What the Economy Is Actually Doing to Dental and Orthodontic Patient Acquisition
Demand is still there. Patients are slower to decide and more likely to stall during the financing conversation, so the work is to compete more aggressively for them.
The short version
Dental patient acquisition in 2026 does not work the way it did in 2023. Demand for dental care appears to have softened as costs have risen and potential patients are slower to convert. However, consumer spending on dental services has increased.
What has changed is the path a patient takes from first interest to a signed treatment plan: it is longer, more price-sensitive, more reliant on financing that is harder to obtain, and more crowded with advertisers than it was three years ago.
Demand is still there. Patients are slower to decide and more likely to stall during the financing conversation, so the work is to compete more aggressively for them.
This briefing covers what the primary data shows from 2023 to 2026 and what it means for a practice’s marketing.
1. Patients are spending more on dental care
According to the American Dental Association’s Health Policy Institute, consumer spending on dental care in January 2026 was up 4% from twelve months prior and 11% above pre-pandemic levels, after adjusting for inflation. Over ten years, consumer dental spending is up 24%.
At the same time, one-third of dentists reported in Q1 2026 that they were not busy enough and could have treated more patients. That figure was one-quarter in Q1 2024. Average wait times for a new patient appointment fell from roughly 14.6 days in Q1 2024 to 12.4 days in Q1 2026.
2. Dentist confidence tells a split story worth reading carefully
The ADA’s Q1 2026 survey of 796 dentists found 44.4% confident about the dental care sector and 29.1% skeptical.
The confident group cites durable demand: dentistry is always needed, practices remain busy, and the sector has historically been recession-resistant.
The skeptical group cites the following, in order of frequency: low reimbursement and insurance pressure (36.3%), rising practice costs and inflation (30.5%), the broader U.S. economic downturn (21.5%), staffing shortages (11.7%), and policy or geopolitical uncertainty (11.2%).
We deliberately flag this split because it is easy to quote only the pessimists and call it an industry consensus. In reality, dentists are broadly confident in demand for care and broadly worried about margins, and those are different problems with different solutions.
3. The documented margin squeeze
4. Financing is often the real constraint
Federal student loan payments resumed in October 2023 for roughly 40 million Americans. Federal Reserve research using ZIP-code-level spending data found that households in high-student-debt areas cut spending measurably, amounting to a drag on aggregate demand of roughly $80 billion at an annual rate. Notably, the spending cutback began after the June 2023 announcement, before payments actually restarted.
The second-order effect matters more for orthodontics, and it is recent:
Newly defaulted borrowers are also behind on other obligations: nearly 40% of those with auto loans, 56% of those with at least one credit card, and 20% of those with a mortgage are past due.
Damaged credit files mean declined applications for third-party patient financing. A practice can generate the lead, book the consult, and present the plan, and lose the case at the financing step.
5. Household conditions are volatile and improving unevenly
Inflation re-accelerated sharply in 2026 before reversing. The Consumer Price Index rose 4.2% over the twelve months ending in May 2026, the largest increase since April 2023, driven overwhelmingly by energy, which rose 23.5% year over year. Food prices rose 3.1%.
Then, in June 2026, CPI fell 0.4% month over month, the largest single-month decline since April 2020, bringing the annual rate down to 3.5% as energy prices fell 5.7%.
Consumer sentiment followed the same arc. The University of Michigan index hit a record low of 44.8 in May 2026, recovered to 49.5 in June, and reached 54.4 in July. Even after that rebound, sentiment remains roughly 12% below a year earlier and is in the 2nd percentile of the index’s history. Year-ahead inflation expectations remain elevated at 4.2%.
Two observations for practice owners:
Sentiment is not spending
Retail spending grew in June 2026 despite historically bleak sentiment. People who report feeling terrible about the economy continue to buy things. Sentiment surveys measure mood, and mood does not reliably predict elective-care decisions.
The result of volatility
Between February and July 2026, sentiment moved from a record low to a five-month high and back toward uncertainty. In a stretch this turbulent, a few soft months can reflect the market’s mood swinging rather than a practice losing ground. Reading a real trend apart from the noise takes several months of data and a look at what the wider market did over the same stretch. A decline that holds while sentiment recovers is a different signal than one that tracks a broad dip.
Financing shapes case acceptance across dentistry, and orthodontics relies on it most heavily given the size of a typical case. Most practices, dental and orthodontic alike, rely on third-party financing to close treatment plans, tying acceptance directly to their patients’ credit. Those conditions have deteriorated in a specific, dated way.
Over the past twelve months ending in February 2026, prices for dental equipment and supplies rose 6%, while hourly earnings for dental office staff rose 2% and overall inflation was 2%. Provider reimbursement rates, meanwhile, have not kept pace with inflation over the longer term.
6. Regional conditions: Texas, California, and Oregon
The national factors above hit every market: consumer debt, the student loan restart and rising defaults, financing decline rates, inflation, and consumer sentiment. The one factor that varies meaningfully by metro and has reliable local data is the labor market.
Read this section alongside the national picture rather than in place of it. Strong local employment does not rule out economic pressure on a practice, because the debt and financing factors above apply everywhere regardless of the local job market. What a local labor market can tell you is narrower and still useful: does the local employment picture add to the economic explanation for softness, or point away from it? Often it points away, which redirects attention to causes a practice can actually address.
Metros below are grouped as Metropolitan Statistical Areas, the federal geographic unit built around an urban core and the surrounding counties tied to it economically. Employment data is published at the MSA level, which is why the cities in each subsection cluster the way they do.
Sacramento–Roseville–Folsom
The Sacramento metro unemployment rate was 4.8% in June 2026, up from a revised 4.2% in May and below the year-ago figure of 5.1%. That compares to 5.2% statewide and 4.4% nationally. By county: Placer 4.2%, El Dorado 4.7%, Sacramento 4.8%, Yolo 5.6%.
Total nonfarm employment rose from 1,112,400 in May to 1,112,700 in June, and grew by 7,600 jobs, or 0.7%, between June 2025 and June 2026.
Private education and health services payrolls fell by 1,100 jobs in June, with health care and social assistance accounting for most of that decline.
San Francisco–Oakland–Fremont
The San Francisco–San Mateo–Redwood City division posted unemployment below 3.8% in early 2026, with San Francisco County at 3.7% and San Mateo County at 3.5%. Both sit well under the 5.2% state rate and the 4.3% national rate.
Job growth is roughly flat. Employment in the two counties rose by 3,000 jobs, or 0.3%, over the twelve months ending March 2026. Professional and business services showed the largest monthly decline at 2,600 jobs, driven by professional, scientific and technical services. Government led year-over declines with 4,500 jobs lost, mostly state and federal. Private education and health services gained 3,300 jobs, with health care and social assistance accounting for 97% of that.
One important distinction within this coverage area: Vallejo, Benicia, and Fairfield technically sit in the Vallejo MSA, which historically runs higher unemployment than San Francisco proper. Practices concentrated in those cities face somewhat softer conditions than the figures above suggest.
San Jose–Sunnyvale–Santa Clara
Santa Clara County unemployment was 3.7% in spring 2026, against 5.2% statewide. San Benito County, also in the MSA, ran considerably higher at 6.2%.
Employment in the MSA grew by 15,200 jobs, or 1.3%, year over year, the strongest rate among the California markets here. Construction added 3,800 jobs annually. Leisure and hospitality led declines at 2,300 jobs, and government lost 1,300.
Los Angeles–Long Beach–Anaheim
Orange
Los Angeles County’s seasonally adjusted unemployment rate held at 5.5% in May 2026, unchanged from April and down from 5.7% a year earlier. Orange County was materially lower at 3.5% not seasonally adjusted, down from 3.7% in April.
Total nonfarm employment in Los Angeles County rose by 9,000 between April and May 2026 to over 4.6 million jobs. Leisure and hospitality added 6,300 positions; information shed 3,300. Longer term, the county entered 2026 with employment down 6,700 year over year as of December 2025.
San Diego–Chula Vista–Carlsbad
San Diego County unemployment was 3.9% in May 2026, down from a revised 4.1% in April and below the year-ago 4.1%. It rose to 4.4% in June. The county consistently outperforms the state, which stood at 4.7% unadjusted in May.
Total nonfarm employment reached 1,584,300 in June 2026, up 16,700 jobs year over year. Private education and health services led all gains with 17,700 jobs added, 17,400 in health care and social assistance. Six sectors lost a combined 14,800 jobs over the year, with government down 8,500, of which 7,000 was federal.
Fresno
Fresno
Fresno County unemployment was 7.4% in spring 2026, against a state rate of 5.2% and a national rate of 4.4%. Madera County, also in the MSA, was 7.0%.
Fresno runs well above both state and national unemployment, and this is structural. The EDD’s own analysis notes that California MSAs with above-average unemployment tend to hold that position over the long term, reflecting local occupational and industry mix.
Fresno runs well above both state and national unemployment, and this is structural. The EDD’s own analysis notes that California MSAs with above-average unemployment tend to hold that position over the long term, reflecting local occupational and industry mix.
Modesto
Stanislaus County unemployment was 6.8% in April 2026, down from a revised 7.2% in March and below the year-ago 7.2%. That compares to 5.0% statewide and 4.0% nationally at the time.
These figures are one month behind the other markets in this section, because Modesto MSA data lags slightly in publication.
Salem, Oregon
Oregon is underperforming nationally. The state unemployment rate was 5.2% in early 2026 against 4.3% nationally, among the highest in the country. Oregon lost nearly 23,000 nonfarm jobs in 2025, a 1.1% decline, with roughly 7,500 of those in professional and business services.
Salem is the exception within the state. The Salem MSA posted 1.7% job growth over 2025 while Bend, Albany, Eugene-Springfield, and Portland-Vancouver-Hillsboro all recorded negative growth. A Business Oregon economist characterized Salem as the only metro area in the state with substantive job growth over that period. Salem-area nonfarm employment was up 3,100 jobs year over year as of spring 2026, led by transportation, warehousing and utilities at 3,200 jobs, with local government and health care also adding.
Salem’s unemployment rate was 4.9% in April 2026, up from 4.4% a year earlier. Wages in the Salem metro remain below the national average.
For a Salem practice, conditions are soft but not deteriorating, and better than anywhere else in Oregon. Below-average local wages make price sensitivity and financing availability more consequential than the unemployment rate alone would suggest.
Central Texas and the Austin metro
For Central Texas practices, the local labor market is a more relevant indicator than national figures, and the recent picture is better than the headlines suggest.
Texas employment was essentially flat in 2025, growing by 0.1% and adding only 10,700 jobs statewide, an unusual stall for a state whose long-run average is near 2%. The Dallas Fed attributed it to higher productivity suppressing labor demand, slower immigration constraining supply, and employer caution amid policy uncertainty.
2026 has been considerably stronger. According to the July 2026 Dallas Fed forecast, Texas job growth was revised up to 2.0% for the year, with year-to-date growth at 1.9%. Texas employment grew at an annualized 3.5% in June, adding 42,100 jobs. Among major Texas metros, Austin posted the fastest growth at 5.8%.
A note on comparing these figures
Publication schedules also differ. California EDD publishes monthly, typically mid-month for the prior month, so each market here reflects the most recent available release for that metro and the reference months vary slightly between them. Where the distinction matters for a specific decision, check the underlying release.
7. What this does not explain
Read this section carefully because there are limits to an economic explanation of a slowdown in new patient starts.
A sharp drop points somewhere specific
When a neighbor is growing and you’re not, look past the economy
One channel down while others hold has a cause in that channel
“It’s the economy” is the easy answer and rarely the complete one
8. What we do about it
Defend the searches that indicate readiness
Treat the financing conversation as a marketing problem
Compete on what a corporate chain cannot copy
Instrument the full funnel, not just lead volume
Judge trends on rolling windows
Sources
All figures are drawn from primary sources.
| Claim or market | Source |
|---|---|
| Consumer dental spending, dentist busyness, wait times, confidence, practice costs, reimbursement | ADA Health Policy Institute, State of the U.S. Dental Economy, Q1 2026 (n=796) |
| CPI, energy and food prices | U.S. Bureau of Labor Statistics, Consumer Price Index, May and June 2026 |
| Student loan restart spending impact | Federal Reserve Board, FEDS Notes, Debt Payments and Spending: Evidence from the 2023 Student Loan Payment Restart (September 2025) |
| Student loan delinquency, default, cross-product delinquency | Federal Reserve Bank of New York, Quarterly Report on Household Debt and Credit, Q1 2026, and Liberty Street Economics (May 2026) |
| Texas and Austin employment | Federal Reserve Bank of Dallas, Texas Employment Forecast, February and July 2026 |
| Consumer sentiment and inflation expectations | University of Michigan Surveys of Consumers, May–July 2026 |
| California statewide | California Employment Development Department, monthly labor force releases, May and June 2026 |
| All California metros (Sacramento–Roseville–Folsom, San Francisco–Oakland–Fremont, San Jose–Sunnyvale–Santa Clara, Los Angeles–Long Beach–Anaheim, San Diego–Chula Vista–Carlsbad, Fresno, Modesto) | California EDD, Labor Market Information Division, monthly MSA reports |
| Salem and Oregon | Oregon Employment Department; U.S. Bureau of Labor Statistics, Local Area Unemployment Statistics; Oregon Office of Economic Analysis, June 2026 forecast |
| National comparison figures | U.S. Bureau of Labor Statistics |
Prepared by Lime 42 ®. Figures current as of July 2026. Economic conditions in this period have been volatile; we update this briefing quarterly.
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