Good morning. Dentistry has rules for everything. This week, even tail wagging is under review. In Kansas, a dentist is fighting to keep his therapy dog Ivy after regulators decided the hypoallergenic, bathed-twice-a-week poodle was a public health risk. Forget COVID. Fear the pupdemic.

Inside this issue:
- The great hygiene shake-up
- The rise of diagnostic drool

⏰ Your reading time today: 5 mins 7 seconds

👑 Our Word of Mouth dental-wordle game has a new set of weekly champs, including Dr. David Kao of LA Wilshire Periodontics, Nikki Winders of Hawaii Dental Clinic, and Leslie Espinola of PepperPointe Partnerships. Play today to get on next issue’s leader’s list!

MARKETS

📉 Align Technology ($ALGN) – 177.61 | -3.95 (2.18%)
📉 Colgate-Palmolive ($CL) – 90.74 | -0.15 (0.17%)
📉 Dentsply Sirona ($XRAY) – 13.84 | +0.03 (0.22%)
📈 Envista Holdings ($NVST) – 16.97 | +1.00 (6.26%)
📈 Henry Schein ($HSIC) – 66.58 | +1.11 (1.69%)
📈 Patterson Companies ($PDCO) – 10.70 | +0.31 (2.98%)
📈 3D Systems Corp ($DDD) – 2.00 | +0.07 (3.63%)
📉 Weave Communications ($WEAV) – $10.70 | 0.35 (2.98%)

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

💧 Dental industry pushes back against RFK Jr.'s fluoride comments, as over 250 organizations warn that removing fluoride could worsen oral health outcomes and strain the dental workforce. The ADA is also pushing back against proposed cuts to the U.S. Department of Health and Human Services.

🦷 Iowa allows dental assistants to work without state registration, as Governor Kim Reynolds signs a bill creating a new tier of unregistered assistants to address workforce shortages. A growing trend in light of shortages?

📄 Texas dentists urge lawmakers to join the Dentist and Dental Hygienist Compact, arguing that reducing licensure barriers could ease the state's dental shortage. Big sky, bigger waitlists.

🪥 Hygiene leadership pushes back against efforts to lower training standards, warning that allowing non-hygienists to perform preventive care threatens patient safety. A scaler and good intentions aren't enough?

🩺 ADA supports House Republicans advocating for dental Medicaid protections, applauding moves to secure coverage for low-income adults. Molars make strange bedfellows.

DENTAL HR

The great hygiene shake-up

The hygienist shortage isn’t a staffing blip anymore. Instead, it’s a system-wide disruption. Appointment calendars stretch months out, practices scramble daily to fill chairs, and DSOs are feeling the squeeze. Burnout, retirements, and pipeline bottlenecks have collided, reshaping the labor market faster than most practices can react. Turns out you can’t scale if there’s no one to scale with you.

What’s happening: The numbers are brutal. Nearly 90% of dentists now describe hiring hygienists as "very" or "extremely" challenging, with workforce levels still stuck roughly 5% below pre-pandemic levels. Meanwhile, the pipeline isn’t catching up: Hygiene school graduations are flat compared to a decade ago, even as dentist graduations have surged 28%. Layer in the reality that about one-third of hygienists are nearing retirement, and the imbalance is baked into the system.

Why hygienists are leaving: The shortage isn’t driven by disinterest in the profession; it’s a product of systemic pressure. Hygiene programs have limited enrollment spots due to faculty shortages and accreditation caps. Meanwhile, burnout is pushing many hygienists out of clinical care long before retirement age. Nearly one-third report severe burnout, citing unrealistic scheduling, physical strain, and feeling disrespected within their offices. 

The hidden costs: Hygiene isn’t just cleanings. It anchors much of the operatory’s long-term value. Missed hygiene visits mean fewer diagnoses, treatment plans, and revenue opportunities. Recruitment and temp costs add up quickly. Patient trust suffers. Staff morale drops. And every lost hygienist triggers a cascading headache that reaches far beyond hygiene production.

How DSOs are adapting: Under pressure, DSOs are moving faster and thinking bigger:

• Building internal pipelines: Groups like Heartland Dental are partnering with colleges and opening their own training centers to create a direct, reliable source of hygienists and assistants.
  

• Deploying flex models: Regional float pools allow DSOs to share hygienists across offices. Instead of every practice fighting alone, floaters plug gaps before they turn into full-scale problems.
  

• Rethinking retention: Winning groups aren't relying on slogans—they’re delivering better pay, real benefits, flexible schedules, and tech-driven workflows. Assisted hygiene models, where assistants handle turnover and charting, let hygienists focus on patient care without physical breakdown.
  

• Plugging gaps with gig work: Platforms like Cloud Dentistry and TempStars let hygienists pick up shifts on their own terms. DSOs gain operational flexibility but trade off on continuity and consistency, and pay a premium for the privilege.

Licensing bottlenecks: State-by-state rules remain a hurdle, with relocating hygienists facing duplicative exams and long approval delays. The Dentist and Dental Hygienist Compact, now adopted by twelve states, offers a potential fix by letting licensed professionals move across member states without starting over.

Scope creep: To ease shortages, some states are turning to dental therapists and there have been policy proposals within the ADA to allow dental students or internationally trained dentists to perform hygiene tasks. But critics, including the ADHA and IFDH, warn this risks patient safety and dilutes professional standards.

Bottom line: The hygiene shortage isn’t a passing issue; it’s a structural reset. Stopgap measures like gig work and float pools may buy time, but real solutions will come from changing talent pipelines and building sustainable careers, including better pay, smarter workloads, stronger culture, and faster licensing. The winners will fix the foundation, not just patch the cracks.

BUSINESS BITES

📉 Henry Schein weathers dental market slowdown while holding profit forecasts, citing soft demand and inflation in its latest outlook. Margins down. Confidence unchanged.

🪪 Align reports Q1 earnings and launches aligners with mandibular advancement, rolling out occlusal blocks for Class II cases while posting 6.2% growth in clear aligner volume and expanding into the growing mandibular segment.

🌐 Straine Dental Management expands into Maryland, entering its sixteenth state as the DSO network continues rapid growth. 

🏥 Smile Doctors adds six new affiliates, widening its orthodontic footprint across the country. 

🦷 PDS Health adds 10 practices and expands its specialist-owned DSO model, continuing its April growth streak while increasing specialist ownership and geographic reach across four states.

💰 MAX Surgical secures $77M credit facility, accelerating growth plans for oral surgery partnerships in the Northeast. OMS, meet ROI … hopefully.

TOOTH TECH

The rise of diagnostic drool

Dentistry’s newest secret weapon might be sitting in your patient’s mouth. Saliva, long dismissed as a clinical afterthought, is becoming a promising potential diagnostic tool, even as it continues to jump through regulatory hurdles. DSOs are waking up to spit’s potential not just for better preventive care, but as a powerful strategic differentiator in increasingly crowded markets. Drool is the new cool.

What’s happening: Salivary diagnostics are moving from the lab into dental operatories. Though most tests lack FDA approval, new molecular tools are showing promise in detecting biomarkers for periodontal disease, oral cancers, systemic inflammation, diabetes, and heart disease, often earlier than traditional methods.

By analyzing saliva, dental teams could screen patients quickly and painlessly, delivering clear, actionable data. Results can be returned chairside or via specialized labs, enabling faster, more precise intervention with greater clinical confidence.

Regulatory and reimbursement hurdles: While saliva diagnostics offer exciting promise, challenges remain:

• Limited FDA approval: Many current saliva tests operate as laboratory-developed tests (LDTs) under CLIA certification rather than full FDA approval, limiting widespread adoption and creating uncertainty.
  

• Insurance coverage gaps: Few insurers currently reimburse saliva-based tests, forcing practices to either absorb the cost or pass it along directly to patients.
  

• Evidence gaps and clinical training: Robust clinical outcome data is still evolving, making some providers skeptical about the investment. Additionally, training dental teams to accurately collect, interpret, and communicate test results remains essential to successful implementation.

Why DSOs are watching: Despite these limitations, DSOs recognize several compelling advantages:

• Early detection and proactive care: Saliva tests enable earlier intervention and more personalized care, reducing costly treatments later and significantly improving patient health outcomes.
  

• Practice differentiation: Offering advanced diagnostic capabilities sets DSOs apart from traditional dental practices and builds their reputation as healthcare innovators.
  

• Operational and financial upside: Easy integration into routine hygiene appointments creates additional revenue streams, elevating profitability without extending chair time.

How leading DSOs are adapting: Progressive DSOs aren’t waiting—they’re moving quickly to integrate saliva testing into their preventive workflows:

• PDS Health (Pacific Dental Services): PDS fully integrates saliva diagnostics into its established "Mouth-Body Connection" initiative, utilizing chairside tests to assess periodontal inflammation and pathogen profiles, and systemic tests (like HbA1c) to detect diabetes risk.
  

• Dental365: Dental365 adopted chairside SalivaScore testing across its locations, providing immediate visual feedback about patients’ periodontal inflammation levels through aMMP-8 measurements.
  

• Emerging pilot programs: Mid-sized DSOs nationwide are actively piloting saliva diagnostics through platforms like Direct Diagnostics and OralDNA, evaluating both clinical outcomes and patient satisfaction.

Hidden operational challenges: Successfully adopting saliva diagnostics means managing both workflow and expectations. Practices need to integrate testing without disrupting schedules, ensure staff are trained to use and explain results effectively, and clearly communicate the value to patients to avoid it being seen as just another added fee.

Strategic calculus: Early adoption offers clear strategic advantages:

• Market leadership: It establishes a practice as an innovator in advanced preventive and integrative care.
  

• Enhanced patient loyalty: Personalized, data-driven preventive care deepens patient trust, strengthening long-term relationships.
  

• Value-based integration: It positions your DSO strategically for future integration with medical groups and value-based care models, leveraging saliva diagnostics as credible, compelling evidence of clinical quality and patient outcomes.

Bottom line: Salivary diagnostics could help to reshape preventive dentistry. DSOs that embrace diagnostic drool could be finding a new point of differentiation and competitive advantage. The spit that was once suctioned away could now be a strategic asset to build a practice on.

CLINICAL NOTES

🩺 Healthcare workers, including dental teams, report high rates of long COVID symptoms, with fatigue, cognitive issues, and respiratory complications persisting after infection.

🧠 Chronic constipation and diarrhea linked to higher risk of poor teeth condition, with a U-shaped association between bowel habits and oral health according to a new study. When one end’s off, the other takes the hit.

🔬 Microscope-assisted root canals significantly outperform traditional methods in posterior teeth, showing nearly a threefold increase in success. 

😴 Mandibular advancement devices show strong 10-year outcomes for sleep apnea, improving adherence, patient satisfaction, and symptom reduction over the long term. Sleep better, snore softer, bill confidently.

BEYOND THE CUSP

• Oklahoma City ceremony honors dentists 30 years after bombing response, recognizing the teams who used forensic dentistry to help identify victims.
  

• Kanye West is suing his dentist, following accusations of reckless nitrous oxide administration during his dental visits.
  

• New device uses tongue stimulation to retrain the brain and ease tinnitus, allegedly helping over 90% of patients reduce symptoms.
  

• California prison dentist receives $1.2M payout for unused time off, triggering scrutiny over state policies. Out of office set to forever.