Dental Support Organizations, or DSOs, have become a major force in dentistry. They promise efficiency, consistency, and growth by centralizing operations like billing, marketing, and human resources. With the right structure, DSOs give dental providers the freedom to focus more on clinical care while the business side runs smoothly in the background.
But as many DSO leaders have discovered, size can bring new complications. After a certain point, adding more offices, more staff, or more advertising does not automatically produce better results. In fact, the opposite can happen. Growth can create disconnect. And that disconnect often shows up where it matters most.. in the patient experience.
Growth is not the problem. Disconnection is.
Early growth tends to be exciting. One office turns into three, then ten. Central systems are put in place, hiring becomes streamlined, and marketing efforts expand. But then the cracks begin to show.
Here are some of the most common struggles DSOs face as they scale:
Patient retention becomes harder.
Patients are more likely to return when they feel known and understood. As DSOs grow, the local feel of a practice can disappear. Patients may see different providers each visit, receive different explanations, or feel like just another appointment in a busy schedule. That sense of connection is critical, and when it fades, patients quietly leave.
Training does not always translate.
Even with centralized onboarding and systems, not every location has the same quality of communication. Some front desk teams are excellent at explaining treatment plans. Others struggle. This inconsistency results in confusion, lower case acceptance, and poor follow-up.
Appointments are still going unfilled.
Despite better scheduling software and a larger call center, DSOs often report high no-show rates or last-minute cancellations. The issue is not access. It is motivation. Patients who do not fully understand the importance of their care are less likely to follow through.
Marketing gets clicks, but not results.
A centralized marketing team might create beautiful campaigns. But if the messaging is not tailored to the needs and concerns of each community, it falls flat. And if the practices themselves are not ready to receive and convert those leads, the investment goes to waste.
The core issue is communication
At the heart of these struggles is a simple but often overlooked truth: patients need clarity. They want to know what is happening, why it matters, and what the next steps are. When these things are not explained well, patients hesitate. They cancel. They disappear.
This is not a technology problem. It is a people problem. More specifically, it is a communication problem that technology alone cannot fix.
So what does work?
The DSOs that are thriving today are not just focused on scale. They are focused on clarity. They ask different questions:
Are we making it easy for staff to explain care options?
Are patients receiving timely and clear follow-up?
Are we building trust with every interaction?
Improving these areas does not always require more tools. It requires smarter use of the tools already in place. Video education, automated follow-up, and clear patient messaging can help bridge the gap between systems and relationships.
DSOs must evolve beyond efficiency
Efficiency brought DSOs to this point. But clarity and connection will define what comes next. The most successful DSOs of the future will be those that use their infrastructure to build stronger relationships, not just stronger balance sheets.
If your organization is feeling stuck despite having the right people and the right systems, consider whether your patients are hearing the right message and whether they are hearing it clearly enough to say yes.