Dental Service Organizations

From Wikipedia, the free encyclopedia

Dental Service Organizations, known in the industry as "Dental Support Organizations"[1] or abbreviated to DSOs, are independent business support centers that contract with dental practices in the United States. They provide business management and support to dental practices, including non-clinical operations.[2][3]

Following the passage of the Affordable Care Act and the recent expansion of Medicaid, the DSO model has become increasingly popular for dental practices. In certain parts of the United States, dental practices have begun to transition from a traditional practice to a DSO model in order to provide more affordable care to a larger patient population. Dentistry innovations have meant that DSOs have become a common dental care solution to many low-income families in the United States. The grouping of dental practices has allowed DSOs to minimize their costs, allowing practices to pass the saving on to patients currently without adequate dental care.


A Gallup survey in 2001 polled the effectiveness of medical care for low-income patients in the United States. The survey found that 19 percent of respondents had not received the medical treatment they required due to the affordability of the treatment.[4] Over a period of eight years, the percentage continued to rise, reaching 29 percent in 2009. Passage of the Affordable Care Act (ACA) was intended, in part, to combat the growing number of people not receiving medical or dental care, due to the unaffordable cost.[5] Yet the unaffordable care statistic continued to rise. In 2014, the statistic reached 33 percent, before falling a year later to 31 percent.[5]

New Mexico Health Resources produced a report in 2008, showing the impact and drawbacks of general dental care in the United States. It stated that many of the figures used to measure dental care could be inaccurate without diagnostic codes. The report summarized at the time there were widespread unexplained variations in clinical decisions among dentists.[6] Other reports published around the same time, stated there was "conflicting definitions of quality and quality-related activities."[7] Industry and legal experts have stated that dental professionals are bound by legal and professional standards, no matter which dental model they choose to participate in.[8]

A 2015 National Minority Quality Forum report stated that Dental Support Organizations (DSOs) are one innovation that is helping to address the accessibility problem in dental care. The same report found that 47 percent of Americans had limited or poor access to quality healthcare.[9]

Growing demand among low-income populations increases the needs for DSOs to curb the poor dental care issue in the United States. DSOs have been credited for much of the improved access to dentistry for Medicaid-eligible children in the last decade.[10] The National Institute of Dental and Craniofacial Research carried out further research into dental care for minorities and found that black and Hispanic families in lower-income areas had much higher incidences of tooth decay.[11] Similar research shows that poor dental hygiene directly affects educational abilities and school attendance.[12]

There has been a steady increase in the number of dentists in the United States that have opted to contract with a DSO in recent years. The number of practices using the DSO model is growing at nearly three times the rate of the industry itself.[13] Towards the end of 2015 and into 2016, more studies were carried out on the efficiencies of DSOs. The dental company Kool Smiles operates as a DSO and was found to have per-patient Medicaid expenditures that were 33 percent lower than non-DSO patients.[14]

Several state dental associations have attempted to introduce legislation to restrict DSOs from competing within their state.[15][16] Associations claim that the DSO may exert pressure on dentists to do more work than what is needed,[17] despite studies that show DSO-affiliated dentists actually do less work than the average dentist.[18][19][20] The FTC has commented that this type of legislation would harm consumers.[21] Groups such as Americans for Tax Reform and the National Taxpayers Union have opposed this legislation.[22]

DSOs distinguish themselves from Dental Group Practices when the support services provided by the DSO to dental offices such as billing, IT, marketing, human resources, payroll and accounting are part of a separate, legally independent company, as required by many states.[23]

An Invisible DSO is a Dental Support Organization that remains anonymous after it affiliates with the Dentists. It is defined as a DSO which owns all or part of multiple practices, usually built through acquisitions, which retain the doctor's original branding. The practices owned by these DSOs have a local brand, but benefit from large scale and professional management.[24][25][26]


  1. ^ "Home - Association of Dental Support Organizations ||". Association of Dental Support Organizations || Retrieved 2016-05-18.
  2. ^ "About DSOs". Association of Dental Support Organizations. Archived from the original on 2016-03-15. Retrieved 2016-03-09.
  3. ^ Winegarden, Wayne. "Benefits Created by Dental Service Organizations" (PDF). Pacific Research Institute. Archived from the original (PDF) on 2016-03-07. Retrieved 2016-03-09.
  4. ^ Dugan, Andrew (November 30, 2015). "Cost Still Delays Healthcare for About One in Three in U.S." Gallup.
  5. ^ a b Winegarden, Wayne (December 8, 2015). "The Health Care Sector Needs Innovation, Not Regulation". Forbes.
  6. ^ "Quality Measurement in the New Era of Dentistry and Healthcare" (PDF). University of New Mexico - Department of Medicine.
  7. ^ "Oral Health Quality improvement in the era of accountability" (PDF). Kellogg Foundation. December 2011.
  8. ^ Picard, Joe. "Competition's latest battlefield – the practice of dentistry". TheHill. Retrieved 2016-03-21.
  9. ^ "Reassessing the Dental Care Paradigm: A National Minority Quality Forum White Paper". National Minority Quality Forum.
  10. ^ "Dental Visits for Medicaid Children: Analysis & Policy Recommendations". Retrieved 2016-03-21.
  11. ^ "An Examination of Minority Populations and the Dental Service Organization Model in the United States" (PDF). National Hispanic Medical Association. July 2015. Archived from the original (PDF) on 2016-02-07. Retrieved 2016-03-09.
  12. ^ "Dental Health Issues Take a Bite Out Of School Attendance". AttendanceWorks. July 1, 2011.
  13. ^ "Infographic: Why Dental Service Organizations Are Here To Stay". Dental Alliance.
  14. ^ "New study: Medicaid dental programs in 7 states could save $550 million annually through adoption of a DSO model". Dentistry IQ. February 5, 2016.
  15. ^ "Smears Against 'Corporate Dentistry' Are Not Based In Fact". Forbes. Retrieved 2016-03-21.
  16. ^ "Protectionist Dentistry Legislation Makes its Way Through Capitol". MacIver Institute. 2016-02-10. Retrieved 2016-03-17.
  17. ^ "Executive Outlook: Corporate influence in delivery of dental care - State of Reform". State of Reform. Retrieved 2016-03-17.
  18. ^ "Laffer: Bridging the dental divide for Texas children on Medicaid". Retrieved 2016-03-21.
  19. ^ "Dobson | DaVanzo & Associates, LLC - Health Care Consulting". Retrieved 2016-03-17.
  20. ^ "Laffer: Bridging the dental divide". Retrieved 2016-03-17.
  21. ^ "FTC Staff Comment: Proposed Dental Services Rules in Texas Would Likely Reduce the Benefits of Competition for Consumers | Federal Trade Commission". Retrieved 2016-03-17.
  22. ^ "Wisconsin Is Next State To Consider Protectionist Bill That Cuts Access To Care, Hikes Costs". Forbes. Retrieved 2016-03-17.
  23. ^ "When Does a Dental Group Practice Become a DSO? | Group Dentistry Now". Retrieved 2016-08-05.
  24. ^ Fichtner, Chip. "The practices that invisible DSOs value most". Endeavor. Retrieved 12 Feb 2020.
  25. ^ Lerner, Perri. "Silent Partner Allows Specialist to Focus on Patient Care". aegis. Retrieved 1 June 2019.
  26. ^ Fichtner, Chip. "Invisible' DSOs: Friend or foe?". Endeavor. Retrieved 1 May 2019.