On September 16, the Federal Reserve raised its target range to 3.75% to 4.00%, tightening the math for dentists seeking to buy a practice.
In an October 8 speech, Federal Reserve Governor Christopher J. Waller said the 25-basis-point increase came after nine months in which the policy rate had been held unchanged. The higher rate adds to buyers' borrowing costs, including for floating-rate loans and working-capital financing, as Waller's account of the decision describes. New SBA underwriting rules took effect on October 1. Lenders can submit and service loans through the Capital Access Financial System, or CAFS, or the Intelligent Capital Access Platform, or iCAP, according to the agency's loan administration information. Meanwhile, operating costs are rising faster than payer reimbursement: reimbursement increased 1.1% in the first half of 2026, against 1.8% inflation.
For associates and recent graduates, the traditional purchase route is getting harder to finance.
TUSK Practice Sales' Q4 2026 Dental Market Report examines how financing pressures are changing sale and ownership options for US dentists. It also tracks the expansion of dental service organisations, or DSOs, and private equity groups.
The report says DSOs and private equity groups entered new states during 2026. One Canada-based group entered the US for the first time. It cites projected annual growth of 17.4% for the global DSO market, compared with 4% for the US dental services industry. The report also points to North Carolina's Session Law 2026-41 as a state-level change that lowers administrative hurdles for management arrangements.
TUSK expects M&A activity to revive when new capital enters the market. The report cites PitchBook's Q2 2026 healthcare services report, which found that 20 or more PE-backed dental companies had been held for at least seven years. Those companies could represent a supply of businesses preparing to go to market. The finding does not confirm that sales have begun.
Ownership patterns are shifting alongside deal activity. Dentist practice ownership fell from 85% in 2005 to 73%, while DSO affiliation has more than doubled since 2015. The class of 2025 entered practice with average education debt of $297,800. TUSK President and Founder Kevin Cumbus said 33.8% of dentists are aged 55 and up and may need to consider full or partial sales to a DSO.
Specialties are growing at different rates. Pediatric dentistry has grown 126% since 2001, compared with 25.5% for dentists overall. The report says orthodontic service organizations are showing more interest in multi-specialty practices with orthodontic and pediatric lines. It also includes an explainer on what an IPO means for doctors partnering with a public dental company.
Ownership decisions now intersect with technology adoption. The Young Dentist examined related concerns in its review of AI risks. TUSK Managing Director and Partner Ryan Mingus advises dentists who are five to ten years from an exit to assess their business value and discuss options with advisers.
The Q4 2026 Dental Market Report is available from TUSK Practice Sales for dental practice owners considering a transition.
