How to Buy an Oral Surgery Practice in 2026

Oral and maxillofacial surgery is the highest-EBITDA, highest-multiple corner of dentistry, and it is also the most technically complex to underwrite. Oral surgery practices routinely generate 30-40% EBITDA margins — nearly double what a general dentist produces — because of the procedure mix, the sedation capabilities, and the fact that OMS is the natural endpoint for referrals from every general dentist and pediatric dentist within 30 miles. Those economics have attracted serious PE attention, and platforms like US Oral Surgery Management (backed by Oak Hill Capital), MaxHealth, and Beacon Oral Specialists have been rolling up the space since 2018.

If you're a fellowship- or residency-trained OMS buying your first practice in 2026, the good news is that the economics still work. The bad news is that you are walking into a diligence process more complicated than any other dental specialty, and a single missed item can unwind the deal. Let me walk through what actually matters.

Sedation Is the Business

The reason oral surgery practices generate the margins they do is in-office deep sedation and general anesthesia. A wisdom tooth extraction without sedation bills at $300-500 per tooth. The same extraction with IV sedation bills at $800-1,500 per case, and reimburses under separate CPT codes (00170, D9222, D9223, D9243) for the anesthesia time. Sedation turns a 15-minute procedure into a $2,000-3,500 case.

Before you buy, you need to verify the sedation license of the selling surgeon and confirm it can transfer to you. Sedation permits are state-issued, personal to the provider, and vary by level (minimal, moderate, deep, general). The OMS community has a long-standing single-operator anesthesia model where the surgeon performs both the procedure and the anesthesia simultaneously — a model that has come under increasing scrutiny in the last several years.

Make sure you personally hold (or are on track to hold) the state permit for deep sedation and general anesthesia. If you're an OMS resident buying mid-career, the transition is usually straightforward. If you're an out-of-state surgeon relocating for the deal, start the state permit process at LOI signing — some states take 6-9 months, and you can't bill anesthesia codes until your permit is active.

The Anesthesia Staffing Model

Not every oral surgery practice uses single-operator anesthesia. Larger practices — especially in the Northeast and California — are moving toward a dedicated anesthesia provider model using a CRNA or a dental anesthesiologist. This model increases cost (a CRNA runs $180-240K all-in) but reduces clinical risk and allows the surgeon to focus on the surgical side.

Which model the target practice uses has big implications for your deal. If there's a W-2 CRNA or contract anesthesiologist, their continued employment is essentially a condition of the deal. Get their contract, understand their non-compete, and meet with them before close. I've seen OMS deals go sideways at the 11th hour because the CRNA decided to leave and the buyer couldn't staff anesthesia on day one.

Hospital Privileges and Call Coverage

Unlike general dentistry, oral surgery often involves hospital-based work — orthognathic cases, facial trauma, pathology, and TMJ surgery. Many selling surgeons carry active hospital privileges and take ED call on a rotation. This matters for two reasons.

First, hospital-based cases are frequently the most lucrative single cases a practice bills — an orthognathic double-jaw surgery can bill $15K-40K in professional fees. If the seller has been doing 10-20 of these a year, that revenue is at risk unless you have the credentials and volume history to replicate it. Hospital credentialing for a new surgeon routinely takes 90-180 days, so budget for a revenue gap in the first quarter after close.

Second, ED call generates trauma cases that often become permanent patients of the practice. Getting on the call schedule at the local Level I or II trauma center is a major referral channel. Find out if the seller's call slot transfers automatically or whether the medical staff office will treat you as a new applicant — it varies hospital by hospital.

What Oral Surgery Practices Actually Sell For

Individual OMS buyers pay 2.5-3.5x SDE or roughly 70-95% of collections for solo practices, which is meaningfully higher than general dentistry because of the margin profile. For a solo OMS generating $2M in collections and $700K in SDE, expect the asking price to be in the $1.75M-$2.2M range.

The institutional market is where it gets interesting. PE-backed OMS platforms pay 8-11x EBITDA for bolt-ons and 12-16x for platform acquisitions. US Oral Surgery Management has been the most active consolidator since 2020, followed by Beacon Oral Specialists and MaxHealth Dental. Multi-surgeon groups with $1.5M+ in EBITDA are the sweet spot for platform interest. For how OMS stacks up against other specialties, see our industry multiples guide.

Financing an OMS Acquisition

The economics of OMS are strong enough that lenders get comfortable quickly. SBA 7(a) is the primary vehicle up to $5M — Live Oak Bank and Bank of America Practice Solutions are the most active OMS lenders I work with. Expect 10% equity, 10-year amortization, and debt service coverage requirements of 1.4-1.5x.

Deals over $5M typically use a combination of conventional bank debt and a seller note. Because OMS EBITDA is so reliable, some lenders will go as high as 4.0-4.5x EBITDA in senior debt for a solo surgeon buying a solo practice — materially more aggressive than what you'd see in general dentistry. A 15-20% seller note at 6-7%, standby behind the bank, is a common structure that reduces the buyer's equity check and keeps the seller invested in the transition.

Diligence Items Specific to OMS

Procedure mix report. Pull a report of CDT and CPT codes billed over the last 24 months. You want to see the breakdown across third molar extractions, implants, bone grafting, orthognathic, pathology, and trauma. A practice that's 90% wisdom teeth is a different business than one that's 40% wisdom teeth and 30% implants — and neither is wrong, but they command different multiples and require different skill sets.

Implant volume and lab relationships. Implants are a major profit center — $1,800-3,500 per fixture with margins over 50%. Look at the implant brand mix (Nobel, Straumann, BioHorizons, Neodent) and confirm whether the practice has negotiated volume pricing. Also check who does the restorative work. If the OMS places and the referring GPs restore, the referral relationships are crucial.

Emergency drug protocols and malignant hyperthermia readiness. OMS offices administering general anesthesia are required to have emergency equipment, dantrolene stock, and staff trained in anesthesia emergencies. Verify the crash cart contents, AED functionality, and recent staff ACLS/PALS certifications. State dental boards audit this, and a lapse can shut down sedation privileges.

Malpractice claims history. OMS has one of the highest malpractice premium rates in dentistry because of the anesthesia exposure. Get a claims history report (the carrier will provide it with seller authorization) and understand any prior incidents. Tail coverage is expensive — budget $25K-75K depending on the carrier and the seller's claim history.

Referral source diversification. If more than 20% of new patients come from a single general dentist or a single orthodontist, that's concentration risk. OMS referrals are sticky but not permanent — a new OMS in town can peel off volume within 18 months if the relationship isn't maintained.

Transition Considerations

OMS transitions are generally cleaner than other dental specialties because the referring dentists — not the patients — are the real customers. If you can keep the GPs referring, the patient flow continues. That means your transition plan should focus on the referral network, not the patients.

I recommend the selling surgeon stay on for a minimum of 60-90 days post-close, covering call, co-treating complex cases with you, and personally introducing you to the top 30 referring GPs and orthodontists. Most sellers are happy to do this because it protects their reputation — and frankly, because they're usually ready to cut back but not fully retire.

The Bottom Line

Oral surgery practices are among the best dental assets you can buy — but only if you navigate the sedation licensing, the anesthesia staffing, and the hospital credentialing without tripping. The margin profile gives you real operating leverage, and the PE interest means you have an exit multiple waiting for you on the other side if you build the practice. Before you sign your LOI, run the target through our instant valuation tool to benchmark the asking price against comparable OMS transactions.