The sale of a dental practice is a pivotal moment in any doctor’s career, and errors during the preparation phase can lead to significant financial losses. According to Jennifer Sims—a certified public accountant and Vice President of Business Valuation at Professional Transition Strategies — one of the key risk areas remains the misunderstanding of the practice’s true value. At the same time, as the expert emphasizes, an accurate and objective valuation is necessary even if the sale is only planned several years down the line.
Against the backdrop of active market consolidation, with over 375 Dental Service Organizations (DSOs) currently operating, competition among buyers is intensifying, and along with it, business valuations are rising. This makes it even more crucial for practice owners to avoid common misconceptions.
One of the most persistent myths remains the belief that a dental practice can be valued simply by taking 70–80% of its annual revenue. This approach was indeed used in the past; however, it has now become obsolete, regardless of the type of buyer. Such oversimplification ignores a whole range of factors that can significantly impact the final value: profitability level, location, specialization, payer mix, and the profile of the potential buyer.
Another common misconception is the belief that the practice’s price should reflect its potential growth: future production, development under new ownership, or unrealized opportunities. In practice, experienced buyers, especially DSOs and private equity funds, pay for current performance, not hypothetical scenarios. Misplaced expectations can lead to delays in the transaction or even a reduction in the final offer. In some cases, such errors cost sellers hundreds of thousands, and sometimes millions, of dollars.
The type of buyer fundamentally influences the valuation methodology. The key difference lies in which metric is used — SDE (Seller’s Discretionary Earnings) or EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization).
Private buyers typically focus on SDE, as they personally step into the owner’s role in clinical work and anticipate the owner’s total compensation, including salary, benefits, and discretionary expenses. This metric is more relevant for solo practices.
DSOs and private equity funds, on the other hand, use EBITDA because they view the business separately from the individual owner. In such transactions, it is assumed that the selling doctor will eventually leave the practice, and their clinical role will be taken over by a hired professional. Buyers are interested in scalable and transferable profits that ensure stable cash flow. As a result, transactions with DSOs often lead to higher valuations—provided the deal structure is properly arranged.
Currently, the valuation of a dental practice is most strongly influenced by its location, profitability level, growth trajectory up to the point of sale, and the presence or absence of specialized services. The payer mix, such as the ratio of fee-for-service to Medicaid patients, also plays a significant role.
While macroeconomic factors — interest rates and inflation — do indeed make buyers more cautious, particularly in individual acquisitions involving bank financing, the key importance still lies in “clean” financial metrics, team stability, and operational efficiency.
Owners often underestimate the impact of lease terms. The ability to transfer the lease, its duration, and renewal conditions can significantly affect a deal. Overpriced rent, especially if the owner is leasing the premises from themselves, can reduce adjusted EBITDA.
Staff retention is equally important. Practices with stable, experienced teams are particularly attractive to DSOs; however, buyers also closely analyze not only salary levels but also employee productivity. Overinflated salaries without corresponding efficiency can negatively impact the valuation.
Difficulties can also arise from cross-collateralization of assets or debts, which can delay the deal closing process. Transparent accounting, up-to-date licenses, and documented procedures reduce risks and increase buyer confidence.
According to Sims, the ideal time for a valuation is right now. A valuation is needed not only before a sale but also as a tool for strategic planning. The sooner an owner obtains an objective assessment, the more opportunities they have to address weaknesses and increase the business’s value well before entering the market.
When selling to a private buyer, the owner typically remains for a short transition period, and this rarely affects the value. In deals with DSOs, the situation is different: sellers may be asked to stay for three to five years to ensure continuity and protect the investment. Such involvement often improves the deal terms; however, refusing it can narrow the pool of buyers or lower the offer. In the absence of clear expectation alignment, the owner’s presence, on the contrary, can complicate the transition.
A qualified broker or consultant should have a deep understanding of both the financial and clinical specifics of dentistry, as well as an insight into current market consolidation trends. Red flags include a lack of transparency in valuation methodology, alignment solely with the buyer’s perspective, and an emphasis on potential rather than actual business performance.
An accurate valuation of a dental practice is not a formality but a strategic tool. Understanding the true value, abandoning outdated myths, and working with experienced consultants enable owners not only to avoid financial losses but also to maximize the value of their business in a competitive market.
The global dental industry is undergoing periods of restructuring, forming new growth models based on digital transformation and strategic cooperation.
Public dental services operate in conditions of a combination of rising demand, limited resources, and systemic challenges to long-term accessibility.
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