Maybe you’ve been an associate dentist for a couple of years or maybe you’re tired of building someone else’s business. Either way, buying a dental practice it’s one of the biggest decisions you’ll make in your career as a dentist. 

We sat down with Bill Henderson, former President of Tier Three Brokerage, Canada’s leading national dental practice brokerage, which he built from a small Ontario operation into a coast-to-coast firm before selling it to Henry Schein in 2021. 

And Jennifer Blair, transition consultant and sales representative at Henry Schein Tier Three Brokerage. She spent eight years managing Tier Three’s appraisal team, giving her an unusually deep understanding of what drives practice value and what buyers should watch for in the numbers. 

Between them, they’ve watched dentists overpay for the wrong practice, get blindsided by lease clauses that killed their business, and buy patient bases that were half fiction. The mistakes are predictable. Most of them are avoidable. Here’s what they told us.

This is the first question dentists have. Ask other dentists and half will tell you buying an existing practice was the best decision they ever made. The other half will swear their startup was worth it. The problem is both of them are right for their specific situation, with their specific location, budget, and timing. What worked for someone else may have nothing to do with what will work for you.

Bill Henderson and Jennifer Blair have seen both paths succeed and fail hundreds of times. They know exactly what separates the ones that worked from the ones that didn’t. And it all boils down to this:

It’s not just an opinion. The Globe and Mail reported that dentist supply has been significantly outpacing population growth for years, with competition for patients in major cities described as fierce.

You’d be surprised how many dentists spend months agonizing over the layout of their waiting room, the brand of their equipment, or whether the office has the right aesthetic  and never stop to ask the most basic question: where are the patients coming from?

Because a marble countertop isn’t going to fill your chairs. 4K TVs in the waiting room aren’t going to either. At the end of the day none of that matters if you don’t have patients in your schedule.

So here’s what Bill and Jennifer had to say about what it actually takes to get patients through the door and why the path you choose, startup or existing practice, makes that job dramatically easier or harder.

Jennifer Blair breaks down why the existing practice has such a head start:

A startup has none of that on day one. And the timeline to get there is longer than most dentists plan for.

Bill Henderson puts the referral math in perspective:

And Bill is clear that startups are not impossible. Plenty of dentists have built successful practices from scratch. But it requires a completely different skill set, a much longer runway, and realistic expectations about how long it takes to get there.

Most dentists don’t budget for that reality. They expect results in six months. The truth is closer to two or three years before the numbers actually make sense.

This one is more nuanced than it looks. The instinct for a lot of dentists is to go where there’s the most people. More people = more patients. But that’s also where the competition is fiercest.

Our own data tells the story clearly. In markets with around 2,200 people per dentist, the cost to acquire a new patient runs about $75. In oversaturated markets with 500 people per dentist, that number jumps to around $400, more than five times higher. 

According to the ADA’s 2025 Dentist Workforce Report, the dentist-to-population ratio varies dramatically across the US — from 40.2 dentists per 100,000 people in Arkansas all the way up to 103.2 in Washington D.C. American Dental Association.

 That gap tells you everything about why location matters so much. The same practice in two different markets can have completely different odds of success.

One thing a lot of dentists miss when they’re evaluating a location is that if they can spot an opportunity, so can everyone else. A small town with a favorable dentist-to-population ratio and a bunch of older dentists who aren’t doing much marketing, that looks like a wide open door. The problem is it looks like a wide open door to every other dentist running the same analysis.

Jennifer Blair recalls a dentist who bought in a small town thinking he’d dominate because the competition was old and tech-averse.

Here are a few easy ways to get a feel for how active the competition actually is in a small town before you commit to anything.

Google Maps — search “dentist in [town]” and look at every listing. Check how many reviews each practice has and how recent they are. A practice that picked up 50 reviews in the last couple of months has an owner who is paying attention. One with 40 reviews and the last one from 2022 probably isn’t.

Their website — An older dentist coasting toward retirement has a website that looks like it hasn’t been touched in a decade. An active owner has a modern dental website, online booking, blog posts, before and after photos, etc.

Facebook and Instagram — search the town name plus dentist. Are any of them running ads? Posting regularly? An active social media presence is a clear sign someone is investing in growing their practice.

Check if they’re running ads – Go to Google and search “dentist” plus the town name. Look at the results and see if any practices are running ads at the top of the page. If you spot multiple ads from different practices, that tells you dentists in that area are actively competing for new patients.

There’s also a lifestyle argument worth taking seriously. Bill Henderson makes the point that a dentist who lives in the community they practice in builds trust and retention in ways you simply can’t fake.

It sounds simple but a lot of dentists get this backwards. They chase the market with the best numbers, buy in a city they don’t want to live in, and commute. Or they buy in a small town purely for the economics and never actually become part of the community.

If you’re in a small town, people notice that you just come in for a job and then you go back to Chicago where you live. You’re not part of the events, you’re not part of the community involvement. People notice that.

A dentist who shows up to the local hockey game, whose kids go to the same school as their patients’ kids, who is genuinely part of where they practice, builds a kind of loyalty that no dental marketing budget can replicate.

The math on dentistry is good almost everywhere. The question is whether you want to spend the next twenty years building something in a place you actually want to be.

Most dentists focus on the wrong things. They walk into a practice and start looking at the equipment, the décor, the number of operatories. Bill Henderson has a different priority list entirely.

A single patient count number tells you almost nothing. What matters is the trend. Is the patient base growing, flat, or declining year over year? How many new patients are coming in each month? What’s the attrition rate?

Normal attrition runs around 8% annually. Patients move, switch jobs, pass away. That’s unavoidable. But attrition above 12-15% is a red flag. It usually means something is wrong with the patient experience, not just the demographics.

The old rule of thumb: 0.6 to 0.8 times gross revenue is not how practices are actually valued.

In Canada, practices typically sell for 5 to 6.5 times projected earnings with some going higher depending on the quality of the patient base and earnings. 

In the US, most doctor-to-doctor transactions are valued at roughly 60% to 80% of annual gross collections, or around 1.75 to 2.25 times seller’s discretionary earnings for practices under $2.5 million. High-performing practices can reach 5 times EBITDA or more versus a market average closer to 3.5 times.

This one surprises a lot of dentists but the math is pretty straightforward. When you earn $1 from a hygiene appointment, your costs are low. You’re paying the hygienist, a bit of supplies, and that’s about it. When you earn $1 from dental work you’re paying the dentist, a chairside assistant, and more in supplies. The profit margin on that dollar is significantly lower.

Bill Henderson breaks it down:

So a practice doing $800K with a strong hygiene program is actually worth more than a practice doing $800K driven mostly by dental procedures. The margins are better and the earnings are more stable.

There’s also a second thing to look for. Hygiene patients come back every six months. Every visit is a chance to spot a crack, early decay, or wear that turns into a filling, a crown, or an implant conversation. A strong hygiene base is basically a built-in pipeline for all the high value treatment in the practice. Industry data shows that 75% of restorative needs are discovered during hygiene visits.

When you’re doing due diligence, ask for the hygiene billing as a percentage of total revenue. A healthy practice typically runs hygiene at around 30 to 35% of total production. If it’s significantly lower than that, the practice is either under-investing in hygiene or patients aren’t coming back for their recall appointments,  both of which are problems you’ll inherit the day you take over.

Most dentists buying a practice spend a lot of time looking at the financials and almost no time looking at the lease.

The specific thing to watch for is demolition and termination clauses. These are clauses buried in the lease that give the landlord the right to terminate your lease early, sometimes with very little notice, if they decide to redevelop or demolish the building.

A decade ago these clauses showed up in maybe one in ten dental leases. Jennifer Blair says that number has changed dramatically.

Think about what that actually means. You buy a practice, take out a loan, build up your patient base, invest in the space, and then your landlord tells you the building is coming down. You now have to find a new location, negotiate a new lease, fit out a new space, and hope your patients follow you. All while still paying off the loan on a practice that no longer exists in the place your patients know.

Look for any clause that gives the landlord an early exit. Check how many years are left and whether there are renewal options. A practice with two years left on a lease and no renewal option is a very different purchase from one with ten years left and two five year renewal options.

And get a dental specific lawyer to review it. Someone who reads dental leases every day and knows exactly what to look for. It’s one of the cheapest forms of protection you can buy before signing anything.

Here’s one that a lot of buyers overlook but it can be one of the best signs of hidden value in a dental practice.

Every dental practice refers some work out to specialists. Endo, ortho, oral surgery, implants. When the current dentist isn’t comfortable doing a procedure or doesn’t offer it, they send the patient to someone else. That revenue leaves the practice every single time.

Now think about what that means for you as a buyer. If you’re comfortable doing any of those procedures and the practice has been referring them out for years, you can start capturing that revenue from day one. 

Jennifer Blair looks at this specifically when evaluating practices.

So when you’re doing due diligence, ask for a production report broken down by procedure code. Look at what’s being done, how often, and what’s noticeably missing. If you see a practice with a big patient base and almost no endo or implant billing, ask why. Chances are it’s all being referred out. And if you can do that work, you just found yourself a significant revenue opportunity.

Revenue spikes in the last two years before sale. If a practice was doing $800K for years and suddenly jumped to $1.3 million, ask why. Sometimes it’s legitimate growth. Sometimes the seller has been pushing treatment hard to inflate the numbers before listing. A patient base that’s been overtreated tends to have high attrition 12 to 24 months later, which shows up in the data if you look at the trend, not just the most recent year.

Inflated patient counts. Ask for the 12-month active patient count, meaning patients who actually showed up and had treatment billed. Not the total number in the software. Practices that don’t actively deactivate departed patients can have software counts that are 20 to 30% higher than the real number.

Flat revenue with strong new patient flow. If new patients are coming in but revenue isn’t growing, attrition is eating the gains. You’re buying a leaky bucket.

A practice where the revenue depends entirely on one dentist’s skills. If the current owner is doing complex ortho or implant work that you can’t replicate, that revenue walks out the door with them.

Overbuilt space. “We see a number of dentists that get in trouble because they do a startup without any clear plan as to how they’re going to get enough patients to make it work,” Blair says. “You’d be surprised how many phone calls I get for appraisals and sales where they’ve set up a 2,500 to 3,000 square foot facility with eight operatories and they only have maybe a thousand patients. You could treat a thousand patients in 1,200 square feet.”

Staff tenure and termination liabilities. Before you sign anything, find out how long each staff member has been there. Long-tenured employees are great for patient retention and continuity but they come with a cost if you decide to make changes. 

In most provinces and states, terminating a long-term employee means significant severance pay. Jennifer Blair flags this as something buyers regularly overlook. You might be inheriting a team that looks stable on paper but carries real financial liability if anything changes in the first year.

Partnership history. If the practice was previously co-owned, ask what happened to the other partner and when they left. A partner departure can take a significant chunk of patients with it, especially if that partner had strong personal relationships with certain patients or brought their own patient base into the practice.

 This can explain a sudden drop in patient numbers that shows up in the data. It doesn’t necessarily make the practice a bad buy but you need to know about it and understand how the numbers looked before and after.

Patient age concentration. Ask for a breakdown of the patient base by age. A practice where a large portion of patients are elderly is going to face higher natural attrition over the next few years regardless of how well you run it. 

Patients passing away, moving to care facilities, or reducing their dental visits as they age is something you simply can’t market your way out of. It doesn’t make the practice bad but it does mean you need to factor in a higher new patient acquisition cost just to stay flat.

Before you sign anything, make sure you have verified all of the following:

Buying a dental practice is one of the most complex financial transactions you will ever make. It involves tax structuring, lease law, employment contracts, healthcare regulations, practice valuation, and financing. None of those things are simple on their own. All of them happening at once, is not the moment to cut corners on who’s helping you.

At minimum you need:

This is probably the most important person on your team. A dental specific accountant has looked at hundreds of dental practice financials. They know what normal looks like, they know what suspicious looks like, and they know how to structure the deal in a way that protects you at tax time. The difference between a well structured purchase and a poorly structured one can cost you tens of thousands of dollars. Get them involved before you start seriously looking, not after you’ve already fallen in love with a practice.

Your family’s lawyer is great for writing a will. They are not the right person to review a dental lease, negotiate a purchase agreement, handle staff contracts, or make sure you’re compliant with your state or provincial dental regulations. A dental specific lawyer does this every day. They know what clauses to look for in a lease, what warranties to push for in a purchase agreement, and what liabilities to watch out for. Given how much is at stake, their fee is one of the best investments you’ll make in the whole process.

A good broker knows what practices are available, what they’re actually worth, and what problems are hiding in the numbers. They’ve seen enough transactions to spot when something doesn’t add up. One important thing to understand though: a broker representing the seller works for the seller. Their job is to get the best price for their client, not to protect you. If you want someone genuinely looking out for your interests, engage your own transition consultant or advisor who is working exclusively for the buyer side.

This one surprises a lot of dentists but it matters more than you’d think. Banks will lend dentists 100% of the purchase price at very favorable rates, amortized over 12 years. That kind of financing exists almost nowhere else in business lending. But not every banker understands dental cash flows or knows how to structure a dental practice loan properly. Work with someone who specializes in dental lending. They’ll make the financing process faster, smoother, and they’ll know how to present your deal in the best possible light to get you the terms you deserve.

The reason banks offer financing like that is because dental practices, when bought right, have an extremely high success rate. “There’s a reason banks are loaning dentists 100% of the purchase price at prime minus a quarter amortized over 12 years,” Henderson says. “They know that the probability of success is about 98%. Dental practices by and large succeed.”

The key phrase there is when bought right. The mistakes that derail dentists are predictable and mostly avoidable: chasing a perfect practice that doesn’t exist, ignoring patient base trends, skipping due diligence, buying a lease with a demolition clause, or not having the right team in place before signing anything.

Don’t buy based on how the office looks. Buy based on who’s in the chairs, how often they come back, and whether the numbers tell a story that makes sense.

The right practice, in the right location, with the right team behind you — it’s one of the best business decisions you can make.

Whether you buy an existing practice or build one from scratch, the next challenge is the same: getting patients through the door and keeping them coming back. That means a website that actually converts, an online presence that puts your new practice in front of patients, and a marketing system that brings in new patients consistently and keeps the schedule full. 

That’s what we do at RevUp Dental. We work with dental practices across North America to build the kind of marketing engine that fills schedules and grows patient bases. Whether you need a new dental website, want to run Google Ads, improve your SEO rankings, or just want to understand what it would actually cost to grow in the market you’re looking at before you buy, we can help.