Good morning. Before TikTok dentists and Instagram ortho revealers, there was Edgar “Painless” Parker. In the early 1900s, he performed extractions on a horse-drawn stage, hired a brass band to drown out screams, and handed out bottles of local anesthetic like merch. Was he dentistry’s first influencer—or just really ahead on brand strategy?

Inside this issue:
- Will a recession crack the crown?
- The smile that flew away

🏆 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 ($ALGN) – 153.35 | -4.84 (3.06%)
📉 Colgate-Palmolive ($CL) – 89.19 | -5.14 (5.45%)
📉 Dentsply Sirona ($XRAY) – 13.24 | -1.69 (11.32%)
📉 Envista Holdings ($NVST) – 15.29 | -1.90 (11.05%)
📉 Henry Schein ($HSIC) – 64.31 | -3.60 (5.30%)
📉 Patterson Companies ($PDCO) – 30.85 | -0.40 (1.30%)
📉 Weave Communications ($WEAV) – 9.27 | -1.78 (16.11%)
📉 3D Systems Corp ($DDD) – 2.03 | -0.11 (5.14%)

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 warns of severe impacts from HHS job cuts, expressing concern that the Trump administration's plan to reduce 10,000 positions at the Department of Health and Human Services could undermine essential public health programs, including those related to oral health.

📜 Texas lawmakers consider bill to boost dental workforce amid shortage, looking to join the interstate licensing compact backed by ADSO, making it easier for dentists and hygienists to practice across state lines. Arkansas just recently passed a bill to join the interstate arrangement. Everything's bigger in Texas—except, apparently, the dentist pool.​

🏛️ Connecticut legislature advances proposals to curb private equity's influence in health care, aiming to increase oversight and transparency of health care acquisitions.

🚱 Utah becomes first state to ban fluoride in public water, drawing sharp criticism from dentists and public health experts who predict increased rates of tooth decay. On his Make America Healthy Again tour, HHS Secretary RFK Jr. called on other states to enact fluoride bans. Cavities incoming.

🩺 REDI Act reintroduced to address doctor shortage, as bipartisan legislation aims to allow medical and dental residents to defer student loan payments without interest during their residency. Because the only thing scarier than dental school debt is dental school debt with interest.

THE ECONOMY

Will a recession crack the crown?

No one wants to say it out loud, but the recession warning lights are blinking. Tariffs have been announced, the economy is slowing, and markets are wobbling. Most industries are preparing for a downturn—but what about dentistry?

While the profession has long enjoyed a reputation for being "recession resistant," history—and the latest data—tell a more nuanced story. So, how worried should dentists and DSOs be? More importantly, what should they be doing about it now?

Storm signals mount: Recession fears are mounting. March saw the Conference Board’s Consumer Confidence Index fall to 92.9, while future expectations hit a 12-year low. According to a CNBC CFO Council survey, 60% of CFOs expect a recession in the second half of 2025. Goldman Sachs estimates the odds at 45%, and J.P. Morgan puts them at 60%. Even President Trump, normally bullish on economic optimism, did not dismiss these concerns as he announced this week’s tariffs.

Dentistry’s immunity myth: The Great Recession exposed dentistry’s soft underbelly. While not as volatile as other sectors, the profession was not spared. A landmark study published in JADA found:

• General dentist visits dropped steadily, reaching a low of 38.4% in 2010.

• Orthodontic utilization fell to just 2.5% of the U.S. population.

• Out-of-pocket spending declined and remained below 2003 levels even by 2015.

Practices saw income decline, receivables increase, and case acceptance fall.

Brace for impact: Whether you’re a solo practice or a regional platform, expect turbulence if a recession hits:

• Reduced patient volume: Especially for elective and cosmetic procedures

• Delayed treatments: Patients will wait until “it hurts.”

• Coverage churn: As insurance plans shift with employment changes

• Cost pressures: Everything from gloves to rent is more expensive

DSOs hold an edge—sort of: DSOs and large group practices may weather a downturn better than most. Their structural advantages include:

• Economies of scale for supply and lab cost reductions

• Centralized admin that keeps overhead lean

• Private equity backing that offers access to capital while others freeze

But those advantages aren’t a guarantee. DSOs built on aggressive roll-ups and high leverage could see their margins evaporate if patient demand drops. Deals made in the cheap money era look different in a dimmer light. In this environment, operational discipline—not just acquisition volume—is the make-or-break factor.

PE playbook: Private equity likely won’t retreat from dentistry in light of dark clouds. In fact, the last major recession didn’t slow down dental deals; it accelerated them. The years following 2009 marked the beginning of a major wave of PE-backed DSO growth. Economic downturns tend to shift strategy—not trigger exits. The current cycle is no exception.

• Distressed acquisitions: Recessions often present discounted buying opportunities.

• Operational tightening: PE-backed platforms may focus on integration, cost containment, and EBITDA stabilization.

• Disciplined dealmaking: Expect more earnouts, minority recaps, and equity rollovers as investors get more selective.

Resilience now: Smart operators will take steps before the forecasts get grim:

• Reinforce retention: Focus on systems that boost recall, processes that encourage the pre-booking of hygiene, and limit no-shows.

• Stay accessible: Given patient challenges, offer flexible financing and simplify payment plans.

• Tighten operations: Evaluate staffing models, review any high-cost vendor contracts, and reconsider which capital investments can wait. 

• Double down on marketing: Focus on referral programs, targeted digital campaigns, and messaging that speaks to value, rather than luxury. 

Bottom line: A recession won’t spare dentistry—it’ll stress test it. Margins will tighten, patients will hesitate, and undisciplined operators will feel the squeeze.

But for DSOs, investors, and proactive clinicians, this is also a moment to gain ground. The operators who move early—tighten systems, protect cash flow, and stay acquisition ready—won’t just weather the storm. They’ll grow through it. 

BUSINESS BITES

💼 KKR considers acquiring U.S. dental labs chain Leixir, aiming to expand its footprint in the rapidly consolidating dental services market.

👩‍💼 Dental Care Alliance CFO named to the Women in DSO Board of Directors, with Victoria Garcia joining the board to support women leaders in the dental industry. More crowns, fewer glass ceilings.

🌶️ PepperPointe Partnerships expands into Virginia, extending its dental support services to practices in the state. Adding some spice to the Old Dominion.

🏢 BEAM Dental expands with six new locations, growing to nine offices across New York and New Jersey, including a brand-new location in Edison.

🦷 Mortenson Dental Partners affiliates with West 10th Dental Group, adding four more dental locations to its network.

🦷 Solventum partners with SprintRay to revolutionize digital dentistry, aiming to develop high-quality, permanent same-day restorations through cutting-edge 3D printing technology. Because patience isn't always a virtue.​

💰 Orthobrain secures $7.5 million in funding, planning to accelerate growth and technological advancements that empower general dentists to integrate orthodontics into their practices. 

DENTAL TOURISM

The smile that flew away

Is a $900 implant in Mexico teaching us something your MBA didn’t cover? Nearly half a million Americans now leave the country each year for dental work, fueling a $5 billion global market.

It’s easy to write them off as bargain hunters or TikTok tourists. But these patients are making deliberate trade-offs—revealing what they value, what frustrates them, and what they’re willing to risk. For U.S. dentistry, especially DSOs, this isn’t just about lost revenue. It’s about understanding what’s driving patients away—and what might bring them back.

What’s happening: Dental tourism has gone mainstream. In 2019, 470,000 Americans traveled abroad for dental care. Even after the pandemic, the trend bounced back fast—hitting 390,000 by 2022. 

Mexico leads the pack, with “Molar City” towns like Los Algodones catering almost entirely to dental tourists. Costa Rica, Turkey, Hungary, and Thailand are also major hubs—offering treatment at 50% to 70% less than U.S. prices. And patients aren’t going abroad for cleanings. They’re getting implants, veneers, and full-mouth rehabs.

Why they go: Cost is the obvious driver. With nearly 68.5 million U.S. adults lacking dental insurance—and limited coverage for those who do—many are choosing to fly rather than finance.

But cost isn’t the only factor. Dental tourists describe an easier, more coordinated experience: upfront quotes, bundled treatment plans, faster timelines, and even concierge-style support. Many U.S. practices, including DSOs, have the clinical capacity—but haven’t matched the wraparound experience.

Lessons for big dentistry:
Despite ADA warnings about infection control and follow-up gaps, patients keep going. They’re choosing uncertainty abroad over the guaranteed friction and cost at home. That says something. What can DSOs and group practices take from this trend—beyond pricing?

• Bundle the offer. Foreign clinics quote a price, timeline, and recovery plan up front. U.S. patients often get estimates and disclaimers. Flatten pricing. Bundle where you can. Make it feel complete.
  

• Rethink payment. If paying overseas is simple and immediate, local options should be too. Offer in-house plans or staged payments that reduce sticker shock—and make it part of the treatment conversation from the start.
  

• Package the experience. Many DSOs offer same-day dentistry, multi-specialist visits, sedation, and spa amenities. But they rarely frame it as one cohesive journey. Make patients feel looked after—not managed.
  

• Tighten the loop. Dental tourists often get prompt, digital pre-consults and check-ins. U.S. systems should match that energy: follow-up texts, digital records, clear instructions. High-tech doesn’t matter if it feels low-touch.
  

• Make your value obvious. U.S. care comes with safety, licensure, and continuity—but patients don’t always see it. Tell them why it costs more. Highlight warranties, quality materials, and next-day follow-up. Don’t assume they know.

Bottom line: Dental tourism isn’t just about saving money—it’s about escaping friction. Patients aren’t just buying treatment; they’re buying ease, clarity, and agency. U.S. dentistry can deliver that. But the offer—and the experience—need to evolve.

CLINICAL NOTES

• 🍫 Theobromine intake linked to reduced periodontitis risk, according to an analysis of NHANES data from 2009 to 2014. Finally, good news for chocolate lovers.

• 🍷 Alcohol consumption tied to higher periodontitis risk, as a new study identifies clear links between drinking habits and gum health. Periodontal disease: the ultimate hangover.

• 🛡️ Dental varnish inspired by bridge paint technology, offering a durable new way to protect children's teeth against decay. 

• 🦠 Postbiotics show promise in caries prevention, with a review highlighting their potential role in boosting oral health. Some help for the good type of bacteria. 

• 💊 Dentists adapt antibiotic prescribing post-ADA guidelines, showing increased adherence to recommendations for responsible use. Less is more.

BEYOND THE CUSP

• Care for some sprinkles with your toothpaste? Moon Oral Beauty collaborated with Sprinkles for a sweet dental care line with cupcake-inspired flavors. 

• Rick Ross opens a dental practice in Atlanta, expanding his entrepreneurial ventures into oral healthcare. From dropping beats to filling teeth—boss moves in every industry.

• French expats stunned by America's obsession with dental floss. Flossing, très bizarre.

• Aimee Lou Wood's natural smile sparks Hollywood dental debate, as her role in The White Lotus challenges the industry's obsession with perfect teeth. Finally, a reason to grin and bear it.