Good morning. A dentist in Iowa was fined for posting “unprofessional responses to negative online reviews of him” that (according to the Iowa Dental Board) violated patient privacy. 

We reviewed the practice’s Google Maps listing to see if any of the offending replies were still public, but it looks like they were all edited around six months ago with the disclaimer that “to protect privacy, we cannot discuss specific situations publicly.” 

Sounds like they learned a lesson, though we’d also suggest that refraining from fighting with people on the internet is just good practice generally.

Inside this issue:

- Saliva testing’s first real job
- How consolidated is dental, really?

⏰ Your reading time today: 6 minutes 52 seconds

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

MARKETS

📈 3D Systems ($DDD) – 3.28 | +0.07 (2.18%)
📈 Align Technology ($ALGN) – 159.79 | +0.64 (0.40%)
📉 Colgate-Palmolive ($CL) – 89.82 | -1.80 (1.96%)
📈 Dentsply Sirona ($XRAY) – 11.17 | +0.200 (1.82%)
📉 Envista Holdings ($NVST) – 27.14 | -0.330 (1.20%)
📉 Henry Schein ($HSIC) – 89.80 | -0.19 (0.21%)
📈 Park Dental Partners ($PARK) – 20.74 | +0.44 (2.17%)
📈 Straumann Holding ($STMN) – CHF 93.90 | +2.18 (2.38%)
📈 Weave Communications ($WEAV) – 7.31 | +0.010 (0.14%)

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

THE DRILL DOWN

⏸️ Colorado Dental Board pauses enforcement of rule restricting DSOs, earning praise from the The Association of Dental Support Organizations (ADSO), which said in a press release that the pause would create time to modify the regulations (covered by The Morning Grind last month) and protect “access to care without imposing undue compliance burdens on the practices working to provide it.” Problem avoided … for now.

📉 Private equity deal activity in healthcare slumps, with Pitchbook's Q2 Healthcare Services Report finding deal count down 18.5% year over year and exit value falling nearly 31%, while flagging dental as a sector with significant aged inventory among PE-backed companies.

📋 FinCEN permanently eliminates Corporate Transparency Act reporting requirements for many dental practices, finalizing a rule that exempts small businesses with fewer than 20 employees or under $5 million in annual gross receipts from beneficial ownership disclosure obligations. One less form on the front desk.

💊 ADA urges dentists to rein in antibiotic prescribing, publishing a clinical practice statement calling for restraint after finding dentist prescribing rates were have not fallen since 2012, with dentists still accounting for roughly 10% of all outpatient antibiotic prescriptions. When does the “Only you can stop antibiotic resistance” PSA drop?

📈 Dental therapy program enrollment surges 533% since 2021, climbing from just 6 students to 38 in the current academic year, according to new ADA data.

🔒 Minnesota dental nonprofit settles class-action lawsuit tied to a 2024 cyberattack, with Community Dental Care agreeing to compensate the nearly 135,000 patients whose names, Social Security numbers, and health information were accessed without authorization.

🪥 Delaware expands dental hygienists' scope of practice, allowing hygienists to apply sealants and perform cleanings without a prior dentist exam, administer fluoride under standing orders, and directly supervise dental assistants.

⚠️ Texas advocates push for stricter pediatric dental safety laws following a four-year-old's death at a Fort Worth dental office, calling for mandatory Pediatric Advanced Life Support (PALS) training and required public disclosure when a patient dies at a practice.

CLINICAL

Saliva testing's first real job may be converting perio

For years, saliva has been pitched as the next frontier in dental diagnostics. Now, some researchers think the frontier has arrived—and its first job may be getting patients to say yes to perio treatment.

What happened: Salivary testing is moving out of research and into operations thanks to breakthroughs in our ability to read what’s in our spit.

• Saliva contains a dense mix of potential biological signals, but extracting any information from it has been—until recently—expensive and slow. That’s changing, however, as advances in genomics and other fields have made it possible to quickly and affordably detect more of the biological markers transmitted in saliva. 

• A 2026 review, for example, highlighted advances in sensors that can allow providers to detect specific biomarkers from saliva samples without having to send anything to a lab.

The perio connection: Perio is becoming an early proving ground for salivary testing because of its potential to measure something conventional exams do not directly capture: active tissue breakdown.

• While traditional exams largely show the current condition of the periodontium and damage that has already occurred, salivary testing has the potential to show what’s happening in the mouth right now by measuring levels of an enzyme called aMMP-8 that’s involved in collagen degradation.

• The science still isn’t perfect, however. A 2025 meta-analysis found point-of-care aMMP-8 testing had moderate overall diagnostic accuracy and concluded saliva testing should supplement, not replace, a clinical exam.

Why it matters: In terms of deployment in the real world, salivary testing is still not standard for most practices, though there’s at least one good reason for DSOs to consider changing that: it appears to be an effective way to encourage more patients to accept perio treatment. 

• Delta Dental of Massachusetts tested that idea with Smile Generation by offering chairside aMMP-8 screening during regular exams at no additional out-of-pocket cost. Of the 1,600 people who underwent an assessment during a regular exam, 50% subsequently accepted a periodontal treatment plan when recommended by their provider.

• More than 400 patients in the Delta program were tested multiple times, and returning patients' aMMP-8 scores improved by more than 33% on average. One participating dentist argued that repeatedly showing patients an objective wellness score helped drive engagement and action.

What you can do: It’s up to DSOs to decide whether the potential for greater perio conversions justifies offering salivary testing at a price point patients will accept (or at no cost).

• The good news is DSOs are well positioned to do this—a pilot program measuring the impact of this run across 20 locations can generate more useful real-world evidence than a single practice could collect in years.

Zoom out: Perio may only be saliva's opening act. Researchers are studying salivary biomarkers for caries, xerostomia, diabetes, cardiovascular disease, neurodegenerative disease, and other conditions—some day, a visit to the dentist may include screening for all of that and more.

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BUSINESS BITES

👔 Notable leadership changes: Andrew Smith is stepping down as CEO of the Association of Dental Support Organizations (ADSO) at the end of the year, U.S. Oral Surgery Management names Jennifer Ellis as its chief financial officer, Curve Dental makes Luke Anderson its chief product officer, and Patterson Companies appoints Wasi Ahmed as its chief information officer.

📈 Deals and de novos: Straine expands into Idaho, its 17th state, with the acquisition of a practice in Idaho Falls, U.S. Oral Surgery Management partners with a New Mexico practice, Qualitas Dental Partners adds an office in Rhode Island, Sage Dental opens a new practice in Florida, Aspen Dental opens a new practice in North Carolina, Specialized Dental Partners adds a Georgia location, and Heartland Dental signs a new affiliate in Virginia.

🤝 Shared Practices Group lands PE backing from M-One Capital, with the 48-location DSO saying it plans to use the minority investment to expand its denture and implant-focused affiliate network, upgrade technology, and build out clinical support infrastructure.

🤖 Planet DDS announces year-over-year growth for Denticon of 24.3%, driven by enterprise adoption by Coast Dental, Jefferson Dental, Mosaic Dental Collective, and Orthodontic Partners.

💊 Arcato Laboratories completes Phase 1 trial and closes first financing round, saying its non-opioid anesthetic gel delivered successful top-line results in post-extraction pain management. A promising step toward opioid-free recovery.

💰 Sonendo secures a $15.5M loan, which it says will be used to refinance an existing $13.7M debt facility.

CONSUMER

How consolidated is dentistry? It depends on what you're counting

Every growth plan in the DSO world rests on estimates of how much of dentistry is still unaffiliated. Yet figuring out the actual number is proving to be surprisingly difficult.

What happened: A recent estimate by advisory firm TUSK Practice Sales that around 35% of the industry is already consolidated raised eyebrows and sparked questions about where consolidation in the dental space actually stands.

The math: Four numbers get quoted, but they’re actually answering four different questions. 

• 12.8%. The lowest number you’ll usually see is 12.8%. Peer-reviewed research in Health Affairs tracked private equity affiliation among dentists from 6.6% in 2015 to 12.8% in 2021. But keep in mind that’s a narrower category than DSO-affiliated practices.

• 16.1%. The ADA Health Policy Institute (HPI) puts DSO affiliation at 16.1%, though that counts dentists rather than offices.

• ~26%. Speaking on The Dental Economist Show, Boston Consulting Group's Chris Moxon splits roughly 137,000 practices into about 9% held by the top 50 DSOs and another 17% inside smaller groups. Moxon says that only about 8,600 unaffiliated practices clear $2 million in annual revenue, though, suggesting that consolidation of larger practices may be further along than headline numbers suggest.

• 35%. And the highest number comes from the aforementioned TUSK Q3 2026 market report, which opens with the line that roughly 35% of the dental industry is now consolidated.

So, why the discrepancy? Two of those gaps have clear explanations. HPI counts dentists who report affiliating with a DSO, while BCG counts offices inside a group of any size, which would capture a three-location owner who would likely not describe themselves as a DSO.

• TUSK names 5,600 practices across the five largest DSOs but does not publish its full methodology, so it’s difficult to assess its claim that the industry is 35% consolidated. It’s true, however, that group-affiliated practices skew larger, so a quarter of offices could plausibly account for a third of the $189 billion Americans spent on dental care in 2024.

Why it matters: The degree of consolidation has implications for what sort of multiples practices can expect to command when acquired. TUSK argues that the 35% consolidation figure places dentistry in the middle of a consolidation lifecycle in which multiples fall from the 8 to 10x of the golden age toward 4 to 7x at full consolidation.

• It’s also relevant for buyers trying to determine how big the pool of sellers is. At 16.1%, five out of six dentists sit outside a DSO and you're early. At 35%, the easy phase is behind you.

Bottom line: If you need one number, Moxon’s count of roughly a quarter of offices is a reasonable one to anchor on. It’s the broadest measure with a published denominator that can be corroborated, and it captures practices in smaller groups, which is the larger bucket. But remember that this figure is contested and will swing depending on what it is you’re actually trying to measure.

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CLINICAL NOTES

🦷 Natural tooth count may predict long-term survival after pancreatic cancer surgery, according to a Japanese study finding that patients with more remaining natural teeth fared better following the procedure. 

🌿 A chemically modified form of curcumin shows potential as a periodontal treatment aid, with a recent scoping review finding that modified versions of the compound found in the root of the turmeric plant could support the body's immune response to gum disease. Add a dash of spice to your perio toolkit.

💊 The FDA has approved the first over-the-counter pill combining acetaminophen and naproxen sodium in a single tablet, giving dental practices a new opioid-free, nonprescription option to recommend for acute or post-procedure pain management.

😮 New research links upper jaw constriction in children to nasal septum deviation and airway problems, with a new study suggesting that inadequate growth in parts of the jawbone can alter nasal cavity development—and pointing to softer processed diets, allergies, and enlarged tonsils as likely drivers of the trend.

BEYOND THE CUSP

• Why a 17th-century French aristocrat strung a gold wire through her teeth.

• The odds of bad breath by state (according to an admittedly completely non-scientific source).

• Watch: Why dentists in the UK are dropping out of the NHS.

• The biggest travel trends for fall 2026.