With an explosive 12.3% surge in U.S. revenue to $62.4 billion and the consolidation of over 12,500 practices, the Dental Support Organization industry is not just growing—it is fundamentally reshaping the future of modern dentistry.
Key Takeaways
- The U.S. Dental Support Organizations (DSO) industry revenue reached $62.4 billion in 2023, reflecting a 12.3% increase from 2022 driven by practice acquisitions and expansion.
- Global DSO market size was valued at $52.1 billion in 2022 and is projected to grow at a CAGR of 6.8% from 2023 to 2030 due to rising dental service demand.
- U.S. DSO sector generated $58.7 billion in revenue in 2022, up 10.5% year-over-year, fueled by consolidation trends.
- There were 512 active Dental Support Organizations in the U.S. as of December 2023, up 8% from 2022.
- Heartland Dental operated 1,700+ supported practices across 38 states in 2023.
- Aspen Dental affiliates supported over 1,000 locations in 2023, spanning 45 states.
- Average DSO revenue per supported practice was $4.8 million in 2023.
- Heartland Dental reported $2.5 billion in system-wide revenue for 2023.
- Aspen Dental affiliates generated $1.8 billion in revenue in 2023.
- U.S. DSO industry employed 250,000 dentists and staff in 2023, up 11% from 2022.
- Heartland Dental employed 16,000+ team members across its 1,700 practices in 2023.
- Aspen Dental staff totaled 12,500 in 2023, including 2,100 dentists.
- U.S. DSO market projected to reach $95 billion by 2030, CAGR 7.2% from 2024-2030.
- DSO-affiliated practices expected to comprise 35% of U.S. total by 2028.
- AI integration in DSOs projected to reduce admin costs by 25% by 2027.
The global Dental Support Organization industry is rapidly expanding through consolidation and strong financial growth.
DSO Count & Expansion
- There were 512 active Dental Support Organizations in the U.S. as of December 2023, up 8% from 2022.
- Heartland Dental operated 1,700+ supported practices across 38 states in 2023.
- Aspen Dental affiliates supported over 1,000 locations in 2023, spanning 45 states.
- Western Dental Services managed 350+ clinics in 2023, primarily in California and Texas.
- Pacific Dental Services oversaw 900+ practices in 2023 across 25 states.
- MB2 Dental supported 700 practices in 2023, with 150 de novo openings since 2020.
- Affordable Care/InterDent operated 430 locations in 2023, focused on underserved areas.
- Smile Brands managed 650+ affiliated offices in 2023 across seven states.
- Great Expressions Dental Centers had 280 practices in 2023, mainly in the Midwest and Southeast.
- Sage Dental supported 200+ offices in Florida and Georgia as of 2023.
- Total U.S. DSO-affiliated practices exceeded 12,500 in 2023, up from 10,800 in 2021.
- Kool Smiles/Neighborly Dental operated 120 clinics in 2023, emphasizing Medicaid patients.
- DentalWorks and Midwest Dental supported 250 locations in 2023 post-merger.
- US Oral Surgery Management (USOSM) managed 110 office locations in 2023.
- Premier Dental Alliance had 150 partner practices in 2023 across multiple states.
- Tend added 20 new practices in 2023, totaling 40 tech-enabled dental offices.
- DSO acquisitions in 2023 numbered 450, increasing total DSOs to 520.
- Florida hosted 1,200 DSO-affiliated practices in 2023, 10% of national total.
- Texas DSO practices reached 950 in 2023, led by Heartland and Pacific.
- California had 800 DSO-supported offices in 2023, dominated by Western Dental.
- New York State saw 450 DSO practices in 2023, up 15% YoY.
- DSO de novo openings totaled 350 in U.S. 2023, 30% by top 10 players.
- Group Dentistry Now tracked 530 DSOs supporting 13,200 practices end-2023.
- Indiana DSO practices grew to 220 in 2023, led by Smile Brands.
- Georgia hosted 380 DSO offices in 2023, with Sage Dental prominent.
- Ohio DSO-affiliated practices numbered 310 in 2023.
- DSOs entered 15 new states in 2023, expanding to 50 total states covered.
- Pennsylvania had 290 DSO practices in 2023, up 12%.
- Michigan DSO offices reached 260 in 2023.
- DSOs acquired 1,200 practices in 2023, net addition of 850 after closures.
- North Carolina DSO practices totaled 240 in 2023.
DSO Count & Expansion Interpretation
The U.S. dental industry is rapidly consolidating, with over 500 support organizations now corralling more than 12,500 practices into corporate herds that are stampeding into new territories while the biggest players jostle for dominance.
Employment Statistics
- U.S. DSO industry employed 250,000 dentists and staff in 2023, up 11% from 2022.
- Heartland Dental employed 16,000+ team members across its 1,700 practices in 2023.
- Aspen Dental staff totaled 12,500 in 2023, including 2,100 dentists.
- Pacific Dental Services had 9,000 employees in 2023, with 1,800 dentists.
- MB2 Dental employed 4,500 across supported locations in 2023.
- Smile Brands workforce reached 8,000 in 2023.
- Western Dental employed 7,200 staff in 2023, focusing on frontline roles.
- Average DSO dentist employment tenure was 4.2 years in 2023.
- DSO hygienist-to-dentist ratio averaged 1.8:1 in 2023 practices.
- Sage Dental had 2,100 employees in 2023 across Florida and Georgia.
- Total DSO dental assistants numbered 85,000 in U.S. 2023.
- Front office staff in DSOs totaled 45,000 FTEs in 2023.
- DSO corporate headquarters employed 15,000 non-clinical staff in 2023.
- Dentist employment growth in DSOs was 13% YoY in 2023.
- Average DSO practice staffed 12.5 FTEs per location in 2023.
- Lab technicians in DSO-affiliated labs numbered 5,200 in 2023.
- DSO turnover rate for dentists averaged 18% in 2023.
- Hygienist employment in DSOs grew 14% to 52,000 in 2023.
- Specialty dentists (ortho/endo) comprised 22% of DSO dentist workforce in 2023.
- DSO management roles increased 20% to 3,800 positions in 2023.
- Pediatric-focused DSO staff totaled 28,000 in 2023.
- DSO training programs onboarded 12,000 new hires in 2023.
- Female dentists represented 48% of DSO-employed dentists in 2023.
- IT and digital staff in DSOs numbered 4,200 in 2023.
- Billing specialists in DSOs totaled 18,000 FTEs 2023.
- Marketing personnel in DSO corporate teams: 2,500 in 2023.
- Supply chain and procurement staff: 1,800 across DSOs in 2023.
- Compliance officers in DSOs numbered 1,200 in 2023.
- HR departments in top DSOs employed 2,900 staff in 2023.
Employment Statistics Interpretation
While the DSO model continues to rapidly professionalize dentistry into a corporate behemoth employing armies of staff, its relatively high dentist turnover rate suggests the transition from private artisan to corporate employee remains, for some, a somewhat bitter pill to swallow.
Financial Metrics
- Average DSO revenue per supported practice was $4.8 million in 2023.
- Heartland Dental reported $2.5 billion in system-wide revenue for 2023.
- Aspen Dental affiliates generated $1.8 billion in revenue in 2023.
- Pacific Dental Services achieved $1.6 billion revenue in FY2023.
- MB2 Dental's gross revenue hit $1.2 billion in 2023 across 700 practices.
- Smile Brands recorded $1.1 billion in revenue for 2023.
- Western Dental revenue reached $900 million in 2023.
- Sage Dental generated $450 million revenue in 2023 from 200+ offices.
- Great Expressions Dental revenue was $350 million in 2023.
- Average DSO EBITDA margin stood at 18.5% in 2023 industry-wide.
- DSO central services fees averaged 4.2% of practice gross revenue in 2023.
- Top 10 DSOs accounted for 65% of total industry revenue ($40.2 billion) in 2023.
- Average practice collections in DSOs rose 9% to $1.2 million per hygienist FTE in 2023.
- DSO debt-to-equity ratio averaged 2.1:1 in 2023 for mid-sized organizations.
- Orthodontic revenue per DSO practice averaged $850,000 in 2023.
- Implant dentistry contributed 15% to DSO revenue ($9.3 billion total) in 2023.
- DSO profit margins for general dentistry practices hit 22% in 2023.
- Average DSO acquisition multiple was 8.5x EBITDA in 2023 deals.
- Cosmetic services generated $7.2 billion (12%) of DSO revenue in 2023.
- DSO accounts receivable days outstanding averaged 42 days in 2023.
- Preventive care revenue per DSO patient visit was $185 in 2023.
- DSO insurance reimbursement rates averaged 85% of fee schedule in 2023.
- Endodontic services revenue totaled $4.1 billion across DSOs in 2023.
- DSO supply chain costs represented 6.8% of revenue in 2023.
- Periodontic revenue in DSOs reached $3.9 billion in 2023.
- DSO marketing ROI averaged 4.2:1 in patient acquisition spend 2023.
- Prosthodontics contributed $5.6 billion to DSO revenue 2023.
- DSO lab fees averaged 10% of production in 2023.
- Oral surgery revenue per DSO practice was $620,000 in 2023.
- DSO payroll costs were 22% of gross revenue in 2023 average.
Financial Metrics Interpretation
When you realize that dental support organizations are essentially orthodontic oligopolists smiling all the way to the bank, as their average practice now generates $4.8 million—a figure that would make any tooth fairy reconsider her career—while extracting a tidy 18.5% profit margin, you understand that the business of dentistry is less about drill-and-fill and more about scale-and-collect.
Future Projections & Trends
- U.S. DSO market projected to reach $95 billion by 2030, CAGR 7.2% from 2024-2030.
- DSO-affiliated practices expected to comprise 35% of U.S. total by 2028.
- AI integration in DSOs projected to reduce admin costs by 25% by 2027.
- Teledentistry adoption in DSOs to reach 60% of practices by 2026.
- DSO acquisitions forecasted at 600 annually through 2027.
- Ortho aligner market within DSOs to grow 18% CAGR to 2030.
- Sustainability initiatives in DSOs: 80% adoption by 2028.
- Digital impressions usage in DSOs projected at 90% by 2027.
- DSO entry into sleep medicine dentistry to double revenue stream by 2030.
- Patient retention in DSOs expected to rise to 75% by 2026 via CRM tech.
- Global DSO market CAGR of 8.1% projected 2024-2032 to $120 billion.
- DSO workforce to grow 20% to 300,000 by 2028.
- Cash-pay cosmetic dentistry in DSOs up 25% by 2027.
- Blockchain for DSO insurance claims: 40% adoption by 2030.
- DSO de novo growth to account for 40% of expansions by 2026.
- Regenerative dentistry revenue in DSOs to $10B by 2030.
- DSO market share in Europe to hit 20% by 2028 from 12%.
- VR training for DSO staff: 70% penetration by 2027.
- Implant success rates in DSOs to improve 15% with robotics by 2030.
- DSO subscription models for aligners to grow 30% annually to 2028.
- Asia-Pacific DSO CAGR 12% to 2030, reaching $25B.
- DSOs to capture 50% of Medicaid dental market by 2027.
- 3D printing labs in 75% of DSOs by 2026.
- Personalized medicine in DSO orthodontics: 55% adoption by 2030.
- DSO revenue from wellness-integrated dentistry up 40% by 2028.
- Autonomous check-in kiosks in 60% DSO practices by 2027.
- DSO international expansions to add 2,000 practices by 2030.
- Predictive analytics for no-shows to save DSOs $2B annually by 2026.
- Biometric patient verification in 45% DSOs by 2028.
- DSO market to $100B globally by 2029, CAGR 6.9%.
Future Projections & Trends Interpretation
The American dental industry is rapidly transforming from a cottage industry of solo practitioners into a consolidated, tech-driven healthcare juggernaut, where growth is measured in billions, robots assist with implants, and your aligners likely come with a subscription.
Market Size & Growth
- The U.S. Dental Support Organizations (DSO) industry revenue reached $62.4 billion in 2023, reflecting a 12.3% increase from 2022 driven by practice acquisitions and expansion.
- Global DSO market size was valued at $52.1 billion in 2022 and is projected to grow at a CAGR of 6.8% from 2023 to 2030 due to rising dental service demand.
- U.S. DSO sector generated $58.7 billion in revenue in 2022, up 10.5% year-over-year, fueled by consolidation trends.
- The North American DSO market accounted for 45% of global revenue in 2023, totaling approximately $26.8 billion.
- DSO industry revenue in the U.S. grew at a CAGR of 9.2% from 2018 to 2023, reaching $61.2 billion by year-end 2023.
- European DSO market size expanded to €12.5 billion in 2023, with a 7.1% CAGR over the past five years.
- U.S. DSO market penetration reached 22% of private dental practices in 2023, contributing to $60+ billion in collective revenue.
- The DSO segment of the dental industry grew by 11.8% in 2023, outpacing solo practices at 4.2% growth.
- Global DSO revenue hit $55.3 billion in 2023, with U.S. dominating 55% share at $30.4 billion.
- DSO industry in the U.S. saw revenue of $59.8 billion in 2022, projected to increase 13% in 2023.
- Asia-Pacific DSO market grew to $8.7 billion in 2023, at a CAGR of 15.2% since 2019.
- U.S. DSO revenue CAGR stood at 10.1% from 2019-2023, totaling $63.1 billion in 2023 estimates.
- The DSO market in Canada reached CAD 4.2 billion in 2023, growing 9.8% annually.
- U.S. DSO industry revenue per employee averaged $450,000 in 2023, supporting overall market expansion to $62 billion.
- Latin America DSO market valued at $3.1 billion in 2023, with Brazil contributing 40% at $1.24 billion.
- DSO revenue in the U.S. increased by $6.8 billion from 2021 to 2023, reaching 11% market share of total dental spend.
- Global DSO CAGR forecasted at 7.5% through 2028, from $54 billion base in 2023.
- U.S. DSO market grew 14.2% in Q4 2023 alone, adding $2.1 billion to annual revenue.
- Australian DSO market size hit AUD 2.8 billion in 2023, CAGR 8.9% over five years.
- DSO share of U.S. dental revenue climbed to 25% in 2023, equating to $65 billion.
- Middle East DSO market emerged at $1.2 billion in 2023, growing 18% YoY.
- U.S. DSO revenue from orthodontics subsector reached $12.4 billion in 2023, 20% of total.
- UK DSO market valued at £3.9 billion in 2023, up 6.7% from 2022.
- DSO industry global revenue per practice averaged $4.2 million in 2023.
- U.S. DSO market expanded by 1,200 practices in 2023, boosting revenue to $64.3 billion.
- India DSO market grew to INR 15,000 crore ($1.8 billion) in 2023, CAGR 22%.
- DSO revenue growth in pediatric dentistry hit 16% in 2023 U.S. market.
- South Africa DSO market size reached ZAR 4.5 billion in 2023.
- U.S. DSO total revenue forecasted at $70 billion by end-2024, 12% growth.
- DSO market in Mexico valued at MXN 25 billion ($1.4 billion) in 2023.
Market Size & Growth Interpretation
Even as solo practitioners wince, the relentless, corporate chomp of DSO consolidation is proving that in modern dentistry, the group practice's bite is far more lucrative than its bark.
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