In his most recent article, Dr. Miguel Stanley highlights a scenario that many dentists across the globe find themselves struggling with: wanting to deliver world-class care and managing real-world economic challenges. More important than acknowledging the problem is ensuring that the industry evolves, because dentistry deserves a system built on trust, quality, and accountability. And because patients deserve better. 

Introduction

Dentistry today sits at a crossroads between technological evolution and economic reality. While incredible advancements like 3D imaging (CBCT), 3D printed surgical guides, laser-assisted surgeries, digital workflows, and new biocompatible materials have redefined the standard of care, many patients still unknowingly receive outdated treatments – often under the impression they are getting the best available care. According to who?

This is not just a technical issue – it’s an ethical one.

Is it acceptable for dentists to promise “their best” while relying on outdated techniques, technologies, and materials because of financial pressures? In an ideal world, dentists would all have the best technology, up-to-date training, all the time to do the right thing, interdisciplinary team approach, and state-of-the-art materials. Unfortunately, a large majority of clinics around the world cannot afford this. But is “doing your best” or “trying your best”, actually the best?

And more importantly, do patients even realize the difference, and do insurance companies reward better care or even know the distinction?

The Hidden Truth About Dentistry’s Economic Pressures

Delivering high-quality, modern dentistry is expensive.

Consider just a few examples:

• A state-of-the-art CBCT machine costs between €50,000 and €150,000.
• Advanced laser technology for surgical disinfection can cost upwards of €60,000.
• Proper training to master these technologies and techniques can cost tens of thousands of euros across a dentist’s career.
• Investing time – rather than rushing patients through – cuts daily patient volume by 50-70%.

Meanwhile, the average global dental clinic profit margin hovers around 5-10% – significantly lower than many other professional service industries.

In short: the financial system is not naturally designed to reward slow, careful, high-tech dentistry.

But the patient’s expectations haven’t changed.

They expect – and deserve – the best available care.

Slow Dentistry and the Call for Higher Standards

In response to these systemic issues, I created the Slow Dentistry Global Network: a movement encouraging dentists to slow down, dedicate more time to diagnosis and treatment, and prioritize patient safety and quality over quantity.

Yet, even within this philosophy, the larger economic structures often push clinics toward older workflows and outdated techniques, technologies, and materials simply to survive.

This leads to an uncomfortable reality:

• Dentists are taught the highest standards at university.
• Many attend postgraduate courses to stay updated.
• Yet, once in practice, they may be forced by business pressures to revert to cheaper, less precise ways. This always comes at the expense of the patient.

This creates an ethical grey zone that few speak about – but many feel internally.

I’ve been promoting Slow Dentistry concepts for over 10 years now in my lectures around the world, and it’s surprising how so many colleagues come to me afterwards in private saying they would love to be able to have more time but their boss simply doesn’t afford them that possibility. It’s heartbreaking because if you think about it, dental insurances see absolutely no difference between the quality of one treatment over the other, and do not control this. So, in reality, the worst, and the best treatment will get rewarded the same. This is one reason why I have never worked with insurance companies in over 25 years. I clearly understand their value. I personally have one for my medical issues, but in dentistry, it has a lot to evolve, especially on this topic.

Healthcare vs Dentistry: A Broken Comparison

Imagine this scenario:

If you have a suspicious lesion in your brain, your general practitioner doesn’t diagnose and treat it alone – they refer you to a neurologist and, if necessary, a neurosurgeon with the latest MRI technology.

If you have aggressive cancer, you are not treated by a general doctor, but by an oncologist using precision diagnostics and multidisciplinary teams.

In medicine, serious cases are escalated to specialists equipped with cutting-edge technology.

Why doesn’t this model apply clearly in dentistry?

Dental infections, failing root canals, jawbone pathologies, and catastrophic failure of old treatments are not minor problems.

They can cause systemic inflammation, chronic diseases, cardiovascular complications, and even impact the brain.

The stakes are higher than most patients realize.

They warrant advanced diagnostic capacities, interdisciplinary team approach and experienced clinicians backed by awesome technology. But how to find the right team?

The 2-Star vs 5-Star Analogy

If you book a 2-star motel, you accept simpler accommodations – because it’s clear and transparent. They play an important role for lower income travelers.

The problem arises when a service sells a 5-star promise but delivers 2-star quality – without the patient even knowing.

In dentistry, without obvious outward signs, a patient cannot distinguish between:

• A rushed diagnosis using outdated 2D X-rays vs a comprehensive CBCT evaluation and team approach.
• A traditional root canal with manual non-sterile instruments and no dental dam used vs one disinfected with lasers and sealed with biocompatible biomaterials and all safety measures in place.
• A low-cost crown vs a digitally designed, high-precision, fully biocompatible ceramic crown cemented with gold standard protocols (takes a lot of time).

The differences are invisible – until problems emerge, often years later.

By that time, the patient’s trust, time, health, and finances may have been severely compromised.

The Problem of Transparency in the Digital Age

In today’s digital environment, another concerning issue has emerged: 

There is very little regulation over what dental clinics can state on their websites.

Stock images, marketing-driven language, and unverified claims create a digital landscape where any clinic – regardless of its technology, materials, or protocols – can market itself as “state-of-the-art”.

Patients, often unaware of the clinical nuances, rely heavily on these online impressions.

But the quality of a website is not the quality of care.

Unfortunately, insurance companies reinforce this problem.

For many insurers, the key metric is volume of sales and procedural codes billed, not quality of diagnosis, precision of treatment, or long-term patient outcomes.

There is currently no standardized oversight system that evaluates:

• The quality of diagnostic tools used.
• The technologies and materials selected.
• The biological safety of procedures.
• The health outcomes and complication rates over time.

This absence of outcome-driven quality control is deeply problematic – especially in an era where technology easily allows for detailed tracking, auditing, and reporting.

The Challenge of Competitiveness and Reluctance to Refer

Another important challenge must also be addressed:

In many countries, due to high market competitiveness, dental clinics tend to avoid referring patients to specialists, even when advanced diagnostics, surgery, or interdisciplinary care would clearly benefit the patient. But commissions are lost and this is a sad reality that affects millions. Obviously, there are still many great dentists that have strong moral codes that prefer to do the right thing. My greatest respect to those.

Unlike in general medicine – where serious cases are escalated up the ladder of specialization – in dentistry, the fear of “losing the business” often overrides optimal patient care.

This reluctance to refer is a disservice to the patient, undermines trust, and perpetuates a fragmented, incomplete approach to health.

Vision, Trust, and Quality Materials

I have always said that vision in dentistry is about seeing not just what is, but what could be better.

Trust in dentistry is built when patients feel secure that their health is prioritized, not just their payment.

And quality materials are not a luxury – they are an obligation.

Every material placed into the human body has a biological impact.

Poorly manufactured materials amongst other things carry risks – sometimes silent, but eventually profound.

We cannot allow price pressures to lower the biological safety and longevity of our treatments.

The Future of Transparency and Accountability in Dentistry

Here’s what must happen:

• Mandatory public differentiation between clinics based on technologies, materials, protocols, and clinical standards and not just pricing.
• Transparent communication during consultations about diagnostic methods and material choices.
• Certification programs recognizing clinics that consistently invest in best practices.
• Patient education campaigns about the risks of outdated techniques and materials.
• Insurance reform to measure not only procedure volume, but actual clinical outcomes and biological safety.
• Ethical oversight bodies capable of verifying claims made in marketing and holding clinics accountable.
• Cultural encouragement for appropriate referrals to specialists, putting patient health ahead of commercial competition.

Patients deserve to make informed choices.

And dentists deserve a system that rewards quality, ethics, and technological excellence – not just volume.

Final Thoughts: A Call for Evolution, Not Blame

It’s easy to criticize dentists operating under difficult circumstances.

But we must recognize that many are caught between wanting to deliver world-class care and managing real-world economic challenges.

However, acknowledging the problem is not enough.

The industry must evolve.

It’s time to:

• Speak openly about the gap between technological possibilities and real-world practice.
• Push for transparency, certification, and outcome-based standards.
• Encourage insurers to value health outcomes, not just the procedure itself. Quality matters!
• Educate patients about what modern, safe dentistry looks like – and why it matters.

Because the truth is simple: Patients deserve better. And dentistry deserves a system built on trust, quality, and accountability.

*Written by Dr. Miguel Stanley.