The economy has driven a financial cavity into the dental offices across America. According to The Modesto Bee, fewer Californians are looking to spend money on dental care. More dental practices are using dental specialist contractors to eliminate the need to refer patients to other offices. Dentists are also extending their workdays to cater to working adults, who don’t want to take a day off work to visit the doctor. The clinical hours are now usually between 7 a.m. and 7 p.m. during the week.

“One of our biggest challenges: People truly don’t want to go to the dentist. So we’re in competition for their discretionary dollar,” said Herman, 52, head of A+ Personalized Dental Care. “I have patients come in and say – ‘Oh that (treatment) is so expensive,’ but they’ve just spent $200 on the slot machines in Reno. It’s a reality we all live with.”

According to the American Dental Association (ADA), the outlook for per-patient expenditures is showing bleak numbers for working adults and children. It is expected to be between 0.22 percent and 1.25 percent for the annual per-patient spending over the next ten years. Between 1996 and 2002, it was around 3.9 percent.

California dentists are being pushed to lower their costs by insurers, employers and the government (the Affordable Care Act). Because of the struggle, some dentists use unethical practices to increase revenue, such as through recommendation of high-cost procedures and equipment. The 25,000 dentists who are a part of the CDA (California Dental Association), that requires adherence to ethical practices, are also being forced to accept eight to 12 percent lower rates because of the binding arbitration with Delta Dental. Internet-savvy Californians are finding dental quotes online, which further compels the dentists to create an online presence to compete.

“You give the patient a chance to say ‘Yes’ to the best dentistry possible,” said JoAnne Tanner, a Northern California dental management consultant based in Granite Bay. “It’s all about patient satisfaction. If they’re happy, they’ll refer you (to friends) and the money will follow.”