In this essay, Scot Armstrong explains how his company built a dental “Iron Man suit” for those looking to grow their DSOs.
By Scot Armstrong, CEO, Milledge Dental Partners
Two years ago, our company didn’t own a single dental practice. Today, we have 10 profitable locations, partnerships with other DSOs all over the country, and our own dental lab in Louisville, Kentucky that services all of our practices.
I had almost no experience in the dental industry when we started in 2023. My background was in strategy, technology, and AI learning. But by combining that experience with good people, new processes, and smart services, we’ve been able to quickly grow a portfolio of small practices into larger, healthier operations.
When friends, partners, and competitors ask how we’re doing it, I break it down into three main steps:
Supplies. People. Process.
Supplies
When we started, we discovered that supplies are often the first and most overlooked area to get right. When we acquired our first few practices, we saw supply costs eating up 15–22% of collections.
At first, we thought the issue might be inflated pricing, so we talked to the big distributors and explored GPOs promising bulk discounts. But after looking at the issue under a microscope, we realized we didn’t have a supply cost problem—we had an ordering problem. People were keeping excess materials in every operatory, buying duplicate products, and ordering things they didn’t use, and we didn’t have much visibility into any of it.
So to add experience and discipline to our supply management we brought a company called Dental Supply Chain Ninja onboard. They made us aware of the Zimbis smart cabinet inventory management system and the impact was immediate. Our average practice now spends around 2.9% of collections on supplies. In some months, it’s even lower.
If you’re a doctor, the difference between 5% and 15% in supply costs is your ability to buy a beach house one year. It’s your ability to go out and buy a six-figure car. It’s a big difference.
We implemented a centralized, automated system. Orders go into Zimbis once a week. Our assistants sweep the operatories each night and return unused materials. Supply rooms are pristine, stocked with what we need—nothing more. If someone wants to order a new product, it is reviewed by a clinical doctor and goes before our supply panel for review before it’s approved.
We have over 1,200 items in our system now. Yes, we could reduce it to 800, but we’re okay giving clinicians their preferred supplies—as long as we manage how much of it we carry.
People
Dentistry is a hands-on, people-driven business. Your business won’t thrive through trickery or technology.
To be successful you need to ingratiate the people that you have, build referrals from patients, and have really good Google My Business location capabilities so when people look for a dentist, they find you nearby. It’s about that simple.
We made a commitment early on: we would put our employees first. We believe if we create a workplace where people are respected, well-paid, and trained for success, the patient experience will reflect that.
We pay 30–40% above local market rates. We have structured career paths and training programs so that assistants, hygienists, and front office staff can grow with us. If someone joins as a sterilization tech, they can become a lead DA or clinical trainer if they show initiative and master the required skills.
We had zero turnover last quarter. That’s not typical in this industry, but it’s possible when you value your team and invest in their success.
Process
You can have the right supplies and the right people, but if you don’t have the right processes, you’ll never scale.
From day one, we designed Milledge Dental Partners to operate like a system.
Now, each of our practices follows the same scheduling, inventory, and ordering protocols. We implemented centralized support teams that allow each location to focus on patient care while we handle the back-office complexity.
Each week, every practice receives a performance scorecard with key metrics: patients seen, new patients, production, collections, claims, and supply costs. We don’t expect perfection, but we do expect transparency and improvement.
We’ve also built an onboarding system that allows us to integrate new acquisitions or de novo practices seamlessly. Three of our Medicaid practices, for example, were launched from scratch. Within nine months, each is doing $150,000 a month. That’s the power of having a repeatable process.
Technology helps—but only if it supports the process. Zimbis helped us reduce waste. AI-supported diagnostics helped standardize treatment planning. But the real power is in aligning everyone around a clear, consistent way of doing things.
You can’t scale chaos.
The Bottom Line
I couldn’t sleep the week before we purchased our first practice because I was worried about getting into a brand new industry with new dynamics and demands.
But from my experience, I knew to be successful we had to figure out how to combine people and processes in a new and effective way.
What we created is like an “Iron Man” suit for a dental practice. The practice is made up of people, and when those people are surrounded by a suit of services, technology, and training, they get top-notch supplies on demand, labs that are inexpensive and high quality, and access to great talent.
If you’re reading this as a DSO operator, here’s my best advice:
- Get your supply costs under control by using a good supply chain manager like Dental Supply Chain Ninja and an inventory management system like Zimbis.
- Invest in your people. Pay them well. Train them well.
- Create repeatable processes. Then enforce them consistently.
None of this happens overnight. But in just two years, we reduced our lab and supply costs from 22% to 2.9% of collections—without cutting corners or quality.
Most of our success has come down to one thing: the willingness to challenge what’s considered “normal” in dental operations.
Normal isn’t profitable.
Normal isn’t scalable.
But with the right supplies, the right people, and the right processes, we’ve proven there’s a better way than normal.