The First 90 Days After You Buy a Dental Practice

Key takeaways

• The seller's visible presence in week one, and a transition letter patients see before their first visit, tell everyone this is a continuation, not a takeover.
• Change almost nothing clinically or culturally in the first month. Change financial policy immediately if it needs it. That one gets harder to fix the longer you wait.
• Honor the recare already on the books before you chase new patients, and treat every existing patient's first exam with you as an audition, not a résumé rewrite.
• Check the same handful of numbers every week for 90 days. A transition is exactly when small problems compound fastest if nobody is watching.

Closing on a practice feels like the finish line. It's the starting line. What you do in the first 90 days decides whether the team stays, whether the patients stay, and whether the numbers you underwrote actually show up in your bank account.

Here is the sequence I run every time.

The transition letter, and the seller's role#

Before day one, patients should already know a change is coming, from a letter, ideally co-signed or at least endorsed by the seller, that introduces you and frames the sale as planned and positive. A patient who finds out their doctor sold the practice by walking in and seeing a stranger is a patient who starts looking for a new dentist that afternoon.

The seller's actual presence in the first weeks matters more than most buyers expect. If your letter of intent settled a transition period (clinical coverage, consulting, or just being visibly around) this is where it pays off. A seller who disappears the day after closing leaves you introducing yourself to a full schedule of strangers with no one vouching for you. A seller who sticks around, even briefly, is doing something no amount of your own charm can replace: telling long-time patients and staff that this is fine.

The sequence, not the speed. Watching comes before changing.

Keeping the team: what to change, and what not to touch#

Watch before you touch. The team, the patients, and the culture were all here before you were. The first 90 days are for learning how they actually work, not for stamping your name on everything at once.

A stable, well-trained team that stays through a transition is one of the most valuable things you actually purchased, more valuable than most of the equipment. I've written before about the red flags I look for before buying, and disorganized team dynamics are on that list for a reason. I once took over a practice where the seller had merged two offices into one building without ever integrating the teams. They ran as two separate tribes under one roof, and it took me eighteen months of turnover and culture-building to fix what should have been caught before I signed.

If you did your diligence, you already know whether you're walking into that situation. Either way, the first 90 days are for watching, not overhauling:

• Watch for systems, or the lack of them. Is there real delegation, or is everything running on the previous owner's memory? You'll know within a few weeks which one you have.
• Watch family dynamics carefully if the seller's relatives are on staff. Their loyalty and their role may both need to be renegotiated, and that conversation goes better after you've built some trust than in week one.
• Watch turnover, but don't manufacture it. A long-tenured team is a gift. Don't reorganize roles or change compensation structures in the first month just because it's your practice now. You'll spook people who had no say in the sale and no reason yet to trust you.

The one place I don't wait is financial culture, and I'll get to that below. Everything else (scheduling templates, software, even most of the clinical protocols) can wait until you've actually watched how the practice runs for a full cycle.

Keeping the patients: recare on the books, and the first exam#

Your existing patients did not choose you. They chose the seller, years ago, and they're being asked to trust a stranger with their teeth because of a transaction they had no part in. Respect that.

The single best thing working in your favor is the recare already scheduled. Those appointments represent patients who were already coming back on their own rhythm. Don't disrupt that cadence trying to backfill your schedule with a marketing push in month one. Fill gaps, don't create them.

Every existing patient's first exam with you is an audition, in both directions. Resist the urge to immediately find everything the seller "missed" and present a wall of treatment on visit one. I understand the temptation: a broader clinical skillset than the seller's is genuinely one of the better reasons to buy a given practice, and there's often real, legitimate treatment sitting there. But a new dentist who reflexively diagnoses aggressively in the first visit reads as a sales pitch to a patient who's already nervous about the change, whether or not the diagnosis is correct. Build trust with a normal exam first. The treatment conversation lands better in visit two.

The numbers to watch weekly#

A transition is exactly when small problems compound fastest, because nobody has established a rhythm yet and everyone (you included) is distracted. I check the same handful of numbers every week for the first 90 days of any acquisition:

Number	What it tells you
Collection percentage	Whether the practice is actually collecting what it produces, not just producing
AR aging, 60- and 90-day buckets	Whether receivables are growing under new ownership: an early transition red flag
Schedule utilization	Whether the schedule you inherited is holding up, or quietly eroding
Production vs. collections	Whether the gap between the two is widening, which usually means a billing or insurance problem forming
New patient count and recare kept	Whether the patient base you bought is actually staying

I use these same benchmarks day to day once a practice is stable. I go through the full framework in the profit-leak audit I run quarterly, including the specific targets for collection rate, overhead, and payroll ratio. In the first 90 days, the point isn't hitting a target yet. It's catching a number that's moving in the wrong direction while it's still small.

These are also the same collections and cash flow numbers that fed your original price and your lender's underwriting. If your first quarter of real numbers doesn't look like what you underwrote, run them back through the practice valuation calculator and be honest with yourself about whether the gap is a slow start or a sign the numbers you were shown weren't the real ones.

The systems I install first#

Almost everything can wait a quarter. Two things can't.

Financial policy, immediately, if it needs fixing. If the practice has a culture of billing patients after insurance pays instead of collecting at time of service, fix it now. This is the one habit I would not wait on, because I've seen it firsthand: financial culture is incredibly hard to change once it's established, and every month you let it run is another month of receivables you'll be chasing later. Some things are easy to change in a practice. This isn't one of them, which is exactly why it doesn't get to wait.

A weekly cash flow rhythm. I run every practice on the same logic I've written about for managing practice cash flow: payroll timed so it doesn't collide with your biggest deposit days, and a buffer equal to one month of operating expenses before anyone, including you, takes a distribution. In a newly purchased practice, install this from week one. You inherited someone else's cash flow patterns along with their patient base, and they may not be the patterns you want to keep.

Everything else (new equipment, new marketing, restructured roles, renegotiated insurance contracts) belongs later in the year, after you've actually watched a full quarter of the practice's own rhythm.

The 90-day checklist#

1. Before closing: a transition letter is drafted and ready to reach patients.
2. Week one: the seller is visibly present in whatever capacity you agreed to; you're doing exams, not aggressive treatment planning.
3. Weeks one through four: watch the team's systems, turnover, and dynamics. Change nothing structural yet.
4. Immediately: fix financial policy if the practice was collecting after insurance instead of at time of service.
5. Week one, ongoing: install your weekly cash flow rhythm: payroll timing and a real operating buffer.
6. Every week for 90 days: check collection percentage, AR aging, schedule utilization, and production versus collections.
7. Day 30: honor existing recare, fill schedule gaps rather than overbooking around them.
8. Day 60–90: you should have a real read on the team, the numbers, and the patient base: enough to start deciding, deliberately, what actually needs to change.

Ninety days in, you should know your practice, not just own it. For the sequence that gets you here (the diligence, the price, the financing, and the LOI) start at the topic hub on buying, building, and partnering.