A dental practice is one of the few businesses where the principal asset walks out of the building every evening. Patients did not choose a company; they chose a dentist. When that dentist is also the seller, the buyer's central question is not what the practice earned last year — it is how much of that will still be there once the person who produced it has gone.
Everything else in a dental transaction is secondary to that question. The equipment is replaceable, the premises are usually leased, and the patient list is only worth what it will still be worth under someone else's hands. The whole preparation problem, and most of the price, comes down to producing credible evidence that the practice is a business rather than a personal following.
This article sets out who is buying dental practices now, what they actually pay, how the owner-dentist discount is calculated, and what evidence closes the gap.
The traditional exit — selling to a younger dentist who takes over the chair — has been narrowing for a decade, and the data on career choices explains why.
The ADA Health Policy Institute tracks how dentists practise. The share of dentists affiliated with a dental service organisation rose from roughly 7% in 2015 to nearly 13% in 2022 and about 14% in 2023. The career-stage breakdown matters more than the headline: in 2023 roughly 29% of dentists zero to five years out of school were DSO-affiliated, around 20% of those six to ten years out, about 12% at eleven to twenty-five years, and roughly 8% among those at least twenty-five years out. Solo practice, meanwhile, slipped from 36% to 35% of all dentists between 2022 and 2023, declining at every career stage, while the proportion working in practices with more than a hundred locations rose from 9% to 10%.
Read that from a seller's point of view. The generation that would historically have bought your practice is increasingly choosing employment over ownership, and often carries student debt that makes a bank-financed acquisition unattractive. That does not mean there is no buyer — it means the buyer is more likely to be a group.
Group buyers behave differently from an individual successor. They underwrite on normalised EBITDA rather than on income they expect to earn personally. They pay more for practices that already run without the owner and less for those that do not. And they are systematic about diligence in a way an individual purchaser never was.
Published ranges for dental practices are unusually unreliable, because brokers quote platform pricing to owners of single practices.
The honest reference point comes from the deal data. Lincoln International, which advises in this sector, reports that add-on acquisitions — the category a single practice falls into — typically transact at 3x to 6x EBITDA, and that in Europe add-on multiples have declined by one to three turns of EBITDA since the 2021 peak, varying by geography. The high multiples circulating online belong to platform transactions: groups of practices with their own management infrastructure and, usually, more than a million in EBITDA.
The same source is worth reading for what it says about the top of the market: more than forty DSO platforms were brought to market over two years and fewer than ten transactions closed, while over 120 add-on acquisitions completed in 2024 alone. Small practices are trading. Large groups are struggling to trade. An owner of one or two surgeries is in the liquid part of the market, which is good news, but at add-on pricing rather than platform pricing.
Two structural points follow. First, EBITDA in dentistry has to be normalised for the owner's own clinical work: a buyer must pay an associate to do what the departing principal did, and the market rate for that production is deducted before any multiple is applied. An owner who takes a modest salary and keeps the rest as profit has not created profit — they have deferred a cost. Second, percentage-of-revenue rules of thumb are close to useless at this size, because two practices with identical revenue can have entirely different cost structures depending on how much of the production is the owner's. When a client at Conclave Partners asks for a valuation before we have seen the production split by provider, the honest answer is that no number is possible yet.
Every buyer runs the same mental model: strip out the owner's chair, replace it with an employed associate at market rates, and see what is left. The size of the discount is set by three things.
The first is the share of production the owner personally performs. A practice where the principal generates 80% of revenue is being valued largely on whether that revenue is transferable. Where the principal generates 35% and associates and hygienists produce the rest, most of the business demonstrably runs without them.
The second is the cost of replacing that production. Associate compensation in most European markets runs at a substantial percentage of the production they generate, and that percentage is deducted from EBITDA permanently. Practices where the owner does high-value work — implants, complex endodontics, orthodontics — face a harder version of this: replacement associates capable of that work are scarcer and cost more, and if none is recruited, that revenue leaves with the seller.
The third is whether patients are attached to the practice or to the person. This is the part sellers can actually influence, and it is where the evidence matters.
Buyers do not accept assurance on this point. They accept data, and the data has to exist before the process starts.
The single most valuable document a selling dentist can produce is a monthly report of production and collections split by provider for the last two to three years. It answers the central question directly and it establishes that the practice's reporting can be trusted. If the share produced by associates has been rising, the trend line does more work than any argument.
Hygiene production is the closest thing dentistry has to recurring revenue. It is delivered by employed clinicians, it drives recall attendance, and it generates the diagnoses that fill the dentists' diaries. Buyers look at hygiene as a percentage of total production and at the recall rate behind it, because a strong hygiene programme is both stable in itself and evidence that patients are engaged with the practice as an institution.
Define active patients on a consistent basis — typically those seen within the last eighteen months — and report the number the same way every month. Then show the recall system behind it: how patients are scheduled, what proportion of the diary is pre-booked, how failed appointments are followed up. A buyer who can see a functioning recall system is looking at a business; a buyer who is shown a raw patient count is looking at a list.
New patient flow attributable to the practice — location, online presence, reviews, referrals from other practices to the clinic rather than to the individual — transfers. New patient flow attributable to the principal's personal reputation may not. Documenting the sources honestly is more persuasive than inflating the number, and buyers verify it against the practice management software anyway.
Long-serving hygienists, nurses and reception staff are a retention asset, because for many patients the practice is the person who greets them and cleans their teeth. Buyers ask about staff tenure and about whether key employees intend to remain. Where associates are central to production, their contracts, notice periods and any restrictive covenants become material to the price. In our experience at Conclave Partners, an associate leaving quietly during diligence does more damage to a dental transaction than any finding in the accounts.
Three practical items decide whether a well-prepared practice completes smoothly.
The lease is first. Most practices are tenants, and a short remaining term or a landlord's right to refuse assignment can stop a transaction outright. Buyers typically want a decade of security or a defensible option to renew. Where the owner also owns the property personally, the same logic applies as in any other sector: selling the practice alone and granting a market-rent lease widens the buyer pool, and an artificially low intercompany rent inflates EBITDA that the buyer will normalise away.
Equipment and deferred capital expenditure come second. Chairs, imaging and sterilisation equipment have finite lives, and a buyer facing an immediate re-equipment programme deducts it from the price. Practices that have quietly under-invested for five years to protect profit are, in effect, borrowing from the sale price.
Regulatory standing is third. Registration, inspection history, radiation protection compliance, infection control documentation, waste handling and patient records under GDPR all get examined. None of this creates value; all of it can destroy time and leverage. Patient records deserve particular attention because their transfer is regulated and buyers will want the position documented rather than assumed.
Group buyers structure around exactly the risk this article describes. A substantial share of the consideration is paid at completion, with the remainder split between rollover equity in the acquiring group and an earn-out tied to the practice's performance over the following one to three years. Sellers are also usually asked to continue working for a defined period, both to hand over relationships and because their production supports the earn-out they are being paid from.
This is where an owner-dependent practice pays for it twice: once in a lower multiple and again in a longer tie-in and a larger contingent element. The negotiation that matters is therefore not only the headline multiple but how much is contingent, what it is measured against, and what happens if the buyer changes the practice in ways that affect the target. On dental mandates Conclave Partners spends more time on those definitions than on the multiple itself, because that is where the money actually moves. A seller who has spent a year moving production to associates arrives at that negotiation in a materially stronger position.
Reduce your own share of production deliberately. Recruit or expand associate hours, transfer routine work, and let the change appear in a full year of reporting. This is the single highest-return action available and it cannot be done quickly.
Build the hygiene programme and the recall system, and document both. Report active patients, recall attendance, pre-booked diary percentage and failed-appointment follow-up on a consistent monthly basis.
Get the production-by-provider reporting clean for at least twenty-four months. Reconcile it to the accounts. If practice software has been used loosely, fix that first, because a buyer who cannot reconcile production to revenue stops trusting everything else.
Secure the lease. Extend the term or obtain a documented renewal option before the process starts, not during it.
Normalise the accounts honestly, including the market cost of the owner's clinical work and a market rent if the property is related-party. Personal expenses run through the practice should be identified and evidenced with invoices; adjustments a buyer can verify are accepted, and adjustments supported only by the owner's word cause the buyer to discount the whole earnings figure. Sellers who ask Conclave Partners where to begin are pointed at the production split and the recall data first, because those two documents determine which buyers will engage at all.
A prepared single-site practice typically takes six to nine months from launch to completion. Buyer identification and initial offers occupy the first two to three months; clinical, financial and regulatory diligence, together with lease consents, take the rest. Landlord consent is the item most likely to extend the timetable and the one most often left too late.
Confidentiality deserves more attention here than in most sectors. A dental practice's staff and patient base are unusually sensitive to rumour, and a leak during diligence can damage the very retention metrics the buyer is underwriting.
Single practices generally transact as add-on acquisitions, which Lincoln International places at 3x to 6x EBITDA, with European multiples having fallen by one to three turns since the 2021 peak. The higher figures often quoted apply to multi-site platforms, not to individual practices. The multiple is applied after EBITDA is normalised for the market cost of replacing the owner's clinical production.
It works through two channels. The replacement cost of the owner's production is deducted from EBITDA before any multiple is applied, and the remaining transfer risk lowers the multiple itself and increases the contingent portion of the consideration. A practice where associates and hygienists already produce most of the revenue avoids both effects.
Retention is generally better than owners fear where the team, the location and the recall system remain in place, and worse where the practice was built entirely on the principal's personal reputation. What matters commercially is that you can evidence which of the two you have, using production splits, recall attendance and new-patient source data.
Both routes exist, but the pool of individual buyers has been shrinking: ADA Health Policy Institute data shows solo practice declining at every career stage and roughly 29% of dentists within five years of graduation working with DSOs. Groups typically pay more for a practice that runs without its owner and structure more of the price as contingent.
Usually for a defined transition period, and often longer where an earn-out is attached to practice performance. The length and the terms are negotiable, and they are easier to negotiate down when the practice does not depend on you clinically.
Roughly six to nine months from launch to completion for a prepared practice, with landlord consent and regulatory diligence the most common causes of delay. Preparation before launch — shifting production to associates and cleaning up reporting — needs a further twelve months to show in the numbers.
Ildar Zakirov — Conclave Partners ildar@conclavepartners.com
Sergi Kosiakof — Conclave Partners sergi@conclavepartners.com