Effingham, Ill.-based dental support services provider Heartland Dental LLC's accelerated pace of office expansion, along with increased one-time investments in 2018, has resulted in a decline of adjusted EBITDA margin of more than 200 basis points (bps) and a significant increase in 2018 leverage to 13.8x from 9x in 2017. We expect EBITDA margins to further erode to about 8% in 2019, as the addition of lower margin offices will likely offset the benefits from one-time investments. S&P Global Ratings revised its rating outlook on Heartland Dental to negative from stable and affirmed our 'B-' issuer credit rating. We also affirmed the 'B-' issue level rating, with a recovery rating of '3', on the first-lien debt and the 'CCC' issue
