Politicians, press and the public will always look for a villain – Rasnaam Tiwana asks if the CMA inquiry into the cost of private dentistry will see the sector scapegoated.
When prices rise, the instinctive reaction is to go looking for villains, asking: ‘If patients are paying more, who is making the money?’
It is hardly surprising that the chancellor has asked the Competition and Markets Authority (CMA) to examine private dental pricing, and that the media were quick to turn it into a ‘dentists are ripping off patients’ story. What many overlooked was that reviewing prices to patients tells you very little about why prices are rising.
Dentistry has not become more expensive because dentists and owners suddenly developed a taste for excess profit and juicier EBITDA. It has become more expensive because the economic system around it has changed, and it’s government policy that has quietly shaped that change.
Five years of economic pressure
Over the past five years, small healthcare businesses have lived through an unusually punishing economic cycle. COVID-19 closures were followed by energy shocks, rising borrowing costs, persistent wage inflation, national insurance increases, and steadily expanding regulatory demands. These pressures did not arrive randomly. They are the cumulative result of fiscal decisions taken since 2020, including the budgets of each year, which progressively shifted costs onto employers, while offering limited operational relief for small businesses.
Dentistry simply happens to be one of the few sectors where patients feel the impact directly. The same forces are affecting vets, physios, opticians and care homes. Dental practices prices are just more visible.
The numbers tell a different story
If dentists were price gouging, we would expect to see margins rising. The data tells a very different story. Christie & Co’s Dental Market Review 2024 shows materials and lab spend increasing from around 9% of turnover in 2019 to roughly 15% by 2024, while staff costs have risen from about 14% to approximately 18%. Over the same period, EBITDA margins have softened by around 3-4% across both associate-led and owner-operated practices.
This is not profit expansion. It is structural margin erosion. Prices have risen only after years of cost increases were absorbed.
Rising payroll and staffing crisis
Rising employee costs have continued to put pressure on practices. Even as practices strive to retain quality staff, essential for high-quality care, these costs have increased in a climate where compensation uplifts often lag general inflation and operational pressures.
Price blindness
In many practices, no one ever sees a true market price. A box of supplies arrives, an invoice is paid, and life moves on. Yet it is not unusual for two otherwise identical practices, buying the same products from the same suppliers, to be paying radically different prices.
Not because they are careless, but because they have nothing to compare against. Economists call this price blindness. When purchasing is fragmented and invisible, nobody develops a sense of what ‘normal’ looks like. Inflation then magnifies inefficiencies that were already present. This isn’t inefficiency; it’s simply not knowing what you don’t know.
Changing expectations also carry real costs
There has also been a quiet shift in patient expectations. Modern dentistry rightly involves longer appointments, better service, digital systems, financing options and higher standards. All of these are positive developments; but each requires sustained investment in people and infrastructure.
The hidden cost of compliance
Alongside rising wages and materials, practices now carry a growing compliance burden that the public rarely sees. None of this is optional, and little of it comes with extra funding. For most practices, compliance now means extra admin, possibly external consultants, software and ongoing reinvestment in facilities. These costs do not increase profits, they simply keep doors open, yet they are largely absent from public debate on dental pricing.
Media amplification missed the context
The way the press covered the CMA announcement helped frame the debate as if dentists were the primary cause of rising treatment costs. Headlines pointed to ‘sharp rises’ in dental charges and calls to investigate private prices, including reports that some procedures had jumped by 23-32% in recent years. Those stories were widely shared without the necessary context of underlying inflation, input costs or sector margins, reinforcing a simplistic narrative that misses the root cause.
You don’t fix prices by blaming dentists
Behavioural economists have a simple rule: you do not change outcomes by lecturing individuals. You change outcomes by redesigning systems. If we want dental care to remain affordable, we do not need more investigations into dentists. We need policymakers who understand how their decisions play out in real businesses.
Because what currently looks like price gouging is actually system design failure.
