One-third of dentists aren't busy enough. ADA's Q4 2025 data shows why patient demand isn't the real problem.

One-third. That is the share of US dentists who told the ADA Health Policy Institute they were not busy enough to treat all the patients requesting care in the fourth quarter of 2025. A year earlier, in Q4 2024, that figure was one-quarter. The gap did not close. It widened, and it widened while equipment costs kept climbing and reimbursement stayed flat (ADA Health Policy Institute, Economic Outlook and Emerging Issues in Dentistry Poll, Q4 2025).

That number matters most to a specific decision: whether to open a third location. The pitch for expansion usually assumes patient demand will grow to fill new capacity. The ADA's own Q4 2025 data says that assumption needs a second look.

The demand gap, in the ADA's own numbers

Consumer spending on dental services, adjusted for inflation, grew 9% between January 2020 and September 2025. Over the same five-year window, spending on health care overall grew 22%, and spending on physician services specifically grew 24% (ADA Health Policy Institute Q4 2025 update, citing U.S. Bureau of Economic Analysis data, accessed December 2025). Dentistry is not shrinking. It is growing at roughly a third of the rate of health care spending around it.

Run the two growth rates against each other and the shortfall becomes concrete. If dental spending had tracked the 22% overall health care growth rate since January 2020 instead of its actual 9%, the dental services market would be running about 12% larger than it is today (1.22 divided by 1.09, minus one). That gap has held for five years. It is not a one-quarter dip that corrects itself.

Appointment wait times confirm the same story at the practice level. New patients waited an average of 13.4 days for an appointment in Q4 2025, nearly flat against Q4 2024's 14.4 days (ADA Health Policy Institute Q4 2025 update). Capacity is not tightening. It is holding steady or loosening, which is the opposite of what a genuinely undersupplied market looks like.

The practice-level takeaway: a third-site model built on the assumption that patients will simply appear once the doors open is not supported by the national data. Capacity is expanding faster than demand right now, not the other way around.

Costs did not wait for demand to catch up

While consumer demand grew slowly, the cost side did not stand still. Dental equipment and supply prices rose 5% between January and September 2025 alone (ADA Health Policy Institute Q4 2025 update, citing U.S. Bureau of Labor Statistics data). Provider reimbursement rates, over the same period, stayed largely flat and have not kept pace with general inflation. The ADA's own term for this combination is a "fiscal squeeze," and its report states plainly that the squeeze on dental practices continues into 2026.

The practical effect shows up in what dentists say worries them for the year ahead. Insurance issues, including low, delayed, or denied reimbursement, are the single most-cited challenge for 2026, named by 55.3% of dentists. Staffing is close behind at 54.2%. Overhead costs rank third at 41.5% (ADA Health Policy Institute, "Looking Ahead into 2026" poll, Q4 2025). Notably, dentists affiliated with dental support organizations, the segment usually assumed to have solved the demand problem through referral networks and marketing scale, still name "maintaining a full schedule" as a top-three concern, at 35.2%. Scale did not make the capacity problem disappear. It just changed who is responsible for solving it.

For a practice budget, that rules out waiting the problem out. The reimbursement side of the equation is not fixing itself, and the ADA's own forecasting shows dentists do not expect it to improve in 2026 either.

Where dentists say they are actually heading in 2026

Asked about their plans for the year ahead, 42.3% of dentists said they intend to add staff, 35.0% plan to drop out of at least one insurance network, 24.4% plan major equipment purchases, and just 16.9% plan to invest in new software. Only 8.7% plan to reduce staff (ADA Health Policy Institute, "Looking Ahead into 2026" poll, Q4 2025).

That software figure is the one worth sitting with. Insurance friction and overhead costs are the two most-cited problems facing dental practices in 2026, and neither is solved by adding staff or by dropping a payer network. Both are, at least partly, operational efficiency problems: how consistently a practice verifies coverage, fills schedule gaps, and converts already-booked appointments into completed, paid visits. Software investment, the category most directly aimed at those problems, is the smallest of the five actions dentists report planning. A practice that does invest there in 2026 is not following the herd. It is doing something five out of six of its peers are not.

The opening this creates is real, not a marketing claim: recall automation, scheduling tools, and cleaner insurance workflows are currently underused across the sector, not oversaturated.

What this means before you sign a third lease

A third site adds fixed costs on day one and variable revenue that depends on patients showing up. The national data says two things clearly: organic demand growth cannot be assumed to fill that new capacity, and the DSO segment, which has the strongest theoretical advantage in patient acquisition, is still naming schedule-filling as a top-three problem. Referral networks and marketing budgets have not solved this. Operational consistency might.

Before committing to a third location, the more defensible move is to audit your existing sites first: current no-show rate against the industry benchmark, appointment wait times against the 13.4-day national average, and whether insurance verification and recall processes run the same way at every location or depend on which front-desk staff member is on shift. Two related pieces cover the mechanics of that audit in more detail: how AI recall economics hold up outside DSO-scale practices, and the specific revenue math behind no-show rates at a multi-site group.

The call

The ADA's own numbers do not say dentistry is in decline. They say the demand growth a third site needs to rely on has been running at roughly a third of the pace of health care spending overall for five straight years, and costs have not waited for it to catch up. If your expansion plan assumes new patients will materialize to fill new chairs, run the numbers on your existing sites' capacity utilization before you commit. If you cannot currently prove your recall, scheduling, and insurance-verification processes are consistent across every site you already operate, a third site will inherit that inconsistency rather than fix it.

If you want an independent read on where your practice's capacity utilization actually sits against these national benchmarks, the AI Opportunity and Growth Assessment scores scheduling, recall, and billing operations against the same efficiency questions this data raises. The starting point is a free 20-minute discovery call.

See also: the 5 questions every dental practice owner should ask before buying any AI tool.

Related: 84% of US dentists are independent. AI recall works there too. · Dental practices lose $140K a year to no-shows · The 5 questions every dental practice owner should ask before buying any AI tool