With the passage of the One Big Beautiful Bill (OBBBA) and the rise in tariff-driven operational costs, the dental M&A landscape is shifting in ways that practice owners can’t afford to overlook. While valuations remain strong for high-performing practices, the path to a premium exit is more complex when navigating today’s financial, political, and operational headwinds.

Here’s how these broader economic policies are directly impacting dental practice transitions—from deal structure and buyer behavior to after-tax proceeds and valuation pressure.

Sale Proceeds & Tax / Wealth Planning

Higher tax exposure and policy shifts can impact post-sale outcomes.

The OBBA introduced several sweeping changes to the financial environment that directly affect the wealth planning side of a practice sale. Among the most significant:

• A rollback of certain healthcare-related deductions, including depreciation benefits tied to equipment-heavy practices and interest write-offs tied to real estate or leveraged buyouts.
• A lower threshold for Medicare surtaxes, increasing effective tax rates for high-income earners, including many dentists.
• More scrutiny around pass-through entities and trust structures used to mitigate capital gains.

While we’re not CPAs or wealth advisors, we’ve seen firsthand how these shifts can potentially alter the net proceeds from what looks like a strong headline offer.

That’s why one of our first recommendations for owners even considering a sale is to bring in a wealth planning team early in the process. With capital gains exposure increasing and deal structures becoming more complex, strategies like installment sales, equity rollovers, and proper entity structuring can make a material difference in what you take home after the sale.

Valuation Trends: What’s Holding and What’s Changing

Strong dental practices are still commanding premium multiples—if the numbers hold up.

Dental remains one of the most active verticals in healthcare M&A. General dentistry and specialty practices with clean books, efficient staffing models, and consistent collections are still seeing high multiple EBITDA offers, especially in competitive metro or group-oriented markets.

But here’s where many owners are caught off guard:

We’re no strangers to working with practice owners who present fantastic financials—everything trending up and to the right. But when we roll those numbers forward to reflect more current trailing twelve months (TTM) performance, we sometimes see margin compression and signs of a slowdown. That may be due to staffing changes, inflation on supply costs, or softening patient flow—none of which are uncommon right now.

These moments don’t mean the deal is off the table. But they do underscore the need for updated financials and an advisor who can proactively frame these changes in a way that gets buyers comfortable. DSOs understand that no business is immune to short-term fluctuations—especially in a post-OBBBA, inflation-aware economy. What they want is context and a clear plan. In many cases, they’re banking on their ability to leverage scale and infrastructure to reverse those trends post-close.

Buyer Sentiment: Still Active, More Disciplined

The appetite is there. But DSOs are sharper, more data-driven, and focused on long-term fit.

DSOs and private equity groups remain highly active in the dental space, especially those with existing infrastructure in place looking to grow by acquisition rather than de novo. Today’s buyers are less emotional and more methodical.

They’re digging deeper into:

• Production per provider
• Provider churn
• New patient trends and case acceptance
• Insurance plan concentration and Medicaid exposure
• Operational leadership and long-term clinical stability

In the context of OBBA’s changes, particularly the risk of reduced Medicaid reimbursements and increased patient out-of-pocket costs, buyers are adjusting their diligence models to focus on resilience and scalability.

Still, the right deal with the right structure can command significant interest. The differentiator is preparation and a clear narrative around both short-term performance and long-term potential.

What TUSK Is Advising Dental Practice Owners Right Now

If you’re even considering a sale in the next 1–3 years, here’s what we’re telling our clients:

• Start with a valuation that reflects your most current performance. Don’t rely on 2023 numbers or best-case annualized models. We build our analysis around what’s happening now, because that’s what buyers are doing.
• Get your financials in order. DSOs will scrutinize margin trends, EBITDA adjustments, and patient retention metrics. Practices that show discipline—and can speak to short-term setbacks—are winning.
• Loop in a wealth advisor. Even the most competitive deal can lose value if it’s not structured right. From tax deferrals to equity participation, how you sell matters as much as what you sell for.  Additionally, if you need to maximize cash balance plans and other retirement benefits that go away post sale.
• Have the right story. You may not be able to control every trend in your business—but you can control how you present it. The practices getting the best deals today are those that acknowledge the headwinds and show how the right partner can accelerate through them.
• Control your own timeline.  Although there is no way to accurately “time the market” we can be certain that it is the goal of this administration to lower interest rates.  If the rate goes from 4.50% to 3.25% that would be a close to 30% decrease and still be higher than where rates were in 2019.  This feels achievable and will have material impact on valuations, deal structures, and the number of active buyers.

The Dental Market Is Still Strong—But the Bar Is Higher

Buyers are still buying. Valuations are still attractive. But the difference between a good exit and a great one comes down to strategy, structure, and execution.

At TUSK, we work exclusively on the sell-side—helping you prepare, position, and present your practice in a way that aligns with how buyers underwrite deals today.

If you’re curious where your practice stands or want to understand what a DSO deal could look like for you, we’d love to connect. We’ll show you what’s possible in this market, and how to turn it into a premium exit on your terms.