Good morning. Most dental records are clinical. This one made the Guinness World Records. A guy in Egypt just set a new record by dragging a whole train with his mouth. Yes, you read that right, and can watch it too. The 32-year-old strongman earned this title by pulling nearly 280 tons using only his teeth, proving once and for all that occlusion matters. Please consult your dentist before you do the locomotion.

Inside this issue:
- Who controls the dental dollar?
- PDS wants to be your primary care dentist

⏰ Your reading time today: 5 mins 32 seconds

👑 Our Word of Mouth dental-wordle game has a new set of weekly champs, including Jake Sligh, Chief Growth Officer at Rock Dental Brands and oncology hygienist Margaret Livingston, RDH. Play today to get on next issue’s leader’s list!

MARKETS

📉 3D Systems Corp ($DDD) – 1.70 | -0.07 (3.95%)
📉 Align Technology ($ALGN) – 184.84 | -4.78 (2.52%)
📈 Colgate-Palmolive ($CL) – 91.74 | +2.82 (3.17%)
📉 Dentsply Sirona ($XRAY) – 16.63 | -0.08 (0.45%)
📉 Envista Holdings ($NVST) – 17.70 | -1.00 (5.35%)
📈 Henry Schein ($HSIC) – 71.84 | +1.39 (1.97%)
📉 Straumann Holding AG (STMN.SW) – CHF 111.75 | -0.95 (0.84%)
📉 Weave Communications ($WEAV) – 10.47 | -0.49 (4.47%)

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

🍭 HHS Secretary Robert F. Kennedy Jr. calls sugar “poison,” while dental leaders warn his proposed cuts to oral health programs could make dental problems worse, putting preventive care efforts at risk. Great diagnosis, tough prescription.

🩺 Congress reintroduces a bill to require insurance coverage for dental care tied to congenital conditions, with ADA backing the push to protect medically necessary treatment. 

💸 ADA pushes back on a proposed tax bill that could reduce financial aid for dental students, warning it may worsen access and long-term workforce development. Nothing like a tuition hike to cure the national dental staff shortage.

💊 FDA moves to pull ingestible fluoride prescriptions for children from the market against ADA advice, a move that may add fuel to RFK Jr.'s ongoing anti-fluoride agenda. 

🏛️ Georgia passes major teledentistry bill, allowing virtual evaluations, consultations, and referrals while preserving in-person care standards and clinical protections.

INSURANCE

Who controls the dental dollar?

A quiet but consequential fight is unfolding across the country. At the center is the dental loss ratio (DLR), a policy mechanism that sets how much of every premium dollar insurers must spend on patient care.

Massachusetts launched the first strike with its 83 percent rule. Now, more than twenty states are considering similar mandates. The insurance industry is pushing back, but DSOs are not on the sidelines. These rules are reshaping how dental care gets paid for, and what comes next could change how DSOs operate, negotiate, and grow. Welcome to the margin wars, soldier.

What’s happening: Dental loss ratios mandate that insurers allocate a specific percentage of patient premiums directly to patient care and quality improvements rather than overhead, administration, or profits. Modeled after the Affordable Care Act (ADA) medical loss ratio, DLR laws aim to ensure dental insurance provides meaningful care.

In 2022, Massachusetts voters overwhelmingly approved an 83 percent DLR rule. By 2025, twenty-three additional states have proposed similar legislation, ranging from mandatory reporting and transparency to strict spending thresholds with rebate requirements.

The ADA champions these laws, highlighting insurer filings showing some plans allocate as little as 11 percent of premiums to patient care. Insurers, represented by the National Association of Dental Plans (NADP), oppose rigid mandates, citing potential market instability, higher premiums, and reduced consumer choice.

Why you should care: DLR laws significantly impact DSO operations and finances:

• Increased reimbursement leverage: Spending mandates may push insurers to improve reimbursement rates or expand covered procedures, directly benefiting DSOs.
  

• Higher patient utilization: Potential rebates or expanded coverage from DLR enforcement could boost patient demand for preventive and restorative services.
  

• Enhanced insurer transparency: Mandatory legislative reporting clarifies insurer spending practices, helping DSOs negotiate contracts and forecast revenues more accurately.

However, insurers facing tighter margins might narrow networks, impose stricter contract terms, or shift costs to patients, presenting new challenges for DSOs.

Massachusetts experiment: The 83 percent rule did impact insurers:

• Several exited the small-group market entirely due to profit pressures.
  

• Broker commissions dropped, which could affect consumer navigation.
  

• Some proposed premium hikes of 30 to 40 percent that they said were necessary to sustain financial viability.
  

Yet DLR advocates highlight wins: increased transparency, potential consumer rebates, and strong voter support. North Dakota recently became the second state adopting a similar 75 percent minimum, underscoring growing legislative momentum.

Insurers push back: Insurers argue dental premiums are fundamentally smaller than medical ones, making strict DLRs financially challenging. Necessary administrative costs like compliance and claims management remain fixed despite smaller premium pools.

Insurers warn that strict mandates could lead to higher premiums, insurer exits, fewer employer-sponsored dental plans, and growth in unregulated self-funded plans. They advocate gradual measures like the National Council of Insurance Legislators (NCOIL) model, emphasizing transparency without rigid thresholds.

DSOs can adapt fast: Forward-thinking DSOs shouldn’t wait passively amid change. Organizations such as ADSO publicly support DLR initiatives, framing them as beneficial for providers and patients alike. DSOs can respond proactively in these waysstrateg:

• Contract reassessment: Reevaluate Preferred Provider Organization (PPO) agreements, exiting unsustainable networks, and renegotiating terms aligned with new spending mandates.
  

• Enhanced compliance: Scale up compliance teams and processes to handle potentially increased insurer reporting and scrutiny.
  

• Data-driven payer management: Leverage analytics to challenge insurer denials, prove clinical value, and strengthen negotiating positions.
  

• Diversified revenue streams: Expand fee-for-service, specialty offerings, in-house memberships, and teledentistry to reduce reliance on traditional dental insurance.

Strategic calculus: The push toward DLOs could reshape insurance dynamics. DSOs can leverage these shifts to enhance transparency, improve reimbursement rates, and build patient-centric care models through:

• Proactive contract negotiations: Renegotiate with insurers around new spending mandates to strengthen reimbursement and coverage terms.
  

• Market positioning: Embrace transparent financial models to differentiate from competitors, attract patients, and improve retention.
  

• Alternative revenue models: Accelerate growth in fee-for-service and membership plans to mitigate potential insurer-driven disruptions.

Bottom line: DLRs aren’t just policy tweaks; they’re pressure points on the insurance model with ripple effects that touch DSOs directly. These new rules are forcing a long-overdue conversation about where premiums go, what coverage should mean, and who defines value in dental care.

For DSOs, this is less about regulation and more about leverage. The smartest groups will use DLR momentum to renegotiate contracts, diversify revenue, and tighten up on payer strategy. In a market that’s finally asking where the money’s going, the DSOs that help patients get that answer clearly will come out ahead.

BUSINESS BITES

👔 123Dentist appoints Jeff Leger as CEO to lead its next growth phase, bringing in the former head of Canada’s largest pharmacy chain to lead the KKR- and Heartland-backed Canadian DSO, one of the country's biggest, as it positions for expansion.

💰 Henry Schein completes $250M strategic investment from KKR, with the firm taking a 12% stake and adding both former Danaher EVP Dan Daniel and KKR’s Max Lin to the company’s board of directors.

🏥 OMS360 partners with Pittsburgh Oral Surgery and secures financing from TPG Twin Brook, marking its entry into Pennsylvania and bolstering its capital structure for continued growth.

🤝 Smile Source and ACT Dental announce historic merger, combining platforms to scale services for independent practices. 

💰 Align Technology announces new $1 billion stock repurchase program, granting buyback over the next three years following the completion of its previous authorization. Talk about betting on yourself!

📊 Envista reports Q1 earnings, noting pressure in equipment sales but growth in implants and specialty products. 

🚀 Planet DDS expands its Launchpad program, offering tools to help emerging groups scale. 

📉 Dentsply Sirona reports Q1 2025 results, with net sales down 7.7% year-over-year but maintaining its full-year outlook amid challenging market conditions. Rose-tinted glasses in turbulent times.

FUTURE OF DENTISTRY

PDS wants to be your primary care dentist

In seven Arizona dental offices, something strange is happening. Patients are getting screened for diabetes right in the dentist’s chair. A quick fingerstick test checks HbA1c levels during routine dental visits, providing immediate results and physician referrals if needed.

This pilot between PDS Health and Delta Dental of Arizona might seem modest, but it’s part of a strategic push with major implications. For DSOs watching closely, the stakes are clear: Could your dental office become the new entry point for primary care?

What’s happening: In March 2025, PDS Health and Delta Dental of Arizona began a year-long pilot study offering free HbA1c screenings to 1,500 dental patients. Titled "The Role of Oral Health in Primary Care and Diabetes Awareness," the pilot uses chairside fingerstick testing devices that are CLIA-waived, meaning they meet federal standards for simplicity and safety. Patients flagged as at-risk receive guidance and care pathways.  

Mouth-body connection: Stephen Thorne, founder and CEO of PDS Health, told The Morning Grind, “Most people don’t see their primary care provider regularly, but they do go to the dentist, often twice a year. That creates a huge opportunity.”

This project operationalizes PDS Health’s longstanding Mouth-Body Connection® philosophy. Thorne emphasizes this holistic approach clearly: “The connection between oral health and overall health is well established. What happens in the mouth impacts the entire body, and we cannot treat them separately.”

To back this philosophy, PDS Health was the first major DSO to implement Epic's integrated medical-dental EHR platform across its entire network, supporting data sharing between dental clinicians and physicians. They’ve also opened co-located dental-medical offices, as part of their vision of full-body healthcare integration.

“We’re already applying these tools because they support a model of care that’s predictive, preventive, and personalized—exactly where healthcare needs to go,” Thorne told The Grind.

Why DSOs should care: The pilot challenges traditional boundaries. Dental practices see patients regularly and often have established trust, advantages that primary care providers may lack. Integrating chronic disease screening at these visits could profoundly reshape patient relationships and loyalty, payer dynamics, and revenue models.

As Thorne told The Grind, “This technology strengthens the role of the dentist as part of the primary care team, which is long overdue.”

Thorne emphasized the strategic importance: “We partnered with Delta Dental of Arizona on this study because it reflects the way care should work. It gives us a chance to identify patients who may not have a physician, spot signs of disease earlier, and connect them to the right next step. It also helps build the evidence base.”

Strategic hurdles and scaling: Thorne acknowledges significant hurdles remain: “The bigger challenge is integration. Dentistry and medical care still operate separately in too many places, and that slows progress.”

Generally, a significant barrier to dentist screening of chronic conditions has been reimbursement. Current dental billing codes for HbA1c testing (D0411) exist but typically aren’t covered by insurance. Delta Dental of Arizona bypassed this obstacle by funding the pilot directly, making the screenings available regardless of patient coverage.

Other challenges to further “whole-body” dentistry include CLIA compliance, scope-of-practice regulations, staff training, and integrating new workflows. But the benefits of scaling could extend far beyond diabetes screening to other conditions and patient services.

Strategic calculus for DSOs: For other DSOs contemplating similar moves, key considerations include:

• Technological infrastructure: Ability to capture and share data seamlessly and accurately across dental-medical platforms
  

• Payer engagement: Creating value-based agreements with relevant payors and partners to fund screenings
  

• Regulatory navigation: Managing state-level practitioner scope issues and compliance hurdles like CLIA certification
  

• Workforce readiness: Training and equipping teams to handle new testing and referrals

Bottom line: The PDS Health-Delta Dental of Arizona pilot tests dentistry's role as a driver, rather than a passenger, on the road to integrated healthcare. The success of this model could offer DSOs a powerful new positioning: transforming dental visits into pivotal healthcare touchpoints and redefining their relationship with payers, patients, and the healthcare system at large.

As Thorne put it succinctly, dentistry’s role in chronic disease management is “long overdue.” DSOs paying attention now could lead this transformation, creating a new era of preventive and integrated care.

CLINICAL NOTES

🦷 Tooth loss without dentures linked to sodium/potassium imbalance in older adults, suggesting broader risks for cardiovascular and kidney health. 

😴 Sleep bruxism in children tied to internalizing symptoms and disturbed sleep, supporting closer psychological and behavioral screening in pediatric care. Poor kiddos.

🤖 HKU launches world’s first AI-powered oral cancer screening clinic, combining deep learning diagnostics with early detection and triage for high-risk patients. 

📘 ADA announces Living Guideline Program, a dynamic update model to provide real-time, evidence-based recommendations across caries, perio, endo, and systemic links. Because waiting five years for an update isn’t evidence-based.

BEYOND THE CUSP

• Scientists develop lab-grown chocolate from cocoa cells, aiming to reduce deforestation and child labor linked to traditional cocoa farming. Finally, a guilt-free indulgence.

• Ready to be jealous? Look at this beautiful clinic featured in the Los Angeles Times. 

• Austrian dentist Harald Ambros competes in one of the world’s top horse events while still running his clinic, returning to the international stage after an 18-year break. One hoof in sport, the other in scrubs.