Why the DSO Boom May Be Over — and What Comes Next

After years of acquisition-led growth fueled by cheap capital, the DSO model is showing structural cracks. Dental Care Alliance and Affordable Care have both reportedly transitioned into lender control following financial difficulties tied to higher interest rates and rising operating costs. States including Kentucky and Illinois are advancing legislation to restrict non-dentist ownership and DSO control over clinical decisions, while the American Economic Liberties Project released model legislation that would ban DSOs outright. Independent dentists cite clinical autonomy and excessive production expectations as primary reasons to avoid or exit affiliations. Experts say organizations that scaled rapidly without operational infrastructure are experiencing compounding difficulties, and that future success depends on financial discipline, clinical trust, and building genuine provider and patient loyalty — not continued acquisitions.