Over the last 100 years, Dentistry has been provided by the dental team, either in private practice, dental hospitals, schools, institutions such as prisons, or the armed forces.
In the UK, the traditional practice for primary care was often the house or a converted residential property owned by the Dentist. This landscape has been changing over the past 25 to 30 years. UK Dentistry was made free at the point of delivery in 1948 by the NHS, but that quickly changed in 1951 with dental charges being introduced. By 1955 only dentists were allowed to own dental practices unless they owned one of the 27 Dental Body Corporate licences that allowed companies to own practices. In 2006 the limit was removed, and anyone could set up a practice. (Still though with certain conditions).
In the UK, this has seen the rise of ‘Corporate Dentistry’. Corporate Dentistry is a term applied to dental organisations that are incorporated, e.g. part of a limited company. It normally applies to multi-site, multi-clinician practices and an arbitrary figure of 3 or more locations is often applied.
Some of these have many 100s, though, where companies own more than one practice – in fact, ‘My Dentist’ owns over 650, Portman Healthcare and Dentex, who have recently merged to form the largest ‘Privately’ focused group of dental practices in the UK and Ireland with over 350.
BUPA owned over 500 sites, mainly through inorganic growth, such as the acquisition of Oasis Dentalcare, which itself had acquired a variety of different groups over the last ten years.
Recently BUPA announced they were selling, closing or merging 85 of their practices[i]. A move seen by some as a possible end to the recent growth of corporate dentistry, but others, including myself, see this as a sensible review of the business, taking tough decisions where some practices acquired over the years in larger deals show little or no possibility of profitability and are just seen as a bad cost. Many of them had NHS contracts which were handed back to NHS England, but that is an article in itself.
Corporate Dentistry was not a new thing – in Canada, in 1980, an entrepreneurial Dentist called Howard Rocket opened a dental practice in a department store. This was the start of Tridont, which ended up with almost 100 practices throughout Canada. It, unfortunately, failed, though, as Howard explained to me in 1998 when I met him in Toronto; this was mainly due to diversifying into other services they knew very little about. In 1998 though, all locations were still trading but under different ownership. Coming right up to date, Dentalcorp in Canada has won awards for being one of Canada’s best-run companies and now boasts over 500 sites and, last year, over 5 million patient visits.[ii]
In the US, there was the first-ever Walmart Health Center. The new 10,000-square-foot health centre is located in Dallas, Georgia. Walmart Health is the first to put primary and urgent care, labs, x-ray and diagnostics, counselling, dental, optical and hearing services all in one facility, partnering with expert providers to deliver these services.
Heartland Dental Group, also in the US, offers non-clinical support with over 2,400 dentists; these are one of many Dental Support Organizations (or DSOs) – other such companies are Pacific Dental, Midwest Dental, and Aspen, which offer geographic support or similar marketing strategies. This appears to be the favoured model.
Australia’s first-ever corporate group was established in 2001; by 2012, there were five groups, and by 2014 10% of practices had joined such groups[iii].
Multi-national companies also exist, e.g. Colosseum Dental has over 80 locations in the UK but well over 200 when you include Switzerland, Scandinavia, Germany, and Italy. It is owned by the Jacobs Foundation, part of one of the wealthiest families in Germany. They also recently bought a majority share in Vitaldent, a Spanish Dental Corporate. Portman Dental also has sites outside the UK. So too, does BUPA, which has been offering Dentistry in Spain for many years.
Corporate Dentistry had gone from offering less than 1% of UK Dentistry in 1995 with just 27 corporates (and many at that stage just individual practices) to over 205 corporate groups by 2018[iv].
In 2022 a Global market estimated value of dental services was USD433.2 billion[v], despite COVID-19 causing restrictions in many countries in 2020 and, for a short while, the closure of dental practices. The interest from Private Equity and Venture Capitalists continues, and the consolidation of practices that is more established in the US and now the UK and Europe, I believe, will continue to grow in other areas as well. The trust that lay initially with an individual clinician is now being replaced with the trust of a well-organised brand (although some dispute this will ever replace that fully). As digital dentistry becomes more the norm, the economies of scale that corporate dentistry offers are even more important for growth.
In this short article, I have not differentiated between payment methods for patients, but these include government-backed, fee-per-item private, dental plans, insurance or a hybrid of several. We could also consider payment methods to the service providers, which most commonly are based on a percentage of fees, but salaried services also exist.
The increasing demand for more services that are based on a ‘want’ (e.g. straighter smiles, whiter teeth, fixed/implanted replacement teeth) rather than a healthcare ‘need’ (no cavities, no pain, no gaps) will see the Global market grow at 4.5% CAGR[vi] over the next 7 or 8 years – with some countries at 8%.
Corporate Dentistry, whilst still very much a profession, is now an established business, with all the challenges that will continue to bring, including, but certainly not limited to, recruitment of all team members and funding.
Chris Potts is a UK-based Dental Surgeon who is a former practice owner who has been involved with Corporate Dentistry for almost 30 years. He has lectured both in the UK and abroad and is the Dental Expert for Greybeard Healthcare.
References
[i] BUPA Website – https://www.bupa.co.uk/dental/dental-care/news/dental-changes-news
[ii] Dentalcorp – https://www.dentalcorp.ca/site/home
[iii] O’Selmo, E. Dental corporates abroad and the UK dental market. Br Dent J 225, 448–452 (2018).
[iv] Laing and Buisson 2018
[v] Grand View Research – Dental Services Market Size, Share & Trends Analysis Report 2023-2030
[vi] Grand View Research – Dental Services Market Size, Share & Trends Analysis Report 2023-2030
