🦷 Where are all the dental therapists?

Why there are still so few dental therapists, States start to enforce dental loss ratio rules

October 13, 2026

Good morning. Halloween is approaching, but if you see more people than usual walking around with sharp teeth, it may not have anything to do with the spooky season. 

Cosmetic work for pointy, vampiric canines is becoming increasingly popular, even outside of “goth” subcultures. One dental surgeon specializing in the procedure said that after getting their new look, his patients “start smiling differently, taking photos and showing their teeth without hesitation.” 

There’s not much point getting vampire fangs if you’re not going to show them off, after all.

Inside this issue:

- Why there are still so few dental therapists
- States are starting to enforce dental loss ratio rules

⏰ 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 ($DDD) – 3.24 | -0.29 (8.35%)
📉 Align Technology ($ALGN) – 140.42 | -0.04 (0.03%)
📈 Colgate-Palmolive ($CL) – 89.98 | +2.33 (2.66%)
📈 Dentsply Sirona ($XRAY) – 8.53 | +0.07 (0.83%)
📉 Envista Holdings ($NVST) – 22.72 | -0.54 (2.32%)
📉 Henry Schein ($HSIC) – 84.23 | -1.17 (1.37%)
📉 Park Dental Partners ($PARK) – 20.26 | -0.300 (1.46%)
📉 Straumann Holding ($STMN) – CHF 91.64 | -0.18 (0.20%)

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

THE DRILL DOWN

📉 Dental reimbursement rates continue to fall short of inflation, per the ADA's Health Policy Institute Q3 2026 update, with the reimbursement rate index climbing just 1.5% through August against a 2.3% inflation increase, amounting to a cumulative 8-point gap since 2021. Another year of doing more with less.

🎖️ The VA awards Optum Serve a 10-year, $30 billion contract to build and run its national dental network, covering general and specialty care for the roughly 26% of enrolled veterans eligible for VA dental benefits.

🏆 48 U.S. dental schools rank among the world's best, with the University of Michigan, Ann Arbor claiming the top global spot in ShanghaiRanking Consultancy's 2026 assessment of 300 schools across categories including research output, faculty quality, and international collaboration.

📱 Aspen Dental rolls out a new patient-facing app designed to streamline appointment booking, treatment plan visibility, and care navigation across the company’s network.

💳 Nearly 4 in 10 adults carry dental debt, according to a new Robert Wood Johnson Foundation report, which found that 38% of adults with unpaid medical bills owe money specifically for dental services, making dental one of the leading sources of healthcare debt nationwide.

⚖️ ADA urges Senate to bring dental coverage into broader insurance reform talks, pushing for state waiver authority over self-funded dental plans, prior authorization fixes, and greater benefit transparency as Congress considers health insurance reforms.

🪥 83% of HSA and FSA holders say they'd spend account funds on everyday oral care products if the law allowed it, according to a new survey, with that share climbing even higher—to nine in ten—among those raising children under 18. Toothpaste: the next eligible expense?

🏫University of Rochester announces plans to open the Eastman School of Dentistry in January, which will offer a DMD program and house the university's Eastman Institute for Oral Health.

📜 California passes dental insurance reforms, requiring dental plans to honor assignment of benefits and expand network oversight, allowing out-of-network dentists to bill plans directly and ensuring cost transparency for patients before treatment begins.

💻California also eases infection control training rules for unlicensed dental assistants, with a newly signed law allowing virtual coursework to satisfy the requirement that previously forced practices—especially in rural areas—to find scarce in-person options before bringing on new hires.

⚔️ Missouri dental hygienists sue to block a change that would let some dental assistants perform scaling and periodontal charting, arguing the proposed Missouri Dental Board regulation directly conflicts with state statutes that reserve those procedures for licensed dentists and hygienists.

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WORKFORCE

The dental therapist pipeline is barely a drip

Dental therapists have been pitched as a potential solution to the labor shortage in dental, particularly for underserved communities. There’s just one problem: barely any are being trained. 

What’s happening: A growing number of states are creating license pathways for dental therapists—staff who work under a dentist’s supervision and typically handle everything a hygienist can do plus some basic dental procedures, like placing fillings.

  • As of earlier this year, the American Dental Therapy Association (ADTA) counted 14 states that permit dental therapists to practice. 

Yes, but: States may be allowing dental therapists to practice, but very few people are actually taking them up on that offer. Only around 300 dental therapists are currently practicing nationwide, according to the executive director of the ADTA, and almost half of those are in Minnesota. 

  • Minnesota authorized dental therapy in 2009, graduated its first students in 2011, and now has three of the country’s seven training programs, making it by far the most established market.

  • Other states have struggled to build their own pipeline. In Oregon, for example, just 13 therapists received licenses in the two years after its 2021 law came into effect. Michigan created its dental therapist scope in 2018 but has since licensed just two practitioners.

  • And there is no wave of new graduates coming: Only 38 people were enrolled in CODA-accredited dental therapy programs for the 2025–26 school year, down slightly from the prior year, according to ADA data.

Why it’s happening: The biggest bottleneck is training. Most states that allow therapists still have no local training program or have only recently spun one up. The ADTA lists only seven dental therapy programs in the country, three of which are in Minnesota.

  • Entry requirements and job restrictions create more hurdles. Some states require a hygiene qualification as well. Others restrict where therapists can work and what patients they can serve.

  • The ADA has also resisted efforts to expand licensing of dental therapists, arguing that the role compromises patient safety and diverts resources from existing dental training programs.

Why it matters: Unless there are dramatic changes in the training landscape, it seems unlikely that dental therapists will be of any help in relieving the industry’s staffing shortages. 

  • Even if more training programs were to be established, it would still take years for new graduates to start entering the job market.

  • At least one dental group is circumventing this bottleneck by building its own pipeline: Oregon’s Willamette Dental Group trained licensed hygienists as therapists while they continued working full time as part of a small pilot program.

Bottom line: For most DSOs, retaining hygienists and making full use of assistants remain more immediate options. Outside of Minnesota, being able to tap dental therapists at scale is still years away.

BUSINESS BITES


👔 Notable leadership changes: Henry Schein announces Emmanuel Caprais as its new CFO, Georgia School of Orthodontics appoints Christopher M. Lazzara as president, The Aspen Group promotes Erin Karr to VP, Digital Experience, DECA Dental Group makes Nathan Smith its COO, Pearl Street Dental Partners announces Rene Sauerteig as its new CEO, and COCOLAB names Gayle Tait CEO. 

📈 Deals and de novos: Aspen Dental opens new practices in California and North Carolina, Specialty1 Partners announces a partnership with Connecticut’s Greater Waterbury Oral & Maxillofacial Surgeons, MB2 Dental acquires Hawaii Pacific Dental Group in Honolulu, and EPIC4 Specialty Partners adds pediatric practices in Illinois and Texas.

🤝 Heartland Dental absorbs Foundation Dental Partners, adding the DSO’s 33 practices spanning Georgia, Tennessee, South Carolina, and Kentucky to its network.

🖥️ Planet DDS announces it has surpassed 100 integration partners on DentalOS®, the company’s platform for multi-location dental groups and DSOs.

LAST ISSUE’S POLL RESULTS

REGULATION

Massachusetts orders insurers to pay dental premium rebates

How much of your patients’ insurance premiums actually pay for dental care? According to Massachusetts lawmakers, at least, the answer is: not enough.

What happened: Massachusetts ordered six dental insurers to return $8.4 million to customers this summer, making it the first state to enforce dental loss ratio standards.

  • The rule, approved by voters in 2022, requires insurers to spend at least 83% of their premium revenue, after certain adjustments, on patient care and qualifying quality improvements.

  • Blue Cross Blue Shield of Massachusetts accounts for much of that total and will issue rebates amounting to over $6 million to tens of thousands of its policyholders.

Why it matters: The law may already be changing what dentists can expect to be paid by insurers.

  • Dentists’ negotiated fees increased. ADA Health Policy Institute researchers found that negotiated prices for dental procedures rose 5.2% in Massachusetts relative to five comparison states after the vote. The difference between dentists’ submitted fees and insurers’ negotiated prices also narrowed.

  • Individual and small-employer plans face more pressure. Massachusetts insurers reported an average spending ratio of 85.2% in 2025, but individual coverage averaged 77.5%, while averages across small-group categories ranged from 64.4% to 79.4%.

  • Regulators can now exercise more control over premiums. Every year, carriers must show the state that a minimum amount of their premiums will cover care, effectively capping overhead growth and margin. That keeps pressure on insurers to route more money into claims (and, ultimately, fees for dental practices). 

Yes, but: Some insurers are opting to pull out of the state or offer fewer plans rather than accept the regulated loss ratios.

  • The National Association of Dental Plans, which represents insurers, says Massachusetts had roughly 20% fewer dental plans available in 2026 than in 2022.

  • Higher fees can also leave patients paying more if negotiated prices rise without an increase in annual coverage limits, leading patients to consume their benefits faster.

Zoom out: North Dakota is preparing to join Massachusetts in enforcing loss-ratio rules after passing a 75% minimum spending requirement set to take effect next year.

  • Thirteen states beyond Massachusetts also have loss-ratio laws, according to the ADA, but many require only that ratios are reported, and no other states require refunds when minimum spending requirements aren’t met.

What’s next: Massachusetts has given dentists pushing for similar laws elsewhere a concrete talking point to argue their case with legislators and the public, and early evidence of higher negotiated fees gives dental groups another reason to press lawmakers. Expect a state-by-state fight as each side battles for favorable regulations.

🗳️ The Check-up:

⬆ VOTE: Does your group use a cloud-based PMS?

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CLINICAL NOTES

💉 Clinician training may matter more than provider setup when it comes to pediatric anesthesia safety in dental offices, with new research turning up no evidence that stationing a dedicated anesthesia provider in the room yields better outcomes than a single qualified clinician handling both the procedure and sedation.

😟 Children and teens who have problems at home may have more tooth decay, with a study of nearly 44,500 children uncovering a link between these experiences and cavities, even though these experiences did not appear to affect whether children received preventive dental visits.

🍬 A small study found that xylitol oral-care products changed the mix of microbes in the saliva of children with autism, with researchers also reporting that six of the 30 participants showed notable improvements in verbal skills, with three more showing improvements after later using oral probiotics. Another case of the mouth-body connection?

🏊 Pairing mouthguards with toothpaste containing arginine may help protect competitive swimmers from tooth sensitivity better than mouthguards alone, according to a randomized trial, which found the combination also improved swimmers’ reported oral health despite regularly swimming in chlorinated water. Dive in, but brush first.

FUN AND GAMES

BEYOND THE CUSP