--- title: "Dental private equity: what the ADA and studies found" description: "ADA researchers report private equity affiliation among dentists rose from 6.6 percent in 2015 to 12.8 percent in 2021. See findings on prices and Medicaid." url: https://joncopeland.multisites.ai/blog/dental-private-equity-ada-findings publisher: Copeland Consulting Services email: drcopeland@joncopelanddds.com contact: https://joncopeland.multisites.ai/contact --- # Dental private equity: what the ADA and studies found ADA researchers found that private equity affiliation among U.S. dentists rose from 6.6 percent in 2015 to 12.8 percent in 2021. A follow-up study found list prices rose 3.3 percent after acquisition while negotiated prices did not change. Medicaid participation was higher at private equity practices. Effects on quality remain unstudied. Practice managementPublished October 26, 20265 min read Private equity (PE) firms have bought dental practices and dental support organizations for years. Dentists ask how common that is and what it changes. This post summarizes what researchers at the ADA Health Policy Institute (HPI) and their co-authors have published. It reports findings on both sides. It does not tell any dentist whether to sell, join or avoid a PE-backed group. ## How many dentists are affiliated with private equity? About one in eight in 2021. ADA News reports that “dentists affiliated with private equity increased from 6.6% in 2015 to 12.8% in 2021.” The study, in the journal Health Affairs, was written by an ADA health economist, a DePaul University economics professor and the ADA’s chief economist. It used a dental provider database that mapped dentists to offices and large groups, and transaction data that flagged offices tied to PE firms. Measure Finding Period Dentists affiliated with PE 6.6% to 12.8% 2015 to 2021 General practice dentists affiliated with PE 6.8% to 12.7% 2015 to 2021 Documented PE transactions per year Fewer than 20 2004 to 2015 Documented PE transactions in 2019, 2020, 2021 62, then 46, then 96 2019 to 2021 Affiliation grew faster among endodontists, oral surgeons, orthodontists, pediatric dentists, periodontists and prosthodontists than among general dentists. The paper offers two possible reasons. One is higher prices that specialists can earn for procedures such as root canals and implants. The other is “underrealized economies of scale in dentistry.” The authors call the dental market “highly fragmented,” which they say makes it a likely target. Older ADA material treats private equity as one part of a wider shift to groups and DSOs. See [how many dentists work with a DSO](https://joncopeland.multisites.ai/blog/how-many-dentists-work-with-a-dso) for those numbers. ## What happens to prices after a PE acquisition? A follow-up study looked at practice-level changes. It appeared in Health Services Research and found that after acquisition, “private equity-owned dental offices increased charges for dental care services by 3.3% (95% CI: 2.3%-4.4%), although allowed prices for these services remained statistically unchanged.” The two price types differ. Charges are the list prices an office sets. Allowed prices are what insurers agree to pay. The authors conclude that negotiated prices “did not change,” yet list prices rose, “meaning higher prices can still be passed on to patients.” They add that financial enhancement of practices “may not translate into benefits for providers or patients.” This is an association from observed data, using acquisitions the authors could identify. It does not describe every PE-backed practice. ## Does the procedure mix change? The Health Services Research study found it did. In its words, offices acquired by PE firms “tended to shift from diagnostic and preventive procedures to generally higher reimbursement restorative, specialty, and surgical procedures.” It also found offices were more likely to become multispecialty practices after acquisition. The study does not say whether the added procedures were needed. It reports billing patterns, not clinical judgment or outcomes. ## What about Medicaid and access? The ADA study points the other way on access. It found that PE-affiliated practices had a higher rate of Medicaid participation than practices without PE affiliation. The authors could not rule out “unobserved confounding factors, such as profit margins or the number of auxiliary staff members such as dental hygienists.” So the evidence has two sides. Prices and mix moved in one direction, and Medicaid participation was higher in the same group. The numbers do not settle which effect matters more. ## What do the researchers say is still unknown? Quality of care. The ADA study concludes: “These trends bear watching.” It also says, “Future research should focus on the effects of \[private equity\] affiliation on access to and quality of care for dental patients.” Neither study reports clinical outcomes. Two limits apply to both. The data end in 2021. Two of the three Health Affairs authors work for the ADA, a professional association. Read the papers yourself, and follow the research as new studies appear. ## Why does private equity show up in dentistry? The ADA paper gives its own explanation: “The dental provider market is highly fragmented, which makes it an attractive acquisition target for \[private equity\] firms, given the perceived potential to improve the efficiency of practices and increase \[private equity\] firms’ profit margins or market share.” In plain terms, many small practices exist, and an investor may see room to run them more efficiently. The authors give a second possibility. Higher prices for procedures such as root canals and implants may attract interest in specialist practices. They also allow that “underrealized economies of scale” may play a part. These are the authors’ hypotheses. The paper does not test why firms buy. ## How should you weigh these studies? Read each study for what it measures. The first study counts affiliation. The second studies price, procedure mix and Medicaid participation. Neither one follows patients, so neither can say whether any patient’s care got better or worse. Several details help you judge the strength of the evidence: - The follow-up study used a design that compares acquired offices with others over time, which the authors say addresses the fact that acquisitions are not random. - The data cover 2015 to 2021, so later deals fall outside the sample. - The papers report averages. Individual practices may differ widely from the average. A fair reading holds both sets of results together and waits for more research. ## What can a dentist do with this information? Use it as background, then look at the actual deal. Questions that apply to any buyer or affiliate include: 1. What does the [management services agreement](https://joncopeland.multisites.ai/glossary/management-services-agreement) allow the managing company to decide? 2. How is the practice valued, and does the offer use an [EBITDA](https://joncopeland.multisites.ai/glossary/ebitda) multiple? 3. Is there a [partial exit](https://joncopeland.multisites.ai/glossary/partial-exit) or rollover, and how are future payments set? 4. What protections exist for [clinical autonomy](https://joncopeland.multisites.ai/glossary/clinical-autonomy)? Have an attorney and a CPA review every term. The glossary explains [private equity in dentistry](https://joncopeland.multisites.ai/glossary/private-equity-in-dentistry) and [DSO](https://joncopeland.multisites.ai/glossary/dso) in more detail. For the wider comparison, read the [DSOs and private practice guide](https://joncopeland.multisites.ai/guides/dso-vs-private-practice-guide). ## Next step Read the [DSOs and private practice guide](https://joncopeland.multisites.ai/guides/dso-vs-private-practice-guide) and the [dental practice ownership guide](https://joncopeland.multisites.ai/guides/dental-practice-ownership). Contact Dr. Copeland about [dental practice consulting](https://joncopeland.multisites.ai/contact?topic=consulting). ## Frequently asked questions ### How many dentists are affiliated with private equity? ADA researchers report 12.8 percent of dentists in 2021, up from 6.6 percent in 2015. The study ran from 2015 to 2021 and used transaction data to flag offices tied to private equity firms. Newer numbers may differ. ### Does private equity raise dental prices? A later Health Services Research study found list charges rose 3.3 percent after private equity acquisition, while negotiated or allowed prices stayed statistically unchanged. The authors say patients could still pay more, since list prices can be passed on. They call for more study. ### Do private equity practices take Medicaid? The ADA study found private equity practices had a higher rate of Medicaid participation than other practices. The authors could not rule out other causes, such as profit margins or the number of hygienists. They called for research on Medicaid participation and quality. ## Terms on this page - [Management services agreement](https://joncopeland.multisites.ai/glossary/management-services-agreement) - [Private equity in dentistry](https://joncopeland.multisites.ai/glossary/private-equity-in-dentistry) - [Practice ownership](https://joncopeland.multisites.ai/glossary/practice-ownership) - [Clinical autonomy](https://joncopeland.multisites.ai/glossary/clinical-autonomy) - [Partial exit](https://joncopeland.multisites.ai/glossary/partial-exit) - [EBITDA](https://joncopeland.multisites.ai/glossary/ebitda) - [ADA](https://joncopeland.multisites.ai/glossary/ada) - [DSO](https://joncopeland.multisites.ai/glossary/dso) ## Sources 1. [ADA News: Private equity affiliation among dentists increases (2024)](https://adanews.ada.org/ada-news/2024/august/private-equity-affiliation-among-dentists-increases/) 2. [ADA News: Private equity affiliation among dentists increases (Medicaid)](https://adanews.ada.org/ada-news/2024/august/private-equity-affiliation-among-dentists-increases/) 3. [ADA News: Private equity affiliation among dentists increases (future research)](https://adanews.ada.org/ada-news/2024/august/private-equity-affiliation-among-dentists-increases/) 4. [Health Services Research via PubMed: Financial Incisors (Nasseh, LoSasso, Vujicic, Downey)](https://pubmed.ncbi.nlm.nih.gov/41367221/) 5. [Health Services Research via PubMed: Financial Incisors (conclusions)](https://pubmed.ncbi.nlm.nih.gov/41367221/) Written by Copeland Consulting Services and checked against the sources above on October 26, 2026. Rules, data and guidance change, so check the linked page before you act on it. ## Keep reading - [DSOs and private practice: models, data and questions to askA dental support organization (DSO) manages some or all of a practice's nonclinical work, such as billing, marketing and human resources. ADA data show 16.1% of U.S. dentists were DSO-affiliated in 2024, and 27% of those under 10 years out of school. Each model has trade-offs.](https://joncopeland.multisites.ai/guides/dso-vs-private-practice-guide) - [Dental practice ownership: buying, starting, valuing, selling, associates and DSOsDentists reach ownership by starting a practice, buying one, buying in as a partner, or working as an associate or for a DSO first. ADA data show 73 percent of dentists owned a practice in 2023, down from 85 percent in 2005. Each path needs an attorney, a CPA and often a lender or broker.](https://joncopeland.multisites.ai/guides/dental-practice-ownership) - [How many dentists work with a DSO? ADA data by yearThe ADA Health Policy Institute reports that 16 percent of U.S. dentists were affiliated with a dental support organization as of 2024. The share was 8.8 percent in 2017, 10.4 percent in 2019 and 13 percent in 2022. Affiliation is highest among dentists in their first ten years after graduation.](https://joncopeland.multisites.ai/blog/how-many-dentists-work-with-a-dso) - [Buying a dental practice: steps, financing and due diligenceBuying a dental practice usually runs in six stages: define your goals, get financing, value the practice, sign a letter of intent, complete due diligence, and close. Lenders, attorneys and accountants each own part of the work. This guide explains the steps and lists questions to ask. It is not legal, tax or financial advice.](https://joncopeland.multisites.ai/guides/buying-a-dental-practice) - [Dental study clubs: what they are, how to join one and how to start oneA dental study club is a group of dental professionals who meet regularly to discuss real cases and learn together. Some are run by national education networks, some are organized locally by alumni of a course, and some are informal. Credit for fellowship or mastership requires an approved provider.](https://joncopeland.multisites.ai/guides/dental-study-clubs) - [Dental technology ROI: how to evaluate a purchase before you signTo evaluate a dental technology purchase, name the problem it solves, list every cost beyond the price, check what independent studies say, plan training and workflow changes, then set a review date with measures chosen before you buy. A return figure is only as good as the inputs you can verify.](https://joncopeland.multisites.ai/guides/dental-technology-roi) ## Talk with Dr. Copeland [Contact Dr. Copeland](https://joncopeland.multisites.ai/contact)[Email](mailto:drcopeland@joncopelanddds.com)