Written by Dr. Adriana Leone, DMD, founder of Wall Street Dental Spa
A DSO, or dental support organization, is a company that owns or manages the business side of dental offices, often backed by private equity. A private practice is owned and run by the dentist who treats you. Both models can deliver excellent care. The difference patients tend to feel is continuity, meaning who you see each visit, who makes the call on your treatment, and whether one dentist follows your history over the years.
Patients rarely think about who owns their dentist’s office, and honestly, why would they? You walk in, you get your cleaning, you leave.
But ownership shapes a few things that matter, from how treatment decisions get made to whether you see the same face next year. I’ve owned an independent practice in the Financial District since 2005, so I’ll be upfront that I have a perspective here. I’ll also try to give you the fair version, because both models exist for good reasons.
A DSO handles the non-clinical work of running a dental office so the dentists can focus on patients. Think billing, payroll, marketing, IT, supply purchasing, HR, and compliance.
In theory, the dentists still make the clinical decisions while the DSO runs the business behind the scenes.
The model exists because running a modern dental office is genuinely hard. New dentists often graduate with significant debt, and a DSO lets them practice without taking on a loan to buy equipment or a building. That’s a real benefit, and it’s a big reason these organizations have grown so fast.
According to the ADA Health Policy Institute’s data on practice modalities, about 16% of U.S. dentists were affiliated with a DSO by 2024, and the share is much higher among dentists early in their careers.
DSO stands for dental support organization. You’ll also hear “dental service organization”, and the two terms are used interchangeably.
The “support” part is the point: the organization supports the business operations of one or many dental practices, sometimes dozens or hundreds under a single brand.
When people mention DSOs and private equity in the same breath, they’re describing who funds the larger ones. Many of the biggest DSOs are owned or backed by private equity firms, which are investment companies that buy businesses, grow them, and sell them later for a profit.
This is where the conversation gets more pointed. Private equity capital is what allows a DSO to buy up practice after practice and expand quickly.
Industry reporting suggests private equity firms back the majority of the largest DSOs. There’s nothing inherently wrong with investment, and plenty of well-run, PE-backed offices treat patients beautifully. The thing worth understanding is simply that the ownership structure adds a layer whose primary goal is financial return, and that goal sits above the dental chair even when you never see it.
A DSO earns money the way most businesses do, by bringing in more than it spends, but the model has a few specific levers.
First, scale lowers costs. Buying supplies for two hundred offices is cheaper per office than buying for one, and negotiating with insurance companies is easier with more bargaining power.
Second, centralizing the back office spreads administrative expenses across many locations.
Third, and this is the part patients should understand, growth itself creates value. A private-equity-backed DSO often buys practices, improves their numbers, and then sells the whole group to a larger buyer at a higher price. Revenue growth and efficiency are what drive that sale price, which can create pressure to increase production.
Done responsibly, that pressure is invisible to you. Done poorly, it can show up as a longer treatment plan than you expected.
It depends entirely on who’s asking, so let me split it into two.
For a dentist, a DSO can absolutely be worth it. It:
For a patient, the answer is more nuanced. A good DSO office can give you modern equipment, convenient hours, and solid routine care, often at competitive prices.
What you may trade away is consistency. You might see a different dentist each visit, and treatment recommendations can feel more standardized.
None of that is a dealbreaker for everyone. If you mostly need cleanings and the occasional filling, a well-run corporate office may serve you perfectly well.
Where I think the private practice model earns its keep is in relationships and judgment over time, which brings me to the honest part.
The clinical work can look identical on paper. The experience around it often isn’t.
In an independent practice like mine, the dentist who examines you also owns the place, which means the person making recommendations is the same person accountable for them years later. You tend to see the same provider, so the team that knows your history actually remembers the crown we watched two years ago or the tooth that gives you trouble in winter.
Decisions are made one patient at a time rather than according to a company-wide template. The pace is usually calmer, the visits a little more personal, and there’s room for the kind of comfort-focused touches that don’t fit neatly into a high-volume schedule.
To be fair to the other side, independence has tradeoffs too. Smaller offices sometimes have less flexible hours, and they may cost a bit more per visit because they don’t buy supplies on a corporate scale.
I’d never pretend the private model is cheaper or more convenient in every case. What I’d say is that you’re paying for continuity and personal accountability, and for many people, that turns out to be the thing they value most once they’ve had it.
I’ll give you my honest recommendation, with my bias on the table. I believe most patients are best served by a dentist who knows them, sees them consistently, and answers only to them and you.
That’s the whole reason I run an independent practice in Lower Manhattan rather than selling to a group. I wanted to make treatment calls based on what a specific person in my chair needs rather than a quarterly target.
That said, I don’t actually think the answer is to default to private every time. The better move is to look past the logo on the door and ask a few questions that genuinely matter, such as whether you’ll see the same dentist each visit, who owns the office, and how treatment plans are decided. A confident office will answer all of that without flinching.
If the answers sit well with you, you’ve found good care, whatever the model.
A DSO, or dental support organization, is a company that manages the business operations of one or more dental offices, including billing, marketing, payroll, IT, and supply purchasing. The dentists provide clinical care while the DSO runs the administrative side, often across many locations under a shared brand.
DSO stands for dental support organization. It is sometimes called a dental service organization, and both terms refer to the same thing: a business entity that supports the non-clinical operations of dental practices.
In private equity terms, a DSO is the platform an investment firm uses to acquire and consolidate dental practices. The firm provides capital to buy practices, grows the group’s revenue and efficiency, and aims to sell the larger organization later at a profit. Most of the biggest DSOs are private-equity-backed.
DSOs make money through scale and efficiency: buying supplies in bulk, centralizing administrative costs across many offices, and negotiating better insurance rates. Private-equity-backed DSOs also create value by growing a group of practices and reselling it at a higher price, which can increase the focus on production.
The 80/20 rule, or Pareto principle, appears two ways in dentistry. In practice management, roughly 80% of revenue often comes from about 20% of patients or procedures. For your own health, about 80% of your oral health outcomes come from the 20% that is daily home care like brushing and flossing.
For a dentist, a DSO can be worth it by removing the burdens of business ownership and offering a steady income. For a patient, a well-run DSO office can provide good routine care and convenience, though you may see different providers over time. A private practice generally offers more continuity and personalized treatment.
Dr. Adriana Leone, DMD, is the founder of Wall Street Dental Spa in Manhattan’s Financial District. A graduate of Tufts University School of Dental Medicine, she has practiced dentistry since 1999 and opened her boutique practice in 2005. Dr. Leone is recognized among America’s Top Dentists and is one of New York City’s most experienced Invisalign providers, with more than 500 cases completed. She built Wall Street Dental Spa around calm, judgment-free, wellness-focused care for busy NYC professionals.
