14 minute read
The ‘Continuing’ Mission
Continuing education is vital to dentistry, and various DSOs have created their own systems to provide it.
By William S. Bike
Dental continuing education (CE) is vital both for retaining licensure and for learning the latest chairside techniques. An advantage of working as a member of a dental services organization (DSO)–owned practice is that DSOs offer educational opportunities as an employee benefit — from online programs to hands-on table clinics and even their own educational facilities.
The top five DSOs in terms of practice numbers are Heartland Dental with more than 1,700 practices; The Aspen Group (TAG) with more than 1,300; PDS Health (formerly Pacific Dental Services) with more than 1,000; MB2 Dental with more than 700; and Smile Brands with more than 600.(1)
For dentists and staff who are members of DSOs, whether the DSO is small or large, CE can be an important, career-enhancing perk — particularly for newer dentists. Larger DSOs tend to develop their own internal education, while midsize or smaller DSOs tend to contract out some or all.
“CE, and education in general, is a huge benefit of partnering with a DSO,” said Lisa Gushin, DDS, FAGD, of Heartland Dental in Fayetteville, North Carolina. She noted that in her more than three years with Heartland, when it comes to CE, “I have done as much as I can get my hands on. I have taken beginner courses and advanced courses in endodontics, clear aligner therapy and implants.”
Laura Sage, director of Learning and Development–Doctor Development at TAG, noted that education at TAG “is more than a training program. It’s a culture of lifelong learning that connects clinical development with career advancement and practice leadership.”
It’s also a massive undertaking. In a recent year, TAG issued more than 50,000 CE credits and committed $6 million to clinical, operational, professional and leadership development. TAG employees completed more than 170,000 hours of learning across the organization.(2) Heartland offers more than 200 hours of CE, including through its five-year Doctor Mastery Program, which features clinical training from foundational to complex dental care.(3) The Doctor Mastery Program also helps participants earn their AGD Fellowship or Mastership.
“In the past year, Heartland Dental administered more than 400,000 CE credits,” said Anna Singh, DMD, senior vice president of clinical operations for Heartland Dental. “We estimate there have been around 450,000 self-paced web-based course completions, 60,000 virtual instructor-led course completions and 30,000 in-person course completions in the last year.”
PDS offers more than 600 hours through its PDS Health University.(4) Smile Brands offers a 52-week CE curriculum, with registrations consistently in the 300–400 range each week.(5)
DSOs generally allocate $3,000 to $5,000 annually per dentist for CE, while individual practitioners usually pay for CE out of pocket.(6)
A Career Boost at Any Stage
“We’re especially proud of how our learning architecture helps new graduates thrive,” TAG’s Sage said. That learning architecture not only includes the physical TAG University in TAG’s headquarters and the TAG Oral Care Center for Excellence, both in Chicago, but it also includes “a culture of lifelong learning that connects clinical development with career advancement and practice leadership,” she said.
Sage noted that the TAG University space measures about 50,000 square feet, with a mock Aspen Dental office with six operatories and six mock consult rooms that are used for multiple courses and programs. At the TAG Oral Care Center for Excellence, 16 operatories function as a full dental clinic for the underserved community, as well as a training facility. The main campus became fully operational in 2023.
“All TAG team members can access TAG University and enroll in courses,” Sage continued. “The aspects of TAG University that make it stand out are its comprehensive, role-tailored curriculum, blended delivery (virtual and in-person), immersive training facilities and strong organizational investment.”
CE is not just for early-career dentists. “From seasoned clinicians to recent graduates, our continuing education offerings provide diverse opportunities for growth in clinical expertise, business acumen and leadership capabilities,” Heartland’s Singh said.
“I actually learned how to do Invisalign late in my career [through Heartland],” said Gushin.
And DSO CE is not just for dentists. “The biggest advantage is implementation,” Gushin added. “Many times, I would learn a new skill or product and then face pushback from staff. Heartland has created systems to prevent that from happening. Team training and involvement are the keys to success, and Heartland has timelines and check-ins to keep implementation progressing successfully.”
A Variety of Offerings
Eoin Halpin, DMD, MBA, FAGD, an AGD Dental Practice Council member based in Washington County, New Jersey, works for a DSO. As an MBA holder and assistant professor of community health at the Rutgers School of Dental Medicine, he has also studied them.
“Larger DSOs may have structured curricula similar to dental school CE departments, while smaller DSOs may rely on third-party CE providers,” Halpin said.
William G. McBride, DDS, MAGD, a dentist for Midwest Dental in Coralville, Iowa, noted that Midwest Dental provides weekly CE virtually and “regional CE experiences” that may be sponsored by dental suppliers.
He explained that Midwest Dental works with the Kois Center of Seattle, a CE center that also conducts research, and Implant Direct of Thousand Oaks, California, which offers dental implants, restorative products and education.
Andrew Smith, CEO of the Association of Dental Support Organizations (ADSO), noted that “guiding the next generation of dentists is a huge priority for DSOs.” That includes providing dentists with information on all aspects of dentistry.
“Recently ADSO signed a partnership with the Association of Dental Safety (ADS), giving our DSO members full access to the ADS’s expanding toolkits,” Smith said. ADS, formerly the Organization for Safety, Asepsis, and Prevention, provides “toolkits” of resources on dental infection prevention and safety information.(7)
TAG also aims to ensure that employees are exposed to a wide range of topics.
“Within TAG University, we’ve curated programming within the four Schools of Excellence: 1) clinical, 2) leadership, 3) business and operational, and 4) service and support, which ensures that we are developing clinicians and team members as wholes versus only building their clinical skills,” Sage said.
The School of Clinical Excellence features clinical skills courses from foundational to advanced levels and the latest in implant techniques and technology. The School of Leadership excellence teaches skills such as coaching, delegation and feedback as well as management of practices, locations and business functions. The School of Business and Operational Excellence has courses in business acumen, decision-making, and schedule and resource management. Meanwhile, the School of Service and Support Excellence courses help participants improve patient interactions and build trust and rapport.
PDS “holds its in-house academy and CE courses in state-of-the-art facilities that feature simulation labs,” Smith noted. “These programs are held in PDS Health’s own facilities, located at its national support centers in Irvine, California; Henderson, Nevada; and Dallas, Texas, as well as in its regionally located training centers.”
McBride was employed with Midwest Dental when it was a smaller company (230 offices) and continued to practice after it was acquired by Smile Brands in 2020, an acquisition that made the company one of the largest DSOs in the United States.(8)
When the DSO was smaller, before 2020, “there were [CE] options, but they weren’t as robust,” McBride said. “There’s definitely access now to more specialty-type training, such as for implants and clear aligners. Before, it was a little more casual and topical, maybe a one-day hands-on course. Now, there are opportunities for intensive trainings that are more valuable.”
Halpin noted that “support is less consistent at smaller DSOs and may depend on the dentist’s tenure, the relevance of the course to the DSO’s services and budget availability,” adding that smaller DSOs “often rely on partnerships with CE providers, dental associations or manufacturers; online platforms like Spear Education; mentorship programs with experienced clinicians inside the DSO; and local study clubs or regional seminars sponsored by dental companies.”
A different type of educational opportunity is offered by PDS: “The PDS University College Advancement Program provides eligible employees with 100% tuition coverage [including fees and the cost of textbooks] to pursue an undergraduate degree through Arizona State University’s online program,” Smith said. This is a particularly good employee benefit for non-dentist DSO staff members who may not yet have their undergraduate degrees. It is helpful to dentists because it allows their operations managers, benefits coordinators and dental assistants to gain more education debt-free while remaining employed with the dentist full time.9
Little or No Cost
Smith noted that, at DSOs, “much of the CE does not come at any cost to the dentist.”
For particularly extensive education in areas such as implants, “some DSOs will provide a stipend to go receive this training,”
Halpin said. “I have also seen examples where the DSO pays for a portion up front for training and then another portion after a number of cases have been completed.”
“Dentists apply and are selected to participate in larger programs — such as those at the Kois Center — and the DSO will pay for it,” McBride said.
Quality of Education
McBride is enthusiastic about DSOs’ CE offerings, saying, “the quality in general is very, very good,” but admits that “just like any CE, it can be hit or miss both inside and outside the organization.”
“Quality varies, and content often aligns with the DSO’s clinical focus,” Halpin said. “As a result, some dentists prefer external CE for broader exposure to diverse techniques and philosophies.”
“If the course is deemed valuable for clinical development and patient care, Heartland Dental covers the cost,” Singh said.
David A. Keller, DDS, MAGD, ABGD, of Vancouver, Washington, worked for Gentle Dental from 2008 to 2011. At the time, the DSO had about 40–50 locations in southwest Washington. While Keller worked for Gentle Dental, he attended a number of company-provided CE courses.
“It wasn’t amazing CE. It wasn’t CE I would’ve paid for,” said Keller, adding that he had already achieved his FAGD at the time, so most of the knowledge was redundant.
Keller said that all of the CE that Gentle Dental, which now has over 150 locations, mainly on the West Coast, provided was internally produced.
“If they wanted to do an endodontics course, they would go and find a company endodontist to do it,” he said.
It also would not reimburse for any outside education.
“If you wanted to learn a procedure like rotary endo, the company was not going to provide that CE for you,” said Keller. “They would say, ‘Here’s our calendar. Here’s our CE.’”
Keller said that, of the CE he took, most courses did not provide much variability in terms of products used.
“Most of the CE courses I experienced took the approach of: ‘We want all our doctors to use this product, so we’ll do a CE on it,’” he said.
The approach makes sense for DSOs, especially the larger ones, which specialize in creating economies of scale. DSOs use their production numbers as leverage to drive costs down when dealing with suppliers. It’s logical to assume that, if a company was able to acquire large numbers of a certain product at lower cost, it would want all its doctors to use that supply.
Halpin also noted that “a DSO’s internal education can be somewhat biased toward the organization’s preferred treatments and vendor relationships. These partnerships often shape clinical protocols and product choices emphasized in training. While this standardization can enhance consistency and cost efficiency [within the organization], it may also limit [dentists’] exposure to alternative techniques or materials outside the DSO’s selected network.”
But, in McBride’s opinion, DSO CE “is right up there” in quality “and doesn’t seem biased,” and there are no treatment modalities that are unavailable.
“If somebody expresses interest in anything that requires a very large buy-in, like a certain piece of equipment, that might be something where the organization says, ‘learn the technique first,’ but they’re always very encouraging,” McBride added, referring to Midwest Dental. “And if [the DSO doesn’t already] offer something, I think that they would be willing on some level to get a provider additional training on something that [the provider thinks] would be beneficial for their practice.”
AGD also has worked to be a resource for all general dentists, regardless of their employment position, by creating high-quality CE for those seeking education on a wide range of topics.
“A core tenet of AGD is to educate and empower our member dentists,” said AGD Immediate Past President Chethan Chetty, DDS, MAGD. “Our education department and councils are actively innovating to ensure members are ready for the challenges of a changing dental landscape. This focus allows our dentists to offer better, more comprehensive care to patients across all practice settings.”
Dedicated Educators
The big DSOs rely on teams of dedicated educators both in-house and outside.
“More than 40 TAG University faculty members lead the design, delivery and optimization of our programs,” Sage said. “Many of them come from both educational and clinical backgrounds. When relevant, we also bring in outside educators or thought leaders, especially when exploring new technology or specialized procedures.”
“Our clinical education team is composed of experienced clinicians who are masters in their field and skilled course developers,” Heartland’s Singh said. “We also collaborate with external clinicians and educators who align with our mission and philosophy of care. The majority of Heartland’s clinical education team actively continue to practice and see patients in their supported offices.”
Other Employment Factors
While free CE may be a perk of working for DSO, dentists should be aware of other factors when considering DSO employment. Keller said that DSO dentists have a lesser degree of autonomy compared to their solo or small practice counterparts.
“You don’t get to pick your hours. You don’t get to pick your time off,” he said. “I had to work Saturdays. The company would also say, ‘We need you at this location today.’”
Keller added that he also had inconsistent help while working for Gentle Dental. While he would always have a dental assistant, it would frequently be a different person each day.
Keller said this may not be true of all DSOs, especially midsize ones, but it’s one of the tradeoffs that dentists should keep in mind when considering employment options.
Priorities and Opportunities
When asked about their top priorities, DSO leaders frequently list education opportunities for dentists and staff.(10)
“We believe in cultivating a culture of continuous learning, whether that learning takes place inside or outside our organization,” Heartland’s Singh concluded. “Our focus is always on growth, improvement and excellence in patient care.”
Ultimately, for a DSO practitioner, “there are a lot of CE opportunities within the company that are not like what you would get otherwise,” Gushin said.
William S. Bike is a freelance writer and editor based in Chicago. He is a former director of advancement communications for the University of Illinois Chicago College of Dentistry. To comment on this article, email impact@agd.org.
References
1. Portalatin, Ariana. “Top 10 Largest DSOs Headed into 2025.” Becker’s Dental + DSO Review, 21 Nov. 2024, beckersdental.com/dso-dpms/top-10-largest-dsos-headed-into-2025/.
2. Nichols, Meredith. “TAG-The Aspen Group Launches TAG University to Provide Innovative and Personalized Professional Growth and Development Courses to More than 20,000 Team Members.” Team TAG, 31 Aug. 2023, teamtag.com/newsroom/TAG-university-launch-08312023/.
3. “Enhance Your Career with the Doctor Mastery Program.” Heartland Dental, blog.heartland.com/enhance-your-career-with-the-doctor-mastery-program. Accessed 8 Oct. 2025.
4. “Life at PDS.” PDS Health, pacificdentalservices.com/life-at-pds/. Accessed 28 Aug. 2025.
5. “Smile Brands Promotes Learning Culture with 52-Week Virtual CE Curriculum.” Smile Brands, smilebrands.com/press-release/smile-brands-promotes-learning-culture-with-52-week-virtual-cecurriculum/. Accessed 28 Aug. 2025.
6. “Benefits of Joining a Dental Service Organization that Change Everything.” Professional Transition Strategies, 3 June 2025, professionaltransition.com/benefits-of-joining-a-dental-service-organization-that-change-everything/.
7. “Toolkits & Topics.” Association for Dental Safety, myads.org/toolkits-topics. Accessed 28 Aug. 2025.
8. “Smile Brands Acquires Midwest Dental.” Becker’s Dental + DSO Review, 9 Dec. 2020, beckersdental.com/dso-dpms/smile-brands-acquires-midwest-dental/.
9. “Pacific Dental Services Launches College Advancement Program, Offering Eligible Employees Full Tuition Coverage for Undergraduate Degrees.” PDS Health, 26 Oct. 2021, pdshealth.com/news/press-releases/pds-college-advancement-program/.
10. Gaddis, Beth. “DSO Leaders Share Their Top Priorities for Fall 2025.” DrBicuspid.com, 14 Aug. 2025, drbicuspid.com/dental-business/dso/article/15752260/dso-leaders-share-their-top-priorities.
