Dentira Index Puts the DSO Supply-Spend Gap at 3.3 Points of Collections

Dentira has released its first Dental Spend Index, using live procurement, formulary, budget and invoice activity from 267 dental service organizations spanning 15,000 U.S. locations.

The headline finding is a 3.3-percentage-point gap in supply spend between the smallest and largest groups in the dataset. Organizations with two to 10 locations spend 7.4% of collections on supplies, groups with 11 to 100 locations spend 5.5%, and DSOs with 101 or more locations spend 4.1%.

That means the largest groups in Dentira's sample spend 45% less on supplies as a share of collections than the smallest groups.

The index arrives as reimbursement continues to trail inflation. Since 2021, dental reimbursement has risen 19% while inflation has increased 27%, according to ADA Health Policy Institute data cited in the report. Avized's analysis of the Q3 dental economy found the same margin pressure is pushing practices to demand clearer operating returns from technology.

What happened

Dentira describes the Fall 2026 edition as the first dental spend benchmark built on live procurement data at this scale. The 42-page report groups results by DSO size and examines supply expense, formulary compliance, supplier strategy, invoice exceptions and acquisition activity.

Several findings stand out:

• Supply expense falls with scale. The dataset moves from 7.4% of collections at groups with two to 10 locations to 4.1% at organizations with 101 or more.
• Formulary leakage remains substantial. About half of ordered products sit outside the formulary across the sample. Even enterprise DSOs order 45% of products off formulary.
• Three in 10 locations are over budget. The benchmark suggests central procurement visibility does not automatically translate into location-level control.
• Every tracked top-10 supply category became more expensive from 2021 through 2025. Labels and signs increased 20.1%, followed by disposables at 15.8%.
• Implants and bone-regeneration materials are top-four spending categories in every segment. Specialty and surgical services are materially shaping the supply mix.
• The South Atlantic accounts for nearly one in three acquisitions recorded on the platform over three years. Florida, Texas and California lead the state rankings.

Dentira also says customers report reducing supply spend by 1.1 percentage points of collections in their first year on the platform, equivalent to moving from 8% to 6.9%.

That last result is a vendor-reported customer outcome, not an independently controlled estimate. The index is based on organizations using Dentira, so the findings should be treated as a platform benchmark rather than a census of every U.S. DSO.

Why it matters

The report gives operators and investors a more concrete way to think about the economics of dental scale.

A 3.3-point supply-spend gap is not automatically proof that adding locations creates savings. Larger groups may differ from smaller groups in specialty mix, payer mix, purchasing discipline, collections and acquisition strategy. But the pattern is directionally important: scale creates the opportunity to consolidate suppliers, negotiate pricing, standardize products and centralize approvals.

The harder problem is turning negotiated economics into location behavior.

If roughly half of ordered products remain off formulary—and 45% are off formulary even at enterprise DSOs—the market's biggest procurement opportunity may be compliance rather than another round of price negotiation. A contract discount has no value when locations continue buying substitutes outside the agreement.

That reinforces the distinction in Avized's dental procurement software guide between price discovery, procurement governance and inventory optimization. Large groups need all three, but formulary control and exception management become especially important once purchasing decisions are distributed across dozens or hundreds of offices.

The acquisition data also connect procurement to integration. Avized's analysis of dental consolidation argues that larger organizations are becoming a more important part of dental ownership. Each acquired practice brings its own suppliers, products, ordering habits and clinical preferences. The financial value of scale depends partly on how quickly a buyer can integrate that variation without disrupting care.

For private-equity sponsors and DSO boards, supply spend therefore belongs beside labor, payer mix and same-store growth in monthly operating reviews. It is measurable, location-specific and potentially addressable during post-acquisition integration.

What to watch next

Independent validation. The market needs additional benchmarks from distributors, group purchasing organizations and other procurement platforms to test whether the 4.1% to 7.4% range holds across different customer populations.

Like-for-like comparisons. Implant-heavy and surgical groups naturally have different supply profiles from general dentistry platforms. Benchmarking will be most useful when organizations can compare specialty mix, revenue model and clinical complexity—not only location count.

Formulary adoption. The most important operating metric may be the percentage of spend, not just products, that occurs inside the formulary. Product counts can overstate leakage if low-cost exceptions receive the same weight as high-value purchases.

Acquisition integration. Buyers should track how long it takes a new location to move onto approved suppliers, standardize high-volume SKUs and reach the group's target supply-spend ratio.

Spring 2027 data. Dentira says the next edition will add category-level formulary views. That should make it easier to distinguish ordinary clinical exceptions from categories where purchasing discipline is breaking down.

The larger takeaway is that dental procurement is becoming a margin-management system rather than an ordering function. Scale can create a cost advantage, but the index suggests that the advantage depends on execution at the location and SKU level.

Primary sources

• Dentira — Fall 2026 Dental Spend Index landing page and benchmark summary
• Dentira — November 2, 2026 announcement via Business Wire