Millions of Americans are delaying dental appointments due to concerns about the coronavirus, prompting increased fees and fewer family practices.

Stress and isolation due to the pandemic are certainly bad for our mental health, but dentists are seeing evidence our oral health is suffering too.
Wochit
Millions of Americans are delaying dental appointments over concerns about coronavirus infection, and that’s likely to trigger increased fees for patients, job cuts for workers and fewer family practices.
When the pandemic began this spring, essentially all dentists temporarily shut down for all but emergency appointments, putting hundreds of thousands of Americans out of work.  While 99% of dentists have reopened, the number of patients visiting offices remains about 20% below usual levels, according to the American Dental Association.
And dentists don’t expect it to improve much more anytime soon despite significant safety measures theyve rolled outto protect themselves and patients from COVID-19.
Spending on dental care could fall by up to 38% in 2020 and 20% in 2021, the ADA projects. Of dentists surveyed by the trade group, more than 46% said their patient volume was down at least 15% from usual levels during the week of Oct. 5.
Dr. Linda Rasubala and Dental Assistant Olga Kushch treat a patient in Eastman Dentals Howitt Urgent Dental Care clinic.
 (Photo: Keith Bullis, Eastman Institute for Oral Health)
About 15% to 20% of regular dental patients say theyre not going to go back to the dentist until theres a vaccine or a proven treatment, said Marko Vujicic, chief economist of the ADA.
Theyre a segment of the population thats very cautious, and theyre waiting for COVID to pass, so to speak, Vujicic said. Theyre simply not returning to usual activities, period.
Don’t be fooled: Debunked QAnon conspiracy theories are seeping into mainstream social media
Working from home, in your bed?: You’re not alone. Mattress sales are soaring during the pandemic.
Katia Lee is among them.
Lee, a self-employed professional photographer in Columbia, South Carolina, hasnt gone to the dentist since before the pandemic began, in part because she doesnt want to risk getting infected and passing it to her 76-year-old mother.
The practice I go to, they are lovely, dont get me wrong  I really like my dentist and my dental hygienist, she said. But I know at least half of them have families that means youre trusting not just them but their kids, their husbands, thats why its so scary. I have to trust everybody else to keep myself safe.
With COVID-19, can I visit the dentist?
In August, the World Health Organization angered dentists by advising that routine non-essential oral health care which usually includes oral health check-ups, dental cleanings and preventive care be delayed until there has been sufficient reduction in COVID-19 transmission rates from community transmission to cluster cases or according to official recommendations at national, sub-national or local level.
The ADA said it respectfully yet strongly disagrees with the WHOs guidance, pointing to numerous safety measures dentists have set up to reduce the risk of transmission, steps advised by the Centers for Disease Control and Prevention.
Those measures include heightened use of personal protective equipment (PPE) such as N95 masks and surgical masks, disposable gowns, air purifiers, cleaning solutions, temperature checks, hand washing and social distancing, including forcing patients to wait in their cars until their appointment is ready to begin.
Dental industry leaders have said they’re not aware of any documented cases of COVID-19 outbreaks stemming from dental offices, but they acknowledge that patients remain concerned about opening their mouths wide in the presence of others for extended periods of time.
I know I would rather go into a dental office than a restaurant, said Scott Asnis, a practicing dentist in his role as founder and CEO of Dental365, a network of dentists based in New York.
Consolidation coming
If patient volume remains at current levels for a few more months, dentists say theyll give serious consideration to raising their fees, including for insured patients, as well as cutting jobs or selling their practices, according to the ADA.
Were at a very important next couple of months, said Vujicic, the ADA economist. I do think we will see additional layoffs and some exits in the market. Its suggesting to me that its not a sustainable situation.
Caring Smiles Family Dentistry dental hygienist Adrienne Vasquez puts on her personal protective equipment before seeing patient Jenny Grondin on June 30, 2020, in West Bloomfield, Michigan. In addition to gowns, the dentists and other staff members are also wearing head gear that protects their faces and adds a different layer of protection. The West Bloomfield practice also has patients fill out a COVID-19 questionnaire and have their temperatures taken before they can be seen.
 (Photo: Kelly Jordan)
Lee, the self-employed photographer, said that even if its safe to go back, itll be hard for her to justify going to the dentist since she doesn’t have dental insurance and the struggling economy makes her hesitant to spend hundreds of dollars on an appointment.
Peoples hesitation to go back has led dentists to seek help. When they temporarily shut down, about 9 in 10 dentists applied for some form of financial assistance from the federal government, including forgivable loans, and the vast majority received some, according to the ADA.
Thats actually helped them retain staff, Vujicic said. It would have been much, much, much, much worse otherwise.
Dentist Eliza Callwood checks 10-year-old Xander Barton’s teeth during a routine cleaning at Timberlane Dental in South Burlington, Vermont, on June 23, 2020.
 (Photo: APRIL BARTON/FREE PRESS)
But theyre still hurting. The ADA estimated that the average dentist is spending an extra $15 to $20 per patient due to measures related to COVID-19 prevention. Some are passing those costs along to patients in the form of fee hikes.
Dentists are also unable to see as many patients as normal due to the extra time they need to devote to cleaning and spacing out patients to ensure they don’t come into contact with each other.
The upshot is that family dental practices are struggling the most since they are unable to spread out the costs of PPE. Industry leaders and analysts say dentists are increasingly likely to sell their family practices to private equity companies or other investors.
To a lot of dentists thats an attractive way to go, said Brandon Couillard, a Jefferies  stock analyst who tracks dental service providers. The pandemic will make it more difficult for the single office practitioner to remain economical,” he said.
Asnis, whose practice has more than 50 locations, said hes being flooded with inquiries from dentists seeking to potentially join his network.
Everyone in this area is wanting to join group practices, and its happening throughout the country, he said. Ive never had more dentists reach out to me than I have since June.
To be sure, the move toward group practices and private equity ownership was already underway before the pandemic, in part because younger dentists with a lot of student debt arent as interested in taking on the financial burden of launching their own practice and handling office processes like payroll.
One increasingly popular option is for dentists to join dental support organizations, or DSOs, which provide back-office support for tasks like human resources and billing.
Emmet Scott, president of the Association of Dental Support Organizations, said DSOs are appealing to dentists who want to focus their time primarily on care.
Without support services, they sit there doing crowns and fillings all days and then doing payroll on Friday evenings, he said. I think that drives more consolidation.
Will pent-up demand save the day?
As anyone who’s ever had a cavity will know, the longer you put off an appointment, the worse it gets. Which is one reason why dentists have reported a quick uptick in patient volume in recent months after they began reopening.
But there is lingering concern about what will happen once theyve satisfied pent-up demand for patients who were forced to defer treatment during the shutdown period.
Volumes in dental offices hasnt fully bounced back, and its beginning to flatline or taper, Couillard said. We maybe satisfied a lot of pent-up demand.
Meanwhile, dentists are becoming more likely to embrace new avenues for doing business.
One option is that dentists may get involved in distributing COVID-19 vaccines. About 3 in 4 are willing to vaccinate patients or would consider it, according to ADA polling.
In addition, dentists are increasingly looking for new revenue opportunities in the form of clear removable plastic aligners, a braces alternative sold by companies like SmileDirectClub, Align Technologys Invisalign and ClearCorrect. Unlike traditional braces, which are managed by orthodontists, dentists are qualified to manage treatment plans for aligners and say that aligners can generate new customers.
SmileDirectClubs model is predicated largely on the distribution of mail-order aligners and remote monitoring of each patients progress through photos, eliminating the need to visit an office for treatment.
The pandemic has clearly strengthened the argument for teledentistry, Couillard said.
Last SlideNext Slide
But are people really concerned about having straight teeth at a time when no one can see their smile in public due to face masks?
Christophe Carsault, vice president of North America at ClearCorrect, said aligners are still appealing to patients because they can help fix an overbite, underbite or crossbite.
The benefit of having straight teeth is way bigger than just the smile, he said.
Among them: looking good on video while working from home.
Some Invisalign doctors are hearing patients talk about the Zoom effect from video calls and seeing patients focus more on their smiles and seeking treatment, said Shirley Stacy, vice president of finance, corporate and investor communications for Align Technology, in an email.
Follow USA TODAY reporter Nathan Bomey on Twitter @NathanBomey.
Read or Share this story: https://www.usatoday.com/story/money/2020/10/19/dentists-coronavirus-pandemic-ada-cdc/3653734001/