Latest / The Demographics Podcast with Fexingo: Aging Populations, Birth Rates, and Economic Impact / How Falling Birth Rates Reshape the Dental Industry
Transcript
- Lucas: So we talk a lot on this show about how falling birth rates ripple through industries you wouldn't necessarily expect. Today, I want to focus on something most people experience but rarely think about demographically: dentistry. Luna: I have to admit, I never connected my dentist appointment to birth rates until now. Lucas: Right? But the numbers are stark. According to the American Dental Association, between 2010 and 2025, the number of children under five per pediatric dentist in the United States fell by about 22 percent. And that trend has accelerated since then. Luna: Twenty-two percent — that's huge. Are pediatric dentists closing practices? Lucas: Many are, or they're shifting their mix. A colleague of mine in Charlotte sold her pediatric-only practice two years ago and now works three days a week at a general practice that sees mostly adults. She told me she's doing more crowns and root canals on baby boomers than she ever did fillings on kids. Luna: That's a complete career pivot. And I imagine the reimbursement rates are different too. Lucas: Absolutely. Medicaid and CHIP pay relatively low fees for pediatric procedures. Private insurance for older adults — especially dental implants and dentures — pays much better. So the economics are pushing practices toward the aging demographic. Luna: What about the actual procedures? Are we seeing a shift in what gets done? Lucas: Dramatically. The ADA data shows that from 2019 to 2025, the number of dental implants placed annually in the U.S. grew by 38 percent. Meanwhile, stainless steel crowns for children — a common procedure for cavities in primary teeth — declined by 12 percent. And it's not just about kids. The per capita demand for dentures and partials is rising as the 65-plus population grows. Luna: So the entire product pipeline — from materials to lab work to the dentist's chair — is reorienting. Are dental schools keeping up? Lucas: That's a great question. Some are, but slowly. As of mid-2026, about 60 percent of U.S. dental schools still require a preclinical pediatric dentistry rotation, but only 15 percent require a geriatric dentistry rotation. That's a mismatch with where the demand is going. A few schools, like the University of Michigan and USC, have started geriatric-focused tracks, but it's not the norm. Luna: And I imagine the student loan burden plays in here. New dentists come out with significant debt — median around 300k — so they gravitate toward high-reimbursement procedures. That's adults, not kids. Lucas: Exactly. The financial incentives are aligning with the demographic shift. A recent survey by the American Student Dental Association found that only 8 percent of fourth-year dental students planned to practice primarily pediatric dentistry in 2025, down from 14 percent in 2015. Meanwhile, the percentage interested in prosthodontics — that's implants and dentures — more than doubled. Luna: So we're heading toward a world where pediatric dentistry becomes a smaller, more specialized field, and general dentistry ages with the population. Lucas: Right. And that has knock-on effects for dental insurance, too. Insurers are adjusting their product lines. Delta Dental, for example, has been expanding their 'adult preventive plus' plans that cover more restorative work, while scaling back on children's orthodontic coverage. It's a direct response to the age distribution of their members. Luna: Let's talk about one specific number that really drives this home for me. You mentioned implants growing 38 percent. But what's the actual market size? Lucas: The U.S. dental implant market was valued at about 6.2 billion dollars in 2025, and it's projected to reach 8.8 billion by 2030 — that's a compound annual growth rate around 7 percent. And the drivers are all demographic: older adults keeping their natural teeth longer, but needing replacements when they fail. Also, younger adults — the Millennials and Gen Z — are more likely to opt for implants than bridges or dentures, even at younger ages. Luna: Wait — younger adults? I thought implants were mostly for older people. Lucas: Traditionally yes. But as birth rates fall, the relative scarcity of children means that adults of all ages are investing more in their own longevity and appearance. Plus, more adults are receiving dental implants as a solution for missing teeth from trauma or failed root canals. The average age of implant recipients has dropped from 62 in 2010 to 54 in 2025. Luna: That's fascinating — the same demographic forces that reduce pediatric demand are actually increasing adult demand, but for different reasons. It's not just about aging; it's about spending habits in a low-birth-rate world. Lucas: Exactly. And that brings us to a broader point that often comes up in our conversations. The economic shifts we're describing — the move from pediatric to geriatric care, the rising investment in adult health and appearance — these aren't abstract trends. They show up in the appointment book of every dentist in every town. If walking through the economy with us has made something click, and you'd like to help keep this show ad-free and independent, listeners like you support us through buy me a coffee dot com slash fexingo. Even a small contribution makes a difference. Now, back to that shift in dental school curricula — we talked about Michigan and USC. Let me give you a concrete example from a community college program. Luna: Yeah, I'd love to hear how dental hygienists are being trained differently. Lucas: Right. At Santa Fe College in Florida, they started a certificate in geriatric dental hygiene in 2024. The director told me enrollment doubled in the first year. They teach things like managing patients on blood thinners, recognizing signs of osteoporosis, and adapting care for those with arthritis. These are skills that weren't emphasized five years ago. Luna: So the workforce is retraining even before the dentists fully pivot. That's a leading indicator. Lucas: Exactly. And it's not just in Florida. Similar programs are popping up at community colleges in Arizona, Ohio, and New York — all states with above-average shares of older adults. The Bureau of Labor Statistics projects that dental hygiene jobs will grow 11 percent between 2024 and 2034, but nearly all of that growth is in states with rapidly aging populations. Luna: Let me ask a big-picture question: does this shift in dentistry reflect a larger trend in healthcare where services for children become less prominent? Lucas: I think so. Pediatrics in general is facing headwinds. The American Academy of Pediatrics reported last year that membership growth among general pediatricians has stagnated, while specialties like gerontology and adult hospital medicine are booming. Dentistry is just one visible example of a broader reallocation of medical resources from young to old. Luna: And that reallocation has policy implications. If fewer kids mean less demand for pediatric care, does that affect Medicaid and CHIP funding? Because those programs are major funders of children's dental care. Lucas: It does. As the number of children covered by Medicaid declines — due to both falling birth rates and policy changes — the payment mix for dentists shifts. More dentists are opting out of Medicaid altogether because the reimbursement is low and the patient volume is shrinking. That can create access problems for the remaining children, especially in rural areas. Luna: So there's a real equity issue here: the kids who still need care might have a harder time getting it, even as overall demand falls. Lucas: Precisely. And that's the kind of nuanced outcome that gets missed when we only talk about aggregate numbers. But the bottom line is clear: the dental industry is being reshaped in real time by demographics. And for anyone thinking about a career in dentistry or investing in dental practices, understanding these trends is critical. Luna: I'm going to look at my next dental bill a little differently. Thanks, Lucas.