Reality Check: A Closer Look at DSO’s Abundance Theory Mentality

GDN recently posted ‘One Dentist’s Opinion on DSOs. What’s Yours?’.  In response, we received the following opinion from Amy Kinnamon, RDH’s perspective.  Kinnamon is the owner of BigFish Dental, editorial board member at Crest/Oral B, and hygiene advisory board member at Straumann USA LLC.


Over the past few years, I have found in research and review of literature on DSOs, that many of the allegations of “bad acting” are more unfounded public opinion than fact. I agree that strengthening existing state and federal law will keep patient interest at the forefront; however, the risk is NOT created by corporate interest.

DSOs support an ‘abundance theory mentality’ in that they support choice and competition by providing services that have been shown through analysis are less costly than procuring those same services in a private practice setting. DSOs have also been shown to perform procedures at not only a lesser cost, but also at a lower rate in all categories, except radiographs which came in only slightly higher than their private practice counterparts.

DSOs have existed since the 1960s and became much more prevalent in the 1990s. DSOs operate at a much lower cost due to scale, compared to traditional dental practices. The lower operating cost creates opportunity for access to care for underserved and Medicaid populations, and DSOs have stepped up in this arena where traditional practices have are unwilling or unable to perform. For example, our practice services an underserved and Medicaid population for a nine-county area. Out of the ample supply of dentists in this nine-county area, we are one of three that includes an FQHC and a private practice that accepts one Medicaid patient/month age 21 or under.

At the end of the day, all dentistry, whether DSO or private practice, is a healthcare business and all dentists work under the same incentive of fee-for-service and quantity of care, yet only DSOs are villainized for this practice. The quality of care provided by a DSO is the ethical, moral, and legal responsibility of the attending dentists and not the owner of the corporate entity. DSOs follow rigid metrics to ensure the treatment of the patients is quality, necessary and comprehensive.

In conclusion, there is good and bad in all models of dentistry. After much research, there are many positives to the DSO model, not only for underserved communities, but populations of all socioeconomic status.

References: (not compiled in order)

Pew Center on the States. “A Costly Dental Destination: Hospital Care Means States Pay Dearly.” Issue Brief.
Buchmueller, Thomas C., Sean Orzol, and Lara D. Shore-Sheppard. “The Effect of Public Insurance Coverage and Provider Reimbursement on Access to Dental Care.”
See, for example: Government Accountability Office. “The Extent of Dental Disease Children Has Not Decreased, and Millions Are Estimated to Have Untreated Tooth Decay.” GAO-08-1121. Government Accountability Office. “State and Federal Actions Have Been Taken to Improve Children’s Access to Dental Services, but Gaps Remain.” GAO-09-723; Government Accountability Office. “Efforts Under Way to Improve Children’s Access to Dental Services, but Sustained Attention Needed to Address Ongoing Concerns.” GAO-11-96.
Wall, T. P. “Dental Medicaid — 2012.” Dental health policy analysis series.
“Improper Payments for Medicaid Pediatric Dental Services.” OEI-04-04-00210: pg. 26.
Edelman, Marian W. “Deamonte Driver Dental Project.”
The Henry J. Kaiser Family Foundation, “Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA)”, February 2009.
“Expand Eligibility for the State Children’s Health Insurance Program (CHIP).”
From here on we will refer to patients treated under either federal program as CHIP/Medicaid patients unless we are explicitly referencing a single program.
The State of Children’s Dental Health: Making Coverage Matter.”
Dr. Burton Edelstein. “Dental Visits for Medicaid Children: Analysis and Policy Recommendations“,, June, 2012.
Moriarty, Jim, and Charles S. Siegal. “Unethical Private-Equity-Owned Dental Clinics Receive Well Deserved Attention.”
Moriarty Leyendecker. “Small Smiles Lawsuit.”
Domino, Donna. “Private equity firms eye big profits in dentistry.”
J. M. Brux, Economic Issues & Policy, (Mason, OH: Thomson, 2008), chap. 9.
University of South Carolina School of Medicine, “Detection and Prevention of Fraud, Waste, and abuse and applicable federal and state laws.” Accessed September 7, 2012.
Managed Healthcare Executive. “Healthcare Fraud and abuse remains a costly challenge.” Managed Healthcare Executive, 2004.
Rosenbaum, Sara, Nancy Lopez, and Scott Stifler. Health Care Fraud. Post-Doctoral Report, Washington, D.C.: National Academy for State Health Policy, 2009. Page 1.
Washington State Office of the Attorney General. “Common Types of Medicaid and Provider Fraud.”
Heath, David, and Jill Rosenbaum. “The Business Behind Dental Treatment for America’s Poorest Kids.”, June 27, 2012.
American Academy of Pediatric Dentists. “Guideline on Management of Acute Dental Trauma.” Reference Manual 33, no. 6: 220–228.