentures. The market of patients over the age of 65 also is rapidly growing and often overlooked for practice growth. They could benefit from dentures and implant overdentures as well.
The pent-up demand for extractions, dentures, and implant-retained dentures will be large immediately and will get larger over time. People will come in with pain, having deferred treatment for distancing reasons, financial reasons, and fears of obtaining dental care.
Because of the backlog of denture and implant patient needs and wants, same-day procedures of just one or two hours will be critical in bolstering revenue, cashflow, and patient satisfaction. While this market segment has been overlooked, it now is important for practice growth and revitalization.
Current denture and implant procedures require multiple visits and higher costs. Digital dentures, standard conventional dentures, and osteointegrated implants all require weeks or even months from the beginning of treatment to final delivery. These delays can wreak havoc with cashflow, continued overhead, and employee costs.
Alternative Denture and Implant Treatment
There is an alternative to these procedures and their extended treatment times. The Larell One Step Denture is a one-visit denture procedure completed in about an hour. Immediate-load dental implants can be placed at the same time for a complete implant-retained overdenture, all completed in about two hours.
The advantages of a one-visit solution are many. There is no delay in delivery, so billing is immediate. For cash patients, the doctor is paid at the first visit. For patients with insurance coverage, a claim can be submitted that day for faster payment. No outside lab bill needs to be paid prior to delivery, unlike multi-visit dentures. They can be completed without expensive hardware, software, or complex training as well.
Plus, immediate-load dental implants such as Zest Dental Solutions’ Lodi Implants enable easier placement and eliminate the need to refer patients to an outside doctor for placement. Also, while helpful in many cases, CBCT scans aren’t a necessity. Standard panoramic radiographs are sufficient for most cases.
Attaching the dentures to the implants is easy and doesn’t require complex surgical guides. The implants can be placed first and then picked up in the denture when it is relined. Or, the denture can be made first, and then the pickup procedure using something like Zest’s Locator Implant Attachment System is done. Either way, the entire process is completed in a single visit of one to two hours. It is efficient with a lower overhead and much faster completion time.
The Larell One Step Denture is based on a thermoplastic denture template with the teeth individually preset in the arch. The technique is easily learned. These dentures are easily customized for the patient and then relined with a chairside reline material such as Lang Dental’s Flexacryl. Teeth such as Myerson Tooth’s Kenson teeth are individually customized for a natural patient look. The results are a functional aesthetic denture, with or without implants, completed in the one visit. With the standard of care requiring a minimum of two implants to retain a lower denture, patients receive what they need when they need it.
There are additional benefits to this efficient one-visit process. There is no outside lab bill. All procedures are done chairside under the control of the dentist. The staff necessary to assist with the process is minimized, often to one assistant. Denture patients can be appointed to specific days or half days when only dentures are done, further increasing efficiency. And, the procedures are easily learned and intuitive, and they can be provided remotely.
According to the ADA, dentist median net income has been basically flat over the past 10 years, since the recession of 2008, at about $180,000 per year. A one-hour process like the Larell One Step Denture can generate hourly net income of up to $900 per hour. With immediate load implants as part of the treatment plan, net income can increase to $1,400 per hour.
What’s Next
The economics of this recovery for the dental practitioner will not be linear. Much attention must be placed on all aspects of our practices, not just clinical procedures. Overhead, fixed and variable expenses, treatment times to completion, and giving patients the procedures and service they want and require all need to be considered and are all vital to bringing dental practices back to pre-pandemic health.
It isn’t always the most expensive or cutting-edge technology or ideal treatment that will make our practices successful again. Providing service, efficiency, and cost-effectiveness will get us through and past these difficult times.
Cashflow and revenue generation are the keys to revitalizing dental practices. We must look at all possible methods and approaches to help return to full schedules and immediate cashflow. As practicing dentists, we need to look at every procedure we offer and provide the care that will reboot and sustain our practices.
Offering what patients want, keeping overhead and expenses low, and streamlining what we do will be the hallmarks for a speedy rebound for our businesses. The crisis will pass. The path to profitability will be efficiently providing what our patients want and need at an affordable fee. This is how we will come back to practice health.
Dr. Wallace has led an impressive career in the dental industry as a practicing oral and maxillofacial surgeon, medical consultant, and founder and CEO of the Larell One Step Denture. He has been published in many journals including Dentistry Today, WebMD, and Dentaltown. He has played a major role in expanding the use of one-hour dentures to the dental profession as well as to many national and international philanthropic organizations. He has lectured extensively on denture and dental implant topics. He can be reached at larry@larell.com.
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