Like many Canadians, Anne-Marie Klein has been seeing the same dentist for years. Indeed, the 62-year-old Torontonian has visited one dentist virtually her entire adult life.
So for Klein, it was noticeable when the practices at her dentist’s clinic began to change during the pandemic.
“ I got the sense of upselling,” she said.
Klein attributes the change to the dental clinic being acquired. She says the quality of the patient experience began to decline shortly thereafter.
“I mean, like any kind of takeover, it wasn’t as personal,” she said. Canadian Affairs is not identifying the name of the dentist or dental clinic, as it was unable to reach the dentist or independently verify the clinic’s ownership structure.
A lack of transparency around the corporate structures of Canada’s dental clinics is not unique to the clinic where Klein was a patient. It is in fact common to the industry. And it may help to explain why a growing trend of dental clinic consolidation has attracted little attention.
Industry experts say there are many reasons dentists choose to sell their practices to larger corporations.
Dentists get to spend more time focusing on their patients’ oral health, rather than on running a business, says Cheryl Reicin, a life sciences lawyer at Mintz who has been involved in multiple dental clinic acquisitions. “You don’t have to take care of the day-to-day administration,” she said.
But some experts say the trend may not be in patients’ best interests.
“[T]he increasing corporate consolidation of dental clinics in Canada has led to many problems,” says Dr. Brandon Doucet, a dentist and founder of the Coalition for Dentalcare, which advocates for publicly funded dental care in Canada.
“Over-treatment is a problem across the board in dentistry, but the increased drive for profits in dental corporations makes this worse,” he told Canadian Affairs in an email.
Why dentists are buying in
Doucet, who authored the 2023 book About Canada: Dental Care, says dentistry in Canada has become increasingly commercialized and corporate-owned in the last several decades.
Corporate dentistry is “a growing trend where a dentist (alone, with another dentist or with a non-dentist) owns and operates several dental practices through the use of corporate vehicles,” Doucet writes in his book. “These corporate vehicles, known as dental corporations or dental service organizations (DSOs), have a fiduciary responsibility to maximize profits, the same as any other corporation.”
In the U.S., dental service organizations account for an estimated 25 to 40 per cent of the dental market. Canada has lagged behind the U.S. in this trend by about a decade, Doucet says. Currently, dental service organizations account for at least six per cent of the market.
In Canada, the most prominent dental service organization is Dentalcorp, a publicly listed company with a market capitalization of about $1.5 billion. Other large players include the private companies 123Dentist and Huron Dental.
Dentalcorp, which was founded in 2011, today owns 550 practices and is in advanced stages of negotiation with another 160 clinics, according to a 2024 investor presentation. Its practices employ more than 4,400 health-care professionals and see 5.4 million patients a year.
Nate Tchaplia, Dentalcorp’s president, says dentists have many reasons for joining Dentalcorp.
“We know dentists want to focus on caring for their patients — not paperwork,” Tchaplia told Canadian Affairs in an emailed statement. “Our Support Centre handles compliance, risk management, scheduling, finance, staffing and recruitment, and marketing support, giving them more time chairside.”
Dr. Scott Spackman, a Calgary-based dentist who sold his practice to Dentalcorp in 2021, touted the professional benefits of joining the company.
“One of the many things that drew me to Dentalcorp was being able to tap into the expertise of thousands of dentists across the country while still maintaining my own approach to patient care,” said Spackman in a statement provided to Canadian Affairs by a Dentalcorp spokesperson.
“It’s incredible to be able to pick up the phone and consult with experienced colleagues or jump into continuing education programs that keep me at the forefront of dentistry,” Spackman said.
The Canadian Dental Association, which represents dentists across the country, pointed to additional factors driving the dental clinic consolidation trend.
“[O]wning and managing a dental practice is increasingly demanding,” a media representative for the association told Canadian Affairs in an email. Many dentists are seeking better work-life balance, are facing increased family demands or are at a later stage in their practices.
Reicin, the life sciences lawyer, noted the cost of properly equipping a clinic can be another factor. “There’s a big push for the latest and greatest technology, and that’s expensive,” she said.
Plus, there may be financial incentives to join. Dental partners typically earn more practicing under Dentalcorp than practicing independently, according to the company’s investor presentation.
Patient concerns
Doucet, of the Coalition for Dentalcare, says the consolidation of Canada’s dental industry raises concerns.
Doucet, who practices as a dentist in Springhill, N.S., says his colleagues who have worked with dental service organizations have expressed frustration with the expectations of high production. They have told him they are expected to run two or three chairs at a time.
“Spending less time on a procedure can lead to more mistakes/lower quality of care,” he said in his email.
Doucet, who has been described by the Canadian Health Coalition advocacy group as “the Tommy Douglas of dentists,” says a clinic’s ownership structure is not strictly determinative of the level of patient care. But dental service organizations’ “drive for profit encourages the behaviours that lead to increased profit,” he said.
“A corporation doesn’t know if a patient needs one filling or three, but it knows that their profits will be higher with the latter,” said Doucet.
“This also goes for aggressively pushing cosmetic and luxury treatments, like implants, whitening and veneers, where the trusted advice of a dentist can influence a patient into believing that those expensive treatments are necessary rather than elective.”
Dentalcorp’s public investor documents indicate the company has programs in place to increase “frequency of visits” and profits. These programs include an “advanced digital recare and patient engagement platform to drive network-wide recall” and “automated campaigns to re-activate lapsed patients.”
The investor presentation says it expects to see a 15 per cent increase in visit frequency after a clinic joins Dentalcorp, and “0.5-1.0% of Same Practice Revenue Growth derived from expansion of specialty service offerings.”
Tchaplia, Dentalcorp’s president, says Dentalcorp dentists are still the ones calling the shots.
“Clinical autonomy is fundamental to our partnership model,’ he said in his email. “When a practice joins Dentalcorp, the dentist maintains complete control over patient care decisions while gaining access to a network of thousands of peers across Canada.”
Lack of scrutiny
For Doucet, another concern is that the dental consolidation trend has received little scrutiny — a problem he attributes to conflicts of interest.
“One problem we run into with researching this problem is that the institutions responsible for investigating this, mainly dental schools, have taken millions of dollars in donations from dental corporations.
“Dental schools therefore do not do research on dental corporations out of fear of losing future donations. Further, many dentists are personally invested in these dental corporations, even dentists involved in the self regulation of dentists/provincial dental boards. Keep in mind, dentists are a self regulating profession.”
In its investor report, Dentalcorp says it has donated more than $6 million to Canadian universities through academic partnerships, and more than $1.1 million in “tuition reimbursements.”
A recent study by Ontario’s dental regulator, the Royal College of Dental Surgeons of Ontario, found that “the prioritization of business interests in dentistry can create conflicts of interest and lead to losses in clinical autonomy which can negatively impact quality of care (e.g., lead to unnecessary treatments, fraudulent billing).”
The study notes that “examples of these negative impacts may be more apparent in corporate dentistry, [but] they can manifest in all practice models.”
The Ontario Dental Association, which represents Ontario dentists, noted that dentists have a professional obligation to prioritize their patients’ best interests.
“No practice arrangement can override a dentist’s professional, moral and ethical responsibility to provide the highest standard of care to patients,” Maneesh Jain, the association’s president, told Canadian Affairs in an email.
‘Practice identity’
It can also be difficult for patients to discern whether their clinic is part of a dental services organization.
Individual clinics do not typically change their names or rebrand after being acquired by Dentalcorp. Spackman’s clinic, for example, has continued to operate under the name Spackman Dental.
Canadian Affairs reviewed the websites of the five dental practices listed in Dentalcorp’s May 2024 announcement of new practices. None of the clinics’ websites advertise a relationship with Dentalcorp.
“This is why many people are unaware these dental corporations exist, and it is likely an acknowledgement by [Dentalcorp] itself that their corporate takeovers would be unpopular and result in the loss of some of their patients,” writes Doucet in his book.
The Royal College of Dental Surgeons of Ontario told Canadian Affairs it is currently exploring ways to address risks to patients from dental clinic consolidation, including “resources to help patients make informed decisions.”
Dentalcorp says that allowing practices to keep their “practice identity” is a strength of its model.
“This is especially meaningful in smaller communities, where dentists have often built trusted relationships over decades,” said Tchaplia.
Spackman agrees that continuing to operate as a local practice is key.
“Best of all, I’m still the same neighbourhood dentist my patients know and trust — just with a broader support system behind me,” he said.
Klein, in Toronto, says she initially chose to remain a patient at the clinic out of loyalty to her dentist. But once he left the clinic, she did too.
“He was the reason I was staying. I endured the rest of it because he was there.”
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