Selling an orthodontic, oral surgery or other specialty dental practice

Your buyer may be another specialist, a DSO or a platform built around specialty practices. In orthodontics, part of what you sell is treatment already under contract.

Last updated October 14, 2026

This guide is general information about selling a specialty dental practice, not legal, tax or financing advice. Dental ownership, patient record and wastewater rules differ by state, and those rules, DEA rules and SBA lending rules change over time, so confirm how they apply to your sale with your attorney, your CPA and the buyer's lender.

Is there a valuation multiple for orthodontic or oral surgery practices?

No. We could not verify SDE multiples, percent-of-collections ranges or sale prices for any dental specialty on its own, so this guide gives none. If you pick a specialty in the valuation estimator, it applies the range for all dental practices and says the result is not specialty-specific. For orthodontics it also says the range does not account for contracts receivable or prepaid treatment. The guide to what a dental practice is worth shows that all-practice range and explains when SDE, collections or EBITDA applies.

The only specialty multiple we found in a source we could check is a passing remark. A November 2025 Journal of Clinical Orthodontics editorial said corporate groups often value orthodontic practices at around seven times EBITDA. That is one editorial's remark, not deal data, and not a figure an orthodontist selling a practice should expect.

What we can show is goodwill, which is only part of a practice's price. CBIZ, a valuation firm, reported in 2024 the average goodwill in practice sales that the Health Care Group Goodwill Registry records for general dentistry and four specialties. CBIZ does not give the years or the number of sales behind the averages.

Average goodwill by practice type

Approximate average goodwill as % of annual gross revenue, not total price. CBIZ (2024), citing the Health Care Group Goodwill Registry.
Practice	Goodwill
General dentistry	52%
Orthodontics	50%
Oral surgery	44%
Prosthodontics	41%
Periodontics	39%

Who buys specialty dental practices?

Another specialist in your field, a DSO or a specialty platform. The ADA Health Policy Institute (HPI), whose 2024 figures are in the table, counts a practice as DSO-affiliated if an outside entity manages some or all of its non-clinical functions, such as billing, marketing or human resources. That is a research definition, not a legal one.

DSO affiliation by specialty, 2024

Rounded shares of dentists, not practices sold. ADA HPI, 2024 data, which HPI says slightly undercounts DSO affiliation.
Dentists	DSO-affiliated
Orthodontists	23%
Oral and maxillofacial surgeons	22%
Endodontists	21%
Pediatric dentists	15%
Periodontists	14%
Prosthodontists	11%
General dentists	15%
All dentists	16%

From 2015 to 2021, private equity affiliation grew faster among most specialists than among general dentists. That is a different measure and period from the DSO figures above.

An ADA Health Policy Institute study published in Health Affairs in 2024 found the share of all dentists affiliated with private equity rose from 6.6% to 12.8% over those years. It more than doubled among endodontists, oral surgeons, orthodontists, pediatric dentists and prosthodontists, while general dentists went from 6.8% to 12.7%. The authors named the higher prices specialists can earn for procedures such as root canals and implants as one possible reason for private equity's interest, not as a finding.

Orthodontists

Younger orthodontists were more likely to work in a support organization. In the American Association of Orthodontists' 2023 member survey, 14% of responding members worked in a DSO or an orthodontic support organization (OSO) in 2022, up from 6% in 2018, and 28% of respondents under 35 did, against 12% of those 35 and older.

In the AAO's 2025 Economics of Orthodontics and Patient Census Survey, 68% of responding orthodontists said they owned a practice alone or as a partner in 2024, down from 80% in 2018. That survey covers AAO members in the U.S. and Canada, and 6.6% of them took part. If you plan to sell to an associate orthodontist, find out early whether they want to own a practice or stay employed.

Pediatric dentists

The authors of a law column in the American Academy of Pediatric Dentistry's Pediatric Dentistry Today (September 2024) wrote that DSOs often acquire practices “of a certain revenue level”, which tends to increase their presence in urban rather than rural areas and leads them to larger rather than smaller practices. They gave no revenue figure.

Which DSOs partner with orthodontists, oral surgeons and other specialists?

Smile Doctors in orthodontics, Specialty1 Partners in oral surgery, endodontics and periodontics, U.S. Oral Surgery Management in oral surgery, and Lone Peak Dental Group in pediatrics. The first three describe their deals with specialists as affiliations, partnerships or joint ventures.

Specialty dental platforms

Each company's own press release; counts as of the date shown. None of these releases gives deal terms or prices.
Company	Size; model	When
Smile DoctorsOrthodontics	591 locations, 36 states; JV, de novo	Jul 2026
Specialty1 PartnersOral surgery, endo, perio	226 locations, 29 states; JV partnerships	Sep 2026
U.S. Oral Surgery ManagementOral surgeons only	32 states; MSO	Sep 2026
Lone Peak Dental GroupPediatrics	69 clinics, 13 states; DSO	Jan 2024

Orthodontics. Smile Doctors calls itself the largest orthodontic support organization in the U.S. and says it takes affiliations with single-practice orthodontists and multi-location groups. In January 2022 it announced that Thomas H. Lee Partners would invest as an equal partner with Linden Capital Partners, which had backed it since 2017, and that affiliated orthodontists would keep a significant ownership stake.

Oral surgery, endodontics and periodontics. Specialty1 Partners, based in Houston, said in September 2026 that it supports more than 350 specialists. Its 2026 joint venture partnerships included oral surgery, endodontic and periodontal practices.

U.S. Oral Surgery Management (USOSM) is a management services organization that serves only oral and maxillofacial surgeons. In a December 2024 release, USOSM said it had recapitalized with the private equity firm Oak Hill Capital in November 2021 and that its surgeons owned more than 54% of the company.

Pediatrics. Lone Peak Dental Group, a pediatric-focused DSO, announced a strategic investment from the BlackRock Impact Opportunities Fund in January 2024.

How a DSO joint venture is often structured

None of the releases above gives deal terms. Writing for DrBicuspid about DSO sales generally, Kim McCleskey of Professional Transition Strategies, a firm that brokers DSO transactions, says that in a joint venture the owner typically sells 60% to 70% of the practice up front. That is her description of typical terms, and yours are negotiable.

Joseph W. Gallagher, a consultant with The Health Care Group writing in AAOMS Today in 2024, describes the DSO model as a contract under which the clinical practice pays the DSO's management services organization a percentage of practice collections for administrative and operational work. He gives no percentage. Some states limit how that fee may be set; the guide to who can own a dental practice covers New York, North Carolina and the other states we checked.

The ADA's legal guide to DSO arrangements, updated January 2021, warns that taking equity in a DSO can come with a longer employment term and less ability to leave, and that non-compete and non-solicitation terms commonly extend to other practices the DSO services. Non-compete law varies by state and has changed in many states.

If a platform runs other orthodontic or oral surgery offices across your referral area, ask exactly which of them your non-compete covers. Before you compare a platform's offer with a sale to another specialist, also ask:

Which entity your retained stake or rollover sits in, such as the platform's MSO or a holding company above it, and whether it is the same class of equity the investors hold.
How the management fee is calculated, and whether it is a percentage of your collections.
Who keeps the relationships with your referring dentists if you leave the practice.
How many years you are expected to keep treating patients, and what happens to your stake if you stop.

Larger platform deals can need a state filing before closing. The guide to selling to a DSO covers Oregon and the other notice laws we checked; ask your counsel whether any of them applies to your deal.

How do buyers judge a specialty practice's referral base?

Orthodontic practice consultants Ken and Ryan Alexander of Alexander & Sons Consulting tell buyers to check how much of it depends on a few referring offices. Writing in Orthotown in November 2024, they suggest asking the seller whether any single source makes up more than 10% of new-patient referrals, and investigating if 15% or more of the practice is referred from one pediatric or dental practice. Expect that question about your top referring dentists, and have the numbers ready.

The Alexanders also push back on judging an orthodontic practice by its conversion rate alone. A practice with 250 new patients that starts 80% of them is often considered more valuable than one with 400 new patients that starts 50%, they write, but each starts 200 patients a year, and in their view the one with 400 new patients has far more potential and less risk.

They add that an orthodontic practice with more than 30% of its patients in HMO and Medicaid plans should generally see an impact on value. Report new-patient exams and starts separately, by referral source and by payer.

Referrals are also part of what a multispecialty DSO offers: Gallagher, in AAOMS Today, says the multispecialty DSO gives specialists a captive patient referral base, such as an orthodontist referring a patient to an oral surgeon in the same DSO.

The ADA's page on selling a practice lists referring dentists among the people to notify of a sale. For a specialist, that notice starts the handover. Plan who will introduce the buyer to each referring office, and when, before you sign a letter of intent that sets how long you stay.

What happens to orthodontic contracts receivable and prepaid treatment?

Expect them to be negotiated with the price, because how much of the balance is left for the buyer to collect can lower what the practice is worth. A patient partway through treatment has paid part of the fee to you, and the buyer will see that patient through to debond and retention.

Ken and Ryan Alexander estimate that an orthodontic practice's contracts receivable balance averages about 55% of yearly collections, though it varies greatly with payment terms. They give one practice at 75% with small down payments and another at 30% that asks for one-third down and accelerated payments over 18 months. Those are two examples, not a range, and practices where many patients pay in full show lower balances.

The Alexanders write that even major appraisers cannot agree on how much of the balance should be left for the buyer before a practice's value is reduced. With your attorney and your CPA, settle these points in the letter of intent:

Which patients' remaining payments go to the buyer, and which you keep collecting after closing
What the buyer is credited for finishing patients whose contracts you have already collected in full or nearly so
How retainer checks, refinements and patients who stop paying mid-treatment are handled after closing
How the contracts receivable are allocated in the purchase agreement, and how that is taxed

Before you go to market, run a contracts receivable report by patient: total fee, amount paid, balance, months of treatment left and payment status. The Alexanders stress checking how much of a balance can actually be collected, so expect a buyer to test yours.

Will you have to keep treating patients after you sell?

It depends on who buys and how the buyer pays. Attorneys writing about pediatric practices sold to DSOs, in the AAPD's Pediatric Dentistry Today (Q1 2026), say a DSO buyer will likely require the seller to keep working clinically, often for three or more years.

They add that the employment agreement will let the buyer end your employment, and that DSO employment likely means lower pay but possibly better benefits. The same article says DSO buyers often hold back part of the price, paid only if profitability markers are met. The guide to selling to a DSO covers how long dentists typically stay.

An SBA 7(a) loan can work the other way. When a buyer uses one for an Initial Acquisition or a Business Expansion, such as a specialist from outside your practice buying all of it, the practice may keep you on only as a consultant, for up to 24 months in total, under SBA SOP 50 10 8.1, effective October 1, 2026.

The SOP does not say whether that consulting can include treating patients, so confirm the arrangement with the buyer's lender and your counsel before you tell referring offices you will still be seeing their patients. SOP 50 10 8, as published effective June 1, 2025, allowed up to 12 months, so ask the lender which version covers a loan already in process.

A partial sale, in which you keep a stake, is a separate SBA structure in which you may stay as an owner or employee. Under SOP 50 10 8.1, if you keep less than 20%, you must personally guarantee the full loan amount for at least two years after final disbursement. That is one SBA structure, not a recommendation; ask the buyer's lender and your counsel. The guide to selling to an associate or another dentist covers how dentist buyers, including your own associate, finance a purchase.

Are any rules different for a specialty practice?

The amalgam separator rule. EPA's 2017 dental amalgam rule does not apply to dental offices that practice nothing but one or more of these specialties: oral pathology, oral and maxillofacial radiology, oral and maxillofacial surgery, orthodontics, periodontics or prosthodontics (40 CFR 441.10(c)). A practice that also does general dentistry is not excluded, and endodontics and pediatric dentistry are not on that list.

EPA's 2017 FAQ calls the rule a floor, not a ceiling, so state and local rules can still apply. If your office is subject to the rule, the new owner must file a new One-Time Compliance Report with the Control Authority within 90 days of the transfer (40 CFR 441.50(a)(4)); confirm the form and filing method with your Control Authority.

Orthodontic and pediatric records in Texas. Texas dental board rules require dental records to be kept at least five years from the last treatment, and for a patient last treated before age 18, until age 21 or five years from the last treatment, whichever is longer. The amendment effective May 28, 2026 added a seven-year period for orthodontic-device records (22 Tex. Admin. Code §108.8(b) and (d)(2)). Longer periods apply where other law requires them.

A dentist who leaves a Texas practice by sale must keep the records, transfer them in writing to the succeeding dentist or sign a written records-maintenance agreement, and notify the board in writing within 15 days of either agreement (§108.8(f)). In a Texas pediatric or orthodontic practice, check how many of your charts fall under the under-18 rule before you agree who keeps them. Other states set their own periods; the dental practice due diligence checklist covers records, X-ray registrations and payer contracts in every practice.

What should you prepare before selling a specialty practice?

Start with the ADA's lists. Its page on selling a practice names new patients per month, referral sources and the fee-for-service to managed care ratio among the items to assemble. The ADA Practice Transitions valuation document checklist, which prepares an owner for a valuation, also asks for services offered and referred, broken out by treatment code. For a specialty practice, add:

A referral report for at least three years: new patients by referring office, and each top source's share
For orthodontics, a contracts receivable report by patient, new-patient exams and starts by year, and your payment-plan terms
Your payer mix, including the share of patients in HMO and Medicaid plans
Every DSO, MSO or platform agreement you have signed, with any non-compete in it
Associate agreements, with whether each one can be assigned to a buyer
If you hold controlled substances (for IV sedation, for example), your DEA registration and controlled-substance records

Attorneys writing in the AAPD's Pediatric Dentistry Today (Q1 2026) say a DSO buyer often requires associate dentists to be under written contracts that can be assigned to a third party. The due diligence checklist covers DEA registration and controlled substances in a sale.

The guide to selling a dental practice covers the full sequence, and selling a dental practice to a DSO takes a DSO offer apart line by line.

Sources

All sources accessed October 14, 2026.

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