Where DSO deals are actually pricing.
The inaugural edition of our quarterly read on the dental transition market: multiples by deal size, what moved, and what it means if you are two to seven years from an exit. Free, ungated, and sourced, because informed sellers make better deals.
Between the two of us we have spent forty-five years in dentistry: one of us in the operatory, the boardroom, and the founder’s chair, the other in the models and at the LOI table. The question we get most often has not changed in a decade: what is my practice actually worth, and is now the time? What has changed is how hard that question is to answer from public information. Multiples get quoted like folklore, every survey has a sales agenda, and the honest data sits scattered across a dozen sources.
So each quarter we are going to assemble it in one place, cite everything, and tell you what we think it means. Where a number comes from a firm with something to sell, including us, we will say so. That is the whole editorial policy.
Size still sets the multiple. The gap is widening.
Every published 2026 guide tells the same structural story: the market pays for scale, and it pays exponentially rather than linearly. Single locations trade around 4 to 7 times adjusted EBITDA, group add-ons around 6.5 to 9, regional multi-site groups 8 to 11, and platform-grade organizations with $5M or more of EBITDA at 10 to 15 in the current market.[6][7][8] Specialty adds a premium on top: published ranges put oral surgery one to three turns above comparable general practices, with orthodontics and pediatric close behind.[6][7]
Read those tiers as a map, not a menu. Your practice does not receive the band; it earns a place inside one, and the same size practice can price a full turn apart on payor mix, doctor dependence, and how clean the EBITDA bridge is. Published driver lists agree on the levers: hygiene production above 30 percent of collections, associate-led production, and fee-for-service weighting all price up; heavy single-payor concentration and owner-produced collections above 70 percent price down.[6][7]
The peak is gone. The panic is too.
Synthesis of published ranges.[6] The 2025-26 rebase is not a return to the 2020-22 peak, and nobody credible is promising one.
The story of 2023 through 2025 was capital getting expensive. Deal processes slowed, more than fifty significant DSO sale processes were abandoned after mid-2022, and 2025 played out as what Dykema’s survey called a muted recovery, with their outlook pointing to an uptick in DSO M&A beginning in the second half of 2026.[5] Rates have started easing, sponsors are sitting on committed capital, and the published outlooks lean optimistic heading into 2027.[5]
What we are seeing at the table matches the data: capital is available and ruthless at the same time. Practices that fit a buyer’s geography, payor mix, and clinical model draw aggressive competition. Practices that do not draw polite offers. That selectivity is why the spread between the best and the median offer on the same practice is now the single most important number in a transition, and why one unsolicited offer is an anecdote, not a market check.
The market is consolidating. Slower than the hype, faster than comfort.
A third of active dentists are now 55 or older, and the average retirement age has pushed to 68.7, four years later than a generation ago.[1][3] Put those two facts together and you get the quiet math of the next decade: a very large cohort of owners will transition, and the buyers know exactly when the wave arrives. Meanwhile the practices themselves are getting harder to run solo: staffing remains the top reported challenge, reimbursement is not keeping pace with expenses, and about a third of dentists told the ADA they are not as busy as they would like to be.[11] None of that means you must sell. It means the bargaining power of waiting is not what it used to be, and preparation is worth more than timing.
The headline is not the deal
Published 2026 norms put cash at close at 60 to 80 percent of enterprise value, rollover equity at 15 to 30 percent, and the remainder in earnouts and holdbacks, with three to five year post-close employment now standard.[6] Rollover is where the marketing runs hottest: brokers publish second-bite stories with returns of several hundred percent,[9] and some of those stories are real. MB2’s late-2024 recapitalization at a reported $3.5B valuation paid real partner doctors real money.[12]
But there is no independent, audited dataset of rollover outcomes in dentistry. None. Every published return figure comes from someone selling the model, and the law firms that paper these deals warn that secondary sales often require continued rollover and that hold periods run three to seven years.[10] Our standing advice: the cash portion has to stand on its own, and the equity should be underwritten like the illiquid minority investment it is. We wrote a full, pitch-free guide to rollover and the second bite.
Bar drawn at illustrative midpoints of published ranges.[6] Model your own offer’s split with the offer second read.
What the pitch decks leave out
An honest market report includes the ugly slides. Several large DSOs spent 2024 and 2025 restructuring: lenders at one national group converted $1.4B of debt to equity, and another shed over a billion in debt through reorganization.[13] For a seller, the lesson is not to avoid DSOs. It is that the buyer’s balance sheet is part of your deal, especially the part of your price arriving as equity or earnout. Ask about debt load, ask about maturities, and treat reluctance to answer as an answer.
The other honest caveat is dispersion. The strongest published claims about competitive processes, offers averaging 50 percent above the first unsolicited number, come from advisors marketing their own results.[7] We run competitive processes for a living, so discount our enthusiasm accordingly, but the direction is not in dispute anywhere in the published record: one buyer is a number, several buyers are a market.
What we would do with 2026 and 2027
If you are two to seven years out: this window is preparation gold. Clean the EBITDA bridge, reduce doctor dependence, shape the payor mix. The moves are ranked by payoff in our preparation guide, and a free yearly valuation turns the plan into a measured one.
If you are considering going to market: the second half of 2026 into 2027 looks constructive in the published outlooks, with easing rates and buyers signaling appetite.[5] Constructive does not mean forgiving: selective buyers reward prepared practices and discount everyone else.
If an offer is already on your desk: congratulations, you have an anecdote. Run it through the free offer second read, then get a real market check before exclusivity locks your bargaining power away.
Our indicative view, informed by our deal work and the published comps cited in this edition. Instant, anonymous version at the estimate tool.
Methodology and sources
Figures marked ADA HPI or ADEA are reported survey data. Multiple ranges are published advisory and investment-banking guides, which are informed estimates, not closing statements; where a figure comes from a firm marketing its own results, the text says so. We publish nothing we could not trace to a named source, and we drop widely repeated figures that fail that test. Corrections: cameron@eslingerdental.com.
- ADA Health Policy Institute, The U.S. Dentist Workforce, 2025
- ADA Health Policy Institute, Practice Ownership Trends in Dentistry: A New Look at Old Data, June 2025
- ADA Health Policy Institute, Dentist Workforce data and retirement trends, 2025
- ADEA, Dentists of Tomorrow 2024 survey of graduating seniors, 2025
- Dykema, 2025 Annual M&A Outlook Survey, DSO Sector Spotlight, 2025
- CT Acquisitions, Dental and DSO M&A Multiples Report, June 2026 (synthesizing Provident Healthcare Partners, Skytale Group, Cain Watters, PitchBook)
- McLerran & Associates, DSO Dental Practice Valuation Multiples: 2026 Guide, July 2026
- FOCUS Investment Banking, Dental Practice EBITDA Multiples, December 2025
- Large Practice Sales, 2024 results and recapitalization commentary, 2024-2025
- McGuireWoods, Pushing Upmarket: Consolidation of DSOs and Secondary Private Equity Sales, May 2023
- ADA Health Policy Institute, State of the U.S. Dental Economy, Q4 2025 and Q1 2026 editions
- Becker's Dental Review, MB2 Dental recapitalization coverage, November 2024
- Dental Economics, Dental Care Alliance's restructuring signals a new era for DSOs, 2025
- Physician Growth Partners, State of Oral Surgery & Specialty Dental Private Equity, 2024
This report is education, not an appraisal, an offer, or financial advice. All multiples are indicative ranges; your practice prices on its specifics.
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