What Should a DSO Do During the First 100 Days After Acquiring a Dental Practice?

DentalDex · Winning and integrating · 3 min read · Methodology

The first 100 days after acquiring a dental practice should stabilize employees and patients, preserve production, establish trust with the selling dentist and integrate only the functions that create immediate value without disrupting clinical operations. Most value destroyed in dental acquisitions is destroyed here, by changing too much too fast in front of people who did not choose to be acquired.

Before day 1

The 100-day plan is written before closing and shared with the seller. It names one integration lead who is on site in week one, and it lists what will change on day 1, day 30, day 60 and day 90. A seller who has seen the plan does not spend the first month worrying about what is coming.

Days 1–30: Stabilize

Goal: nothing visible breaks.

Owner	Must happen	Must not happen
HR / payroll	Payroll runs on time on the same schedule; benefits enrolled with a named contact for questions	Pay dates move; benefits gap
Integration lead	Meets every employee individually in week one; staff hear the plan from a person, not an email	Corporate email announcing "exciting changes"
Revenue cycle	Credentialing filed for every provider on day 1; claims continue under existing arrangements until switched	Claims interrupted by a system change
Clinical	Selling dentist's schedule, labs and materials untouched	New formulary in week two
Front desk	Same phone number, same PMS, same recall process	PMS migration
Patients	No communication unless the seller wants one, and then in the seller's words	Rebranded signage before the seller has told patients
Finance	Cash management set up; daily deposits reconciled	Operating account swept without the office manager knowing

The seller should spend days 1–30 doing dentistry. If they are spending it in integration meetings, the plan is wrong.

Days 31–60: Diagnose

Goal: know what you bought.

Measure, weekly, against the acquisition thesis: production and collections by provider, hygiene production and reappointment, schedule utilization by chair, new patients by source, treatment acceptance, AR by payer, supply spend as a percent of collections.

Compare each to the number in the LOI package. Where the practice is running below thesis, decide whether it is the transition (usually) or the thesis (sometimes). Where it is running above, find out why before you change anything.

This is also when the integration lead has the second round of one-on-ones with staff. The questions are what is harder than it was, what is easier, and what have they heard patients say.

Days 61–100: Improve

Goal: deliver the first things the seller was promised.

Sequence by visibility and by seller benefit, not by your org chart:

1. Things the seller feels first: HR administration off their desk, recruiting support for the associate they have wanted for two years, a working procurement discount that they can see on an invoice.
2. Revenue-cycle improvements that do not touch the front desk workflow: payer contract migration where your rates are better, denial management.
3. Hygiene optimization: reappointment, perio protocols, adding a hygiene day into open chairs. This is usually the largest EBITDA lever and the least disruptive.
4. Marketing and specialty referral capture, now that you know the new-patient sources and the leakage.
5. Only then: procurement formulary, PMS migration, branding, if at all in year one.

What not to do

Do not treat integration as an IT deployment. Do not change PMS, payroll, branding, labs and scheduling in the same quarter. Do not let the acquisition team disappear the day after closing and hand the seller to an operations manager they have never met. Do not measure the integration by systems migrated; measure it by whether the seller and the office manager are still there at day 100 and would tell a colleague to sell to you.

The day-100 review

Three questions, answered with numbers: is production at or above the thesis; is every provider and the office manager still employed; would the seller do it again. Two of three is a warning. One of three means the next acquisition in that region waits until you understand what happened.

Record the answers against the deal in your transaction data. The pattern across ten integrations is the most valuable operating intelligence a DSO can own.

Market ranges on this page are illustrative planning ranges, not offers. Involve qualified legal and tax advisers on any transaction.