The dental industry is undergoing a structural shift in how practices are owned and operated. Dental service organizations, once a minor presence in most local markets, now own a growing share of practices in nearly every metropolitan area. DSO affiliation among U.S. dentists climbed from under 9% in 2017 to 16% by 2024, according to ADA Health Policy Institute data. At the same time, a significant number of solo and small-group practices continue to open or change hands independently, often within a few miles of a DSO-owned office. Two distinct ownership models are now competing for the same patient base, and both continue to grow.
The DSO model succeeds because it addresses challenges an individual owner cannot easily solve alone: staffing across multiple locations, negotiated rates on supplies and equipment, and shared marketing and scheduling systems. Group ownership does not automatically produce superior dentistry, but it does produce lower overhead per chair, a meaningful advantage in a business defined by thin margins.
The Rationale Behind DSO Acquisitions
A retiring dentist with an established patient base is, from a DSO’s perspective, simply a cheaper way to enter a market than building a practice from scratch. Multiplied across dozens or hundreds of acquisitions, a regional or national group begins to resemble any other consolidating service industry, from home health to veterinary care to optometry. What changes in these deals is rarely the clinical work itself. It is the ownership structure and back-office infrastructure surrounding it.
The Case for Independent Ownership
Owners who remain independent are generally relying on something DSOs cannot easily replicate at scale: a specific relationship with a specific patient, built over years. This is a genuine asset, though a fragile one, since it depends entirely on the dentist remaining in the chair. A DSO-owned practice can withstand the departure of a single dentist. A solo practice built around one person’s reputation cannot.
A Quiet Shift in Recruiting
DSOs are also succeeding in a less visible arena: recruiting associate dentists who prefer clinical work without the administrative responsibilities of ownership. New graduates carrying substantial student debt are often more interested in a predictable salary and benefits than in purchasing a practice outright, and the data reflects this preference. More than 1 in 4 dentists within ten years of graduation are now DSO-affiliated, compared to a much smaller share of dentists later in their careers. This shift in what younger dentists want is likely contributing as much to DSO growth as acquisition activity itself.
Conclusion
Neither model shows signs of receding, and dentists on either side of the divide will continue to compete for the same patients and the same associates. The practices that hold up best over the next decade, corporate-owned or independent, will likely be the ones that never stopped treating clinical quality as the actual product, regardless of the ownership structure behind it.
