Hamza Asumah, MD, MBA, MPH
If you are a practice owner or DSO leader weighing a transaction in 2026, the most important thing to understand is this: the market did not simply get colder. It got smarter. The peak-era dynamic — where almost any practice with a pulse could attract an aggressive bid — has been replaced by something more discriminating. Buyers are still hungry. They are just no longer indiscriminate. And that distinction changes everything about how you should approach a sale.
The headline that surprises people
There is a widespread belief that dental valuations have collapsed. The data tells a more nuanced story. Headline EBITDA multiples have actually held steady for two consecutive years. Across much of the market, valuations have not uniformly reset downward.
What has changed is not the ceiling — it is the spread. The gap between the best and middle-tier offers on any given practice has widened significantly. In 2026, practice owners can expect to see multiples ranging from roughly 6 to 12 times EBITDA depending on the size and health of the business. That is an enormous range, and where you land within it is no longer a matter of luck or timing. It is a direct reflection of how a more sophisticated buyer prices the specific risk your practice carries.
The peak years told a different story. During the 2019–2021 boom, historically low interest rates created an environment of abundant, cheap capital that fueled aggressive dealmaking and drove multiples to record highs — highs that simply do not have the conditions to exist in today’s landscape. The advisors closest to the market now treat roughly 12 times EBITDA as a practical ceiling except in extraordinary cases. A buyer paying 13 times in 2026 has to justify it with genuine strategic fit and synergy. The era of blind aggressive expansion is over.
Buyers are hungry — and constrained
None of this means demand has dried up. The appetite is real and intensifying. Sixty-nine percent of DSOs expect to meaningfully increase acquisition activity in 2026, and 78% anticipate a recapitalization within the next 12 to 36 months — a powerful catalyst, because a recap creates pressure to add durable EBITDA before the clock runs out.
But there is a supply problem on the other side. Premium practices that fit buyers’ underwriting standards are in short supply, and DSOs are openly worried about it. One DSO representative admitted they are relying on brokers more than ever to fill a pipeline that quality inventory is not filling on its own. When rising acquisition mandates collide with constrained premium supply, competitive tension builds — but only for the practices that actually qualify as premium. For everyone else, the hunger does not translate into a bidding war.
That is the crux of the 2026 market. Demand is high, but it is concentrated on a narrow band of clean, well-run assets. If your practice sits in that band, this is a genuinely good market to sell into. If it does not, the buyers’ enthusiasm will largely pass you by.
What makes buyers walk away
The clearest guide to maximizing value is understanding why deals died in 2025. The top reasons buyers stepped away were remarkably consistent: over-reliance on a single producer, and declining trailing-twelve-month EBITDA.
Think about what those two have in common. Both are signals of fragility. A practice whose revenue depends heavily on one dentist is one departure away from a cliff, and buyers underwrite that risk ruthlessly. A practice with declining recent EBITDA is telling a story of momentum running the wrong way, and no amount of historical performance fully offsets a negative trend line. Buyers are pricing risk far more divergently than they used to, which is exactly why the offer spread has widened.
There is a newer factor in the underwriting too: reimbursement exposure is now evaluated as a state-level variable. Buyers are looking conservatively at payer mix and asking how state policy direction — particularly around Medicaid dental economics — could affect the durability of collections. A practice heavily concentrated in a state facing Medicaid cuts will be priced for that exposure, regardless of its current numbers.
What buyers actually reward
The flip side is just as clear. The practices commanding the top of the range share a recognizable profile: provider stability and clinical continuity, durable financial performance with a positive trend direction, and manageable reimbursement exposure. Clean earnings, stable provider coverage, and scalable operations are what turn a buyer’s general interest into a competitive offer.
Notice that none of these are last-minute fixes. You cannot manufacture provider stability or a positive EBITDA trend in the quarter before you go to market. They are the product of how the business has been operated for years — which means the work of maximizing your eventual sale is the same work as running a genuinely good practice today.
What operators should take from this
The strategic implication runs in two directions depending on which side of the table you are on.
If you are a potential seller, abandon the 2021 framing immediately. Many sellers are still clinging to peak-era valuations and a higher cost of capital simply will not support them. The realistic path to a strong outcome is not waiting for the old multiples to return — they are not coming back on the timeline you want. It is doing the operational work that lands you in the premium band: reducing single-producer dependence, protecting your EBITDA trend, and cleaning up your earnings and operations so a sophisticated buyer’s due diligence finds strength rather than surprises. Fundamentally solid practices will still fetch very good prices. The reward now goes to substance.
If you are a buyer, the discipline that the market is enforcing on everyone is your opportunity. The constrained supply of premium assets means competition for the good ones is fierce, but it also means the diligence rigor that defines this market protects you from the overpayment that strained so many balance sheets in the last cycle. The recovery is expected to be gradual, building through 2027 and 2028 as interest rates ease and more players return to the pool. That gives disciplined acquirers time to be selective rather than frantic.
The bottom line
The deal market has not closed. It has simply started paying for what it actually values — clean earnings, stable providers, durable economics — and stopped paying for momentum and hope. For owners who built real businesses, that is the fairest market in years. For those who counted on the rising tide to carry them, it is a reckoning. Either way, the message is the same: in 2026, the quality of your operation is the quality of your exit.
Dr. Hamza Asumah 
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