Sell, Wait, Or Grow: The Decision Dentists Can’t Afford to Get Wrong

Connor Jorgensen and Ryan Mingus sat down to talk through the difficult decisions dentists are facing about their practices in 2026. Between them, they have advised hundreds of dentists in the sale of their life’s work, and the questions owners bring to them have shifted noticeably this year.

Four Things Worth Knowing

1. Practices producing $500,000 to $2 million of EBITDA have transacted with more ease due to less strain from DSO due diligence. TUSK’s clients generating between $500,000 and $2M of EBITDA have relatively shorter sales cycles, and are more attractive to the active buyers in the market.
2. Costs have risen 23% since 2021 while reimbursement has risen 19%, and that four-point spread comes directly out of practice margin.
3. Dentists do not need to sell their entire practice in order to partner with a DSO. An owner can sell a majority stake and still retain ownership in the practice, collecting distributions from the larger group as it grows.
4. The average 2025 dental school graduate carries $296,500 in education debt. Younger generations are more likely to join DSOs or existing groups, rather than own a practice. With the high cost of debt, on top of their pre-existing educational debt, doctor-to-doctor sales have become more difficult to finance.

Following the release of the ADA Health Policy Institute’s Q2 2026 report, the findings confirm that dentistry and practice ownership have become measurably more difficult over the last 12 to 24 months. Since January of 2021, the cost of dental supplies has increased by 23%, and staff wages have risen by the same amount. Reimbursement rates across all payers are up 19%. All of that difference goes directly to the margin in dental practices, and the report shows that the spread is continuing to widen through the first half of this year.

The demand side offers no relief. Consumer spending on dental care grew 1% over the last twelve months, and over ten years dental spending is up 24% against 46% for physician services. Dentists reported being busier this quarter while revenue stayed flat. Confidence in both their own practice and the sector did rise in Q2 2026, so what owners face is a margin squeeze rather than a collapse in demand.

Owners are now facing a decision to sell, wait, or grow, and the one option no longer available to them is standing still.

What Changed in the Dental Market

To understand the shifts in the dental market over the last 12 months, owners must first understand the forces driving the shifts. Today’s inflationary environment and high cost of debt have made the buy-side more risk-averse and strategic in their acquisitions. Acquisition financing now runs close to 10.75% all-in on an SBA 7(a) loan with the prime rate at 6.75%, and overall inflation has climbed 27% since January 2021 while dental reimbursement has moved 19%. The operating costs in dental practices, paired with the surges in dental staff wages, have decreased margins. Practice owners are also seeing the effects of tariff policy. Consumers are faced with difficult decisions related to insurance coverage, impacting patient retention.

Buyers want a clean profit and loss statement, an owner willing to stay 5 years after the sale, providers who are likely to remain after the owner has exited, and a payer mix that holds up under a quality-of-earnings review, which is the buyer’s accounting team pressure-testing your financials more than ever.

The premium has consequently moved down-market. Practices producing between $500,000 and $2 million of EBITDA are more attractive assets in the current dental market, because more DSOs can finance a transaction of that size and a practice in that range lifts a platform’s blended multiple rather than diluting it.

Appetite in dental M&A has not weakened. TUSK’s DSO Sentiment Survey found 61% of DSOs expected higher deal volume in 2026, though some delivered and others went quiet, and knowing which is which is much of what a marketed process provides. Dental also has more private equity platforms past the five-year mark than any other healthcare segment, and those sponsors need EBITDA growth before they can recapitalize.

Scrutiny in dental M&A is higher than it was two years ago. Diligence takes longer, add-backs are challenged rather than accepted, and payer mix has become an underwriting input rather than a closing formality. None of that is a reason to avoid a sale. It is a reason not to run one alone, because the group across the table does this every week and you will do it once.

Why Owners Continue to Partner with DSOs

Connor Jorgensen also covered the common misconception that partnering with a DSO entails selling the entirety of their practice. A common DSO deal structure has the owner selling a majority stake, keeping meaningful ownership, and participating in distributions from the larger group as it grows, so the owner keeps running a living, breathing business while the partner absorbs the administrative load.

That administrative load is substantial and difficult for a single practice to build alone, covering billing and claims, credentialing, human resources and recruiting, marketing, and purchasing power a single location cannot negotiate on its own. Adding chairs, providers, or a service line using a partner’s balance sheet is also a materially different proposition than financing that expansion yourself at current interest rates.

The benefit owners raise first, however, is none of the above. They describe going back to practicing dentistry rather than running a business after hours. Support quality varies meaningfully between platforms, which is why knowing the buyer matters as much as knowing your own numbers. Ryan Mingus and the TUSK deal team are in regular conversation with DSOs and their private equity sponsors, tracking what makes each group different and how healthy their balance sheet actually is. By the time a dentist sees a list of bidders, we already know who is funded, who is integrating well, and who has quietly slowed down.

Why Doctor-to-Doctor Transitions Are More Difficult Today

Owners planning a doctor-to-doctor transition should pressure-test that plan now. The average dental school graduate in the class of 2025 carries $296,500 in education debt, and lenders routinely ask sellers to carry 10% to 25% of the price as a note, meaning you finance part of your own exit and wait years to collect it.

A recent situation from our pipeline illustrates the problem. A lender approved 80% of the purchase price and asked the selling dentist to carry the remaining 20%. The seller declined, the transition did not happen, and the sale was delayed another 18 months.

The counterintuitive part is that stronger performance makes the math worse. At $200,000 of EBITDA an associate can generally service the loan. At $900,000 the practice is worth several times that, and the debt service exceeds what one buyer can carry on top of student debt. The profitability that should be your largest asset becomes the obstacle in a doctor to doctor transaction.

Where Owners Are Finding Margin

Reimbursement rates and wage inflation sit outside your control. How much revenue leaks on its way through the practice does not.

Technology is the practical lever, and it extends beyond artificial intelligence. 43.3% of dentists already use AI for at least one task, most commonly imaging and diagnostics, while only about one in ten uses it for practice analytics, which is precisely where large platforms have built their advantage. A further 82.6% will not use AI for treatment recommendations, and that caution is well placed. The opportunity for most owners is administrative rather than clinical.

A recent referral shows how unglamorous this work can be. A three-location dental group we introduced to Spendly, a vendor spend platform that uses artificial intelligence for cost-savings analysis, reviewed eight expense categories and cut spend by 23%. That produced over $158K in additional EBITDA without touching clinical care, production, or the schedule. They went to market six months later carrying the higher figure.

A dollar of recurring expense removed becomes a dollar of EBITDA, and EBITDA is the figure a buyer multiplies, which is how work done this quarter shows up in a purchase price years later.

Sell, Wait, or Grow

Practice owners who are uninformed when it comes to making the right decision for their practice are at a disadvantage they cannot afford. The first step in making the right decision for your dental practice begins in the numbers.

▪  What is my adjusted EBITDA?

▪  Where is my payer mix trending?

▪  What is my hygiene recall rate?

▪  Which expense lines have grown fastest over three years?

At TUSK, we run complimentary practice valuations for dental practices to help dentists make the right decision at the right time. TUSK’s valuation analysis will help you answer the questions above, as well as project what the future of selling, growing, or waiting could look like.