Growth throughout the dental and DSO industry has not been as fruitful in 2025 as previously anticipated, as there have been a number of challenges.
Established and stable organizations have found opportunities for growth this year, but others have had a more difficult time.
From DSOs being over-leveraged to continued staffing shortages to rising operational costs, here are five of the biggest roadblocks to DSO growth so far in 2025, according to industry leaders, dentists and DSO executives.
Note: Responses were lightly edited for clarity and length.
David Skelton. CFO of Flagship Specialty Partners (Charlotte, N.C.): I expect that we will continue to see transactions in dental, but the bar will be high due to the uncertainty around consumer spending, tightening credit, high interest rates, rising default rates, trade wars and the increasing potential for a mild recession. DSOs with high-performing doctors, solid operations, integrated platforms, healthy margins and favorable organic growth will continue to find buyers at reasonable prices, and DSOs that don’t meet these criteria will have difficulty achieving exits. There are companies looking to exit and private equity capital that needs to be put to work in growing sectors for the right opportunities.
Richard Hall. CEO of U.S. Oral Surgery Management (Irving, Texas): What we’re seeing so far this year is a continuation of the market being a little softer. Coming out of last year, we saw the market being soft, and I think that’s continuing in 2025. Last year, it was pretty well known that general dentistry was only slightly up and orthodontia was flat or down. We’re a 90% referral-based specialty, so we rely on patients going to general dentists and other specialists and ultimately being referred to us for the oral surgery care they need. So, we’re continuing to see some softness in the market in that regard. Implants are actually up a little bit from the prior year. So, that’s kind of a contradictory trend when you think about the overall macro market conditions in the economy in general. You would think that implants, which tend to be a little bit more discretionary by nature, would be the first affected, but that doesn’t appear to be the case thus far this year.
Trevor Lines, DDS. Business Development Consultant of Revolutionary Tribes (Gilbert, Ariz.): There is a lot of economic uncertainty out there. Many DSOs are highly leveraged and consumer confidence or recession issues could throw an existential wrench in their financial plans and outlook. I would be expecting those operating without a high degree of discipline to struggle. This will open an opportunity for more well positioned organizations to expand, which they should also do with discipline. Integration is tricky and running more than one business model is a recipe for future pain.
David Nguyen, DMD. CEO of URBN Dental (Houston): One of the most concerning trends for me is corporate dentistry’s one-size-fits-all approach: Many large DSOs are scaling with cookie-cutter models that prioritize uniformity over patient-centric, market-specific strategies. This creates a race to the bottom in terms of quality, pricing and patient retention. The future belongs to DSOs that can balance profitability with exceptional patient outcomes, leverage technology without losing the human element and build a brand that patients trust and value beyond insurance-driven decision-making.
Kerry Straine. CEO of Straine Dental Management (Sacramento, Calif.): There are external challenges and internal challenges. You’ve always got rising labor costs and rising expenses. If you don’t know how to support the clinical team with the right advice to help integrate services that will get the lift in revenue, you’re going to have diminished margins. Externally, I think there’s some irrational offers being made, because people are getting close to recap and they’ve stalled it. So there’s some last-minute equity boosts that groups are looking at.
