By Wesley W. Lyon II, CPA, CFP®
The days of placing an ad on Indeed or the local job board and finding an employee in a few weeks are gone. Dentists need to be more creative with finding employees, and even more competitive when it comes to having a job that potential employees will fight for.
By William S. Bike
Invisible dental support organizations (DSOs) offer nonclinical services to dental practices while allowing them to retain their name and branding, avoiding the stigma of corporate dentistry. This model helps maintain patient trust and allows dentists to continue leading their practices with a vested interest in their success. However, dentists have many factors to consider before selling their practices to an invisible DSO.
Each year during the AGD scientific session, the organization hosts the prestigious Convocation Ceremony for the year’s Fellowship, Mastership, and Lifelong Learning and Service Recognition recipients. These awards highlight the dedication to the craft of general dentistry that recipients demonstrate, and holders of these awards can be considered the top of the profession. AGD Impact spoke to several of this year’s recipients.
With age comes experience — and hopefully wisdom. This combination allows information to pass from one generation to the next, minimizing the same mistakes that create anxiety and less-than-adequate results. Albert Einstein once said, “The only source of knowledge is experience.” Life is full of lessons, and taking this information, understanding it thoroughly and incorporating it into ethical, practical and proficient procedures benefits one’s professional well-being.
If experience is the foundation of wisdom, how can we be sure we’re gaining the best experience possible? One challenge is realizing what is known and what may not be fully known at any stage. As an educator, my goal is to provide a broader picture of the opportunities available. This requires a sense of what knowledge my audience requires to become competent in the skill or procedure on which I’m lecturing.
After learning the steps of a procedure, the next step to gain experience is just that — experiencing what you’ve learned. Predicting outcomes requires an understanding of how best to address clinical issues, and the best way to do that is to apply what you’ve learned in the real world. There’s never just one way to accomplish a goal, and there’s never just one solution to a problem. Patients aren’t textbooks, and it’s best to experience all the permutations that life can throw at you.
Once you know the basics of a skill and have practiced it, it’s now possible to visualize the case prior to surgical intervention. Today’s technology and AI can also help with this, but these are simply better tools to help us, not substitutes for experience.
Taking all this information and proceeding ethically and professionally takes wisdom.
Goodhart’s Law states that “when a measure becomes a target, it ceases to be a useful measure.” For each case, we must be able to assess what is best for the patient and also take into account the patient’s goals and desires. Looking only at financial gains in treatment is a flawed approach. Traits needed to attain wisdom include empathy, intelligence and creativity. Wisdom becomes useful for navigating life’s many decisions.
Part of being wise is knowing that it takes work to keep up your wisdom. New knowledge and fresh experiences help evaluate new situations. Previous experience may not be as useful as it once was due to constant changes in materials and techniques.
Confidence in one’s ability is important, but so is the willingness to question assumptions and develop true proficiency. It’s easy to become confused when things don’t go as expected. Predicting outcomes is challenging when dealing with the human psyche. Wisdom often arrives as we confront limitations in our preconceptions.
Talent comes with intelligence and repetition. The combination of talent, wisdom and experience enhances the ability to see the whole picture and treat patients more effectively. Improving every day is a worthy goal, benefiting both practitioners and patients. The best among us continue learning and developing, allowing experience to carry us through difficult times.
Timothy F. Kosinski, DDS, MAGD Editor
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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Five individuals were recognized April 25 for their dedication to the West Virginia University (WVU) School of Dentistry and the dental profession during the school’s annual Alumni Association Spring Reunion, three of whom are AGD members: AGD Associate Editor and past president Bruce L. Cassis, DDS, MAGD; Lorena M. Surber, DDS; and W. Craig Wilcox, DDS, FAGD.
“On behalf of the WVU School of Dentistry Alumni Association, it is both an honor and a personal privilege to extend my heartfelt congratulations to the recipients of these prestigious awards,” said Dr. Moe Momen, president. “Their unwavering commitment to excellence, compassionate care and tireless service to the profession and their communities reflect the highest ideals of our alma mater. We are deeply proud to celebrate this moment and grateful to count them among our most esteemed Mountaineers.”
To be considered for the Distinguished Alumni and Achievement awards, recipients must display outstanding service to the field of dentistry as well as contributions to their community, state or nation. Honorees are selected by a committee representing the WVU School of Dentistry Alumni Association.
Bruce L. Cassis, DDS, MAGD
Cassis has been dedicated to improving the welfare of his community, state, profession and alma mater since completing the Doctor of Dental Surgery program in 1980. He has practiced in Fayetteville, West Virginia, for 45 years, while serving in many leadership positions at the local, state and national levels and providing educational opportunities for current WVU students and fellow dentists.
Cassis has been a member of AGD since 1985, providing leadership throughout his time in the organization as secretary, vice president and president, becoming the first person from West Virginia to be named to the position. He has also served on AGD’s Program Approval for Continuing Education Council and Communications Council, and he currently serves as associate editor. In his community, he has been an integral member of the New River Dental Society. Cassis is a fellow of the American College of Dentists and Pierre Fauchard Academy, and he has received Mastership and the Lifelong Learning Service and Recognition from AGD. He has presented continuing education courses in laser and cosmetic dentistry, orthodontics, and sedation across the United States and internationally. He has also taught seminars at the WVU School of Dentistry and served as preceptor for its rural rotation program for many years. He has also been a member and leader in the Fayetteville Lions Club and Fayetteville Baseball League.
A two-time graduate of the WVU School of Dentistry, Surber has remained engaged with her alma mater since her time as a student. She earned a Bachelor of Science in dental hygiene in 1972, and, after practicing in her hometown of Charleston, West Virginia, for nearly 15 years, she returned to WVU and earned a Doctor of Dental Surgery in 1990. She holds the distinction of being the only School of Dentistry graduate to finish at the top of both her dental hygiene and dental surgery classes. Surber also completed a general practice residency at Charleston Area Medical Center, and she has been named a fellow in the American College of Dentists and International
College of Dentists. Surber has held many leadership positions, including serving as a member of the Alumni Association Board of Governors for several years and president in 2010; member of the School of Dentistry Leadership Council; vice president and president of the Kanawha Valley Dental Society; member of the Executive Council of the West Virginia Dental Association; and editor and president of the West Virginia AGD. She has also held faculty positions at the School of Dentistry and WVU Institute of Technology and delivered keynote addresses at several school events, such as the clinic induction ceremony and commencement.
In addition to private practice in his hometown, Wheeling, West Virginia, Wilcox’s extensive involvement at Wheeling Health Right has provided important opportunities for local residents and WVU students. For several years, he has led the dental school’s program that mentors DDS students and residents as they provide care to underserved patients in the region. He has also provided leadership to the Wheeling District Dental Society, having served as secretary, vice president and president, and he served in numerous leadership roles for the West Virginia Dental Association, including president. He has also served as a delegate to the American Dental Association for multiple terms. Wilcox is a Fellow of AGD as well as the American College of Dentists and International College of Dentists, where he held the position as deputy regent and provided leadership on multiple committees. In 2021, Wilcox was presented with the Dr. Robert B. Bridgeman Distinguished Dental Award, the highest honor awarded by the West Virginia Dental Association.
The Constituent Recognition Program’s (CRP’s) mission is to enhance the exposure and recognition of constituent successes and efforts throughout the year via AGD meetings, newsletters, local constituent meetings/events and other platforms to highlight the great initiatives of constituents at the grassroots level. This month, the CRP honors Timothy A. Hess, DDS, MAGD, of Washington AGD.
During the COVID-19 shutdown, Hess played a crucial role in planning and hosting Washington AGD’s “Stay Home, Stay Healthy” series of free Zoom lectures. Over 11 weeks, Hess organized 56 different CE courses, totaling 108 hours of essential education. Remarkably, these sessions were accessed by more than 110,000 individuals, highlighting their widespread impact. Additionally, the Washington AGD YouTube channel, where the lectures now reside, boasts over 2,000 subscribers, further underscoring the series’ significance in disseminating vital information during a challenging time. In his current role as CE director, Hess oversees Washington AGD’s MasterTrack, FellowTrack, OrthoTrack, EndoTrack and Implantology programs, and he was instrumental in setting up and equipping Washington AGD’s 10,000-square-foot education center.
Some things in life just come together — like a good idea and the right timing. This summer, AGD members have the perfect mix of both. From July 1 through Sept. 30, AGD’s Half-Year Dues promotion gives eligible dentists a chance to join for 50% off AGD dues. It’s a strong incentive for new members and an even stronger opportunity for current ones. When your referral joins, you both earn $50 in Referral Rewards to apply toward future membership dues. The more colleagues you recruit, the more rewards stack up. There’s no limit to how much you can earn. To qualify for the Half-Year Dues rate, recruits must not have had AGD membership expire on or after Dec. 31, 2024, and must not be 2024 or 2025 graduates. Get started on earning Referral Rewards at agd.org/ my-agd/access/refer-a-colleague
AGD is proud to present the 2025 Future Leader in General Dentistry Award recipients. These exceptional senior dental students from across the United States, Canada and Puerto Rico have been recognized by their faculties for maintaining a strong academic balance between clinical and didactic coursework and for demonstrating the potential to become outstanding general dentists. Each recipient receives one year of complimentary AGD membership and a certificate presented by their dental school’s dean. View the full list of this year’s winners at agd.org/FLGDA.
Hess is a distinguished graduate of both the University of Alberta and the University of Washington, where he earned his DDS in 1994. A dedicated clinician and educator, Hess is currently affiliate assistant professor in both restorative dentistry and oral medicine at the University of Washington School of Dentistry, and he is the former director of the Richard V. Tucker Institute. Additionally, he mentors the Pacific Northwest Gnathology Study Club.
Hess remains deeply engaged in continuing education and professional development. He is set to receive his fourth Lifelong Learning and Service Recognition at AGD2025 in Montréal. In 2026, he will serve as president of the Canadian Academy of Restorative Dentistry and Prosthodontics. Most recently, he earned the designation of certified dental technician in digital workflow from the National Board for Certification in Dental Laboratory Technology, further underscoring his commitment to excellence in digital dentistry. Hess is an active member of numerous professional organizations, including the Academy of Operative Dentistry, American Academy of Restorative Dentistry, Pierre Fauchard Academy, International College of Dentists, American Academy of Gold Foil Operators and American College of Dentists.
By Amrita Feiock, DDS, FPFA, FICD, FACD
As an owner dentist, hiring an associate is a crucial step in the growth and success of your practice. Not only does it relieve the burden of an overwhelming workload, but it also allows you to provide better care for your patients and potentially expand your patient base. However, bringing the right associate into your practice requires thoughtful consideration. There are specific do’s and don’ts that should guide your hiring process, ensuring you find a skilled and compatible candidate who will contribute positively to your team.
Beyond technical skills, the most important trait you should look for in an associate is compatibility with your practice culture. Whether you run a family-oriented dental practice or a more high-end specialized facility, the associate you hire must align with your values, patient care philosophy and overall goals for the practice. Consider their personality, communication style and work ethic. Will they be able to get along with your staff and interact well with your patients? The key is to find someone who fits in seamlessly with your practice’s existing atmosphere. This can enhance teamwork, improve morale and make for a more cohesive environment overall.
While it’s important to assess the candidate’s overall demeanor, you must also carefully evaluate their clinical skills. Are they versed in the latest technologies and treatment methodologies? Are they experienced in the types of procedures you typically perform? If your practice focuses on specialized services like orthodontics, implants or pediatric dentistry, you’ll need an associate who has expertise in these areas. Make sure to assess their abilities through clinical interviews or even working alongside them for a day to observe their techniques and efficiency. If the associate is lacking experience in certain procedures, consider whether they’re willing to learn or if they need additional training. From the outset, be clear about your expectations. Outline the responsibilities and duties expected from the associate, including patient volume, specific procedures, work hours and any administrative tasks. Make sure they understand the expectations for patient care, interaction with staff and any performance metrics you use to gauge success. This level of clarity will help avoid misunderstandings and potential issues down the line. Establishing mutual expectations up front also sets the stage for open communication, which is key for maintaining a healthy professional relationship.
An associate’s career will benefit from continuous learning and growth, so offering mentorship opportunities is essential. Not only does this demonstrate that you value their professional development, but it also helps ensure they align with your approach to dentistry. Continuing education courses should be encouraged and supported, helping both of you stay current with evolving dental
technologies and treatment techniques. By offering mentorship, you can guide your associate through the complexities of patient care, practice management and professional development, fostering loyalty and a long-term working relationship.
It can be tempting to rush the hiring process when your practice is busy or understaffed, but this is a decision that warrants careful deliberation. Rushing into hiring an associate without thoroughly vetting candidates can lead to missteps that negatively impact the practice’s quality of care, team morale and financial stability. Take the time to thoroughly interview candidates, check references and assess their clinical skills. A common mistake many owner dentists make is focusing too much on technical skills and neglecting the importance of communication. A great associate dentist may be proficient in complex procedures, but if they lack
strong communication skills, it can create friction with patients and staff. They should be able to clearly explain treatment options to patients, listen attentively and communicate effectively with your dental team. Strong communication skills are essential for building patient trust, preventing misunderstandings and promoting a positive work environment. Don’t overlook this aspect of the hiring process.
Before hiring an associate, make sure you have a clear understanding of how their compensation structure will work and what it means for your practice’s finances. Will they be compensated based on a percentage of the revenue they generate, or will they be salaried? What benefits will you offer, and what are the terms regarding time off, sick leave and retirement plans? Having a well-structured financial agreement that is fair to both parties is essential to maintaining a healthy business relationship. Avoid making vague or unrealistic financial promises that could lead to future conflicts.
While qualifications and experience matter, credentials alone should not be the sole factor in your hiring decision. An associate may have an impressive educational background or work history,
but it’s equally important to evaluate their attitude, patient care approach and personality. For example, a dentist with top-tier credentials but poor bedside manners might not be the best fit for your practice, especially if you pride yourself on building long-term, trust-based relationships with your patients. It’s easy to focus solely on the short-term benefits of hiring an associate to help with the current patient load, but you must also consider the long-term impact on your practice. Will the associate dentist be able to grow with your practice and potentially take over leadership roles in the future?
Ideally, your associate dentist should not just be someone who fills a current gap, but someone you can envision working with long term, whether that involves transitioning into a partner role or becoming a mentor themselves. Remember that this is a relationship that extends beyond hiring — the right associate can become a valuable partner in your practice’s success. ♦
By Jackie Ulasewich Cullen
Anew patient calls after finding your practice online. They schedule a consultation, accept treatment and leave a glowing review. A few weeks later, one of their friends reaches out to book an appointment, too.
That’s how great marketing works. It’s consistent, connected and built to support long-term growth.
But, for many dentists, marketing still feels like a guessing game. How much should you be spending? Where should that money go? And what does a successful strategy even look like?
There’s no single formula. But when your marketing investment is aligned with your goals, your patient base and the stage of your practice, you’re in a much better position to grow with confidence.
What a Healthy Marketing Investment
Marketing budgets can vary widely depending on your practice goals, growth stage and location, but that doesn’t mean you have to guess. The key is treating marketing as a strategic investment — not just another line item.
Start by thinking like a business owner. Successful small businesses typically spend 4%–7% of their gross revenue on marketing. That number may trend higher for newer or more competitive practices, especially if your goal is to expand, break into a new market or introduce high-value services like implants or cosmetics.
But the dollar amount is only part of the equation. Equally important is how your marketing spending aligns with:
• Your goals. Are you trying to grow quickly, or are you trying to stabilize and optimize?
• Your patient base. Are you nurturing existing relationships, or are you trying to attract more ideal patients?
• Your market. Are you in a dense, high-competition area, or are you one of a few practices in town?
Rather than fixating on what others spend, ask yourself: Is my current marketing investment aligned with where I want to take the practice — and is it actually delivering results?
Once you’ve established a healthy marketing investment, the next question is: Where should it go?
This decision is where many practices go off track — not because they aren’t investing enough, but because their investment isn’t aligned with what they actually need.
A newer practice in a competitive area might benefit from paid search ads and local SEO to drive visibility. An established office with a strong patient base might get more value from consistent email outreach and personalized content that strengthens loyalty with existing patients and encourages referrals.
Smart allocation isn’t about jumping on every trend — it’s about choosing tools and strategies that support your specific goals. That might include:
• Website updates that reflect your current services, technology and patient experience.
• Regular blog posts that support SEO, highlight your expertise and answer common patient questions.
• Social media content that builds connection and credibility by showcasing your team, culture and community involvement.
• Email campaigns that keep patients engaged and informed between visits.
The best marketing mix for your practice is one that reflects where you are now — and where you want to go next.
Many practices assume marketing is just about finding new patients. But your existing patients are often your best opportunity for long-term growth.
They already trust your team. They’ve experienced your care firsthand. And when they feel genuinely connected to your practice, they’re more likely to:
• Accept additional treatment recommendations.
• Leave positive reviews that improve your visibility.
• Refer friends, family and coworkers who share similar values. That kind of organic growth isn’t just cost-effective — it’s sustainable. And it starts by nurturing the relationships you’ve already built.
Think about the moments between visits. Are you staying in touch? Are you creating experiences that feel personal and memorable? Are you inviting feedback and encouraging patients to share their stories?
The more you engage your existing patients, the stronger your marketing foundation becomes — because every loyal patient has the potential to be an advocate for your practice.
Marketing your dental practice isn’t about chasing trends or checking boxes. Rather, it’s about building a strategy that reflects your values, supports your goals and grows with your business.
No matter what stage your practice is in, the right marketing approach can help you stand out, build loyalty and reach more of the patients you’re truly meant to serve. ♦
Jackie Ulasewich Cullen is co-founder and CEO of My Dental Agency, a dental marketing agency. An experienced speaker and writer, Cullen is passionate about helping dentists attract the patients they want and build thriving practices. To comment on this article, email impact@agd.org
By Howard E. Ong, DDS, MAGD
Apractice thrives when its team members are on the same page — which is built through familiarity and consistency. Your team is not only your work family, but it also impacts your patients’ perceptions and interactions with your practice. On average, my team members have been with my practice for 12 years. Here are a few tips I’ve found work well when we hire, train and retain talent to give our patients the best experience possible.
In the last five or six years, there’s been a shortage of dental professionals, especially in auxiliary dental or dental assistant positions. We feel there are few viable candidates, and many are seeking immediate high-end pay without having the high-end talent or experience. People know there’s a shortage. I don’t think it’s because offices are unwilling to compensate. Offices are willing to invest the time to train and develop someone; rather, finding suitable candidates is the issue.
The dental assistant or chairside roles are probably the hardest to fill because they are very personable positions. You’re side by side with these people for many hours of the day, so it’s vital that you get along with the person you’re hiring. Second to that are administrative positions, because it takes a while to train for those roles. Most offices — definitely ours — work in teams. One dentist will work with a couple of dental assistants and an administrative person. We form a cohesive team so that everyone is on the same page because it’s most productive that way. Patients see the same familiar faces every time — so we all have to get along, and we all have to appreciate each other.
You have to be specific about what you’re looking for during the hiring process. For many years, I was involved in an organization called Rotary, and one of its mottos is, “Service above self.” That’s something you can recognize in a lot of people — that they’re not just in it for themselves and are genuinely looking to serve the community. That’s a great way to start.
Culture is by far the No. 1 way to retain good team members. People want to belong to an organization that has a winning method or a culture of caring and success. One thing a dentist can do right now to minimize turnover is create an environment that’s safe and appreciative. Recognition of good work goes a long way. Reward your staff — it doesn’t necessarily have to be with money. You can reward them with praise. Reward them with a sense of belonging to something bigger than themselves.
What happens outside of work is also important. Every quarter, we have a team outing. Not everyone can participate because of scheduling, but at least it’s available. We also celebrate our team’s accomplishments, whether it’s a birthday or an anniversary. This year, we’re celebrating someone who’s been at
the practice for 20 years and another employee who’s been here 25 years.
Building culture begins the moment you hire someone. So, invest resources in training employees. Having a genuine interest in the new team members and spending time with them is the best way to make them feel like they belong. Care for their success by offering all the resources and tools available within your practice. Continuing education — sending team members out to third-party training — is excellent. We do that annually with every department. Vendor partners also offer training at no cost — like CareCredit. I have found its training on teaching your team to have great financial conversations to be especially helpful. This type of patient dialogue can be challenging for many people, and having the ability to train my team through a company that specializes in making cost conversations easy is a plus. Additionally, taking the time to have one-on-one training with your employees also shows that you are invested in them as individuals.
Leadership is the second most important factor when it comes to retaining team members because it takes leadership to build culture. Leadership doesn’t just mean the owner or dentist. Leadership can be bestowed on any team member because we are all leaders of our patients.
Our vision statement is: “Treat everyone like we want to be treated.” No matter your position, we try to highlight and emphasize leadership qualities in every team member because they are leaders in their own roles. If employees don’t feel that way, then they’ll just feel like subordinates — and that’s a recipe for resentment and failure.
Learning how to be a leader is possible. With some effort, you can gain really great leadership qualities in a very short period of time. Then you have to practice. It’s hard to put yourself out there sometimes, but, when you display leadership qualities and an attitude of service, your team will notice — and it’s infectious.
Ultimately, hiring, training and retaining talent take time and effort. It truly is an investment in the health of your practice and patients. ♦
Howard E. Ong, DDS, MAGD, has been mastering his craft through education and practice for over 25 years. He holds mastership in the International Congress of Oral Implantologists (ICOI) and is certified in oral conscious sedation. Ong works as the primary surgeon at his practice in Seal Beach, California. His love for implants, surgery and customer care inspired him to add a specialty suite dedicated to surgical treatments. Ong is a member of the American Dental Association, California Dental Association, Harbor Dental Society, AGD and ICOI. This content is subject to change without notice and offered for informational use only. You are urged to consult with your individual advisers with respect to any information presented. Synchrony and any of its affiliates, including CareCredit, (collectively, “Synchrony”) make no representations or warranties regarding this content and accept no liability for any loss or harm arising from the use of the information provided. All statements and opinions are the sole opinions of Dr. Ong. Your receipt of this material constitutes your acceptance of these terms and conditions.
While AGD is an organization for general dentists, it also boasts a number of specialist members. Alexandra Otto, DDS, FAGD, FACD, FPFA — a board-certified pediatric dentist and nationally recognized speaker and leader in the dental community — is one such member. She shared why membership in AGD and staying on top of her skills as a general practitioner are important to her as a pediatric dentist.
AGD Impact : What made you want to become a dentist, and what was your educational journey like?
Otto: I’ve always been drawn to healthcare, but dentistry stood out as this perfect intersection of science, artistry and human connection. I loved the idea of working with my hands and using technical skills in a way that was both creative and precise. But, more than anything, I was drawn to the ability to make a real and lasting impact on people’s lives. Whether it’s helping someone out of pain, restoring a smile or building trust over time, dentistry offers a unique opportunity to blend clinical care with deep, meaningful relationships. I earned my DDS from Virginia Commonwealth University’s School of Dentistry and completed a general practice residency (GPR) at Denver Health Medical Center, where I was exposed to a broad range of care in a fast-paced, highneeds environment. That experience gave me a solid foundation and confidence early in my career.
When did you decide to specialize in pediatric dentistry and why?
After my GPR, I practiced as a general dentist for five years. During that time, I found myself increasingly gravitating toward pediatric patients, and I ultimately worked in several pediatric-focused group practices as a general dentist. I loved the energy, the fast pace and the ability to be playful with my pediatric patients — finding ways to make each visit fun and enjoyable not just for the kids, but for their
Alexandra
parents as well. That interest eventually led me to pursue specialty training through NYU Langone in Anchorage, Alaska. Through my program at the Alaska Native Medical Center, I exclusively treated Native Alaskan children, many of whom were among the highest caries-risk and most in need of dental care in the country.
My specialty training was eye-opening. I realized that pediatric dentistry isn’t just general dentistry for children — it’s a completely different philosophy of care. There’s a level of behavioral, emotional and developmental complexity that I honestly didn’t fully appreciate when I was a general practitioner. My training gave me a much deeper understanding of how to approach pediatric patients holistically — not just clinically.
Having had the unique opportunity to practice as a general dentist before specializing, I’m especially passionate about bridging the gap in understanding between general and pediatric dentistry. I love sharing these insights with general dentists, because once we recognize that pediatric care requires a distinct approach and mindset, we can collaborate more effectively to serve our youngest patients with greater empathy, intention and clinical success.
My residency experience also reinforced my passion for prevention and culturally
“One of the things I’ve truly loved is that AGD has continued to be a space where I can contribute as a specialist and share knowledge that benefits general dentists and their patients.”
responsive care, and I left feeling more committed than ever to improving access and experiences for children across all communities. That commitment inspired the creation of Kids Tooth Team Outreach, our 501(c)(3) nonprofit mobile dental program that has now provided over $500,000 in free dental care to underserved children. It’s one of the ways I’ve tried to turn passion into direct community impact.
When did you join AGD, and what has your membership and leadership experience been like?
I first connected with AGD leadership during dental school, when I served as the national vice president of the American Student Dental Association. Drs. Jeffrey M. Cole and Linda J. Edgar were on the AGD Board at the time, and they — and the entire leadership team — welcomed me with open arms. They made me feel like part of the AGD family and encouraged me to stay involved.
After graduating, I served on the national AGD Membership Council for four years. During that time, working toward my Fellowship became a major personal goal. It kept me motivated to prioritize continuing education (CE) and gave me a clear path for growth. I reached my 500 CE hours during my pediatric residency and took the Fellowship Exam in Alaska. I was honored to receive my FAGD the following year.
Once I became a specialist, I looked for ways to continue contributing to AGD. Speaking and lecturing for local, state and national groups felt like a natural fit. I’ve developed multiple MasterTrack programs
to help general dentists earn pediatric CE credits toward their MAGDs, taught the pediatric portion of the Texas Fellowship Review Course, and presented national AGD webinars — including on one of my favorite topics, “Unleashing the Power of AI in Dentistry.”
One of the things I’ve truly loved is that AGD has continued to be a space where I can contribute as a specialist and share knowledge that benefits general dentists and their patients. Having practiced as a general practitioner myself, I
remember not always feeling especially welcome in pediatric-specific CE spaces, which struck me as shortsighted. Every child deserves outstanding, patient-centered care. If we can help more providers deliver that — especially in rural areas without pediatric specialists — that’s a win for our patients and our profession.
As a pediatric dentist, why is participation in AGD important? How does it benefit you and other specialists?
AGD is an organization that champions lifelong learning and professional excellence, and that resonates with me deeply — regardless of specialty. Most kids are seen by general dentists, so supporting general practice providers with highquality, practical pediatric education is one of the most impactful things I can do as a specialist.
I also firmly believe that, in order to be an exceptional pediatric dentist, you need to be a great general dentist first. Having that foundational training has shaped the
“Specialists
and general dentists don’t exist in silos; we rely on each other to deliver comprehensive, compassionate care.”
way I approach treatment planning and decision-making. It’s also why I believe it’s essential for pediatric dentists to stay informed about what’s happening in general dentistry. It keeps our perspective broad and our care collaborative.
Because of my background and continued education, I’m able to take on more advanced surgical and esthetic procedures — impacted mesiodens, surgical extractions and cosmetic cases that many pediatric dentists might refer out. I feel a strong responsibility to stay sharp clinically so I can provide comprehensive care and meet the needs of my patients and community.
AGD also keeps me connected to the broader dental landscape — what’s changing in policy, public health, education and technology. It helps me stay proactive and collaborative. Specialists and general dentists don’t exist in silos; we rely on each other to deliver comprehensive, compassionate care.
How do you juggle involvement in organized dentistry while running a private practice?
Balancing organized dentistry with private practice definitely takes intentionality — but, for me, it’s not an extra obligation; it’s
a vital part of how I stay connected to the broader purpose of what we do.
I’m currently the incoming president of the Texas Academy of Pediatric Dentistry and the incoming chair of the Texas Dental Association’s Council on Professions and Trends. Roles like these energize me. They give me a platform to advocate for children, families and providers — whether that’s influencing policy, elevating standards of care or addressing the real-world trends that are reshaping our profession.
I truly believe that when clinicians get involved beyond the walls of their practice, it makes the profession stronger. Whether it’s shaping legislation, guiding CE, or helping dentists at every career stage feel seen and supported, organized dentistry gives us the tools to lead — and to protect the future of patient-centered care. That same spirit of collaboration is what led my husband, Tim,
and me to create Alcan Dental Cooperative, a practice partnership organization that supports pediatric dentists in growing successful, mission-driven practices with shared values and clinical integrity.
What advice do you have for new dentists and AGD members who want to get involved?
You don’t have to wait until you feel “ready.” Start by showing up — attend a local event, reach out to a mentor, or take a course that excites you. AGD is filled with people who care deeply about this profession and are eager to welcome you in. Set a goal — like obtaining your Fellowship or finding a way to contribute through education or leadership — and take that first step. The relationships and opportunities that follow will shape your career in ways you can’t even imagine. ♦
By Wesley W. Lyon II, CPA, CFP
According to the American Dental Association Health Policy Institute’s (HPI’s) Q1 2025 survey on Economic Outlook and Emerging Issues in Dentistry, just 5.8% of dental practices found it only “slightly challenging” to “not challenging at all” to recruit a hygienist (or “not applicable”). Meanwhile, a whopping 94.2% of dental practices found it moderately, very or extremely challenging to recruit a hygienist, a figure unlikely to surprise anyone. 1 When fighting increased demand and a lack of supply of good employees, it is more important than ever that you are competitive when searching for employees.
The COVID-19 pandemic dramatically shifted the employment landscape in the United States. The availability of remote jobs took many clerical employees out of the office and into other industries. Furthermore, the surging number of corporate-owned dental practices placed further increased demands on the number of employees. A CEO of a major private equity firm revealed to me in private that they did not see the hiring troubles coming, leading to substantially inflated wages. The combination of COVID-19 labor shifts and corporate-owned practices increasing demand led to a disaster for many privately owned practices, with many of my clients reporting losing hygienists who left to make $65 per hour or more at corporate practices. Some good news is that remote jobs are declining across the country,² which should bring back some employees to search for jobs locally. However, it won’t solve the entire staffing crisis.
The days of placing an ad on Indeed.com or the local job board and finding an employee in a few weeks are gone. You need to be more creative with finding employees, and even more competitive when it comes to having a job that potential employees will fight for. Based on my experience as a tax, business and planning consultant, as well as data from the HPI and DentalPost’s annual salary survey, I have found the following three factors to be of utmost importance when seeking to hire staff: culture, benefits and wages.
1. Culture: This is overlooked by many doctors, but having a company culture where your employees want to come to work is key to attracting top talent. With practices competing for a limited pool of staff members, potential employees are going to seek opportunities they feel excited about. In DentalPost’s 2025 Dental Salary Survey, most hygienists and dental assistants cited a better work environment as their second-most important factor when seeking out a new opportunity (15.5% and 24.3% of respondents, respectively), second only to compensation (19.9% and 38.3%, respectively). However, lower-cited reasons, such as a more appreciative employer (11.4% for dental hygienists) and career opportunity (9.3% for dental hygienists and 17.5% for dental assistants), also fall under the umbrella of work culture, so it is important not to underestimate the impact of work culture on staff morale.3 (Note: 2025 response data was not available for dental hygienists, so 2024 data is used here.)
“When fighting increased demand and a lack of supply of good employees, it is more important than ever that you are competitive when searching for employees.”
Be certain to take the time to appreciate your employees, make them feel empowered and sporadically schedule team-bonding events. One of my clients has great success sending his staff to happy hour with his credit card — but not actually attending himself. He has found that staff morale and team-bonding are increased substantially by the staff enjoying time together without the stress of the boss being around. Another client of mine has implemented “Bubbles with the Boss,” where she invites different positions to have champagne with her and chat once per month. Check your ego at the door, and make sure your staff members are enjoying any appreciative events you do.
The DentalPost 2025 Dental Salary Survey also revealed great appreciation for continuing education (CE) and empowerment. More specifically, team members cited a wish for more group learning and CE to help better patient experiences. There were also negative connotations toward dental services organizationaffiliated practices (note that corporations are only allowed to own practices in a handful of states), showing employees have higher job satisfaction when working directly for the decision-maker.³ I found these comments to be indicative of a lack of autonomy or input into patient care, especially in the hygiene department. If your office does not have a “treatment philosophy” or culture built around how you treat, now is the time to change that.
Recently, my hygienist found a soft spot lesion on the side of my tooth. She very calmy explained that she wanted the doctor to take a look, but that, in her experience, it would likely just require a small filling to get ahead of the problem before it could get worse. I was immediately relieved that I wouldn’t be spending thousands of dollars for repairs. When the doctor arrived and completed the exam, he explained that a small filling would prevent the problem from getting worse and having to complete painful treatment. My only question was, “How soon can we get it done?” This was a great win for the dentist as both a practitioner and as a businessowner. Hygienists who have autonomy and are allowed to provide input on patient care report substantially higher job satisfaction than those with lower autonomy.⁴
To summarize, take a hard look in the mirror, and answer truthfully: Is your practice a place employees enjoy working? If not, aim to fix it immediately.
2. Benefits: In 2022, the HPI found that over one-half (53%) of private dental practices were not offering any type of health
insurance, with costs being the No. 1 factor for those not offering health insurance.⁵ The DentalPost 2025 Dental Salary Survey report showed similar data. While 92.2% of hygienists received benefits in 2024, versus only 70% in 2022, health insurance coverage was not listed among the top benefits received (paid time off, retirement and dental) and remains the most coveted benefit for hygienists who do not have it.³ According to the Kaiser Family Foundation, the average premium for single health insurance coverage has increased 25% over the last five years, while family coverage is up 24%. This premium increase is more than 50% if the last 10 years are taken into account, easily explaining why jobseekers prioritize employer-paid health insurance.⁶
Unfortunately for businessowners, times have changed, and offering health insurance is a must in order to attract top talent. Dentists have two major options when looking to add health insurance. The first is to offer an employer-sponsored health insurance plan to the employees. In my experience, the typical dentist will pay at least 50% of the premium for individual plans, with some offering to pay 100%. However, most dental offices will not voluntarily choose to pay for family coverage, but the employees can choose the coverage and cover the difference themselves.
The second option is to offer a qualified small employer health reimbursement arrangement (HRA). Under a qualifying HRA, an employer may reimburse staff members for medical expenses, including health insurance premiums. This tool is great for practices that want to offer a benefit, while still encouraging staff members to take advantage of their spouses’ employer-sponsored health insurance. Under this arrangement, the employer can choose to reimburse only health insurance premiums, or health insurance premiums and qualifying medical expenses up to a certain threshold, to be chosen by the employer. This provides flexibility to exclude all employees receiving health insurance elsewhere, as you cannot reimburse premiums that have been paid pre-tax, but rather only plans purchased personally. Employers can also decide to reimburse for both premiums and medical expenses up to a chosen threshold. I generally recommend doctors reimburse between $300 and $500 per month, depending on their circumstances.
In order to institute a qualifying HRA, you must have fewer than 50 full-time employees and create a plan document. An employer cannot offer both health insurance and an HRA to employees. Employees must prove they have health insurance in order to participate and receive reimbursement from the practice. Those without health coverage would not be eligible. Thereafter, they can submit receipts for tax-free reimbursement. I recommend that dentists choose to reimburse quarterly in order to keep headaches to a minimum while avoiding paying a third party to administer the plan.
In a shocking change of pace, retirement replaced time off as the second-most coveted benefit in the DentalPost 2025 Dental Salary Survey. 3 This is good news for dentists, as private practitioners should be implementing practice retirement plans for their own tax and retirement savings! However, not all retire -
ment plans are created the same. Historically, small employer retirement plans have operated in a pooled account due to the cost of running a participant-directed plan; in simpler terms, the retirement plan has one account, and participants receive an annual statement without the ability to choose their own investments. In a participant-directed 401(k) plan, every employee can log in and see their investments daily, making changes as they wish. Costs have come down for participant-directed plans, and I recommend every dentist look into making the change if they haven’t done so already. If your employee only receives a statement once per year, the benefit isn’t tangible, and their view will not be as favorable.
Lastly, staff members should not be paying for their own CE. Attending CE as a team is a great way to build culture, especially if you combine the outing with a social event. Even better, you can ensure everyone receives their necessary CE for their licensure or certification and that you pay for it. Asking a dental assistant or hygienist to pay for their own CE is a definite red flag for hiring. Even if the cost is only a couple hundred dollars, the perception of paying for the ability to do their job is not worth the hassle.
3. Wages: Every dentist is facing increased demands for wages, with many feeling like they have nowhere to turn for accurate data. DentalPost ’s 2025 Dental Salary Survey Report is a great resource, but the U.S. Bureau of Labor Statistics website is an even better resource. I recently helped a client determine his wage profile. By utilizing the U.S. Bureau of Labor Statistics wage data, I was able to find the mean hourly wage, 75th percentile and 90th percentile of wages for his specific zip code and job title. While this data was backwards-looking to 2023, it was a great starting point.
The dentist had two hygienists working full time. One hygienist was making $37 per hour, and the other was making $39 per hour. He had heard reports that hygienists were making more than $45 per hour in the area, but he had no definitive source to prove it. Another consideration was that the highest pay rates were likely to be found at corporate offices. Given his location, he did not feel he was competing with corporations, as his staff members valued the culture of his office. Since the dentist had a few all-star hygienists he wanted taken care of, we pulled the 90th percentile of wages and determined it was $40 per hour. With this information, he was able to offer a $2 per hour increase to each hygienist, costing him approximately $7,000 total per year in wages and payroll taxes. This data was particularly helpful since he was in a rural area, and the wages paid in rural areas are much lower than the national averages that are widely quoted. Had he taken advice from his dental colleagues in different areas, he could have ended up overpaying by tens of thousands each year, with hygiene wages reaching $60 per hour or more in many parts of the country.
Most of my clients prefer to calculate total wages including retirement benefits, health insurance and other perks. While cal-
“Offering health insurance is a must in order to attract top talent.”
culating total pay is a better metric for total compensation from an owner’s perspective, my experience has taught me the hourly wage is king of compensation. Benefits are an addition to staff wages but will not win you a battle to keep an employee happy. To be sure your staff compensation is in line with industry norms, add up all benefits except for retirement plan contributions, payroll taxes and wages. The combination should not exceed 27% of collections, excluding any associate dentist compensation.
For small practices, determining if pay is adequate can be quite painful. One of the most successful ways to determine pay ranges is to join a local study club and have each member complete a survey. Thereafter, schedule a meeting dedicated to discussing staffing and compensation. There is no better source than actual data from dentists in your specific area. If this data isn’t available, retrieve the data from the U.S. Bureau of Labor Statistics at bls.gov/bls/blswage.htm . These sources should be great ways to quickly determine market value and give raises to all-star employees as necessary.
“You need to be more creative with finding employees, and even more competitive when it comes to having a job that potential employees will fight for.”
Next, I recommend asking each staff member during an annual review what their preferred method of receiving additional compensation would be. Some benefits, such as retirement, can be increased for individual staff members based on their needs. Find out what benefits they get elsewhere, such as through their spouse’s employer, and what would truly benefit them. Afterall, the purpose of a benefit is in the name — your benefits plan should be tailored to what will benefit your employees the most. The only way to truly understand where you are coming short is to ask.
Associate compensation is quite a bit easier to calculate. Associates should be paid based on a percentage of net production or collec-
tions, with a daily minimum to get started. Since fee schedules will vary based on the cost of living in different areas, you don’t need to acquire data to determine pay. Compensation with associates can vary in corporate offices versus private offices; however, this is a function of how much dentistry is being done rather than a difference in the rate. Be certain you have enough work to keep an associate happy! The three components of associate pay you need to consider are pay rate, benefits and guaranteed minimum.
1. Pay rate: Pay rates for general dentists will vary between 30% and 35% of net production or collections. I recommend owners pay associates based on net production, since it is the owner’s job to collect the money and the associate’s job to produce the dentistry. I have seen cases where associates do work they know they won’t be paid for, so many owners will choose to pay based on a percentage of collections instead. Either way will work great for a private practice. When deciding on a pay rate, it is important to know your market and how your compensation offer compares in both percentage terms and total dollar compensation. If you are a fee-for-service office that has an overflow of patients in a high-demand area, you should aim for 30%. The availability of production combined with no insurance write-offs will net the associate much higher pay at 30% than the associate would make at an insurance-based practice with a 35% pay rate. For example, if an associate produces $1 million, at 30% they would collect $300,000 in a fee-for-service office. If the same production was discounted 30% due to in-network fee schedules, the associate would collect on $700,000 of net production, which, even if paid out at a higher pay rate of 35%, would only be $245,000. Not all dentists understand this, so be certain to drive this point home when speaking with candidates. If you are practicing in a competitive area and battling insurance write-offs, you may need to offer 35% to be competitive.
Some practices will choose to net out a portion of the lab bill in the calculation. I prefer to stay away from this practice for simplicity of the calculation with a couple of exceptions. Aligner treatment should be negotiated separately on how much the dentist will take home due to the high lab bills. Some practices will do a flat dollar amount, while others will pay a lower percentage. The same applies to practices that are doing large implant cases. Since the cost of marketing to obtain these cases is much higher, oftentimes the percentage paid will be lower. In both aligners and large implant cases, it is common to pay the associate dentist 25% instead of 30% to 35%. This does not apply to practices that do occasional implant work, but rather strictly to implant-based practices.
2. Benefits: Benefits were not even a consideration for associates in the not-so-distant past. Looking forward, benefits may become an expectation. Over half (53%) of associate dentists
reported receiving medical benefits in 2024, and it was the topwanted benefit for those who did not receive it.³ This can put owners in a peculiar position, having to choose between paying benefits or potentially paying an associate as a 1099 independent contractor rather than a W-2 employee. Fortunately, there is an easy solution: Allow the associate dentist to receive benefits so long as they are deducted from their percentage of pay. This strategy allows the associate dentist to take advantage of health insurance, retirement, CE and more on a tax-deductible basis. Meanwhile, this doesn’t cost the dentist anything, since the amount of benefits paid is part of production-based compensation. Employment agreements should be written so that the associate dentist is paid the greater of their guaranteed salary or a percentage of their net production/collections, less any of the following practice-paid perks. Many owners will also add a provision to pay the first $2,000 of CE on behalf of the associate dentist, leaving the remainder to be paid from the associate’s compensation package.
3. Guaranteed minimum: In order to be competitive, owners should expect to pay a guaranteed minimum. Since many senior dentists did not receive a minimum guarantee when they started, they are opposed to the idea. My recommendation is to swallow your pride and offer the guaranteed minimum. This will allow the new dentist to feel safe renting or purchasing a home, paying their student loans, and continuing to live their life while they get on their feet. The minimum can either be structured as a guaranteed daily rate or as a guaranteed monthly rate with a set number of days to work. This figure will vary based on location, but, as a general starting point, will be $600 per day or $10,000 per month for the first six months of employment. Do not let this deter you if you truly need an associate. If the new dentist cannot produce at least $1,800 per day within a few months to cover their daily minimum, it’s time to either rethink your need for an associate or move on to a better associate.
According to the DentalPost 2025 Dental Salary Survey, 28.8% of associate dentists, 20.5% of dental hygienists and 23.2% of dental assistants had changed employers in the last year. Currently, 46.6% of associate dentists, 33.7% of dental hygienists and 56.7% of dental assistants are job hunting or considering job hunting. 3 The odds imply that some of those job seekers browsing the job boards right now could be your own staff members. Use the information above to increase your staff retention rates and also help you attract more of these job seekers to fill gaps in your staff. ♦
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 Danielle Fitzgerald at 877.306.9780, or email consulting@mcgillhillgroup.com . To comment on this article, email impact@agd.org
1. Health Policy Institute. Q1 2025 Main Report: Results for Private Practice Dentists. American Dental Association, 2025, ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/ hpi/q12025_economic_outlook_dentistry_main.pdf. Accessed 13 May 2025.
2. Johnson, Arianna. “Remote Jobs Disappeared Nationwide This Year—Here’s Where They Fell Fastest.” Forbes , 4 July 2024, forbes.com/sites/ariannajohnson/2024/07/04/remote-jobs-disappeared-nationwide-this-year-heres-where-they-fell-fastest/.
3. "2025 Dental Industry Salary Survey Report." DentalPost , 2025, dentalpost.net/salary-survey/.
4. Patel, Badal M., et al. “Job Satisfaction, Burnout, and Intention to Leave Among Dental Hygienists in Clinical Practice.” Journal of Dental Hygiene , vol. 95, no. 2, April 2021, pp. 28–35.
5. “HPI: Nearly Half of Dentists Offer Health Insurance to Employees.” ADA News , American Dental Association, 8 Aug. 2022, adanews.ada.org/ada-news/2022/august/hpi-nearly-half-of-dentists-offerhealth-insurance-to-employees.
6. Kaiser Family Foundation. “2024 Employer Health Benefits Survey: Section 1: Cost of Health Insurance.” KFF , 2024, kff.org/report-section/ehbs-2024-section-1-cost-of-health-insurance/.
(Subject Code: 550)
The 10 questions for this exercise are based on information presented in the article, “Implementing an Effective Compensation Plan to Attract and Retain Employees,” by Wesley W. Lyon II, CPA, CFP, on pages 14–19. This exercise was developed by members of the AGD editorial team.
1. According to the American Dental Association Health Policy Institute’s (HPI’s) Q1 2025 survey on Economic Outlook and Emerging Issues in Dentistry, _____% of dental practices found it moderately, very or extremely challenging to recruit a dental hygienist.
A. 79.2
B. 84.2
C. 89.2
D. 94.2
2. In DentalPost’s 2025 Dental Salary Survey, most hygienists and dental assistants cited _____ as their secondmost important factor when seeking out a new opportunity, second to only compensation.
A. a better work environment
B. better benefits
C. better work-life balance
D. better location
3. In 2022, the HPI found that over one-half (_____%) of private dental practices were not offering any type of health insurance.
A. 51
B. 52
C. 53
D. 54
Reading the article and successfully completing the exercise will enable you to:
• understand the current staffing challenges dentists are facing;
• evaluate your current benefits and compensation packages; and
• revise your benefits and compensation packages based on current market rates and your practice goals.
This exercise can be purchased and answers submitted online at agd.org/ self-instruction
Answers for this exercise must be received by June 30, 2028.
4. Which of the following benefits were not listed among the top benefits dental hygienists received in 2024?
A. paid time off
B. health insurance
C. retirement
D. dental insurance
5. According to the Kaiser Family Foundation, the average premium for single health insurance coverage has increased _____% over the last five years, while family coverage is up _____%.
A. 25; 24
B. 26; 23
C. 27; 22
D. 28; 21
6. Instead of health insurance, dentists can also offer a qualified small employer health _____ (HRA).
A. refund account
B. rebate agreement
C. repayment allocation
D. reimbursement arrangement
7. In order to institute a qualifying HRA, you must have fewer than 30 full-time employees and create a plan document. An employer cannot offer both health insurance and an HRA to employees.
A. Both statements are true.
B. The first statement is true; the second is false.
C. The first statement is false; the second is true.
D. Both statements are false.
8. Dentists can find the mean hourly wage and 75th percentile and 90th percentile of wages for a specific zip code and job title using the _____ website.
A. National Office of Workforce Analysis
B. Federal Labor Data Authority
C. U.S. Department of Employment and Labor Statistics
D. U.S. Bureau of Labor Statistics
9. To be sure your staff compensation is in line with industry norms, add up all benefits except for retirement plan contributions, payroll taxes and wages. The combination should not exceed _____% of collections, excluding any associate dentist compensation.
A. 25
B. 26
C. 27
D. 28
10. According to the DentalPost 2025 Dental Salary Survey, 28.8% of associate dentists, _____% of dental hygienists and 23.2% of dental assistants had changed employers in the last year. Currently, _____% of associate dentists, 33.7% of dental hygienists and 56.7% of dental assistants are job hunting or considering job hunting.
A. 20.5; 46.6
B. 25.5; 41.6
C. 30.5; 36.6
D. 35.5; 31.6
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help preserve goodwill and retain patients,” said David Haynes, MBA, of Menlo Dental Transitions, Tempe, Arizona.
“You don’t have that stigma of being corporate dentistry,” said Lisa Gushin, DDS, FAGD, a dentist in Fayetteville, North Carolina. “You’re not wearing the scarlet letter ‘C’ on your chest.”
“What makes an invisible DSO different from a regular DSO is that the invisible DSOs — the good ones, anyway — want to become a doctor’s silent partner by buying anywhere from 51% to 80% of the doctor’s ownership stake,” explained Chip Fichtner of Large Practice Sales (LPS), an Irving, Texas-based company that specializes in invisible DSO partnership transactions. “This is critical — the doctor retaining ownership and continuing to lead the practice with skin in the game as an owner.”
The theory is that “an owner-led practice will be more profitable and easier to manage than an employee-led practice, such as you might find in the branded DSOs,” he said.
What Adam Smith wrote about in 18th-century economics is driving many DSOs today.
By William S. Bike
Adam Smith wrote in the 1700s about how an economic “invisible hand” can lead to positive outcomes for an industry.1
In dentistry today, there also is an invisible hand running many practices: “invisible” dental services organizations (DSOs).
DSOs “provide nonclinical business services to dental practices, including administrative, marketing, bookkeeping and financial services,” according to Eileen O’Grady, director of programs at the Private Equity Stakeholder Project, a nonprofit that researches and reports on private equity investment in multiple sectors.2
O’Grady authored a 2021 report that pointed to the dangers of private, completely profit-driven equity firms’ DSOs
buying and running dental practices.2
Private equity generally comes from institutional investors such as pensions, insurance companies and wealthy individuals or families.3 Dentistry began seeing significant private equity investment in the late 1990s.4
“They would buy a practice, change the name immediately, and everyone got mad, so they figured out they’d better change a few tactics,” said Wes Lyon II, CPA, CFP, president and CEO of McGill and Lyon Dental Advisors, Charlotte, North Carolina, and AGD Impact Financial Management columnist.
Enter the invisible DSO.
“Invisible DSOs often allow practices to retain their name and branding, which can
“One of the myths in the invisible DSO business is that they are all backed by private equity,” Fichtner continued. “They are not. Billions of dollars went into invisible DSOs last year that were not from private equity.”
Haynes noted, in invisible DSOs, “private investors — often a group of doctors — form an entity, pool their money, buy multiple practices and operate them under a unified back-end infrastructure while keeping the individual brand identities intact.”
Gushin noted that, in her state of North Carolina, a DSO must be run by dentists because “a dental office has to be owned by a licensed dentist.” No state allows the practice of dentistry by a nondentist, and most states do not allow nondentists to own practices either. Only Arizona, Mississippi, North Dakota, New Mexico, Ohio and Utah allow unlicensed entities, such as DSOs, to own practices.5
Invisible DSOs are becoming increasingly common. “Today, there are over 1,000 invisible DSOs in the United States,” Fichtner said. “The invisible DSOs last year had somewhere north of $5 billion invested in them. They are operating in all 50 states.”
A 2023 article in ADA News revealed that 13% of dentists nationwide were affiliated with a DSO, and, for dentists less than 10 years out of school, the figure was 23%.6 “In 10–15 years, 75%–80% of dental practices will be consolidated,” said Brian Colao, leader of the Dykema Dental Service Organization Group.7
DSO
“The main benefit of selling to an invisible DSO is that you get to continue treating patients without the hassle of operational tasks, such as accounting, marketing and human resources,” Haynes said.
“The typical setup is that the dentist sells and stays on for a number of years, and the DSO spreads out the buyout,” explained Eoin Halpin, DMD, FAGD, AGD Dental Practice Council member, Washington County, New Jersey.
In Gushin’s case, she sold to Heartland Dental, which has more than 1,750 practices and is the largest DSO in the country.8
“I got top dollar,” she said. “Selling the practice was seamless and easy. I chose five years as my contract with them. After five years, if I’m happy, I stay. If I’m not happy, I can find another place in the company or just go on my merry way.”
“They kept a six-figure holdback [a retention of a portion of the purchase price], and they pay me one-fifth plus interest once a year,” Gushin said. “That keeps me honest, because I have to maintain the output they bought the practice for.”
She noted that another dentist she knows, however, “got too comfortable and started working only two or three days a week. He didn’t uphold his end of the deal and was surprised when he didn’t get his holdback.”
Ben A. Bratcher, DDS, MAGD, past president of Texas AGD, partnered his practice with MB2, which defines itself as a “dental partnership organization.” A DPO is similar to a DSO, but in a DPO the dentist retains a minority ownership stake, while in a DSO the dentist may transfer full ownership. He said “the positives for me were both financial and professional. By partnering with MB2, I was able to monetize the equity in my
“[With an invisible DSO], you don’t have that stigma of being corporate dentistry. You’re not wearing the scarlet letter ‘C’ on your chest.”
— Lisa Gushin, DDS, FAGD
practice while maintaining complete control over clinical and day-to-day business decisions.”
Another benefit is being able to sell a practice, period. Bratcher found that when he wanted to sell, it was “virtually impossible to find a buyer among recent graduates, who are already strapped with excessive debt from school.”
“Being able to sell my practice to a new dentist for the price Heartland paid me was not realistic,” Gushin agreed.
Close to a quarter of dentists starting out are more likely to join DSOs compared with more experienced dentists.9
Halpin is happy working for a DSO, but, as an industry observer, he warns dentists of some possible drawbacks.
For dentists who want to still be managers, “that typically doesn’t happen,” Halpin said. “Business operations are outsourced to the main hub of the DSO.”
Concerning favored dental materials, the DSO “may say you cannot buy that product, or it may heavily discourage it,” Halpin added. Some dentists are fine with that. DSO procurement teams “negotiate with all the major vendors to secure significant discounts across the board,” Bratcher said. “They also negotiate the best pricing for
“Today, there are over 1,000 invisible DSOs in the United States. The invisible DSOs last year had somewhere north of $5 billion invested in them. They are operating in all 50 states.”
— Chip Fichtner, Large Practice Sales
services such as clear aligners and labs. Additionally, in my opinion, one of the best features is the leverage they can exert on insurance carriers.”
Because of economies of scale and lower operating costs, they may also accept more Medicaid and CHIP (Children’s Health Insurance Program)-eligible patients.2 And, when a crisis like COVID-19 hits, they may
be better positioned to handle it.10
DSOs are “paying 30% less for supplies and 50% less for implants, and, in many cases, they’re getting reimbursed at higher rates from insurance payers,” Fichtner said, citing LPS internal data. “Some of these invisible DSOs have 20 people in their headquarters helping recruit everything from front desk personnel to associate
dentists for their partner practices across the country. They’re also helping them attract new patients primarily through digital marketing.”
“There are a lot of continuing education (CE) opportunities within the company,” Gushin added. “I actually learned how to do Invisalign late in my career [through Heartland].”
Like Halpin, Lyon also warns of some drawbacks.
“Not all of the money may be guaranteed, and you’re not really the boss anymore,” he said. “You’re somebody’s employee. You have to look at the five years of profit you give up. The DSO owns the profit, so look at what they pay you, and then compare that to five years of owning your own practice or selling to an
1. When did the DSO purchase its first practice?
2. How many practices does the DSO own in my city and overall?
3. How long has the DSO’s leadership team been in place? (This is a reflection of the DSO’s stability.)
4. What is the formula for practice valuation? Earnings before interest, taxes, depreciation, and amortization? Percentage of collections? Multiples?
5. Where is the capital coming from that the DSO will use to purchase my practice? (To avoid being leveraged by a creditor.)
6. Does the sales price depend on the practice’s post-sale performance?
7. Will the practice remain in my name?
8. What will I be compensated for my production after closing?
9. What is the DSO’s required work-back period? What occurs if I leave early?
10. How are the DSO’s sales structured? Is the entire purchase price in cash at close? Is there a holdback or earnout?
11. What class of stock will I receive?
12. How much debt does the DSO carry?
13. Will I be a partner or an associate?
14. Is the DSO planning any recapitalization? How will that affect my practice?
15. Can my practice under the DSO grow or add locations?
16. Is my equity eligible for recap at the same terms as the DSO?
17. Is my equity in my practice or in the DSO?
18. Does equity pay dividends? If so, how frequently?
19. What will my percentage be vis-à-vis production and collection?
20. What degree of autonomy will I have in leading the practice after the DSO comes in?
21. What services will be provided for our practice? Will there be a CE allowance?
22. What are the details about health insurance, disability insurance, life insurance, malpractice insurance and a 401(k)? What provisions will be made for my family’s safety and future if something should happen to me?
23. What is the policy concerning days off, vacation, etc.
24. If I own my building, will the DSO buy my building or rent it from me?
25. May I speak with doctors who have partnered with the DSO previously?
(Questions compiled from interviews with Ben A. Bratcher, DDS, MAGD; Chip Fichtner; Lisa Gushin, DDS, FAGD; Eoin Halpin, DMD, FAGD; David Haynes, MBA; and Wes Lyon II, CPA, CFP.)
individual. Look at what you are guaranteed in cash and what’s not guaranteed.”
Lyon offered a startling statistic: “Out of every 100 practices that think they’re going to sell to a DSO, it’s probably a good idea for three of them.”
Fitchner advises that, when selling a practice to a DSO, “dentists should not be representing themselves in this transaction. They’re very complex. Our average deal has 320 pages of documents.”
He also feels that a typical dentist’s attorneys or accountants “don’t know anything about what an invisible DSO is and how to negotiate an agreement with them.”
Haynes explained that “an experienced dental practice broker by your side can help you negotiate favorable earning before interest, taxes, depreciation and amortization; multiples; work-back terms; compensation; rent rates if real estate is owned; allocations; equity splits; structure; management fees, etc.”
Bratcher also advises that sellers and their representatives examine profit-sharing, exit clauses and management structure.
In one case where LPS got involved at the eleventh hour, the firm obtained for a dentist $42 million — more than double their original negotiated price.
“This was a dentist who was willing to take $19 million. So, net of our $3.5 million fee, he got $20 million more — more than double what he was about to take,” Fitchner said.
An early criticism of corporate DSOs was the fear that they would dictate patient care decisions.
Today, however, Fichtner said, “all of the DSOs — good, bad, visible, invisible — will leave the clinical decisions up to the doctors. Not just because they have to from a legal standpoint, but also just because the doctors need to make the clinical decisions and dictate the treatment.”
“Patient care, treatment decisions and all aspects of the patient experience are 100% the responsibility of the treating doctor,” Bratcher said. “The patients have not, and will not, experience any difference in their level of care.”
Haynes, however, said, “in some cases treatment decisions can be influenced by corporate goals — which is why it’s crucial to understand the clinical autonomy terms in your agreement.”
Fichtner noted that invisible DSOs “are on the cutting edge of technology” because they can afford breakthroughs such as artificial intelligence (AI).
Continuity of care can be an issue. Lyon warned that “while the selling doctor is still there, he or she is still usually in charge of the treatment. When the next doctor comes in, that’s when things get a little dicey. Some DSOs do a fine job in patient care. Some are mills.”
The transition itself, however, is often so seamless that when a dentist sells or partners with an invisible DSO, “the patients don’t even know that the dentist has a new partner,” Fichtner said.
“But shifts in administrative policies or staff turnover could subtly impact patients’ experiences over time,” Haynes warned.
Fitchner believes that, for the associates, an invisible DSO acquiring a practice is “all win-win for them. The invisible DSO’s basic operating philosophy is: ‘We want owner-doctors to operate our partner practice.’ So, any of the really good invisible DSOs are going to create a path to ownership for those associates. Typically, those pathways to ownership do not require the associates to borrow money to buy a piece of the practice.”
Lyon, however, warns that associates “should be wary of any offers to buy shares in the DSO in case they’re locked into working for the DSO for too long a period. “And they want to be careful regarding what they sign in a noncompete clause or agreement,” he said.
Bratcher concludes that invisible DSOs are typical of the invisible hand ubiquitous in business today. “I had no idea the last time I ate at a Chili’s restaurant that it was owned by Brinker International. It is very common in business for an entity to own multiple brands.” ♦
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
1. Smith, Adam. The Wealth of Nations. New York: The Modern Library, sixth edition, 1994. First edition, 1776.
2. O’Grady, Eileen. Deceptive Marketing, Medicaid Fraud, and Unnecessary Root Canals on Babies: Private Equity Drills into the Dental Care Industry. Private Equity Stakeholder Project, July 2021, https://pestakeholder.org/wp-content/uploads/2021/08/PESP_ DSO_July2021.pdf.
3. “What Is Private Equity?” British Private Equity and Venture Capital Association, bvca.co.uk/our-industry/what-is-private-equity.html. Accessed 24 April 2025.
4. “Private Equity Investment in Dental Care.” Provident Perspective, October 2017, providenthp.com/wp-content/uploads/2017/10/ Provident-Dental-WhitePaper.pdf.
5. Cutler, Erick. “Although a Non-Dentist May Be Prohibited from Owning a Dental Practice, There Is a Way for Financial Participation.” EisnerAmper Dental Blog, 1 March 2021, eisneramper.com/ insights/blogs/dental-blog/dental-practice-management-0421/.
6. Ganski, Kelly. “More Dentists Affiliating with DSOs.” ADA News, 1 June 2023, adanews.ada.org/ada-news/2023/june/more-dentists-affiliating-with-dsos/.
7. “Dental Service Organizations.” Dykema Law Firm, dykema.com/ MnA-2024/dental-service-organizations.html. Accessed 24 April 2025.
8. Busch, Melissa. “These Are the Top 10 DSOs in the U.S.” DrBicuspid.com, 23 Dec. 2024, drbicuspid.com/dental-business/ dso/article/15710563/these-are-the-top-10-dsos-in-the-us.
9. Portalatin, Ariana. “Why Younger Dentists Are More Likely to Join a DSO, Per 1 Exec.” Becker’s Dental + DSO Review, 7 June 2023, beckersdental.com/featured-perspectives/why-younger-dentistsare-more-likely-to-join-a-dso-per-1-exec/.
10. Booth, Jeremy. “Has the Pandemic Really Strengthened DSOs on the U.S. Dental Market?” Dental Tribune International, 24 Nov. 2021, coronavirus.dental-tribune.com/news/has-the-pandemicreally-strengthened-dsos-on-the-us-dental-market/.
“Private Equity and Dentistry” AGD Impact, December 2023
“To DSO or Not to DSO?” AGD Impact, September/October 2020
AGD’s 2013 Investigative Report on the Corporate Practice of Dentistry agd.org/dental-practiceadvocacy-resources/career-tools/ selecting-a-practice-model
Each year during the AGD scientific session, the organization hosts the prestigious Convocation Ceremony for the year’s Fellowship, Mastership, and Lifelong Learning and Service Recognition (LLSR) recipients. These awards highlight the dedication to the craft of general dentistry that recipients demonstrate, and holders of these awards can be considered the top of the profession. AGD Impact spoke to several of this year’s recipients and asked about their motivations, their strategies for tackling the requirements of these awards and their advice for other general dentists who are pursuing these marks of professional recognition.
AGD Fellowship was a personal goal I pursued in order to challenge myself, broaden my clinical knowledge across different dental specialties and refine my skills to provide more comprehensive care to my patients. Staying at the cutting edge of general dentistry is important for ensuring evidence-based treatment. By broadening my knowledge, I have developed a greater sense of professionalism and confidence, which in turn fosters increased trust from my patients.
I was encouraged to seek this award by fellow AGD members who have successfully completed their Fellowship and Mastership awards. Completing the 500 continuing education (CE) hours necessary for Fellowship was not a very big issue. I obtained the required credits over five years ago; however, I delayed taking the Fellowship Exam. My preparation for the exam was significantly hindered when I acquired my clinic just months before the onset of the COVID-19 pandemic. Balancing the responsibilities of running a clinic as a new owner, managing renovations, dealing with staffing shortages and learning to oversee a team of approximately 12 employees — without the support of a manager — became my primary focus since I took ownership. I advise anyone pursuing it to not delay in preparing for the Fellowship Exam; if you are an associate, it is much easier to study for the exam than when you are operating your own practice. I also advise you to connect with other AGD members or mentors who have already achieved Fellowship, Mastership or LLSR, as they can offer guidance and encouragement throughout your journey.
Reaching this milestone was a source of both personal and professional pride, yet it was also a humbling experience. It strengthened my resolve to challenge my limits and motivated me to continue my evolution. This accomplishment signifies not an end, but rather a new beginning for further growth. I do not profess to possess all knowledge. Throughout my life, I have been influenced by a quote attributed to Socrates by Plato: “The only
thing I know is that I know nothing.” This philosophy encourages humility and fosters a continuous quest for knowledge. Dentistry is constantly evolving as a profession because of an explosion of research and emerging technologies, which makes it very exciting. By staying up to date with these advancements, you can offer more effective care for your patients. Fellowship is a valuable investment in your professional growth.
Connie
Tse-Wallerstein, DDS, MAGD, Two-Time LLSR Recipient I am truly honored to receive the AGD LLSR award and am deeply grateful for the opportunity to be recognized by AGD for my contributions in various leadership roles. Successfully balancing my responsibilities and attaining my second LLSR has been a truly enriching and inspiring experience. Although I did not actively pursue this accolade, my dedication to continuous selfimprovement and commitment to serving my community naturally led me down this path. My inspiration comes from my deep-rooted desire to constantly enhance my skills and knowledge, ultimately striving to be the best dentist I can be.
Completing all the necessary criteria and accumulating the required volunteering hours demanded significant time, effort and commitment. This experience has reinforced the importance of efficient time management and perseverance in pursuing professional excellence. The LLSR has inspired me to continue making a positive impact through volunteer work. By serving as a regional director, a constituent executive for Quebec AGD, a faculty adviser for McGill University, a member of the Scientific Meeting Council and chair of the 2025 Local Advisory Committee for AGD, I have been able to expand my reach and engage in various volunteering initiatives. Among these endeavors, the “Gift from the Heart” project has been especially rewarding. This initiative has provided dental care to individuals in need, granting them access to services
they may otherwise be unable to afford and making a tangible difference in their lives.
AGD’s LLSR award highlights the significance of prioritizing continuous education and self-improvement throughout our careers. In a rapidly evolving landscape shaped by advanced technology and research, it is imperative that dental professionals stay abreast of the latest techniques and developments. By committing to lifelong learning, we ensure that we are equipped to provide the best possible care for our patients. By committing to lifelong service, sharing expertise and experiences through collaborative mentorship, we support and enhance the capabilities of other practitioners and foster a culture of innovation, camaraderie, excellence and continual advancement in our profession.
For members who are pursuing their LLSR, I offer this advice: Stay dedicated to your pursuit of excellence in education and service, and place a strong emphasis on giving back to the profession by empowering and motivating the next generation of dental leaders. This commitment not only instills your work with a profound sense of purpose, but it also unites us in our collective efforts to achieve exceptional outcomes, strengthens the foundations of our esteemed profession, and elevates the practice of dentistry to new heights of success and fulfillment.
Bernardino Octavio Elizondo, DDS, MAGD, Three-Time LLSR Recipient
I have come to realize that the only obstacles we face are those we place on ourselves. During my pursuit of Mastership, I met Dr. Tony Menendez, who has achieved numerous LLSR awards. He was instrumental in inspiring me to work toward further achievement within AGD. Once I made the commitment to work toward my LLSR, I overcame whatever obstacle I felt was presenting itself in my mind.
CE is crucial in maintaining — as well as expanding — our knowledge in dentistry. Continuous learning keeps us relevant in our profession. It has helped tremendously in keeping my dental knowledge and skills at their utmost level and for my own personal satisfaction. I feel that my patients appreciate my commitment to being the best dental provider that I can be for them.
My advice to anyone striving for an LLSR is to start early and stay motivated. The friendships and camaraderie formed in our pursuit of these awards are lifelong and meaningful. I have come to treasure all the memories of attending various MasterTrack programs and AGD meetings. Attaining these AGD awards helps us to enjoy lifelong friendships and the sense of great achievement when the award is bestowed. This is my third LLSR, and I feel very proud of this achievement. I have made a personal goal of earning at least six LLSR awards.
Taylor F. Townsend, DDS, MAGD
Pursuing AGD Mastership is a worthy challenge, and dentistry breeds performers! Seriously, I often say that there is value in doing the hard things. So, when given the opportunity to expand my knowledge and skills through Mastership, the return on investment for the benefit of my patients and those I teach is unmatched.
Balancing steady progress toward Mastership and all the demands of not only the provision of care but also of doing so as a sole business owner — especially in the midst of additional challenges such as the COVID-19 pandemic and raising a family — were the most significant obstacles. But these obstacles sure made the journey fuller and less boring!
For me, the main value of attaining Mastership initially was the journey. As a private practice dentist in a very rural area with no local specialists, I found the skills acquired along the way allowed me to more comprehensively serve my patients and team. Now that I have transitioned professionally into full-time postdoctoral academics, my Mastership provides increased value to my faculty appointment as well as to our residents.
Everything about our profession is dynamic. Our patients are all different. Our knowledge base and available resources continue to expand. The pressure of economics and business structure require adaptability to change. When we continue to push ourselves to grow through high-quality CE and milestones such as Mastership, we are able to excel among such ever-changing variables, and we owe as much to the patients we treat and the teams we are responsible for leading.
When I achieved Mastership, I felt appreciation for my family and dental team’s support. I also felt appreciation for AGD for creating a path encouraging its members to better ourselves professionally. Remember, there is value in doing hard things! Attaining Mastership is about keeping the end goal in mind while placing one foot in front of the other. The pursuit of Fellowship or Mastership sets a trajectory that provides much more professional depth to and enjoyment of what we do.
My inspiration to pursue AGD Fellowship stemmed from a deep commitment to lifelong learning and a desire to provide the highest standard of care to my patients. Interestingly, I made the decision to pursue Fellowship during the COVID-19 pandemic, a time when many dentists — including myself — found themselves with unexpected free time due to clinic closures. I chose to stay positive and make the most of the situation by focusing on professional growth and education during this challenging period. AGD’s emphasis on CE and clinical excellence aligns
closely with my own professional values, and I wanted to challenge myself to reach this distinguished milestone.
Balancing the rigorous requirements of Fellowship — particularly the 500 hours of approved CE and preparation for the comprehensive exam — with the demands of a busy clinic schedule and personal commitments was a significant challenge. As a busy mom to two active young boys, I had to find time for my own professional growth while managing family and personal responsibilities. Staying organized and maintaining consistent progress over several years required dedication, perseverance and a lot of creative time management.
Earning Fellowship has broadened my clinical knowledge and refined my skills across multiple dental disciplines. The process of completing extensive CE and preparing for the exam pushed me to stay current with advancements in dentistry, which has translated into more comprehensive care for my patients and increased confidence in my clinical decision-making. It also enhanced my professional reputation and sharpened my mentorship skills.
Achieving AGD Fellowship was incredibly rewarding and fulfilling. It was a proud moment to see years of hard work, dedication and commitment recognized in an official capacity. Joining the select group of dentists who have earned this distinction truly motivated me to continue striving for excellence. I was also deeply grateful for the support of my family and colleagues throughout the journey.
CE and awards like AGD Fellowship are vital in dentistry because they ensure practitioners remain at the forefront of evolving techniques, technologies and evidence-based practices. CE sharpens critical thinking and broadens clinical knowledge, enabling dentists to deliver confident, high-quality patient care. Professional awards affirm a dentist’s commitment and expertise while fostering a culture of excellence that strengthens the dental community.
My advice is to start early, stay organized, and view the process as a significant opportunity for professional growth. Take advantage of the educational opportunities AGD offers, and don’t hesitate to reach out to colleagues who have completed the process. The effort is substantial, but the personal and professional rewards are well worth it.
Toni Yeu-Shyr Tien Neumeier, DMD, MS, LLSR Recipient
I received the MAGD award in 2010. I have been very involved with AGD (state president, Fellowship Examination Committee, Scientific Meeting Council) and was otherwise very busy and put thoughts of LLSR aside until four years ago. One of my colleagues, Dr. Wendy Holder from Alabama AGD, started a MasterTrack program and invited me to be the first speaker for it. The program started with nine participants, and their enthusiasm stimulated me to complete all the requirements for LLSR. It took
me almost three years to meet this goal. I was very excited when I took the final required participation course last year and eager to fill out the LLSR application form. I felt relieved that I had finally achieved the highest reward/award I could through AGD.
As an educator and faculty adviser for the student chapter, I always tell students there is no end to studying and learning. Dentistry has new techniques, materials and knowledge that come up every day. Attending CE courses not only enhances knowledge but also provides self-confidence in patient treatment and office management. Receiving an award or certification from the organization is a statement that informs patients and colleagues that you have spent time and worked harder to be a better dentist than others in this field.
Having this updated information will continue to be useful as long as I keep treating patients or teaching at school. All of this new knowledge makes me a better educator for students and a better dentist for patients. The process has also led me to teach MasterTrack courses and other classes. Since I have been involved with AGD both at the national and local levels for the past 15 years, I will continue to be a volunteer for AGD as long as I can contribute to the organization.
Since one of the requirements for LLSR is service, if you have already received the MAGD award, please volunteer to be more involved with AGD at either the national or local levels. Participation in AGD strengthens the organization because you are sharing your talents. You are also providing service to dentistry and your community. The rewards for any kind of volunteer service are not something that can be purchased, but they leave a permanent, positive mark on someone’s mind and life, which is priceless.
As a former aerospace engineer and now an Air Force military dentist, I’ve always been drawn to careers grounded in structure, discipline and purpose. When I transitioned into dentistry, I was seeking a profession that would allow me to connect directly with people and make a lasting impact on their well-being. AGD Fellowship stood out as a symbol of excellence and commitment to continuous learning — values that align closely with both military service and healthcare. AGD supported me through dental school and residency, and pursuing Fellowship felt like a meaningful way to advance my skills while honoring my duty to serve others.
Serving in the military brings unique challenges, from unpredictable schedules to deployments and the high demands of providing care in diverse, sometimes resource-limited environments. Balancing CE requirements with the responsibilities of being a military dentist — along with maintaining family life — required a high level of discipline, time management and persistence. There were moments of fatigue and sacrifice, but the
support of my family, colleagues and the AGD community helped me stay focused and motivated.
AGD Fellowship helped me become a more well-rounded and confident clinician. The broad scope of CE empowered me to take on complex cases and deliver comprehensive care — even in the dynamic and often fast-paced setting of military dentistry. It enhanced my leadership within the Dental Corps and reinforced my role as a resource for junior providers and teammates. Fellowship didn’t just elevate my clinical skills — it deepened my sense of service, both to my patients and to the profession.
Achieving AGD Fellowship was a moment of deep pride and reflection. It symbolized not just personal growth, but also professional resilience — a commitment to lifelong learning under the demands of military service. I felt honored, grateful and humbled. It reaffirmed why I chose to leave a stable engineering career: to serve others through hands-on care and leadership. It was a moment that reminded me of the responsibility I carry — not only to provide the highest quality care to those I serve, but also to lead by example.
CE is the foundation of excellence in dentistry. In the military, where we may treat a wide range of patients under varying conditions, staying sharp and adaptable is critical. Awards like AGD Fellowship go beyond recognition — they represent a commitment to staying current, ethical and clinically sound. They also encourage a culture of learning within the dental community, helping to raise the standard of care across the board and inspiring others to invest in their own growth.
If you decide to pursue Fellowship, start with a clear purpose, stay organized, and trust the process. Whether you’re in private practice or military service, it’s possible to make steady progress, even with a demanding schedule. Take full advantage of the diverse CE opportunities available, and approach the journey with curiosity and passion. Most of all, enjoy how much you evolve along the way. Fellowship isn’t just a milestone — it’s a reflection of how far you’ve come and how committed you are to delivering the best possible care.
Timothy F. Kosinski, DDS, MS, MAGD, AGD Editor, Four-Time LLSR Recipient
I began my AGD journey back in my second year of dental school at the University of Detroit Mercy. It seemed obvious to me — even in those early years — that there was so much to learn and that AGD was a means to document all the courses I took. I liked the idea of pursuing some acknowledgment or recognition, and Fellowship seemed like a natural path. My general practice residency at Miami Valley Hospital in Dayton, Ohio, promoted great education and a means to accrue many of the CE hours needed for Fellowship. I was fortunate to be mentored in my five-year associateship by a great educator and promoter of learning.
Implants were a natural fit for me, so participation courses became paramount. I achieved Fellowship early. My accumulation of participation courses didn’t stop there, and I believe it took me another five years to achieve Mastership. LLSR was the next step. I focused on the topics that interested me the most and sought out hands-on programs. Community service has always been important to me — giving back to those less fortunate is an important part of being a professional — so that part of the LLSR requirements came naturally.
I have never stopped learning in my long career. This year in Montréal, I will receive my fourth LLSR. I tell my students and the attendees at my courses that learning never stops, and the importance of each and every course is to learn something. It might be one simple process that will make me a better dentist — more efficient, proficient and competent — but, as long as I learn at least one new thing, CE is worthwhile.
The process of accumulating specific CE credits in specific topics that interest me and that can be easily incorporated into my practice can be a chore, but it is certainly doable. Hands-on or participation courses are especially important, but not always easy to obtain. Travel and time away from the office can get expensive, but it is important to me.
Each course stimulates the mind and allows for an opportunity to advance. Technology is moving quickly, and making the proper investment that will improve my proficiency and efficiency as well as increasing patient compliance is critical. Never standing still makes me a better dentist. I have patients who have been with me for nearly 40 years, and I know that my patient family appreciates my efforts to keep my skills and knowledge current.
As AGD editor and an Executive Board member, I have the opportunity to help give out the Fellowship and Mastership awards on stage. I see the excitement in the eyes of each and every recipient as they begin their walk to the center to meet the AGD president. I reminisce about that feeling of accomplishment. It’s a good emotion and makes me want to do even more. Families, too, are involved in this journey, and I know how proud they are when I see all the smartphones in the audience taking photo after photo. It is truly heartwarming to see those emotions of love and respect.
Keep it up, and never stop learning. Hunt out the hands-on programs that most interest you. Our AGD scientific session is a great place for camaraderie and advancing clinical skills with some of the most prominent experts in all fields of dentistry. Belonging to AGD is such a small financial investment, but the return on that investment is immeasurable if you also invest your time and commit to growing as a professional. Never stop gathering experience and knowledge, and keep pursuing those great feelings of accomplishment that come in the moments when our patients are healthy and satisfied, our families are proud of and inspired by us, and we earn the respect of our peers and ourselves with achievement-based awards.
By Ross Isbell, DMD, MBA
BufferPro™ Premier® premierdentalco.com
There are many ways to deliver local anesthesia, and every practitioner finds a style that they believe delivers the most “painless” injection. Few marketing phrases are as effective as a patient testimonial saying, “The shot didn’t hurt.” Absence of pain leads to absence of fear, which leads to more patients in my practice. My father was an early champion of bicarbonate buffering with the Onpharma system, and the literature support for the effectiveness of buffering anesthetic is solid. Neutral or basic pH anesthesia injections burn or tingle less than acidic ones, and they deliver more profound anesthesia at a faster rate. This occurs because a neutral pH allows for faster diffusion of anesthetic across cell membranes and is, therefore, more effective at infiltration delivery. The basic nature of sodium bicarbonate at an average pH of 7.8 balances the acidic nature of lidocaine that has an average pH of about 5. Articaine typically has a higher pH around 7.3 and so is already significantly closer to the physiologic pH of 7.4 that leads to speedy pulpal anesthesia. Since I primarily use articaine, I felt like I couldn’t justify the additional cost of buffering every anesthetic carpule when the effectiveness wasn’t as significantly different. Premier® and Septodont have partnered to deliver a new product that eliminates the need to use an opened bicarbonate cartridge quickly or on every anesthetic carpule because its BufferPro™ delivery system is single-use for a single carpule, and it has a two-year shelf life. You can store it at room temperature in your supply closet and dispose of it in a sharps container. The cost per carpule is about $3 compared to $5+ for others. To use, there are no calculations or additional hardware involved — simply open the sealed package, slip the bicarbonate delivery cartridge onto your anesthetic cartridge of choice, and press it down to push bicarbonate buffering solution into your anesthetic. It will mix on its own to some extent, but spin it around slowly a few times or give it some gentle shakes for good measure. You will notice that the plunger has moved back slightly, so be careful when loading it into your syringe in case it has pushed beyond the glass, since that can snag on the plunger. Once loaded, use immediately to avoid formation of precipitates. Personally, I like to keep BufferPro on hand for when I am going to block a patient that I know has a history of not getting numb easily. While I know that recent studies — like those from Jason Goodchild, DMD — have shown that articaine is perfectly safe as an initial block anesthetic, I still often block with lidocaine first. Using buffered lidocaine increases my successful block percentage to a similar rate as with articaine, and I have even noticed a faster onset time when buffering articaine. BufferPro isn’t an all-the-time product for me, but it is super easy to use and definitely effective enough that it has found an important role in my practice.
Eagle Dental eagle-dental-burs.com
In most situations, when I cut gingiva with a handpiece, I have very little expectation that I will gain hemostasis quickly. Bur gingivectomy is quite common during crown preparations, and, when possible, I use a red stripe finishing diamond as I approach or go below the gingival margin to minimize tissue tearing and the prolonged bleeding that follows it. When I plan ahead to do a gingivectomy, such as with anterior exposure cases or implant uncoveries, I have used a scalpel or diode laser. However, I have found that tissue is significantly more likely to remain where I placed it after healing if I use a ceramic soft tissue trimmer from Eagle Dental. While they are expensive at $75+ per bur, they last a long time since they are only encountering soft tissue — these burs should not be used for contouring hard structures such as tooth or bone. Postoperative healing and bleeding is significantly less than with other strategies because the tissue has been trimmed so finely that capillary beds are less disrupted and there is minimal surface area affected that needs tissue regrowth. I prefer the football-shaped bur for working on the buccal aspect of a prep and for doing implant uncovery because the shape allows for a nicely sloped graduated bevel when directed at a 90-degree angle to the tissue. You can run the bur at full speed on a high-speed handpiece without worrying about it breaking apart, but I typically trim at about half speed to ensure that I’m not being too aggressive and am following a smooth path. Ceramic burs do not generate as much heat as metal or diamonds, so water-cooling is unnecessary for protecting the tissue from burns and should only be used if you need it for debris removal. The flame-shaped bur is useful for interproximal trimming or for following the margin around a prep in subgingival margin situations if I need more exposure or coagulation for a scan. While I still prefer my laser for quick hemostasis, I am becoming increasingly fond of conservative tissue preparations with ceramic soft tissue trimmers from Eagle Dental.
Ross Isbell, DMD, MBA, currently practices in Gadsden, Alabama, with his father, Gordon Isbell, DMD, MAGD. He attended the University of Alabama at Birmingham (UAB) School of Dentistry and completed a general practice residency at UAB Hospital. Isbell has confirmed to AGD that he has not received any remuneration from the manufacturers of the products reviewed or their affiliates for the past three years. All reviews are the opinions of the author and are not shared or endorsed by AGD Impact or AGD. To comment on this article, email impact@agd.org
Liquid Strip
Ivoclar
ivoclar.com
Freehand composite sculpting and the associated bonding and curing processes are among the most technique-sensitive that general dentists perform. Especially when considering the cosmetic success of composite veneers or anterior restorations, I often feel like my surface finish is imperfect. Typically, I will address the finish and shine by overbuilding a veneer and then polishing it back to eliminate voids and any trace evidence of the oxygen-inhibited layer (OIL). Depending on your polishing system of choice, this may or may not be a time-consuming process. The only way to prevent the presence of the OIL is to create an absence of air, such as when a mylar matrix strip is wrapped around a Class IV. In situations where you don’t want the pressure of a physical strip affecting your recent contouring and sculpting work, you could utilize a glycerin gel like Liquid Strip from Ivoclar. This material is shelf stable at room temperature for multiple years and is easy to dispense with a viscosity similar to most etchants. It is a clear gel composed of glycerine, water and highly-dispersed silicon dioxide and aluminum oxide. Indications for use include as an indirect restoration try-in aid, a barrier for use in lab-etching processes, and a cover for preventing OIL formation during final curing of composites or resin cements. I am typically unsatisfied with my composite placement during veneer creation, so I significantly polish and recontour. Because of this, I usually am removing the OIL with a polishing system, even when I don’t use Liquid Strip. The OIL is important for increased bond strength between layers of composite because the OIL adapts readily to the new layer and allows for a copolymerization reaction at the interface. So if you plan to stack layers for color blending, anatomy and translucency, this product should not be used until your final layer has been placed. Also, if you are using a low-viscosity flowable, make sure to tack cure before placing Liquid Strip so that the materials do not mix. If you are using a chameleon-style composite, such as Omnichroma, and doing the majority of work with a single layer that just needs contouring, glycerine-curing can help increase the beauty, shine and hardness of the most-exterior layer of your restoration with less polishing, less post-cure reduction and less soft resin to clog your bur flutes. While I personally haven’t found a critical need for it in daily workflows beyond freehand veneering as an additional step after tack-curing, Liquid Strip by Ivoclar is a high-quality dental-grade glycerine gel and is really good at its intended purpose of preventing formation of the OIL and being easily rinsed away afterward.
Look for the following article in the July/August issue of AGD’s peer-reviewed journal, General Dentistry.
A case of canalis sinuosus mimicking internal root resorption in periapical radiographs
The canalis sinuosus is the terminal anatomy transporting the anterior superior alveolar neurovascular bundle from the infraorbital canal to the anterior maxilla. Due to its termination in the anterior maxilla and potential diameter of 2.0 mm or greater, it has been previously reported to mimic a periapical radiolucency on 2-dimensional radiographs. This case report highlights incidental findings in a 25-year-old man following trauma to the anterior maxilla. During 2-dimensional radiographic assessment, a well-defined radiolucency suggestive of internal resorption was identified at the junction of the middle and apical thirds of the root of the maxillary left lateral incisor. Assessment via cone beam computed tomography identified the radiolucency as the canalis sinuosus. This case highlights the importance of 3-dimensional assessment of confounding findings in the anterior maxilla.
Read this article and more at agd.org/generaldentistry
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