INDUSTRY

How consolidated is dentistry? It depends on what you're counting

Every growth plan in the DSO world rests on estimates of how much of dentistry is still unaffiliated. Figuring out what number actually is is proving to be surprisingly difficult. 

What happened: A recent estimate by advisory firm TUSK Practice Sales that around 35% of the industry is already consolidated raised eyebrows and sparked questions about where consolidation in the dental space actually stands.

The math: Four numbers get quoted, but they’re actually answering four different questions. 

• 12.8%. The lowest number you’ll usually see is 12.8%. Peer-reviewed research in Health Affairs tracked private equity affiliation among dentists from 6.6% in 2015 to 12.8% in 2021. But keep in mind that’s a narrower category than DSO-affiliated practices.

• 16.1%. The ADA Health Policy Institute (HPI) puts DSO affiliation at 16.1%, though that counts dentists rather than offices.

• ~26%. Speaking on The Dental Economist Show, Boston Consulting Group's Chris Moxon splits roughly 137,000 practices into about 9% held by the top 50 DSOs and another 17% inside smaller groups. Moxon says that only about 8,600 unaffiliated practices clear $2 million in annual revenue, though, suggesting that consolidation of larger practices may be further along than headline numbers suggest.

• 35%. And the highest number comes from the aforementioned TUSK Q3 2026 market report, which opens with the line that roughly 35% of the dental industry is now consolidated.

So, why the discrepancy? Two of those gaps have clear explanations. HPI counts dentists who report affiliating with a DSO, while BCG counts offices inside a group of any size, which would capture a three-location owner who would likely not describe themselves as a DSO.

• TUSK names 5,600 practices across the five largest DSOs but does not publish its full methodology, so it’s difficult to assess its claim that the industry is 35% consolidated. It’s true, however, that group-affiliated practices skew larger, so a quarter of offices could plausibly account for a third of the $189 billion Americans spent on dental care in 2024.

Why it matters: The degree of consolidation has implications for what sort of multiples practices can expect to command when acquired. TUSK argues that the 35% consolidation figure places dentistry in the middle of a consolidation lifecycle in which multiples fall from the 8 to 10x of the golden age toward 4 to 7x at full consolidation.

• It’s also relevant for buyers trying to determine how big the pool of sellers is. At 16.1%, five out of six dentists sit outside a DSO and you're early. At 35%, the easy phase is behind you.

Bottom line: If you need one number, Moxon’s count of roughly a quarter of offices is a reasonable one to anchor on. It’s the broadest measure with a published denominator that can be corroborated, and it captures practices in smaller groups, which is the larger bucket. But remember that this figure is contested and will swing depending on what it is you’re actually trying to measure.