American Dental Association (ADA) says new data from its Health Policy Institute (HPI) show U.S. dental practices remain under sustained financial pressure, driven by softening demand for care and rising operating costs.
The Q4 2025 analysis combines dentist survey data with federal economic indicators to track confidence, patient demand, staffing trends, reimbursement and investment intentions across the dental sector.
“Looking ahead to 2026, continued uncertainty is a key theme,” the ADA said. “Dentists are concerned about insurance issues, staffing shortages and rising overhead costs. A significant share intend to drop out of at least some dental insurance networks.”
1. Dentist confidence in the U.S. economy remains weak
Only 32.7 per cent of dentists reported confidence in the U.S. economy in Q4 2025, down from a year earlier.
Among key sentiment indicators:
- 58.0% expressed confidence in U.S. leadership
- 52.1% said key economic indicators were stable or improving
- 51.8% viewed the U.S. economy as historically resilient
- 40.5% believed trade, tariff and tax policies support economic strength
2. Tariffs and economic uncertainty weigh heavily
Dentists cited multiple macroeconomic concerns:
- 82.7% pointed to tariffs and rising costs
- 74.7% cited broad economic uncertainty
- 62.0% reported low confidence in current U.S. leadership
- 59.3% pointed to social or political unrest
- 47.1% cited rising national debt
Equipment and supply costs were up 5 per cent year-to-date as of September 2025.
Related: U.S. tariffs and Canadian dentistry: How to shield your practice
3. Consumer dental spending up — but lags health care
According to U.S. Bureau of Economic Analysis data cited by HPI, consumer dental spending in September 2025 was:
- Up 0.4% month over month
- Up 3% year-to-date (January–September)
- Up 4% year over year
- Up 9% compared with pre-pandemic levels
By contrast, five years post-pandemic:
- Physician services spending is up 24%
- Overall health-care spending is up 22%
- Dental services trail at 9%
4. One-third of dentists report insufficient patient volume
In Q4 2025:
- 33% of dentists said they were not busy enough
- 12% said they were too busy to treat all patients
- 18% reported treating all patients but feeling overworked
Average wait times for new patients rose slightly to 13.4 days, roughly unchanged from a year earlier.
5. Rising wages, lagging reimbursement intensify pressure
Hourly earnings for dental office staff have increased slightly faster than inflation over the long term. However, provider reimbursement rates remain flat and continue to trail both inflation and rising practice expenses.
6. Fewer hours worked across the dental sector
As of November 2025, average weekly hours worked by dentists and staff were:
- Down 0.1 hour from the prior month
- Down 0.5 hour year-to-date
- Down 1.0 hour year over year
- Up 0.9 hour compared with pre-pandemic levels
Related: 2025’s top five health expenditure trends in Canada
7. U.S. job growth slows
U.S. job growth moderated after April 2025, with approximately 50,000 jobs added in December, reflecting a broader cooling in the labour market.
8. About one in three dentists recruiting
In December 2025, total employment in dental offices was:
- Down 0.2% month over month
- Up 1.3% year-to-date
Nearly 31.4% of dentists reported recruiting dental hygienists in the previous three months, while 34.9% recruited dental assistants.
9. Dental hygienists remain hardest to hire
Among dentists actively recruiting, hiring challenges for dental assistants have eased slightly. Recruitment difficulty for dental hygienists, however, remains virtually unchanged over the past three years and continues to be rated as “very” or “extremely challenging.”
10. Insurance participation under review
Looking ahead to 2026:
- More than 40% of dentists plan to add staff
- More than one-third plan to drop at least some dental insurance networks
Top concerns for 2026, according to HPI:
- Insurance issues, including low reimbursement and denials
- Staffing shortages
- Rising overhead costs
Additionally, non-DSO dentists most frequently cited insurance (55.2%), staffing (53.8%) and overhead costs (42.3%). DSO-affiliated dentists cited staffing (59.3%), insurance (55.6%) and maintaining a full schedule (35.2%).