Thinking about selling your dental practice or partnering with a DSO… but not fully sure if it’s the right move? With everything changing quickly in the dental industry, it’s normal to feel uncertain about what to do next.
Selling a practice is one of the most significant decisions a dental practice owner will ever make. Whether you’re a solo owner feeling burned out, part of a small group growing quickly, or a dentist thinking about long-term financial security, you deserve to make an informed decision—not a rushed one.
This article breaks down everything you need to know about selling to a DSO, including due diligence, practice value, potential buyers, deal structure, financial stability, work-life balance, clinical autonomy, and how to choose the right fit for your personal and professional goals.
If you’d rather watch the full interview with one of the most trusted voices in dentistry, Brian Colao, and learn everything directly from him, you can watch the full YouTube episode now before reading the article.
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Why So Many Dentists Are Considering a DSO Sale
Over the past few years, the dental industry has shifted faster than anyone expected. Larger practices are growing, private equity firms are pouring money into dental support organizations, and DSOs are becoming a dominant business model.
Three major changes are driving dentists to consider selling:
1. Economic pressure
Rising interest rates, higher staffing costs, and supply price increases have squeezed net income for private practice ownership. Many dentists feel the administrative burden more than ever.
2. Quality of life
Dentists who once loved clinical work find themselves spending more time on HR, payroll, compliance, insurance negotiations, and operational responsibilities. The emotional and physical toll adds up.
3. Competitive environment
With DSOs sending unsolicited offer letters, making phone calls, and presenting attractive DSO offers, dentists are curious about what their practice might be worth from a DSO buyer’s perspective.
Whether you are in a rural area, a busy metro, or growing a new practice, the pressure looks different—but the question is the same:
“Is selling to a dso the right choice for me?”
Understanding What DSOs Actually Are
A Dental Service Organization (or Dental Support Organization) provides non-clinical support to independent dental practices. This includes:
• Human resources
• Payroll
• Marketing
• Insurance verification
• Billing
• IT and cybersecurity
• Compliance
• Real estate support
• Administrative systems
• Operational support through regional managers or office manager structures
This structure allows dentists to focus more on clinical work while the DSO handles day-to-day operations. For many dental professionals, that’s the main reason a DSO affiliation feels attractive. Less stress. Cleaner processes. More predictability.
However, every DSO is different. Some offer flexible clinical autonomy and long-term growth. Others are more rigid, and not every DSO is a good cultural match.
This is why careful consideration and due diligence are essential.
The Rise of DSO Buyers and Private Equity Investors
Private equity groups and private equity firms see dentistry as a stable, recession-resistant industry with strong cash flow. This is why DSO buyers are expanding so rapidly.
These groups often bring:
• Financial stability
• Economies of scale
• Better negotiated supply costs
• Centralized support teams
• Opportunities for rollover equity
• The potential for higher values through large-scale recapitalizations
Selling to a DSO can be financially rewarding—but only when the entire process is handled correctly.
How Do You Know If Selling to a DSO Is Right for You?
Deciding whether to pursue a DSO sale depends on your:
• Long-term goals
• Need for work-life balance
• Interest in reducing administrative burden
• Stage of career
• Desire for operational support
• Financial goals
• Comfort level with giving up certain business decisions
• Personal life priorities
Ask yourself:
Do you want to keep practicing clinical dentistry without running a business?
A DSO may be a great fit.
Do you love full control over your schedule, policies, and operational decisions?
Then private buyers or internal transitions may be better.
Is maximizing your sale price the top priority?
A competitive process with multiple potential buyers—NOT the first offer—will always give you more favorable terms.
Understanding Practice Value: What Determines the Sale Price?
Before selling to a DSO, know what determines your market value:
1. EBITDA (Earnings Before Interest, Taxes, Depreciation, Amortization)
This is the single biggest factor affecting purchase price. DSO offers are based on multiplying EBITDA by a valuation multiple.
2. Practice performance
Strong hygiene systems, consistent new-patient flow, a loyal patient base, and efficient day-to-day operations increase value.
3. Your location
A rural area may be less competitive, but DSOs often pay high multiples for underserved regions because of growth potential.
4. Growth opportunities
Open chair time, outdated marketing, older equipment, or the potential to add services may lead to more competitive offers.
5. Team stability
DSOs pay more for practices with reliable staff and an office manager who can support a smooth transition.
As a business owner, your job is to understand the value of your practice before talking to potential buyers.
The Biggest Mistake Dentists Make: Responding to the First Offer
DSOs frequently send unsolicited offer letters or emails—hoping a dentist will accept the first offer without exploring the market.
This is rarely a good idea.
DSOs are professional buyers. Their goal is to acquire practices at the lowest purchase price. That’s their business model. You would do the same in their position.
When you create a competitive environment, everything changes:
• Higher sale price
• Better deal structure
• More favorable earn-outs
• Stronger rollover equity options
• Better cultural and operational fit
• Better long-term financial benefits
This is why involving senior transition advisors, practice brokers, financial advisors, or investment bankers can dramatically improve outcomes.
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Deal Structure: What DSOs Typically Offer
A typical DSO sale may include:
• Lump-sum cash payment at closing
• Rollover equity in the larger DSO platform
• Earn-outs based on performance
• Long-term employment agreement
• Clinical autonomy terms
• Reduced operational responsibilities
• Defined expectations around work schedule and production
Each part of the deal affects your financial stability, tax strategy, and future growth.
The right DSO can create incredible upside.
The wrong DSO can create frustration and limit your decision-making process.
Potential Drawbacks of Selling to a DSO
While DSOs can solve many problems, there are also things dentists must consider:
| Risk Factor |
Explanation |
| Reduced Autonomy |
You may lose control over decisions related to branding, staffing, scheduling, or clinical protocols. |
| Changes in Practice Culture |
Some DSOs maintain the existing environment, while others implement rapid operational or cultural changes. |
| Financial Pressure |
You may be expected to meet aggressive production goals that can impact work-life balance or patient care standards. |
| Contractual Obligations |
Non-competes, employment terms, and equity rollovers can limit your flexibility post-sale. |
| Dependence on DSO’s Success |
Your future income or equity value may decline if the DSO underperforms or restructures. |
The Role of Professional Advisors
Before the sale of your practice, the right advisors can help you avoid costly mistakes.
Your team should include:
• A dental attorney experienced in DSO deals
• A CPA who understands capital gains and dental practice sales
• A financial advisor familiar with exit strategy planning
• A practice broker or investment banker to handle competitive offers
• Consultants who can help improve EBITDA before going to market
Their job is to guide the entire process, protect your clinical care standards, ensure a smooth transition, and help you make an informed decision.
How AI and Technology Are Changing the DSO Landscape
Technological advancement in dentistry is one reason DSOs are growing quickly. Many offer:
• Diagnostic AI
• Automated phone call systems
• Insurance verification AI
• Cloud-based practice management
• Streamlined billing systems
• HR platforms
• Predictive analytics
For dentists focusing on clinical work, DSOs with advanced technology can provide a significant advantage.
Making the Right Choice for Your Practice and Personal Life
Selling to a DSO is not just a financial transaction—it’s a decision that will impact your professional life, personal life, schedule, and long-term goals.
The right DSO affiliation can:
• Improve work-life balance
• Remove administrative stress
• Increase financial security
• Support future growth
• Allow you to focus on patient care
But only when you choose the right fit.
Take your time. Ask questions. Review every detail.
And remember — your first offer is rarely your best offer.
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