Here are six trends affecting DSO deals in 2026:
1. Acquisitions have been the primary growth strategy for many DSOs over the last decade, with low interest rates and investor interest fueling this activity. However, higher rates and operating costs have led to financial challenges for several groups in recent years. LADD Dental Group said organizations that grow rapidly without appropriate support systems in place, such as operational infrastructure and clinical alignment, experience additional challenges. The group noted that future success for DSOs will likely rely on operational enhancements, including regional density, doctor support, clinical leadership and sustainable financial structures.
2. The DSO field is experiencing a high-demand, low-supply environment that is expected to continue for the next nine months, according to TUSK Practice Sales’ “Dental Market Report” for the second quarter of 2026. TUSK stated that these conditions will force DSOs to be more selective of their deals, placing more scrutiny on financials, operations and practice performance projections.
3. Despite the low supply environment, DSOs are gearing up for increased M&A activity. Sixty-nine percent of DSOs expect to increase their acquisition activity this year, and several have gained new investments to fuel growth, including Dental Care Alliance and Qualitas Dental Partners.
4. DSOs are choosing to walk away from deals over provider risk and clinical continuity issues, including insufficient staffing and over-reliance on a single producer. More DSOs are now requiring a minimum 5-year post-close employment term to close a deal.
5. Several DSOs have begun to invest more in de novos for the unique benefits these offices bring. Launching new practices is often seen as a way for DSOs to maintain consistency and growth across their brands. Additionally, de novos can be used as a cost-saving strategy for DSOs that want to continue expanding their network in a tough macroeconomic environment. They can also help DSOs build their presence in a new market and lead to partnerships with existing practices later on, several execs told Becker’s.
6. Several states have introduced legislation to limit corporate entities’ ownership of dental practices and their influence on clinical decision-making. Organizations have also spoken out against corporate dental ownership to protect patient care and clinical autonomy.
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