🦷 Navigating the shutdown

November 04, 2025

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Inside this issue:

- Navigating the government shutdown
- Private equity is back, and here’s what it means for you

⏰ Your reading time today: 7 minutes 12 seconds

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

MARKETS

📉 3D Systems Corp ($DDD) – 2.76 | -0.48 (14.81%)
📈 Align Technology ($ALGN) – 138.53 | +4.36 (3.25%)
📉 Colgate-Palmolive ($CL) – 74.99 | -2.48 (3.20%)
📉 Dentsply Sirona ($XRAY) – 12.55 | -0.46 (3.54%)
📉 Envista Holdings ($NVST) – 20.09 | -0.050 (0.25%)
📈 Henry Schein ($HSIC) – 64.64 | +0.93 (1.46%)
📈 Straumann Holding AG (STMN.SW) – CHF 99.50 | +10.34 (11.60%)
📈 Weave Communications ($WEAV) – 7.02 | +0.080 (1.15%)

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

🦷 FDA restricts the use of prescription fluoride supplements, saying it would “take enforcement action” against those marketing the supplements to children under 3 and children at low or moderate risk for tooth decay.

⚠️ Orthodontists raise alarm over “fashion braces” trend, responding to a rise in people using unqualified providers or “at-home” products for orthodontic work. Let’s keep DIY to Pinterest projects.

🚫 Federal judge dismisses New York fluoride lawsuit, ruling that the state's Green Amendment does not guarantee access to fluoridated water. Guess the case didn't hold water—fluoridated or otherwise.

🧾 Kentucky lawmakers vow to revive optional fluoride bill, aiming to reintroduce legislation that would allow communities to choose whether to fluoridate drinking water.

🏦 ADA launches new credit union to serve the dental community, offering financial services such as loans and personalized coaching, along with support for dental students.

🇨🇦 A new Ontario bill could reshape dental practice, potentially allowing dentists and hygienists licensed across Canada to practice in Ontario as-of-right. Yours to Discover, now with fewer licensing hoops.

👔 Dr. Richard Rosato was inaugurated as the next ADA president, saying he would focus his presidency on unity, listening, and wellness initiatives for dental providers and patients alike. Dr. Thomas Paumier was chosen as president-elect and will succeed him next year.

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GOVERNMENT

How DSOs can navigate the government shutdown

The federal shutdown is already one of the longest in history, and despite reduced government capacity, you still need to operate like its business as usual. The question is what happens if D.C. stays dark into winter.

What’s happening: A federal shutdown has dimmed the lights in Washington, yet most of the plumbing that matters to dentistry keeps running for now. Medicaid and the Children’s Health Insurance Program (CHIP) are funded through the rest of the year, federal employees’ dental coverage continues, and the Centers for Medicare and Medicaid Services (CMS) is still running Medicare and ACA open enrollment. 

That said, some disruptions may impact dentistry. Here’s where some practices may be feeling the shutdown soon, if they aren’t already:

  • Medicaid claims may be slower: While coverage will persist until at least the end of the year, eligibility help desks and some federal systems support may be slower. Claims will be processed, but longer timelines could impact your revenue cycle. With fewer live humans to resolve small problems, minor snags that would typically clear in five minutes can drag on for days. Think of it as delayed gratification—emphasis on delayed.


  • Federal layoffs: The Trump administration’s efforts to lay off thousands of federal workers have been blocked for now, but if they eventually proceed, patients on federal employee benefit plans will lose their insurance.


  • Federally supported access points: Community health centers operate on a mix of mandatory and discretionary funds. With some funding streams expired, cash‑flow strain is possible if the lapse drags on; local referral relationships could shift.


  • Provider services and credentialing gridlock: With half of CMS staff furloughed, new provider enrollments and license verifications may take longer, creating credentialing delays for DSOs expanding or opening de novo sites that could postpone revenue.


  • Economic uncertainty: The longer the shutdown drags on, the more the consequences will be felt across the economy. More uncertainty often means layoffs belt-tightening, which could impact patient volume. And even if patients aren’t impacted, they may think that “shutdown” means “no insurance.”

The looming risk: If the shutdown drags on into December, funding for Medicaid and CHIP will be at risk and reimbursements could slow or stop. DSOs with large numbers of patients covered by these programs need to keep their eye on the calendar.

What you can do: The shutdown risks for most DSOs right now are around cash‑flow timing, patient sentiment, and administrative friction, but smart preparation and tight operations can get around most of them. Here are five ideas to get you started: 

  • Clear messaging: Proactively reassure Medicaid, CHIP, and federal‑employee patients: “Your dental coverage is active during the shutdown.” Train teams to cite FEDVIP and CMS facts succinctly. Publish a simple FAQ on your site.


  • Claims hygiene blitz: Submit same‑day, attach complete diagnostics, and clear edits before transmission.


  • Watch the calendar: Build January risk scenarios now. If Congress has not resolved funding by late December, prepare for slower state‑federal transfers.


  • Schedule mix: Pull forward preventive and pediatric visits while benefits are certain.


  • Vendor cash discipline: Reconfirm terms with labs and suppliers in case their federal workforces or shipping partners feel secondary effects from the shutdown. 

Bottom line: A shutdown creates turbulence, but Medicaid and CHIP dollars are still flowing today, and federal‑employee dental benefits remain intact. Now is a good time to tighten RCM, overcommunicate with patients, and scenario plan for if things get worse come January—all valuable exercises even outside of a shutdown.

BUSINESS BITES

📈 Align Technology’s stock jumps after it reports $995.7M in Q3 revenue, with a 4.9% year-over-year increase in clear aligner sales volume, reflecting strong market demand for Invisalign products.

🤝 Angelalign Technology invests in LuxCreo to co-develop innovative 3D printing materials to manufacture clear aligners. The future of smiles may be printed.

💰 Newton raises $3.8M for its AI-powered workflow automation platform from investors including Y Combinator, enhancing patient communication and scheduling efficiency in dental practices.

LAST ISSUE’S POLL RESULTS

M&A

Private equity activity is back, but don’t expect a clean exit

If your DSO took growth capital in 2018–2020, the investment clock is probably chiming. In the last cycle, that could often mean a tidy cash-heavy sale or, for the bold, an IPO. In 2025, the window for an exit is still open, but the break might look more like a partial extraction than a full pullout.

Driving the news: Private equity (PE) exit activity has reopened in 2025, with US $470 billion in PE exits year‑to‑date, a 40% increase over the same period in 2024, according to a new report from EY.

  • Meanwhile, the booming private credit market is attracting massive sums (like the $50 billion announced by JPMorgan Chase earlier this year) that needs to be deployed.

Yes, but: All-cash buyouts that allow owners to walk away are likely not realistic for most DSOs. More common are deals that allow owners to take some money off the table while remaining involved in the business. You can cash out, but don't expect to clock out just yet.

  • The broader PE market for secondaries is at a record high this year, and in dentistry we have seen large recapitalizations of DSOs (like Silver Oak’s investment in Smile Partners earlier this year) that reinforce that trend.

What this means for you: If you’re searching for liquidity in the coming months (or deciding whether to go to market), don’t expect to find an exuberant, 2021-era landscape. Buyers are looking for deals, but they can afford to be selective.

  • Expect partial liquidity over full exit. Continuation funds, minority recaps, and structured preferred are common paths to extend holds while paying insiders.


  • Earnouts are still prevalent and increasingly complex. Earnout prevalence is somewhat above the historic average, and earnout terms are becoming increasingly complex, relying on multiple metrics.


  • Greater focus on tight operations. Investors in DSOs want to see “seasoned EBITDA,” proof of resilience in tough conditions, and clean tech stacks, according to Dykema’s Brian Colao.

Want to maximize your value? Prove consistent EBITDA over multiple consecutive quarters, set yourself apart from the pack by showing growth that’s not just driven by price hikes, and prepare for a deal that keeps you involved with realistic earnout targets.

The bottom line: If you’re considering whether to seek PE financing, there is a real window of opportunity today. Dealmaking is starting to come back, exits are up, and the market may become more crowded next year as more DSOs look for capital.

🗳️ The Check-up:

⬆ VOTE: Has the federal shutdown impacted your organization?

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CLINICAL NOTES

🧠 Having both gum disease and cavities may increase the risk of having a stroke by 86% and increase the risk of heart attacks by 36%, according to a new study.

🍏 A naturally occurring compound found in fruits like apples and guava shows promise as an alternative to antibiotics for treating gum disease, demonstrating antimicrobial, anti-inflammatory, and antioxidant effects on bacteria similar to what causes gum disease. Turns out grandma was right about the apple thing.

🦷 Innovative two-step mock-up techniques may improve complete arch restorations compared to one-step methods, as research shows that more supporting teeth can reduce restoration deviations.

📱 Researchers have developed a smartphone-based imaging system that may improve early oral cancer diagnosis by using machine learning to analyze oral lesions and patient risk factors. The most useful app we’ve heard of in years.

FUN AND GAMES

BEYOND THE CUSP