Straight answers to the questions dentists ask.

Ryan Smith, DDS is a dentist in the Portland, Oregon area who has owned and managed more than 20 dental practices. He founded a multi-location dental assisting school, a dental supply company and a dental lab. He teaches the business of dentistry on YouTube (100,000+ subscribers), in The Dental Grind newsletter and podcast, and in his Business Fundamentals course.

The Dental Grind is Ryan Smith, DDS's free Monday newsletter and podcast for dental students, associates and new owners. Each issue takes one part of a dental practice apart with real numbers, covers three news items from the week with his take, and ends with one thing to do in under 30 minutes. It takes about five minutes to read.

Business Fundamentals is Ryan Smith, DDS's online course on running a dental practice as a business: 10 modules and 219 lessons on leadership, systems, patient experience and financial mastery, with more than 20 hours of video and a Systems Library. It costs $3,499, or 3 payments of $1,250, with lifetime access and a 30-day guarantee.

Yes. Business Mastery coaching is 1-on-1 on your own practice's numbers, team and bottleneck, from $1,500 a month on a 12-month commitment with bi-weekly calls. Acquisition Coaching guides dentists buying a practice through finding, evaluating, negotiating and closing, for $9,999 or 6 payments of $1,800.

Yes, by application. A practice partnership lets a dentist step into ownership with shared equity and a path to buy out the practice, without solving financing, staffing, insurance and leadership alone.

Dental brands, products and services can partner with Ryan Smith, DDS through sponsorships, product reviews, ambassador roles, speaking and advisory work. He reaches dentists on YouTube, on social media, in The Dental Grind newsletter and podcast, and on ryansmithdds.com, and he only recommends what he would buy for his own practices. Sponsored content is always disclosed.

Total overhead should run about 60 to 65 percent of collections, which leaves a 25 to 35 percent net profit margin. Staff costs, excluding the doctor, should stay around 22 to 25 percent of collections, and supplies and lab together around 12 to 15 percent.

98 percent of adjusted production, meaning production minus contractual insurance write-offs, with A/R under half of one month's collections. Get there by pre-collecting for major treatment, collecting at the time of service for everything else, billing insurance within 24 hours and posting EOBs within a week.

Ten: production per provider, collections percentage, overhead percentage, new patients per month, case acceptance, hygiene reappointment, patient retention, staff cost as a percentage of collections, online reviews and net profit margin. Review production and collections weekly, overhead and profit monthly, and retention quarterly.

Three reports, every Friday, in about fifteen minutes: burdened labor cost against collections, the collections engine (over-30 and over-60 aging and over-the-counter collections), and the adjustments and write-off report. As a check, $10,000 in payroll should mean at least $35,000 to $40,000 collected.

A plateau is a capacity problem, not a marketing problem: the systems cannot process more dentistry. Around $800,000 the owner is doing every job; around $1.2 million hygiene is booked so far out that it chokes restorative work; around $1.5 million case acceptance caps hourly production. More new patients fix none of these.

Diagnose first: decide whether it is a demand, execution or leadership problem before spending on marketing. Then work in two-week sprints, starting with recall and emergencies (hygiene reappointment to 95 percent, same-day ER visits), then phones, diagnosis, case acceptance and completion. Most struggling practices leak patients they already have.

Clear aligners, implants with same-day solutions, same-day CAD/CAM crowns, one-appointment endo and crown, and in-house wisdom teeth extractions within your skill level. Each pairs high production per hour with real value for the patient, and same-day work frees chair time by turning two appointments into one.

Use the low-point method. Find the day each month when the bank balance is lowest, usually right after the biggest payroll, and keep a buffer of one month's operating expenses. Whatever sits above that buffer at the low point is distributable profit. With $75,000 monthly overhead and $130,000 in the account, that is $55,000.

Run the math first. Take the plan's average monthly production, reprice it at your full fees, then cut that by a conservative 40 percent attrition. If the result is about equal to or higher than what the plan pays you now, dropping is likely safe. With clear communication, 60 to 80 percent of patients typically stay.

Usually your smallest, lowest-stakes plan, not your worst-paying one. It teaches your team the whole process at low risk before you touch a bigger plan. Then rank the rest on write-off percentage, patient count, administrative friction and growth; most of the write-off dollars usually sit in one or two contracts.

Average the plan's monthly production over three months, then average its discount across your top ten procedures. Discount times monthly production times twelve is what the plan costs you a year. Your break-even patient loss equals the write-off percentage: a plan discounting you 36 percent can lose 36 percent of its patients before dropping it hurts.

Ask for about 10 percent, in one letter with three attachments: your cost increases (payroll, supplies, lab), your top ten procedure codes at the plan's allowed fee next to your standard fee, and your patient volume and years in network. A yes buys time with a plan you are not ready to drop; keep tracking it.

Give it 90 days: train the team at 90 days out, mail the patient letter at 60, and start personal conversations at 30. Keep filing claims as a courtesy so patients are reimbursed directly, and have the team practice one consistent answer to "are you in network?" until it sounds natural.

A clause in a network or PPO agreement you signed lets that company lease your discounted fees to other carriers and administrators, so their members show up as in-network at your leased rate even though you never contracted with them. Keep every signed agreement, fee schedule and leasing addendum so you can prove underpayment.

Yes. Your full fee is the number every PPO discount is measured against, so a fee set too low makes your write-off report understate what each plan really costs you. It also caps what out-of-network and indemnity patients are reimbursed against UCR, the usual, customary and reasonable range for your area.

Price it off what the covered visits actually cost you plus a margin. Include the preventive care patients need every year (cleanings, exams and routine X-rays), then add a flat percentage discount on major work. In my practices that lands around $300 a year. It is not insurance: no claims, no network and no annual maximum.

Two ways, side by side: a percentage of annual collections, usually 60 to 75 percent, and a multiple of adjusted EBITDA, usually 3.5 to 5.5 times. Adjusted EBITDA replaces the owner with a market-rate associate. Payer mix, hygiene strength, equipment, the lease and the seller's transition role move a practice within that range.

Three years of P&Ls and tax returns, production and collections by provider and payer, an AR aging report, the fee schedule and every PPO contract, the active patient count and how it was counted, hygiene recall statistics, the lease, an equipment list with ages, and a staff roster with wages and tenure. Request all of it first.

Weak cash flow behind a high price, a dysfunctional team, facility costs above about 7 percent of collections, hidden liabilities or vague contracts, and billing patients after insurance pays. A practice collecting $1 million can still be breaking even, so start with real take-home cash flow after expenses and debt service.

Lenders lend mostly against the practice's collections and cash flow, not the buyer's net worth, which is why an acquisition is often easier to finance than a smaller startup. Many lenders cap total practice debt near 65 percent of annual collections, so growing collections and paying down debt is what opens room for the next purchase.

The price and how it was reached, what is included, the seller's transition period and role, a non-compete in principle, financing and diligence contingencies, and an exclusivity period with a target closing date. Most of an LOI is non-binding; confidentiality and exclusivity usually bind. Leave allocation and indemnification for the purchase agreement.

Add back personal expenses and the owner's pay, then subtract what a market-rate associate would cost to do the owner's dentistry. Skipping that subtraction is how napkin valuations come out too high. Then compare each line to a benchmark: total overhead around 51 to 64 percent before doctor pay.

A startup looks cheaper, about $750,000 all in against $850,000 to $900,000 for a $1 million practice, but year one of a startup often pays the owner nothing. A practice collecting $1 million at 60 percent overhead can pay you $250,000 or more from the start. Over three years the gap is roughly half a million dollars.

Change almost nothing clinically or culturally at first; watch before you touch. Send patients a transition letter before day one, keep the seller visible early on, and honor the recare already on the books. The one thing to fix immediately is financial policy: collect at the time of service, not after insurance pays.

At its peak, not after a year or two of decline. Buyers pay a multiple of profit, not revenue, so clean personal expenses out of the P&L for the three years before a sale; each dollar cut can be worth four to six dollars in price. Use a dental-specific broker, attorney and CPA.

It depends on which dentist you decide to be. Inflation-adjusted earnings for general dentists peaked around 2005, overhead keeps rising and insurance maximums have barely moved, while debt-to-income has gone from about 1 to 1 in the 1980s to 3 to 1 today. Average is no longer a safe plan, but the ceiling has never been higher.

Choosing a practice that does not fit their skills or personality, unrealistic pay expectations, forgetting who the boss is, adding skills too slowly, having no goals, not saving, and above all not taking ownership of their situation. Pick a practice for its culture and clinical philosophy, not just the pay and the location.

Rarely for the money. Most departures start with a mutual oversell at the interview: the owner oversells patient volume and loyalty, the associate oversells their speed and case acceptance. When reality lands in between, both sides go quiet instead of talking, and the silence ends the relationship.

DSOs make most of their money on multiple arbitrage: buying practices at roughly 3 to 4 times profit and selling the group at 8 to 12 times. Private practice cannot out-spend them, but it wins on culture and patient relationships, which private equity is weakest at.

No. Start on the lowest legally required payment and build a 3 to 6 month expense reserve before touching the principal. Paying the loan down hard from day one feels good but is mathematically weak next to building liquidity and investing in your clinical skills first.

Find a mentor who practices the way you want to, and copy their communication, diagnosis and clinical workflows as closely as you can. Learn communication first, before prep speed, then real-world diagnosis, then master your bread-and-butter procedures: fillings first, then crown and bridge.

Sometimes. Partnerships bring capital, larger loans and company, but they add real complexity; if you can do it alone, you probably should. Before signing, agree on how it ends (valuation and buy-sell terms), the what-ifs, how management time is valued, whether your visions align and who owns what.

Build a box around the practice so a bad day at work is not a bad day for who you are: hobbies, friends outside dentistry, and exercise that is non-negotiable. Then fight the isolation of private practice by joining a study club or mastermind, finding a mentor and becoming one.

Get a financial commitment up front: for any appointment over an hour in the doctor's chair, collect a deposit or the full co-pay when it is scheduled. Patients with skin in the game show up, and a miss no longer costs the whole production value. No-show fees mostly punish your best patients.

If acceptance sits at 30 to 40 percent, the exam is the problem, not the patients. Spend two minutes on rapport before talking teeth, use benefit language instead of jargon, recap the why to your treatment coordinator in front of the patient, quote a monthly payment instead of a lump sum, and do it same day when you can.

It rarely means they will think about it. It usually means they are confused by the explanation or do not feel enough urgency to spend the money today, and are too polite to say so. Explain the outcome, not the procedure, and the polite no shows up far less.

At least three times their loaded cost, which includes benefits and payroll taxes. A hygienist paid $60 an hour costs about $72, so the floor is about $216 an hour. A full schedule can still lose money if it is full of prophy and perio maintenance visits without x-rays or a doctor's exam.

Most general practices have 300 to 700 patients who have not been in for 18 months or more. With conservative numbers, reactivating 15 percent of 500 lapsed patients at about $3,500 each over two years is roughly $262,500, more than most new-patient marketing returns, and nobody has to find them.

Under ten minutes. Use a seven-minute stand-up: one minute for a win, one for yesterday's numbers against goal and today's target, three to scan the schedule for gaps, unscheduled treatment and problem cases, one for action items and owners, and one to kick off.

Variety, not one fixed plan, because a fixed monthly collections bonus turns into entitlement within a couple of months. Alternate Prize Months in the busy season, with team goals and experiential rewards, and Push Months in the slow season, with a cash bonus tied to an ambitious production or collections goal.

Because they do not plan for the predictable time sucks: late arrivals, talkers, anxious patients, complex new patients, complications, "one more thing" requests and equipment failures. Build them into the schedule, and give the team a polite script for late patients that adjusts what gets done instead of running everyone late.

Replace decisions that wait on you with systems: scheduling rules built into the software, photo tray maps in sterilization, a Monday call list, a tag-on-the-last-box inventory system, and a daily scoreboard the whole team can see. Each one removes a question the team would otherwise bring to you.

Roughly 90 percent of crowns survive 5 years, about 81 percent survive 10, and about 62 percent survive 20, from a cohort of 1,037 crowns followed for more than 11 years on average. Whether the tooth is vital, where it sits and whether the patient grinds matter more than the crown material.

Four situations have real evidence: a definite crack, a posterior tooth after a root canal (uncrowned ones are extracted at six times the rate), a large preparation with a lot of restored surface, and a fractured cusp. The popular rule that a filling wider than a third of the tooth needs a crown is folklore.

Yes, for routine cases. A 2022 Cochrane review of 47 trials and 5,805 patients found no meaningful difference in healing between single-visit and multi-visit root canal treatment, and no difference in flare-ups. Single-visit patients report slightly more pain in the first week.

Not stable, low-risk adults. The largest trial on the question followed 2,372 adults for four years on 6-month, 24-month or risk-based recall and found no meaningful difference in cavities, gum bleeding or quality of life. Set the interval by each patient's risk instead of the calendar.

The best human evidence says yes. Two independent multi-year randomized trials in children, plus a 2021 Cochrane review, found no clinically meaningful difference in IQ, memory, kidney function or nerve conduction between children restored with amalgam and children restored with composite.

Yes, in high-risk patients. A review of 16 clinical trials found SDF arrested about 81 percent of active lesions in baby teeth, and a 2,998-child trial found it as effective as glass-ionomer sealants at preventing new cavities after two years. Its use for caries is still technically off-label.

Yes, when it is used per the manufacturer's instructions. A five-year split-mouth trial and a meta-analysis of 941 restorations found no significant difference from 2 mm incremental layering in failure rate, marginal integrity or post-operative sensitivity.

In the short term, no: a 2023 meta-analysis found 97.4 percent survival for immediate and 97.5 percent for delayed, mostly over one to three years. The one long-term study, 1,500 implants over six years, found a large gap after 24 months, worst in the upper jaw. Treat it as unresolved.

No. A post only retains a core when there is not enough tooth left to hold one; it does not reinforce the dentin. Across six systematic reviews, the remaining walls and the ferrule predict survival, and with two sound walls and a ferrule a post adds nothing measurable.

Yes, in a vital tooth without symptoms. A 2021 Cochrane review of 27 trials found higher odds of failure with complete removal than with selective or stepwise removal in deep lesions, and the ADA's 2023 guideline conditionally recommends the more conservative approach, especially for advanced lesions.