Here are five trends that have dominated dental M&A this year:
1. Financing conditions tightened significantly after the Federal Reserve raised its target rate to 3.75%-4% on Sept. 16 and new underwriting rules from the Small Business Association took effect Oct. 1. Lenders now require a 1.25x debt service coverage ratio, a 36-month seller note standby period and an independent quality-of-earnings review on deals above $3 million, according to TUSK Practice Sales’ Q4 2026 Dental Market Report.
2. Dental consolidation has made its way up the food chain this year as some of the biggest organizations have gone shopping for other DSOs, from a Canadian company’s entry into the U.S. market to a three-way merger that created one of the country’s largest networks.
3. DSOs that are looking to buy are scrutinizing practices’ financials, operations and projections more intensely, as the supply of “premium” practices is tight, according to a report from TUSK Practice Sales. The top reasons why DSOs are walking away from deals include provider risk and clinical continuity, declining financial performance and reimbursement exposure.
4. Dentistry is one of the more active segments in healthcare in terms of transactions, with about 128 transactions through the first five months of 2026.
5. DSOs are facing a new challenge this year that could threaten their operations and ability to grow: increased scrutiny and oversight from providers and legislators. Several states have introduced legislation to limit corporate entities’ ownership of dental practices and their influence on clinical decision-making. Driving these initiatives is increased scrutiny from clinicians, patients and legislators seeking to protect patient care and clinical autonomy.
