Do you remember when the local dentist felt like part of the community? The dentist was known around town and throughout the surrounding areas. The same families came back checkup after checkup, year after year, and the dentist knew them all by name. Dentistry used to feel rooted and personal; today, it feels more interchangeable and transactional.
That older model was never spotless. There were bad dentists then, just as there are now. There were dated offices, problematic communication, and plenty of blind spots. Still, it was grounded in a different set of priorities. It assumed that the profession existed first to serve patients and the surrounding community and that profit followed from doing well over time.
Matt Hutchings.
Over the past 20 years, pressure on dental practices came from many different places. Insurance reimbursements stopped keeping up. In a 2022 ADA Health Policy Institute poll, nearly 60% of dentists said reimbursement rates had remained stagnant, while another 25% said they had decreased.
Costs climbed. Hiring got harder. DSOs started gobbling up market share and private equity began treating dentistry as an investment opportunity. By the time the COVID-19 pandemic hit, most practices were already stretched thin, and many still are.
When the business side of dentistry gets tighter, it influences how success is defined. Efficiency becomes the goal, scale looks more attractive, and solutions that promise control or predictability get more attention.
Growth strategies started to mirror what was occurring in other industries. Terms like scale, exit value, and positioning entered conversations that used to center on patients and care. Even though day-to-day work with patients had not changed that much, the way many practices made decisions and measured success had.
There is nothing wrong with improving the business side of dentistry. Better systems help overall efficiency, and improved growth creates more options. The problem is where the profession begins placing its attention. Systems can reduce friction, support consistency, and free teams from unnecessary administrative strain. They cannot replace the human work that makes patients feel understood, safe, and confident in the recommendation.
Some parts of dentistry scale well. Scheduling systems, operational workflows, and administrative processes can all become more efficient. But trust does not scale the same way.
Diagnosis, judgment, communication and long-term patient relationships still depend on human attention. From the outside, a practice can look successful but still struggle where it matters most: clear diagnosis, patient understanding and trust in the recommendation.
What the numbers show
Recent data show how much the structure of dentistry has changed. In 2022, 13% of U.S. dentists were affiliated with a dental service organization (DSO), up from 8.8% in 2017.
Among dentists five years or less out of school, the share was 27%. Newer ADA workforce data show the trend continuing, with more than 1 in 4 dentists up to 10 years out of dental school affiliated with a DSO in 2024.
Practice ownership is arriving later and later, and private equity has also deepened its presence. Among general practice dentists, private equity affiliation rose from 6.8% in 2015 to 12.7% in 2021, with even faster growth among several specialties.
By the numbers
- Sixty percent of dentists told the ADA in 2022 that reimbursement rates had remained stagnant. Another 25% said rates had decreased.
- Thirteen percent of U.S. dentists were DSO-affiliated in 2022, up from 8.8% in 2017.
- Twenty-seven percent of dentists five years or less out of school were DSO-affiliated in 2022.
- General practice dentists affiliated with private equity rose from 6.8% in 2015 to 12.7% in 2021.
- Thirteen percent of the population reported cost barriers to dental care versus roughly 4% to 5% for other major health services.
- About 57 million Americans live in a dental health professional shortage area.
This is usually where conversation about the dental profession becomes shallow. People start arguing over whether DSOs are good or bad, whether private equity helps efficiency or hurts quality, and whether independent practice can still compete. The more important question is what all of this has done to dentistry’s posture toward the patient. The patient did not become less human just because the business became more sophisticated.
Patients walk into dental offices carrying the same fear, shame, confusion, and financial hesitation. They still want someone to explain what is happening in a way that makes sense. They still want to feel that the person recommending care is using judgment rather than pressure.
CareQuest Institute research on trust in the patient-dentist relationship found that communication, listening, and acting in the patient’s best interest remain central to whether trust is built at all. That should be obvious. Yet much of dentistry has spent years behaving as though trust is something that can be layered onto a model after the financial machinery is already in place. It does not work that way. In dentistry, when patients do not trust the recommendation, they delay treatment or do not come back at all.
Part of the problem is that dentistry has spent years trying to professionalize and scale itself in ways that sometimes flatten the very qualities patients respond to most. The doctor’s personality, the team’s warmth, the familiarity of the front desk, the feeling of being recognized and remembered -- all of that is part of how trust is formed.
Many practices have become so focused on efficiency, polish, branding, and consistency that they unintentionally downplay the human qualities that make patients feel connected.
Patients rarely describe their favorite dental experience in terms of systems. They remember feeling understood, respected, safe, and genuinely known. Don’t believe it? Read the Google reviews of just about any dental practice.
Where’s the trust?
That is one reason the high-end turn in dentistry deserves more criticism than it gets. There is nothing wrong with an attractive office. There is nothing wrong with wanting to present quality well.
The trouble is that many practices have allowed premium to become a substitute identity. The office gets more curated. The photography gets better. The language gets smoother. The brand becomes more aspirational. Yet the patient sitting in the chair often feels less certain about their care. A place can look impressive and still feel emotionally thin. It can signal status while failing to signal safety.
That matters because dental care is already one of the most financially deferred forms of health care in the country. ADA national trends data show that cost barriers are more severe for dental care than for other major health services. The latest ADA data show that 13% of the population reported cost barriers to dental care compared with roughly 4% to 5% for other kinds of healthcare. When people are already hesitant, the last thing a profession should do is make itself feel more distant.
The community side of the story matters just as much. The U.S. Centers for Disease Control and Prevention reports that about 57 million Americans live in a dental health professional shortage area, and about 67% of those shortage areas are in rural communities.
In that environment, the local dentist is a public health asset. A practice rooted in its town or neighborhood lowers the threshold for people to seek care. It becomes familiar to families who might otherwise delay. It offers continuity. It builds informal confidence in a field where formal coverage is often thin and consumer trust is fragile.
What trust actually does
The profession weakens itself when it starts to act as though community rootedness is sentimental and scale is serious. In reality, community rootedness is one of the few durable advantages dentistry still has.
A patient who trusts the doctor returns. A family that trusts the practice brings others. A patient who believes the recommendation is grounded in care is more likely to accept needed treatment over time. A practice with strong local credibility spends less energy manufacturing authority because the market already grants it.
The pandemic forced everyone to look at the profession’s vulnerability. Once the interruptions came, it became easier to see which practices had actual patient loyalty and which were more dependent on momentum. It became easier to see how exposed many offices were to labor shortages, reimbursement pressure, and brittle staffing models.
Five years after the start of the pandemic, staffing remains an active problem. In the ADA’s late-2025 economic outlook, 70.7% of dentists who were recruiting hygienists described that effort as extremely or very challenging. Reimbursement pressure also remains persistent.
In early 2026, ADA News was still summarizing the state of the market in the same terms: reimbursement rates are not keeping pace with inflation and practice expenses, and the fiscal squeeze is real.
The experience has to hold up
A practice can have the right website, photography, videos, and language about being warm, comprehensive, and patient-centered. But if the administrative team feels rushed or disconnected, or if the office energy does not match the promise, the patient notices.
That is where the old idea of the local dentist still matters, because the experience has to feel real. Patients are not only asking, "Is this practice impressive?" They are asking, "Do I believe them?"
That was the heart of a recent conversation on the Everyday Practices Dental Podcast, Episode 323, “Stop Blaming Your Marketing, Start Fixing Your Experience.” Phoenix Dental Agency Senior Marketing Adviser Sara Hansen and I discussed what happens when the story a practice tells online meets the reality patients feel in the reception area, the hand off, the huddle, and the treatment conversation. The episode makes the same point from inside the practice: Marketing reveals the experience.
The strongest practices are fully aligned. The doctor knows what kind of practice they are building. The team understands how that vision should feel to the patient. The systems support the promise instead of working against it.
That might be one of the clearest ways dentistry gets back to center: by building an experience strong enough to make the message true.
What patients still want
So what happened to the local dentist? In many markets, the profession stopped aspiring to be one. It started aspiring to look more scalable, more premium, more optimized, more financially viable.
That shift happened because the incentives changed, the pressure intensified, and the people steering the conversation increasingly came from worlds that measure value differently.
Patients, however, still know what they are looking for, even if they cannot always say it clearly. They want someone whose judgment they can believe. They want to know exactly what is going on in their mouths. They want a sense that the person on the other side of the recommendation still feels accountable to something larger than the monthly production report.
The practices that will hold up over the next decade will be those that rebuild around trust, sound diagnosis, clear communication, and a real sense of responsibility to the people they serve. These values are the foundation of a practice that can endure pressure without losing its character.
For some dentists, that work can be done internally. For others, the model is too tangled to unwind without outside help. That is where a program like PDA’s Unrestricted becomes useful. It is framed around the practical problems this article has been describing: reducing PPO dependency, strengthening revenue quality, aligning diagnosis and communication, and helping owners build a financially durable practice without becoming more detached from patients. The point is not to chase another image of success. It is to build a practice that can hold together clinically, financially, and relationally.
That might be where the profession has to go now, not backward but back to center -- back to a model where the practice belongs somewhere, means something to the people around it, and earns its strength by being believed.
Matt Hutchings is the multimedia content manager at Productive Dentist Academy, where he leads employer branding strategy and produces the organization’s podcasts. With a background in marketing and sales, Hutchings focuses on helping dental practices attract and retain top talent while building stronger, more sustainable teams.
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
