Data from the newest Q3 report from the ADA Health Policy Institute (HPI) shows a dental economy at odds with itself. 

Moving into the last leg of 2026, researchers reviewed a large scope of practices (750 respondents nationwide) to gather insights on dentists’ economic confidence, consumer dental spending, general practice economics, and the state of the dental job market. 

Clinicians’ confidence in the economy drops significantly from 2025 

This time last year, 67.5% of dentists reported they were “somewhat” or “very” confident in their practice—but now that figure has dropped to 50.4% with an increasingly downward trend. This number dovetails with their outlook on the US economy, which clinicians were more confident in for Q3 of 2025 compared to now. 

Additionally, consumer sentiment (as measured by the University of Michigan) is also near its lowest point since 2021.¹ 

Despite the drop in confidence, 40.9% of clinicians feel optimistic about the dental care sector moving forward for the following reasons: 

1. Dentistry is always needed

2. Strong demand, practice busyness 

2. Positive economic outlook in general 

3. Patient awareness/value of oral health 

4. Economic resilience of the dental sector 

However, those who were “skeptical” (36.9%) reported feeling this way because of: 

1. Low reimbursement, insurance pressures 

2. Rising practice costs/inflation 

3. Patients unwilling/unable to prioritize dental care 

4. US economic downturn 

5. Uncertainty due to current administration or war 

On this, researchers said: “since January of this year, for example, inflation is at 2.3% while reimbursement rates to dentists have increased by 1.5%. Prices for common dental practice expense items continue to increase. Dentists continue to face a ‘fiscal squeeze’ within their practices.”¹

Widening gap between consumer dental spending and healthcare spending 

Researchers noted a widening gap between consumer dental spending and consumer spending on other health-related services and treatments. Over the past 10 years, spending on physician services rose by 51%, health care by 43%, and dental by only 20%. 

As of August 2026, dental spending increased by 0.5% compared to July, which is still down 2.4% from year-to-date through August 2026. But why is this happening? 

The ADA believes affordability pressures, shifting insurance safety nets, and more selective patient choices are contributing to this gap.² Furthermore, dental care is treated more like a separate, out-of-pocket budget item for many Americans and thus stagnates its long-term growth rate compared to general medical care. 

Dentists’ open schedules have not eliminated hiring issues for hygienists 

Overall, dentists aren’t as busy as they were two years ago. In Q3 of 2024, 14% were too busy to treat every patient requesting care, 21% were able to treat everyone but felt overworked as a result, and 28% were not busy enough. 

In Q3 2026, only 8% reported being too busy to treat every patient, 15% treated everyone but felt overworked, and 38% were not busy enough—yet open hygiene positions remain unfilled. 

These findings do not necessarily describe the same practices. The busyness measure includes all responding dentists, while the hiring results describe dentists who had recruited for a position during the previous three months. The data therefore show that weaker overall patient demand and a constrained hygiene labor market are occurring simultaneously—not that every underbooked practice has an unfilled hygiene position. 

Researchers stated that "in both Q3 2025 and Q3 2026, among dentists who were recruiting in the prior three months, only two out of five filled the open hygiene position compared to around two-thirds of dentists recruiting dental assistants.”¹

Even though practices have increasingly open schedules, 21.2% have had open hygiene positions for over six months; only 9.6% are filling them urgently—in less than two weeks. Most dental assistant positions are filled more quickly; only 7.5% remained open six months down the line and the majority of open positions are filled anywhere from two weeks to three months (31.1% and 37.9%, respectively).¹

The Q3 report does not identify a single cause of the hiring gap. Previous HPI analysis points to a limited supply of candidates willing to accept the available wages and hours, along with reimbursement and expense pressures that make substantial wage increases difficult. The latest results indicate that softer patient demand has not, by itself, resolved those structural labor-market constraints. 

The Q3 data do not establish that the same practices reporting open schedules are also struggling to hire hygienists. They do show, however, that softer patient demand has not resolved the hygiene shortage. With reimbursement trailing inflation, practices continue to face pressure from both sides: generating enough patient volume while offering compensation that attracts and retains staff. 

References: 

1. The state of the US dental economy. ADA Health Policy Institute. September 2026. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/state_us_dental_economy_q32026.pdf  

2. Anderson O. ADA highlights dental market reforms in advance of insurer CEO hearings. ADA News. January 23, 2026. https://adanews.ada.org/ada-news/2026/january/adahighlightsdental-market-reformsin-advance-ofinsurer-ceo-hearings/