Dr. Steven Bloom is seeing it in his St. Petersburg dental practice. So are Drs. Craig Oldham in Brandon and Rodney Holcombe in New Tampa.
Patients are coming back to the dentist, after years of staying away because they felt they couldn't afford to take care of their teeth.
Having weathered several recessionary years in which they had to cut staff and office hours, dentists welcome the traffic. But they say it would be a mistake to take this trend as an encouraging economic indicator. Fact is, many patients are coming back not because they can afford it, but because after years of inattention their teeth just hurt too much to stay away.
Result: Dentists are doing more complex work, and it's costing patients more. National data show that dentists' profit margins are ticking upward slightly after years of decline, partly due to the need for complex care.
People who once would have needed only checkups and cleanings now are requiring tooth extractions and root canals. But dentists say they'd rather be doing routine exams.
"It is a little more alarming, the decay problems we're seeing," said Holcombe, a dentist of 25 years. "We're spending a lot more time educating our patients on the benefits of prevention."
Dentists are also spending more time helping patients find a way to pay for treatments. More patients are coming in without insurance. More are being put on payment plans. More simply aren't paying their bills.
And others are still staying away, fearful of incurring bills they know they can't pay.
"I need about $5,000 in dental work, but it might as well be $5 million," said Rus Cooper-Dowda of St. Petersburg. "It's pointless."
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As the economy began to crumble in 2007, people lost their jobs and their homes. They cut back on vacations, shopping and dining out.
And many stopped going to the dentist.
In 2008, more than a third of Americans skipped dental care or checkups because of costs, according to a Kaiser Health Tracking Poll. And dental office net profit margins declined to 13 percent, down from 17 percent five years before, according to Sageworks, which analyzes the finances of private companies.
"The economy certainly affected most dental practices, as it has other businesses," said Bloom, a former president of the Pinellas County Dental Association, who runs a practice in St. Petersburg with his wife, Dr. Charlene Wygodski. "People may be going longer between oil changes, and they're stretching out time between teeth cleanings."
But in the past year, patients have started to return, some realizing what dentists have long preached: You can pay a little now, or pay a lot later.
"Problems don't fix themselves. The problem only gets bigger," said Oldham, who is doing more extractions and root canals.
The economy isn't the only problem dentists see when they look in our mouths.
Holcombe says the growing popularity of sweetened sports beverages and energy drinks, as well as sugary specialty coffees, has led to an increase in cavities in young people. He's also seeing greater instances of dry-mouth conditions in older patients due to the many medications they take, and that affects oral health.
So while skipping a dental exam and regular cleaning may save you about $160, it also may help set you up for an $800 deep cleaning later, Oldham said. If decay has advanced past the stage where a filling can save the tooth, a root canal can cost about $900, a crown as much as $1,200.
The more expensive treatments are likely one reason that dental office profits have begun to rise again. From the low of 13 percent in 2008, profits rose to 14 percent in 2009 and 15 percent last year, according to Sageworks.
"After recessions, dental professions tend to do well," said Bassim Michael, a Fresno, Calif., accountant whose firm provides financial consulting to nearly 50 dental offices across the United States, including some in Florida. "Because the dental work needs to be done at some point."
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Despite some signs of a rebound, many patients continue to stay away. A call for St. Petersburg Times readers who have skipped dental care for financial reasons drew more than 80 calls and e-mails in a week.
Among them was Dave Springer of St. Petersburg, who hasn't been to the dentist in a couple of years. The 60-year-old, who is retired due to a disability, has dental insurance that covers him and his wife, Dickie, yet he can't afford the out-of-pocket costs.
He said his wife went to the dentist last year with a toothache and had to pay $150 out of pocket to have it extracted.
"That's the last time she's been to the dentist," Springer said. "No matter what insurance does, they always want a whole lot more out-of-pocket."
For Cooper-Dowda, 56, skipping regular dental care carries greater risks because she has lupus, an autoimmune disorder. "Any infection in the mouth can be dangerous," she said.
The former teacher and minister can no longer work due to her condition. She has Medicaid, the government health-insurance plan for the poor, but it doesn't cover dental exams or cleanings.
It does pay for extractions, and she has had four in recent years.
"When I get to the point where I smile, and people can see my missing teeth, I just won't go outside any more," she said.
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Government programs such as Medicare and Medicaid offer very limited, if any, dental services.
Much has been said about the many Americans who have no health insurance. But of the 172 million Americans under age 65 who do have health coverage, 45 million of them have no dental coverage. And those that have dental insurance are paying a greater share of the costs.
Last year, Florida earned an "F" grade in a national study for failing to enact stronger policies to improve access to dental care for disadvantaged children.
The federal health reform law won't help much, either. While it will require all Americans to have health insurance in 2014, it won't require them to have dental coverage.
"We are still an extra," said Oldham, who is vice president of the Hillsborough County Dental Association. "Teeth are never as important as treating cancer or treating heart disease."
But the benefits of a dental exam extend beyond keeping your teeth healthy. "It's well-documented that there is a connection with your mouth, oral health and the rest of the body," Holcombe said.
Dental exams can detect oral cancer, gum disease and osteoporosis, among many other conditions. Several studies indicate people with gum disease are almost twice as likely to suffer from coronary artery disease.
Oldham and others encourage people who are struggling financially to talk with their dentists about payment plans.
"While it may be a thought to skip the dental visit to save money, we all know prevention is much cheaper," Holcombe said. "The greatest feeling we get is praising patients for doing a good job and having no cavities or gum problems."
Richard Martin can be reached at firstname.lastname@example.org or (727) 893-8330.