Keynes’s economics offers a lens on how markets shape oral health needs

Eighty years after the death of John Maynard Keynes, two researchers in oral health argue that his economic ideas still have something to say about dentistry. In an opinion article published in Frontiers in Oral Health, Demetrio Lamloum of the University of Bern and Stefan Listl of Heidelberg University Hospital contend that Keynesian concepts of uncertainty, social convention, and the distinction between absolute and relative needs can explain a paradox in contemporary oral health: why demand for dental care keeps expanding even as oral diseases remain among the most prevalent non-communicable conditions worldwide.

The authors write from the perspective of high-income countries, mainly in Europe, where dental care is financed through a mix of public and private sources and where a large private market exists for elective and aesthetic treatment. They explicitly note that their argument does not apply to low- and middle-income countries, which face different burdens, including absent basic care, out-of-pocket payment, and financial hardship. Their central claim is that standard welfare economics, which assumes individuals hold stable preferences and sufficient information to make rational choices, poorly describes how people actually come to want dental treatment.

Keynes never wrote about health or dentistry, and the authors are careful to present his concepts as analytical lenses rather than as findings. They draw on three features of his thought. The first comes from his 1930 essay Economic Possibilities for our Grandchildren, where he distinguishes absolute needs, felt regardless of social comparison, from relative needs, which emerge through comparison, status competition, and the desire for distinction. The second is his account of decision-making under fundamental uncertainty, in which probabilities cannot be calculated and people fall back on conventions and the judgement of others. The third is his policy conclusion that the state should act where private markets cannot be relied on to deliver what society needs.

The uncertainty argument connects directly to the founding text of health economics. Kenneth Arrow’s 1963 paper showed that uncertainty about the incidence of illness and the effects of treatment, together with unequal information between providers and patients, are defining features of the market for medical care. The authors note that Arrow’s uncertainty is closer to measurable risk than Keynes’s, but that both analyses reach the same conclusion: when outcomes cannot be judged in advance, people rely on others’ judgement. In dentistry, that reliance extends to providers’ recommendations, opening the door to preferences shaped from the supply side.

The distinction between absolute and relative needs has a long pedigree in economics. The authors point to Thorstein Veblen’s conspicuous consumption, in which goods are consumed to display wealth and rank, and to Fred Hirsch’s positional goods, whose value depends on the user’s position relative to others and falls as more people obtain them. Applied to oral health, the distinction is not narrow. Contemporary understandings of health, influenced by the World Health Organization’s definition, include psychological well-being, social participation, communication, and self-esteem, and oral health legitimately matters for confidence, employability, social interaction, and quality of life. The problem, the authors argue, arises when these dimensions of well-being are colonised by market forces that continuously redefine them, so that teeth meeting clinical standards of health are still perceived as imperfect if they are not sufficiently white, straight, youthful, or aesthetically desirable.

To make the distinction workable in practice, the article proposes a working typology of four categories and three diagnostic questions. Is there disease, pain, or loss of function that can be assessed clinically? Would the need remain if everyone else’s teeth looked the same, which the authors call the Keynesian test of whether satisfaction depends on comparison? Does demand rise when the average standard of appearance rises? They note that dentistry already has an instrument drawing a similar line: the Index of Orthodontic Treatment Need separates a Dental Health Component, capturing clinically assessed need, from an Aesthetic Component, capturing perceived aesthetic impairment. A similar logic, they suggest, could be applied to other elective treatments.

The article traces how oral health has been reframed over recent decades. Historically, improvements were driven largely by population-level interventions, including water fluoridation, improved nutrition, and expanded access to dental services, although the relative weight of these factors is debated and experts consider fluoride toothpaste, whose use as a commercial product was supported by public health endorsement, the main reason. Oral health was long conceptualised as a public good shaped by social, environmental, political, and economic conditions, with frameworks emphasising structural prevention and recognising inequalities as reflections of broader social inequality. In recent decades, the authors argue, oral health has increasingly been framed as a matter of individual responsibility, in line with broader neoliberal trends in health governance. That shift may have raised patient awareness and encouraged healthier behaviours, but it has also opened the door to overconsumption of dental services.

The growth of cosmetic dentistry illustrates the dynamic. One commercial market research firm values the global cosmetic dentistry market at about USD 32 billion in 2025 and forecasts nearly USD 100 billion by 2034, while other firms estimate about USD 28 to 29 billion in 2025 and forecast about USD 60 to 66 billion by 2034 or 2035. The authors stress that these are industry estimates whose methods cannot be verified, and that the size of the disagreement shows how uncertain they are. Even so, they argue, whitening, aligners, and other aesthetic treatments are increasingly framed as health necessities, and in Keynesian terms part of what the industry sells responds to relative rather than absolute needs.

Commercial pressures also operate through the supply of care itself. The authors cite evidence of supplier-induced demand in dentistry: in the United Kingdom, Birch found patterns of treatment consistent with supplier inducement under a fixed-fee system, and in the Netherlands an experiment that liberalised dental fees in 2012 was followed by price increases and was reversed after one year. A more recent force is corporate and private equity ownership of dental practices. In the United States, the proportion of dentists affiliated with a dental service organisation rose from 7.4 percent in 2015 to 16.1 percent in 2024, reaching 26.5 percent among dentists in their first ten years of practice, and the share affiliated with private equity almost doubled between 2015 and 2021, from 6.6 to 12.8 percent. Dental offices acquired by private equity firms tended to shift from diagnostic and preventive procedures to generally higher-reimbursement restorative, specialty, and surgical procedures. In the European Union, dental chains are legally permitted in 24 of 26 countries surveyed, non-dentists may own practices in 22, and 11 countries reported an increase in dentists working in chains since 2018. The authors argue that investor ownership brings the expectations of financial markets into dental clinics, a strong driver of marketisation that operates regardless of how well-informed patients are.

As oral health becomes increasingly governed through markets, the authors contend, commercial solutions expand while structural interventions are de-prioritised, and scarce public funding and marketisation reinforce each other. Marketing extends beyond the clinic: sugar-rich foods and beverages are widely marketed as compatible with healthy lifestyles, particularly to children and adolescents, despite strong evidence linking sugar consumption to dental caries. A Keynesian reading, they conclude, would caution against relying on market-driven conventions to achieve equitable oral health outcomes, and would support upstream interventions including regulation of harmful marketing and fiscal measures targeting risk factors. Concretely, they propose needs-based workforce planning rather than planning driven by market demand, public dental services with payment systems that do not reward volume for groups the market serves poorly, such as children, older people in residential care, people with disabilities, and low-income households, and the protection of prevention budgets, treating prevention as public investment rather than current spending. Invoking Keynes’s dictum that government should do those things which at present are not done at all, the authors close with his hope that economists might become humble, competent people on a level with dentists, and argue that both economics and dentistry serve society best when focused on needs rather than manufactured demand.

Subject of Research: Applying Keynesian economic theory to commercialisation and preference formation in oral healthcare

Article Title: What would John Maynard Keynes say about contemporary oral health? Reflections on preferences, social conventions, and marketisation

Article References: Lamloum, D., & Listl, S. (2026). What would John Maynard Keynes say about contemporary oral health? Reflections on preferences, social conventions, and marketisation. Frontiers in Oral Health, 7, Article 1986109. https://doi.org/10.3389/froh.2026.1986109

Image Credits: AI Generated

DOI: 10.3389/froh.2026.1986109

Keywords: oral health, Keynes, health economics, commercial determinants, cosmetic dentistry, marketisation, public health, dental policy, social conventions, supplier-induced demand, prevention, health inequalities