[Byte Sized Podcast Ep. 63] Overpromised and Under-Deployed: The Dental Tech Buying Problem

What You’ll Learn

The Dental Technology Bottleneck Has Shifted

The dental industry has more technology coming into it than ever before. AI diagnostics. Voice receptionists. Automated insurance verification. Revenue cycle management tools. Patient engagement platforms.

And yet DSOs have never been less equipped to actually put any of it to work.

Dave Salciccioli has spent years sitting between vendors and DSO operations teams, first as a fractional COO and VP of operations, now as the leader of Relay, a consulting firm that helps both sides of the transaction actually deliver results. On a recent episode of the Byte Sized Podcast, he broke down what’s going wrong and why the problem isn’t usually the product.

“Tons of really good tech,” Dave told Adrian Lefler. “And we don’t have the ability right now to ingest that much new innovation across our practices to try to lift same store growth.”

Overjet CEO Wardah Inam made the same point at a recent AI summit when he said that the bottleneck has changed. Vendors can now ship more product in three months than they could in three years. The constraint is no longer development. It’s adoption.

AI Theater and the Design Partner Problem

Not every product being sold actually exists yet.

Dave uses the phrase “AI theater” to describe what’s happening with some new market entrants. What’s being presented in front of the curtain looks impressive. Behind the curtain, the product may not be fully developed. No real users are running it in front of patients.

“What they’re really looking for is somebody who’s called a design partner,” Dave said. “Basically, who’s my first DSO that will let me work with them through implementation, get a ton of feedback, and improve my own product.”

Being a design partner isn’t inherently bad. Some DSOs like MB2 actively seek out early stage founders because they want something customized to their needs. They’re willing to provide feedback and iterate. They usually get lower pricing and a bespoke solution in return.

The problem is when a DSO thinks they’re buying a finished product and they’re actually signing up to be a beta tester. That’s a different commitment with different expectations.

“You just need to know what you’re buying,” Dave said. “And what it looks like.”

The Messy Middle

When technology fails inside a DSO, both sides usually point fingers. The vendor says they delivered what was promised. The DSO says they did their part. Both are technically right.

The failure happens in what Dave calls the messy middle, which is the gap between a signed contract and operational outcomes. Somebody has to own that space and usually, nobody does.

From the vendor side, two gaps show up consistently.

First, implementation windows are too short. Vendors are incentivized to get software installed quickly, so onboarding timelines run 8 to 12 weeks. That’s not enough time to drive true adoption. Training comes in heavy doses rather than spaced repetition. A four hour training session might result in one hour of retained knowledge.

Second, sales promises don’t make it to the implementation team. Reps say yes to everything to close the deal. Customizations. Integrations. Timelines. Those promises don’t get documented. They don’t get communicated in the handoff. The implementation team delivers the standard package. Months later, the DSO feels shortchanged and the vendor calls it extra scope.

“It took us having to sit down and have a real level set conversation,” Dave said about one current project. “With everybody involved. Okay, like what was communicated? What can we do now?”

The DSO Side of the Problem

Vendors aren’t the only ones creating failures. DSOs often aren’t ready to implement the products they’re buying.

Take voice AI as an example. Everybody wants an AI phone receptionist right now. At least 150 companies are selling one. But implementing a voice AI product requires operational infrastructure that many DSOs haven’t built.

“You have to have a lot of scheduling intelligence built into your PMS before you can layer on a voice AI product,” Dave said. “If you don’t have scheduling blocks, nor know where the doctor’s time is within those scheduling blocks, you don’t have overflow columns for where patients can schedule if these three or four get filled up, it’s not going to matter.”

The product can work perfectly. If the scheduling foundation doesn’t exist, the AI agent has nothing reliable to schedule against.

Adrian Lefler saw this firsthand helping develop Annie AI. The team launched with a couple dozen test practices and discovered that scheduling worked completely differently at almost every location. Two columns instead of one. Fifteen minute appointments mixed with 45 minute appointments. Variations everywhere.

“You can’t ask the practice to change the way they schedule,” Adrian said. “That’s just not going to happen. So you have to build into the software a way for this agent to schedule appropriately.”

Working out those kinks took months. A vendor coming into the industry cold wouldn’t know to ask about overflow columns or double operatory scheduling. A DSO wouldn’t know to mention it.

What to Ask Before Signing

Dave recommends four questions for any DSO evaluating new technology.

Do you have other customers currently using this in front of patients today? If the answer is no, you’re a design partner whether you wanted to be or not. That can be valuable if you go in with open eyes.

Can I talk to somebody else who’s using your product? Push for the referral. If the vendor is nervous about connecting you with an existing customer, that tells you something. A conversation with another operator will surface implementation challenges faster than any sales demo.

What have you seen in other customers that made this process more difficult? This forces the vendor to be honest about what you need to have in place before the product can succeed. If they say you need standardized scheduling templates across 30 locations, you’ll know to spend six months on that first.

Do you have read-only access or read and write access to the PMS? Many platforms can pull data from a practice management system. Fewer can write data back. If bidirectional integration matters for your use case, confirm it exists right now, not on a roadmap.

The Middle Management Gap

One reason DSOs struggle with implementation is structural. The people who would normally manage technology projects don’t exist anymore.

Margin compression hit hard over the past few years. Supplies cost more. Staffing costs more. Insurance reimbursements stayed flat. To protect margins, DSOs gutted middle management. Project managers and resource managers were cut. The roles that would normally own a technology transition evaporated.

“This middle management layer has just been gutted,” Dave said. “There’s no more project managers. There’s no resource managers.”

Some DSOs have cobbled together cross-functional technology committees mixing IT, operations, and finance. That’s the model Dave sees working best. But it requires executive attention to form and maintain.

Meanwhile, practice managers are being asked to run implementations on top of their actual jobs. They’re dealing with patient emergencies and staffing issues and involuntary terminations. Getting back to a vendor about a data mapping question isn’t the top priority.

“You have no idea the craziness that’s going on,” Dave said. “Like the last thing on their mind is, I need to get back to that vendor.”

Build vs. Buy

Some DSOs have decided the answer is building their own tools. Claude and ChatGPT made it feel possible. Vibe coding became a thing. Suddenly everyone thought they could replace vendor subscriptions with custom internal software.

Dave has watched this play out. The results are often worse than paying for existing products.

“I have seen some groups go down the path where they’re like, okay, we’re going all in,” Dave said. “We’re going to build everything on Claude or Codex. And they’re trading a $300 a month subscription for a $10,000 a month cost.”

Token pricing adds up. Maintenance becomes a job. Bug fixes require developer time. The DSO accidentally becomes a software company that happens to do dentistry on the side.

Dave’s recommendation is to never try to replace a system of record like a PMS. Build narrow “systems of action” only when no product on the market solves your specific problem. Keep humans in the loop. And do the math on what custom development actually costs before assuming it’s cheaper than a subscription.

“Pick,” Dave said. “Are you going to be someone who grows practices, or are you going to be a software company?”

The Relay Model

In This Episode:

Dave Salciccioli, CEO and Co-founder of Relay

Adrian Lefler, CEO and Co-founder of My Social Practice

Adrian Lefler, CEO of My Social Practice, is a seasoned expert in the dental marketing industry with 14 years of experience. He is widely recognized for his engaging and informative presentations. Based in Suncrest, Utah, Adrian shares his life with his wife, four children, and a lively mix of pets. My Social Practice is a leading dental marketing company, and Adrian is passionate about helping dental professionals succeed in this dynamic field.