Good morning. Baseball has chewing tobacco, eye black, and now floss picks.

Colorado Rockies rookie Ryan Ritter keeps a dental flosser in his back pocket during games, a superstition turned hygiene routine that started in Triple A. He’s not saying it is the reason behind his recent lucky streak, but he’s also not ruling out. Turns out elite habits start at the gumline.

Inside this issue:
- Siri, place the implant please
- Are your books lying to you?

⏰ Your reading time today: 5 mins 16 seconds

👑  Enjoy your coffee break with Word of Mouth, a dental-themed word game inspired by Wordle … guaranteed to leave you grinning, not grinding! Congrats to Dr. Allison Konick, dentist and owner of Kind Smile Dental Health, for joining this week’s leaderboard.

MARKETS

📈 3D Systems Corp ($DDD) – 1.54 | +0.085 (5.84%)
📈 Align Technology ($ALGN) – 189.33 | +8.30 (4.58%)
📈 Colgate-Palmolive ($CL) – 90.90 | +3.11 (3.54%)
📈 Dentsply Sirona ($XRAY) – 15.88 | +0.24 (1.53%)
📈 Envista Holdings ($NVST) – 19.54 | +0.43 (2.25%)
📈 Henry Schein ($HSIC) – 73.05 | +1.13 (1.57%)
📉 Straumann Holding AG (STMN.SW) – CHF 103.55 | -0.90 (0.86%)
📈 Weave Communications ($WEAV) – 8.32 | +0.12 (1.46%)

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

🚫 ADHA opposes Arizona bill undermining CODA standards for dental assistants, warning that Senate Bill 1037 risks public safety by allowing underqualified OPAs into practice. 

💰 Dentists push back as GOP tax bill targets SALT cap workaround, with ADA lobbyists warning new limits would raise taxes on pass-through dental practices by ending deductions previously allowed under Trump-era rules.

💧 RFK Jr. admits fluoride bans raise cavity risk as Oklahoma enacts anti-fluoride law, acknowledging the potential for increased decay as states continue explore restrictions on tap additives.

🤝 Louisiana becomes first state to join AADB-backed dental compact, permitting some cross-border licensure under a model that rivals the ADSO’s interstate framework. The battle of the pacts continue!

🦷 In a win for the AAO, Texas mandates in-person exam before orthodontic care begins, joining seven other states to ensure no brackets are placed without a real-world check. No scan, no brace.

🔍 North Carolina dentists pressure lawmakers over private equity ownership and low Medicaid rates, urging House leadership to block legislative language that they say would allow private equity-owned clinics in the state.

💰 ADA urges Congress to fund federal oral health agencies, requesting increased budgets for HRSA, CDC, and IHS to address care gaps and workforce shortages. Make Teeth Great Again.

🔄 ADA pushes for national interoperability standards, calling on policymakers to support secure data exchange to improve treatment planning. 

TECH WATCH

Siri, place the implant please

From surgical robots offering sub-millimeter precision to sci-fi-inspired hygiene swarms, robotics has long promised to reshape the dental operatory.

Sure, one FDA-cleared system is delivering real clinical value. But others are stuck in trials, seen only in showrooms, or buried in academic research. 

As DSO leaders flip through robot brochures and skim bold headlines, we’re cutting through the noise to separate what’s real from what’s still a futuristic sales pitch. Some assembly, and scrutiny, required.

What’s working now: Neocis’s Yomi is the only FDA-cleared robotic dental surgery system currently in use in the United States. With more than 60,000 implants placed and over 200 robots installed, Yomi uses haptic guidance and real-time feedback to reduce angular and platform deviation to less than one-third that of freehand placement.

Practices report faster full-arch workflows and significantly higher volume. One Texas clinic grew implant cases by 529% after implementation. Across the board, average volume rose by 137% in the first year.

The price tag reality: The Yomi system proves that robotic precision is already here and new innovations will likely be just as impressive. But the case study also provides a warning that the economics of deployment may be a barrier to robot adoption. That will remain a challenge not just for Yomi but for every surgical robot that follows.

For example, the YOMI system was selling for approximately $175,000 several years ago, with an additional cash outlay annually for maintenance. This upfront and ongoing cost must be justified by a significant increase in treatment cases or in enhancements to efficiency. To lessen the impact of the cost, Neocis launched a subscription model to shift robotic acquisition from a capital outlay to an operational expense. 

Still in development:  The next generation of robotics looks impressive, but most systems are not close to commercial rollout.

Boston-based Perceptive captured attention in 2024 by completing what it claimed was the first fully autonomous crown procedure. The robot aims to perform a fifteen-minute start-to-finish treatment, including preparation, fitting, and placement. But the system remains in human trials and is likely years away from FDA approval.

China’s Yakebot and Remebot offer fully or semi-autonomous implant placement, and early videos and case studies look promising. But they have not been reviewed in the United States, and it is difficult to separate marketing polish from clinical reliability. As of now, these systems remain locked behind China’s regulatory firewall.

Swarm of microbots: At the more experimental end, researchers at the University of Pennsylvania have demonstrated a swarm of microbots capable of brushing and flossing autonomously. These iron-oxide nanoparticles reconfigure under magnetic fields to scrub plaque and release antimicrobials. The concept is real, the science is sound, and the lab tests are impressive, but clinical translation, biocompatibility, and practical delivery are still unresolved.

Strategic considerations: For DSOs evaluating potential robotic and automation investments, the question is whether these systems make financial, operational, and patient experience sense now and into the future. The answer depends on an ROI evaluation of volume, infrastructure, execution, and marketing.

• Economics: If systems continue to require significant upfront capital investment like Yomi, robotic ROI will depend on high treatment value and volume. To justify robo-investments, both the operational realities of workflow implementation and the associated revenue have to be positive. 
  

• Infrastructure: Robotic systems need more than a plug. They require power upgrades, CBCT integration, layout adjustments, and IT support. DSOs will not only have to prepare buildouts to support robotic infrastructure but also plan for downtime, operatory modifications, and staff coordination.
  

• Training and execution: In the case of Yomi, clinical teams typically need twenty to thirty cases to become fluent. Based on that experience, DSOs should expect that early efficiency drops are common with new robotic systems, and that the shift from freehand to guided workflows is not trivial. DSOs may start thinking about training one or two of their staff as AI and robotic champions to begin thinking about product fit and the strategy to eventually scale adoption.
  

• Patient receptivity and marketing: Like any new technology, robot investments may invite initial patient skepticism. Messaging that emphasizes safety, precision, and innovation can enhance case acceptance and distinguish your brand in competitive markets. Patient-facing videos, simple visuals, and real case stories often work better than technical jargon. 

Bottom line: Robotics is no longer a futuristic concept. One system is proving its value. Others are on the way.

For DSO leaders, the real challenge is not just identifying what works. It is avoiding the temptation to adopt early without a clear plan. Every investment must answer three questions: Does it make financial sense, does it fit your operations, and does it improve the patient experience?

Dental automation will not arrive through one product or one breakthrough. It will depend on focused pilots, deliberate timing, and a business case that holds up in practice. ROI first, robo-revolution later.

BUSINESS BITES

🏆 Heartland Dental named one of America’s greatest workplaces in healthcare, earning national recognition for employee experience, growth, and workplace culture. Retention isn’t just about recalls.

🔗 MB2 Dental launches Carabelli Club for independent dentists, giving private practices access to perks without giving up ownership. Friends with benefits.

🧬 OrisDX raises $4M seed to launch saliva-based multiomic oral cancer test, using machine learning and salivary biomarkers. 

🔄 North Carolina halts private-equity dentistry proposal, shelving plans to change Medicaid reimbursements and board structure.

📢 Align launches integrated kid-focused Invisalign campaign, targeting both parents and providers with early ortho messaging.

💰 SALT Dental appoints David Pallaschke as CFO to drive multi-state growth, bringing along a wealth of experience to scale their DSO expansion.

FINANCE

Are your books lying to you?

For emerging DSOs, cash-based accounting often makes sense during those awkward early teen years. It is simple, familiar, and shows what is in the bank. When you are running lean and growing fast, that clarity feels like control.

But as your business matures, that simplicity can start to get in the way. Are you measuring true performance or just tracking cash?

That is where the shift to accrual accounting comes in. Let’s dive into why DSOs start on cash, what happens when they stay too long, and what it really means to switch.

What’s the deal: Cash accounting records revenue when it is received and expenses when they are paid. It tracks what hits your bank account and when. That makes it easy to monitor cash flow, stay lean, and simplify tax reporting.

Most DSOs begin here. It keeps bookkeeping tight and gives owner-operators a clear sense of what is available to spend. In the early stages, especially for single-site or low-complexity groups, it works.

Where it breaks down: Cash keeps it simple. Until it does not. As complexity increases, cash-based accounting starts to distort reality. Once you operate across multiple locations, handle insurance billing, or use performance-based compensation, the timing gaps between work and payment become a problem:

• Collections show up in a lump even if the work was done weeks ago.

• Bonuses tied to collections may lag or misalign with actual production.

• A big cash month might reflect old receivables, not current performance.

• Lab fees and supply costs may hit in one month while associated revenue lags into the next.

This makes it harder to benchmark, harder to budget, and harder to manage growth with confidence.

What accrual fixes: Accrual accounting records revenue when it is earned and expenses when they are incurred. It matches income to the work and expenses to the moment they happen.

This gives DSOs a clearer view of performance and a more consistent basis for decision-making:

• Revenue aligns with production.

• Bonuses can be based on actual output, not delayed collections.

• Future cash flow becomes easier to forecast.

• Reports support GAAP compliance and investor diligence.

"Accrual accounting isn't just about compliance; it's about clarity. It aligns revenue with the work performed and expenses with their occurrence, providing a true picture of a DSO's financial health," said Mike White, CPA at CliftonLarsonAllen LLP, who regularly advises operators in the industry.

When to switch: There is no single trigger. DSOs may make the move as they approach higher levels of revenue (e.g., $10 million or more in annual revenue), open more locations, get more complicated payer or revenue models, or foresee investor involvement in the near future.

The earlier you convert, the cleaner your financials will look, especially to prospective investors or buyers. Many recommend going back at least twelve months when switching to ensure year-over-year trends are accurate and investor ready.

What it costs to wait: Staying on cash too long does not just cloud decision-making. It can reduce enterprise value. Buyers and lenders expect accrual-based, GAAP-compliant statements. If you are not there, you may need to restate years of financials or delay a deal entirely.

"When done correctly, accrual accounting will immediately make your financial information far more accurate and enable more reliable forecasting. In the long term, it will ensure you maximize the enterprise value of your business," said Ken Kaufman, a longtime DSO CFO who regularly advises emerging DSOs on finance strategy through his company AccruDent.

How to make the switch:

• Bring in a CPA with DSO experience.

• Upgrade your accounting system to support accrual and multi-entity tracking.

• Educate your team on how to build, read, and act on accrual-based reports.

• Start the conversion with a clean twelve-month retrospective to align your baselines.

• Pull data carefully from your practice management system. If not done correctly, this is where costs and chaos escalate fast.

Bottom line: Accrual accounting is not about technical correctness. It is about visibility, credibility, and long-term value.

For growing DSOs, it unlocks better decisions, tighter operations, and a stronger path to investment. The longer you wait, the less your numbers reflect the business you are actually running. And the harder it is to convince someone else to buy it.

CLINICAL NOTES

🧲 Orthodontists test shape-memory aligners using smart polymers, designed to snap back to form with specific temperatures. 

🪢 Tufts researchers use dental floss to measure stress hormones, collecting biomarkers from gingival crevicular fluid. Now your floss can diagnose your anxiety spiral.

💉 DentalJect gets FDA clearance for needle-free anesthetic spray, delivering numbing agents before local injection. 

🌿 Theodent’s fluoride-free Rennou Varnish gets FDA clearance, marking the first pro-grade fluoride-free cavity varnish. RFK Jr. is smiling somewhere.

🧠 Lower oral microbiome diversity linked to higher depression scores, with researchers suggesting the mouth could be a noninvasive screening site for mental health risk. 

🦷 Dental cementum analysis offers new tool for tracking lifetime tobacco exposure, helping identify smoking history in both living patients and archaeological remains. Your teeth keep receipts.

BEYOND THE CUSP

• Czech man charged for running unlicensed dental clinic after learning procedures online. DIY is for Ikea, not dentistry.

• Tufts dentist Abe Abdul transitions from solo advocate to State House strategist.

• Humpback whales caught blowing bubble rings toward boats, with researchers wondering: Are they talking to us?

• How-to guide: jumping from manager to executive.

• Trailblazing Native American dentist Dr. George Blue Spruce Jr. dies at 94, remembered for expanding dental education and founding the Society of American Indian Dentists (SAID).