🦷 Dental squeeze

October 21, 2025

Good morning. Egyptian strongman Ashraf Mahrous pulled a 700-ton ship with a rope held only by his teeth to set a new world record for, well, pulling a ship with your teeth. This wasn’t Mahrous’s first feat-of-teeth-strength, either: Earlier this year, he set a Guinness World Record for pulling a train weighing 279 tons by his teeth. 

Impressive achievements by Mahrous, to be sure, but we also think this guy’s dentist deserves some recognition here.

Inside this issue:

- New ADA report finds dentists feeling squeezed
- How DSOs can get the most out of consultants

⏰ Your reading time today: 7 minutes 14 seconds

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

MARKETS

📈 3D Systems Corp ($DDD) – 3.78 | +0.80 (26.85%)
📈 Align Technology ($ALGN) – 134.93 | +8.60 (6.81%)
📈 Colgate-Palmolive ($CL) – 78.75 | +1.62 (2.10%)
📈 Dentsply Sirona ($XRAY) – 12.93 | +0.92 (7.66%)
📈 Envista Holdings ($NVST) – 20.14 | +0.98 (5.09%)
📈 Henry Schein ($HSIC) – 63.93 | +0.84 (1.33%)
📈 Straumann Holding AG (STMN.SW) – CHF 87.68 | +1.52 (1.76%)
📈 Weave Communications ($WEAV) – 6.77 | +0.23 (3.52%)

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

🌍 Planet DDS partners with the Dentist Entrepreneur Organization (DEO), making its Launchpad Program available to DEO’s 550 members, including up to 80% savings on practice management and imaging software. That's one powerful partnership prescription.

⚖️ Vyne Dental, Henry Schein One in legal battle. The two dental technology companies are locked in dueling lawsuits, each lobbing allegations of unlawful conduct around data access and software interoperability. 

🩺 National Dental Association supports new licensure compact, the Interstate Dental and Dental Hygiene Licensure Compact, aiming to streamline licensing for dental professionals across states.

⚖️ California enacts law to curb private equity influence, prohibiting interference with the autonomy of dentists to make healthcare and treatment decisions. Putting the dentist back in the driver's seat.

🦷 ADA pushes back against insurer downcoding, encouraging dentists to address reimbursement issues directly with insurers to combat increasing claims payment challenges by third-party payers.

📈 Dental implants market projected to triple, growing from $5.45B to $15.41B by 2035, fueled by advancements in technology and materials, according to new market research. That's some serious growth to sink your teeth into.

🛡️ ADA seeks visa clarity for international faculty, expressing concerns over new visa restrictions that may exacerbate faculty shortages in U.S. dental schools. 

🎓 Maine creates adjunct dentist license pathway, addressing dental shortages by allowing international graduates to practice under supervision, paving the way for future licensure.

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STATE OF THE INDUSTRY

New ADA report finds dentists feeling squeezed

The ADA’s latest State of the U.S. Dental Economy report is out, and it paints a picture of a dental market that’s not giving clinic owners much to grin about.

What the report found: The data points to a sluggish market where revenue is being supported by price hikes, not growing demand from patients. 

  • Most dentists are raising fees. 65.8% of dentists say they’ve raised fees this year. Among those, the average fee hike was 6.7%.

  • Patient spending is up a touch, but volume is flat: Patient spending is up around 4% so far in 2025 (and 10% above pre-pandemic levels), but 35% of dentists say they’re not busy enough, up from 27% in the previous quarter. New patient wait times are also the shortest in over three years, another sign of slack in the system.

  • Dental insurance reimbursement rates aren’t keeping up with inflation: Supply, equipment, and wage costs are rising faster than inflation, creating a “fiscal squeeze” on margins.

  • Hiring remains a challenge: About 1 in 3 dentists are hiring, but 90% can’t find hygienists easily (20% of hygienist jobs stayed open more than 6 months).

  • Dentists are dropping out of insurance networks: 25% of dentists say they’re dropping out of some insurance networks due to reimbursement rates that haven’t kept pace with costs.

  • Practices are investing in tech: About 20% of owners have already installed new software or digital systems this year. 

Why it matters: Dentistry is experiencing a sluggish market that’s propped up by price increases, not true growth. Patient demand is essentially flat, so practices can’t simply rely on more visits to boost revenue. Instead, dentists are driving revenue from higher charges per visit (hence that uptick in spending alongside shrinking wait times) and efficiency gains through investments in upgraded tech.

What’s next: Feeling the squeeze? You don’t have to just accept shrinking margins. Here are some ideas to consider to get your practice onto a profitable growth path: 

  • Focus on same-store growth and diversifying services into specialty care to capture higher-margin revenue and new patient segments.

  • Tighten the operational screws to protect EBITDA by centralizing functions, renegotiating supplier contracts, and doubling down on tech-driven efficiencies.

  • Focus on improving retention to avoid falling into a costly cycle of constantly needing to recruit—take a real look at your organization’s culture and what you offer in terms of professional growth and financial upside. 

Bottom line: A year ago, many expected pent-up post-pandemic demand to keep dentistry booming. Now we’re looking at an environment of flat demand and tighter margins that rewards efficiency and dialed-in operations.

BUSINESS BITES

📈 123Dentist acquires MCA Dental Group Limited, a DSO with 27 locations across Ontario and Québec, expanding its network to more than 450 locations.

🧑‍⚖️ SEC concludes investigation into Dentsply Sirona without enforcement action, a move the company said signals a positive turn for the company after resolving weaknesses in internal controls and undergoing leadership changes. Case closed.

🚰 GTCR investing $200M in Solmetex, a provider of systems to maintain clean water in dental practices.

🤝 ZimVie stockholders approve buyout by ARCHIMED, a healthcare-focused private equity firm that will now acquire the dental implant manufacturer for $730M as part of a deal expected to close this week. 

🏥 Archway Dental Partners acquires five dental offices in Connecticut, a move it says will make it the largest DSO in the state. Connecticut's new crown holder.

LAST ISSUE’S POLL RESULTS

MANAGEMENT

The right time for DSOs to hire consultants

As anyone who has been watching the MLB postseason knows, sometimes even the best teams need to make a call to the bullpen. For DSOs, that can mean bringing in outside consultants to help solve some of their thorniest problems. Knowing when (and whom) to consult could spell the difference between hitting the next level or hitting a wall.

What’s happening: DSOs big and small are increasingly bringing in outside management consultants to tackle specialized problems or accelerate growth.

  • Firms like Polaris Healthcare Partners and TUSK Partners focus exclusively on group dental practices, offering strategic consulting and M&A advisory services tailored to DSOs.

  • The big generalist consultancies—the McKinseys, Bains, and BCGs of the world—have started paying attention too, with large DSOs engaging these blue chip firms for broad strategic initiatives.

What it means for you: Not every DSO needs McKinsey on speed dial, of course. The calculus for hiring consultants depends on your size, stage, and goals:

  • Emerging DSOs (small groups): If you’re an entrepreneurial dentist with, say, 3 to 5 locations, you’ll likely hit a point where you can’t do it all yourself. At this stage, hiring a full-time COO or CFO may be financially out of reach, but a specialized consultant can fill the gap and save you from reinventing the wheel or making rookie mistakes in legal structure, financing, or practice integration.

  • Mid-market DSOs: Once you’ve scaled locations to double-digits, consultants are often brought in for specific projects or expertise where the core team lacks bandwidth. For example, say you’re implementing a new cloud-based practice management system across 40 offices—that’s a massive change-management task. It might make sense to engage a healthcare IT consulting firm or specialist to map the rollout.

  • Large enterprise DSOs: Even the giants find moments to bring in outside heavy hitters. Common triggers include a planned transformational move, like merging with another large DSO, entering a new national market, or overhauling the organizational structure, where an objective outside perspective is valuable. Top consulting firms (generalist or specialist) can provide a broad strategic review, extensive benchmarking data, and cross-industry knowledge.

Why it matters: Engaging outside consultants is a high-stakes decision. Done right, it can be a game-changer for a DSO’s trajectory; done poorly, it can become an expensive distraction (or worse). 

How to get the most out of consultants: If you do decide to hire outside help, follow some critical guidelines:

  • Scope surgically: Define the business outcome, the timeline, and the owner on your side. Tie fees to milestones where possible.

  • Pick for fit: Boutique for dental‑specific problems, generalist for cross‑functional change. Validate with at least two references that look like your business.

  • Wire to EBITDA: Ask explicitly how recommendations flow to revenue, cost, cash, or valuation.

  • Plan the handoff: Build internal capability and schedule knowledge transfer so the improvements stick after the team exits.

  • Benchmark relentlessly: Use external data sets, like Planet DDS’s mid‑year benchmarks, to set targets and track lift. 

Watch out for these gotchas: Scope drift, junior teams, and “playbooks” that ignore chairside realities will stall adoption. Demand senior time, insist on measurable outcomes, and keep your operators in the room.

Bottom line: A carefully chosen consultant, deployed at the right moment and for smart reasons, can give your DSO the extra horsepower it needs to grind out a win in the modern dental marketplace.

🗳️ The Check-up:

⬆ VOTE: Have you ever hired external consultants?

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CLINICAL NOTES

⚠️ Wrong-site surgeries are the most frequent dental errors, according to an analysis of safety incidents in the Veterans Health Administration, making up 40.5% of total incidents, followed by ingestion (19.1%) and the use of inadequately sterilized equipment (7.1%). Not exactly the kind of drill down anyone wants.

💊 In what researchers described as the first case of its kind, a 45-year-old man developed toothaches after taking the high blood pressure drug losartan, suggesting a potential link between the medication and dental pain. Symptoms resolved upon discontinuation, highlighting the importance of recognizing medication side effects to avoid unnecessary dental procedures. 

🪥 A basic electric toothbrush may outperform manual brushes in reducing plaque and gingivitis, with benefits noted after just one use, suggesting that even basic electric toothbrushes can significantly enhance patient oral health. 

🧑‍⚕️ A recent study highlights that only one-third of dentists regularly discuss substance use with adolescent patients, despite recognizing its importance, suggesting a need for better screening practices to support at-risk youth.

FUN AND GAMES

BEYOND THE CUSP