May 2026 Benchmarking Report: Top-Quartile Gap Continues to Widen
Practice expenses have outgrown revenue for five years, per the ADA Health Policy Institute. Where the squeeze shows up, why staffing is the fault line, and two moves that close the gap.
An earlier summary of this report listed headline benchmark figures (median and top-quartile collections, overhead and hygienist wage) that came from a projection model, not measured data. We have removed them. The analysis below cites its sources directly.
The gap between average dental practices and top-quartile operators got wider again this year, and the reason is boring: costs. Over the most recent five-year period, practice revenues rose 1.4% while expenses rose 4.9%, a mismatch the ADA Health Policy Institute now flatly calls a fiscal squeeze. The practices pulling away aren't doing anything exotic. They're repricing faster than their expenses grow, staffing hygiene profitably in a brutal labor market, and exiting the PPO contracts that no longer pencil. Everyone else is absorbing the squeeze and calling it a plateau. This report walks through the numbers, then does the operator math on what the drift actually costs you.
The Squeeze in One Number
Start with the headline stat, because it explains everything downstream: inflation-adjusted incomes of general dentists were unchanged in 2025 and have been declining for the past 15 years, per the ADA Health Policy Institute's income and hours trend data. Fifteen years. That's not a bad quarter or a soft patch after a rate cycle. That's a structural condition.
And the mechanism is right there in the same dataset: revenue up 1.4% over five years, expenses up 4.9% over the same window. When your cost line grows three and a half times faster than your top line, margin compresses every single year you don't actively push back. The average practice isn't shrinking. It's standing still while its overhead walks forward.
The top quartile treats those two growth rates as levers, not weather. They reprice annually, audit their fee schedules against what procedures actually cost to deliver, and renegotiate or drop the payers dragging the blended rate down. The result is a compounding gap: a practice that holds margin flat while the median loses a point a year looks average in year one and looks untouchable in year five.
