Dental practice trends report: economics, staffing and patients

The biggest dental practice trends are rising costs that outpace reimbursement, a persistent shortage of dental hygienists and patient volume that is not keeping up in many offices. The ADA Health Policy Institute (HPI) has described this as a fiscal squeeze on dental practices that continued from 2025 into 2026.

This report compiles HPI's quarterly economic outlook polling of dentists and its State of the U.S. Dental Economy reports, as published by ADA News, Becker's Dental and DrBicuspid, along with BLS workforce data and Census business counts. HPI's dentist panel is the standard national source for practice conditions. Its Q1 2025 poll, for example, surveyed 738 dentists in private practice, according to Becker's Dental.

Dentists are more confident about their own practices than about the economy. In HPI's Q1 2025 poll, reported by Becker's Dental, 54.5% of dentists were confident in their own practice's six-month outlook, down from 67.5% in Q4 2024, and confidence in the U.S. economy fell from 56.3% to 34.9%.

Confidence stayed below its late-2024 peak through the rest of the year. ADA News reported in its Q4 2025 summary that only one-third of dentists were confident in the U.S. economy. By Q1 2026, DrBicuspid reported nearly 44% of dentists felt confident about dentistry while about 29% felt skeptical.

The reasons are telling. Confident dentists cited the fact that dentistry is always needed (33.3%) and strong demand or practice busyness (31.6%). Skeptical dentists cited low reimbursement and insurance pressures (36.3%), rising practice costs and inflation (30.5%), a U.S. economic downturn (21.5%) and staffing shortages (11.7%).

Many are not. DrBicuspid's coverage of HPI's Q1 2026 State of the U.S. Dental Economy report found about one-third of dentists said their practices are not busy enough, up from about one-quarter in Q1 2024. ADA News's Q4 2025 summary likewise reported that one-third of dentists have insufficient patient volume.

Spending on dental care is growing more slowly than other health care. ADA News reported that, in HPI's comparison, spending has increased 22% for overall health care and 24% for physician services, but only 9% for dental services. HPI also described continued declines in appointment wait times in its Q3 2025 update, which is consistent with spare capacity in many schedules.

For a practice with open chair time, the issue is less about clinical capacity and more about filling the schedule: attracting new patients, keeping recall patients on schedule and reducing cancellations.

Costs are rising faster than what insurers pay. ADA News reported in its Q4 2025 summary that equipment and supply expenses have risen 5% since the beginning of 2025, and HPI notes that prices for equipment, supplies and technology are rising faster than reimbursement for dental services.

Practices have responded with fees and network decisions. ADA News reported in October 2025 that two-thirds of dentists had increased their fees since the start of the year, and that practice prices were rising faster than inflation. Looking to 2026, more than one-third of dentists said they plan to drop some dental insurance networks.

Dropping a network can raise revenue per visit but can also cost patients. Practices that make that move usually need a plan to keep those patients, such as clear communication about out-of-network benefits, membership plans or payment options.

Hiring hygienists is very hard for most practices. HPI's April 2026 analysis of the hygienist shortage found only 60% of dentists have an adequate number of dental hygienists on staff, and 91% of those recruiting a hygienist found it very or extremely challenging. DrBicuspid reported about one-third of dentists are consistently trying to recruit hygienists.

Staffing issues tied with insurance issues as dentists' top challenge looking ahead to 2026, according to HPI. Total staff in dental offices has been flat for at least a year and a half, and HPI says inflation-adjusted wages for dental office staff are lower than a few years ago.

Supply is growing slowly. HPI reports first-year enrollment in hygiene programs rose 16% from 2020 to 2025. The BLS projects dental hygienist jobs to grow 8% from 2025 to 2035, much faster than average, with about 15,000 openings a year. BLS counts 225,300 hygienist jobs and a median wage of $98,100 in May 2025.

There were 134,662 offices of dentists with paid employees in the U.S. in 2023, employing 1,021,722 people. Monvell summed the Census Bureau's County Business Patterns 2023 county records for NAICS 621210 to reach that total.

Dental offices are small businesses with real teams. In the same data, 37.1% had fewer than five employees and 71.8% had fewer than ten. A typical office has a front desk of one or two people handling phones, scheduling, insurance verification and payments, which is where both patient experience and lost appointments are decided.

Dentists are planning moderate investment despite the squeeze. ADA News reported in its Q4 2025 summary that about 40% of dentists plan to add staff and about 25% plan major equipment purchases in 2026, while more than one-third plan to drop some insurance networks.

The plans reflect a practical bet: demand for dental care is steady over time, and practices that run efficiently can stay profitable while reimbursement lags. The practices with open chair time are the ones with the most to gain from better scheduling, recall and new-patient follow-up.

Practice conditions come from the ADA Health Policy Institute. HPI runs a quarterly panel of U.S. dentists (its Q1 2025 poll included 738 private-practice dentists) and combines it with government economic data in its State of the U.S. Dental Economy reports. As of Q1 2026, HPI publishes panel results only through those reports, so several figures here come from coverage of them in ADA News, Becker's Dental Review and DrBicuspid. We name the outlet and quarter for each figure because results shift from quarter to quarter.

Hygienist staffing figures come from HPI's April 2026 analysis of the hygienist shortage and from BLS Occupational Outlook Handbook data for 2025. Practice counts are Monvell's sum of the Census Bureau's County Business Patterns 2023 county file for NAICS 621210 (offices of dentists), which covers offices with paid employees and counts each location separately, so a dental group with several offices appears several times.

For a dental practice, the data says the biggest gains are in filling the schedule you already have and protecting front-desk and hygiene capacity. Hiring is slow and reimbursement is tight, so efficiency and patient retention carry more weight than they did a few years ago.

Steps that follow from the findings:

• Measure open chair time and hygiene recall rates. If you are in the one-third that is not busy enough, the recall list is usually the fastest place to find appointments.
• Automate recall, confirmation and reactivation messages so a small front desk can keep up without extra hires.
• Answer every new-patient call or capture it. With patient volume soft, a missed call from a new patient is a direct loss.
• If you plan to drop an insurance network, plan the patient communication first: what changes, what it costs them and what options you offer.
• Protect hygienist time. With 91% of recruiting practices struggling to hire, keep hygiene schedules full and move admin tasks off clinical staff.
• Track new patients by source so marketing spend goes to the channels that fill chairs.

Monvell builds recall, confirmation and new-patient follow-up systems and call handling that keep a dental schedule full without adding front-desk hours. If you want to see where appointments are slipping, the free digital audit is a good first step.