Although DSOs are expected to face several challenges in terms of patient care, finances and technology, many leaders are optimistic about what 2026 will bring.
Here is what six executives recently shared with Becker’s about the opportunities and challenges facing DSOs:
Samantha Adams. COO of Imagen Dental Partners (Scottsdale, Ariz.): During COVID, low interest rates were combined with significant supply-chain challenges, particularly for independent practices. Many didn’t have the same vendor relationships or purchasing leverage as larger DSOs, which led some doctors to seek partnerships for greater stability and support.
Today, interest rates are higher, but there are still DSOs and DPOs [like us] that continue to look for the right opportunities to grow. For Imagen, that means being more methodical in our approach and disciplined in our due diligence. We do say no to potential partnerships, and we’re comfortable doing so. While some groups may take a more aggressive approach, our focus is on setting clear expectations around how we support doctors. That may mean growing more conservatively, but it allows us to build stronger, more sustainable partnerships over the long term.
Mark Censoprano. Co-CEO of MAX Surgical Specialty Management (Hackensack, N.J.): I’m optimistic about advances in technology that simplify operations and have the potential to make life easier for frontline providers in dentistry and oral surgery. At MAX, we’re always exploring tools that drive greater efficiency across workflows, and 2026 will bring even more meaningful advancements. From phones and scheduling to reputation management, billing, AP and case planning, the right tools remove friction across the practice ecosystem and empower surgeons to devote more of their time and energy to what matters most: surgical excellence.
The key to successfully integrating these enhancements is thoughtful adoption. When technology is evaluated through the lens of the surgeon experience, it becomes a force multiplier that streamlines operations, strengthens communication and improves the patient experience. Looking ahead to 2026, we will remain surgeon-led in how we assess and implement new platforms, focusing on solutions that give surgeons more time with patients and give practice teams the support they need to operate at the highest level.
Faraz Edalatpajouh, DDS. CEO of Clark St. Dental Partners (California): I think we’re on the other side of this inflation thing. I’m hoping to see better reimbursement rates from the [insurers.] Thank God they’re having those conversations. This is my biggest soapbox that I get into with older doctors: Their gripes are always the same gripes. Insurances don’t pay enough. Patients aren’t thankful enough, so on and so forth. I think they may have made some hay because insurers are willing to talk about reimbursement a little bit more. You can negotiate your fee schedule a little bit better. I think this Medicaid thing is going to factor in. The people who take Medicaid just to add a payer type are the ones who are probably going to have a little bit more figuring out to do. The people who take Medicaid and read the bulletin and work hand in glove with Medicaid, and really work to understand it and understand that they’re providing a service for a [section] of the population that not only the government has deemed needs support here, but also that rely on this. Their rug is sort of getting pulled from under them. These are people who want dentistry. If you can carve out a way to get [them] access, it’s a win-win. It’s a win-win for the state, because the state gets their population taken care of. It’s a win-win for the patient because they get their needs met, and then it’s a win-win for us who have Medicaid as part of a payer mix.
Ash ElDifrawi. Chief Commercial and Brand Officer for The Aspen Group (Chicago): The biggest challenge [for DSOs] will be keeping up with changing consumer expectations. Patients expect the same speed and clarity they get in every other part of their lives. Delivering that at scale is hard.
Another challenge is the amount of information patients see online. Some of it is helpful, and some of it creates confusion. Claims like “implants starting at $99,” sound incredibly appealing for patients who already feel overwhelmed by cost, but we’re now seeing the fallout from those types of claims: unrealistic expectations, hidden fees and clinical issues that come from oversimplifying complex treatment. DSOs will have to help patients sort through all of that without adding to the noise.
Finally, as competition heats up, protecting clinical quality will be key. Growth only works if quality stays at the center. The organizations that invest in their clinicians and refuse to cut corners will stand out.
James Jones. CEO of Cal Dental USA (Los Angeles): The biggest challenge for DSOs in 2026 is going to be discipline — financially, operationally, and culturally.
- Rising costs and tighter margins: Rent, supplies and labor keep climbing. DSOs that don’t understand their numbers or pivot fast enough will struggle.
- Recruiting and retaining talent: The talent pool is shrinking, and doctors want more than a paycheck — they want mentorship, stability and a culture that actually supports them. I’ve always loved developing talent in house. That’s been the key to my success, and I want others to experience that same path. When growth is internal, it becomes passion-driven.
- Operational consistency at scale: Growth exposes every weakness. DSOs that scale too fast without strong systems will feel it immediately.
- Patient expectations are changing: People expect faster communication, more transparency and a smoother experience. If DSOs don’t adopt AI, automation and improved workflows, they’ll fall behind quickly.
I’ll be honest — even though AI is exciting, I’m still a believer that patients want more human interaction. I’m a hands-on CEO. I’m in the offices every day. I literally had a patient tell me recently, “Do you guys actually answer the phone?” I said yes. He said, “Good — I’m coming here. My dentist has robots and I can never get through.” That told me everything. Technology is powerful, but the human connection is irreplaceable. The DSOs who master both will win the next decade.
Barry Lyon, DDS. Dental Director for Main Street Children’s Dentistry and Orthodontics and Dental Care Alliance (Sarasota, Fla.): Investors are bullish, and for good reason. They recognize there’s an aging population that requires continued maintenance, periodontal therapy and implants. The post-pandemic response has dentists hiring hygienists, associate dentists and dental assistants to meet the demand. Office infrastructure is being upgraded and the newest technologies are being adopted. Timing all of this with recapitalization cycles and the anticipated lower interest rates, one can see how a renewed M&A cycle is reignited.
