Introduction

As we all know, dentistry or dental practice has a long history and has undergone many changes since its inception. To be precise, the dental practice has evolved in phases which can be explained by the acronym 3Cs. Initially, the dental practice was confined to colleges (the first 'C') i.e. academic institutions. Colleges lay down the foundation stone for dental practice enriching students with the basic knowledge and practical skills of this science and are quite relevant and indispensable today. Later, to cater to the dental and oral health needs of a wide range of populations, another C emerged i.e. Clinics. Dentists started setting up private clinics; thus, the dental practice expanded and got wider reach.

In recent years, due to growing awareness, dental treatment is being seen as a service and hence specialty treatment became the need of the hour. So private dental practitioners developed the culture of calling consultants to their practice and thus the 3rd c i.e. Consultations got incorporated. Thus, the 3 C's of dental practice, College, Clinics, and Consultations flourished with time.

However, looking at the growing demand for dental services, few corporates got enticed towards the charm of dentistry, and thus another 'C' i.e. Corporate dentistry has emerged.1

Corporate dentistry is defined as a practice modality in which management services, at a minimum, are provided in a manner that is organizationally distinct from the scope of activities performed by a dentist within only his or her practice.2 Corporate dentistry is not of recent origin, it dates back to the 1950s when the British Dental Association pioneered the concept of corporate dentistry. Corporate dentistry introduced commercial interests into the profession and the treatment did not remain patient-centric so the British dental association (BDA) mitigated these effects in the 1950s by increasing strictness and restricting these corporate practices. But with changing times and changes in reforms, these restrictions were lifted in 2006, by BDA, to increase competition and open up the market to new providers. 3 Talking about the Indian scenario, in 2002 Apollo White emerged as one of the first dental cooperate chains with a humble setup but with advancement not only in technology but also in our living lifestyles.

Since then, corporate dentistry has evolved by leaps and bounds. In today's scenario, India has many successfully running corporate dental chains to list a few, Narayana Health Care, Axis Dental, Total Dental, and Star Dental which is now commonly known by the name Clove Dental. Some of the other famous corporate dental chains are Dentistico, Dentz, My family Dentist, and Orthosquare. 4

There are differences between Corporate Dentistry and Private dental practice.4 (Table 1, Table 2)

Discussion

Though the essence of corporate dentistry and private dental practice remains the same, which is, providing the best dental care to the patients. But the basic idea behind corporates entering into dental practice is to make it more high-tech, accessible, and convenient with strict hygiene measures which are feasible with huge investments and funds put into. 7

So, it is more market-driven, having a business model which needs to be understood to get knowledge about its functioning. It includes Business strategies, standard operating procedures, costs, earnings, and other financial information. Failing to plan, is planning to fail. While preparing a business plan the first and foremost thing the owner looks for is - a partner if the owner wants to or not to, secondly procuring the finances is a crucial step, then comes choosing the best location, obtaining the appropriate equipment, hiring the staff and last but not the least marketing the setup. 8

Teaming up can help offset the costs of opening a dental setup. Finances are obtained either from self-investment or taking loans from banks. Selecting the locale also plays a major role. The owner needs to consider that area where people have good spending power. For example, if focusing on cosmetic dental treatments, then an area should be selected where residents have money to spend on these elective services. If it's a paediatric dental office, then the location should be selected near expanding communities, and providing ample space for parking are the two things that need to be looked for while selecting a location.9 The third and the most imp thing is the investment, when a corporate office is a setup it initially needs an amount of 30-50lakhs, which is comparatively less for a private practitioner, out of which 80 to 85% is utilized in equipment, instruments, machinery as they try to incorporate all those things which are advanced and high-tech despite how much costly it gets having all the high tech equipment's, software's, scanners, in house laboratories which require a huge investment if these have to set up in a private dental setup. Detecting caries is made easier with diagnodent using high technologies. The setup layout of corporates being having multiple rooms dedicated to consultations, clinical work, sterilization, waiting rooms, an X-ray room, a big reception area, and own magnificent laboratory setups. Finding employees for a dental practice isn't always the easiest task, One needs to hire a receptionist, dental assistant, and a billing specialist which holds the same for a private practice but in a corporate office they have a zonal head for each zone which has a manager, HR, materials and stock team, advertising team, faults, and complaint lodging team to manage the setup. A dental corporation is owned and operated at a corporate level and controlled by a board of shareholders. 10 Salaries come directly from the head office with the director determining the average salary for each position. To open up a corporate practice registration with the state dental council has to be done and one has to obtain a license from a state-level professional medical establishment authority. These corporates also have to take AERB clearance-atomic energy research board, radiation safety tags, biomedical waste management from the pollution control board, and have to register the dental setup with pan card for TDS, service tax, and GST. 11 Marketing the setup has now become the need of the hour, every business needs a website. Having a Facebook business page and a dental practice social media is simply not enough. These corporates have a specific team for doing digital marketing and designing websites. 12 Marketing on road, with help of signage and billboards and by the method of pay-per-click (PPC) has made the work easier and more effective.

Once the planning is completed, then comes the execution. In execution, one needs to look for, recruitment, services, social responsibilities, mobile dental setups, policies, and targets. Recruitments start by filling in the dentist's details on the portal & uploading the CV, followed by the profile check and interview and Forwarding to the director of the state corporate office coming back to HR and the Selection and branch allotment process begins, having specialist spread globally, whose expertise, experience, and the location is displayed on the website, giving the patient full freedom to choose his or her doctor. 13

Specialists are allocated for even a simple restoration or tooth extraction. Providing and accepting insurance, and third-party finances to the patients, 14 so that the patients can fix their treatment in their monthly budget. Providing medical facilities under the central govt. health schemes, Ex-servicemen contributory health schemes for reimbursements. Dental tourism is also emerging as a new concept in which along with providing high-quality dental treatment, traveling, and accommodations are also provided by these corporates. Socially maintaining their responsibility by organizing theme walks, free dental camps, street plays, and dental awareness programs. The new concept that has come up is the mobile dental clinic, a moving dental office, with small examination rooms but with all the equipment necessary for basic dental service, including x-ray equipment, sterilization facilities, and computers to schedule appointments and process insurance claims. 15 Stricting to the policies is what makes the corporates stand firm, with the Mission being, providing quality dental care to patients on a timely and efficient basis, preventing discrimination and harassment within the employees, occupational safety and health administration providing valuable reminders of "existing mandated safety and health standards, health insurance portability and accountability act determining how & under what circumstances practices can handle predeterminations, Authorization requests, claims, Paychecks & benefits and when and how often to expect compensation for work. Targets are financial or patient and practitioner related. The patient-related targets include improved communication, consistent performance, and motivation. Whereas the practice-related targets include improved effectiveness, performance, teamwork, and communication. As a dentist, it becomes important to value everyone, gain satisfaction, experience, learn and recognize the peer. The other targets the corporate aims for are, providing a comfortable and efficient place to the patients keeping them loyal, and stay longer. Having at least 40% of patients referred from friends or relatives- word-of-mouth advertising is the most effective and least expensive form of marketing. Growing production by 15% within 12 months, by consistently hitting the daily targets. Improving efficiency helps alleviate long waits for the patients and keeps new patients flowing in the door.16

The third and last step is the maintenance of what has been planned and executed. So under maintenance, the aspects looked for are, promotions, patient management software, new offers and schemes or rewards, customer satisfaction and feedback, membership plans, audit, and sterilization.17 Promotions are done through social networking platforms. In case of dental emergencies, doctors are just a click away, proving customer support just a call away, asking a series of questions to the patients and directing them to the most appropriate place to receive care. Giving instant call-back options, 24x7 customer support, and long-term warranties in a hassle-free manner.12 Patient management software aid in appointment scheduling, Billing, Clinical documentation, maintaining Patient records, helping with Security and compliance, and scheduling the staff. Increasing efficiency and streamlining everything from administrative tasks to patient follow-up, so a dentist can focus on delivering quality care, leaving all such responsibilities to the concerned team behind. Corporates maintain and encourage their employees through promotions, rewards, and incentives based on the reviews of the patients, cases they have handled, and income generated to motivate them to do better and to maintain the quality of work. Taking customer satisfaction very seriously by recording the reviews and by series of questions after each appointment, having the name and unique id of the doctor who treated mentioned, also provided with a feedback form to fill. Various membership plans for women, and students, annual dental health plans, and platinum packages for the whole family are also given at discounted rates. 12

Another phase of maintenance is Audits. Every two months a meeting is held with the C.E.O. and Director, to provide investors and stakeholders with confidence that a company's financial reports are accurate and to provide assurance that a company is adhering to the appropriate legal and regulatory standards. Some of these corporate maintain the highest standards of sterilization Providing a 10x sterilization including, Sample testing by an accredited external pathology lab and maintaining 'free from infection' certificates in each clinic.4-step sterilization for instruments and air rotors, special high technology equipment installed in the clinics to reduce the aerosols generated during the treatment. This technology uses high suction strength, coupled with special filters like the high fiber cotton filter, fiberglass filter, HEPA (h13) filter, and activated carbon filters to clean the air and reduce the risk of infection. UV light disinfection for even napkins, masks, tubing, telephones, etc. Modified pre and during-treatment protocols including hand sanitization, sharing travel &medical history, infrared thermal scanning, oxygen level monitoring, and iodine mouth rinse are still taken very seriously, which might get missed sometimes in private practice. Best in class & global standard PPEs for all dentists and dental assistants. Disposal of biomedical waste as per WHO guidelines only. They have an in-house secured central electronic medical system that records the entire journey of the patient starting from their first visit. Bimonthly audits to maintain and check sterilization and safety and fumigate the clinics multiple times a day, for the elimination of viruses, fungi, and bacteria. 12

There is nothing in the world that is perfect, same goes for corporate dental practices which have their pros but have many cons too attached to them. So under pros, Having a large team associated, the team members are slightly less stressed and can take time for other priorities too, and still able to provide patient care. Excellent infection control system, Easy relocation, Mandatory latest technologies, Patient has freedom, high-quality care by a specialist only, Benefit of a recognized brand, Price war lower price will mean cheaper materials and instruments, but it does not hold for corporate dentistry even if the price is low there is no compromise on the quality of the materials. 13

The biggest cons of corporate practice are, to achieve the targets the doctors sometimes do unethical practices, e.g., if a patient can be cured with just a restoration, patients are convinced to get a root canal done just to achieve the targets. Non-dentists can be providing the dentist with criticism and feedback decreasing the morale and motivation of the dentists. Tighter schedules, lead to overscheduled workdays with a high volume of patients. Time to spend with each patient to consider treatments or recommendations may be reduced. Narrower practice accounts for less flexibility to take on different procedures based on company treatment policies. Doctors working are replaceable, i.e. they get changed or rotated after every 4-5 years which is again a disadvantage for a patient visiting the same doctor for years. Doctors have to fill a bond as a shred of evidence so that if they leave before completing a particular period, a certain amount of fine can be imposed on them. These corporates are set up from a business point of view, not from the patient point of view, with no practice equity.

Retention of patients rather than merely adding new ones should be a priority in any practice. The aim should therefore be to create a welcoming environment for patients, while providing an excellent patient experience.

Conclusion

Trust in the dental profession is based on ethical conduct and feedback from the interaction between the dentist and society. The trust of the patients and society in the capabilities of a dentist has granted this occupation, the status of the profession. Following standardization, the paradigm may shift from generating profits to providing more quality dental care.

Source of Funding

None.

Conflict of Interest

None.