Dental Practice Models in the USA and Canada: Differences, Commonalities, and Growth Strategies

The North American dental industry has evolved far beyond the traditional owner-operator model. Today, there is a spectrum of organizational structures, ranging from the highly independent solo practitioner to vast, institutionally-backed group practices. While all dental models share the common mission of providing high-quality oral healthcare, their underlying business models, capital structures, and operational complexities vary dramatically.

This blog identifies the five primary typologies of dental practices in the USA and Canada—Independent Solo, Independent Group, Independent Multi-Location, Dental Support Organization, and Nonprofit-Public Health—and summarizes their inherent business differences, capital dynamics, and management structures. It also details the shared, systemic challenges (talent, revenue cycle, and technology) that affect all models, concluding with a discussion of the strategic solutions that have evolved for long-term operational success.

A Review of the Primary Types of Dental Practices 

The structure of a dental practice dictates its approach to capital, management, and growth. These models are defined by their level of centralization, clinical autonomy, and dependence on external financing.

The Independent (Private) Solo Dental Practice

This is the classic, traditional model, typically involving one owner-dentist operating from one location.

Traits of Independent Solo Dental Practices

• Independent Solo Practice Business Model: This model is highly focused on becoming a Fee-For-Service (FFS) practice, prioritizing high-quality, personalized care, and often resulting in an out-of-network status. Revenue is closely tied to the owner's chair time and personal reputation.
• Capital & Management: These dental practices are either self-funded or bank-financed; management is almost entirely in the hands of the owner, who serves as CEO, COO, and lead clinician. 
• Practice Growth: Growth is limited by physical capacity, the owner's available time, the cost of overhead, operational efficiency, reputation, market share, human and financial resources, and the mix of services.

The Prevailing Hybrid FFS/PPO Business Model

The reality for the vast majority of private dental practices is operating a hybrid model, which balances insurance participation with Fee-For-Service (FFS) care. Because most new and established patients in today's market rely on dental insurance (PPOs), the solo practice typically must be in-network with at least the most popular plans to maintain a necessary steady flow of new patients and keep the schedule full. 

This PPO dependency comes with a downside: the practice is forced to accept lower, contracted PPO fees, resulting in significant write-offs as the financial trade-off for patient volume. 

The practice's FFS component—which represents its autonomy and higher profitability—is derived from a mix of sources, including minimally or non-insurance covered procedures  (e.g., veneers and implants), and loyal patients who highly value the dentist's personalized care and are willing to pay the full, non-discounted fee regardless of their network status.

Prevalence of Independent Solo Dental Practices in North America

In the United States, the proportion of dentists in private practice operating a solo clinic was 46.2% as of 2021 (ADA HPI, 2021), representing a substantial decrease from two decades prior. While overall practice ownership (full or partial) among U.S. dentists remains high at approximately 72.5% in 2023 (ADA HPI, 2023), the solo model faces increasing competition from group practices and the growing influence of Dental Support Organizations (DSOs).

This shift is especially pronounced among younger dentists, who are much slower to pursue solo ownership early in their careers compared to previous generations. The slower speed is driven by factors such as high student debt and a preference for a better work-life balance.

In Canada, the figures suggest that solo practice ownership is lower than in the United States. Recent Canadian Dental Association (CDA) surveys indicate that only about one-third (approximately 33% to 42%) of dentists now operate solo practices, with more than half reporting that they work alongside two or more other dentists. Regardless of the precise number, the trend is one of steady decline, mirroring the trend in the United States.

Both countries are seeing an acceleration of new practice models, including the growth of DSOs, which appeal to new graduates by alleviating the administrative burden and high costs traditionally associated with starting or acquiring a wholly independent, solo practice.

The Independent (Private) Group Dental Practice (Partnership)

This model involves two or more owner-dentists operating a single, integrated practice under a shared business structure (such as a Partnership or a Professional Corporation). It is the leading alternative to the solo model for independent dentists. 

Prevalence of Independent Group Dental Practices in North America

Around 46% (CDA Data) of dentists in Canada work in independent group practices. Around 41% (ADA HPI, Composite Data) of dentists in the United States work in independent group practices. This 41% figure includes all dentists who are not in solo practice or directly affiliated with a DSO, representing the population that makes up multi-dentist partnerships, small multi-location practices (MLPs), and non-owner associates.

Distinguishing Traits of Independent Group Dental Practices

• Private Partnership Business Model: Private partnerships are characterized primarily by a Hybrid of FFS and PPO, similar to a solo practice, but immediately more scalable. It leverages partners' pooled patient bases and specialized clinical skills to increase service offerings and potential FFS revenue.
• Capital & Management: Private partnerships are co-funded (shared debt) or financed by combined partner equity. Management burden and risk are distributed among the owners, allowing greater focus on clinical work. A group practice requires a comprehensive partnership agreement to govern roles, revenue distribution, and disputes.
• Practice Growth: Growth is enhanced by shared capital, capacity, and a focused management approach, allowing for faster expansion of clinical services and increased patient volume compared to a solo practice.

The Multi-Location Independent (Private) Dental Practice (MLP)

This model emerges when a successful solo owner or partnership scales by acquiring or opening new sites, typically employing associates and a non-clinical Director of Operations. MLPs are typically 2 to 5 locations and rarely more than 8 locations. This range is often cited as the "sweet spot" for an MLP. 

MLPs with fewer than 8 locations are generally considered to be in the process of scaling or still manageable under the direct oversight of the original owner(s) and a small administrative team. Once an MLP grows significantly beyond 8-10 locations, it often transitions into a more formalized, corporate structure, referred to as a "DSO" for Dental Support Organization or Dental Service Organization.

Prevalence of Independent Multi-Location Dental Practices in North America

It’s estimated that 10% (Industry Estimates) of dentists in the United States and more than 50% (CDA, Industry Estimates) of dentists in Canada work in an MLP or emerging DSO of less than 10 locations. 

Distinguishing Traits of Independent Multi-Location Dental Practices in North America 

• MLP Business Model: Often a Hybrid of FFS and PPO, seeking to balance high production volume with quality service. Relies on the local brand and reputation of the founding dentist(s).
• Capital & Management: Primarily bank-financed or self-funded (non-institutional). Management begins to centralize, often in areas such as RCM, payroll, and HR, but clinical decisions remain locally influenced by the founder.
• Practice Growth: Constrained by the founder’s time and the difficulty of standardizing operations without a large support team (the mid-scale trap). The MLP model (2 to 8 locations) is widely considered the scaling stage for independent practice owners before they either transition to a corporate model (DSO) or choose to remain as a mid-sized, independent organization. 

Understanding The Mid-Scale Trap

The failure to make the critical investment in a dedicated, non-clinical manager means that high-risk, time-consuming functions such as payroll and HR are not centrally and professionally managed. This lack of specialized administrative support stifles further growth, prevents standardization, and increases the risk of management failure, effectively trapping the business at a size that is too large for the solo model but too small to function efficiently as a true large-scale DSO.

The Dental Support Organization (DSO) / Corporate Dentistry

A Dental Support Organization (DSO) is an independent business management service that contracts with, or owns, multiple dental practices to provide comprehensive non-clinical administrative support. This support centers on managing the business functions of the practice, such as human resources (HR), payroll, marketing, information technology (IT), and revenue cycle management (RCM). At the same time, the DSO drives business efficiencies, cost control, and standardization across its network of locations.

Classifications of Dental Support Organizations (DSOs)

The classifications for DSOs are primarily determined by the number of affiliated locations, reflecting the organization's maturity, complexity, and capital structure. 

• Emergent (Small) DSO: A small DSO typically operates between 10 to 25 locations, marking the transition from a Multi-Location Private Practice (MLP) into a structured corporate entity, often taking on initial institutional capital to standardize basic operations. 
• Established (Mid-Sized) DSO: A mid-sized DSO grows to support 25 to 75 locations, demonstrating a repeatable, efficient growth model ("playbook") that attracts significant private equity investment and scales centralized administrative functions. 
• Large DSO: Once an organization reaches 75 to 250 locations, it is categorized as a Large DSO and is characterized by national or multi-regional expansion, complex corporate structures, and a critical focus on achieving massive economies of scale. 
• Major DSO: A major DSO comprises 250 or more locations (often more than 500), representing the industry titans focused on market dominance, maximizing profit (EBITDA) for institutional investors, and maintaining highly sophisticated, centralized management across a vast national footprint. According to industry reports, the largest DSOs are Heartland Dental (with over 1,750 affiliated practices), The Aspen Group (with over 1,300 affiliated practices), and Pacific Dental Services (with over 1,000 affiliated practices).

Prevalence of DSOs in North America

The Dental Support Organization (DSO) model represents a significant and expanding segment of the dental industry across North America, with notable market penetration in the United States. As of 2022/2023, approximately 13-14% of dentists in the U.S. (ADA HPI, Industry Reports) are affiliated with a DSO. This trend is particularly pronounced among recent dental school graduates, where the affiliation rate jumps to around 23-27% (Dental School Graduate Surveys), signaling an accelerated shift away from traditional private practice for new practitioners.

In contrast, the DSO market in Canada is considered less mature, with an estimated 5% to 9% of dentists affiliated with a DSO (Canadian Dental Industry Estimates). Despite the lower current market share, the Canadian DSO model is following a similar trajectory of steady growth, mirroring the increasing appeal of corporate support structures throughout the continent.

Distinguishing Traits of DSOs

• Business Model: The DSO business model is centered on Volume-Based Production and creating high, standardized EBITDA margins across the enterprise. The goal of a DSO is not just to have a high EBITDA number (a dollar amount), but to achieve a high EBITDA margin (a percentage). Success relies on optimal operational efficiency and aggressive cost control.
• Capital & Management: DSOs are institutionally-backed by private equity or venture capital. Management is highly centralized, with corporate headquarters dictating standardized protocols, pricing, and technology. 
• State CPOD Laws:  A DSO is a business that uses common legal structures, such as an LLC or Corporation, to provide non-clinical management services to dental practices. The entire model is structured around navigating state laws, specifically the Corporate Practice of Dentistry (CPOD) doctrine, which prohibits non-dentists from owning or controlling clinical healthcare entities. To comply, a DSO enters into a detailed Management Services Agreement (MSA) with a separate, dentist-owned professional entity (such as a PC or PLLC). This MSA legally separates the non-clinical business functions (billing, HR, marketing) managed by the DSO from the clinical decisions and patient care that remain under the sole control of the licensed dentist

• Practice Growth: Growth is driven by a systematic acquisition strategy, supported by abundant external capital (primarily Private Equity). This capital is used to acquire and integrate existing dental practices, allowing the DSO to scale its centralized management structure, maximize economies of scale, and generate higher profits (EBITDA) for investors.

Nonprofit Public Health Dental Clinics

Nonprofit and public Federally Qualified Health Centers (FQHCs) operate with a distinctly mission-driven business model focused on providing essential healthcare, including dental services, to underserved populations in rural or economically disadvantaged communities, rather than maximizing profit. 

Their revenue streams are a mix of government funding, including federal, state, and local grants, as well as reimbursements from Medicaid/Medicare, and patient payments structured via a sliding-scale fee system. The management of these centers is highly regulated, and managers must focus on strict compliance and reporting requirements mandated by their funding sources. Consequently, their growth potential is limited, dependent on securing sufficient federal funding and new provider-eligible service contracts rather than capital acquisition or market competition.

Types of Nonprofit and Public Health Dental Clinics in North America

Approximately 91% of professionally active dentists in the United States work in private practice (U.S. Workforce Data). The remaining portion, comprising the total public health, government, and academic settings, accounts for less than 6% of the total workforce (around 11,000 to 12,000 dentists) (U.S. Workforce Data).

• Dental school clinics focus on dental training, offering care at reduced rates to the public. Dental school faculty and staff constitute one of the largest non-private categories, accounting for about 2.4% of active U.S. dentists (U.S. Workforce Data).
• Military dental clinics provide mandated dental care to active service members and their families. Approximately 1.8% of active U.S. dentists are employed in the Armed Forces (U.S. Workforce Data).
• Hospital dental clinics often provide emergency or complex care, frequently integrated within nonprofit hospital systems. A small percentage of United States dentists, approximately 0.2%, work in hospitals. (U.S. Workforce Data).
• County Public Health dental clinics serve local low-income residents and provide essential community services.
• Public school system dental clinics provide preventive and restorative services to students, addressing health equity within the public education system.
• Prison clinics provide constitutionally mandated dental care to incarcerated populations.
• Indian Reservation clinics provide federally mandated health services to members of federally recognized tribes.

Specific figures on the percentage of Canadian dentists working in public health versus private practice are not readily available (CDA, Health Canada). However, like the United States, the dental care delivery system in Canada is generally dominated by the private sector due to the lack of a national, comprehensive public dental care mandate.

Distinguishing Traits of Nonprofit and Public Health Dental Clinics

• Business Model: Mission-driven and not profit-maximizing. Revenue is derived from a mix of government grants, Medicaid/Medicare payments, and patient sliding-scale fees.
• Capital & Management: Funded by federal, state, and local entities. Management is highly regulated by compliance and reporting requirements.
• Practice Growth: Limited by funding and the availability of provider-eligible service contracts.
• Dentist Income: Dentists entering private practice typically prioritize a higher potential income, while those choosing public health often trade a higher salary for loan repayment benefits and a focus on community service.

Comparing Dental Practice Models

The foundational differences between these models can be distilled into three key strategic areas: Capital, Management Structure, and the Role of the Dentist. 

Capital Structure and Growth Funding

• Private Solo and Group Dental Practices: Independent (Private) Solo and Group Dental Practices (MLPs) rely on bank debt and retained earnings. Their focus is on slow and cautious growth, with an emphasis on capital preservation. Owners weigh every possible investment (e.g., facilities expansion, technology, and human resources) to judge whether the potential return will outweigh the increased personal liability and strain on the practice's cash flow. 
• Dental Support Organizations (DSOs): Conversely, DSOs leverage institutional capital (primarily private equity) to fuel rapid scaling through both strategic acquisition of existing practices and the de novo establishment of new ones. This structure creates an overriding focus on demonstrating high, repeatable EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization) to satisfy investor demands and target a high valuation for a future "exit" (sale). This growth mandate often leads to operational pressure to reduce supply and administrative costs through bulk purchasing, centralize management functions for efficiency, and maximize patient volume and revenue cycle performance across all affiliated practices.
• Nonprofit and Public Health Dental Clinics: The Nonprofit/Public Health model is entirely different, prioritizing compliance with grant requirements over profit, meaning capital deployment is focused on equipment and facility access rather than market expansion. 

Management and Centralization Dynamics

Management evolves from personal to professional as organizations scale. 

• Private Solo and Group Dental Practices: The dentist or partners in the practice personally oversee all administrative work. A growing multi-location practice (MLP) eventually needs a dedicated non-clinical manager (Director of Operations) to handle high-risk functions such as payroll and HR across the multiple locations. Failure to hire this person increases the risk of the "mid-scale trap" previously described.
• Dental Support Organizations (DSOs): The DSO model centralizes finance, RCM, marketing, and IT, ensuring standardization and cost control across the network. This centralization removes administrative burden from the clinical team but requires significant investment in technology and professional business managers. 
• Nonprofit and Public Health Dental Clinics: These clinics are typically overseen by a Board of Directors composed of community members and stakeholders, ensuring the clinic remains responsive to local needs. Operational management focuses on implementing a sliding fee scale to serve low-income and uninsured patients, while also balancing this charitable care with the clinical and administrative demands of a high-volume practice. Successful management requires a strong Director of Operations or a similar non-clinical leader who can navigate complex compliance, maximize billing (especially Revenue Cycle Management for Medicaid), and foster strategic partnerships with federal, state, county, local community, and private foundation entities to integrate oral health with overall public health initiatives.

The Role of the Dentist and Autonomy

The fundamental role and autonomy of a dentist change significantly as the dental practice evolves from an independent model to a large corporate or non-profit structure. In an Independent 

• Private Solo and Group Dental Practices: The solo practice dentist is typically the Founder-Clinician and CEO, maintaining total clinical autonomy and also bearing total business responsibility for all administrative and financial functions. This is the model of maximum control but also maximum burden.

As the practice expands, its management structure becomes more diverse. Dentists in an Independent Group Practice become Partner-Clinicians and Shareholders, who share business responsibility and retain high clinical autonomy within the group's common standards. The founder of a Multiple Location Practice (MLP) serves as the Founder-Clinician and CEO but delegates most day-to-day administration to a non-clinical manager, which frees the dentist in the CEO role to focus on high-level strategy and organizational growth.

• Dental Support Organizations (DSOs): Conversely, models built for scale or social mission reduce the dentist's non-clinical responsibilities, often in exchange for limiting autonomy. The DSO-affiliated Dentist is primarily an Employee-Clinician, focused purely on production and patient care. They have minimal business responsibility and follow predefined corporate protocols, which maximizes their clinical productivity while minimizing their influence on non-clinical corporate decisions. 
• Nonprofit and Public Health Dental Clinics: Dentists in Nonprofit and Public Health Dental Clinics primarily function as salaried, mission-driven providers and protocol experts. They may have administrative (business) duties. Their clinical autonomy is moderate, constrained by the limitations of available funding, standardized public health protocols, or government regulations (such as Medicaid compliance). They focus almost exclusively on delivering mandated, affordable care.

Convergence and the Strategic Horizon: 2026 and Beyond

While the structures of dental practice ownership in the United States and Canada vary widely, the strategic imperatives shaping their future are converging. Independent practices, group partnerships, and corporate DSOs alike are being to the same operational priorities: digital transformation, integration of artificial intelligence, sustainable staffing models, and patient-centric care delivery.

Across all models, AI is emerging as the great equalizer—automating revenue cycle management, optimizing scheduling and case acceptance, guiding clinical diagnostics, and strengthening patient communication. The practices that most effectively harness AI will gain a decisive advantage: reducing administrative friction, improving care accuracy, and freeing clinicians to focus on relationships and outcomes rather than data entry and compliance.

In both countries, the next phase of growth will depend less on ownership structure and more on the ability to build scalable, technology-enabled systems that unify AI-driven analytics with clinical excellence. Practices that deploy cloud platforms capable of learning from performance data, predicting revenue flow, and personalizing patient engagement will define the next generation of success.

Ultimately, the convergence of models points toward a hybrid future—one that blends the autonomy and community identity of private practice with the efficiency, intelligence, and management sophistication of large organizations. Whether in the U.S. or Canada, the winning strategy going into 2026 is not to emulate a single model, but to integrate the best elements of each: human trust and personalization from independent dentistry, AI-enhanced operational precision from DSOs, and mission-driven accessibility from the public health sector.

In an increasingly data-driven market, this convergence represents more than an economic evolution; it is a technological and cultural realignment of dentistry itself—toward an AI-empowered, connected, and patient-focused profession capable of meeting the health demands of modern society.