I’ve noticed a definite change in the flood of emails, blog posts and other content we dentists are inundated by daily. Over the last six months to a year there has been little if any mention of the evils of “corporate dentistry”. Considering how long corporate dentistry has been dentists’ chosen “Great Satan” and the cause of everything wrong with dentistry, this is a huge change of topic, attitude and blame in the dental space. It’s surprising in and of itself that the attitudes, fears and desires dentists can shift so quickly but it shouldn’t be. There is a definite pattern here if you look big picture/long term and that kind of thing is terribly interesting to me.

When I was in dental school in the late 90s and ortho residency in the early 2000s, Align Technology was the enemy of the day. The common complaints about Invisalign back then were:

  • You can’t straighten teeth without braces
  • Aligners will never work and patients will be unhappy
  • Aligners will ruin bites
  • Align is using orthodontists to destroy our profession
  • Align should not have allowed dentists to use Invisalign

These complaints are funny now considering how entrenched and generally accepted Invisalign is now and how many major orthodontic companies are trying to break into the aligner market. Were we dentists wrong? Did the world change? Why was Align the devil then but an integral part of dentistry just a few short years later? What changed? Does mass conversion to the “dark side” by fellow dentists transform something that was evil into something good just because of widespread penetrance and utilization? How many conversions does it take? Are our objections and name calling about ethics or economics?

Once the hatred for Align began to fade, Corporate Dentistry became the preferred whipping boy of dental professionals. If I had a dollar for every email I received about the evils of corporate dentistry or how to win against corporate dentistry over the years, well, I’d have a lot of dollars! The definition of “corporate dentistry” was not as clear and the target for our angst was not as defined as it was when Align was the enemy but this incarnation of the Dental Great Satan was every bit as evil… until it wasn’t. The common complaints about Corporate Dentistry back then were:

  • They don’t care about patients
  • They are just running mills and treating patients like cattle
  • The doctors are not the real owners and therefore don’t care
  • They don’t do quality work

However, over the last year and especially over the last six months there has been a definite decline in the venom spewed towards our corporate peers/competitors. Why is this? Why the change in attitude? Were we wrong about the “evil” corporate practices who were always willing to see the patients we refused to see? Is it that we now understand the value of an affordable option? Has corporate dentistry miraculously changed itself from a terrible, evil empire into something that is normal and accepted? Have enough fellow dentists joined the ranks of those who get a paycheck from corporate dental outfits and has the number of converts from detractors to collaborators finally reached that magic tipping point where acceptance/utilization make what was bad into something good? It seems to me that these days many of the best and brightest dentists dream of one day being acquired by a PE group or involved in a large corporate rollup. How ironic/fantastic is that? Again I ask, were our objections to “corporate dentistry” ethical or an attempt to protect our wallets from something we perceived as a threat at the time? In hindsight the answer to this question seems obvious for both the hatred aimed at Align and Corporate Dentistry. Now that many of our fellow dentists depend on corporate dentistry and Align to get paid, they are “one of us” and part of the dental establishment we defend like junkyard dogs.

Now that Corporate dentistry is acceptable, are we dentists finally done with anointing what we all agree is the greatest threat to our wallets (ahem, I mean a threat to patients)? I think not. It seems readily apparent that Direct to Consumer, Doctor Directed orthodontic treatment using aligners is the new target for dentists who are dissatisfied with their lot in life and looking to blame someone for their lackluster results. It’s been interesting to watch the DTC orthodontics companies rise from being dismissed as a joke to being perceived as a threat by dentists and organized dentistry to becoming major players in the orthodontic space. And from what I can tell they are just getting warmed up – it’s not unreasonable to think that DTC companies will become the primary/largest provider of orthodontics in the next decade. But we dentists never look at the big picture or think long term. We are, once again, launching headlong into massive spending of time and money and effort to “defend the profession” from this latest Great Satan. From the AAO spending hundreds of thousands on Google Adwords buying the names of DTC aligner companies, to the AAO legal team filing an Amicus Brief in the SDC vs Alabama Dental Board case supporting the dental board’s motion to dismiss the case (but only doing so after the judge has already ruled that he won’t dismiss the case – day late and a dollar short as usual), to the ADA president declaring war on DTC aligner therapy… the repeating pattern is clear.

We haven’t learned a damn thing and probably never will. In the short amount of time I’ve been a dentist, the pattern that we dentists follow and our track record of failure when it comes to being wrong about and opposing what we perceive, at the time, as a threat to our wallet is readily apparent. As I watch orthodontists adopt “lite treatment” and “reasonably priced aligner treatment” and companies like HSO tout the efficacy of “no attachment aligners” (all of these things obviously copied from the wildly effective tactics of DTC aligner companies) I wonder how long it will be until the adoption and utilization curve will hit the tipping point for this latest Enemy of the State (board). Time will tell I guess but I sure hate to see dental professionals convince themselves that they are right and good and defending the public just because they all agree it is so when this is, in reality, just the latest of many epic leadership failures in dentistry and a colossal waste of time and money.

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