The Accidental Dental Strategist

The three prices of a dental business

By Andy Sloan

· 6 min read

Every number you hear is true

Every few weeks someone tells me what a dental group went for. The number is usually somewhere between 7x and 12x. It is rarely wrong. It is often the wrong number for the person hearing it.

Four pieces of market data have landed in the last three months: Christie & Co's Dental Market Review 2026, the Dental Elite Goodwill Report 2026, NASDAL's latest quarterly goodwill survey, and Lincoln International's market update at DentalForum EMEA in Malaga this month, which I chaired. Read together, they describe a market that is recovering, competitive at the top and still poorly understood in the middle.

The ladder

UK dental trades on three distinct rungs. The published data now lines up closely on two of them.

RungTypical multipleSource
Independent saleAbout 3.5xDental Elite 3.44x, Christie 3.5x
Sale to a groupAbout 7xDental Elite 7.15x, Christie 7.0x
European platform9x to 12xLincoln, 10.8x average

The first rung is where most deals happen. Independents made up 69% of Dental Elite's transactions, at an average price of £886,562, and their average multiple rose from 3.31x to 3.44x. Two brokers, two datasets, and they land within a tenth of a turn of each other.

The second rung is the group buyer. Dental Elite's group multiple has risen from 6.7x five years ago to 7.15x, with a 2027 projection of 7.37x. Groups of 20 or more practices paid 7.78x. Christie measures it differently, by practice structure rather than buyer type, and lands in the same place.

The third rung is the platform. Lincoln's figures cover European platform deals since 2024, mostly above €10m of EBITDA, priced on pro forma or run-rate earnings, which flatters the headline. They are still the right reference point for anyone building towards an institutional exit.

The first step is mostly arithmetic

The jump from 3.5x to 7x looks like a premium. Much of it is a change of denominator. An owner-operated practice reports EBITDA before anyone is paid to replace the principal. Once a buyer costs in an associate, earnings fall and the multiple rises to compensate.

Christie's margin data shows the gap. In 2025, owner-operated practices ran at 31.4% EBITDA and associate-led practices at 23.7%. Same chairs, same patients, a different line for clinical cost. The genuine group premium is smaller than the headline suggests, and Christie's own commentary says the gap between single-site and group multiples has been narrowing.

The rung nobody publishes

The most interesting businesses in UK dental sit between the second and third rungs. Groups of three to fifteen sites, with £1m to £5m of EBITDA, too big to be bought as practices and too small to be priced as platforms. Christie counts 1,862 practices in groups of three to 29 sites, and groups of three to ten sites heavily outnumber the rest. No published report puts a multiple on them.

What moves a business across that gap is not the number of sites. Lincoln's read is that scaled buyers are paying for procurement and head office savings they can actually bank. That matches what I saw across the 120-plus acquisitions I oversaw on the Portman board. The groups that priced as businesses were the ones a buyer could underwrite without the founder in the room. Monthly management accounts the buyer believed. Governance that did not live in one person's head. The same systems in every site. That is what DOMI measures, and it is why a five-site group and a fifteen-site group can be worth the same multiple.

The number you get is not the number you hear

Headline multiples describe the price. They do not describe the cash. Christie's data puts the average deferred element at 29% of the price, over a three-year tie-in. Deferral appears in 40% of deals with corporates and larger groups, 25% with mid-sized groups and 9% with independents.

On a deal with the average deferral, a 7x headline is about 5x at completion, with the rest earned over three years and usually reduced pound for pound against any shortfall. A seller comparing a 7x corporate offer with a 5x independent offer is often comparing two similar cheques on completion day, with very different risk after it.

Competition is real, though. In the first half of 2026, 57% of accepted offers through Christie were at or above asking price, and 45% were above it.

What changed in 2026

Three things shifted this year. The largest groups came back. Dental Elite reports that the five biggest buyers paid higher multiples across every practice type, after two years spent managing their estates rather than growing them.

NHS practices came back too. Dental Elite's headline figure for NHS practices is 7.68x. Christie reports corporates increasingly favouring NHS and NHS-led practices, and Lily Head has seen a 24% rise in NHS buyer enquiries over 12 months. The new contract's 8.2% urgent care requirement means buyers are now pricing delivery capability, not just UDA value.

Money got easier. Bank Rate stood at 3.75% in July, and lenders are funding up to 90% of goodwill on strong cases.

What operators said out loud

At the Healthcare Summit in September, where I chaired the dentistry stream, the operators on stage described the same shift in their own words. Christie & Co and HealthInvestor UK's summary of the day records groups treating acquisition as one growth lever rather than the strategy itself. Groups are walking away from deals over culture, leases or diligence findings, and one operator was comfortable writing off aborted deal costs rather than buy the wrong practice.

The panels contrasted today's market with the old buy, build and sell model. Value now comes from management capability, integrated systems, clinical quality and organic growth. Several speakers said central support and leadership need strengthening before expansion speeds up, because founders lose touch with individual sites as groups grow. One group weighed the cost of building its own data lake and concluded it was "not a tech company". On AI, the question in the room was how technology lets existing teams see more patients in a capacity-constrained sector, not whether it replaces staff.

That is the gap between 7x and 10x, described by the people trying to cross it.

The counter-signal

Not every dataset agrees. NASDAL's survey for the quarter to 30 April 2026 put goodwill at 109% of gross fees, with private goodwill down 13 points over the year and mixed down 19. NASDAL measures goodwill against fees rather than profit, draws on accountants rather than brokers, includes off-market deals and runs nine to twelve months behind. The brokers report the deals they run competitively. Both views can be true at once.

The public markets add a second note of caution. Lincoln's data shows listed diversified dental companies trading at 12.0x forward EBITDA on a one-year average, against 15.8x over ten years. The listed sector has de-rated. Private platform multiples have held at around 10.8x. The CMA's final report on private dentistry, due in March 2027, is the next test of how long that gap can last.

Where this leaves a five-site group

The market is healthy at both ends. Independents are paying more, groups are paying more, and platform capital is waiting for 2027. The question for a group in the middle is not what the market pays. It is which rung its numbers can prove it stands on.

Sources

Next read: The risk in a group acquisition sits between the practices →