In this episode of Beyond Bitewings, we're bringing back some of our favorite advice from our episodes that discussed selling a dental practice to a Dental Support Organization (DSO), highlighting the significant differences between selling to a DSO and an independent buyer. The conversation covers how DSOs value practices using EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization), and why this can result in higher sale prices compared to traditional methods that use a percentage of collections. We also explain the importance of understanding value from the DSO and private equity perspective and warns practice owners about the risks of responding to unsolicited offers without proper representation.

The episode addresses key concerns for dentists, such as what to expect after the sale, how contracts are structured, and why it’s essential to shop around for multiple offers before committing. They discuss the impact of EBITDA calculations on a practice’s valuation, the role of lease agreements when the seller owns their building, and strategies to maximize the value of the transaction.

Key Topics Discussed:

1. How DSOs value dental practices using EBITDA
2. Differences between DSO and independent sales
3. The structure of post-sale contracts and earn-outs
4. Pitfalls of responding to unsolicited DSO offers
5. The importance of getting multiple offers and proper representation
6. EBITDA calculations and their effect on practice valuation
7. Lease agreements when the seller owns the building
8. Advice for maximizing practice sale value
9. The changing dental industry landscape with the growth of DSOs

Ash sits down with Dr. Ruth Mannschreck, a seasoned dentist turned practice transition coach, to talk about the real-world challenges and overlooked opportunities when selling a dental practice. Dr. Ruth shares the mistakes she made during her own transitions, such as not planning far enough in advance and not preparing the practice to be attractive to buyers from both a financial and operational standpoint. She emphasizes the importance of understanding what you want from a sale, proactively increasing value, and reducing buyer risk in ways that go beyond just the numbers.

The conversation moves into the role of practice culture, team involvement, and the transition process. Dr. Ruth advocates for engaging the dental team early in the transition, highlighting the benefits of transparency and preparing the team to operate independently. They also discuss the pitfalls of overreliance on the practice owner and the risk of selling a practice that functions more like a job than a turnkey business. Dr. Ruth offers listeners access to her resource checklist at prepitnow.com and outlines how planning and open communication can support a smoother transition for everyone involved.

To find out more or connect with Dr. Ruth, visit: https://shorelinestrategies.com/

Key Topics Discussed:

• The importance of early planning and preparation when selling a dental practice
• Common mistakes practice owners make during transitions
• Financial versus operational readiness for sale
• The value of culture, systems, and team capability in the sale process
• Strategies for increasing practice value and reducing perceived risk
• The impact of naming and branding on practice transitions
• Including the dental team in discussions and evaluations with potential buyers
• Creating a turnkey business versus selling a “job”
• Overcoming the challenge of letting go of control as an owner
• How to access Dr. Mannschreck’s Prep It Now checklist for selling a practice

Ash welcomes Paul Sippil, a forensic 401k consultant, to discuss the complexities and hidden issues often found in group retirement plans, particularly 401k and profit sharing plans within dental practices and other small businesses. Paul shares how his unique role focuses on exposing conflicts of interest, unnecessary fees, lack of transparency, and even fraud within these plans. He describes how business owners and plan participants frequently misunderstand how fees are assessed, often assuming they pay nothing out-of-pocket—when in reality, high costs may be embedded, sometimes even continuing long after the original adviser has left or, in some cases, passed away.

Paul explains the mechanics of broker commissions, how these fees are often hidden from both employers and employees, and the importance of transparency in fee structure. He provides practical advice for dental practice owners and other professionals on how to minimize costs by paying fees directly at the employer level, allowing for tax deductibility and better cost control. Paul also covers the value of one-on-one meetings with advisers for plan participants, and offers recommendations on how owners can better manage their retirement plans to avoid unnecessary expenses and potential abuses.

To learn more or connect with Paul, visit: https://www.paulsippil.com/

Key Topics Discussed:

• What a forensic 401 (k) consultant does
• Common misunderstandings and hidden fees in group retirement plans
• Broker commissions and lack of fee transparency
• Real-world examples of fee abuses and potential fraud
• Why dental and other professional practice owners should pay retirement plan fees directly
• Importance of transparent, fixed-fee arrangements with advisers
• The value and scarcity of one-on-one meetings between advisers and participants
• Simple steps to reduce retirement plan costs and improve oversight

Ash sits down with Luke Oyler from CARR, a company specializing in dental real estate services. The conversation centers around how dental professionals can make smarter decisions when leasing or purchasing practice locations, highlighting the importance of working with expert advisors. Luke explains how CARR advocates for dentists, negotiates key aspects of their leases—including base rent, tenant improvement allowances, and free rent—and brings market insights to help avoid costly mistakes.

The episode also covers strategies for lease renewal and negotiation. Luke stresses the need for dentists to start planning at least a year in advance to maintain leverage, especially given the high costs and complexity of moving a dental office. The discussion clarifies that CARR’s services typically come at no cost to the client, as agents’ fees are paid by landlords. Additional topics include how CARR supports clients throughout the process, keeps track of important timelines, and provides access to a network of trusted professionals in areas like lending, construction, and accounting.

To find out more, you can visit: https://carr.us/

• Importance of negotiating base rent and advertised lease rates
• Tenant improvement allowance and how it impacts startup costs
• Free rent periods and working capital for new practices
• Lease renegotiation strategies and how to keep leverage
• Timing for approaching lease renewal
• How professional dental real estate agents are compensated
• Tracking leases and proactive renewal reminders
• Asking for tenant improvement allowances during renewals

In this episode, Ash sits down with Nick Hinshaw from WinStar Insurance Group to discuss how insurance can play a critical role in reducing stress for dental practice owners and their teams. The conversation covers essential insurance policies beyond the mandatory requirements, like disability insurance and group benefit plans, which can offer peace of mind to both owners and staff. Nick explains how regularly reviewing disability policies ensures coverage matches the evolving needs of practice owners, helping prevent unwanted surprises if a disability occurs.

They highlight the importance of offering group benefit plans—such as health, dental, vision, and disability insurance—to retain employees and build a supportive practice culture. With turnover rates high in dentistry, especially in urban environments, providing comprehensive benefits can make a practice competitive and foster loyalty among team members. Ash and Nick also touch on insurance requirements for equipment purchases and warn against forced-place insurance imposed by lenders, which is often expensive and limited.

To find out more and connect with Nick, visit:

https://www.winstarins.com/breweries.html

Or you can email him at nhinshaw {at} winstarins.com

Key Topics Discussed:

• Insurance as a tool for stress relief in dental practices
• Benefits of non-mandatory insurance, especially disability coverage
• Regularly updating insurance policies to match current needs
• Importance of group benefit plans for retention and practice competitiveness
• How supporting employees with benefits impacts practice culture and output
• Challenges with lender-imposed (forced-place) insurance on equipment
• The need for proactive, communicative insurance agents
• Asking staff about the benefits they value most
• Risk management and reducing pressure for practice owners

Ash welcomes Dustin Long of Big Sky Construction to talk about building dental offices from the ground up. Dustin brings decades of experience and shares what sets dental office construction apart from other building projects. He emphasizes the importance of a collaborative process that starts months before the first wall goes up, involving real estate brokers, CPAs, designers, and other professionals to ensure each practice fits both the client’s immediate and future goals.

They cover the full journey, from picking the right location and working through lease negotiations to tailoring the practice to match the dentist’s vision and workflow. Dustin and Ash also discuss common pitfalls—like hiring non-specialized contractors—and how mistakes in pre-planning can lead to costly corrections and lost income. They stress the benefit of relying on specialized teams and trusted advisors throughout the process and share a story of a client who narrowly avoided disaster by sticking with dental-specific experts.

To find out more about Dustin, you can connect with him at: www.BigSkyConstruction.com, email him at dlong {at} bigskyconstruction.com or call him at 206-259-0936.

Key Topics Discussed:

• Importance of creating a seamless and enjoyable construction experience
• The critical pre-construction planning phase (6–9 months before building starts)
• Working with real estate brokers, CPAs, designers, and equipment reps
• Assessing existing spaces for suitability and hidden costs
• Customizing design based on the dentist’s present and future goals
• Differences between dental office construction and generic builds
• Risks of using non-specialist or inexpensive contractors
• Importance of precise measurements and planning
• Financial planning, including working capital and lender selection
• How a team of specialized advisors can help avoid costly mistakes
• Stories of clients who benefited from using dental-specific experts
• The value of study clubs and peer learning in the dental community

Ash welcomes another guest from the Southwest Dental Conference, Cindy Lozano from Nomad Mobile Dental Specialist. They talk about how general dental practices can keep more specialty work—and the related revenue—in-house by partnering with Nomad. Cindy shares how their model provides mobile specialists such as endodontists, periodontists, and oral surgeons directly to general dental offices. This arrangement allows general dentists to avoid referring patients out, while Nomad handles all clinical aspects and support, bringing everything needed except the dental chair and sterilization area.

The discussion covers practical points like insurance liability, operational flexibility, and implementation steps. Cindy highlights the partnership-based approach, customizable scheduling, and support with everything from training to specialty insurance verification. Real-world examples illustrate significant revenue growth for practices utilizing the Nomad model, and Cindy explains how offices can get started, emphasizing how easy integration can unlock previously unrecognized potential for specialty production within general practices.

You can find out more by visiting:

https://www.nomaddentalspecialists.com/

Key Topics Discussed

• Nomad Mobile Dental Specialist’s mobile partnership model for general dental practices
• Keeping specialty work and revenue in-house
• Services provided by Nomad, including specialists, assistants, and equipment
• Practice requirements and logistical considerations
• Insurance and malpractice coverage details
• Payment structure and tax setup (W9/1099)
• Flexible scheduling based on practice needs
• Results and revenue improvement examples
• Implementation timeline and onboarding steps
• How to contact Nomad for more information

Ash welcomes CJ Carroll from Dental Intelligence, a leading provider of dental analytics software. They discuss the pressing questions many dentists have about practice data—how to interpret analytics reports, which key performance indicators (KPIs) matter most, and whether investing in dental analytics is worth it for your practice.

CJ explains how Dental Intelligence integrates seamlessly with major practice management software like Dentrix, Eaglesoft, and Open Dental to transform complicated data into actionable insights. From tracking provider performance and hygiene reappointment rates to revealing untapped revenue hiding in unconverted treatment plans, CJ breaks down how analytics empower owners to make smarter management decisions. Whether you’re a new dental startup or a seasoned practice owner, this episode sheds light on the real-world benefits of embracing data-driven growth, streamlining workflow, and ultimately maximizing your practice’s potential.

To find out more about Dental Intelligence, visit: https://www.dentalintel.com/

Key Topics Discussed:

• Overview of Dental Intelligence and its analytics tools
• Key performance indicators for dental practices
• Importance of data accuracy and common mistakes
• Onboarding process and ongoing support
• Suitability of analytics for startups versus mature practices
• Capturing lost production and reactivating patients
• Tracking patient flow, attrition, and recaptured patients
• Integrating with practice management systems
• Using analytics for employee bonuses and performance plans