New data shows DSOs preparing for increased acquisition activity as recapitalization cycles accelerate.
TUSK Practice Sales released its Q1 2026 Dental M&A Market Report, offering a fact-based view of the forces shaping dental practice sales as the industry enters 2026. Drawing on 2025 market conditions, macroeconomic indicators, and proprietary buy-side survey data from DSOs nationwide, the report outlines how buyers are underwriting risk, valuing growth, and prioritizing acquisitions.
A central theme is the continued decline in practice ownership among younger dentists. According to the ADA Health Policy Institute, ownership among private-practice dentists fell from 84.7 percent in 2005 to 72.5 percent in 2023, with particularly low rates among dentists age 44 and younger. Rising dental school costs, which increased 30 percent at public schools and 38 percent at private schools over the past decade, combined with higher borrowing costs and conservative lending standards, have extended timelines to ownership and reduced the predictability of associate buy-in exits. As a result, many late-career dentists are finding it more difficult to execute traditional doctor-to-doctor transitions.
These ownership shifts are occurring alongside a “Silver Wave” of retirements, as roughly four million baby boomers retire annually. For DSOs, this signals a steady influx of practices coming to market, while increasing scrutiny on provider continuity, succession planning, and an owner’s willingness to remain post-sale. Younger dentists are remaining in group and DSO settings longer, narrowing the pool of individual buyers and increasing reliance on institutional capital.
The 2025 dental M&A market remained active but volatile. Inflation moderated to 2.7 percent CPI-U, and the Federal Reserve lowered rates to a 3.50–3.75 percent target range in December 2025, yet cost pressures, tariffs, and delayed margin impacts slowed deal velocity midyear. Valuation multiples generally held steady, though dispersion widened as buyers priced risk more selectively and leaned more heavily on equity structures.
Looking ahead, sentiment is constructive. Sixty-one percent of surveyed DSOs expect increased deal activity in 2026, and 78 percent anticipate recapitalizations within 12 to 36 months. As acquisition mandates rise and premium inventory remains constrained, practices with durable earnings, stable providers, and scalable operations are positioned to benefit most.
