Ⅴ The US Dental Education

米国歯科医療市場のカテゴリーに投稿されている記事は、米国の歯科医療市場を網羅的に知るために私がビジネススクールにて書き上げてきたレポートをそのまま掲載したものです。いずれ時間があれば日本語に翻訳する可能性があります。


Ⅴ　米国における歯科医療教育

こちらでは、米国の歯科医療教育に焦点を当てています。歯科医師、歯科衛生士、歯科助手、歯科技工士それぞれの教育について記載しています。


1. School of Dentistry
According to the ADA, there are about 65 accredited dental schools in the United States. In 2010, 5,023 freshman, including 164 international, enrolled in these schools. Top 10 Schools of Dentistry’s average acceptance rate is 2.8%(from 2.2% to 3.2%), and lowest 10 Schools’ average acceptance rate is 14.6%(from 9.2% to 31.8%). Total average acceptance rate is 6.4%. Mean GPA of top 10 schools is 3.72(from 3.70 to 3.79), and that of lowest 10 is 3.21(from 3.00 to 3.44). Total average is 3.54. Thus, School of Dentistry can be said super selective. With the average income after graduation, Dentist is ranked as the #1 popular job in U.S. News though the cost of dental education has soared over the years.

(1) How to enroll in School of Dentistry
Most dental students need at least a bachelor's degree before entering dental school; requirements vary by school. All dental schools require applicants to have completed certain required science courses, such as biology and chemistry. Majoring in a science, such as biology, might increase the chances of being accepted, but no specific major is required to enter most dental programs.

College undergraduates who plan on applying to dental school accredited by ADA must usually take the Dental Acceptance Test (DAT) during their junior year. Admission to dental school can be competitive. Dental schools use these tests along with other factors, such as grade point average and recommendations, to admit students into their programs.

(2) Education at School of Dentistry
The first 2 years of dental school consist mostly of didactic education as well as simulation courses. The last two years generally involve direct patient care under supervision. There tends to be much overlap in most schools' curricula; the didactic years may have some clinical components while the last two years still have significant didactic coursework. During dental school, students must take and successfully pass Part I and Part II of the National Board Dental Examination, which are administered by the ADA. Part I is usually taken after the second year of dental school, while Part II is usually taken sometime in the fourth year. Graduates receive either a Doctor of Dental Surgery (DDS) or Doctor of Medicine in Dentistry or Doctor of Dental Medicine (DMD) degree.

(3) Education to be a specialist
All nine dental specialties require dentists to complete additional training before practicing that specialty. They must usually complete a 1 or 2 year residency in a program related to their specialty. General dentists do not require any additional training after dental school. There is no statistics but according to my interview, I figure out that a student who would like to take advanced education to be a specialist needs to take high grade at school of dentistry and win the selective race because the seat to be specialist is limited. Dentists who want to teach, called faculty, or do research full time usually spend additional 2 to 5 years in advanced dental training. Many practicing dentists also teach part time faculty, including supervising students in dental school clinics. Being a faculty is a very prestigious position for dentists.

For example, 200 to 250 students, including considerably number of internationals, enroll in advanced education to be endodontists every year. These students are called “resident”. Additionally, Endodontists need to belong to the American Association of Endodontists (AAE). According to residents who I interviewed, AAE tries to balance the demand for endodontic treatment and new endodontists. So these kinds of organization like AAE not only work as an academic representative of specialty but also a political organization.

(4) Continuing education
The ADA provides members with continuing education tailored to your specific needs. From the day you graduate dental school until the time you sell your practice, we'll provide cutting-edge, unique education that has an immediate impact on your ability to treat patients, grow your practice and meet state licensure requirements. From online to in-person, ADA has continuing education to fit your needs. There are online educational options, in-person educational options, and other educational options including a 3 weeks intensive managerial education problem at Northwestern University's Kellogg School of Management.


2. Education for Dental Hygienist
There are 335 dental Hygiene programs in the US in 2014 and 7,211 enrollments in 2013. Dental hygienists receive their education through academic programs at community colleges, technical colleges, dental schools or universities. The majority of community college programs take at least two years to complete, with graduates receiving associate degrees. Receipt of this degree allows a hygienist to sit for the National Board Dental Hygiene Examination, a written exam administered by ADA, and then complete a regional or state clinical board examination.

48 university based dental hygiene programs may offer baccalaureate and master's degrees, which generally require at least two years of further schooling. These additional degrees may be required for a career in teaching and/or research, as well as for clinical practice in school or public health programs.

Dental hygiene program admission requirements vary depending upon the specific school. High school level courses such as health, biology, psychology, chemistry, mathematics and speech will be beneficial in a dental hygiene career. Most programs show a preference for individuals who have completed at least one year of college. Some baccalaureate degree programs require that applicants complete two years of college prior to enrollment in the dental hygiene program. Contact the particular dental hygiene program of interest to you for specific program requirements.

Dental hygiene education programs offer clinical education in the form of supervised patient care experiences. Additionally, these programs include courses in liberal arts, basic sciences, and clinical sciences.


3. Education for Dental Assistant
The path to becoming a dental assistant depends on where you plan to practice. In some states, there are no formal requirements to become a dental assistant, while other states require aspiring dental assistant to pass a specific licensure examination.

Dental assistant programs take between one or two years to complete, depending on whether it’s a certificate, diploma or degree program. These programs prepare students to take licensing or certification exams and provide students with the skills they need to work in a clinical setting. There are approximately 270 CODA accredited dental assisting programs in the United States. Dental assistants receive their formal education through academic programs at community colleges, vocational schools, technical institutes, universities or dental schools. Graduates of these programs usually receive certificates. Although the majority of academic dental assisting programs take nine to eleven months to complete, some schools offer accelerated training, part time education programs or training via distance education.

There are four types of dental assistant; Dental Assistant without certification, Qualified Dental Assistant, Registered Dental Assistant, and Certified Dental Assistant. State regulations vary, and some states offer registration or licensure in addition to this national certification program.

(1) Dental Assistant without certification

(2) Qualified Dental Assistant (QDA)
Qualified Dental Assistant is a dental assistant who has received on the job training or instruction through a dental assisting school. There is no credential for this level of training or instruction.

(3) Registered Dental Assistant (DSA)
Registered Dental Assistant is a dental assistant who has successfully completed the state level registration process with the State Board of Dental Examiners (SBDE). Dental Assistants who successful register and have been issued a Dental Assistant Registration Certificate by the SBDE may use the credential "Registered Dental Assistant" or "RDA".

(4) Certified Dental Assistant (CDA)
Certified Dental Assistant is a dental assistant who have been trained on the job for 2 years or have graduated from non accredited programs established by the Dental Assistant National Board (DANB) passes the DANB CDA Examination and continues to maintain the CDA credential by meeting DANB requirements. Dental Assistants who complete this process may use the credential "Certified Dental Assistant" or "CDA".


4. Education for Dental Technician
Dental Technician’s entry level education is high school diploma and equivalent. Many dental laboratories (larger ones in particular), offer positions for trainees. Persons hired at the entry level may rapidly progress to being productive employees, performing a limited range of laboratory procedures.

Another route to a career in dental laboratory technology is by completing one of the two or four year degrees in dental technology offered through educational programs. Graduates of these programs receive either an associate degree or a certificate.

National Board of Certification in Dental Laboratory Technology (NBC) recognizes educational institutions that provide these programs. In 2015, there are 45 NBC recognized educational institutions, and they are classified to three types. First is dental technology programs which are accredited by ADA’s CODA. Second is dental laboratory technology programs which are accredited by ADA’s CODA but which is listed in the US Department of Education Database of Accredited Post Secondary Institutions and Programs. Third is dental laboratory technology program that can provide proof of accreditation through their State’s Higher Education Executive Officers of the Council for Higher Education Accreditation. The burden of proof would fall on the school.

Dental technicians can become certified by passing an examination that evaluates their technical skills and knowledge. The examination is administered by NBC. A dental technician who passes the certification examination becomes a Certified Dental Technician (CDT). CDTs specialize in one or more of five areas: complete dentures, removable partial dentures, crown and bridge, ceramics or orthodontics.


5. Historical increasing of Dental Personnel in the Labor Force
All of the dental workers in the US are increasing continuously in the past half-century because of the development of dentistry.

Exhibit: Historical increase of dental labor force


(This exhibit is from Journal of Dental Education)

Ⅳ Dental related industry

米国歯科医療市場のカテゴリーに投稿されている記事は、米国の歯科医療市場を網羅的に知るために私がビジネススクールにて書き上げてきたレポートをそのまま掲載したものです。いずれ時間があれば日本語に翻訳する可能性があります。


Ⅳ　歯科医療関連産業

こちらでは、米国の歯科医療関連産業に焦点を当てています。日本には存在しない歯科医療任意保険産業（最近出てき始めたようですが）、歯科医療材料・機器などのメーカー、卸売業、歯科技巧産業それぞれについて記載しています。


1. Dental insurance Industry
- Market Revenue: $49.8bn(2012) to $65.9bn(2017)
- Profit: $2.9bn(5.9% of revenue)
- Annual Growth 2012-17: 5.8%
- Businesses: 48

Dental insurance currently makes up just 7.0% of the health and medical insurance sector. In 2012, 17.1% of Americans lack medical insurance; according to industry players, about 45.1% have no dental insurance. This drastic difference helps to illustrate the considerable distinction between the two types of healthcare coverage. Dental insurance largely focuses on covering regular maintenance and preventative oral health treatments, while medical insurance largely covers unpredictable and urgent health ailments. Consequently, dental care costs and the Dental Insurance industry are stable.

There are 3 types of dental insurance plans; Indemnity plan, Preferred provider organization plan, and Capitation plan. Dental insurance plans differ in the level of reimbursement offered for certain procedures and in annual dental spending caps. Dental insurance allows people to use dental care without incurring some of the extremely high costs.

Dental insurance plans can generally be divided into two categories: managed- care and fee-for-service. Managed-care dental plans are cost-containment systems that restrict the type, level and frequency of treatment; limit the access to care and control the level of reimbursement for services.

Dental plans can also be broken down into different categories for procedures. Preventative and diagnostic services generally include cleaning, oral exams and X-rays. Insurance plans typically cover 100.0% of these costs. Basic restorative services include fillings and extractions, among other things. Dental insurance usually covers 80.0% of the costs. Major restorative services include bridges, crowns and complete dentures. Dental insurance usually pays 50.0% for these procedures. Lastly, corrective services include services such as orthodontia, but are not directly included in most dental plans.

Exhibit: Services segmentation in 2012


(1)　Indemnity plan
Indemnity plan coverage allows patients to choose their own dentist. Under this plan, limits and co-payments are set according to the level of coverage purchased. The dental indemnity insurance plan pays the dental office on a traditional fee-for-service basis.

(2)　Preferred provider organization plan
Preferred provider organization (PPO) plans give patients the ability to select a dentist from a network or list of providers who have contractually agreed to discount their fees. If the patient chooses to receive treatment from a no-participating dentist, that patient may be required to pay a greater share of the fee-for-service or pay higher deductibles and co-payments. PPOs can be fully insured or self-insured. PPOs are usually less expensive than indemnity plans and are regulated by the appropriate state insurance department.

(3)　Capitation plan
In capitation plans, patients are assigned to a specific dental office where contracting dentists receive a fixed monthly fee per patient or family regardless of whether treatment is performed. Under this plan, dentists agree to provide specific types of treatment to the patient at no charge, usually preventative or routine services. For other services, clients must pay premiums and co-payments per visit.


2. Dental clinical instrument manufacturing industry
- Market Revenue: 　　　$5.9bn(2014) to $7.7bn(2019)
- Profit: 　　 $450.3m(7.6% of revenue)
- Annual Growth 2014-19: 5.4%
- Businesses: 1,109

The Dental Clinical Instrument Manufacturing industry has grown steadily because of both consistent demand for routine dental procedures as well as the growing population of Americans over the age of 65 who demand significantly more dental care due to age-related conditions. Growing consumer disposable income levels have also led to increased demand for more specialized procedures, in turn driving growth in industry profitability, as more dental laboratories demand high- end, high-margin instruments. Industry performance during the past five years has further been accentuated by overall growth in demand and ability to pay for healthcare.

Exhibit: Products segmentation in 2014

Total $5.9bn

This industry is consisted by 4 major segmentations. Dental clinics are the primary market that dental instrument wholesaler’s target. However, many industry firms also employ sales personnel that target this market segment directly.

Exhibit: Market segmentation in 2014

Total $5.9bn


3. Dental wholesalers
- Market Revenue: $12.8bn(2015) to $15.9bn(2020)
- Profit: $740.4m(5.8% of revenue)
- Annual Growth 2015-20: 4.5%
- Businesses: 872

The dental wholesalers industry distributes dental supplies and equipment to dental, orthodontic, periodontic, maxillofacial and other licensed dental practices. Demand for dental supplies and equipment is largely correlated with overall demand among individual consumers for dental work. Dental equipment dealers work as intermediaries between manufacturers of dental products and dental practitioners to help identify the specific needs of private practices, provide regular customer service and ultimately sell the latest and most advanced dental equipment that manufacturers have to offer.

Exhibit: Products segmentation in 2015

Total $12.8bn

Exhibit: Major segmentation in 2015

Total $12.8bn


4. Dental Laboratory Industry
- Market Revenue: $5.2bn(2015) to $6.1bn(2020)
- Profit: $629.0m(12.1% of revenue)
- Annual Growth 2015-20: 3.3%
- Businesses: 9,381

During the past five years, the Dental Laboratories industry benefited from growth in the number of individuals with private health insurance, which boosted industry revenue. However, some consumers were still budget-conscious over the period, thereby limiting out-of- pocket healthcare costs by cutting elective procedures, including tooth implants and cosmetic procedures. Nevertheless, as the number of people with private health insurance increased at an annualized rate of 1.8% during the five years to 2015, this trend has provided a boon to the industry. Additionally, rapid technological changes, such as new filling, bonding and implant compounds, such as all-ceramic restorative systems; cutting edge computer-aided design and computer- aided manufacturing (CAD and CAM systems); and computer imaging, stimulated demand for industry services.

Exhibit: Products segmentation in 2015

Total $5.2bn

Exhibit: Market segmentation in 2015

Total $5.2bn

Dentists are the primary users of dental laboratories. Dental laboratories also provide services to other industry operators. For example, industry operator Glidewell Laboratories markets industry products to dentists and laboratories, providing the former with prescription services and the latter with laboratory coping outsourcing services. Other services include providing record- keeping services.

Ⅲ Dental Clinics in the US

米国歯科医療市場のカテゴリーに投稿されている記事は、米国の歯科医療市場を網羅的に知るために私がビジネススクールにて書き上げてきたレポートをそのまま掲載したものです。いずれ時間があれば日本語に翻訳する可能性があります。


Ⅲ　米国の歯科クリニック

こちらでは、米国の歯科クリニックについて記載しています。

Ⅲ　Dental Clinics in the US
The dental industry is comprised of clinics of varying sizes and can be segmented as follows.

Exhibit: Size of the dental clinics and labor


The Dentists industry is highly fragmented with no single operator making up a significant portion of total industry revenue. In 2013, the four largest firms are expected to account for less than 2.0% of total industry revenue.

Visiting some dental clinics in the US, I sometimes realized that the operational IT system, such as electronic dental record system, is not introduced because the US does not have universal insurance system that covers dental treatments. In universal insurance system of Japan, dental offices need to send Medical prescription to insurer monthly, and they naturally have electronic system to make the operation smooth.

In the US, some small dental clinics even do not have appointment software system, and even manage the information in the hand with paper format scheduler. On the other hand, DPMCs that run number of dental clinics, has developed their own electronic systems for improving their operational efficiency as much as they can. Some of them even have their own engineering team. Last year, I visited a dental clinic of Smile Brands Group, and realized that dentist job in DPMCs is only treating patient in very efficient environment. Dentists even do not contact with managers of the company in their daily operation. This is totally different from that of Japan. Followings are representative dental companies in the US.


1. Comfort Dental Inc.
Estimated market share 0.1%, the company generated $154.7 million in revenue in 2013. Since its foundation in 1977, the Colorado-based company has become one of the largest dental franchises in the United States. Comfort Dental serves more than 3 million patients and has offices located across 10 states. The dentists own their offices independently. The company’s growth is attributed toward a low price strategy and other offerings targeted to a broad consumer base. Comfort Dental’s business model is oriented toward the lower-income population, with prices 20.0% to 30.0% lower than most local dental practices.


2. Coast Dental
Estimated market share 0.1%, the company generated $117.5 million in revenue in 2013. Established in 1992 as a single dental practice, Coast Dental has become the Southeast’s leading provider of dental services with more than 100 neighborhood dental practices in Florida and Georgia. Coast Dental was a public company until 2003. On March 24, 2004, the company issued a press release announcing intentions to unregister from the Exchange Act. The factors that led to the company’s decision to go private included the considerable legal, auditing, accounting and other costs associated with remaining a public company; the significant amount of time management spent meeting public company obligations; and the competitive disadvantages of public disclosure of sensitive information. In 2011, the company expanded significantly by acquiring Dental Technology, which gave Coast Dental about 60 SmileCare dental practices in California, Nevada and Texas. The acquisition also added about 1,200 staff workers and 130 dentists to Coast Dental’s workforce.


3. Dental Management Service Companies
As third-party payment, labor laws and technology grow more complex, group practice management companies are becoming much more relevant in the Dentists industry. Laws vary by state regarding the corporate practice of dentistry. In most states, direct employment of a dentist by a non-dentist is prohibited. Consequently, dentists use affiliation agreements that expressly dictate the non-clinical role a management company will serve. It also dictates that dentists should maintain complete discretion over clinical decision making and patient care activities within the practice.

Current market trends in healthcare, including provider demographics and resource requirements, are adding to the complexity of operating a dental group practice. In addition, the owners of many dental group practices are reaching retirement age and are beginning to investigate means for transitioning the non-clinical leadership and management of their dental group practices. The dental practice management business model enables dentists to focus on the clinical aspects of their dental group practices, while outsourcing the non- clinical aspects. This is totally aligned with what I saw at Smile Brands Group.

Dental management companies are also able to provide the necessary organizational structure, resources and capital for growth efforts. These companies often assist with organizational planning and development, administer employee benefits and payroll, manage inventory and supply procurement, maintain technology systems, assist with marketing and payer relations and provide financial planning. Management companies may also have authority to approve strategic and operational goals and review contractual relationships.

Based on the number of dental offices, Smile Brands Group is the largest provider of support services to general and multi-specialty dental groups in the US. Smile Brands’ services support more than 1,300 dentists and hygienists practicing in more than 400 offices nationally. The company canceled its roughly $125.0 million initial public offering in 2010 and withdrew its filing due to reportedly poor market conditions.
American Dental Partners Inc. is one of the largest dental management services companies in the US. Currently, the company is affiliated with 27 dental group practices, operating 300 dental facilities in 22 states. In 2013, its revenue is expected to reach about $307.1 million. In 2012, the private equity firm JLL Partners acquired ADPI.

Ⅱ Dental Labor in the US

米国歯科医療市場のカテゴリーに投稿されている記事は、米国の歯科医療市場を網羅的に知るために私がビジネススクールにて書き上げてきたレポートをそのまま掲載したものです。いずれ時間があれば日本語に翻訳する可能性があります。


Ⅱ 　米国の歯科医療従事者

こちらでは、米国の歯科医師、歯科衛生士、歯科助手、歯科技工士の主に専門性／収入面などについて記載しています。


１. Dentist in the US
There are 200,946 active dentists in the US. Dentists are very well compensated for the services they provide. According to the Business Labor Statistics (BLS), dentists earned a median salary of $146,340 in 2013. The top 10% earned more than $187,999, while the lowest 10% earned less than $72,240. Dentists who work in private offices are paid particularly well, but so are those who work alongside other health practitioners. Additionally there is a big annual difference between General Practitioner (GP) and Specialist.

Exhibit: # of General Practitioner and Specialist in 2014


Following is the list of annual income of representative specialists.

(1) Salary of Endodontist
An endodontist’s annual salary in the US ranged from between $65,000 to $400,000. The endodontists employed in the military and armed services received an annual salary ranging from $141,462 to $260,571 while those employed in hospitals received an equal amount of annual salaries ranging from $141,699 to $245,604. The median salary for an endodontist in partnerships or private practice received is about $227,000.

(2) Salary of Periodontist
A periodontist’s annual salary in the US ranged from $103,000 to $230,000, and the salary varies due to various factors. The periodontist employed in an academic field receives an average annual salary ranging from between $102,000 to $192,000. The periodontists working in the field of dental prosthetic services earned an average salary from between $113,000 to $213,000. Periodontists employed in hospitals receive an annual salary from $104,000 to $198,000 while those employed in well-established dental clinics earned an annual salary from $106,000 to $201,000.

(3) Salary of Prosthodontist
A prosthodontist’s annual salary in the US is about $182,640 and hourly wage raging from $40 to $166.6. The highest paid prosthodontist usually work in a private practice setting. According to the BLS, the highest paid yearly salary for prosthodontists rages from $191,090 to $229,000.

(4) Salary of Orthodontist
Orthodontist’s annual salary in the US is about $206,190 while a media hourly wage is about $99.13. The highest paid orthodontist receives an hourly wage of about $350 which averages to more than $612,500 per year. In contrary, the lowest paid orthodontist receives hourly wage of about $57.69 which averages to about $100,958 per year.

(5) Salary of Pediatric dentist
Pediatric dentist’s annual salary is about $346,070. An average salary for typical pediatric dentist employed in Community Dental Services is grossly about $260,000 per year while the one employed in the one employed in dental care clinician earns an average annual raging from between $200,000 and $250,000.


2. Dental Hygienist in the US
The majority of the 183,000-plus registered dental hygienists work in the US dental offices alongside dentists.

The job market for dental hygienists is booming. According to the BLS, the occupation will grow 33.3 percent by 2022, which is much faster than the average growth rate for most professions. This swell in jobs is likely due to the increased awareness among consumers of how oral health is linked to their overall health. Additionally, physicians’ offices, emergency rooms and medical clinics are increasingly hiring dental hygienists to provide their patients with more holistic health care. These professionals can also be hired in academia and in research.

Hygienists make comfortable salaries, especially considering that more than half of them work part time. In 2013, their median salary was $71,110. The best paid earned about $96,690, and the bottom 10 percent earned $47,880. Many of the highest paid hygienists work in dental offices, but ambulatory health care services also pay well. The state of California tends to compensate their dental hygienists particularly well, especially in the metropolitan areas of San Francisco, Vallejo, Santa Rosa, Santa Cruz and Los Angeles.

In some states like Colorado, Washington, and California, Dental Hygienist can open independent clinic from dentist. However, the job function in the clinic is limited.


3. Dental Assistant in the US
There are 303,200 Dental Assistant in the US. According to the BLS, there should be more than 74,000 new openings for dental assistants up to the year 2022. That amounts to nearly 24.5 percent employment growth, which is much faster than the average for all professions. There are several reasons for the increased openings, including the fact that current generations take better care of their teeth than either their parents or their grandparents, and they regularly visit a dental office. Expanded health insurance coverage has also led to more patients, which should drive the demand for dental assistants in dentists’ offices and outpatient care centers.

The pay scale for dental assistants ranges from about $24,220 to $48,350. In 2013, the average pay for dental assistants was $35,640, and the median pay was $34,900.

Dental assistant is one of the few jobs we cover that doesn’t necessarily require formal training in some state.


4. Dental Technician in the US
According to the Bureau of Labor Statistics, there are 82,900 work forces that belong to dental technicians in the US. However, this includes medical appliance technicians. They work in laboratories. Most technicians work full time. The pay scale for dental assistants ranges from about $36,000 to $100,000. The average pay for dental assistants was $45,000. Employment is projected to grow 7 percent from 2012 to 2022. As cosmetic prosthetics, such as veneers and crowns, become less expensive, there should be an increase in demand for these appliances.

Most dental technicians are employed in commercial dental laboratories. Commercial dental laboratories are often very small, having only two or three employees. There are also, however, some very large labs with over 100 employees. Some private dental offices have their own laboratory.

Ⅰ The US Dental Market

米国歯科医療市場のカテゴリーに投稿されている記事は、米国の歯科医療市場を網羅的に知るために私がビジネススクールにて書き上げてきたレポートをそのまま掲載したものです。いずれ時間があれば日本語に翻訳する可能性があります。


Ⅰ章　米国歯科医療市場

この章では、米国歯科医療市場のサイズや市場の成長率、米国歯科医師会などの組織、連邦政府と州政府によるレギュレーションなどについて記載しています。


1. The Dentist industry in 2013
- Market Revenue: 　　$118.8bn(2013) to $140.2bn(2018)
- Profit: 　　$20.6bn(17.3% of revenue)
- Annual Growth 2013-18: 　　3.4%
- Businesses 　　164,966(increasing 0.4%/year)

Exhibit: Dental Treatment Segmentation in 2013


The Dentists industry held steadfast during the recession, benefiting from favorable demographic trends, technological advances and mounting awareness of the importance of oral hygiene. Furthermore, private dental clinics were one of the nation’s most profitable industries during the economic downturn. This profitability is partially attributed to industry operators being less dependent on reimbursement from healthcare insurers, as many patients pay for dental treatment out-of-pocket. However, better preventive care at home has somewhat suppressed revenue growth. Improved toothbrushes and formulas for toothpastes that keep teeth healthy have somewhat mitigated demand for traditional dental services.

Meanwhile, the cost of dental education has soared over the past five years. Weighed down with debt, dental graduates have been hindered from starting practices, which require significant capital investments. Rapid advancements in technology have also made it expensive to outfit a dental office. These factors have led to the growth of dental practice management companies (DPMCs), large companies that provide services for multiple dental offices. Because DPMCs also buy independent practices, their growing dominance has led to industry consolidation.

The number of dentists per 100,000 people is higher in large metropolitan cities than other areas, particularly rural areas. In fact, the top four regions with the largest number of industry establishments include the West, Southeast, Mid-Atlantic and Great Lakes, accounting for 21.4%, 21.2%, 17.1% and 14.7% of the total number of establishments, respectively. Although dentists are more concentrated in urban areas, 84.7% of the population that lives in the most rural counties has one or more private practice dentists, based on information from the American Dental Association (ADA). There are some areas where do not have any dentist. Dental practitioners are attracted to large cities such as Los Angeles and New York because they can receive higher prices for services in these areas. Personal lifestyle preferences also play a part in a dentist’s decision regarding where to locate.

In the US, most of the dental treatment is provided in the small clinics, so the number of clinics considerably depends on the number of dentists. The final authority on licensure requirements is the individual state. The state board of dentistry, known as board of dental examiners, is an agency of state government created by the state legislature. This agency governs the qualifications for and the practice of dentistry within the state. According to the interview with a student of USC School of Dentistry, each state control the number of new dentists who can work at the state after graduation because of its luck or surplus of dentists.

Now, the US is under implementation of the Patient Protection and Affordable Care Act (PPACA), and healthcare reform legislation increases the number of insured Americans. PPACA mandates that all Qualified Health Plans include oral care coverage for pediatric patients, boosting demand for dental services. Moreover, although the Act does not extend mandatory oral care coverage to adults, PPACA provides a boost to dental care providers by expanding Medicare and Medicaid and by setting up private health insurance exchanges, which had the effect of expanding medical coverage to millions of Americans, leaving them with more disposable income to spend on dental care and elective and cosmetic dental procedures. As a result, the effects of PPACA have boosted patients’ demand and ability to pay for pediatric and adult dentistry, rendering dental offices and laboratories more able to restock their clinical instrument supply. As a result, the industry revenue jumped 5.0% in 2014. However, there is a survey that illustrates two-thirds of dentist respondents revealed that they do not accept Medicaid payments. Though one in three dentists does take Medicaid, many were unimpressed. Through an interview, one dentist who runs his office at Los Angeles told that he do not welcome the expanding Medicare and Medicaid coverage.

In addition, as the job market improves, increased dental coverage from employers and rising disposable income will result in more patient visits. DMPCs will continue to penetrate the industry and grow in size as more dentists recognize the benefits of spreading costs across practices.


2. Organizations of the US Dental market
(1)　American Dental Association (ADA)
Founded in 1859, the not-for-profit American Dental Association is the nation's largest and oldest dental association, representing more than 157,000 dentist members. Since then, the ADA has grown to become the leading source of oral health related information for dentists and their patients. The ADA is committed to its members and to the improvement of oral health for the public. ADA also takes responsibility to define the education at School of dentistry, License Examination, and editing treatment guideline.

A specialty is an area of dentistry that has been formally recognized by the American Dental Association as meeting the specified Requirements for Recognition of Dental Specialties. The responsibilities of the different areas of specialization, the requirements and other information can be found here in Dental Specialties. Currently there are Nine Dental Specialties recognized by the ADA.

- Endodontics
- Periodontics
- Prosthodontics
- Orthodontics and Dentofacial Orthopedics
- Pediatric Dentistry
- Oral and Maxillofacial Surgery
- Oral and Maxillofacial Pathology
- Oral and Maxillofacial Radiology
- Dental Public Health

(2) 　American Dental Hygienists Association (ADHA)
ADHA is the largest national United States organization representing the professional interests of more than 150,000 dental hygienists across the country.

(3) Organization for Dental Assistants
①　American Dental Assistants Association (ADAA)
ADAA has issued a position statement on education and credentialing of dental assistants in the United States as a step toward preventing a recurrence of the unfortunate dental practice incidents recently experienced in various states.

②　Dental Assisting National Board (DANB)
DANB is the nationally recognized, premier certification and credentialing agency for dental assistants. By providing high standards for testing and dental assistant certification, DANB ensures that the public receives quality dental care from qualified individuals.

③　The Commission on Dental Accreditation (CODA)
CODA belongs to ADA is responsible for accrediting dental assisting programs.

(4) The National Board for Certification in Dental Laboratory Technology (NBC)
NBC provides professional certification to both dental technicians and dental laboratories. NBC is dedicated to administering and promoting globally recognized certification programs to assess the knowledge and skills of dental technicians and to review facility and staff training criteria for dental laboratories.


3. Dental Regulation
Dentistry is typically practiced outside of an institutional setting and in private practice.
(1) Federal Regulation
The federal Anti-Kick Back Statute many things especially rerated to Medicare or other government health programs. There are also federal laws that prohibit health practitioners from referring patients to designated health services in which the practitioner has an ownership interest. Many states have also enacted laws similar in scope and purpose to the Anti-Kick Back Statute and the Stark laws to apply to state health programs.
Dentists must also comply with laws and regulations that are more wide ranging and apply to other professions.

(2) State regulation
Dentists define their own scope of practice. However, states regulate who can own and operate dental practices, which may employ dentists, and what level of control non-dentist owners and managers have over dental practices. State boards of dentistry issue licenses and seek to ensure that dental practitioners maintain their competence and practice in accordance with the law of the particular state. State laws also govern the ways that dentists advertise to the general public to solicit business. The laws vary from state to state but generally address ethical matters and the types of credentials a dentist may include in any advertisements.