AGD Impact September 2023

Exploring the Benefits of 3D Face-Scanning Technology

By William S. Bike

The data captured by 3D face-scanning technology, also known as facial scanning or 3D facial imaging, has the ability to streamline and make many of today’s most common dental procedures more affordable — for the patient and the practitioner.

12 Self-Instruction article, 1 CE credit

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Effective Financial Management for Dentists: Unraveling Tax Law Changes, Practice Profitability and Savings

By Wesley W. Lyon II, CPA, CFP

Many dentists are currently focusing on year-end tax planning, scrutinizing practice profitability and assessing their own financial health. If you’ve been putting this off, consider this a wake-up call — the earlier you start, the better.

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AGD2023 Dazzles in Las Vegas

In July, AGD made a triumphant return to Las Vegas after a six-year absence, and the return was worth the wait. Learn more about AGD2023.

AGD Impact Self-Instruction

17 Exercise No. IM150, 1 CE Credit Oral Medicine, Oral Diagnosis, Oral Pathology (Subject Code: 730)

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AGD Referral Rewards Program

Refer your colleagues to join AGD now, and they’ll pay only half of 2023 headquarters membership dues.* You’ll both also earn $50 in Referral Rewards once they join.

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Charlotte, NC

Member since 2016

*Half-year rate does not apply toward constituent and component portion of dues. Half-year rate does not apply for memberships that expired on Dec. 31, 2022, residents, or new dentists who graduated in 2022 or 2023. Members who pay half-year dues may record CE starting on July 1, 2023.

Rebekkah Merrell, DMD

Preparation, Diligence and Success

Ihad an interesting experience during my last presentation at the Washington AGD. I asked if anyone had any questions. A young man in the front row raised his hand and asked, “Dr. K, do you have any regrets in your life?” Expecting a question about techniques or implant dentistry protocols, I was taken aback. What would initiate such an inquiry? Maybe it was the perception that life may have been easy for me. I paused and flashed back to all the events that have shaped my life.

Often, I like to say that I’ve been blessed. Dental school was not my original plan. I wanted to become a professor — I liked teaching and sharing. Once my career path changed, I became proficient and efficient in school, finishing up my clinicals early and working in a specialized treatment center started by the dean of my dental school. It was more like working in a private practice than a typical dental school clinic. Then came my residency and awesome mentoring and experiences that elevated my confidence. After I moved back home, I was fortunate to associate with a pioneer in implant dentistry. After five years, I started my own practice. I built out my dream setting, which I’ve enjoyed ever since.

Of course, there were many trials and tribulations along the way, but I like to think that it is better to consistently move forward. As dentists, moving forward means being aware of all the recent advances in the field. The best way to do that is to attend AGD scientific sessions, which promote clinical, personal and business acumen. I was fortunate enough to attend and lecture at AGD2023 this past July. I know from looking at the impressive number of new Fellows, Masters, and Lifelong Learning and Service Recognition recipients that our organization is made up of special individuals that strive for knowledge and experience. You can find a special recap of the meeting in this issue.

Another part of being a successful dentist is building relationships with our physician colleagues. The first installment of our Medical Perspectives column series aims to do just this. We cannot assume that physicians totally understand the intraoral processes that we address daily, just as we cannot be expected to comprehend every medical condition that our patients present with. Combining our talents makes for a comprehensive medical/dental experience that is in the best interest of our patients.

My dermatologist recently removed some small lesions from my leg. To reciprocate, I performed an extraction and placed a dental implant for him. He was as anxious about his dental care as I was about my medical treatment. I even asked if he wanted to remove his own sutures, and he casually stated, “Oh no. I don’t know anything about the mouth.” This brought a bit of a smile to my face. It made me realize that, although we are both excellently trained professionals, our paths are a bit divergent.

So, our dental lives have many layers. We must learn from personal, business and clinical experiences and navigate complex relationships with the public, our team, our families and our friends. My advice is to embrace each encounter positively and know that you are not alone, but rather part of a comprehensive family — the AGD family.

So, do I have any regrets? Not many — maybe a few business decisions that went awry, planned projects that ended in unexpected ways and mentoring relationships that ended abruptly. People change and ideas evolve, but consistent forward progress and hard work lead to a better endgame and personal and professional success. I may have a few regrets, but developing a passion for dentistry has never been one of them.

EDITOR

Timothy F. Kosinski, DDS, MAGD

ASSOCIATE EDITOR

Bruce L. Cassis, DDS, MAGD

DIRECTOR, COMMUNICATIONS

Kristin S. Gover, CAE

EXECUTIVE EDITOR

Tiffany Nicole Slade, MFA

MANAGING EDITOR

Leland Humbertson, MA

ASSOCIATE EDITOR

Caitlin Davis

MANAGER, PRODUCTION/DESIGN

Tim Henney

GRAPHIC DESIGNERS

Robert Ajami

Eric Grawe

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DISCLAIMER: The Academy of General Dentistry does not necessarily endorse opinions or statements contained in essays or editorials published in AGD Impact. The publication of advertisements in AGD Impact does not indicate endorsement for products and services. AGD approval for continuing education courses or course sponsors will be clearly stated. AGD Impact (ISSN 0194-729X) is published monthly by the Academy of General Dentistry, 560 W. Lake St., Sixth Floor, Chicago, IL 60661-6600. Canadian Mailing Information: IPM Agreement number 40047941. Change of address or undeliverable copies should be sent to: Station A, P.O. Box 54, Windsor, Ontario, N9A 6J5, Canada. Email: impact@agd.org. Periodical postage paid at Chicago, IL and additional mailing office.

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Timothy F. Kosinski, DDS, MAGD Editor

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Advocacy Spring State Legislative Recap

By the end of June, most states have ended their spring legislative sessions. Here are some highlights.

After the success of Massachusetts Ballot Question 2 in November, 13 states introduced a version of medical loss ratio legislation for dental insurers. Three states enacted legislation. In Nevada, the law requires insurers to file their loss ratio with the state and have that information published on the Nevada website. If a loss ratio is under 75%, the state may force the insurer to reduce the rate and compensate their insureds.

Colorado’s new law also requires that dental insurers make their loss ratios available to the public and allows the state to investigate insurers whose loss ratios are outside of the average. Arizona will require

dental insurers to file their loss ratios with the state for posting on its website.

Other insurance reform issues in the states are the prohibition of involuntary third-party network leasing and the use of virtual credit cards. New Mexico passed a bill that limits when insurers can deny claims that are pre-authorized, allows assignment of benefits, bans payments using fee-carrying credit cards and allows providers to opt out of third-party network leases. Other states reforming third-party network leasing and the use of virtual credit cards are Illinois and Minnesota.

Five states introduced legislation to license dental therapy. Washington passed a law licensing dental therapists, but it limits their practice to federally qualified health centers (FQHCs) and FQHC lookalikes.

State legislatures also looked to address workforce issues in dentistry. As of the end of June, three states — Iowa, Tennessee and Washington — had passed the interstate compact on dentists and dental hygienists. Minnesota, Kansas, Ohio and New Jersey all have legislation pending, and the compact will go into effect when the seventh state enacts it.

Connecticut, Illinois, Oregon and Washington all passed laws to make it easier for a member of the dental team to be licensed in the state.

Dental benefits and/or rates under Medicaid were increased in Michigan, Minnesota, New Hampshire, North Dakota, Utah, Vermont and New York (via a court case), and Kentucky voted to take away dental benefits under Medicaid.

Governance Proposal to Amend the Bylaws

There is one proposal to amend the AGD Bylaws at the 2023 House of Delegates (HOD) meeting Nov. 10–12. This proposed amendment would create a new category of AGD membership through the addition of “Resident Member” to the Bylaws. Residents who have previously been members were counted and categorized as “Active Members.” Originally conceived by the New Jersey AGD, the rationale is that residents are still finding where they belong in the dental community, and while they could serve in the AGD HOD as regular members, their residency status would practically bar them from doing so. Through service at the early stage of their career, residents would be more likely to stay long-term AGD members. Both the Membership Council and the Constitution, Bylaws and Judicial Affairs Council have vetted this proposal.

AGD Fact Sheets

Talking to Patients About Vaping

AGD fact sheets provide your patients with all of the information they need to maintain their oral health. Fact sheets on more than 25 oral health topics are available for downloading online and can be customized to include your name and practice information. Download the fact sheet “The Dangers of Vaping” at agd.org/ factsheets

AGD

Podcast

‘Dental Practice Models for Growth and Balance’

AGD Podcast host George J. Schmidt, DMD, FAGD, talks with Brady Frank, DDS, about opportunities for dentists while working with dental services organizations (DSOs) and the business of dentistry. They discuss opportunities for general dentists to build the types of practice they want and find balance in their lives. Frank, a third-generation dentist, advocates for dentists to learn about the autonomous DSO and how to use this practice model in their career planning. He is passionate about teaching others the hardwon lessons he has learned about creating and selling a business. He is the cofounder of Freedom Dental Partners.

Visit agd.org/about-agd/publications-news/agd-podcasts to listen now.

The Daily Grind

Look for the Newest ‘Daily Grind’ Blog Post

AGD’s blog, “The Daily Grind,” offers insight and reflections from dental students and practicing general dentists. Read the beginning of “Fostering a Sense of Community that Benefits All” by AGD

Editor Timothy F. Kosinski, DDS, MAGD:

Our AGD promotes advocacy for all of our members and all general dentists in one way or another. But what does advocacy mean? It is simply defined as public support for or recommendation of a particular cause or policy. Our outstanding leaders reach out to governmental agencies to recommend action on issues that directly benefit dentists. It’s a very tough job in this current political setting, but it’s one that needs to be done professionally and successfully for the present and future.

Education

Get One Step Closer to Attaining AGD Fellowship

Join us for the 2023 Fall Fellowship Review Course at the Capital Hilton in Washington, D.C., Oct. 6–7, and earn 16 hours of CE. The Fellowship Exam will take place the following day, Oct. 8. Premium Plus members receive a 20% discount on the review course. To learn more or to register, visit agd. org/education/awards-recognition/become-an-agd-fellow/ fellowship-review-course.

Inside General Dentistry

Look for the following article in the September/ October 2023 issue of AGD’s peer-reviewed journal, General Dentistry.

Multidisciplinary management of a tooth with severe root dilaceration and enamel hypoplasia: a case report Dental trauma in primary teeth can cause irreversible changes in the development of permanent tooth germs, including enamel hypoplasia, crown dilaceration, and root dilaceration. This article discusses multidisciplinary treatment of enamel hypoplasia and root dilaceration in the maxillary left central incisor of an 11-year-old girl. A 10-year follow-up is reported to demonstrate the long-term clinical outcomes. At the initial presentation, the patient’s mother reported that the child had an accident at the age of 2 years, resulting in intrusive luxation of the primary maxillary left central incisor. After the accident, the patient was monitored for eruption of the permanent successor tooth, and different approaches were proposed during each period of the patient’s development on the basis of the clinical diagnosis of root dilaceration and enamel hypoplasia. The crown was restored with composite resin, and the root defect was restored with resin-modified glass ionomer cement. After 10 years, the clinical outcomes highlight that the multidisciplinary approach was successful in preserving the natural tooth with good periodontal health conditions.

OSHA and the Dental Office — Part One: Bloodborne Pathogens

By J. Kathleen Marcus, Esq.

Among the government inspections dreaded by dental office owners — state dental boards, the Drug Enforcement Administration — perhaps the one that causes the most confusion is a visit from the Occupational Safety and Health Administration (OSHA). In part one of this two-part series, I will discuss OSHA requirements for the dental office regarding bloodborne pathogens. In part two, I will discuss OSHA dental office requirements for infection control. Throughout, I will outline all the required recordkeeping so every dentist employer can sail through an OSHA inspection.

What Could Bring an OSHA Inspector to Your Dental Office?

OSHA can inspect a dental office with no prior notice for any of the following reasons:

1. Imminent danger situations — hazards that could cause death or serious physical harm.

2. Severe injuries and illnesses.

3. Worker complaints.

4. Referrals of hazards from any entity or individual.

5. Targeted inspections — “inspections aimed at specific high-hazard industries or individual workplaces that have experienced high rates of injuries and illnesses.”

6. Follow-up inspections.1

In short, dental offices may have an OSHA inspection at any time with no warning. Since anyone — patient, employee or anonymous stranger — may complain to OSHA, every dental office must have the training and documentation required if an OSHA inspector arrives.

An Introduction to OSHA Standards

OSHA regulations are divided into “standards,” each of which identifies a potential occupational exposure to a dangerous substance, machine or structure; defines an occupational risk; and sets out all legal obligations of the employer to protect employees from that risk. The OSHA standards are long and complicated, and attempting to understand them is daunting.

OSHA and Bloodborne Pathogens

The OSHA standard that applies to every treatment or procedure day in a dental office is standard 1910.1030 - Bloodborne Pathogens 2

It applies to all dentists whose employees come into contact with blood or saliva, regardless of the number of employees in the office. To comply with the OSHA bloodborne pathogen standard, the office must have an exposure control plan (ECP) that is available to all employees. The ECP must contain an “exposure determination,” which is:

• A list of all jobs in which all employees whose job “classifications” involve occupational exposure to bloodborne pathogens or saliva. The list would include at least dental hygienists, dental assistants and all dentists who are not the employer.

• A list of all jobs in which some employees have occupational exposure, which, in the dental office, would be the same people — those who are in the room during patient treatments or procedures.

• “A list of all tasks and procedures … in which occupational exposure occurs and that are performed by employees in job classifications listed” in the two categories above. For this step, look at the job descriptions of the people you have listed, and use your common sense.

• A procedure for responding to exposures.

• “A schedule of how other provisions of the standard are implemented, including methods of compliance, … hepatitis B [HBV] vaccination and post-exposure evaluation and follow-up, communication of hazards to employees, and recordkeeping.”3

‘Methods of Compliance’

What do “methods of compliance” mean in regard to the bloodborne pathogens standard? They primarily pertain to universal precautions, appropriate sharps containers, hand and office clean-

ing, and personal protective equipment (PPE). But there is another requirement that is not commonly known by dentists — the need to annually assess “safer medical devices” less likely to result in employee exposure to bloodborne pathogens. Complying with this component of the standard can be as simple as upgrading to gloves less likely to puncture, but it also requires you to document that, at least annually, you have researched new dental equipment and PPE to ensure you are aware of safer alternatives.

After a Needle Stick

After a needle stick, the OSHA standard on bloodborne pathogens dictates the dentist employer must make “immediately available to the exposed employee a confidential medical evaluation and follow-up,” including at least the following:

1. Documentation of the route of exposure, i.e., needle stick, and the circumstances under which the exposure incident occurred.

2. “Identification and documentation of the source individual,” which would be the patient in most instances.

3. If consent can be obtained, the patient’s blood should be tested for HBV and HIV if the patient’s infection status is not already known.

4. The exposed employee must be told the HBV and HIV status of the patient and told this information cannot be shared other than with a healthcare provider.

5. If the exposed employee consents, their blood must be tested for HBV and HIV.

6. If medically indicated and the employee consents, the employer must provide post-exposure prophylaxis, counseling and treatment of any illness that testing may find.

Additional Requirements

The ECP must be available to all employees with potential exposure to blood or saliva, and these employees must have the opportunity to make suggestions for improvement. And, finally, all these same employees must be trained — and the training documented — on the contents of the ECP at least annually.

Each dental office must also maintain a separate sharps injury log containing the name, date, circumstances and post-exposure response or treatment. Since this log contains confidential medical information about employees, it should be considered confidential and maintained as you would any other medical record.

In addition, every employer dentist must keep medical records for each employee exposed to blood or saliva in the dental office. This record must contain the name of the employee, HBV vaccination status, and all records concerning any occupational exposure requiring a response. While HIPAA does not apply to records kept per OSHA regulation, these records must be confidential and must be maintained for the length of the employee’s employment plus 30 years.

All of this recordkeeping can seem overwhelming, but, luckily, OSHA publishes template ECPs and model bloodborne pathogen control programs that can help your office manage the required training and recordkeeping. 4 But with OSHA, as well as all aspects of dental office compliance, you may want to have your recordkeeping practices reviewed by a healthcare counsel expert in occupational health. F

J. Kathleen Marcus, Esq., is former general counsel at Strategic Dentistry. As a healthcare law and data privacy expert, she has provided regulatory compliance guidance to healthcare practitioners for over 35 years. A post-graduate student at Queen Mary University of London, she expects to receive her LLM in Technology, Media and Telecommunications in 2025. To comment on this article, email impact@agd.org

REFERENCES

1. “Occupational Safety and Health Administration (OSHA) Inspections.” OSHA Fact Sheet, osha.gov/sites/default/files/factsheet-inspections.pdf. Accessed 14 July 2023.

2. “1910.1030 - Bloodborne Pathogens.” Occupational Safety and Health Administration, osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030. Accessed 14 July 2023.

3. “Quick Reference Guide to the Bloodborne Pathogens Standard.” Occupational Safety and Health Administration, osha.gov/bloodborne-pathogens/quick-reference. Accessed 14 July 2023.

4. “Model Plans and Programs for the OSHA Bloodborne Pathogens and Hazard Communications Standards.” Occupational Safety and Health Administration, Publication 3186, 2003, osha.gov/publications/osha3186.pdf. Accessed 14 July 2023.

GERD Symptoms Are Problematic for Both Gastroenterologists and Dentists

By Nick Bartell, MD

This column series features members of various medical specialties discussing what dental problems they routinely see in their patients. The goal is to foster a sense of collaboration among the professions and spark conversations about what dentists should consider when treating different types of patients.

This installment is a collaboration between AGD and the American Gastroenterological Association. Optimal communication between general dentists and gastroenterologists is vital because both professions are concerned about helping patients with acid reflux and limiting the effects of acid erosion on the body.

As a gastroenterologist, what acid-related health problems do you routinely encounter?

K nown or suspected disorders related to reflux of acid from the stomach into the esophagus or proximally in the hypopharynx, oropharynx or oral cavity are some of the most common reasons for referral to a gastroenterologist. These patients are typically diagnosed with gastroesophageal reflux disease (GERD). Just over 30% of adults in the United States have reported some GERD symptom in the prior week.1 Typical GERD symptoms include heartburn and regurgitation; however, there are also a number of “extra-esophageal” symptoms, including chronic cough, throat-clearing and hoarseness, which can be quite troublesome to patients and difficult to treat. It is also important to remember that GERD can have significant complications, including the development of strictures or scarring in the esophagus resulting in dysphagia, or increasing the risk of esophageal cancer through the development of Barrett’s esophagus. Typically, these long-term complications are when gastroenterologists are heavily involved in a patient’s care. Endoscopic procedures are utilized to treat strictures through dilation or stenting and also the identification, surveillance and sometimes direct treatment of premalignant lesions or earlystage cancers of the esophagus.

What advice would you give to general dentists when treating patients with acid reflux?

One of the often underrecognized complications of GERD by gastroenterologists is the acceleration of tooth decay and wear, which is suggested to affect about a quarter of all patients with GERD.2 When dentists recognize significant dental erosion or wear, it is an opportunity to briefly discuss GERD as a possible cause. It is possible for a patient to have clinically significant acid reflux with some complication but either have no typical symptoms or not seek medical care and treat with over-the-counter medications/remedies. If these patients never seek medical care for their condition, they may go on to develop potentially avoidable complications. If patients report trouble swallowing, weight loss or gastrointestinal bleeding, they should be promptly referred for endoscopy. Dentists are uniquely positioned to identify patients with GERD during the oral exam, and they can significantly impact the overall health of a patient if a previously unknown condition is uncovered.

It should also be noted that patients currently undergoing treatment for GERD supervised by a physician often are on medications, most commonly proton pump inhibitors (PPIs) such as omeprazole, lansoprazole and pantoprazole. Given their widespread use, there have been some concerns both in the scientific literature and lay media that PPIs pose significant long-term health risks (including dementia, pneumonia, chronic kidney disease, heart attacks, strokes, etc.). However, there have yet to be rigorous randomized control trials that have identified a strong cause-and-effect relationship for most of these conditions excluding the possibility of an increased risk of intestinal infections.3 Gastroenterologists agree that, in general, if a patient is being treated for a known acid-related

condition, the benefits of PPIs outweigh the overall small risks. Reinforcing this message for patients from other trusted members of the healthcare team is important to ensure patients who truly need treatment do not stop treatment based on poor information.

How can general dentists and gastroenterologists better communicate to treat patients?

All members of a patient’s care team should have open lines of communication with the goal of improving a particular patient’s

overall health. Recognition that GERD can affect a patient’s oral health is obviously important for dentists, but we gastroenterologists could also certainly do a better job ensuring that our patients with GERD are being routinely followed by a dentist. Dentists also should have an understanding of the “red flags” previously discussed, which should prompt a more thorough evaluation by a gastroenterologist. F

”Nick Bartell, MD, is assistant professor of medicine, Gastroenterology & Hepatology Division, at the University of Rochester Medical Center. To comment on this article, email impact@agd.org.

REFERENCES

1. Delshad, Sean D., et al. “Prevalence of Gastroesophageal Reflux Disease and Proton Pump Inhibitor-Refractory Symptoms.” Gastroenterology, vol. 158, no. 5, April 2020, pp. 1250-1261 e2.

2. Picos, Andrei, et al. “Dental Erosion in Gastro-Esophageal Reflux Disease. A Systematic Review.” Clujul Medical Journal, vol. 91, no. 4, Oct. 2018, pp. 387-390.

3. Katz, Philip O., et al. “ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease.” American Journal of Gastroenterology, vol. 117, no. 1, Jan. 2022, pp. 27-56.

Dentists are uniquely positioned to identify patients with GERD during the oral exam, and they can significantly impact the overall health of a patient if a previously unknown condition is uncovered.

The Owner Years

By Clayton Sorrells, DDS

This column is dedicated to the crazy people thinking about becoming practice owners right out of dental school. It feels like a year’s worth of events have occurred since I wrote my previous column, but it has only been a few months. I graduated from dental school, Emily and I finally had a honeymoon in Hawaii, we moved back to my hometown in Arkansas, and I bought a dental practice. The last few months have been a rollercoaster, but I cannot wait to share everything I have learned and what I wish I had known.

I will never forget my first patient as owner of Glenwood Family Dentistry. It was a simple distal composite filling I had done 50 times before. Just as I was about to lean the patient back in the chair, I realized that I had no clue how to operate the chairs. I looked at my assistant and motioned for her to lean the patient back. She replied, “Yeah, these chairs are a little cantankerous sometimes,” and reached to my side and pushed the button to lower the patient. My first lesson as the owner of a dental practice was that just because you are the owner does not mean you will know everything on your first day.

If you are thinking about becoming an owner, you must ensure you are buying the right office. A lot goes into this decision, such as the types of procedures the current owner performs, the profitability of the practice and the current office culture. If the current owner does a lot of complex implant cases or complex root canals, and you have little experience in those areas, it will be hard for you to take over that practice. Before purchasing, you will want to dive deep into the practice’s finances. In my case, Carl S. Plyler, DDS, and I met with his accountant, and he told his accountant to give me every financial document he had. This was a good sign, because it showed he had nothing to hide. If the person you buy from is unwilling to show you the practice’s financials, that should be a red flag.

You also need to focus on what the culture is currently like. While you can always change an office’s culture, you will have more to worry about being a new dentist and owner. Be sure to talk with the current staff and see how everyone works together. You need to be able to lean on your team for a few months as you’re getting settled, and it will be hard to do that if there is not a good culture.

While finding the right office is significant, you also need to ensure you feel comfortable enough with your clinical skills that you will be able to keep up the pace in private practice. On my first day as an actual dentist, I did two crown preparations, two extractions, several fillings, a treatment-planning appointment and six hygiene checks. While I am not clinically superior to anyone, I have enough experience to feel comfortable in most situations. If there is something that completely stumps me, I have a great mentor in my corner who has owned a practice for 38 years. If you

feel your clinical training has not been adequate, it might be best to do either an advanced education in general dentistry program or general practice residency, or be an associate for a little while.

You are also going to have to do some soul-searching. If you do not feel like you can make business decisions right now and need to hone your clinical skills, ownership might not be the right decision at this point. When I thought about doing payroll, managing staff and directing the business in the way I wanted to go, it excited me. One of the most challenging questions I have been asked since graduating is: “Dr. Sorrells, we are about to run out of composite; which brand of composite would you like to order?” The number of simple questions that have kept me awake at night might surprise you.

My last point is all about the owner you are buying from. I have known Plyler almost my entire life, and I know what kind of dentist and person he is. I am lucky that I was able to buy a practice that I knew so well, but only some have that opportunity. I would only jump into ownership if you know the practice owner and the practice very well. I have heard horror stories of people buying practices in which the owners were not completely honest with them. Be sure to have an accountant review the finances and a lawyer review your contract before making any final decisions. You also want to ensure this dentist is someone you want to work with and learn from. Yes, you graduated from dental school and you know how to do most procedures, but there will still be a lot that stumps you. However, there will come a point where you are ready to spread your wings and fly, and, if the previous owner is still there, it will be hard to do that. Plyler and I have decided that he will stay for at least six months, and it will be at my discretion if I want him to be there longer. If the owner wants to stay longer than a year or two, you should talk with them. That can be an awkward conversation during contract negotiations, and discussing it before it becomes an issue is better.

Becoming a dentist and buying a practice right out of school have been the best decisions I have ever made. We had so many dental offices come and talk to us about being associates while I was in school. I always left feeling like I wanted to be the one making all of the final decisions, and I wanted to skip the associate years. This might not be the route you want to go, and that is absolutely fine. Most people choose to be an associate first, but, if you have the right scenario to become an owner, you should jump on it. F

Clayton Sorrells, DDS, is a new dentist and previous AGD chapter president at Louisiana State University School of Dentistry. To comment on this article, email impact@agd.org

AGD HAS BENEFITS FOR YOUR UNIQUE NEEDS

Exploring the Benefits of 3D

Face-Scanning Technology

By William S. Bike

Military technology often can be repurposed to improve the daily lives of civilians.1 One of the latest examples is 3D face-scanning technology, also known as facial scanning or 3D facial imaging.

“3D facial scanning was originated for homeland security,” explained Dean Vafiadis, DDS, program director, New York University full-mouth rehabilitation continuing education course; clinical associate professor, implants and prosthodontics, New York University College of Dentistry; and adjunct professor, prosthodontics, Nova Southeastern University College of Dental Medicine. “Those programs were based on the face, eyes, nose and ears, but the part we need for dentistry is the actual teeth — and with an accuracy of around 50 to 60 microns. We were getting only about a millimeter or two — not good enough. We needed a much more accurate system to create smiles and implants.”

Nowadays, several 3D face-scanning technologies are suitable for use in dentistry, involving “the use of various techniques to capture and analyze the 3D structure and appearance of a person’s face,” said Mohammed Elnagar, DDS, MS, PhD, assistant professor of orthodontics at the University of Illinois Chicago College of Dentistry.

The data captured by this technology has the ability to streamline and make many of today’s most common dental procedures more affordable — for the patient and the practitioner.

Applications

“The primary application of facial scanning is for general dentists, and the primary reason is for cosmetic dentistry — veneers, cosmetic crowns, smile makeovers and smile design,” said Ahmad Al-Hassiny, BDS, director of the Institute of Digital Dentistry

(iDD) in Wellington, New Zealand. “It can also be used for digital waxups, full-arch implants and even dentures. A facial scanner will have value for anything that involves the patient’s smile because you can give your lab so much data about the patient’s facial proportions, buccal corridors and smile alignment — all in one piece of 3D data — and then the lab can design the restoration or cosmetic work to fit the patient’s face for truly tailored dentistry.” “Face-scanning technology in dentistry is often used for treatmentplanning, smile design, orthodontic analysis and creating custom dental restorations,” Elnagar said.

“The data helps in creating precise treatment plans for procedures such as orthodontics, dental implants and prosthodontics,” he noted. “This technology enables dentists to design and fabricate custom-made dental appliances like crowns, dentures and braces that fit better and provide enhanced comfort.”

Additionally, the technology can be used in craniofacial research and in obstructive sleep apnea diagnosis and treatment.2

Technology

“Most dentists are now familiar with an intraoral scanner (IOS),” said Al-Hassiny. “It is essentially a camera that takes pictures of the patient’s teeth and gums. A facial scanner is an extension of that, but, rather than only doing intraoral scans, it takes a digital impression of the patient’s face. It gives you a lifelike, fully 3D model in color.”

Elnagar described five major types of face-scanning technologies: structured light scanning, time-of-flight (ToF) scanning, stereo photogrammetry, 3D laser scanning and photometric stereo.

“There are a number of different approaches for generating a 3D model of an object or face,” explained Derek Riley, PhD, professor

and program director of computer science for the Milwaukee School of Engineering. “Some use stereo high-resolution cameras, others use light detection and ranging (LIDAR), and there are other approaches.”

LIDAR was an early technology, said Al-Hassiny, as was the Bellus3D DentalPro facial scanner app. Launched in 2015, it could be used with an iPhone or iPad. He called it “one of the best and most popular 3D face-scanning technologies in the dental industry.”3 But Bellus3D decided to phase it out by the end of 2022 because “the market for dentistry was only about 12% for them,” Vafiadis said.

Face-scanning technology is available from Artec 3D, Ivoclar, Ray America, Pearl, Revopoint, Umax, Zirkonzahn and other companies.

Vafiadis is a consultant for Ray America and a strong proponent of its RAYFace facial scanner.

“It has 12 cameras that are very quick and take photos 180 degrees around the face, from ear to ear,” he explained. “You get really good resolution of the incisal edges, and it can completely scan the front teeth — not just give you a side view that is not accurate without definition.”

The software automatically provides facial lines that can be moved by the operator if necessary to allow for facial distancing on several data points.

“The software gives you the facial lines of the patient’s face in real time, and I can move those lines integrally,” said Vafiadis. “We’re not drawing lines with a ruler; we’re doing it with a computer. This allows the clinician to accept facial lines or add or adjust them to the specific treatment.”

Al-Hassiny has extensively covered and reviewed RAYFace on the iDD website (instituteofdigitaldentistry.com).4 He noted that a newer entry into the dental face-scanning market is by a company called Shining 3D. “It is called the MetiSmile, and it is quite impressive, using a different technology called vertical-cavity surface-emitting lasers.”

He also noted that “each facial scanner has its own proprietary software; you take the scan and send it to a lab. They can also be

used with the most popular CAD/CAM [computer-aided design and computer-aided manufacturing] software in dentistry, such as Exocad, using STL format.”

Accuracy

Face-scanning technology, Elnagar said, allows dentists to visualize “facial symmetry, tooth proportions and overall harmony” so they “can plan and execute cosmetic procedures with improved accuracy, resulting in enhanced smiles.”

“The accuracy can vary quite a bit based on the technology and the setup,” Riley said. “Most of these scans can be done cheaply at lower resolution; cost goes up quickly with higher resolution needs.”

Should potential purchasers necessarily look for the most accurate technology? “It depends on the application,” Riley said. “Low resolution may be sufficient for some types of applications but not work well for others. I would pay close attention to the accuracy, precision and recall of the systems under a wide variety of examples.”

“Textures and colors between scans can vary quite a lot, especially depending on lighting, but so long as the scan is done properly, they seem to be very accurate,” Al-Hassiny said.

Vafiadis noted that, in the past, dot alignment was used. “One dot on several teeth would be used to merge two STL files,” he said, noting that although dot alignment worked, the possibility of operator error existed and that there were “slight variations” per operator.

“We used to pick two or three dots of the intraoral or CBCT [cone beam computed tomography] scan and merge it with the three dots with an accuracy of about 100 to 120 microns,” Vafiadis explained. “RAYFace uses the incisal ridges of six-to-eight anterior teeth, and it’s 100% accurate.”

Using the central incisor position as a linear outline of the six anterior teeth, all data sets can be merged accurately, he noted.5

Researchers Amornvit and Sanohkan compared the accuracy of several face-scanning technologies and found differences in accuracy depending on scanning length and pattern as well as the technology used by each scanner.6

The lab can design the restoration or cosmetic work to fit the patient’s face for truly tailored dentistry.

— Ahmad Al-Hassiny, BDS

Artificial Intelligence

“Artificial intelligence (AI) integration with face-scanning technology allows for more sophisticated analysis, interpretation and utilization of the captured facial data, enabling a wide range of applications,” said Elnagar.

AI models “can be used to ‘fix’ artifacts introduced by scanning technologies or to upscale a lower-resolution version,” Riley noted. “You can also use models to determine how one scan maps to another, which is called location registration.”

“AI interfaces with face-scanning technology in several ways, enhancing its capabilities and enabling various applications,” Elnagar said, noting that AI is used heavily in the areas of facial recognition, facial expression analysis, age and gender estimation, facial landmark detection, virtual character creation, beauty analysis and enhancement, and deep learning for image processing.

“Automatic recognition of facial landmarks — the pupils, interpupillary line, the nose, the midlines, the auditory canals — is probably the main use of AI right now in face-scanning technology,” Al-Hassiny explained. “The leader in using AI with facial scanners right now is RAYFace. AI can map out and place those quite accurately and can map out the facial planes automatically. You will know if there are midline issues or if the midlines don’t match up with the smile, etc.”

Some AI will automatically align the intraoral scan data to the teeth with 3D scans, he added.

Vafiadis noted that RAYFace AI is updated monthly and requires no additional purchase. “It’s automatic, and it also automatically detects the landmarks we all need for facial esthetics,” he said.

CBCT, CAD/CAM, and Intraoral Scanners

“Face-scanning technology and existing dental technology serve different purposes but can complement each other in certain aspects,” Elnagar said.

Even though 3D face-scanning technology and CBCT are digital imaging technologies, Elnagar says they’re focused on different areas. Face-scanning technology is keyed in on facial features, soft tissues and esthetics. It offers broader options in terms of applications. Radiation exposure is not an issue. In workflow integration, face-scanning technology can be integrated into the dental workflow “as a chairside tool, enabling real-time scanning, treatment planning and communication with the patient.”

“We use face-scanning technology for CAD/CAM and for orthodontics and orthognathic surgery,” Al-Hassiny said. “Facial scanners can replace taking facial photography because a facial scanner is much more accurate, standardized and consistent than a photograph, which could be taken at the wrong angle, with the wrong lighting or with the wrong camera setting. Photographs still have their place for other uses, but, for CAD/CAM, I only use facial scanners now.”

The various imaging technologies “do coexist, and give us a lot of diagnostic information,” he noted. “An intraoral scan gets combined with your facial scan for smile design. If you want

Types of Face-Scanning Technologies

Mohammed Elnagar, DDS, MS, PhD, of the University of Illinois Chicago College of Dentistry, explained the five types of facescanning technologies as:

1. Structured light scanning projects patterns of light onto the face and uses a camera to capture the distortions in the patterns caused by facial contours.

2. Time-of-flight (ToF) scanners emit infrared light and measure the time it takes for it to bounce back from the face. The data is used to create a depth map.

3. Stereo photogrammetry involves capturing multiple images of the face from different angles using multiple cameras. Differences in the images are then analyzed.

4. 3D laser scanning measures the distance to various points on the surface and combines the measurements.

5. Photometric stereo uses multiple images of the face captured under different lighting conditions to estimate surface normals.

From any of these, a 3D model of the face can be constructed by integrating the information.

to go even further, you can combine it with your CBCTs, and then you can get into all sorts of different orthognathic surgery applications and orthodontic applications, using the teeth as the reference points and looking at actual root movements. Combine it with jaw motion tracking, and you get a real kind of 3D twin of the patient.”

The dentist can use face-scanning technology with an existing IOS and CBCT, Vafiadis said, but there may be a few extra steps. “With the Sirona software, for example, you have to go to its website, download your CBCT, and then import it. So, there are little quirks, but you don’t need a facebow anymore. The CBCT is tracking with the IOS and the vision scan at the joint, so it’s automatic.”

He advises dentists to have a dedicated area in the office about the size of a desk for face-scanning technology. “Put it together with the CBCT machine,” Vafiadis said.

Costs

Al-Hassiny notes that facial scanners are available at various price points. MetiSmile is a few thousand dollars, while the RAYFace is at about $20,000. “Right now, some dentists will scoff at the price, while others see the value,” he said. “A lot of these companies are trying to innovate on the software side to make it more of a palatable purchasing decision. But face-scanning technology is already decreasing in price. We’re seeing market adoption, and it’s going to be a no-brainer with time that a dentist will consider buying one, just like intraoral scanning technology.”

Use of face-scanning technology offsets other costs. “The digital scans eliminate the need for physical impressions and manual

model preparations, streamlining the treatment process and enhancing overall efficiency,” Elnagar said.

“Before this, I had a CBCT scan, an intraoral scan, a radiograph, a photo and a video, and the lab would get five files from me and from every dentist, and it would take hours and hours to import all the data to get to what we wanted to do, which was basically design the design platform,” Vafiadis said. “Now, the laboratory just gets one integrated file handed to it, so the dentist is paying for a lot less lab work.”

He advises dentists to look at their return on investment (ROI).

“You put about $4,000 down, you’re financing $16,000 over five years, so it’s costing you about $250 per month,” Vafiadis explained. “Are you doing a denture, a smile design, a provisional or an immediate all-on-X implant full-arch restoration? Then you’re going to save more than $250 per hour — and you’re going to get better results. If you’re doing a provisional, you can save at least an hour per prosthesis. If you’re treating one denture per month, you can save four hours. So, the value of your ROI in just time saved is substantial, much more than $250 per hour. It’s huge.”

Future

Elnagar sees a bright future for 3D facial scanning in dentistry. Its benefits, he said, are precise treatment planning, improved patient communication, customized treatment solutions, enhanced esthetics, reduction of time and improved cost efficiency.

Dental students and dentists “will never have to touch wax,” Vafiadis said. “They just have to look at the scan and make a decision about tooth selection, shape and size based on prosthodontic principles with the lab tech.”

“Like any other piece of technology in dentistry, face-scanning technology is just going to get cheaper in the future,” Al-Hassiny

said. “Anyone doing any sort of cosmetic work will be using one. It’s just a matter of time. The AI will get better, and the textures will get better.”

“Companies will incorporate AI and other features into their facial scanner software to do segmentation of teeth and smile design,” he predicted.

“What’s our alternative in dentistry anyway?” Al-Hassiny said. “A photograph — and we know a photograph is not really that easy to take consistently. So, I believe 3D face-scanning technology will only become more accurate, more easy to use and more useful in dentistry.” F

William S. Bike is a freelance writer and editor based in Chicago. He is a former director of advancement communications for the University of Illinois Chicago College of Dentistry. To comment on this article, email impact@agd.org

References

1. McFadden, Christopher. “9 Military Spin-Off Technologies We Use Almost Everyday.” Interesting Engineering, 7 June 2020, interestingengineering.com/lists/9-military-spinoff-technologies-we-use-almost-everyday

2. Lee, Jason D., et al. “Facial Scanners in Dentistry: An Overview.” Prosthesis, vol. 4, no. 4, 15 Nov. 2022, pp. 664-678.

3. Al-Hassiny, Ahmad. “Goodbye to the Bellus 3D Dental Facial Scanner App.” Institute of Digital Dentistry News, 25 April 2022, instituteofdigitaldentistry.com/news/saygoodbye-to-the-bellus3d-dental-facial-scanner-app/

4. Al-Hassiny, Ahmad. “RAYFace Review—Is it the Best 3D Facial Scanner for Dentists?” Institute of Digital Dentistry, 12 Jan. 2023, instituteofdigitaldentistry.com/rayface/ rayface-review-the-best-facial-scanner-for-dentists/

5. Vafiadis, Dean. “Three-Dimensional Facial Scanning: A New Paradigm.” Dentistry Today, 22 May 2023, dentistrytoday.com/three-dimensional-facial-scanning-a-newparadigm/

6. Amornvit, Pokpong, and Sasiwimol Sanokahn. “The Accuracy of Digital Face Scans Obtained from 3D Scanners: An In Vitro Study.” International Journal of Environmental Research and Public Health, vol. 16, no. 24, 12 Dec. 2019, p. 5061.

AI interfaces with face-scanning technology in several ways, enhancing its capabilities and enabling various applications.

— Mohammed Elnagar, DDS, MS, PhD

Exercise No. IM150, 1 CE Credit

Oral Medicine, Oral Diagnosis, Oral Pathology

Subject Code: 730

The 10 questions for this exercise are based on information presented in the article, “Exploring the Benefits of 3D Face-Scanning Technology” by William S. Bike, on pages 12–16. This exercise was developed by members of the AGD editorial team.

Reading the article and successfully completing the exercise will enable you to:

• understand what facial scanning is and how it can be used in dentistry, specifically general dentistry applications;

• learn the current state of the technology and future developments on the horizon; and

• recognize how face-scanning technology integrates with existing dental technology and what considerations should be taken into account when making a purchasing decision.

This exercise can be purchased and answers submitted online at agd.org/selfinstruction.

Answers for this exercise must be received by Aug. 31, 2024

1. 3D facial scanning was originated for _____.

A. biometric log-in

B. homeland security

C. advertising data

D. anthropology

2. The accuracy needed for 3D facial scanning in dentistry is around _____.

A. 1 to 2 millimeters

B. 0.1 to 0.2 millimeters

C. 100 to 120 microns

D. 50 to 60 microns

3. According to Ahmad Al-Hassiny, BDS, the primary applications of facial scanning in general dentistry include all of the following except one. Which is the exception?

A. veneers

B. caries treatment

C. cosmetic crowns

D. smile makeovers

4. Valuable information about a patient’s smile that can be transmitted to the laboratory via 3D facial scan data includes all of the following except one. Which is the exception?

A. shade value

B. buccal corridors

C. facial proportions

D. smile alignment

5. A facial scanner is like an extension of _____, which takes images of the patient’s teeth and gums, in that it takes a digital impression of the face.

A. 2D radiography

B. 3D cone-beam computed tomography

C. dental photography

D. an intraoral scanner

6. All of the following are major types of facescanning technology except one. Which is the exception?

A. structured light scanning

B. stereo photogrammetry

C. photometric stereo

D. surface telemetry

7. The acronym LIDAR stands for _____.

A. low impact diametric analysis ray

B. light detection and ranging

C. light iridescence detection and recording

D. light detonation analysis ray

8. Researchers Amornvit and Sanohkan compared the accuracy of several face-scanning technologies and found differences in accuracy depending on _____ as well as the technology used by each scanner.

A. projection distances and pattern

B. scanning length and size ratios

C. size ratios and projection distances

D. scanning length and pattern

9. According to Al-Hassiny, _____ is probably the main use of artificial intelligence (AI) right now in face-scanning technology.

A. detection of potentially cancerous oral lesions

B. automatic recognition of facial landmarks

C. detection of facial abnormalities

D. automized reconstruction planning

10. _____ refers to when AI models are used to determine how one scan maps to another.

A. Location registration

B. Location mapping

C. Landmark mapping

D. Landmark registration

Effective Financial Management for Dentists: Unraveling Tax Law Changes, Practice Profitability and Savings

By Wesley W. Lyon II, CPA, CFP®

Now that summer vacations have passed, many dentists are refocusing on less exciting tasks: year-end tax planning, scrutinizing practice profitability and assessing their own financial health. If you've been putting this off, consider this a wake-up call — the earlier you start, the better. For even more tax strategies, read “Owe Less, Save More: Last-Minute Tax Strategies for 2023” in the March 2023 AGD Impact

Incoming Retirement Plan Modifications: The Secure Act 2.0

The Consolidated Appropriations Act, enacted last December, encapsulates various retirement plan changes to be instituted. While the most conspicuous amendment is the rise in the required minimum distribution (RMD) age, there are several under-the-radar modifications with immediate implications.

Foremost for dentists, 2024 brings a modification to the catch-up salary deferrals for those aged 50 or older. These deferrals are currently allowed on a tax-deductible basis. However, starting in 2024, all catch-up salary deferrals must follow a Roth or aftertax basis. Despite the consequent increase

in taxable income for dentists making these deferrals, I strongly advise making the full salary deferral and Roth catch-up deferral starting in 2024.

This transition might seem straightforward, but many dentists may not realize their current plan might not accommodate catch-up Roth deferrals. A good number of dentists lack Roth capabilities in their 401(k) plans, with even more lacking the provision for catch-up deferrals on a Roth basis. It is essential to touch base with your retirement plan administrator immediately to amend your plan accordingly.

Your Taxation Alarm Clock: Be Sure to Take Advantage of These Strategies Before Year-End

No one likes hearing, “What do you think you were doing?” from their certified public accountant (CPA). Often, the dentist isn’t attempting anything illegal; they’re just acting too late. Ensure these strategies are executed before year-end to avoid any unexpected complications:

• Spousal salary deferral. If your spouse was not on the payroll all year and isn’t employed elsewhere, make sure that

you employ them ASAP and make the maximum tax-deductible salary deferral before year-end. Furthermore, if your plan has a 1,000-hour or one-year requirement before eligibility, make sure to apply credit for all of the “unpaid” hours your spouse has previously worked because these hours will qualify them to participate immediately.

• Employment of children. Wages paid to your children are tax-deductible to you and federal income tax-free so long as wages don’t exceed $13,850 per child. This isn’t an issue for most dentists, as wages must be reasonable for the services being provided. If you have forgotten to implement this strategy, I don’t recommend playing catch-up. Wages need to be reasonable for services provided, paid regularly and paid into your child’s account. Paying a year-end bonus annually likely won’t stand up in the case of an IRS audit.

• The “Augusta Rule.” Under Section 280A(g) of the Internal Revenue Code, you can rent your personal residence for up to 14 days income tax-free. In order to qualify, you must have a business purpose for the rental, a reasonable

rental rate and a payment made from your corporation/partnership to you personally (unfortunately, sole proprietors cannot take advantage of this rule). Common examples of business purposes include study-club meetings, staff parties, board of directors and shareholder meetings, business planning meetings and meetings with practice advisers. Make sure you have a check written and proper documentation before Dec. 31, as this is not an accounting trick your CPA can do for you.

• Health savings account contributions. Don’t have a qualifying plan? Act now to begin receiving quotes from your insurance agent to change plans. Most dentists have one of two opportunities to change plans, either at the business renewal date or during open enrollment, which begins Nov. 1 and ends Dec. 15.

• Purchasing a new vehicle. I never recommend spending a dollar to save 40 cents, but, in this case, it may be worth it. Many taxpayers have been using bonus depreciation to write off the purchase of a new vehicle with a gross vehicle weight rating (GVWR) of 6,000 lbs. or more in the first year. Under the Tax Cuts and Jobs Act, up to 100% of the cost could be eligible for bonus depreciation, but that number is down to 80% in 2023. Furthermore, this number will decrease again to 60% next year. I don’t recommend purchasing a new vehicle only for the tax deduction,

but if you’re going to replace one in the next 12 months, it may be advantageous to purchase before year-end. Of course, make sure business use is at least 50% and GVWR is 6,000 lbs. or more to qualify. Some hybrid and electric SUVs will also qualify for the New Clean Vehicle Credit, putting another $7,500 back in your pocket.

• Pass-through entity (PTE) tax.

The Tax Cuts and Jobs Act placed a $10,000 limit on state and local taxes that can be deducted as part of your itemized deductions. Furthermore, many taxpayers no longer itemize due to the increased standard deduction ($27,700 for 2023). As a workaround, over 30 states have implemented a PTE tax, allowing business owners to pay a portion of their state income taxes through their business and therefore gaining back their federal income tax deduction for state income taxes. Make sure to talk with your CPA to find out if you are eligible, as participation is not automatic.

Financial Wellness: Time for an Annual Checkup

Financial health, much like physical health, requires consistent monitoring and progress tracking. According to the American Dental Association Health Policy Institute, the average retirement age for a dentist in 2021 was 67.9. Many dentists claim to work beyond retirement age out of love for the profession, but the reality often is financial incapacity to retire. Financial wellness, like

a sturdy three-legged stool, depends on profitability, taxes and savings. Since we’ve covered taxes, let’s pivot to profitability and savings.

Practice Profitability: Dodging the Common Overhead Culprits

The first step to reviewing overhead is understanding how to properly calculate your profit margin. Profit is simply net operating income before dentist compensation and benefits. Some accountants will organize the practice profit and loss statement to reflect this, but, for many dentists, this may be a bit harder to calculate. While this calculation won’t be perfect for everyone, here is a quick formula most dentists can use to calculate an approximate profit.

Net Income + Owner Compensation + Family Wages + Associate Compensation (if applicable) + Amortization + Interest + Doctor Perks = Profit

Simply divide profit by your total collections to calculate your profit percentage. A healthy general dentistry practice should have a profit margin of at least 40% before dentist compensation, although my company strives for 45% or better. The most common areas of concern are staff, lab and clinical supply expenses. All dentists have felt the impact of a tight labor market and increased lab and supply expenses. There is good news — with proper planning, you should be able to effectively offset these increases.

Operating Expenses

Occupancy: Rent, utilities, repairs, maintenance, equipment (lease or depreciation). 8.5%

Clerical wages: Wages, payroll taxes, medical insurance, medical reimbursement and other fringe benefits (does not include retirement plan contributions, which are considered profit).

Nonoperating supplies and expenses: Advertising and promotion, marketing, office supplies, office expenses, dues and subscriptions, auto expenses, general taxes, general practice insurance, telephone, interest, travel, meals, entertainment, legal and accounting, continuing education, collection expenses, other miscellaneous expenses.

Clinical wages: Same expenses as for clerical wages, but for clinical staff (assistants and hygienists).

Professional supplies: All supplies used in treatment of patients, laboratory fees, wages for internal laboratory employees (plus lab employee benefits), other costs of operating internal laboratory.

9.6%

11.8%

providers, it’s essential first to ensure your fees are appropriately set. Over the past year, my clients have averaged a production increase of over $200,000 by adjusting their fees to the recommended levels for their specific zip codes. Many dentists admitted they hadn’t regularly updated their fees, attributing the stagnant rates to insufficient insurance reimbursements. Before going out-ofnetwork, it’s critical to adjust your fees to the suitable levels, lest you seem greedy rather than fair.

18.8%

Putting It All Together: Results Matter

Source: “2022 – A Challenging Year for Dentistry.” McGill Advisory, May 2023.

See the above table for a closer look at various expenses.

Many dentists ask me annually, “Am I overpaying my staff?” The answer, more often than not, is not that the wage rate itself is to blame, but rather the number of employees typically contributes to inflated labor costs. Though every dental practice has its unique features, a simple formula generally holds: For each dentist in a busy practice, two assistants, two hygienists and two front desk employees should suffice. Theoretically, adding dentists should increase front desk efficiency, but, in practice, this rarely occurs.

Dentists exceeding this formula often justify their decision with a familiar narrative — their staff is overworked and stressed. In reality, the staff might project busyness and stress to convince the dentist of their indispensability. Conversely, some of the most successful practices maintain a roster of top-tier employees, rewarding them with premium wages. Be cautious

not to fall into the trap of resisting wage increases and replacing one excellent employee with two mediocre ones.

Subsequently, two main factors exacerbating high overhead percentages are revenue-related. First, hefty insurance write-offs depress collections, leaving them far below the actual production value. It’s a common practice for dentists not to enter their full usual, customary and reasonable (UCR) fee into their dental software. This practice fosters a lack of awareness about write-offs, often resulting in blissful ignorance. Some practices proudly spend 0% on marketing, considering it a virtue. However, if you’re not investing time, effort and money into marketing, chances are you’re indirectly paying the insurance company to do so. Dentists should aim to collect 85% or more of their full production annually, with the ultimate goal of reaching 100%.

For those contemplating moving outof-network with one or more insurance

Ultimately, what truly counts is tangible results. High profit margins and low tax bills are crucial, but what matters most is increasing your net worth. I once had a dentist call me frantically after attending one of my lectures. He couldn’t believe how much he had screwed up his taxes and profitability during his entire career. However, he informed me that he had put away over $6 million in savings. I recommended that he relax. While he didn’t get an A+ for profitability or taxes, he earned an A+ in savings and had achieved financial independence.

As a general rule, dentists should aim to save one-third of their profit through retirement plan savings, backdoor Roth IRAs, taxable accounts and practice debt payments. Paying down your practice purchase loans counts as savings, but home mortgages and car payments do not. Create an annual net-worth statement each January, listing all debts and assets, and compare it year-over-year. The goal should be to improve your net worth by at least 20% annually. F

Wesley W. Lyon II, CPA, CFP, is president and CEO of McGill and Lyon Dental Advisors. For more information on his firm’s comprehensive tax and business planning services for dentists and specialists, contact Janet Blair at 877.306.9780, or email consulting@mcgillhillgroup.com To comment on this article, email impact@agd.org.

AGD2023 Dazzles in Las Vegas

In July, AGD made a triumphant return to Las Vegas after a six-year absence, and the event was worth the wait. After the COVID-19 pandemic moved the 2020 scientific session (planned for Las Vegas) to the virtual sphere, members were excited to finally make it back to the glitz and glamour of the city for AGD’s annual event that prioritizes world-class continuing education (CE) for general dentists with sides of fun, networking events, product and technology showcases, and even a few surprises.

Despite the wave of record-breaking heat, AGD members showed up and kept it cool all weekend while enjoying a full selection of CE as well as various networking events and opportunities for fun each day. On finally being back in Las Vegas, Hans P. Guter, DDS, FAGD, AGD president, said, “It feels phenomenal. Vegas is a fun city, it’s a fun time. The heat’s a little much, but it keeps us inside doing what we’re supposed to be doing, so it’s great to be back.”

Las Vegas is a great place to check off general activities from your bucket list, like seeing the Eiffel Tower — or at least a half-scale replica of it. But AGD’s scientific sessions are always great places to check off bucket-list educational activities that will propel your career forward. “We offer exceptional CE. We have quite an array of hands-on participation courses and lecture courses,” said Guter. “But, most importantly for me, is the camaraderie that we build while we’re here, meeting new friends and talking with old friends.”

The keynote address was provided by Pro Football Hall of Famer Jim Kelly, who spoke about grief and loss, challenges, perseverance, and what helps us overcome hardships in a presentation that Merlin P. Ohmer, DDS, MAGD, AGD presidentelect, described as “a really great speech

and open dialogue. [He] relayed his life experiences, growing up and also his battle with oral cancer. It was very moving.”

Kelly’s address put general dentists’ roles as frontline oral cancer screeners in the spotlight. As part of their commitment to answering that call to action, four dentists volunteered to help the AGD Foundation’s

oral cancer screening event during AGD2023. In total, 37 meeting attendees were screened. To support this and other efforts to both screen for and raise awareness of oral cancer, the Foundation also hosted a silent auction throughout AGD2023 to support its mission, and over $28,000 was raised.

AGD2023 At a Glance

2725 attendees & exhibitors

102 CE courses

270.25 total CE hours available

13 podcast interviews completed

300 scoops of ice cream served during Scoops & Scores

AGD2023 had all the mainstays of a great scientific session that repeat attendees have come to expect: a wide variety of CE in a versatile selection of formats, from threehour seminars and participation courses to hour-long lectures to shorter “pearl” presentations; a packed exhibit hall filled with the latest materials and tools to make dentistry easier and more fun; and networking events like the President’s Reception, the Convocation Celebration and the New Dentist Lounge. But, this year, some newcomers added variety to the annual event. While Caesars Palace is a staple for fine dining on the Las Vegas Strip, AGD wanted to add some mouthwatering and convenient

14 prizes won in the Exhibit Hall Passport Game

5 footballs thrown to the crowd during Jim Kelly’s keynote address

264 new AGD Fellows

81 new AGD Masters

31 Lifelong Learning and Service Recognition awards conferred

options for those not looking to spend too long away from the event. The AGD Café in the exhibit hall offered a broad selection of options each day, including a slider station and build-your-own ramen bar. Also new this year were a host of games that took the gamble out of whether or not attendees were having fun — even if you happened to be one of the lucky ones who made the giant Jenga tower fall. The Scoops & Scores dessert-themed happy hour combined games with what may seem like an unlikely ally for dentists (but was certainly welcome after a day of 115-degree heat): ice cream. Sparkling CE is the main draw of any AGD scientific session, and AGD2023

$28,000 raised by the AGD Foundation’s Silent Auction

37 attendees screened for oral cancer

4 volunteers assisted with the oral cancer screening event

288 giant Lego blocks in the Fun Zone

33 people took advantage of the AGD2023 Incentive Buying Program in the exhibit hall

did not disappoint. Attendees could take courses from an array of subject areas, from practical topics like business and practice management, ethics, marketing, retirement planning, avoiding malpractice claims, and customer service to clinical topics like implant dentistry, anesthesia and pain management, restorative dentistry, esthetic and cosmetic dentistry, dental sleep medicine, teledentistry, and how to spot common oral lesions. Attendees could learn “Cosmetic and Esthetic Dentistry for the General

Practice” from Ross W. Nash, DDS; handson local anesthesia techniques from Alan Budenz, DDS; dental sleep medicine from Jason R. Doucette, DMD; practical laserassisted dentistry from Bruce L. Cassis, DDS, MAGD; and “Basic and Advanced Suturing Techniques for Implant Surgery and Periodontal Surgery for the General Practitioner” from John Grisdale, DDS. AGD2023 also offered a virtual package for those unable to attend in person, worth 24 credit hours across eight lectures.

New this year was a wellness series of courses put together to help attendees address the reality that dentistry is often cited as one of the most stressful occupations. These complimentary 45-minute lectures focused on topics such as stress reduction, repetitive motion injuries, musculoskeletal disorders, and depression

and burnout. On the opposite end of the spectrum, this year’s attendees also had the exciting opportunity to head offsite on an educational field trip to the Clark County Coroner’s Office for a forensic odontology workshop with Grace Chung, DDS, which allowed participants to work through two case studies: one involving bite mark identification and one involving dental identification and age assessment after a mass fatality scenario. Another field trip allowed attendees to shuttle to and from the University of Nevada, Las Vegas, School of Dental Medicine for tours, networking, food and drinks.

The New Dentist Lounge — a staple at AGD’s scientific session — provided a home base for new dentists, residents and dental students throughout the meeting. In addition to networking events and CE

specifically geared to new dentists, the New Dentist Lounge also hosted a Stop the Bleed® training course, presented by Eric Wong, DDS, MAGD. Stop the Bleed is a program designed to better prepare the public with basic actions to stop lifethreatening bleeding following everyday emergencies and man-made and natural disasters. Participants learned how to apply pressure to a wound, how to pack a wound to control bleeding and how to correctly apply a tourniquet. More than 20 participants attended and received certificates of training completion. All programming presented in the New Dentist Lounge was free of charge.

While the heat all weekend was certainly memorable, even more memorable were the friendships forged and the sparks of new ideas. And for those tempted to swear off ever going to the desert in July again, AGD2024’s Minneapolis location should be a welcome change. F

ATTEND THE PREMIER MEETING FOR GENERAL DENTISTRY

Expand your knowledge and grow professionally with AGD2024’s numerous education offerings:

• Network with more than 2,500 fellow dentists and AGD members.

• Have the opportunity to earn more than 54 CE credits.

• Participate in interactive courses.

• Gain best practices from industry thought leaders.

• Attend free New Dentist Lounge lectures.

• Cutting-edge learning lab presentations.

Make the Most of Your Stay in Minneapolis

With its beautiful lakes, expansive park system, thriving arts scene, plentiful shopping and great food, Minneapolis offers a great backdrop for AGD2024 and a great destination whether you plan on bringing guests or traveling solo.

AGD PREMIUM PLUS MEMBERSHIP

Take advantage of membership tailored to you! For an additional $150 you can receive the following:

• Free CE Library PLUS 4 On-Demand Webinars of your choice

• 20% Fall Fellowship Review Course Discount

• 20% Fellowship Study Guide Discount

• Free Dental Card Services Virtual Terminal Setup

“I wanted to take advantage of all the lectures and classes that the scientific session offers, so, to get the best value, Premium Plus membership was the obvious choice.”

Mohamed H. Attia, DDS, MAGD Member since 2008

LEARN MORE

agd.org/membership