M&A activity snapshot
Dentistry is the most consolidated practice-based category in U.S. healthcare, but most dentists still work outside DSOs. As of 2024, more than one in ten dentists (16%) in the U.S. are affiliated with a dental support organization, according to the ADA Health Policy Institute (HPI).
HPI counts a practice as DSO-affiliated if some outside entity managed some or all of its nonclinical functions, such as billing, marketing, human resources or more. Its analysis covered nearly 200,000 practicing dentists in the U.S.
The market remains fragmented by count. Census data cited by HPI shows 135,665 dental practice establishments in the U.S. as of 2023, so even the largest DSOs hold a small share of total offices.
Ownership is shifting underneath. As of 2023, less than three-fourths of U.S. dentists (72.5%) are private practice owners, down from 84.7% in 2005. Younger dentists favor group settings: more than 1 in 4 dentists up to 10 years out of dental school were affiliated with a DSO in 2024.
Who is buying
PE-backed DSOs dominate. Heartland Dental, the largest, affiliates with over 3,200 doctors in over 1,960 locations across 39 states and the District of Columbia and is majority owned by KKR. In October 2026 it closed its affiliation with Foundation Dental Partners, a doctor-focused dental support organization with 33 supported practices.
DSOs buy other DSOs as well as single practices. Over the prior 13 months, Heartland also added Smile Design Dentistry and its 60 supported practices, as well as Inspire Dental Group and nearly two-dozen solo practices. It builds new offices too, with its De Novo program having opened 51 offices in 2026 with a goal of 68 by year-end.
MB2 Dental is another active acquirer. It is backed by middle-market private equity firm Charlesbank Capital Partners alongside growth equity investor Warburg Pincus, and its September 2026 deal for Hawaii Pacific Dental Group marks MB2 Dental's 14th acquisition of 2026.
Aspen Dental is also owned by private equity firms, per the California Attorney General. Associate dentists remain buyers, but a less reliable pool. Ownership rates at a comparable career stage were 21% of 2016-20 graduates and 33% of 2011-15 graduates, versus 63%-70% of dentists who graduated in 2010 or earlier.
What buyers look for
Provider risk comes first. In TUSK Practice Sales' buy-side survey, historical financial performance and provider risk + stability were the most scrutinized elements in a deal in 2025. Buyers want to know who produces the dentistry, how long the selling dentist will stay, and whether associates will remain.
Labor cost is the second lens. Per BLS data cited by HPI, the national median hourly wage of dental hygienists is $47.16. For dental assistants, the national median hourly wage is $23.11. Buyers test whether hygiene production covers that cost.
Corporate-practice compliance is now a core diligence item. California's settlement with Aspen Dental alleged the company encouraged the sale of particular products and services through direct incentives to practices' clinical employees. Buyers and sellers both check that clinical decisions stay with licensed dentists.
Practical KPIs buyers track include collections per dentist and per hygienist, hygiene recall and reappointment rates, payer mix between PPO, fee-for-service, and Medicaid, new-patient flow, and EBITDA after a market-rate salary for the owner dentist. No independent public benchmark for these KPIs across DSO deals was available, so none is cited here.
What makes a strong company
A dental practice that draws multiple DSO offers typically shows:
- Production spread across more than one dentist, or an associate already in place who plans to stay.
- An owner willing to stay on post-close; TUSK reports increased scrutiny where the owner is unwilling to remain on board for 3–5 years post-sale.
- Stable or improving trailing results through the sale process, since buyers re-check trailing EBITDA during diligence.
- A hygiene department with steady recall, and staffing that does not depend on the owner's personal relationships.
- No ownership, advertising, or incentive structures that would raise questions under state corporate-practice rules.
Buyer demand is strong for practices that fit these criteria. TUSK's survey found 69% of DSOs expect to increase acquisition activity in 2026, and 78% of buyers anticipate recapitalization within 12–36 months. These are survey results from a sell-side broker, not an independent market census.
Valuation and deal structure
No independent data provider publishes a dental-specific multiple series. The closest public commentary comes from practitioners. Dykema's Brian Colao said for larger DSO transactions, multiples once reached 13–16x EBITDA but have fallen closer to 9–10x. He added that for smaller practices, which briefly saw multiples around 7x during the peak years, valuations have returned to more traditional ranges of 5–6x.
As a sector proxy, GF Data recorded healthcare services at 7.7x in the first half of 2026, though a small sample warrants caution. That figure covers $10 million to $500 million deals across healthcare services, not dental practices alone.
Structure matters as much as the headline multiple. TUSK reports that multiples have stayed constant over the last two years, while a portion of the proceeds is commonly allocated to equity. Equity comes as joint-venture equity at the practice level, holding-company rollover into the platform, or a hybrid of the two.
Regulation sets the outer limits of any structure. California's SB 351 restricts private equity groups involved with medical or dental practices from making decisions regarding coding or billing, among other controls. The Aspen Dental settlement includes $2 million in penalties, and $300,000 in restitution and remains subject to court approval.
Outlook
Supply of sellers should keep rising. TUSK, citing ADA data, reports that the average retirement age for U.S. dentists reached 68.7 years in 2024. Combined with later ownership among younger dentists, more late-career owners are likely to look to DSOs rather than associates.
Demand looks steady but more selective. With most surveyed DSOs facing a recapitalization inside three years, platforms have reason to keep buying practices with clean earnings. State corporate-practice enforcement, led by California, will shape how those deals are structured over the next 12-24 months.
Own a dental practice and want a baseline before you talk to a DSO? Run the valuation tool or read what dental buyers look for in detail. Back to Healthcare Services M&A. See also: why vertical-specific buyers outperform generalists in outbound.