Private equity affiliation among dentists nearly doubled, 6.6% to 12.8% in six years: the Health Affairs study

What it says#

The study, by ADA Health Policy Institute economists Kamyar Nasseh and Marko Vujicic with Anthony LoSasso of DePaul University, appeared in the August 2024 issue of Health Affairs (volume 43, number 8, pages 1082 to 1089). The abstract notes that private equity has spent two decades acquiring medical practices, hospitals and nursing homes and has more recently taken a greater interest in dental practices, with few data on the scope of that activity. The authors analyzed dentist provider data for 2015 to 2021 to examine trends in PE acquisition of dental practices.

The headline finding: the percentage of dentists affiliated with PE increased from 6.6 percent in 2015 to 12.8 percent in 2021. Over that period, PE affiliation increased particularly among larger dental practices and among dental specialists such as endodontists, oral surgeons and pediatric dentists. PE-affiliated dental practices were more likely to participate in Medicaid than practices not affiliated with PE. The authors close by saying future research should investigate whether PE's role in dentistry affects the affordability and quality of dental services.

The ADA's own news report on the paper (August 6, 2024) adds detail from the full text. The study compared 2015-17 with 2019-21, using a dental provider database that mapped dentists to office locations and large group practices, and PE transaction data to flag PE-affiliated offices. Documented PE transactions involving dentists were consistently low from 2004 to 2015, at fewer than 20 a year; they rose from 2016, reached 62 in 2019, fell to 46 in 2020 and jumped to 96 in 2021. The share of endodontists, oral surgeons, orthodontists, pediatric dentists and prosthodontists affiliated with PE more than doubled from 2015 to 2021, with endodontists growing fastest; general practitioners went from 6.8% to 12.7%, an 87% increase, which was less than the specialties saw. The paper's suggested explanations are the high prices specialists earn for procedures such as root canals and implants and possible unrealized economies of scale; on the Medicaid finding, the authors could not rule out unobserved confounders such as profit margins or the number of auxiliary staff.

Who it applies to#

The data describe U.S. dentists and dental offices in the ADA's dentist office database for 2015-17 and 2019-21, with PE affiliation assigned from transaction records. That is affiliation with private equity specifically, not with DSOs in general: HPI's separate practice modalities data put DSO affiliation at 16.1% of dentists in 2024, a broader category that includes groups with no PE backing. The study is a count of who is affiliated, by practice size, specialty and Medicaid participation; it does not measure prices, quality or access.

For an owner, the numbers describe the buyer across the table. The growth was in larger practices and in endodontics, oral surgery, orthodontics, pediatric dentistry and prosthodontics, so a specialist or a multi-location group is far more likely to hear from a PE-backed buyer than a solo general practice, and the deal count went from 62 in 2019 to 96 in 2021.

What changed#

There is no prior edition; this was the first peer-reviewed estimate of private equity's footprint in dentistry over time. The same authors, with Tim Downey of IQVIA, followed it in Health Services Research (April 2026, volume 61, number 2) with a study of what happens after acquisition. Using PE transaction data for 2015 to 2021 linked to commercial claims, they found that PE-owned dental offices increased charges for dental services by 3.3% (95% CI 2.3% to 4.4%) while allowed prices stayed statistically unchanged, shifted from diagnostic and preventive procedures toward higher-reimbursement restorative, specialty and surgical procedures, and were more likely to become multispecialty practices. The authors' conclusion is that financial enhancement under PE may not translate into benefits for providers or patients.

Where the source is#

The paper is at doi.org/10.1377/hlthaff.2023.00574 on healthaffairs.org, where the full text is subscription-only; the publisher's site also blocked automated access when this entry was checked, so the abstract was read on PubMed (PMID 39102603) and Europe PMC, and the additional figures come from the ADA News report of August 6, 2024, which quotes the paper. The 2026 follow-up, "Financial Incisors," is in Health Services Research, also paywalled, with its abstract on Europe PMC. HPI's practice modalities page holds the DSO affiliation data used for comparison.