Dentists Drill for Dollars

When the economy turned sour last year, some experts said they thought the recession might actually be good for the country’s roughly 160,000 dentists. After all, people would be grinding, gritting and damaging their teeth as they sweated about layoffs and plunging portfolios. But grinding or no grinding, the business boom didn’t materialize for many dentists, as cost-conscious consumers decided that when times are tight, tooth care can be optional.

The most recent annual survey by the American Dental Association found that 48 percent of dentists said their net income was dropping. This summer the Kaiser Family Foundation, a health-research group, reported that more than one in three consumers were putting off dental care and checkups because of cost. And some cosmetic dentists—those once-popular crafters of Julia Roberts–style pearly whites—say their revenue has sunk 30 percent.

Mark A. Babbitt, a dentist in Ventura, Calif., says that three or four years ago, he took it for granted that new patients would always be streaming through his door, many of them looking for expensive cosmetic treatments like porcelain veneers. Now he goes whole mornings without appointments and reads inspirational books to stay positive. If he can book somebody, he’ll even work during his lunch break—doing the cleanings while his dental hygienists eat. And that’s why he recently decided for the first time in his 13-year career to send out care packages to loyal patients, each one featuring a coffee mug with his name emblazoned on it and a handwritten note reminding his customers to refer friends. “Sometimes it feels like 28 Days Later,” Babbitt explains, referring to the zombie flick. “The world’s ended, and all the people disappeared.”

Welcome to the apocalypse—or something that feels a little like it to many dentists. Their financial pinch is playing out in strange ways for patients. Some dentists have taken on unfamiliar roles, filling in for their own assistants and striking bargains with customers. Others are offering the kind of freebies and reward points that seem less “serious medical office” and more “all-inclusive Cancun getaway.” But some are putting their patients in uncomfortable positions. The Better Business Bureau says dentists are among the top 50 professions consumers complain about, topping even lawyers. Last year the number of complaints rose 9 percent, to 3,570. Consumer advocates say some desperate dentists are up-selling their patients, telling them they need $1,000 crowns and tooth sealants they could easily do without. “It’s a very vulnerable place you sit in as a patient,” says Anika Ball, executive director of the American Society of Dental Ethics—and some dentists may be taking advantage.

Dentists have always faced huge financial hurdles. According to Raymond Willeford, president of the Academy of Dental CPAs, buying an existing practice, a popular way to get into the business, can cost as much as $850,000.

Dental school for specialties like periodontia, the study of gum disease, can cost another $300,000. And in the past decade, the number of dentists doing cosmetic work has more than doubled by some estimates, inspiring an expensive technology binge. A machine capable of making crowns and veneers, for instance, costs $100,000. Things have gotten so bad that Willeford estimates 85 percent of dentists are in significant debt. “It’s very nerve-wracking,” admits Leonard Tau, a cosmetic dentist who borrowed heavily to buy his practice in Philadelphia. “I have a big nut to crack.”

In this recession, those piles of debt are contributing to shifts that can change the focus of an entire practice. Some specialty offices are doing more traditional work like checkups or root canals. More dentists are laying off hygienists to cut costs—and rolling up their sleeves to perform routine cleanings themselves. Experts say the switch might feel a little rougher to patients, since hygienists are much better-trained in “comfort” techniques, like angling hooked instruments so they don’t rip patient’s gums. “If you were in an amphitheater watching a dentist clunk around in your mouth, you’d be horrified,” says Howard Strassler, director of operative dentistry at University of Maryland Dental School in Baltimore. Strassler adds that patients with gum disease are better off with a trained hygienist.