Dentistry is entering a period of rapid change as private equity activity, new insurance rules and faster cycles of clinical innovation start to collide with a sector that has historically maintained a high degree of clinical and operational autonomy. Few people track that shift as closely as Prof. Dr. Claudia C. Cotca, whose dual role as a practicing dental surgeon and founder of C3 Think Tank gives her a view into both daily patient care and the policy conversations shaping the market. From her position, she argues that dentistry’s greatest strength (its clinician-led and open-market structure) is also what makes the current M&A wave more consequential than many investors recognize.
C3 Think Tank is a Washington, D.C.-based policy and clinical-innovation platform that operates in direct parallel with Cotca’s private clinical practice. That rare clinician-think tank combination gives her a perspective few others in the M&A space share.
The LevinPro HC team recently sat down with Cotca to discuss the healthcare M&A market, specifically dental health, and her unique insights as the CEO of a think tank.
Cotca views dentistry as the last major healthcare sector where licensed clinicians still own and control the majority of practices in an open-market environment. In her view, that balance has been the real driver of innovation for decades. However, she shared concerns that the current wave of private-equity consolidation, along with poorly designed insurance reforms, is quietly eroding the very foundation that made dental a standout sector.
From the think-tank lens, the biggest risk is not valuation or leverage. It is the steady transfer of ownership and control away from the licensed clinician, and the failure to recognize decades of trade-secret clinical know-how.
Here are the eight key takeaways that emerged from the conversation with Cotca.
1. Dentistry Still Owns the Open-Market Advantage
“In the USA open-market model, the private sector still holds 60% to 70% market share. Dentistry has kept that healthier balance. That is exactly why you see so much more innovation and discovery space in dentistry.”
Most healthcare sectors have already shifted to managed-care models where corporate or payer priorities often override clinical judgment. Dentistry has resisted that shift longer than any other segment. The result is a higher rate of new techniques, materials and delivery models that originate from the chairside rather than from a corporate committee. That freedom also explains why dental has historically avoided the cost-cutting standardization that now defines physician practice.
2. The Blunt Truth on PE Ownership
“When ownership and control shift from a licensed clinician to a non-licensed entity, quality will inevitably suffer. Without a doubt. It’s like two different brains thinking with completely different knowledge bases.”
Once the person who holds the license no longer holds the equity, the Hippocratic oath stops being the final decision-maker. Financial targets, utilization goals and corporate protocols take over. Cotca says the evidence from other healthcare sectors shows this transition is almost never reversed.
3. The Untapped Asset in Every Private Practice
“Every single privately owned dental practice in the United States already carries an intrinsic collection of trade-secret protocols and discoveries. The market simply does not recognize it yet, and no one is investing to make those assets accessible.”
Current roll-up models value real estate, patient charts and recurring hygiene revenue. They almost never assign any value to the proprietary clinical judgment the selling doctor has built over decades. That judgment walks out the door the day the deal closes unless the structure is deliberately designed to capture it. In Cotca’s experience, most buyers do not even know how to ask the right questions during due diligence.
4. Trophy Discoveries vs. Real Patient Protocols
“Private equity often funds deep, narrow solutions, the equivalent of pulling a tooth out just to place a filling and then putting it back in. Those are trophy discoveries. What the patient actually needs is a synergistic clinical protocol, three or four different elements applied synchronously in concentrations that can change completely if the patient walks in thirty minutes later.”
Many of the “innovations” that attract big checks are single-point products that look impressive on a pitch deck. Cotca points out that real-world patients rarely present textbook cases. They need dynamic, clinician-driven combinations that can shift minute to minute, something no single product can deliver. The current investment focus on isolated technologies risks creating a market full of elegant tools that no one knows how to use in concert.
5. 2025 Insurance “Reforms” May Add Chaos, Not Clarity
“Insurance reforms can actually create more chaos. Virtual credit cards take a college degree to verify. Most people give up after thirty or forty minutes, so the money just sits idle or disappears somewhere else.”
State-level wins on loss ratios and virtual-credit-card bans sound good on paper. In practice, the new processes can be so cumbersome that small offices lose more cash flow fighting paperwork than they ever lost to the old abuses. For independent practices already stretched thin, these administrative hurdles can become the final straw that pushes them toward a sale.
6. Every Practice Needs a Think-Tank Twin
“Think tanks provide a grassroots-up vertical. We deliver real-time insight instead of waiting ten or twenty years for consensus… Every private clinical practice in the U.S. open-market model should have a parallel think-tank or incubator entity. That is how you protect the equity of talent, protocol, and discovery, exactly the way mid-size and large enterprises already do.”
Cotca’s own model (a clinical practice paired with a separate think-tank entity) offers a blueprint. It lets the doctor keep ownership of the IP and protocols even after selling the operating company, exactly the way large corporations keep their research labs and patents in a separate legal structure even when they sell the main business. Without such a structure, decades of clinical refinement are simply handed over with the patient files.
7. Bring Clinicians In Early
“Put interdisciplinary voices at the table early and often. Otherwise, once billions are invested, that capital will not back off just because five or twenty billion dollars would have to be written off.”
Once billions are on the table, investors rarely walk away, even when the clinical reality says they should. Cotca’s advice is simple: get the treating doctors in the room before the term sheet, not after the close. Waiting until post-close integration to discover the clinical gaps almost guarantees expensive rework or outright failure.
8. The Threshold of Chaos Is Exploding
“The golden standard will become the logic of excellence: how we assess diagnostics, how we compile them and how we answer the actual physiological process of disease, not what trends the market and not where the money is. The threshold of chaos has already been met, so it’s a bubble and it’s exploding.”
The era of chasing scale at any cost is ending. The next phase, Cotca predicts, will reward clinical logic over financial engineering. Investors who understand that shift now will be the ones left standing when the dust settles.
Prof. Dr. Claudia C. Cotca is CEO of C3 Think Tank and the Washington Institute for Dentistry & Laser Surgery. She has served as a subject-matter expert on Capitol Hill for two decades and contributes to international standards bodies including ISO, IEC and WHO delegations.
