TUSK Practice Sales Provides Guidance on Doctor-to-Doctor Transitions for Dental Practice Owners

The sell-side exclusive healthcare M&A advisory firm, with more than $1.5 billion in completed transactions, examines why the next generation of dentists is reshaping the private practice ownership landscape.

CHARLOTTE, N.C., Aug. 19, 2026 /PRNewswire/ -- TUSK Practice Sales ("TUSK"), a sell-side exclusive healthcare M&A advisory firm, today published guidance for dental practice owners weighing their retirement and exit options over the next decade. New data from the American Dental Association's Health Policy Institute and the American Dental Education Association shows the next generation of dentists moving away from ownership, with the share of dental students who intend to join a DSO-affiliated group more than doubling since 2018, from 16% to 34%. Today's high cost of debt financing, layered on top of the education debt new graduates already carry, is making younger dentists more risk-averse and reshaping who is in a position to buy a private practice.

While doctor-to-doctor transitions continue to be a pathway, owners planning an exit should understand the full breadth of their options before a sale is on the table.

The Next Generation of Dentists Is Moving Away from Private Practice Ownership

Fewer new dentists are entering or staying in the traditional private practice ownership pipeline.

• Private dental practice ownership has fallen from 85% in 2005 to 73% in 2023, and solo practice specifically has declined from about 67% of dentists in 2005 to roughly 50% in 2024, according to the American Dental Association's Health Policy Institute.
  
  
• According to the American Dental Education Association, the share of dental students who intend to join a DSO-affiliated group rose from 16% in 2018 to 34% by 2023.
  
  
• Dentists who graduated before 2010 owned practices early in their careers at rates of 60% to 70%, compared with just 21% of dentists who graduated between 2016 and 2020.
  
  
• According to the American Dental Education Association, dental school graduates in the class of 2025 carried an average of $297,800 in education debt, making practice ownership a significant financial hurdle early in their careers.

DSOs have been the beneficiaries of the shifts aforementioned. Building a new, competitive dental practice now costs an estimated $900,000 to $1.7 million, a difficult proposition for a graduate already carrying close to $300,000 in education debt. DSOs offer an alternative that removes much of that financial burden: competitive starting pay without the upfront cost and risk of building a practice, along with structured mentorship and administrative support that a solo owner has to build from scratch. Some DSOs report doctor retention rates as high as 98%, which helps explain why the model continues to win the recruiting competition for new graduates rather than losing them to private practice ownership.

For selling doctors, it is important to recognize that finding a dentist who is willing and financially able to take on practice ownership is becoming increasingly difficult.

The Risk of Waiting on an Associate to Take Over

Not only have associates chosen the group practice route with more frequency, but they also may not stay with one practice long enough to be a good candidate for a doctor-to-doctor transition.

DentalPost's 2025 Dental Industry Salary Report found that 28.8% of associate dentists changed employers in 2024. Even more telling, 46.6% of associates were considering or actively pursuing a new position within the year, driven by the search for higher income and better career opportunities.

A succession plan built around one associate being available and willing to take over your practice several years down the road is, by the numbers, more uncertain than ever. There's simply no guarantee that the associate you hire today will still be there when you're ready to sell. They could leave after two years, pursue a different opportunity, or simply not be in a financial position to buy the practice when the time comes.

What to Watch for When Selling to Another Doctor

When a dentist chooses to pursue a doctor-to-doctor transition, that deal will look materially different than a DSO sale.

First, lenders may require the selling doctor to carry a seller note, typically between 10% and 25% of the purchase price, rather than the lender financing the entire acquisition themselves. That means a portion of the seller's proceeds is no longer received in cash at closing. Instead, it becomes tied to the buyer's ability to repay the note and to the practice's performance under new ownership.

Connor Jorgensen, Director of Business Development at TUSK Practice Sales, shares, "I recently spoke with a dentist who was just days away from closing a sale to another doctor when, last minute, they found out that the lender had only approved financing for 80% of the purchase price. They were being asked to carry the remaining 20% as a seller note. They were not comfortable taking on that risk, and decided not to move forward. There was no warning that this was coming, and they were suddenly left having to start the entire process over and consider other sale routes that they were not prepared for."

This is the kind of risk that can be easy to overlook. In reality, the buyer, in this case an associate in the practice, still has to secure financing on terms that work for both sides, and those terms may not become clear until late in the process.

Another warning: A common occurrence in the industry that has been seen is when associates or other dentists purchase a private practice, they turn around to sell the dental practice to a DSO. The owner may successfully execute the doctor-to-doctor succession plan, only to watch the next owner sell to a DSO and capture the upside that the original owner left on the table.

What This Means for Dental Practice Owners

The pool of dentists who want to own and operate a traditional private practice is getting smaller, while the number of dentists choosing the DSO model continues to grow. Dentists who sell their practices to DSOs secure higher valuations and a clear exit strategy.

Dental practice owners should be cautious and proactive in understanding all their options before selling. A DSO partnership does not have to be the preferred path, but having it evaluated and ready gives the owner the flexibility to make the decision based on what is best for the practice and their goals.

TUSK Practice Sales will be hosting a live webinar on Thursday, August 27^th at 7 PM and 9 PM ET that provides a dental market update, including an in-depth review of the dental transitions landscape with more insights on the above. If you are interested in learning more, visit https://tuskpracticesales.com/2026-dental-market-update-sell-wait-or-grow/?utm_campaign=49845143-prnewswire&utm_source=PRNewsWire&utm_medium=Advisory&utm_term=dental-transitions&utm_content=webinar

About TUSK Practice Sales

TUSK Practice Sales ("TUSK") provides M&A Advisory services in the healthcare industry. TUSK has completed over $1.5B of transactions across all specialties. With an in-depth understanding of the marketplace and access to 100's of buyers nationwide, we help our clients confidently pursue M&A transactions that maximize their long-term value. With our significant collective experience of over 125+ years of practice transactions, we offer our clients solutions that help them achieve their strategic and financial objectives. For more information, visit www.TuskPracticeSales.com

SOURCE TUSK Practice Sales