Good morning. This is our final edition of The Morning Grind for 2025, and before we head into the holidays, we wanted to take a moment to thank you for showing up in our first year. You read, forwarded, and debated, making this a lot more fun to write. We started with a simple hypothesis: dentistry deserved better intel, and your reactions told us we’d stepped into a conversation people were eager to have. We’re looking forward to sharing more stories, insights, and "wait, what?" moments with you in 2026.

Inside this issue:

- The year in dentistry, wrapped
- Seniors are your next growth engine

⏰ Your reading time today: 6 minutes 18 seconds

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

MARKETS

📈 3D Systems Corp ($DDD) – 1.95 | +0.19 (10.80%)
📈 Align Technology ($ALGN) – 162.73 | +2.28 (1.42%)
📈 Colgate-Palmolive ($CL) – 79.43 | +2.46 (3.20%)
📈 Dentsply Sirona ($XRAY) – 11.40 | +0.35 (3.17%)
📈 Envista Holdings ($NVST) – 22.06 | +2.02 (10.08%)
📈 Henry Schein ($HSIC) – 77.39 | +4.44 (6.09%)
📈 Park Dental Partners ($PARK) – 14.39 | +0.77 (5.65%)
📈 Straumann Holding AG (STMN.SW) – CHF 95.76 | +5.16 (5.70%)
📈 Weave Communications ($WEAV) – 6.75 | +0.25 (3.85%)

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

🦷 Saliva-based screenings improve patient treatment plan acceptance, according to data released by Delta Dental that found 50% of patients who received saliva-based assessments with their regular exam accepted recommended treatment plans for periodontal disease. Turns out spit sells.

📊 New data reveals that one in three U.S. dentists are now affiliated with a DSO or group practice, with 53% aligning with Elite-level groups, indicating a shift toward support-driven models.

👩‍⚖️ Appeals court rejects immediate review of Delta Dental class certification in antitrust lawsuit, which could force dental providers—the plaintiffs allege 240,000 were harmed—to pursue claims individually. 

🏥 Florida's House advances a bill to authorize dental therapists to perform essential duties like fillings and simple extractions, aiming to address the state's dental shortage crisis affecting 65 out of 67 counties.

📉 Dental benefit enrollment declines by 2.3% this year, leaving 83% of the population covered by some form of benefit plan.

🤖 Isaac OneHealth achieves a perfect score on the U.S. Medical Licensing Examination, marking a significant milestone for the Trust AI platform as the second healthcare AI to reach this achievement after OpenEvidence did so earlier this year. Your study group could never.

YEAR IN REVIEW

The Morning Grind Wrapped

As the year comes to a close, let’s take a stroll down memory lane and revisit some of the most important trends and themes that emerged in 2025. And don’t worry—unlike Spotify Wrapped, we won’t prematurely age you by 40 years or so.

Here are 9 themes that defined the year for the industry:

1. The margin squeeze. Post-pandemic demand never materialized. Instead: 65.8% of dentists raised fees, while 35% said they weren't busy enough. GP dentist income fell $17K to $207,980 despite more hours worked. Insurance reimbursement failed to keep pace with costs. Meanwhile, tariffs and trade fights added to the cost pressures facing practices. Implants, ortho, OS—this was the year everyone remembered where the margins live.

2. The insurer power grab. Delta Dental of Wisconsin acquired Cherry Tree Dental, becoming the first major insurer to own the clinics submitting claims to it. The ADA demanded investigations. Meanwhile, insurers weaponized AI: a Senate investigation found algorithm-driven denial rates up to 16x higher than human review, with 60% of physicians reporting AI drives up rejections. States fought back—Massachusetts enforced 83% dental loss ratios, 23+ states proposed similar mandates. Insurers didn’t just move the goalposts this year—they bought the field.

3. Public market moves. Dentalcorp exited public markets in a C$2.2B take-private by GTCR at a 33% premium, escaping quarterly earnings pressure after its stock ground down 40% from IPO price. Weeks earlier, Park Dental Partners filed for the first U.S. dental IPO in decades, testing whether a doctor-owned group could succeed where others failed. The contrast was stark: one abandoning public markets, one knocking on the door.

4. The workforce crisis intensified. The hygienist shortage escalated into a legislative battle. Nevada's SB 495 would have allowed dentist-trained hygienists without accredited programs. ADHA mobilized nationally to defeat it. Texas limited non-competes to one year and five miles. DSOs will need to respond by focusing on retention: 20% of hygienists and 29% of associate dentists changed jobs in the past year, with 73% citing income as the driver. 

5. AI took center stage. AI transformed from pilot to imperative. VideaHealth landed $40M; Trust AI raised dentistry's largest seed round. About 20% of dental owners installed new software or digital systems, and tech standardization became a valuation factor in M&A diligence. AI also became an important referral channel, influencing 26% of provider choices, matching traditional referrals.

6. The specialty land grab. DSOs chased higher-margin procedures. Smile Doctors acquired myOrthos to become the nation's largest OSO. USOSM expanded to 31 states. The dental implants market was projected to triple to $15.4B by 2035. 

7. Medicaid on the brink. Congress's budget law added work requirements and six-month eligibility renewals, with CBO projecting an increase in the uninsured. With 72M adults lacking dental coverage—triple the number without medical—DSOs with heavy Medicaid exposure must build segmented strategies and prepare for 2026 coverage churn.

8. The fluoride fight goes federal. Utah and Florida enacted America's first water fluoridation bans. Then the FDA restricted prescription fluoride supplements for children. The ADA joined 250+ organizations defending fluoride's safety while JAMA modeling projected bans could cost $9.8B and create 25M new cavities. The fight moved to operatories: staff now face daily questions about toothpaste safety as parents decline fluoride varnish more often. Even fluoride stirred up a fresh debate.

9. Industry titans stepped aside. Stanley Bergman retired after 35 years at Henry Schein amid activist pressure. The ADA faced a reckoning: reserves allegedly dropped from $140M+ to below $50M, a $53M tech project failed, and $20M+ was cut from the budget. Executive Director Dr. Raymond Cohlmia stepped down. The new generation inherits PE pressure, regulatory scrutiny, and technological disruption.

By the numbers: Meanwhile, here are the Grind links that caught your attention (and clicks) this year: 

1. The Inc. 5000 list of fastest-growing companies.

2. The ADA announced its Living Guideline Program.

3. An overview of state-level legislation on dental loss ratios.

4. ADA’s objections to Delta Dental of Wisconsin acquiring Cherry Tree Dental.

5. An academic paper looking at insurers’ views on reimbursement of preventive dental services.

What’s next: We’re looking forward to sharing another healthy and happy year with you and keeping you up to speed on everything dental leaders need to know to thrive.

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BUSINESS BITES

🤖 Overjet acquires DentalBee, adding the software’s range of AI features—including hands-free perio charting and automated notes—to its platform. Terms of the deal were not disclosed. 

💻 Dental tech company Dandy acquires Neem, a dental practice management software company, citing Neem’s “deep expertise in product development, user experience, and engineering.”

🏅 Six dental companies were featured in Newsweek’s Greatest Workplaces for Inclusion & Diversity list, including Align Technology, Colgate-Palmolive, Delta Dental Insurance Company, Heartland Dental, Henry Schein, and Smile Doctors.

MARKETING

Seniors may be your next growth engine

America is aging, and DSOs have an opportunity to turn the “Silver Tsunami” into a gold rush.

What’s happening: Older adults are no longer a niche patient segment. The U.S. 65‑and‑older population hit 61.2 million in 2024, now accounting for 18% of the country. By 2050, that number is expected to swell to 82 million, making up almost a quarter of the population.

Why it matters: In a flat demand environment where DSOs are surviving on fee hikes rather than volume growth, seniors offer a serious growth opportunity. They have higher utilization, higher acuity, and they actually show up.

Yes, but: The senior segment functions as a fundamentally different business within your DSO, marked by more complex needs, bigger treatment plans, and elevated operational risk.

• More teeth, more trouble: Complete tooth loss has dropped to ~13%, but 20% of seniors have untreated decay.

• The medical heavy lift: Most seniors live with multiple chronic conditions, 90% take at least one prescription drug, and 39% take five or more.

• The dry spell: Xerostomia affects up to 40% of patients over 80, fueling a cycle of root caries and failure of existing restorations.

• Uneven insurance coverage: A recent analysis of adults 65+ estimates about 43% have public dental coverage (Medicare Advantage, Medicaid, VA, IHS), 25% have private coverage, and 32%, roughly 18.9 million people, have no dental coverage at all.

When seniors do make it into the chair, the dollars are real. Older adults use roughly similar amounts of care but more expensive procedures, with average submitted charges per treatment 24% higher among people 65+ than younger adults.

What you can do: Treating 75-year-olds like other adult patients (just slightly grayer) is a recipe for clinical failure and lost margin. Here is how to operationalize a "Silver Care" strategy:

• Design "geriatric-friendly" ops: Ditch the generic "new patient" template. Build workflows for longer appointments, simplified tech options, and mobility support (wheelchair access is non-negotiable).

• Target the caregiver: For frail or cognitively impaired patients, the decision-maker is often an adult child. Adjust your marketing and consent workflows to include close family members who may be making care decisions.

• Medical-grade workflows: Standardize medication reviews. Your teams need clear rules on anticoagulants, epinephrine dosing for cardiac patients, and handling "Beers List" drugs.

• Build a senior‑ready payer and pricing strategy. Treat Medicare Advantage (MA) dental benefits as a constrained asset. Train teams to check remaining annual maximums, prioritize disease control, and phase elective work.

• Align financing with senior realities. Offer simple, low‑friction financing (installments, memberships) for seniors who opt to pay out-of-pocket.

Bottom line: The senior surge is not a future projection; it’s probably already in your schedule. DSOs that deliberately design for the "Silver Tsunami"—clinically and financially—will unlock a high-value, loyal patient base. Those that don't will just watch their schedule churn.

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CLINICAL NOTES

👶 Higher maternal vitamin D levels during pregnancy may be linked to a reduced risk of early childhood caries, along with lower decayed, missing, or filled teeth scores, suggesting that vitamin D supplementation in expectant mothers may improve their children's later oral health. Score another win for sunshine.

⚠️ More dental patients are exhibiting hypersensitive reactions to antiseptic rinses, particularly chlorhexidine, which has been associated with an increased frequency of dermatitis and anaphylaxis, according to a study that looked at reported adverse events over the past 20 years.

🧠 A new study links gum disease to brain aneurysms, with gingivitis and severe periodontitis associated with an increased rupture risk over 13 years, possibly due to immune responses to periodontal pathogens.

BEYOND THE CUSP

• The best U.S. cities for dentists, ranked by salaries, job availability, and local demand.

• Meet the Seattle dentist who doubles as the tooth fairy.

• “TikTok is in the middle of a full-on dentist-crush renaissance.”

• Atlanta’s self-described “top veneer specialist” is facing 113 criminal counts related to running an unlicensed dental practice.

• Win your office Secret Santa with 54 good stocking stuffer ideas.