Good morning. The Tooth Fairy’s payouts have dropped for the second year in a row, down 14% to an average of $5.01 per tooth, according to Delta Dental’s annual survey. Even the first lost tooth isn’t safe, now fetching just $6.24. Margins matter, even in fairyland. 

Inside this issue:
- Dentistry’s first report card
- The end of direct-to-patient dentistry?

⏰ Your reading time today: 5 mins

☕️ Enjoy your coffee break with Word of Mouth, a dental-themed word game inspired by Wordle … guaranteed to leave you grinning, not grinding!

MARKETS

📉 Align Technology ($ALGN) – $163.39 | -9.61 (-5.55%)
📈 Colgate-Palmolive ($CL) – $97.50 | +4.40 (4.73%)
📉 Dentsply Sirona ($XRAY) – $16.05 | -0.03 (-0.19%)
📉 Envista Holdings ($NVST) – $17.51 | -1.34 (-7.11%)
📈 Henry Schein ($HSIC) – $75.45 | +5.06 (7.19%)
📉 Patterson Companies ($PDCO) – $31.12 | -0.03 (-0.10%)
📉 3D Systems Corp ($DDD) – $2.78 | -0.23 (-7.64%)
📉 Weave Communications ($WEAV) – $10.61 | -1.39 (-11.58%)

Data is provided by Google Finance. Stock data as of market close, reflecting changes over the past 5 days, as of 5:00 p.m. ET.

THE DRILL DOWN

🦷 ADA launches advocacy effort against tariffs, supporting Medicaid and CHIP, and pushing key health policies, urging the Trump administration to protect dental products from tariffs, backing federal health program coverage from cuts, and advocating to HHS Secretary RJK Jr. for policies on water fluoridation and expanded dental coverage under Medicaid. A policy agenda with teeth.

🔬UCLA lands $21M NIH grant, with a portion dedicated to studying the oral virome and its impact on systemic health. Because what’s in your mouth might be affecting more than your teeth. 

💧 Utah closes in on fluoride ban, as lawmakers vote to eliminate fluoridation statewide, drawing pushback from health experts.  

🗂️ Corporate Transparency Act enforcement paused, as a court ruling temporarily halts new federal ownership reporting rules, sparing many DSOs and solo practices from additional compliance burdens. For now, the paperwork pile shrinks. 

📜 California revives private equity oversight bill, as a new proposal seeks to expand state review of healthcare investments, including DSOs. Scrutiny returns—but so does the debate. 

BUSINESS STRATEGY

Dentistry’s first report card

The numbers behind some of dentistry’s biggest players were just revealed. The 2025 Dental Industry Outlook pulls back the curtain on nearly 3,400 practices—mostly multi-location groups and DSOs—revealing data on what’s driving growth, where revenue is slipping, and which benchmarks actually matter.  

Let’s break down who’s thriving, who’s struggling, and what it takes to stay ahead. Finally, a performance review you want to read.  

The big picture: Growth is happening, but gaps remain. While 60% of practices reported same-store production growth in 2024, others are struggling with inefficiencies in patient flow, case acceptance, and scheduling. 

• Case acceptance sits at 57%, with nearly half of practices converting between 40% and 70% of treatment plans. 

• Case completion rates are lower, with only 42% of presented treatments actually completed within a year. 

• Patient volume is highly inconsistent, with 16.6% of practices seeing more than 80 new patients per month, while 41.2% bring in fewer than 19. 

Where practices lose revenue: No-shows, cancellations, and scheduling inefficiencies remain the enemy of good practices. Unfilled appointment slots remain a major challenge, with some practices losing significant production time due to gaps in patient flow. 

• 7.4% of patients fail to show up without notice, leaving chairs empty. 

• 15.5% of appointments are canceled in advance, forcing offices to scramble for replacements. 

• Only 6 in 10 patients leave with their next hygiene appointment scheduled, impacting long-term retention. 

What’s working: Practices that optimize scheduling and patient retention are leading. The data shows that offices reducing unfilled chair time, improving recall strategies, and securing future appointments are seeing stronger financial performance. 

• Top-performing practices bring in more than 80 new patients per month, often through better scheduling flexibility and marketing efforts. 

• Offices with higher case acceptance rates ensure patients understand the urgency of treatment and have clear financial pathways to move forward. 

• Practices that consistently pre-book hygiene visits are reducing cancellations and keeping production more predictable. 

Why it matters: These numbers aren’t just statistics—they highlight a clear path for practices looking to improve performance. High-growth offices are focusing on patient follow-through, tighter scheduling, and increased case completion. Meanwhile, practices ignoring these inefficiencies are losing revenue they may not even realize is slipping away. 

What the experts say: Beyond essential stats, the report includes insights from key dental industry experts on the biggest trends shaping the profession. 

• M&A trends: Experts predict a potential rebound in 2025, with same-store growth and innovation being key factors for sellers. 

• Staffing challenges: The report highlights ongoing workforce shortages, emphasizing the need for creative solutions, better benefits, and stronger employee retention strategies. 

• Technology advancements: Leaders discuss how AI, automation, and data-driven decision-making are transforming efficiency, patient experience, and revenue. 

• The future of dentistry: Experts highlight the ongoing general shift in dentistry toward DSOs, the rise of women in leadership, and the growing importance of patient-centric care. 

The bottom line: The industry is growing, but only for those who adapt. The 2025 Dental Industry Outlook makes it clear: Practices that improve case acceptance, scheduling efficiency, and patient retention are leading the pack. And those that embrace the next way of trends in dentistry, including data-driven strategies, aren’t just keeping up—they’re pulling ahead. 

The full report is available now from Planet DDS. See where your practice stacks up and get ahead while there’s still time to catch up. Winning starts with knowing the score. 

BUSINESS BITES

📉 Patterson Companies sees sales dip ahead of buyout, as Q3 results show a 2.7% decline in revenue, with dental sales down 6%. The $4.1B Patient Square Capital acquisition remains on track for April. Tough quarter, but a buyout safety net. 

🦷 Judge blocks Align's $27.5M settlement, as a federal judge rejects the Invisalign maker's proposed class-action settlement over price-fixing allegations, citing concerns that coupon provisions could reinforce monopolistic practices.  

📊 ZimVie reports full-year losses but sees margin improvements, with 2024 financials showing a $33.8M net loss, though cost-cutting efforts helped increase adjusted EBITDA margins by over four percentage points. 

💰 Henry Schein reports steady growth, with 2024 financials showing a 5.8% increase in Q4 sales and full-year revenue of $12.7B. The company also announced a new organizational structure and reaffirmed its growth strategy through 2027. Scaling up while tightening the blueprint. 

📉 Align Technology expands buyback, announcing a $225 million stock repurchase to complete its $1 billion program. 

💳 Planet DDS launches integrated payments, introducing Planet DDS Pay to streamline revenue cycle management for DSOs and multi-location practices. Because chasing payments shouldn’t be a full-time job. 

DENTAL TRENDS 

The end of direct-to-patient dentistry? 

The party may be over for direct-to-consumer (DTC) aligners: SmileDirectClub (SDC) has collapsed. Dentsply is phasing out Byte. Straumann sold DrSmile. What was once pitched as a hassle-free, mail-order shortcut to straight teeth crumbled under lawsuits, regulatory smackdowns, and frustrated patients. 

Now, as DTC retreats, dental providers have a clear opening. Patients still want aligners—the industry just has to meet them where they are, offering convenience without cutting corners. Let’s break down what happened, what it means, and where the market is headed.  

The rise and fall: SDC and Byte were some of the biggest DTC aligner players, and both are gone. SDC, once valued at $8.9 billion, shut down in 2023 after years of financial losses, lawsuits, and refund obligations that made its model unsustainable. Meanwhile, Dentsply pulled Byte from the market in early 2025, citing safety concerns and shifting regulatory requirements that made its mail-order model untenable.  

Cracks in the model: What seemed like a consumer-friendly innovation had fundamental flaws. DTC aligners promised a cheaper, more convenient alternative to Invisalign but struggled to deliver. 

• Regulatory pressure mounted, with states passing stricter telehealth laws, including California’s mandatory X-ray requirement for orthodontic treatment.  

• Safety risks surfaced, as FDA reports linked DTC aligners to misaligned bites, gum recession, and worsening dental conditions. 

• Legal battles drained resources, with SDC and state dental boards locked in disputes over its operations, while Align Technology, the ADA, and the AAO were accused by SDC of colluding to eliminate DTC competitors.  

• Trust eroded, as SDC racked up Better Business Bureau complaints, and several challenging press stories, before abruptly shutting down, leaving thousands of customers stranded mid-treatment.  

• The business model was unsustainable, relying on aggressive marketing, tough margins, and high refund rates while failing to turn a sustainable profit. 

Lessons learned: The DTC collapse highlights what patients, and regulators, actually value. For all the talk of convenience and cost cutting, the expectation that orthodontic treatment should be guided, adjusted, and monitored by a clinician has only grown stronger. 

• Orthodontic treatment isn’t a DIY product—many DTC patients eventually turned to dentists and orthodontists for corrective treatment, and regulators took notice. 

• The lowest price isn’t always the best deal—customers drawn in by affordability often paid more in the long run for fixes. 

• Convenience matters, but not at the cost of results—patients want flexible, tech-enabled care but also trust professional oversight.  

Why it matters: The window is open for dental providers to take back the aligner market. With DTC brands fading, dentist-led solutions are back in the driver’s seat. The demand for clear aligners hasn’t disappeared—it’s just shifting back toward trusted providers. 

• A patient pipeline is up for grabs, as millions of potential aligner patients seek alternatives. 

• In-house aligner programs can fill the gap, with DSOs and group practices launching their own clear aligner solutions. 

• Convenient hybrid models are the future, with providers integrating virtual check-ins and AI-driven monitoring, reducing pressure on patients.

• Financing will be key, as the appeal of DTC providers stemmed in part from their flexible payment plans. 

The bottom line: 
The collapse of DTC was not the death of aligners—it was a course correction. Patients still want straight teeth, but they’re choosing quality, oversight, and trusted providers over cut-rate, mail-order promises. The practices that adapt to match patient demands for convenience, enhanced communication, and results will come out ahead. 

CLINICAL NOTES

• 🦷 Nanoparticles tackle root canal infections, as researchers develop an iron oxide-based treatment to break up biofilms and improve outcomes. Tiny tech, big potential. 

• 🍞 Starchy diets may fuel cavities, with a study linking high AMY1 gene copies to oral microbiome shifts that could increase decay risk. Bread lovers, beware. 

• 🍎 Juicing impacts gut and oral microbiomes, with a new study revealing that vegetable and fruit juicing can shift bacterial composition, particularly increasing pro-inflammatory bacteria due to high sugar and low fiber. 

• 💡 Low-level light therapy shows promise for oral lichen planus, with a systematic review revealing that LLLT significantly reduces pain and clinical severity while lowering the likelihood of relapse. A bright future for managing oral inflammation. 

• 🦷 Oral care linked to lower pregnancy complications, as a new study finds that women who received preventive oral health care during pregnancy had lower odds of developing gestational diabetes and hypertensive disorders. 

BEYOND THE CUSP

• NYC dentist sues matchmaking agency for overcharging by $20K.  

• Why straight white teeth are in vogue again. 

• Turns out that Viking dental health was a nightmare. 

• A dentist and his LSD coffee may have changed the Beatles forever.