Good morning. Pop musician Kesha, who you may recall from late-aughts hits like "TiK ToK" and "Timber," is back in the news after revealing that she collects the teeth of her fans and turns them into jewelry. “It’s not a drill and it’s not a joke. I’m a pop star and I need your teeth,” she implored. 

Well, we suppose everyone’s got a hobby, though this isn’t one we’d recommend to anyone in the dental profession.

Inside this issue:

- Payers are using AI to push back on claims
- What you need to know about e-prescribe mandates

⏰ Your reading time today: 6 minutes 51 seconds

🏆 Enjoy your coffee break with Word of Mouth, a dental-themed word game inspired by Wordle.

MARKETS

📉 3D Systems ($DDD) – 2.63 | -0.400 (13.20%)
📉 Align Technology ($ALGN) – 175.05 | -3.18 (1.78%)
📈 Colgate-Palmolive ($CL) – 91.93 | +1.61 (1.78%)
📈 Dentsply Sirona ($XRAY) – 13.46 | +0.76 (5.98%)
📈 Envista Holdings ($NVST) – 26.58 | +0.49 (1.88%)
📉 Henry Schein ($HSIC) – 86.20 | -0.53 (0.61%)
📉 Park Dental Partners ($PARK) – 18.87 | -1.55 (7.59%)
📉 Straumann Holding ($STMN) – CHF 99.18 | -3.970 (3.85%)
📉 Weave Communications ($WEAV) – 7.15 | -0.350 (4.67%)

Stock data reflects market close as of the last day of trading, showing changes over the past five trading days.

THE DRILL DOWN

📊 Transaction activity in dentistry holds steady in Q3, according to TUSK Practice Sales Q3 Dental Market Report, which found that at least 175 reported dental practice locations were sold in the first half of the year. Steady as she goes.

🤖 Pearl AI's analysis of 26 million X-rays suggests the CDC is dramatically undercounting tooth decay, with its index revealing that American adults have an average of more than six decayed teeth, roughly nine times higher than the CDC's figure of 0.7. Not a small discrepancy.

💰 Owner dentists crossed the $1M average gross billings threshold in 2025, with ADA data showing solo practice owners in 2025 averaging over $1.1M and specialty dentists topping $1.2M. 

🦷 Illegal dentistry is a global patient safety crisis, but most cases go unreported, according to a new report built from surveys of 49 national dental associations, which found nearly half of those associations consider current regulations ineffective.

🏥 Michigan's Health Department of Northwest Michigan takes direct control of a nine-clinic dental network, terminating its management contract with the nonprofit operator after an audit flagged financial inefficiencies.

⚠️ A two-paragraph provision tucked into North Carolina's recently passed state budget raises concerns, as some worry the language appears to sunset Medicaid billing codes for services provided to dental patients by ambulatory surgery centers in 2027, a change that could limit access to oral health surgeries. A small provision causes big confusion.

INSURANCE

Payers are bringing AI to the claims fight

AI has unlocked real gains for your practices, from clinical imaging to patient FAQ bots to voice perio charting. The bad news is that payers are increasingly pointing the same technology back across your claims.

What's happening: Payers are pushing back harder on claims. A survey of more than 160 dental billing professionals found 78% of practices reporting more denials or payer scrutiny over the past year.

• The top driver was payers tightening what counts as "medically necessary" and how often a covered procedure actually gets covered.

• Payers rejecting claims is nothing new, but the frequency is, with procedures that would’ve cleared without a second look a year or two ago now a source of friction. 

Why it’s happening: Dental practices aren’t the only ones using AI; payers are also adopting the tech to go over every claim with a fine-toothed comb. Claims that once crossed a human adjuster's desk now get scanned against documentation rules in milliseconds, and the mismatches a person might have waved through get kicked back automatically.

• General medicine may be the tip of the spear on this. On the prior-authorization side, physicians report that payer AI is driving denials up—61% flagged it as a concern to the AMA—and a Senate report found some tools denying at 16 times the rate of manual review.

• It's a trend that’s now drawing bipartisan scrutiny in Congress, even as Medicare itself has already begun rolling out AI-driven review of prior authorization requests in a number of states.

Why it matters: Dealing with denials is already an administrative drag, and this trend compounds it. A dental prior-auth request eats about 24 minutes by phone or fax and 16 by portal, the heaviest portal task the CAQH Index tracks. Now multiply that friction across a DSO's claim volume. 

What you can do: If denials are climbing because payers are making their systems faster and more automated, then piling more hours onto a manual billing process is a losing strategy. The real fix is a tech stack that prevents denials up front and clears the ones that slip through before they age past collectibility. Fortunately, the counter-playbook is well-mapped, with five high-leverage moves you can use against the denial surge.

• Verify before every visit. Pull a full benefit breakdown (frequencies, waiting periods, missing-tooth clauses, remaining maximums) ahead of each appointment.

• Document like you'll be audited. Keep by-carrier attachment lists, and capture the clinical images and narratives that satisfy the medical-necessity bar the algorithm is checking.

• Scrub for downgrades before you submit. Catch code substitutions and missing modifiers at claim creation, and create claims same-day, while the evidence is fresh.

• Centralize denial management. As a DSO, one of your advantages is the ability to centralize this process and bring more resources (and a robust tech stack) to bear on the problem than a solo office.

• Escalate patterns, not just claims. When the same carrier denial keeps recurring, route it to payer relations rather than re-appealing one claim at a time.

Bottom line: Denials are now being driven, in many cases, by an algorithm checking claims the moment you file them. As a DSO, you can only fight fire with fire, automating prevention and denial management and freeing up your team to handle the exceptions. When the payer brings an algorithm, bring one of your own.

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BUSINESS BITES

👔 Notable leadership changes: LightForce Orthodontics names Erica Rogers as CEO, Young Innovations announces Rebecca Whitney as new CEO, MAX Surgical Specialty Management names Dr. Jason M. Auerbach as CEO, Brittany Dellagatta becomes the COO of Rising Tide Dental Partners, Joycelyn James is appointed My Community Dental Centers’ new Chief People Officer, Dandy names Dmitri Krakovsky its new Head of Product, and Universal Orthodontic Lab appoints Dr. Ryo Hamanaka as its new Chief Clinical Officer.

📈 Deals and de novos: SALT Dental Partners adds a 14-location orthodontic practice in North Carolina to its network, Lone Peak Dental Groups acquires 11 pediatric dental and orthodontic practices across Georgia and South Carolina, Smile Partners USA opens its second de novo practice in Michigan, and Aspen Dental opens new Georgia and Chicago locations.

🚌 Kaltroco acquires Smile America Partners, the largest school-based mobile dental DSO in the U.S., after the Michigan-based organization brought dental services to over 8,000 schools in 20 states throughout 2025.

🦷 CenterGate Capital invests in Canadian Dental Labs, with the Austin-based PE firm backing the dental prosthetics and orthodontic appliance manufacturer, which operates eleven labs across Canada and serves more than 5,000 dental practices. PE heads north.

🤖 InsideDesk raises $12.6M to scale AI-powered RCM for DSOs, with the Toronto-based startup closing a round led by Pender Ventures to accelerate claims automation, collections, and hiring—and translating to roughly C$17.7M for the growing DSO-focused platform.

REGULATION

A growing patchwork of e-prescribing rules is creating a compliance headache

Most U.S. states would like you to throw away your prescription pad. In fact, some require it by law.

Catch up: Around three dozen states now require e-prescribing in some form. What these regulations actually require varies quite a bit across the country: 

• In six states—California, Delaware, Florida, Iowa, Michigan, and New York—the mandate covers all prescriptions, not just controlled substances. Elsewhere it's Schedule II only, or all controlled substances, or opioids alone.

• Some states have volume thresholds, below which practitioners aren’t covered by the mandate. In New York, it’s 25 prescriptions in a year, while in California, it’s 100.

• Penalties are also inconsistent. New York’s rules threaten professional misconduct charges plus civil and criminal exposure. California hands it to the licensing board. And Minnesota, one of the early movers on e-prescribing mandates, still has no teeth attached to theirs.

Why it’s happening: E-prescription mandates are meant to crack down on forgeries, make it more difficult to doctor-shop, and feed more data into prescription drug monitoring programs—all tactics aimed at reducing opioid abuse.

Why it matters: While these laws are designed to be enforced against individual licensees, decisions that DSOs make have a significant impact on whether compliance is a breeze or another administrative headache. Everything that needs to happen on the backend to make compliance as easy as possible, from filing state registrations to adopting the right technology, are levers DSOs can control.

What you can do: Taking the burden of worrying about compliance away is exactly the sort of benefit a DSO can offer its clinicians. Here are some steps to consider:

• Build a compliance matrix. If you’re operating in multiple states, build a dashboard that includes information on the mandate’s scope, exemption threshold, state registration requirement, waiver process, and penalties. Refresh it annually.

• Know your tech. The dominant e-prescribing engines in dental right now are DoseSpot, iCore, and Ensora eRx.

• Don’t lean on a low-volume exemption. Particularly if you’re operating in tightly regulated states, this can create real risks. 

• Track paper exceptions by location. Most states permit a non-electronic script during a technical failure. Track those exceptions to spot any irregular patterns early.

• Consider setting your operating standard at the level of your strictest state. Find the state that has the tightest rules and operate everywhere at the level demanded there—keeping your processes standardized at a high level can help avoid slip-ups.

Bottom line: E-prescribing mandates are becoming a critical part of a DSO’s regulatory compliance regime, and—as more states adopt them—one that requires special attention to get right. The answer, however, is straightforward enough: Get clear on what’s required, pick the right tech stack, and run consistent operating procedures.

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CLINICAL NOTES

❤️ Periodontal bacteria may trigger calcium deposits in the heart's aortic valve, with a preliminary U.S. study identifying a possible biological mechanism linking persistent gum disease and bacterial infection to the progressive hardening and narrowing of the aortic valve. What happens in the mouth doesn't stay in the mouth.

🧫 Researchers identified two hydrogel candidates—guanosine monophosphate and deoxyguanosine monophosphate—as promising localized treatments for periodontitis, finding both compounds formed stable, self-healing hydrogels with strong antibacterial and anti-inflammatory properties.

🦷 Most cracked teeth can be saved rather than extracted, according to a new study, which found that cracked teeth with probing depths under 5 mm showed favorable outcomes the vast majority of the time.

BEYOND THE CUSP

• Watch: The history of the first electric toothbrush.
  

• The ADA launched a new series of analysis and insights on policy issues in dental.
  

• Does dentistry need its own hypnosis techniques?
  

• Meet the winners of this year’s ADA 10 Under 10 Award.
  

• Just for fun: A rare glimpse at one of the world’s least-visited nations.