A peer-reviewed journal that offers evidence-based clinical information and continuing education for dentists.

Charting Growth In Dental Service Organizations

Opening one’s own practice used to be the golden ticket at the end of den­tal school.


Opening one’s own practice used to be the golden ticket at the end of den­tal school. If the last two decades are any indication, however, the promise of going solo may not hold the luster it once did. According to the latest data from the American Dental Association’s Health Policy Institute, there’s been a downward trend in solo owner/​practitioners since 1999. At that time, 65% of U.S. dentists ran solo practices, but by 2019 only 50.3% of dentists practiced in this manner.1

Growth in dental service organizations (DSOs) has been seen in almost every state. Geographically, the data2 show that only Alaska and Montana have no DSO involvement. On the other end of the spectrum, Nevada (at 24.7%), Arizona (19.5%) and Texas (19.5%) are the top three states embracing this practice model. In looking at the 13 states with DSO participation above the national average of 10.4%, the trend is strongest in the South (with five states), upper Midwest (four states), and Southwest (three states). The Northwest only has one state above the national average (Oregon), while the Northeast has none.2

What’s causing this shift? Heavy dental school debt has likely driven many young clinicians to join group practices or DSOs. In 2005, just under half of dentists under 35 owned a practice. That number shrank to 30.7% by 2019.3 But practice ownership has seen a decline in every age group, collectively dropping from 84.7% in 2005 to 76.1% in 2019.3 As might be expected, practitioners with the least proclivity to join DSOs were those age 50 and older.2

Gender also seems to be a contributing factor. In 2019, just over half of those graduating from dental school were women.1 The data indicate female dentists are increasingly less likely to start their own practices, trending from 68.1% in 2005 to 62.7% in 2019,3 when 13.3% were reported to be working in DSOs, compared to 8.7% of male dentists.2

Growth in DSOs may also stem from the allure of practicing dentistry without the hassle of running a business, and having access to in-office specialists and sophisticated equipment that many providers could not afford on their own. Whatever the reason, one thing is certain: The upward trend in DSOs is definitely building momentum.


  1.  American Dental Association Health Policy Institute. How Many Dentists Are in Solo Practice? Available at: https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIGraphic_0121_1.pdf?la=en. Accessed February 4, 2021.
  2. American Dental Association Health Policy Institute. How Big Are Dental Service Organizations? Available at: https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIGraphic_0720_1.pdf?la=en. Accessed February 4, 2021.
  3. American Dental Association Health Policy Institute. Dentists’ Practice Ownership Is Declining. Available at: https://www. ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIgraphic_0121_2.pdf?la=en. Accessed February 4, 2021.

From Decisions in Dentistry. March 2021;7(3):46.

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