🦷 Beating the bots

November 18, 2025

Good morning. NHL hockey is back in full swing, and it got us wondering: Why do so many players not get their teeth fixed? 

Turns out, according to this investigation by The Athletic, it’s not just that missing teeth are a badge of honor in the league—it’s also a safety issue. A puck or stick to a replacement tooth can cause even more serious damage by breaking the metal post that supports it, so many players just wait until they retire to get their smile fixed.

(By the way, read on to the “Beyond The Cusp” section for a link to another article about dentistry in hockey with some truly wild anecdotes.)

Inside this issue:

- Insurers are using AI to block claims
- Planning your Medicaid strategy in uncertain times

⏰ Your reading time today: 5 minutes 54 seconds

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

MARKETS

📉 3D Systems Corp ($DDD) – 2.08 | -0.16 (7.14%)
📉 Align Technology ($ALGN) – 132.61 | -5.64 (4.08%)
📈 Colgate-Palmolive ($CL) – 78.81 | +0.13 (0.17%)
📉 Dentsply Sirona ($XRAY) – 10.39 | -0.62 (5.63%)
📉 Envista Holdings ($NVST) – 19.11 | -0.98 (4.88%)
📉 Henry Schein ($HSIC) – 71.25 | -1.65 (2.26%)
📉 Straumann Holding AG (STMN.SW) – CHF 98.22 | -1.16 (1.17%)
📉 Weave Communications ($WEAV) – 6.01 | -0.38 (5.95%)

Data is provided by Google Finance. Stock data reflects market close at 5:00 p.m. ET, showing changes over the past five days.

THE DRILL DOWN

🌍 150+ countries agree to phase out dental amalgam by 2034, as part of global efforts to reduce mercury exposure and protect vulnerable populations from its adverse effects. Silver fillings get the gold watch.

🚫 American Fluoridation Society criticizes FDA for its restrictions on ingestible fluoride products, claiming the decision is a "big mistake" that undermines public health recommendations for young children.

⚖️ American Dental Association asks regulator to block Delta Dental deal, urging the Wisconsin Office of the Commissioner of Insurance to stop the acquisition of Cherry Tree Dental by the insurance company, citing potential issues around conflicts of interest, market competition, and patient care.

💊 Prescription painkiller shortage in Canada is expected to persist into the new year, prompting dentists to seek alternative pain management strategies for their patients amid ongoing supply issues. When your Rx goes MIA, that’s a real pain.

🌟 Centers for Medicare & Medicaid Services (CMS) adds oral health incentive to Medicare fee schedule for 2026, aiming to reward providers for improved quality and patient outcomes, which could drive more referrals from physicians to dentists.

🏛️ Senate passes bill to end government shutdown, extending funding for most agencies, including the United States Department of Health and Human Services (HHS). The lights are back on—for now.

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INSURANCE

What to do when the bot says “no”

If your front desk feels like it is playing whack‑a‑mole with a growing volume of insurance claim denials, you are not imagining things. But unlike the carnival game, this one could be costing you real money.

What’s happening: Three in five U.S. physicians now say AI is driving up prior‑authorization denials, as insurers turn to algorithms to triage, challenge, and sometimes deny treatment claims. A U.S. Senate investigation found that large insurers were using AI tools to make claims decisions with little to no human review, and that these systems produced higher rates of care denial—as much as 16 times higher, in some cases.

  • Reporting on Cigna’s internal “PxDx” system described batches of near-instant claim rejections, spawning ongoing litigation and congressional scrutiny. Cigna disputes the characterization, but the episode illustrates the stakes when AI accelerates volume decisions.

  • A lawsuit against UnitedHealth alleges that its AI software has a 90% error rate, but most claims denials are never appealed.

Dentistry is not an exception to this trend. Across the board, insurance companies in the dental space are open about using AI to assess claims—though they typically emphasize that humans make final determinations. 

  • Delta Dental publicly touts real‑time AI to analyze claim data and route suspect claims for review. Guardian Life describes AI use in adjudication and fraud detection.

  • A growing crop of vendors that power both sides of the market, like Overjet and Pearl, market AI tools for DSOs (to help clean up claims) and insurers (to adjudicate those claims). 

Regulation is starting to catch up. Some states, like California, are passing laws targeting AI use by insurers directly and requiring human oversight in claims assessments. Maryland now requires insurers to provide additional justification when AI is involved in a denial. 

Why it matters: Regulators may be circing, but the burden of proof still sits with you. Proper documentation is more important than ever, as AI systems are looking for measurable evidence that your CDT-coded treatment matches radiographic, periodontal, and charted findings. Incomplete films, vague narratives, missing perio charting, or inconsistent tooth numbers give the machine a reason to route, delay, or recommend “no.” 

Here are five other tactics to consider adding to your playbook to minimize the impact of AI-driven denials: 

  • Turn “AI against AI” pre-submission. Use chairside and RCM tools that score documentation completeness before you transmit. Build automated checks into your claims queue so anything below your internal threshold is held for addenda.

  • Standardize narratives and attachments for “AI-sensitive” codes. Publish one-page templates per procedure family with required images and phrases that map to payer policies.

  • Analyze your denials. Track denial codes, cycle times, and overturn rates. Use those insights to target retraining and to script payer-specific appeal templates, especially where medical-necessity evidence is strong.

  • Don’t be afraid to appeal. A disciplined appeals process can materially lift collections and patient satisfaction without a payer contract change. As federal regulatory timelines for greater transparency kick in, insist on detailed denial reasons and API-enabled status feeds.

  • Negotiate for process, not only rates. In renewals, ask for written documentation protocols, quicker electronic prior authorization pathways, and “gold-card” style exemptions for locations with high approval rates.

Bottom line: DSOs that clean up documentation, automate pre-checks, and litigate denials with data will see fewer stalls and faster cash. Build your claims around what the algorithm must see, then make it effortless for the human reviewer to say “yes.”

BUSINESS BITES

📈 Dentsply Sirona posted disappointing earnings for Q3 2025, including a 5% decrease in net sales from last year and a net loss of $427 million, results that CEO Dan Scavilla said were “short of our expectations.”

💵 Dentalcorp reports 12% revenue growth and 14% increase in Adjusted EBITDA in Q3 2025, in what is expected to be its last earnings report before its $3.3 billion acquisition deal by GTCR wraps.

💼 Henry Schein exceeds expectations with $881 million in U.S. dental sales for Q3 2025, contributing to total net sales of $3.3 billion, driven by a 4.6% increase in global dental distribution merchandise sales.

LAST ISSUE’S POLL RESULTS

MEDICAID

Risks loom for Medicaid-exposed dental practices

If a big share of your patient volume rides on Medicaid, the next 12 to 24 months will test your operating model. And unlike your patients, you can't reschedule.

What’s happening: Congress has rewired big pieces of the program through the most recent federal budget, the Centers for Medicare & Medicaid Services (CMS) is tightening access rules, and states are eyeing deep cuts to balance their books. 

  • The “One Big Beautiful Bill” reconciliation law added work requirements for adults enrolled through the ACA Medicaid expansion, along with six-month eligibility renewals and tighter rules on provider taxes that many states use to finance Medicaid—all changes expected to reduce federal Medicaid spending and increase the uninsured.

Why it matters: Coverage risks will increase substantially in 2026. Work requirements and more frequent renewals create friction that historically knocks eligible adults off the rolls. Even if some re-enroll, DSOs will likely feel it as missed appointments, eligibility denials, and claim rework.

  • At the same time, tighter limits on provider taxes and budget pressures will—if historical patterns hold—push states to cut adult dental benefits and curb already-low reimbursement rates.

What you can do now: The time for practices with heavy Medicaid exposure to de-risk is now. Here are some steps you can take to fortify yourself against what’s coming: 

  • Create a segmented Medicaid-specific patient strategy. Set up automated pre-visit eligibility checks, on-site application and renewal help, reminders keyed to six-month redeterminations, and staffing for high-churn ZIP codes.

  • Hedge geographically and by benefit depth. Tilt de novos and marketing toward states adding or protecting adult dental benefits, such as Utah and Nevada, along with pediatric-heavy markets.

  • Strengthen RCM for churn. Shorten claim cycles with same‑day submission, complete diagnostics, and pre-adjudication edits. Create a “Medicaid cash buffer” in anticipation of patient churn in that segment.

What’s next: Midterm elections next year could change the context for DSOs. If Congress stays the course, expect changes and new eligibility restrictions to roll out on schedule, plus continued pressure on state financing tools. A new Congress with a different makeup could push to delay or soften work rules or financing limits, but that wouldn’t impact the industry until 2027 at the earliest.

🗳️ The Check-up:

⬆ VOTE: Are you concerned about the impact of Medicaid changes on your organization?

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CLINICAL NOTES

🦷 A new gel has been developed that can repair and regenerate tooth enamel by drawing calcium and phosphate ions from saliva using a process called epitaxial mineralization, an innovative solution that could one day offer patients a non-invasive option for enamel repair. Enamel repair in a tube—no drill required.

🧼 Regular interdental cleaning at least three times a week may lead to more stable 24-hour blood glucose levels in adults with type 2 diabetes, adding to a growing body of evidence linking oral health to the successful management of diabetes and other chronic disease.

🤧 Patients with gum disease face double the risk of developing eczema, indicating that regular dental scaling significantly reduces the risk of patients with periodontitis developing eczema. Flossing is the new skincare.

🧬 Research tracing the evolution of saliva back to primates has linked diet to salivary proteins, potentially paving the way for more personalized oral health diagnostics and a better understanding of why different people are prone to different oral diseases. That’s no monkey business.

FUN AND GAMES

BEYOND THE CUSP