# How should DSOs plan acquisitions and de novo openings? Among [firms that serve dental practices](https://ddsintel.com/for), DSOs plan growth by weighing acquisition supply against de novo sites, and the supply is shifting: 16.1% of U.S. dentists were DSO-affiliated in 2024, according to the ADA Health Policy Institute, while 7,443 dental shortage-area designations were open as of December 31, 2025, according to HRSA via KFF. Neither figure picks a site; both frame where to look. By DDSIntel Editorial. Source: DDSIntel, https://ddsintel.com/for/dso. Published 2026-10-26; data as of 2026-10-25. ## Key numbers - **16.1%** of U.S. dentists were DSO-affiliated (ADA Health Policy Institute, The U.S. Dentist Workforce, 2025 update, 2024; https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/US_dentist_workforce_2025.pdf) - **12.8%** of dentists were affiliated with private equity in 2021 (Health Affairs study, as reported by DentistryIQ, 2021; https://www.dentistryiq.com/business-management-leadership/article/55396386/is-dentistry-really-35-consolidated-lets-check-the-math) - **7,443** dental HPSA designations nationally (HRSA, via KFF State Health Facts, As of December 31, 2025; https://www.kff.org/other-health/state-indicator/dental-care-health-professional-shortage-areas-hpsas/) - **10,744** practitioners needed to remove those designations (HRSA, via KFF State Health Facts, As of December 31, 2025; https://www.kff.org/other-health/state-indicator/dental-care-health-professional-shortage-areas-hpsas/) - **135** DSOs and private equity groups in the buyer pool, more than (TUSK Practice Sales, 2026; https://www.prnewswire.com/news-releases/tusk-practice-sales-assesses-the-state-of-the-dental-industry-in-its-q3-2026-dental-market-report-302823046.html) ## How much of dentistry is DSO-affiliated? The ADA Health Policy Institute put DSO affiliation at 16.1% of U.S. dentists in 2024. Broader consolidation estimates run higher because they measure different things. DSOs planning growth should know which measure a figure uses before comparing markets. See [how consolidated dentistry is](https://ddsintel.com/dso). ## When does a DSO choose acquisition over a de novo? Acquisition buys an existing patient base and team, and a de novo builds a site from nothing in a chosen location. The choice depends on where sellers exist, where shortage areas are, and how quickly a site must produce. Retirement supply argues for acquisition; underserved areas argue for building. See [DSO de novo site selection](https://ddsintel.com/for/dso-de-novo-site-selection). Seller supply is sized in [dentist retirement statistics](https://ddsintel.com/data/dentist-retirement-statistics), and [facilities signals](https://ddsintel.com/signals/facilities-signals) show new-location activity in public records. ## How should a DSO enter a new state? Start with the state’s own licensing and entity rules, since practice ownership, supervision and corporate rules differ across states, and have counsel confirm them. Then compare dentist counts and shortage designations on equal terms. The [dentists by state](https://ddsintel.com/data/dentists-by-state) page lists every state’s cited figures side by side. The [DSO landscape](https://ddsintel.com/dso) explains how consolidation is measured. ## What do vendors expect when a practice joins a DSO? Labs, equipment suppliers and IT firms often find purchasing moves to a central team after an acquisition. A DSO that plans vendor transitions early avoids service gaps for patients. See [what a sale means for lab accounts](https://ddsintel.com/for/dental-lab-accounts-after-a-sale) and [IT during a sale](https://ddsintel.com/for/it-during-a-dental-practice-sale). ## Frequently asked questions ### What share of dentists work for DSOs? The ADA Health Policy Institute reported 16.1% of U.S. dentists were DSO-affiliated in 2024. Other estimates use different definitions. ### How many dental shortage areas are there? HRSA data via KFF listed 7,443 dental care HPSA designations nationally as of December 31, 2025. See [dental shortage areas](https://ddsintel.com/data/dental-shortage-areas). ### Does a shortage area guarantee a viable de novo? No. A designation signals unmet need, not payer mix, rent, hiring or competition. Those inputs must be checked site by site. ### Does DDSIntel cover every state? Public figures on the [data hub](https://ddsintel.com/data) cover every state on equal terms. DDSIntel’s own measures are published in aggregate by state and region once each release is signed off. ## Sources 1. ADA Health Policy Institute. The U.S. Dentist Workforce, 2025 update. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/US_dentist_workforce_2025.pdf 2. HRSA, via KFF State Health Facts. Dental Care Health Professional Shortage Areas (HPSAs), as of December 31, 2025. https://www.kff.org/other-health/state-indicator/dental-care-health-professional-shortage-areas-hpsas/ 3. ADA Health Policy Institute, via KFF State Health Facts. Professionally Active Dentists, 2024. https://www.kff.org/state-health-policy-data/state-indicator/total-dentists/ 4. TUSK Practice Sales. TUSK Practice Sales Assesses the State of the Dental Industry in Its Q3 2026 Dental Market Report (July 10, 2026). https://pr.timesenterprise.com/article/TUSK-Practice-Sales-Assesses-the-State-of-the-Dental-Industry-in-Its-Q3-2026-Dental-Market-Report/6a514c9516e7610b3c53e15d --- DDSIntel is a dental transition intelligence platform that detects pre-market dental practice transition signals for brokers, DSOs, lenders and the firms that serve them.