DX / Differentials / DSO & GENERAL DENTISTRY

D-03 — GROWTH PLATEAU · DENTAL GROUPS & DSOs

Growth has flattened — dental groups

Plateaued growth — production flat while the marketing invoice holds or climbs

DIFFERENTIAL — LIKELY CAUSES, MOST LIKELY FIRST

1. 01

   Collections, not production — the money is being written off or never chased

   The schedule produced the same dentistry; a widening gap between production, adjustments and collections means less of it turned into cash.

   8+ location practices collect 72% on average against 97% for the top 10% — a 25-point spread — and the average for large groups runs 8 points below smaller practices.

   Henry Schein One, 2026 Catalyst Index (collection-rate blog, publisher domain)

   NOT THIS IF — Collection rate is already above 95% and stable month over month across every location — then the flatness is in production itself, and the next four causes apply.

2. 02

   Throughput fell, not demand — fewer visits per dentist

   New-patient arrivals held, but completed visits per provider dropped, so chair hours and therefore production dropped with them.

   Average patient visits per general-practitioner dentist per year fell from 3,679.3 in 2024 to 3,307.4 in 2025 — down 10.1% (69.3 visits per week, 2.3 per hour). Gross billings per visit for solo GPs: average $576.30, median $480.70.

   ADA Health Policy Institute, 2026 Survey of Dental Practice, Table 23 and Table 9

   NOT THIS IF — Visits per dentist held or rose while production stayed flat — that points to fee schedules, payer mix or adjustments, not to chair time.

3. 03

   Retention leak — patients arrive and do not come back

   New patients top up a bucket that is emptying at the same rate, so the active base is flat no matter how many arrive.

   Patient retention averages 64% industry-wide, down from 72% year over year. By group size: solo average 70% (top 10% 94%), 8+ locations average 58% (top 10% 90%). Retention is defined as the percentage of active patients who return for care within an 18-month window against the total active base. Hygiene reappointment within 12 months sits at 63% (2025), up from 60% (2024).

   Henry Schein One, 2026 Catalyst Index (press release and retention blog); hygiene reappointment from Planet DDS, 2026 Dental Industry Outlook Deep Dive (n = 8,500+ practices)

   NOT THIS IF — Hygiene reappointment is above the mid-60s and the 18-month active-patient base grew year over year — then the leak is not on the recall side.

4. 04

   Case completion — accepted treatment is not getting done

   Treatment is diagnosed and accepted, then sits as unscheduled treatment dollars in the practice management system and never converts to production.

   Case completion is 47% (2025), up from 42% (2024) — measured as treatment plans created January–June 2025 that were completed by December 2025. Planet DDS's own headline finding is that completion, not acceptance, is the constraint.

   Planet DDS, 2026 Dental Industry Outlook and Deep Dive

   NOT THIS IF — Unscheduled treatment dollars are small and flat quarter over quarter. Note the counter-intuitive finding in the same report: practices with a moderate gap between acceptance and completion grew faster than practices with no gap at all, so a zero gap can mean under-diagnosis rather than excellence.

5. 05

   Genuinely thin demand — the practice sits in the bottom band of the distribution

   There are not enough new patients per location per month to carry growth, and everything downstream is working correctly on too little input — this is the one cause on this page where buying more demand is the correct response.

   38.8% of practices see fewer than 20 new patients per month; 19.0% see 20–39; 14.9% see 40–59; 9.5% see 60–79; 17.7% see 80 or more. Growth tracks it: practices at 10–20 new patients a month average 4.5% growth, practices at 50–75 average 7.6%, and practices at 75+ average 9.0%.

   Planet DDS, 2026 Dental Industry Outlook Deep Dive (n = 8,500+ practices, 2025 data)

   NOT THIS IF — New patients are already above 45 per location per month — Henry Schein One's "strong" tier — in which case the plateau is downstream of acquisition and buying more demand will not move it.

HOW TO TELL THEM APART

How to tell these apart in your own numbers

Each of these is a measurement you can run yourself, without us.

WHAT RESOLVES EACH

What resolves this, and how you will know it resolved

Collections, not production — the money is being written off or never chased	Rx 04 · marketing attribution →	Production, adjustments and collections separated on a monthly readout and tied to the income statement. What does not work: acquisition. Buying more new patients into a group collecting 72% multiplies the write-off, it does not fix it.
Throughput fell, not demand — fewer visits per dentist	Rx 03 · patient conversion →	Same-day capacity matching and routing. The cheapest version of this fix is a schedule change and costs nothing: Planet DDS measures average Friday production at $7,388 against Tuesday at $10,152 — Friday runs 27% lower.
Retention leak — patients arrive and do not come back	Rx 03 · patient conversion →	Recall and reappointment at the chair, instrumented at the front desk. Reappointing before the patient stands up costs nothing and is the highest-yield unpaid fix in this document.
Case completion — accepted treatment is not getting done	Rx 04 · marketing attribution →	Unscheduled treatment dollars belong on the monthly one-page readout beside production, with Rx 03 · intake-and-ops working the list weekly at the desk. The report already exists in every major practice management system; most practices simply do not look at it.
Genuinely thin demand — the practice sits in the bottom band of the distribution	Rx 01 · patient acquisition →	Paid orchestration and demand mapping by market — but only after the four causes above are excluded. Henry Schein One's own conclusion from its 2026 index: "Top-performing groups don't necessarily spend more on marketing. They make it easier for demand to convert."

HOW THIS DIFFERS BY SCALE

How this differs by scale

Single site	One location, one owner, one hygiene column — the owner can see the schedule, so plateau almost always traces to day-of-week production mix and recall before it traces to demand. Planet DDS's chair data cuts against the assumption that a solo is under-utilised: solo revenue per chair averages $236,286 against $205,690 for the DSO segment, and the medians are $184,502 against $156,741. A flat solo is rarely a capacity story.
Group	At 2–25 locations the variance between sites is usually larger than the group's own year-over-year change, so a pooled number hides the answer. Planet DDS's growth by group size: 2–5 offices 9.0% average growth, 6–10 offices 6.9%, 11–25 offices 8.8%. A flat group in this range is normally one or two sites dragging, not a group-wide condition, which is why the workup for a multi-location dental group is run per site and never pooled.
Platform	At 26+ locations plateau is often structural rather than local. Planet DDS's worst-performing band is the middle, not the top: 26–50 offices average 2.8% growth with only 55.3% of offices growing, against 7.4% at 51–100 offices and 7.1% at 100+. Check collections first — Henry Schein One shows 8+ location groups collecting 72% on average against 97% for the top 10%.

OTHER PRESENTATIONS — DSO & GENERAL DENTISTRY

• Rising cost per new patient — and no industry number to compare it to
• Thin pipeline — the phone rings and the chair stays empty
• Multi-site variance — one brand, one playbook, and a fourfold spread between locations
• Preparing for exit — making growth read as a system rather than as a good year