How potential Medicaid cuts will impact dental practices, the state of mergers and acquisitions in the DSO space and the rising operational and business costs are three of the biggest trends that dental leaders are keeping an eye on in 2025.

The 16 leaders featured in this article are speaking at Becker’s 2025 Fall Future of Dentistry Roundtable, set for Sept. 29-30 at the Hyatt Regency in Chicago.

If you work at a DSO or dental practice and would like to be considered as a speaker, please contact Randi Haseman at .

Note: Responses were lightly edited for clarity and length.

Question: What are some of the biggest issues that you are following in the dental industry this year?

Michael Acierno, DDS. President and Chief Medical Officer of DecisionOne Dental Partners (Schaumburg, Ill.): What I see in dentistry and some of the biggest issues has to do with merging dental tech and the office. There are a lot of huge advances in dental technology and the industry as a whole is having a hard time trying to merge that into the profession, especially dental AI. One other issue is that dentistry is moving away from being a relationship-based profession. This to me is a large issue that we are not addressing and will cause the dental world problems in the short and long run.

Catrise Austin, DDS. Owner of VIP Smiles Cosmetic Dentistry (New York City): One of the biggest challenges that I’m following in dentistry today is the tough economy, job loss and growing disparity in access to affordable care. Rising costs and limited insurance coverage force many to delay or forgo essential treatments, worsening oral health issues. Programs like Remote Area Medical, which provides free dental, medical and vision care to underserved communities, highlight the urgent need for more accessible solutions. To bridge this gap, we must expand teledentistry, increase Medicaid and insurance reimbursements, invest in community dental programs and advocate for policy reforms that make dental care more affordable for all.

Sibera Brannon, DDS. Dentist and Owner of Affordable Dentures and Implants (Sun City, Ariz.): One of the biggest issues I’m following in the dental industry this year is the impact of digital transformation on patient care and practice operations. The push for AI-driven diagnostics, digital workflows and same-day prosthetics is reshaping how we deliver care, but it also presents challenges in adoption, cost and training.

Additionally, staffing and workforce shortages continue to be a concern, particularly in recruiting and retaining skilled professionals while maintaining high-quality care. The shift in insurance models and reimbursement structures is creating both opportunities and roadblocks for practice owners, especially within DSOs.

Another critical issue is the economic strain caused by increasing tariffs on imported dental supplies and equipment. These rising costs are putting significant pressure on practice owners, particularly those in small and mid-sized operations. Some dental leaders are concerned that, if the situation worsens, it could force practices to reduce services or even close. As the industry braces for these financial challenges, strategic planning and advocacy will be key to ensuring long-term sustainability.

Christopher Brendemuhl, DMD. Director of Dentistry of Valleywise Health Medical Center (Phoenix): The dental industry is entering an era of exciting change, but at the same time facing considerable headwinds. First, the advancement of AI has the potential to revolutionize how dentists confirm diagnoses and develop treatment plans. As an organization with dental students and an upcoming dental residency program, we hope to harness the power of AI to help calibrate our learners and supplement our knowledge base. I am also excited to see an increase in medical-dental integration, ensuring a holistic approach to patient health. As a safety net health care organization, we are particularly concerned about potential reductions in Medicaid spending. Major changes to Medicaid — even in Arizona, a state without a comprehensive adult dental benefit — would drastically impact our ability to care for people. If the emergency adult benefit is cut, those patients will still have emergencies and they will end up in our emergency departments and hospitals, at significantly higher cost to both the patient and the system. I’m concerned that our ability to provide exceptional care will face significant challenges, and that patients’ health will be adversely affected.

Phil Cassis. Co-Founder and CEO of Providence Dental Partners (Atlanta): Some of the biggest issues in the dental industry that I’m following are the ongoing shortage of dental professionals, the increasing role of artificial intelligence in diagnostics and treatment planning and the impact of rising costs on patient access to care. Workforce shortages, particularly in rural areas, continue to strain practices, making recruitment and retention a top concern. AI-driven technologies are transforming the industry, offering efficiency and precision. Additionally, inflation and insurance reimbursement challenges are making dental care less affordable for many patients, leading to shifts in practice models and service offerings. Keeping up with these trends is crucial for navigating the evolving landscape of the dental industry.

Jaideep Deshpande. Executive Director, Strategy and Marketing of University of Illinois Chicago College of Dentistry: This year, I am closely following several key issues shaping the dental industry. One major challenge is the adoption of AI and digital dentistry, as practices and dental schools navigate integrating AI-driven diagnostics, automation and patient engagement tools. Another critical issue is the transition from legacy EHR systems to more advanced platforms like Epic Wisdom, which impacts operational efficiency and patient care. Additionally, workforce shortages, particularly among dental hygienists and assistants, continue to strain practices, driving discussions on training, retention and new care delivery models.

Joshua Everts, DDS, MD. Chief Clinical Officer of OMS360 (Alpharetta, Ga.): I’m watching several transformative trends reshape the dental landscape this year. First, the continued evolution of private equity and management service organizations is fundamentally changing practice ownership structures. We’re seeing unprecedented consolidation alongside an increasing focus on clinician-centered partnership models that balance operational support with clinical autonomy.

Second, workforce challenges are intensifying across the industry. The recruitment and retention of qualified clinical staff, from assistants to specialists, has become a strategic imperative rather than simply an HR function. Practices that create genuine career development pathways will have a significant competitive advantage.

Third, the advancement of technology and AI applications is accelerating, particularly in diagnostic imaging, treatment planning and patient communication. These innovations are creating new opportunities for both enhanced clinical outcomes and operational efficiencies.

Finally, I’m closely monitoring shifts in patient expectations and behaviors. Today’s dental consumers demand greater transparency, convenience and value-based care models, forcing practices to reimagine the entire patient experience through a digital-first lens.The practices that thrive will be those that can simultaneously address these interconnected challenges while maintaining an unwavering commitment to clinical excellence.

Haim Haviv. Founder and CEO of Hudson Dental (New York City): Two key issues I’m closely tracking in dentistry are the effects of policy shifts and the cooling mergers and acquisitions market. On policy, Medicaid cuts are particularly concerning. Reduced funding threatens patient access to dental care, especially in lower-income communities, and may strain practices financially. Additionally, some communities are reconsidering water fluoridation programs, potentially reversing decades of dental health progress and increasing preventable dental diseases. Meanwhile, the dental M&A market appears to be cooling. Higher interest rates have raised acquisition costs, prompting buyers to become more cautious and selective. Increased regulatory scrutiny of DSOs adds further complexity and compliance risks to deals.

As a result, sellers have grown hesitant amid valuation pressures and economic uncertainty, often preferring to wait for improved market conditions. Overall, the industry is shifting toward a more cautious, strategic approach, making it crucial for dental leaders to stay informed and adaptable.

Andrew Jones. COO of Imagen Dental Partners (Scottsdale, Ariz.): We’re closely following trends in provider availability. The hygiene and dental assistant markets remain supply-constrained, which emphasizes the importance of having strong practice culture, competitive compensation and innovative benefits offerings to attract and maintain great clinical talent.

Geith Kallas, DDS. Dentist and CEO of Smile Makers Dental Center (Tyson’s Corner, Va.): The issue I’ve been following recently is Medicaid cuts and their implications on dentistry. Medicaid cuts pose a significant threat to the dental industry, particularly for practices that rely heavily on Medicaid reimbursement. Reduced funding can lead to lower reimbursement rates, making it challenging for dentists to sustain their practices while providing quality care to Medicaid patients. This can result in a decrease in the number of dentists willing to accept Medicaid patients, exacerbating existing access-to-care issues. The implications of Medicaid cuts on dentistry are far-reaching. Patients may experience delayed or foregone treatment, leading to poor oral health outcomes and increased emergency department visits. Additionally, Medicaid cuts can disproportionately affect vulnerable populations, such as children, low-income families and individuals with special needs. To mitigate these effects, dentists and policymakers must work together to advocate for sustainable Medicaid funding and innovative solutions that promote access to quality oral healthcare for all.

Nick Khalili. CFO of Cornerstone Dental Specialities (Irvine, Calif.): There are some challenges in 2025 that the industry faces: Staff shortages since COVID-19, especially dental assistants, which caused an increase in patient wait times. This is also true for the specialty space in the dental industry. Both financial and operational costs have increased. For example, there has been an increase in staff wages and salaries, supplies, materials and equipment due to inflation. In the specialty space, we always face challenges recruiting clinicians for non-coastal states.

Joseph Kolligan. Director of Growth of Salt Flats Dentistry (Riverton, Utah): One of the biggest issues I’m following this year is the changing landscape of practice ownership, with private practice still thriving but consolidation accelerating. Workforce shortages, particularly in hygiene and specialty care, are making recruitment and retention more competitive than ever. At the same time, AI-driven diagnostics, digital workflows and teledentistry are transforming patient care and business efficiency, though they require significant investment. Rising operational costs such as labor, supplies and insurance are putting pressure on practice profitability, making financial sustainability a key focus. Despite these challenges, dentistry is evolving in exciting ways, and those who stay ahead of these trends will find incredible opportunities for success.

Trevor Lines, DDS. Business Development Consultant of Revolutionary Tribes (Gilbert, Ariz.): There is a lot of economic uncertainty out there. Many DSOs are highly leveraged and consumer confidence or recession issues could throw an existential wrench in their financial plans and outlook. I would be expecting those operating without a high degree of discipline to struggle. This will open an opportunity for more well positioned organizations to expand, which they should also do with discipline. Integration is tricky and running more than one business model is a recipe for future pain.

Tammeka Nickleberry, DDS. CEO of TLN Family & Cosmetic Dentistry (Houston): It is exciting to see what’s happening in the space of AI in the dental arena. From using AI to enhance marketing touch points to allowing it to lay over radiographs to enhance diagnosis capabilities. The new opportunities it has created to reach patients and treat them better will continue to move the profession of dentistry forward.

Francesca Pregano. COO of Smile Makers Dental Center (Tyson’s Corner, Va.): An issue I am closely following in dentistry this year is how offices can remain profitable while maintaining insurance contracts. With rising overhead costs and stagnant or low insurance reimbursements, many small offices are struggling to sustain a viable profit margin. The integration of AI automation in administrative tasks presents a potential solution by reducing labor costs and increasing efficiency. However, this shift comes at the expense of some human interaction, which is a critical component of patient care and experience. In many cases, even with AI-driven efficiencies, sustaining profitability while remaining in-network with insurance providers remains a significant challenge for dental practices.

Mariz Tanious, DDS. Chief Dental Officer of Affinity Dental Management (Holyoke, Mass.): This year, the dental industry is facing a few key challenges that are shaping the landscape. Staffing remains a significant issue, with many practices finding it difficult to hire and retain skilled hygienists and assistants, partly due to retirements and the lingering effects of the pandemic. On the financial side, insurance reimbursements aren’t keeping pace with rising costs, which is creating some strain for practices. At the same time, there’s a growing need to meet higher patient expectations and stay updated with advancing technologies. While these challenges are real, they also open doors for thoughtful solutions and innovation in the field.