Secrets to Buying Your Ideal Dental Practice: 2026 Update

Secrets to Buying Your Ideal Dental Practice was written back in 2016. The core ideas still hold: buy cash flow, know your numbers, pay yourself like you’d pay an associate — 30 percent of your personal production — and never confuse price with value.

A lot has changed since then, though. Technology’s made it easier to control some expenses, like supplies and lab costs. But the biggest shift for anyone buying a practice today is consolidation. Dental service organizations (DSOs) have become a real force in how practices get valued. More buyers in the market means higher prices, plain and simple — some estimates put 40% of practices under DSO affiliation within the next 10 years. That makes the income approach more important than ever if you want to know what a practice is actually worth to you.

The New Average Practice

According to the ADA Health Policy Institute’s most recent Survey of Dental Practice, the average general practitioner in private practice billed $965,660 in gross production in 2025, with average net income of $215,320. Compare that to the $770,700 average collections figure I cited from 2013 ADA data in the original book. Do the math and that’s overhead north of 75%.

ADA Trends in Dentist Income

Overhead and EBITDA, Revisited

Let’s talk numbers, because this is where most buyers get tripped up.

The original book laid out an idealized 60% overhead / 40% net operating income split, with EBITDA landing around 17% after you pay yourself 30% of production. Some  consultants today are encouraging their clients that already own large, established practices to aim for 50% overhead and 30% EBITDA. Don’t let those numbers throw you — here’s what you’ll actually find on the market: a 30% EBITDA margin is rare, and most DSOs themselves don’t hit it. A healthy, well-run independent practice today lands in the high teens to low 20s for EBITDA, and anything above 20% is investment-grade territory worth a serious look. If you’re eyeing a practice running 50% overhead, know that it’s already firing on all cylinders — there’s very little room for error once you take over.

Staff cost is still the category you can least afford to slash quickly, and that’s even truer now than in 2016. The post-pandemic labor market has made good hygienists and experienced assistants harder to find and more expensive to keep. Your team is the practice’s biggest asset. If your staff ratio runs high, the fix is almost always to grow production — not to cut people.

A reasonable, well-run practice in 2026 lands closer to 60%, though the table below also shows what it looks like at the 50% stretch goal.

These are the overhead expenses before you get paid.

Back in 2016, you were mostly bidding against other individual dentists. Today, for practices of a certain size and profile, you might be bidding against a private equity–backed DSO with a much lower cost of capital and a much longer time horizon than you have.

The old cap rate framework from the book still holds up for smaller, single-location deals — 18 to 35%, or 3x to 5.5x EBITDA. Current data actually puts those deals closer to 5x to 8x EBITDA (a 12.5 to 20% cap rate). Larger, well-run practices and multi-location platforms sometimes trade at 8x to 11x EBITDA (roughly a 9 to 12.5% cap rate) when a DSO is the buyer. That’s a price an individual buyer — financing personally and needing to hit 30% of personal production — usually can’t match.

So what does that mean for you? If you’re looking at a large, high-EBITDA practice that doesn’t depend heavily on the owner, expect DSO money to be circling it too. But the “diamond in the rough” practice from the original book — smaller, in a market DSOs haven’t prioritized, maybe underpriced because of a downward trend that’s really just a retiring dentist slowing down — can still be a great opportunity for an individual buyer. That’s where you can still win with the income approach.

What Hasn’t Changed

For everything that’s different, the core discipline from the original book hasn’t:

• Cash flow, not paint and carpet, determines value.
• Pay yourself at least 30% of your personal production, and know that number cold before you make an offer.
• Build your team — a broker, attorney, and CPA who specialize in dental transitions.
• Know your opportunity cost. Compare any purchase to what you’d earn as an associate, in real numbers.
• Calculate your own number before you even look at the asking price, so you know the difference between what a practice costs and what it’s worth to you.