The Future of Organized Dentistry: The Role of Dental Associations in a Group and Supported Practice World

The Future of Organized Dentistry -The Role of Dental Associations in a Group and Supported Practice World: © Andrii Yalanskyi - stock.adobe.com

We spoke to association leaders and support organizations about how they view their role in backing dental practices today and how they see that changing in the future. Here’s what they had to say.

The Roles Associations Each Play in Supporting Dental Practices

The American Dental Association (ADA) is the largest dental association, with 159,000 members. George Shepley, DDS, president of the ADA, says that since its founding in 1859, the ADA has been working to advance the profession of dentistry. Dr Shepley explains that the ADA is a tripartite, which includes memberships nationally and in a clinician’s state and local dental association.

“Collectively, as 1 ADA representing the united voice of the profession, we work together to help dentists succeed and advance the public’s health. From cutting-edge clinical guidelines to provide the best chairside care to important dental standards and infection control protocols to insurance claims and coding support and actionable advocacy on the state and federal level, the tripartite thrives together as a strong support system for the profession,” Dr Shepley says. “There’s great strength in unity, and organized dentistry provides that forum to create and implement change, whether it be the passage of a federal bill, releasing clinical guidelines for the steadfast treatment of caries, or spurring a nationwide drive to provide dental care to the underserved—that’s the power of coming together as 1 ADA.”

Dr Shepley says group practices and dental support organizations (DSOs) began forming approximately 30 years ago and have grown significantly since. DSOs support dental practices by providing nonclinical support around business functions, including human resources, information technology, accounting, marketing, and other services. “Each business model is different, and each group offers different resources and support to the dentists affiliated with their group,” he says.

Dental associations, large groups, and DSOs support practices in many ways. However, their organizational structures dictate how they provide this backing. Gary J. Pickard, senior director of government and industry affairs at Pacific Dental Services (PDS), says dental associations have provided dentists and other oral health care professionals with opportunities to develop professionally in the traditional manner through continuing education (CE), leadership opportunities, and service days. The local and state associations excel in organizing activities and engaging directly with their members. Pickard says national organizations play a vital role in establishing standards, creating platforms, and offering strategic thinking, advocacy, and guidance.

Pickard also says there is a lot of variation in DSOs due to the numerous models. Although he can’t speak for all DSOs, PDS has not only provided those services but has also significantly enhanced them over the years since it was founded in 1994. Other DSOs have made similar strides. “In the early days, DSOs primarily focused on establishing platforms for operational efficiencies, securing purchasing discounts, and managing the marketing, billing, and HR [human resources] functions,” Pickard says.

Dental associations also brought colleagues together outside of school for collaboration, provided support, and created a unified voice for doctors, according to Tim Quirt, DDS, senior vice president of clinical operations at Heartland Dental. However, the associations could only go so far. After their formation, DSOs took collaboration to a new level through their communities. “We’ve created even more ability for doctors to share,” Dr Quirt says.

He thinks the lack of competition between supported clinicians in the same organization improves information sharing. Plus, the top-down approach that applies to all clinician activity associations differs from the environment created by an organization like Heartland Dental, which he describes as a doctor-led organization. “[We ask the question]: ‘What items [do] you need?’ Then we address those from the clinicians rather than the other way around,” Dr Quirt says.

The Roles Continue to Develop as Each Organization Grows

Chris Salierno, DDS, speaker, writer, dental consultant, and chief dental officer for Tend, a growing DSO with multiple locations on the East Coast, says the support roles of organized dentistry and group practices used to be dissimilar but there has been increasing change in that area over time. Dr Salierno says organized dentistry served as the voice of the dental profession, offered tangible benefits (eg, discounts on life insurance), and played a significant role in facilitating CE. Group practices served more as employers for dentists and as a potential exit strategy for established dental practices. “Today, there is more overlap,” he says. “Organized dentistry is still the profession’s voice, particularly in legislative matters. However, group practices are also significant providers of tangible benefits and CE.”

Arwinder Judge, DDS, chief clinical officer at Aspen Dental, says that from an overarching perspective, dental associations and DSOs have pushed in several ways, including advocacy, regulation, and CE. DSOs also provide various nonclinical services to the dentists they support, such as HR, marketing, payroll, information technology, accounting, procurement, scheduling, and compliance, which are all critical business functions that are essential to running a dental practice. However, since its founding 25 years ago, Aspen Dental continues to grow the services they develop for their supported clinicians.

“For example, we’re expanding our learning and development programs for dentists and dental team members. Aspen has built a robust [CE] platform and online learning portal. We’re also set to launch The Aspen Group University, or ‘TAG U,’ [which is] a hands-on, immersive learning program to develop personal and professional growth across the organization,” Dr Judge says. “Each of these entities is important when looking at the future of dentistry.”

Related Reading: The Aspen Group University Opens Impressive Learning Facility in Chicago

Pickard agrees that one of the most evident areas of overlap between DSOs and trade associations is in CE and personal and professional development. DSOs have made substantial investments in facilitating the growth and development of their supported clinicians. “State dental components have tried to compete with DSOs regarding operational excellence and procurement, but they have seen limited success. Trade associations tend to excel in areas like malpractice insurance. For instance, the Florida Dental Association offers a strong package. These challenges partly stem from the differing expertise, objectives, and organizational structures of trade associations compared [with] DSOs,” he says.

“Then there are many complementary areas where their roles do not overlap,” Pickard continues. “For example, associations do not offer mentoring or shoulder-to-shoulder clinical development, along with the sense of camaraderie that occurs within large group DSOs. There may be a competitive spirit within a DSO, but it’s also more supportive and collaborative. Outside the DSO environment, it seems much more cutthroat, which tends to restrict the sharing of best practices and KPIs (key performance indicators).”

Pickard says DSOs and trade associations can and do collaborate on industry standards, advocacy, and broader industry initiatives, hopefully speaking with a large and unified voice on important issues that impact dental professionals and patients across the board.

Dr Salierno also points out examples of group practices taking on legislative battles to support the profession, such as the Association of Dental Support Organizations (ADSO). However, associations are changing their roles, too. “The ADA has recently launched ADA Practice Transitions, which is an interesting example of how organized dentistry can help facilitate employment and exit opportunities,” he says.

How and Why These Roles Differ

John Blake, DDS, executive director of the Children’s Dental Health Clinic and president of the California Dental Association (CDA)—the largest state dental association, with more than 27,000 members—agrees that a significant difference is an organization like the CDA that represents all the ways dentists practice, from private practice to small or large group practices to rural clinics to dental faculty. By contrast, support organizations focus on the success of the dental practices backed by their organization. “The CDA’s approach has been to provide the necessary resources, education, guidance, and support, regardless of their career path,” Dr Blake says. “The DSO has centralized teams that assist with many elements but are more company-specific resources specific to their business model.

“I don’t consider that a bad thing,” Dr Blake continues. “Their focus is different than the broader approach that the CDA has taken, which is agnostic to practice environment.”

Tammy Filipiak, RDH, MS, FADHA, past president of the American Dental Hygienists’ Association (ADHA) and vice president of hygiene support and clinical operations at Smile Brands Inc, has experience in both organization types. The ADHA represents the interests of dental hygienists nationwide. Moreover, association members advocate for hygienists, driving the changes in the scope of practice at the state level. For example, Wisconsin, where Filipiak practices, allows her to practice very differently today than when she started her hygienist career. She credits these changes to the professional association and its advocacy efforts.

Like the ADA and the CDA, the ADHA is a 3-tiered association with national, state, and local levels. Filipiak says the national level is involved in federal advocacy, taking on areas such as interstate licensing compacts, making it easier for hygienists to practice in different states. The organization’s state level works to advance the hygienist’s scope of practice and determine which supervision and setting they can treat patients. For example, Texas recently passed legislation that will allow hygienists to administer local anesthetic. 

“We celebrate all of that progress,” Filipiak says. “Some of it happens sooner and some later. The important thing—the ‘why’ behind it—is we are always looking to provide our care to more patients because we know what we do as dental hygienists is so important not only on the preventive side but also on the therapeutic side of treating disease and infection.”

In Filipiak’s experience, support organizations also have an essential role in these areas, which creates overlap. For example, associations and support organizations want clinicians to advance their clinical skills, leadership, and communication. However, the overlap isn’t a conflict; there is room for both organizations in these areas because people learn in different ways. “Some people prefer a live program, others prefer a virtual,” Filipiak says, adding that clinicians can earn CE in some states through recorded programs such as webinars. “We live in a world where flexibility is critical, so the fact that professionals have options is a good thing.”

Filipiak says Smile Brands provides CE for doctors every week. Their schedule also includes programs for hygienists, dental assistants, and the business office team. The topics range from the whole of dentistry to role-specific areas.

For example, the hygiene programs cover topics from supporting clinical skill development and review to the many scientific topics that inform on things like risk assessment, pathogen pathway, and the impact of inflammatory infection in the body. However, unlike the programs that an association presents, a DSO is also likely to deliver learning to support new technology, and then the necessary and specific workflow changes to incorporate what the participant learned. These practical applications are essential to achieve an improved patient experience and elevate the team’s level of care, Filipiak explains. “It’s a more micro vs macro view on not only what the technology can do but [also] how we use it, implement it, bring value to the patient, and get to the outcome we’re trying to achieve,” she says.

The available resources also differentiate the roles of dental associations vs other support organizations. For example, the CDA addresses state legislation affecting clinicians and patients. From his years on the Government Affairs Council, Dr Blake says the CDA has a strong advocacy team. This year, the CDA is working with the state regarding dental benefits and insurance, which is a significant pressure point for dentists. 

Additionally, when emerging issues affect dentistry, such as the recent COVID-19 pandemic, the profession looks to the state association for guidance. “That’s where the association shines and serves our members well,” Dr Blake says. “Depending on their size, strength, and how they feel about advocacy, it would be more challenging for that to happen with a large group or a DSO environment.”

Dr Blake also explains that the dental board and legislators want to know how the issues they confront in lawmaking affect dental practitioners. For example, the board wanted to know from dentists how dental practices handled the shortages of hygienists and dental assistants following the pandemic and how to create environments that would recruit more new people. “They want to hear from dentists,” he says. “That’s where many of our professionals come into play in those conversations.”

Another significant way that the CDA enhances its membership business is through The Dentists Insurance Company (TDIC). TDIC is available in California only to association members and provides malpractice, property, workers’ compensation, and cyber liability insurance just for dentists. TDIC also provides direct risk management support to California dentists via an advice line that offers practical “in-the-moment” advice and courses that help dentists to avoid risk. “It’s a key benefit,” Dr Blake says, adding that the organization is also available in other states. “TDIC is consistently in the top 3 when we ask members to rank the benefits offered by the CDA.”

What Could Happen Moving Forward

Dr Shepley says the ADA is innovative and is focused on the future so they can deliver for members today, tomorrow, and “for 164 more years to come". Part of that innovation strategy is actively collaborating with many dental industry stakeholders and key organizations, including many DSOs. For example, Dr Shepley says the ADA collaborated with the ADSO on essential advocacy efforts, especially around dental insurance reform and the dental licensure compact. “Collaboration on these issues is crucial because helping all dentists thrive supports and strengthens our profession,” he says.

The ADA and state and local dental associations offer a wide range of products and services to help dentists succeed, Dr Shepley explains. Group practices can’t do everything, so membership value from the ADA tripartite provides meaningful support for dentists throughout their career journey.

To ensure its value proposition is evolving to meet the needs of group practice dentists, the ADA tripartite has engaged in various conversations with DSO dentists and leaders. Likewise, the ADA is introducing a new membership model in 2025 to modernize its membership to meet the demands of changing demographics and practice modalities within dentistry. The new membership model will ultimately offer opportunities to attract and engage both existing and potential members in new and exciting ways across all levels (ie, national, state, and local) of the ADA.

“You can build local and national networks throughout organized dentistry and engage in conversations to foster mentorship, seek out new perspectives, and share innovative ideas. When dentists get involved as volunteer leaders in the tripartite, it strengthens the profession by contributing to the variety of voices in dentistry,” Dr Shepley says.

Dr Salierno says dental professionals will continue to see organized dentistry and group practices overlap further in their value propositions to dentists. “I predict and hope that they’ll improve how they collaborate and find synergies,” he says. “For example, Tend [has] worked cooperatively with local dental societies to encourage membership in the ADA and help affect positive legislative change in our communities.”

Looking ahead, Dr Blake also sees an opportunity to move forward and align interests for the sake of the profession and the patients. He sees natural links and potential cost-sharing to benefit both practices and providers.

The landscape for practicing dentistry is changing. At the end of the day, the most important thing is that patients have access to quality care, and to make that happen, providers need adequate support to practice in a way that suits their unique needs.

“There are multiple ways to practice dentistry, and supporting those in the form of additional services and expertise that demonstrate the value of associations regardless of practice modality is important,” Dr Blake says. “Ideally, open communication and collaboration becomes the foundation of the success for both DSOs and group practice environments and associations.

“Communication is key—whatever the practice environment is or whoever the practice owner is. We want to support newer dentists,” Dr Blake says. “We’re always looking for avenues to make that happen. Currently, most DSO-supported dentists are opting not to join the association. [Although] we are working hard on creating unique value, it is often a challenge for DSO-supported dentists, and particularly those just getting started in the profession, to justify the cost. In our current model, the DSOs don’t directly pay into the tripartite. With that in mind, we are opening conversations about how our current membership model may need to adapt to ensure that associations remain a thriving part of the profession well into the future.”

“This is an innovative time for the ADA,” Dr Shepley says. “As we work to fortify the profession’s future and organize dentistry for many years to come, we are proud to have had a presence at DSO conferences, including most recently the Dykema DSO Conference [Dykema’s Annual Definitive Conference for DSOs]. We plan to continue joining these meetings to collaborate and engage in the necessary dialogue to continue moving dentistry forward, especially as the percentage of dentists working for DSOs has increased from 8.8% in 2017 to 10.4% in 2021, according to data from the ADA Health Policy Institute—a percentage that is expected to grow.”

Pickard thinks predicting how these relationships might change is challenging, given the current climate and distributive environment dental professionals all operate in today.

“I’m very excited about how organized dentistry has embraced DSOs and the tens of thousands of dentists who have chosen to practice this way. Certainly, it makes good financial sense, given the growth of DSOs and the increasing number of dentists opting for affiliation, but it’s widely recognized that this hasn’t always been the case. In fact, there are still a handful of state dental components and local associations that are hesitant to accept the evolving landscape and acknowledge the great work supported dentists provide to their communities,” Pickard says.

“I’m also hearing that [the CDA] is considering offering its members the option to separate from the tripartite membership,” Pickard continues. “I’m concerned that this could potentially fracture our industry, weakening it from the inside—the reason for the fall of many great entities. This would reshape the relationship between dentists and their trade associations. It’s hard to predict its potential impact on the relationship between the associations and DSOs.

“But as DSOs continue to expand and gain prominence, their influence will naturally increase. With thousands of DSOs operating worldwide, supporting tens of thousands of clinicians and steadily growing, and the potential for organized dentistry to become fractured, there could be a day when the association[s] of DSOs could rival that of organized dentistry, leading to another equally strong voice within the industry. I think dentistry will remain a strong and vibrant industry regardless, as long as we continue to stay focused on helping clinicians be successful and prioritizing patient and community health,” Pickard says.

Dr Judge says throughout the past few years, DSOs have seen an alignment with organized dentistry on advocacy issues that affect both DSO-supported and private practice dentists. Aspen Dental and other DSOs have partnered with state dental societies to pass dental insurance reform and licensure portability legislation in multiple states. “In the future, we’ll see this trend continue and perhaps even expand beyond political advocacy into access issues. It’s exciting to think about what we can accomplish by working together in solidarity with the ADA and state dental leadership. We have seen more dental students seeking DSOs not [only] as an optional career pathway but [also] as a preferred pathway,” Dr Judge says.

Dr Quirt agrees that open communication between the 2 entities is critical for dentistry.

The data from associations at a macro level and the data gathered by DSOs could produce some essential insights that would benefit the dental industry. Moreover, working together could unify the industry’s voice more on crucial legislative matters, such as payer relationships and managing the growing demand for care from Medicare patients facilitated by supplemental dental coverage plans.

“We want the whole industry to do well. It’s all about how dentists can care for patients,” Dr Quirt says. “We all should be freely sharing. There’s so much dentistry out there, and it’s needed—not just wanted—even though that’s a big market segment. But we have to unify and come together on what’s best for doctors and the providers.”

Filipiak agrees that these conversations will advance the profession. For example, the ADHA and the ADSO met with industry educators about how to support them and their students at a recent ADHA panel discussion. Conversations between dental entities like these develop new ways to help dentistry in educational, practice, and professional growth environments and patient care.

“All those things ultimately lead to a better profession of dentistry, dental hygiene, dental assisting, and dental practice administrators,” Filipiak says. “We are not that different; we want the same thing. We have different resources, but collectively, we have many of the same objectives.”

“Dental associations like the ADA are different than Aspen Dental and other DSOs, but there is still room for overlap,” Dr Judge says. “The overall mission of each entity is to support dentists in their career journey and improve access to care and the lives of patients. We have more in common than differences, and together, we can ensure that future dental professionals are protected and their quality of life continues to enhance.”