Here are four recent updates that have led to optimism and skepticism among DSO leaders:
Good news
DSO affiliations increase
DSO affiliation among U.S. dentists has more than doubled since 2015 — from 7.2% to 16.1% — as practice ownership has dropped to a 20-year low of 73%, according to TUSK Practice Sales’ Q4 2026 Dental Market Report.
Funding opportunities
Although organizations are facing higher costs of capital, TUSK has reported that there is still fresh equity and new lending agreements to drive DSO activity. Becker’s has reported on several of these deals, including Dental Care Alliance receiving $95 million in new capital and Smile Doctors securing an additional $125 million in growth capital.
Bad news
Healthcare oversight laws
Four states have passed healthcare oversight laws so far this year, which could lead to additional challenges for DSOs and private equity groups, according to the Private Equity Stakeholder Project’s “2026 State Healthcare Policy Review” report.
Transactions decline
Deal volume in dentistry in the third quarter decreased by 7% compared to the second quarter of 2026 and 27% from the third quarter of 2025, according to Levin Associates.
