Good morning. Dental products are going upmarket. At least that’s the forecast of marketing intelligence firm VML, which heralds a “radical redefinition” in oral products as “consumer priorities shift from simple hygiene to cellular optimization and avant-garde self-expression.” 

What will this look like in practice? According to the report, expect to see more high-end toothpastes that serve as “affordable ‘little treats’” and “subversive physical adornments like tooth gems and grills.”

Call us old-fashioned, but we’ll stick with mint.

Inside this issue:

- A trove of new dentistry data
- The science is in on the mouth-body link

⏰ Your reading time today: 6 minutes 58 seconds

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

MARKETS

📈 3D Systems ($DDD) – 2.83 | +0.28 (10.98%)
📉 Align Technology ($ALGN) – 172.89 | -2.82 (1.60%)
📉 Colgate-Palmolive ($CL) – 89.88 | -0.19 (0.21%)
📈 Dentsply Sirona ($XRAY) – 14.13 | +0.53 (3.90%)
📉 Envista Holdings ($NVST) – 27.37 | -0.630 (2.25%)
📈 Henry Schein ($HSIC) – 86.51 | +0.98 (1.15%)
📉 Park Dental Partners ($PARK) – 18.51 | -0.04 (0.22%)
📈 Straumann Holding ($STMN) – CHF 102.90 | +1.65 (1.63%)
📉 Weave Communications ($WEAV) – 6.75 | -0.17 (2.46%)

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

THE DRILL DOWN

🥊 ADSO takes Colorado Dental Board to court over a new rule it says will severely restrict how DSOs operate in the state, arguing the board "overstepped its authority" since the underlying legislation never mentioned DSOs, and warning the restriction threatens patient access and reduces the amount of time dentists can spend treating patients. The Board may have bit off more than it can chew.

🤖 Nearly 30% of dentists say they will never use AI in their practice, even as more than 43% are already using it for at least one task, with imaging and diagnostics leading adoption, according to a new ADA Health Policy Institute report.

📵 A federal court dismisses a class action lawsuit against Heartland Dental over AI-monitored patient phone calls, ruling that the plaintiff failed to show the interception of calls by RingCentral AI violated the Federal Wiretap Act. AI has joined the call— legally—for now.

🍬 Ortek Therapeutics carves out a new product category with its launch of BasicBites soft chews, branding them as "Daily Enamel Nutrition," and claiming they support oral pH and remineralization, targeting customers with dry mouth, elevated caries risk, or GLP-1-related side effects.

🪥 The Centers for Medicare and Medicaid Services urges state Medicaid programs to phase out coverage for mercury-containing dental fillings, the latest push by the federal government to eliminate amalgam from American dentistry.

💰 California delays $1 billion in Medi-Cal dental cuts by one year, with Governor Newsom and the legislature agreeing to preserve current reimbursement rates and benefits through July 2027, after a CDA survey found nearly half of Medi-Cal dentists would have left the program had the cuts taken effect. California hits pause on the extraction.

⚖️ A federal judge strikes down a South Dakota dental advertising rule as unconstitutional, siding with the American Academy of Implant Dentistry and finding that the state Board of Dentistry’s 2023 restriction on dentists using the term "specialist" for non-ADA-recognized fields violated First Amendment free speech protections.

🦷 Delaware's General Assembly unanimously passes a bill expanding dental hygienists' scope of practice, allowing them to administer fluoride under standing orders, place sealants, and directly supervise dental assistants.

🗺️ Washington, D.C. weighs legislation to join a multistate dental licensure compact, introduced to address two designated dental health professional shortage areas in the district, which would make D.C. the third member of the cross-border licensing agreement if passed.

💉 Maine raises Medicaid reimbursement rates for dental deep sedation and anesthesia, updating rates for four procedure codes and eliminating prior authorization requirements for sedation services exceeding five 15-minute units.

🎓 Virginia invests $1 million to expand dental hygiene education programs, part of a broader $20 million career and technical education package, with a new Southwest Virginia program targeting 10–15 graduates annually by 2027 to help close a statewide deficit of roughly 1,000 hygienists. Old Dominion invests in new hygienists.

INDUSTRY

Dentistry in the first half of 2026: Busy practices, squeezed margins, and choosy buyers

It’s just past halftime in 2026 and several new reports are converging on a consistent story about the big trends in the dental sector this year.

What’s happening: Reports from the ADA, sell-side advisory firm TUSK Practice Sales, and Planet DDS all paint a similar picture of an industry experiencing strong demand but struggling to turn that into profitable growth. And below the surface, a sector-wide split into two camps: one growing while protecting margin and the other getting squeezed.

The evidence: Independent government figures, the ADA's quarterly dentist poll, industry surveys, and advisory reports all confirm the trendlines:

• Demand is holding. The share of dentists who say they're "not busy enough" fell to 26%, down from about a third in the back half of 2025, and the average new-patient wait edged up to almost 14 days.

• But the money isn't following. Consumer spending on dental care rose only about 1% over the past 12 months, and over the past decade, dental remains health care's laggard, up roughly 24% versus 39% for health care overall and 46% for physician services.

• Margins are getting squeezed. Averaged across all payers, reimbursement has risen about 19% against 27% inflation since early 2021. In the first half of 2026, staff wages climbed 2.2%, outpacing both reimbursement and inflation. It's the single reason skeptical dentists cite most for their pessimism.

• Beneath the flat average, growth has split in two. Same-store production growth cooled to a weighted 2.2% in the first half, down from 4.0% in 2025, and only 56% of practices grew at all, per Planet DDS’s 2026 mid-year outlook. But the average papers over the real divide: Roughly a third of practices posted double-digit growth, while the share in steep decline—off 10% or more—widened to about one in five, up from the roughly one in seven reported in Planet DDS's 2025 outlook.

• Consolidation and dealmaking growth is still down from its peak. DC Advisory pegs annual growth in private equity-backed locations at under 3% so far in 2026, down from 23% in 2022, and counts more than 50 of the last 55 DSO recapitalization attempts as failed.

• Deals are getting done, but buyers want solid operating models. TUSK counts roughly 175 locations across about 128 reported transactions in the first five months, with 130-plus active PE buyers. So yes, deals are getting done. But the 5–9x multiples of the past couple years are expected to compress, with TUSK projecting a long-term drift toward the 4-7x range. And the gap between the best offer and the middle offer on a given practice this year is the widest TUSK has tracked. How well a practice is run is now the deciding factor in how it’s priced.

Why it matters: Performance is diverging just as the exit ramp is narrowing. Buyers are bidding for the same, shrinking pool of practices that have steady growth and efficient operations, while the rest of the market struggles to attract investment. Practices are being repriced on that basis by the firms that are still actively doing deals. 

• The stakes are particularly high right now given the wave of owners hitting retirement age (in some states more than 40% of dentists are already 55 or older) and looking for a rewarding exit. Many may be facing a surprise discount on what they expected to fetch in this environment.

Bottom line: So far 2026 is a story of a divergence in the industry more than a downturn. The data shows healthy demand and busy practices on average, but with rising cost pressures that are punishing less efficient operators. Meanwhile, without a rising tide to lift all boats, the premium for running a tight ship is growing.

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BUSINESS BITES

👔 Notable leadership changes: Smile Doctors names Jeff Knudson its chief financial officer and DECA Dental Group appoints Michele Silverman its new chief people officer.

📈 Deals and de novos: Imagen Dental Partners adds a Seattle practice, Premier Care Dental Management acquires a practice in Brookline, Massachusetts, and Specialty1 Partners announces a partnership with Periodontal Associates in the Cleveland area.

🍁 Dentalcorp crosses the border into the U.S., acquiring Northstar Dental Partners in Boca Raton, FL, a 21-practice group, expanding Canada's largest dental network to 650 supported locations across North America. Welcome to the States, eh.

🔄 Paradigm Oral Health completes surgeon-led buyback from BlackRock, returning majority control to its surgeons and management team with new backing from Warburg Pincus, Goldman Sachs Alternatives, and Sixth Street. The surgeons are back in the driver's seat.

👔 Henry Schein overhauls its leadership structure, replacing its Executive Management Committee with a new Henry Schein Leadership Team and integrating its global supply chain and distribution groups, with three senior executives transitioning to advisory roles effective October 31.

📈 Align Technology posts $1.06 billion in Q2 2026 revenue, driven by a record 691,785 clear aligner shipments (up 7.4% year-over-year) with clear aligner revenue alone climbing 8.2% to $871 million.

CLINICAL

The science is in on the mouth-body connection, but the clinical rollout lags

Terms like “the mouth-body connection” have been staples of industry conference talks for years, but in practice the dentist-physician divide has remained more or less intact. That may be starting to change, as the science becomes undeniable and evidence that dentists really are “physicians of the mouth” goes mainstream.

What happened: Researchers are increasingly tying gum disease and the mouth's bacteria to larger health conditions, including heart disease, diabetes, and cognitive decline, according to a recent The Wall Street Journal roundup of emerging science.

• One study linked a preventive dental visit before hospitalization to a 10% lower risk of hospital-acquired pneumonia and periodontal therapy to a 30% lower risk.

• Another associated periodontal disease with a 24% higher risk of major adverse cardiovascular events, a 26% higher risk of stroke, and a 31% higher risk of all-cause mortality.

• In people with diabetes, treating gum disease lowered the average patient’s blood sugar by almost as much as some diabetes medications, according to a 2022 analysis.

Why it matters: For DSOs, this is the moment oral-systemic care is quickly becoming a real opportunity. Two things have finally made it actionable:

• Diagnostics that surface these risks, like chairside saliva tests, A1c and blood-pressure screening, have improved, and can now double as case-acceptance tools, giving patients a concrete reason to say yes to treatment they'd otherwise put off.

• Payers are starting to take notice. Some major carriers (Aetna is one) are spinning up dental-medical integration programs that flag at-risk members and cover added periodontal care, and the ADA has created a point-of-care saliva testing code, giving practices a standard way to document the service, a step toward billing for it.

Yes, but: Knowing the science and operationalizing it are different animals, and most of the industry is still in early days, with one of the most significant barriers now being the missing plumbing needed to connect dentists and physicians.

• Dental and medical providers usually work in separate records that can't talk to each other, there's rarely a referral pathway to a patient's physician, and the two sides bill on separate coding systems.

• Dentists also cite a lack of reimbursement as a barrier to integrating more health screening into their practice.

What they’re saying: On a recent episode of The Dental Economist Show, PDS Health CEO Stephen Thorne said his organization is already seeing positive results—a 32% lift in patient activation from saliva testing and millions in medical savings—from its integration of dental and medical care, which includes a shared Epic record spanning both practices, chairside saliva diagnostics, and an in-house medical group.

Bottom line: Some DSOs are starting to treat "physician of the mouth" as an operating model rather than a slogan, betting that reimbursement follows the evidence. At this point, it’s still a differentiator (and one that patients will appreciate), but in the near future, it could be table stakes.

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CLINICAL NOTES

💧 Sparkling water temporarily lowers salivary pH but not enough to threaten enamel, with a new study finding the acidity spike stays above the critical threshold at which enamel dissolves. Reach for the Perrier over the Pepsi.

🧒 A national U.S. trial confirms SDF is effective and safe for halting tooth decay in young children, with a 38% SDF solution arresting 54% of cavitated dentin caries lesions six months after one application—though it also permanently darkens the treated area. A painless solution with a catch.

🧠 Childhood spinal pain may be an early warning sign of painful TMD and headaches in adulthood, with a longitudinal cohort study of nearly 10,000 adults finding that preadolescents with neck or back pain faced higher risk of painful temporomandibular disease later in life.

🍷 Lifestyle factors including alcohol consumption may causally contribute to mouth ulcers, while longer sleep duration appears protective, according to a study that used genetic data to explore links between obesity, habits, nutrients, and recurrent ulcers in roughly a quarter of the population affected by the condition.

BEYOND THE CUSP

• A non-invasive brush test may be able to detect oral cancer in under an hour.

• Heartland Dental has a new podcast “featuring leaders and doctors discussing the key trends and innovations in dentistry.”

• You won’t be surprised to learn the most widely disseminated myths about oral health have to do with fluoride water fluoridation (though sketchy DIY remedies are also in the mix).

• New York City is suing two dental practices that it alleges were pushing unwitting patients to sign up for high-interest loans (sometimes while they were still in the chair) rather than using insurance to pay for treatment.

• Watch: The surprising history of how traffic lights got their colors.