For all the attention earnings before interest, taxes, depreciation, and amortization (EBITDA) receives in dentistry today, you’d think it was the mission, but it’s not. EBITDA is a measurement. It is not a strategy.

I’ve spent my career wearing two hats. One belongs to the oral surgeon who, chairside with patients, believes deeply in surgeon autonomy, clinical excellence, and creating remarkable experiences. The other belongs to the CEO responsible for growth, debt covenants, financial performance, and protecting the long-term health of an organization. 

Contrary to what many believe, those two perspectives are not at odds with each other. In fact, they depend on each other. 

Misunderstanding EBITDA 

The greatest mistake practices can make is viewing EBITDA expansion as something achieved primarily through expense reduction. You can certainly cut your way to better margins for a period of time, but sustainable value creation has always come from somewhere else entirely: delivering such an exceptional experience that patients, referring doctors, and team members naturally fuel top-line growth, which is where enduring EBITDA expansion begins.

Dentistry has no shortage of levers to pull: reduce supply costs, consolidate vendors, limit staffing, decrease benefits, trim schedules, and delay capital expenditures. Most of these strategies have merit, and most would agree that good businesses require discipline. 

But cost-cutting has limits. At some point, excessive focus on the bottom line starts to erode the very thing that made the practice successful in the first place. Patients feel rushed, team members become disengaged, doctors lose autonomy, referral relationships weaken, and ultimately but almost undoubtedly, growth slows. 

Saving your way to prosperity has a ceiling; whereas, serving your way to prosperity does not. Patients don’t really discuss EBITDA; they discuss experiences. 

Was the office welcoming? Did someone answer the phone? Did the surgeon explain everything? Was anxiety reduced? Did the team seem genuinely happy? Did someone call after surgery? Were complications handled with compassion?  Those moments are not soft skills. They’re growth strategies. 

Exceptional experiences create trust. Trust creates loyalty. Loyalty creates referrals. Referrals create revenue. Revenue creates operating leverage. And operating leverage creates EBITDA expansion. 

The formula is remarkably simple: 

Better experience leads to more patients. More patients lead to more revenue. More revenue creates greater EBITDA—not the other way around! 

Another lesson many practices miss 

Doctors who feel empowered generally provide better care.   When surgeons are allowed to practice according to their training and values, they become more engaged, teams become more cohesive, and patients feel the difference. 

Culture and autonomy need to be seen as competitive advantages, not obstacles to growth.   Organizations that lose sight of this simple concept often find themselves protecting margins while sacrificing momentum. 

As organizations scale, EBITDA expansion becomes less about austerity and more about leverage. When infrastructure already exists and fixed costs are largely in place, additional patient volume creates disproportionate value. 

A practice that grows because patients love the experience often discovers something powerful; revenue growth and margin expansion can occur simultaneously—not because anyone squeezed harder, but because excellence created demand. 

As leaders, we have obligations to our teams, partners, lenders, and shareholders. Financial stewardship, profitability, and accountability clearly matter, but those responsibilities should never come at the expense of the patient experience,because the patient experience is the engine that drives everything else. The most successful organizations understand that mission creates margin. 

Dentistry should never lose sight of the fact that patients are not line items, doctors are not expense centers, and culture is most definitely not overhead. So when practices focus relentlessly on clinical excellence, extraordinary service, and empowering great people, EBITDA expansion often follows naturally. 

That’s because EBITDA isn’t the goal.   It’s the scoreboard, and scoreboards don’t win games. Teams do.

Editor's note: This article appeared in the September 2026 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.