🦷 Picky PE

PE gets picky, How to step up your patient experience tracking

March 17, 2026

Good morning. Researchers at Vanderbilt found evidence of periodontitis and heart disease in 4,000-year-old Egyptian mummies using CT scans to look at the (relatively) well-preserved dental cavities and calcified blood vessels of the 37 ancient specimens.

Turns out that patients have been ignoring flossing advice since the pharaohs.

Inside this issue:

- PE gets picky
- How to step up your patient experience tracking

⏰ Your reading time today: 6 minutes 14 seconds

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

MARKETS

📉 3D Systems Corp ($DDD) – 2.43 | -0.050 (2.02%)
📉 Align Technology ($ALGN) – 169.45 | -3.93 (2.27%)
📉 Colgate-Palmolive ($CL) – 90.30 | -2.34 (2.53%)
📉 Dentsply Sirona ($XRAY) – 11.73 | -1.21 (9.39%)
📉 Envista Holdings ($NVST) – 25.02 | -1.80 (6.71%)
📉 Henry Schein ($HSIC) – 74.61 | -3.66 (4.68%)
📉 Park Dental Partners ($PARK) – 17.07 | -1.92 (10.11%)
📉 Straumann Holding AG (STMN.SW) – CHF 81.24 | -3.98 (4.67%)
📉 Weave Communications ($WEAV) – 4.88 | -0.13 (2.50%)

Stock data reflects market close yesterday, showing changes over the past five days.

THE DRILL DOWN

🏛️ Federal report finds top three dental insurers control nearly 67% of the market, with single-insurer dominance reaching as high as 95.1% in some states, raising fresh concerns about vertical integration and lower provider reimbursements. The insurance market is getting more concentrated than Minute Maid.

🧲 The first dental-dedicated MRI system has received FDA clearance, with Dentsply Sirona and Siemens Healthineers unveiling the MAGNETOM Free.Max Dental Edition following a clinical trial validating its use across endodontics, periodontics, TMJ, and orthodontics. Dentistry gets magnetic.

đź’° Dentistry ranks among the top occupations most likely to offer signing bonuses, according to Indeed's Hiring Lab, as employers increasingly opt for one-time payments over wage increases to attract talent in a cooling labor market.

🚨 Pediatric dental ER visits surged 57.9% nationwide from 2019 to 2022, as provider shortages push children—some with widespread tooth decay rather than isolated cavities—into hospital emergency departments for care.

⛰️ Utah passes bill letting hygienists practice in hospitals without dentist supervision, expanding the existing public health setting definition to include hospitals under HB 414, which takes effect May 6 if signed by the governor.

🤖 New York proposed legislation to ban AI chatbots from giving dental and medical advice, and to hold companies like OpenAI and Anthropic liable for damages if their tools imitate licensed professionals. License required, algorithms need not apply.

đź’¸ Virginia is weighing a $2,000 annual cap on Medicaid dental services for adults, a budget proposal tied to a broader state shortfall that’s been exacerbated by the One Big Beautiful Bill Act.

🌿 Georgia earmarked $3.35 million in new oral health funding, including $3.2 million for rural health clinics and $150,000 for the Georgia Mission of Mercy program, which provides free dental care to uninsured and underserved adults.

🪥 A bill to create a new “dental therapist” professional category has stalled in Florida's Senate, despite passing the House 80-29, as the state contends with an ongoing shortage of approximately 1,300 dentists.

đź“ť Indiana’s governor signed into law a bill to create hygienist licensure pathways for internationally trained dentists, part of an effort to address labor shortages in the industry.

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M&A

Private equity is still in on dental, but now it wants proof

Private equity hasn't fallen out of love with dental, but it has gotten pickier about who it takes to dinner.

Driving the news: Dental private equity (PE) deal count fell 36.5% year over year in 2025, per PitchBook's Q4 Healthcare Services Report—the steepest drop of any major healthcare services subsector, even as broader healthcare PE deal activity rose.

  • General dentistry, orthodontics, endodontics, periodontics, and pediatric dentistry all contracted. The lone exception was oral surgery, which grew 9.1%.

Why it’s happening: Two forces are colliding. PE buyers are still digesting COVID-era valuations and the debt loads that came with them, and the credit markets that finance those deals are getting tighter at exactly the wrong moment.

  • JPMorgan recently began marking down private credit loan portfolios and pulling back on lending to private credit firms.

  • That matters for dental because private credit funds are often a primary source of leverage for DSO acquisitions and recapitalizations. When JPMorgan squeezes the lenders, the lenders squeeze the sponsors, and the sponsors squeeze the deal terms.

What’s next: Deals are still going to get done in 2026, but they’ll look different than in past years. Healthcare practice sales advisory TUSK reports that 78% of DSOs it surveyed expect recapitalizations within 12 to 36 months, while 61% say their PE backers expect a moderate or high uptick in 2026 deal volume.

  • PitchBook counted 37 dental platforms past the five-year mark as of early 2024—a number that has only grown since—and industry analysts say almost every DSO in the market is now overdue for a recapitalization.

  • More activity, combined with tighter conditions, means more scrutiny. Premium assets should still command premium pricing. Average assets are more likely to face longer timelines, heavier diligence, and tougher negotiations.

What separates the winners: The spread between top and bottom offers has never been wider, and the benchmarks are getting sharper.

  • Same-store growth is the first filter. Nearly 40% of dental practices didn't grow year over year in 2025, which makes consistent organic growth a genuine differentiator.

  • EBITDA margins at or above 20% are the floor for investment-grade assets. Below that, expect steep discounts and longer timelines.

  • Solid staff and doctor retention is a meaningful metric that buyers and lenders will scrutinize. Leaders in the space achieve retention rates in the mid to 90% range.

And one big green flag: A strong oral surgery practice. This can really set a practice apart for potential buyers, as it enjoys structural advantages like referral-driven patient flow, higher reimbursement, and limited provider supply due to 4 to 6 years of post-dental-school training. At least eight PE-backed platforms are actively consolidating the space.

Bottom line: The next 18 months will separate DSOs that built real operational engines from those that rode leverage and a hot market. All indicators point to 2026 as a major recapitalization year, but the capital will flow to platforms that can defend their cash-flow story under brighter lights.

BUSINESS BITES

đź‘” Notable leadership changes: The American Dental Association named Nader A. Nadershahi as its next executive director, the U. S. Dental Assisting National Board named Michelle Lee as its vice president of external relations and policy, and Dr. Candace Gama joined United Concordia as its director of dental clinical review and auditing.

🏗️ Henry Schein opened its first integrated dental-medical training facility, an 8,300-square-foot Dallas Discovery Center in Southlake, Texas, featuring a fully equipped exam room, ambulatory surgery center site, and immersive learning environments.

LAST ISSUE’S POLL RESULTS

OPERATIONS

How better patient experience tracking can drive bottom line revenue

You probably already watch your production per visit, case acceptance, and hygiene reappointment numbers like a hawk. But do you know whether your patients actually felt heard? Whether they understood what they were paying for? Whether the front desk picked up the phone?

What’s happening: Patient experience is quietly becoming the next DSO operating metric, and the gap between tracking it well and tracking it badly could determine whether your patients stick around for the next appointment or quietly schedule somewhere else.

  • Case studies abound of DSOs and practices that are seeing positive results after focusing on tracking and improving different patient experience: Smile Workshop drove a 193% increase in reviews and surfaced problems for local teams, Dr. Dental saw its online rating jump from 4 stars to 4.7, and Pearl Street Dental Partners said its follow-up workflow helped schedule more than $1.1 million year-to-date across 43 locations.

Why it’s happening: Scale is forcing the issue. Ensuring a quality patient experience is one thing with one or two locations, and quite a different challenge across dozens of locations. As DSOs scale up, tracking patient experience metrics becomes critical to maintaining consistency across practices and surfacing issues before they show up as a serious, organization-wide patient retention problem.

  • CareQuest's North Carolina oral health initiative offers an instructive example. In this case, practices began tracking 14 patient-reported experience metrics and uncovered previously unaddressed issues ranging from price transparency to scheduling bottlenecks that left patients frustrated. 

Why it matters: Patient experience isn't just a "soft" metric. Dental-specific studies have found that a positive patient experience is crucial to driving loyalty and return visits, and DSOs that have deployed structured experience programs report meaningful gains in review volume, booking conversion, and revenue recovery from recall and reactivation workflows. 

  • Studies of the broader healthcare sector have even found associations between patient experience and self-rated and objectively measured health outcomes. In other words, patients that feel well-treated are more likely to have positive health outcomes.

What you can do: A blended scorecard built off a variety of touchpoints with patients and data about patient behavior is the best way to get a realistic picture of your clients experience. Here are some tips to get started:

  • Begin with a short post-visit survey covering access, wait time, communication, treatment understanding, cost clarity, and likelihood to return or recommend.

  • Consider including the opportunity for patients to submit free-text comments and feedback. With AI tools, practices can easily compile these to draw out insights and common concerns (or praise!).

  • Pair direct patient feedback with hard operating data: broken appointments, recall performance, follow-up completion, response times, review-response rates, and booking conversion.

  • Review results by location, not just at enterprise level, and read comments weekly rather than quarterly to identify problems before they spiral. 

What about net promoter scores? Sending a post-visit survey asking for a 1 to 10 net promoter score (NPS) is a fine starting point, and something many practices already do, but research has found this metric often adds limited standalone value and can mislead in markets where patients don't have real provider choice. 

Bottom line: Like any part of the business, understanding your patient experience at scale requires a rigorous, data-driven approach. The evidence shows that the DSOs that get it right will enjoy a real advantage when it comes to keeping patients coming back.

🗳️ The Check-up:

⬆ VOTE: How do you expect PE deal activity in dental to change this year?

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CLINICAL NOTES

🧠 Cerebral small vessel disease may accelerate gum disease progression in older adults, with a study finding that common CSVD markers like white matter hyperintensities and cerebral microbleeds were associated with worse periodontal measures, including greater probing depth, clinical attachment loss, and tooth loss.

đź’Š Nutritional supplements may boost the effectiveness of scaling and root planing, with a review of studies finding that herbal extracts, probiotics, melatonin, vitamins, and antioxidants used alongside nonsurgical periodontal therapy improved key outcomes including bleeding on probing and clinical attachment loss.

FUN AND GAMES

BEYOND THE CUSP