Cosmetic dentistry has been a staple of dental practices since the ’90s, when the widespread availability of teeth whitening products revolutionized the market.
Even the recession couldn’t vanquish vanity; steady consumer demand for teeth bleaching, tooth-colored fillings, implants and other cosmetic procedures has kept dentists smiling through today’s tough economic times. It’s also helped keep dental benefits popular and prompted some leading dental insurers to broaden plan coverage to include cosmetic services.
“More and more dentists see cosmetic procedures as a way to increase their revenue,” says Dr. Roma Virani, second vice president, Dental Cost & Utilization at Assurant Employee Benefits. For example, “most practices are doing tooth-colored fillings. It used to be that only a third of the fillings on back teeth were composites. Now that is reversed.
“While some people are concerned about the safety of amalgams,” she continues, “the switch is primarily driven by aesthetics. You get equally good results, so one type is not better than the other. However, people want their fillings to be tooth-colored so they are not as visible.”
Whitening leads the way
By far the most popular cosmetic procedure is teeth whitening. Dental magazines report that the most common conversation dentists have with their patients is about bleaching. Bradley Dykstra, DDS, wrote about the trend in Dental Economics magazine in April.
“The quest of baby boomers to stay forever young and society’s expectations to look our best drives this demand,” he says. “It is important to understand that patients, both male and female, want whiter teeth – period.”
Until a few years ago, bleaching was not covered by dental benefit plans. This changed when a handful of dental plan providers heeded requests from brokers and employers for voluntary insurance products that would offset the cost of cosmetic dental procedures for employees.
“All insurers in this industry are always looking for something new and different for brokers to sell,” says Kevin Martin, dental product development leader at Sun Life Financial. “Cosmetic was something the industry shied away from because it was not necessary care. Sun Life came up with the thought that since people want nice, shiny teeth, wouldn’t it be nice to offer a benefit that covers some, but not all, of the cost. I guess covering cosmetic was our iPod.”
Sun Life offers two cosmetic dental riders to its insurance plan. One covers teeth whitening done in the dental office or at home with products provided by the dentist. The other includes veneers as well as whitening.
The cost of the riders is based on the annual maximum selected and adds 3% to 6% to the standard dental insurance premium.
“It’s all about the smile,” maintains Paul Sherman, vice president and national sales director for American General Benefits Solutions, which began covering cosmetic procedures under its voluntary “Smile Maker” benefit plan two years ago.
Smile Maker currently covers teeth whitening and implants and will soon be expanded to include implants and composite fillings, according to dental product manager Sadia Zoppi. “It works like a lifetime orthodontia benefit for each family member,” she says. “About 2% of our business has this feature, but we anticipate that it will increase as more plan sponsors ask employees to contribute to the cost of their dental plan.”
The Smile Maker add-on is $8 per month for an individual and $32 per month for a family. “That can be a substantial increase in cost on a lower-priced dental plan that’s, say, $50,” notes Zoppi.
These products are expensive in nature, says so you’d expect this, says Zoppi. “But they are still very attractive, and they are meeting a need. There is a growing demand for these services.”
According to AACD, the mean amount spent by the average patient in 2006, the last year for which data is available, was $5,640 and the median was $3,860. At the high end, 3% of practices indicated an average amount spent per patient of $20,000 or more.
At the other extreme, 2% of practices reported average patient costs of less than $500. The most often indicated categories were $5,000-$9,999 (23%) and $2,500-$4,999 (22%).
Assurant Employee Benefits also was one of the first to cover teeth bleaching. Some of its plans also include posterior composites and porcelain crowns on posterior teeth, which it considers restorative rather than cosmetic.
“Going along with these trends, Assurant has come out with products that will take employees’ benefits farther,” says Virani. “We have Family Share Max and Preventive Max Waiver products that give more benefit dollars to plan members for these services. With the Preventive Max Waiver, preventive work does not count toward the annual maximum, so more dollars are available for non-preventive services.
“This supports our belief that if patients are getting preventive work done, they’ll need less restorative work in the future.”
Guardian broke new ground in 2004 when it extended coverage to implants. The company also offers coverage for whitening, posterior composites, porcelain inlays and onlays, and porcelain crowns and veneers.
“We take a lot of pride in customizing our plan designs to meet brokers’ and plan holders’ price points,” says Dr. Richard Goren, second vice president of Guardian’s group dental unit.
“There are hundreds of options. No one offers everything that we do.”
Brighter smiles, better health
Dentists view cosmetic dentistry not only as a means to increase revenue, but also as an important way to improve Americans’ oral health.
“If I want to whiten my smile, the dentist is going to talk about restorative needs before doing cosmetic work,” says Goren. “The motivation for a bright smile and white teeth is coming from the individual patients, and the drive for overall care is coming from the dentists.”
Like bleaching and tooth-colored fillings, implants improve patients’ appearance and promote self-esteem. But they also can help prevent problems down the road, Goren notes. “Bridge work involves shaving the tooth and cementing the bridge on top of it. When that happens, the tooth is never as good as when it was healthy. With an implant, no one is contributing to a tooth’s demise.”
Dermal filler next?
Dermal filler therapy may be a natural progression of where the cosmetic dental industry is heading, according to Goren. “With proper training, these procedures are easy for dentists to accomplish. Patients are motivated to accept these therapies and excited about having them done under local dental anesthesia, making dentists the health care professionals of choice to deliver these procedures.”
Whether dental plan providers will push the cosmetic coverage envelope to cover dermal filler therapy remains to be seen. Meanwhile, however, a new national movement is underway among dentists that could spark discussions about including cosmetic procedures as part of basic dental plans.
The dental industry has been lobbying across the country for states to prohibit insurers from negotiating discounts on services that are not covered.
Because there is a great deal of discounting on cosmetic procedures, this trend is significant, according to Evelyn Ireland, executive director of the National Association of Dental Plans in Dallas.
“The dentists feel that they are in an unequal, negative position,” she says. “Their position is if a carrier won’t pay toward a service, they shouldn’t be required to discount it.”
“The no-discounts on non-covered services legislation is not very consumer friendly,” says Virani. “If a service that is cosmetic in nature is not covered, the dentist will have better luck convincing the patient to have it done if it can be provided at a discount. Discounts are the cornerstone of PPO products, so this is changing things quite a bit.”
“Carriers aren’t happy [with these regulations] because employees are losing out on discounts,” agrees Martin. “It is possible that we’ll see a resurgence of requests for coverage for cosmetic services because then we could offer a discounted fee if that’s requested.”
Discounted or not, there’s no doubt that patients will continue to request cosmetic procedures and dentists will continue to expand the scope of these services.
“It’s a nice time to be a dentist when you have patients who are smiling, looking good and you know they have a healthy mouth,” says Guardian’s Goren. “It’s a stark contrast to getting feedback that it hurts and they don’t like anything you can do for them.”
By the numbers
In 2007, the American Academy of Cosmetic Dentistry put the market for cosmetic dental procedures at $2.75 billion, based on a 2006 survey of its members. Of that, $138.8 million was for bleaching and whitening, $383 million was for posterior composites, or rear fillings, and $144.3 million was for implants. The total number of patients seeking cosmetic services was estimated at 2.69 million, which represented a 12.8% increase over 2005. Furthermore, the survey respondents expected another 11% increase in patients and revenue in 2007.
Credit: By Lynn Gresham