Oral Surgeon & Periodontist Tax Playbook

Income Profile and Entity Selection

Oral surgeons and periodontists are among the highest-earning dental specialists, with net practice income typically ranging from $400,000 to $1,200,000 per year. Most oral surgeons and periodontists should operate as an S-Corp (or PLLC taxed as S-Corp) to reduce self-employment tax on distributions above a reasonable salary.

A critical threshold question is whether the practice qualifies for the §199A QBI deduction. Specialty dental practices (oral surgery, periodontics, endodontics) are generally NOT classified as specified service trades or businesses (SSTBs) under §199A because they involve the performance of services requiring specialized equipment and facilities — not purely the reputation or skill of the individual. Practitioners should document this analysis carefully.

S-Corp Salary and FICA Savings

The S-Corp election is the most impactful single tax strategy for oral surgeons and periodontists with net practice income above $100,000. By electing S-Corp status, the practitioner pays FICA taxes only on the W-2 salary — not on S-Corp distributions. For a practitioner with $600,000 in net practice income, a reasonable salary of $200,000 saves approximately $17,000–$25,000 in FICA taxes annually.

Reasonable salary for an oral surgeon or periodontist is typically $180,000–$280,000, depending on specialty, geographic market, and hours worked. The IRS scrutinizes S-Corp salary levels for medical and dental professionals, so practitioners should document the reasonable salary determination using comparable compensation data (MGMA, AMGA, or similar surveys).

Retirement Plan Stack

The optimal retirement strategy is a layered approach: (1) S-Corp Solo 401(k) with maximum employee deferral ($23,500 in 2026, plus $7,500 catch-up if age 50+) and employer profit-sharing contribution (up to 25% of W-2 salary); (2) cash balance plan on top of the 401(k) to contribute an additional $100,000–$330,000+ per year in pre-tax dollars, depending on age and income.

Equipment Depreciation and Section 179

Oral surgery and periodontal practices are equipment-intensive, with significant capital expenditures for dental chairs, imaging equipment (CBCT scanners, digital X-ray), surgical instruments, and office technology. Practitioners can accelerate depreciation using §179 (up to $1,220,000 in 2026) and bonus depreciation (60% in 2026). A CBCT scanner costing $150,000 can be fully deducted in the year of purchase under §179.

Practitioners who own their office building should consider a cost segregation study to accelerate depreciation on the building components. A cost segregation study on a $1,000,000 dental office building can generate $150,000–$250,000 in additional first-year depreciation deductions.

Practice Acquisition and Buy-In Planning

Oral surgeons and periodontists frequently acquire practices or buy into existing practices. Asset purchases allow the buyer to step up the basis of all acquired assets (including goodwill) to fair market value and begin depreciating/amortizing them immediately. The purchase price allocation (Form 8594) is a critical planning point — allocating more to equipment (shorter depreciation) and less to goodwill (15-year amortization) benefits the buyer.

Practitioners buying into a practice as a partner or shareholder should negotiate for an asset purchase structure (or §338(h)(10) election) to maximize their depreciation and amortization deductions.

Frequently Asked Questions