The Need For Dentistry’s Secondary Profit Center

By Robert A. Tripke, DMD

Restorative dentistry has always been the “straw” that stirs dentistry’s “drink” so to speak. For decades, restorative dentistry was driving the economic engine of our profession. However, in the early 70’s, this cycle of economic events began to change, even if ever so slowly. In 1971, the number of decayed, missing, or filled permanent teeth in children ages 5-17 years was 7.1. By the year 2004, that same number had plummeted to 2.1. This represents an approximately 70% drop in restorative needs, and by 2004, the “children” of 1971 are now 38-50 years of age! At this point, these middle-aged adults are NOT in need of restorative dentistry but are swamped in unresolved rampant periodontal issues. These changes coincide with preventive modalities (fluoride, sealants) and education. The intriguing unintended consequences resulted in the dramatic reduction in restorative needs in our profession.

The obvious question for dentistry is “how do we compensate for the loss of restorative”? The answer came for me in 1987 when receiving a flyer in the mail, I realized I had been either not providing or had been giving away services to patients for years. These services were not only necessary for the well-being of the patient but became the financial life blood of my practice for 30 years. As time passed, and knowledge had increased, I not only became aware that I was not only compromising the health of my patient (reference my article: Periodontal Disease the Monster Problem in The Profitable Dentist magazine winter 2018-2019 issue), but was literally “throwing away” hundreds of thousands of dollars of dentistry each year. This was the most eye-opening experience of my dental career!

The average national daily hygiene production is approximately $1103. Eighty percent of periodontal therapy is represented by Case Type II patients (pocket depths ranging 3-5mm). The average fee for these Case Types is approximately $1350. Translated, this means a single Case Type II patient per day will more than double that day’s hygiene production.

Unfortunately, most general dental practices bill about 80-90% prophy codes, and prophylactic procedures outnumber periodontal procedures 20:1. Why is this happening? Primarily because our hygiene appointments are designed for prevention NOT therapy! A disease cannot be treated in a onetime 45-60-minute hygiene visit.

Seventy-five to ninety percent of the adult population have periodontal disease (in one form or another). In addition, in an aging population (which we have), patients fifty-five and older show a ninety percent incidence of moderate to severe periodontal disease. The disease is uncontrolled, unrestrained, and unchecked by dental professionals! No reimbursed procedures in dentistry represent 75-90% of our population, except that of treating periodontal disease. Therefore, this represents a tremendous amount of negligence on our part as a profession, and an astronomical amount of lost revenue each HOUR in a dental hygiene chair.

The simple way to access whether your periodontal percentage in hygiene is adequate or not is the following: print a list of all the 4341, 4342, 4910 and 1110 codes, and add those to get a numerical value, we will call “A”. Next print a list of all 4341, 4342, and 4910 codes and call this total value “B”. Now, simply divide “B/A” which will give you your periodontal percentage. Ideally this number should be 60% or above. If it falls between 40-60%, your percentage is adequate but has much room for improvement. If below 40% (representing more than 90% of dental practices), then your periodontal program is on life support! Typical results from my involvement as a consultant, show practices range from about 1.5%-25% in terms of their periodontal percentage. At this point I’m sure you can only imagine the lost quality services and revenue for these dental practices.

In conclusion I would state that the gratification received from treating/controlling this disease surpasses any other procedure in a dental practice, and is solely responsible (in a positive way) for altering the retirement plans and expectations for all dentists.

Robert A. Tripke, DMD


Robert A. Tripke, DMD, author of Behind the Dental Chair, How Smart Dentists Crack the Code and Build a Dream Practice, implemented an organized approach to non-surgical periodontal therapy in his Chenoa, Illinois practice in 1987. Due to the marked elevation in standard of care for his patients as well as a huge positive financial impact on his practice, shortly thereafter he began educating general dentists in these methods and protocols. For nearly 30 years Dr. Tripke has provided structured periodontal therapy training with the newest, most effective techniques available. His program is recognized in the industry as the pinnacle of soft-tissue management.

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