Corporate dentistry is on the rise. Make dental care universal

The Canadian Health Coalition publishes this guest commentary by Brandon Doucet of the Coalition for Dentalcare.

We, at the Coalition for Dentalcare, call on the Liberals to follow through with the last phase of the Canadian Dental Care Plan (CDCP), covering 5 million people between the ages of 18-64, before the next federal election. From here, we need to harness the success of the CDCP to address further systemic problems in our dental care system. While the CDCP has increased public funding of dental care, the delivery of that care still remains problematic.

In recent years, more Canadians have noticed upselling from their dentists, luxury and cosmetic services are now being pushed more and in some instances patients are reporting a sudden increase in the number of cavities detected. Some experts are wondering what role the corporate consolidation of dental clinics is playing in this, as these tactics would drive the increased profits dental corporations desire.

What is corporate dentistry and why is it happening?

Corporate dentistry is when a dental corporation, often with the backing of private equity, are buying up assets of dental offices, owned by dentists, allowing them to assume control over the administrative aspects of the dental office (e.g. hiring, firing, bookkeeping). Many are unaware of this trend, as this takeover often happens with no outward changes to the dental clinic and this not being advertised.

From a 2023 article in The Jacobin:

Despite limited data, experts believe corporate dentistry is growing rapidly, particularly among new dentists. Because new dentists are graduating with a lot more debt than they used to — often $250,000 or more — dental graduates are less likely to take out another loan to buy or set up a dental practice, leaving them vulnerable to the siren song of investors. This corporate funding is driving up the cost of dental clinics, creating a self-perpetuating Möbius loop of corporate influence. As a result, new dentists are often looking to work for an established clinic with a steady stream of patients so they can pay down their student debts.

Many older dentists are ready to retire and want to sell their dental practice, but fewer and fewer younger dentists are willing to buy these clinics. This is creating a window of opportunity for outside investors to buy up dental offices. Dental practices are attractive to investors because they are fabulously profitable — a corporate lawyer working in the field states that they often see a 15 percent yearly return on investment.

Comparing US and Canadian dental corporations

In the US, dental corporations account for 25-40 per cent of dental clinics, and experts state that Canada is following in their footsteps but lagging 10 years behind. The largest dental corporation in Canada, Dentalcorp, owns 550 practices and is in the process of acquiring another 160 clinics, according to a 2024 investor report. This means one dental corporation owns 3-4.5 per cent of Canada’s dental clinics.

In 2018, private equity provided US$900 million to the Dental Corporation of Canada and the following year US$425 million to 123 Dental. These large investments can put undue pressure on providers, who are sometimes personally invested in these dental corporations, to generate enough revenue to pay off this debt.

I have had colleagues who have worked with dental corporations express frustrations to me with the expectations of high production. They have told him they are expected to run two or three chairs at a time. 

A survey of Canadian dentists found that those who see themselves as business people rather than health care providers, as well as those who are still paying student loans, were more likely to be “aggressive in their treatment recommendations.”

With a more aggressive treatment approach, a dentist might diagnose more cavities than is warranted and aggressively promote luxury and cosmetic procedures that are not medically necessary. This involves counseling such treatments as veneers, implants, tooth straightening, whitening, and “replacing old mercury fillings.”

In the US, the dental corporations Kool Smiles and Small Smiles had to return $24 million each to patients after a whistleblower spoke to the US Justice Department about the companies defrauding Medicaid. Plenty of other examples show over-treatment and fraudulent billing among US dental corporations. Considering experts say Canada is following the US trend of corporate consolidation of dental clinics, it is important we learn from their mistakes and correct course.

Conclusion

While millions of Canadians are excited about gaining coverage through the CDCP, we must remember that, as NDP MP Don Davies has stated “the Canadian Dental Care Plan needs to be seen as a down payment on a universal system.” Coverage needs to be universal with no co-payments and the government can stop the corporate takeover of dental offices by nationalizing these clinics and allowing them to focus on improving public health.