The dental industry is changing. Fast. And one of the biggest debates stirring up strong opinions is whether Dental Support Organizations (DSOs) will eventually dominate the profession. Some dentists say it’s inevitable. Others think private practices will always have a place. What’s really happening?
To get a clear picture, let’s look at what real dental professionals are saying.
What Is a DSO — And Why Does It Matter Now?
First, you have to understand the function of DSOs, or dental support organizations, if you want to know what is upsetting the dental landscape. They are not dental clinics, DSO Dental provides dental practices’ behind-the-scenes commercial engine. Their operational load covers everything from payroll and hiring to marketing, billing, IT support, and regulatory compliance.
They take on the operational load — everything from payroll and hiring to marketing, billing, IT support, and regulatory compliance.
That means dentists affiliated with a DSO don’t have to be business managers and clinicians. They can focus more on treating patients while the DSO runs the office in the background. In many ways, it’s a division of labor: dentists handle the dentistry, and the DSO handles the business.
How Does a DSO Actually Work?
Suppose you’re a dentist who owns your own practice. You’ve spent years building your business: hiring staff, managing payroll, negotiating with insurance companies, handling marketing, and staying on top of legal and regulatory changes, all while seeing patients every day. It’s exhausting.
Now, imagine a Dental Support Organization steps in and offers you a deal:
“We’ll buy your practice or partner with you. You keep treating patients like you always have, but we’ll take care of the business side.”
Here’s what happens next:
1. The Business Changes Hands (But the Face of the Practice Might Not)
- The DSO Dental either buys the practice outright or signs a long-term management agreement.
- You, the dentist, might still work there as an employee, partner, or associate.
- The office may keep the same name and staff, so patients often don’t notice anything has changed.
2. The DSO Takes Over Non-Clinical Tasks
Everything that isn’t directly related to patient care is now the DSO’s responsibility:
- Human Resources (hiring, training, payroll, benefits)
- Billing and Insurance Claims
- Marketing and Advertising
- Legal Compliance and Credentialing
- IT Systems and Office Software
- Purchasing Supplies at Lower Costs (thanks to buying in bulk)
This frees up the dentist to focus on clinical work — exams, procedures, diagnosis, treatment planning — without juggling business headaches.
3. The Dentist Stays in Charge of Care
Even though the DSO runs the business, it’s the dentist who makes medical decisions. They still decide what treatment is best, how to care for each patient, and how to practice dentistry.
4. Private Equity Is Often Involved
Many DSOs are backed by investors looking for growth. They buy up multiple practices, streamline operations, and aim to make the entire network more efficient and profitable. These investors eventually want a return, either by selling the DSO to a larger company or taking it public.
So What’s the Goal?
From the DSO’s perspective:
- They want scale. More locations = more revenue.
- They want efficiency. Centralized systems cut costs.
- They want consistency. Standardized processes improve productivity and margins.
- And ultimately, they want growth, so they can sell the business for a higher valuation later.
From the dentist’s perspective:
- It’s a way to reduce stress, offload admin work, and sometimes cash out financially.
- But it also means less control over how the business runs and sometimes, over the pace or style of patient care.
Why does this matter? Because it’s changing the shape of the profession. More practices are being absorbed into DSO networks every year. This affects how dentists work, how care is delivered, and how much control individual providers have over their own practices. And while the DSO model offers clear advantages in efficiency and scale, it’s also raising serious questions about autonomy, patient experience, and long-term sustainability.
Why Some Dentists Say DSOs Are the Future
Several professionals believe DSOs are on a clear path to dominance, and they back it up with strong arguments:
1. Rising costs and complex regulations are overwhelming solo owners. Dentists are dealing with skyrocketing expenses, insurance restrictions, and increasing administrative burdens. Some feel that the rules are built for large companies, making it harder for small offices to stay afloat. In this environment, DSOs have the resources to absorb the stress and manage compliance more efficiently.
2. Burnout is real. Running a practice means being a full-time clinician and a full-time business owner. Many dentists are burning out, especially younger professionals who are already burdened by student debt. For them, joining or selling to a DSO can be a relief.
3. DSOs don’t just want profitable practices anymore. There’s a growing trend where DSOs are acquiring underperforming practices, not to shut them down, but to improve them. They’re leveraging systems, economies of scale, and management strategies to turn struggling practices into profitable ones.
4. New patient behavior and insurance trends favor big systems. As more patients move to state-funded dental insurance and expect seamless digital service, larger systems that mimic the structure of healthcare networks may become more appealing. DSOs are set up to deliver that kind of experience across multiple locations.
What’s in It for DSOs?
So why are DSOs doing all this? Why go after struggling practices or invest heavily in systems and staff? The answer is simple: long-term growth and return on investment.
DSOs, especially those backed by private equity, are not just thinking about today’s profits. They’re playing a longer game. By acquiring practices, profitable or not, they’re building networks that can be streamlined, standardized, and scaled. A solo office might not generate huge income alone, but when dozens or hundreds are grouped under one business model, the cumulative value increases dramatically.
Here’s what’s in it for them:
- Economies of scale: DSOs can negotiate better rates on supplies, labs, software, and equipment. What costs a solo dentist $20 might cost a DSO $12.
- Operational efficiency: By centralizing things like billing, HR, marketing, and compliance, they cut overhead and reduce redundancies across locations.
- EBITDA growth: This is a key metric for investors. By improving operations and increasing profits, DSOs boost EBITDA (earnings before interest, taxes, depreciation, and amortization), which significantly raises the company’s valuation.
- Attractive exit strategies: Once they’ve built a strong network of optimized practices, many DSOs sell to larger investment groups or go through recapitalization events. This can generate massive returns for the original investors.
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Why Others Say DSOs Will Hit a Wall
Despite their growth, DSOs are not without their critics, and many practicing dentists have compelling reasons to believe independent practices aren’t going anywhere.
1. Patients value relationships, not just services
Dentistry isn’t like shopping or dining out. People don’t just want a clean facility and fast service — they want a dentist who knows them, who remembers their history, and who makes them feel safe. That kind of relationship is hard to maintain in a corporate model where providers may rotate or be stretched thin. When patients walk into a private office, they often see the same faces year after year. That continuity builds trust, and it’s something a lot of DSOs struggle to replicate.
2. Ethics and care quality can take a hit
Many dentists worry that the DSO model prioritizes profit over patient care. In a small practice, the dentist makes decisions with the patient’s best interest in mind, even if that means recommending fewer procedures. But when corporate leadership starts setting quotas or measuring productivity in dollar signs, some fear it can lead to overtreatment, rushed appointments, and a focus on volume over quality. It’s not just a philosophical concern — it’s about how clinical decisions are influenced when financial performance is on the line.
3. DSO deals can be complicated and risky
For dentists thinking of selling their practice, DSOs might sound like a clean exit. But the reality can be messy. One dentist shared his experience of spending over a year in talks with a DSO, only for the deal to collapse just days before finalizing. That meant lost time, legal fees, emotional stress, and no sale. These aren’t isolated cases. Many DSO transactions involve complex contracts, shifting terms, and unpredictable outcomes that leave dentists disillusioned.
4. Market fatigue and overexpansion
Some in the industry believe the DSO wave could eventually crash. Like any trend driven by investment money, there’s always a risk of growing too fast. As DSOs chase rapid expansion, they may acquire too many underperforming practices or stretch their systems too thin. And if the numbers don’t add up, private equity firms may pull back, leaving closures and instability in their wake. This isn’t speculation — some labs and dental supply partners already report seeing DSO locations quietly shuttering when targets aren’t met.
What Might Happen Next?
The truth is likely somewhere in the middle. Dentistry is evolving, but not in a one-size-fits-all direction. Here’s what could be ahead:
1. Hybrid models are gaining traction
Not every dentist wants to sell to a large DSO, but many still want the benefits of scale. That’s where hybrid models come in. Some dentists are creating their versions of DSOs, forming small networks or group practices that share back-end support but keep clinical control. Others are partnering with like-minded colleagues to pool resources without giving up autonomy. It’s a way to stay independent while still being efficient and competitive.
2. DSOs will keep growing, but niche practices will stand strong
DSOs will likely expand, especially in urban centers and areas with high insurance-driven demand. But boutique and fee-for-service practices aren’t going extinct. In fact, in markets where patients value long-term relationships, premium care, and a familiar face, small private practices may thrive. These practices might not be mainstream, but they’ll hold their ground, and often do so with loyal, multigenerational patient bases.
3. The job path is changing for new dentists
Today’s dental grads often start their careers in DSOs. These organizations offer structure, steady income, and the chance to focus on clinical work without worrying about business details, which is appealing, especially for those carrying student debt. But over time, many of these young dentists may outgrow the corporate model. After gaining experience and financial stability, they may leave to open their own practices or join smaller, values-driven groups.
4. Patients and insurers will drive the next big shift
What patients want, and how insurance companies operate, will have a huge influence on the future of dental care. People expect faster scheduling, digital tools, transparent pricing, and more affordable options. DSOs are already set up to meet those demands at scale. But independent practices that invest in the right tech, keep up with patient expectations, and maintain strong service can still compete — and in some cases, outshine the big players.
Will Patients Even Notice a DSO?
One of the most common questions from outside the dental world is: Will patients even know—or care—if their dentist is part of a DSO? The answer depends on how the DSO dental is run and how much they standardize the experience across locations.
In many cases, the signage on the door still says “Dr. Smith, DDS,” not the name of the DSO. That’s intentional. Most DSOs operate behind the scenes, handling the business side without changing the branding or disrupting the clinical relationship. To the average patient, their routine cleaning or filling feels just like it always has.
But some things might start to shift over time. Scheduling systems may become more centralized. The office might switch to digital forms or offer teledentistry follow-ups. Patients might see a new hygienist or associate dentist more frequently, especially if staff rotate between locations. And in some DSO-run practices, treatment recommendations may start to feel more scripted or production-driven, which attentive patients can pick up on.
Still, many DSOs are actively working to avoid that kind of feel. They know patients value relationships and consistency, so they often keep existing staff and try not to disrupt the culture of the office. If done well, the average person may never know the practice changed hands at all.
Final Thoughts
DSOs are not a passing trend. They’re changing the business of dentistry, and they’re not going away. But that doesn’t mean the independent dental practice is doomed. The profession is at a crossroads, and dentists have more paths than ever to succeed.
Whether it’s building a small private office with deep community roots or launching a multi-practice business, the future of dentistry will be shaped by those who adapt, not just those who consolidate.
