For an independent dental owner, selling to a private equity–backed DSO can come with real tradeoffs that often show up after the close: control over key business decisions typically shifts to the corporate operator, and the seller frequently remains as an employed clinician under an earn-out structure where a meaningful portion of the purchase price depends on hitting performance targets over the next several years.

This dynamic can create pressure to prioritize short-term production and standardization over practice culture and long-term patient relationships, and it can put clinical autonomy at risk when financial or operational policies conflict with professional judgment—an issue the ADA has explicitly highlighted as an ethical concern when business interests intrude on clinical decision-making.

Evidence in dentistry also suggests PE ownership can be associated with revenue-optimization tactics such as raising list prices and shifting service mix toward higher-cost procedures, even when negotiated payer prices don't change—creating reputational risk for the practice and potential patient trust issues.

These concerns are part of why regulators have been scrutinizing private equity's incentives in healthcare more broadly, warning that profit-maximizing structures can threaten quality of care and patient outcomes.