DSOs vs. independent practice: what the data actually shows

Discussions of dental consolidation often begin with a big number and a prediction. The underlying data supports a narrower conclusion. Dental support organizations (DSOs) are growing, especially among new dentists. Most U.S. dentists in private practice still own their practices, and HPI’s analysis suggests that younger dentists are delaying ownership more than giving it up. Below is what the American Dental Association’s Health Policy Institute (HPI) and peer-reviewed research show, followed by what remains unsettled.

What counts as a DSO

Definitions matter here. HPI counts a dentist as DSO-affiliated when “some outside entity managed some or all of its nonclinical functions, such as billing, marketing, human resources or more.” DSO affiliation is separate from practice size. A solo office can be DSO-supported, and a large group can be independent. Private equity ownership is a third category. Many DSOs are private-equity backed, but the two measures are not the same.

The DSO numbers

HPI’s data show steady growth:

• 8.8 percent of U.S. dentists were DSO-affiliated in 2017.
• 10.4 percent in 2019.
• 13 percent in 2022.
• About 17 percent, roughly one in six, as of 2025, according to HPI’s dental practice research page.

Growth is concentrated among new dentists. In HPI’s 2022 data, 27 percent of dentists five or fewer years out of school were DSO-affiliated, and 18 percent of those six to ten years out. HPI’s 2024 data, reported by ADA News in November 2025, found that more than one in four dentists up to ten years out of school were affiliated with a DSO.

Solo practice and practice size

Practice size has changed along with DSO affiliation. In HPI’s 2022 data, 17 percent of dentists who graduated within the previous ten years worked in solo practices, compared with 38 percent of those 11 to 25 years out and 50 percent of those more than 25 years out. The pattern reverses for large groups: 24 percent of the newest dentists worked in practices with ten or more locations, compared with 8 percent of the most experienced group.

Ownership: down, but delayed rather than gone

According to HPI, 72.5 percent of U.S. dentists in private practice were owners in 2023, down from 84.7 percent in 2005. Read alone, that looks like a steady slide. A June 2025 HPI brief, “Practice Ownership Trends in Dentistry: A New Look at Old Data,” followed graduating classes over time and reached a more measured conclusion.

Early-career ownership has dropped sharply. Among 2016–2020 graduates, 21 percent owned a practice in their earliest career stage. For 2011–2015 graduates the figure was 33 percent, and for those who graduated in 2010 or earlier it was 63 to 70 percent. The gap narrows over time, however. Fifteen to nineteen years after graduation, 81 percent of the 2006–2010 class were owners, compared with 89 percent of the 1991–1995 class.

Marko Vujicic, Ph.D., HPI’s vice president and the ADA’s chief economist, summarized the finding for ADA News: “most roads still, eventually, lead to practice ownership.” The brief identified 2011 as a turning point but said the cause is unclear. Possible factors include the opening of 15 new dental schools since 2011, educational debt, demographic shifts and changing work-life preferences. Women were less likely to own practices at every career stage, by about 16 percentage points early in their careers.

Private equity

A 2024 study in Health Affairs by HPI economists Kamyar Nasseh, Anthony LoSasso and Marko Vujicic measured private equity directly. The share of dentists affiliated with private equity nearly doubled, from 6.6 percent in 2015 to 12.8 percent in 2021. Among general dentists it rose from 6.8 percent to 12.7 percent, and it more than doubled for several specialties, with endodontists growing fastest. Documented private equity transactions involving dentists rose from fewer than 20 a year between 2004 and 2015 to 96 in 2021.

The study also found that private equity-affiliated practices participated in Medicaid at higher rates than unaffiliated practices. The authors cautioned that they could not rule out unobserved factors, such as profit margins or hygienist staffing, as explanations.

Similar pressures on both models

Surveys suggest DSO and independent dentists face many of the same problems. In HPI’s fourth-quarter 2025 survey, as summarized by Oral Health Group, independent dentists’ top concerns were insurance (55.2 percent), staffing (53.8 percent) and overhead (42.3 percent). DSO-affiliated dentists named staffing (59.3 percent), insurance (55.6 percent) and keeping a full schedule (35.2 percent).

California’s new rules

California tightened oversight of outside investment in 2025. SB 351, effective January 1, 2026, bars private equity groups and hedge funds involved with physician or dental practices from interfering with clinicians’ professional judgment. The decisions it protects include diagnostic testing, referrals, patient volume and hours, coding and billing, and equipment selection. It also voids noncompete and nondisparagement clauses in covered contracts. A companion law, AB 1415, also effective January 1, 2026, requires private equity groups, hedge funds and management services organizations to notify the state’s Office of Health Care Affordability of certain transactions. Its thresholds will be set by regulation. Whether and how AB 1415 applies to particular dental deals will depend on those regulations.

Commentary: be careful with the numbers

The following is analysis, not data. Consolidation figures are often quoted without saying what they measure. In an August 2026 DentistryIQ column, dental accountant Brian Hanks questioned a widely shared claim that dentistry is “35% consolidated.” He noted that the figure did not say what was counted, and that DSO affiliation, private equity ownership and group practice are different measures. Each of the measures above shows growth. None of them shows a majority of dentists outside independent ownership.

For an owner thinking about a sale, a partnership or staying independent, the data is clear on two points: DSOs are the fastest-growing model among new graduates, and most dentists still become owners eventually. Two questions remain open. One is whether delayed ownership becomes permanently lower ownership. The other is how ownership type affects prices, quality and access, which the Health Affairs authors identified as the next research priority.

Sources

• ADA Health Policy Institute, Dental practice research (ownership and DSO FAQs)
• ADA Health Policy Institute, Practice Modalities Among U.S. Dentists
• ADA News, “More dentists affiliating with DSOs” (June 1, 2023)
• ADA News, “Practice modality by the numbers” (February 20, 2024)
• ADA News, “HPI: More new dentists affiliated with DSOs” (November 17, 2025)
• ADA News, “HPI: Younger dentists still become practice owners, just later in careers” (June 17, 2025)
• ADA News, “Private equity affiliation among dentists increases” (August 6, 2024)
• Nasseh K, LoSasso AT, Vujicic M. Health Affairs, 2024. DOI 10.1377/hlthaff.2023.00574
• Oral Health Group, summary of HPI Q4 2025 State of the U.S. Dental Economy data
• Epstein Becker Green, analysis of California SB 351
• Morgan Lewis, “Double Dose of Regulation: The Impact of SB 351 and AB 1415 on California Healthcare Transactions” (October 2025)
• Brian Hanks, “Is dentistry really 35% consolidated? Let’s check the math,” DentistryIQ (August 8, 2026)