From co-founding a dental group recognized by Group Dentistry Now as an Emerging Dental Group to Watch to leading one of the industry’s most influential associations, Dr. AJ Acierno brings more than 25 years of clinical, entrepreneurial and executive leadership experience to his new role.
Eight years ago, Group Dentistry Now recognized DecisionOne Dental Partners as one of its 2018 Emerging Dental Groups to Watch. Today, the organization’s co-founder, Dr. AJ Acierno, has been named executive director of the Association of Dental Support Organizations (ADSO), marking a significant leadership announcement for the DSO industry.
The Association of Dental Support Organizations announced the appointment on November 4, 2026, selecting a dentist whose career has spanned nearly every facet of organized dentistry, from associate dentist and private practice owner to DSO founder, CEO and national clinical operations executive. Dr. Acierno is replacing Andrew Smith. Smith’s departure was previously announced as part of a leadership transition planned for the end of the year.
Acierno’s appointment comes at a pivotal time for the dental industry, as DSOs continue to evolve and the association prepares to engage a new generation of policymakers at the state and federal levels.
From Emerging Dental Group to National Industry Leadership
Acierno’s journey into organized dentistry began long before his appointment to lead ADSO.
After earning his DDS from Creighton University in 2001, he began his career as an associate dentist with Heartland Dental. In 2003, he entered private practice ownership in Schaumburg, Illinois.
He later joined forces with his brother, Dr. Michael Acierno, to establish DecisionOne Dental Partners, a Chicago-area dental group.
In January 2018, Group Dentistry Now named DecisionOne Dental Partners one of its Emerging Dental Groups to Watch. At the time, DecisionOne had 22 affiliated locations throughout Chicagoland and 32 dentists. What distinguished the organization was not simply its growth trajectory, but its emphasis on culture, professional development and doctor retention.
DecisionOne wanted to create an organization where people wanted to work, rather than one where they felt they had to work. Its approach emphasized competitive compensation, continuing education, leadership development, communication skills and professional growth. One of its most notable achievements at the time was a reported 97% doctor retention rate since the group’s inception.
The Acierno brothers believed that investing in employees would translate into better patient experiences, stronger relationships and greater continuity of care. Those principles would remain central to Acierno’s leadership philosophy as DecisionOne expanded and eventually partnered with one of the nation’s largest DSOs.
A Vision That Helped Shape Dental Consolidation
In January 2019, Group Dentistry Now published an in-depth article titled The Second Wave in Dental Consolidation Is Here, examining DecisionOne Dental Partners’ strategic partnership with Smile Brands.
At that time, DecisionOne had approximately 30 affiliated practices in the Chicago area and ambitious plans for expansion. But Acierno recognized that growing a successful DSO required more than capital. Emerging groups also needed the infrastructure, systems, operational expertise and mentorship required to scale without compromising their culture. In GDN’s 2019 interview, Acierno discussed why he pursued a strategic relationship with an established DSO rather than following a more conventional private equity path.
DecisionOne’s biggest challenge was not access to funding. It was developing the operational support needed to sustain growth, from centralized communications to insurance administration and other essential business functions. The partnership with Smile Brands was structured to provide additional resources and expertise while allowing DecisionOne to maintain its leadership and organizational culture.
Acierno believed the model could represent an important shift in dental consolidation, one in which larger DSOs could support emerging organizations while learning from their approaches to culture and patient care. The arrangement reflected his belief that successful consolidation should preserve the relationships and individual practice cultures that make dentistry different from other areas of healthcare. The partnership also became a defining step in Acierno’s professional career, positioning him to take on increasingly significant responsibilities within Smile Brands.
Leading Clinical Operations on a National Scale
Following DecisionOne’s 2019 combination with Smile Brands, Acierno’s responsibilities expanded far beyond the Chicago market. He served as Chief Operating Officer of the Midwest Region, overseeing 191 dental practices across 12 states. He subsequently became President of Clinical Operations and Chief Dental Officer, with responsibility for clinical operations across nearly 700 practices, approximately 7,500 team members and 33 states.
Those positions required balancing clinical quality, operational effectiveness, technology adoption, team development and the challenges of supporting hundreds of individual dental practices.
His experience at Smile Brands gave him a national perspective on the opportunities and complexities of the DSO model. It also provided an understanding of the practical challenges organizations face when implementing clinical standards, introducing new technologies and supporting dentists across geographically diverse markets.
A Longstanding Commitment to People and Patients
Throughout his career, Acierno has consistently emphasized the human side of dentistry. In October 2019, he authored an article for Group Dentistry Now titled Ready to Retire? See Practice Transitions from the Perspective of Patients & Staff.
The article examined practice transitions through the experiences of patients, dentists and team members, rather than focusing solely on financial transactions. Acierno emphasized the importance of continuity, trust, communication and preserving the relationships that dentists and their teams spend years developing. His perspective challenged practice owners to consider how transitions affect the people whose lives and careers are connected to their practices.
The same people-first approach that helped define DecisionOne’s culture has remained a recurring theme throughout his leadership career. That experience is especially relevant as ADSO works to communicate the role of dental support organizations in helping dentists deliver patient care.
An Established Voice Within ADSO
Acierno is no newcomer to the Association of Dental Support Organizations. In fact, Group Dentistry Now reported in November 2016 that Acierno had been elected to ADSO’s 2016–2017 Executive Committee.
His involvement with the association dates back at least a decade, providing him with firsthand exposure to the organization’s leadership, advocacy efforts and the challenges facing member organizations. He has also been involved with the American Academy of Dental Group Practice (AADGP) and has participated in industry discussions on the future of group dentistry.
Now, he will have the opportunity to translate that experience into national association leadership.
A Critical Moment for the DSO Industry
Acierno assumes his new leadership role as the DSO industry faces significant opportunities and challenges. The November 2026 elections are bringing changes to state legislatures, governors’ offices, attorneys general offices and Congress.
For ADSO, that political transition creates opportunities to educate new policymakers about dental support organizations and their role in the healthcare delivery system.
The association’s work includes advocating for dentists’ ability to choose the practice model that best meets their professional goals while supporting patient access to quality dental care.
Acierno’s experience practicing as an associate, owning an independent practice, building a DSO and leading clinical operations at scale gives him a particularly broad perspective on those choices.
“I’ve seen dentistry from almost every seat, as an associate, a practice owner and the leader of a growing DSO, and I know what it takes to deliver great patient care and to build and run the organizations that make that care possible,” said Dr. Acierno.
He emphasized that no single practice model is appropriate for every dentist.
“Every dentist should have the right to choose the practice model that best supports them in caring for their patients. For some, that’s owning a practice. For others, it’s working as an associate or partnering with a DSO. A DSO is simply another option, and one that makes investments in technology and training possible and helps practices meet workforce challenges.”
Acierno said his responsibility will include ensuring policymakers understand the value DSOs provide while advocating for dentists regardless of the practice model they choose.
The message is particularly relevant as dentistry continues to confront workforce challenges, changing technologies, evolving business structures and growing demands on clinical teams.
ADSO Leadership Welcomes Acierno
ADSO President Scotte Hudsmith highlighted Acierno’s unusual combination of clinical experience, entrepreneurial success and large-scale executive leadership.
“AJ has built a DSO from the ground up, led it through a major merger, and helped run one of the largest dental support organizations in the country, all with the perspective of a practicing dentist,” said Hudsmith.
Hudsmith also emphasized Acierno’s ability to communicate with policymakers and regulators about the realities of dental practice ownership and DSO-supported dentistry.
The association believes his background positions him to lead its advocacy efforts and organizational growth during a period of significant change.
The Next Chapter in a Career Dedicated to Dentistry
Beyond his executive responsibilities, Acierno maintains strong ties to dental education. He earned his undergraduate and dental degrees from Creighton University and currently serves on the university’s Board of Trustees.
His appointment to ADSO represents another chapter in a career that has included building a dental practice, creating an emerging DSO, navigating consolidation, leading a national clinical organization and serving the broader dental community.
For Group Dentistry Now, his journey is also a reminder of why emerging dental groups deserve recognition and attention. When DecisionOne was named one of GDN’s Emerging Dental Groups to Watch in 2018, the organization was focused on building a sustainable business while improving the professional experience of dentists and their teams.
Eight years later, its co-founder is preparing to represent the interests of an industry at the national level. In GDN’s 2019 interview about the future of dental consolidation, Acierno shared a goal that has particular resonance in light of his new appointment:
“When I retire one day, I want to walk away from this and know that we made a difference in dentistry.”
Seven years later, he has another opportunity to pursue that goal, this time through national industry leadership.
As executive director of ADSO, Acierno will help shape the conversations, policies and advocacy efforts influencing the future of DSO-supported dentistry.
The association represents member organizations that collectively support more than 15,000 dentists, placing its new executive director in a position to influence one of the fastest-evolving segments of the dental profession.
His appointment brings together the perspectives of a practicing dentist, an independent practice owner, a DSO entrepreneur and a national executive. It is a combination of experience that will help define the next chapter for ADSO and the industry it represents.
