Dentists join AGD for many reasons, but two of the most common are topnotch continuing education (CE) and CE tracking. Once they join, many dentists realize that the organization is so much more than CE. In celebration of all that the organization has to offer, AGD Impact reached out to four members and asked them to tell their AGD stories. AGD has shaped their careers in different ways, but, like so many dentists across the country, they all agree that they would not be where they are today without AGD — and that they love their AGD family.
Reports from AGD Benefits Providers
AGD offers myriad benefits to members through its partner companies. This month, two of these providers, Dentist’s Advantage and Hagan Insurance, offer insights into their respective fields of expertise.
Is Your Practice a Great Place for Dental Assistants to Work?
By the Dental Assisting National Board
Creating a great workplace is essential for the success of any business. As dental practices face the challenges of a growing dental assistant workforce shortage, it’s more important than ever to show support for these key employees.
Broaden Your Horizons by Attending AGD2025 in Historic Montréal
This summer, AGD heads to Montréal, Quebec, for what is sure to be an unforgettable experience for all. Whether you’re looking to stay ahead of industry trends, sharpen your clinical skills or build valuable connections, AGD2025 has everything you need.
Empowering General Dentists: AGD Means Lifelong Learning, Professional Development and Networking
We are all aware of the continuing education (CE) and professional development opportunities provided by our AGD.
This unique organization is devoted primarily to general dentists who strive for excellence in all phases of treatment provided by each specialty.
Dentistry is constantly evolving. AGD offers myriad educational resources and, most importantly, networking opportunities to help you keep up with the latest developments. We are big believers in personal contact to increase your knowledge base and learn the latest technologies and clinical techniques from highly qualified colleagues. Continually learning is not easy, but our AGD team helps in this process.
Timothy F. Kosinski, DDS, MAGD
Management of CE requirements was the first reason I chose to join AGD back in my second year of dental school. Having AGD track my courses has made it simple for me to navigate my continued learning, and it’s no small reason I’m achieving my fourth Lifelong Learning and Service Recognition this year at AGD2025 in Montreal. I truly acknowledge that my AGD membership helped me build and continue a lucrative path. Lifelong learning is critical, and the CE provided live and online are second to none.
Another perk of AGD membership is our publications. Our entire editorial team works so hard to ensure General Dentistry and AGD Impact are premier sources of dental information. Our readership has regularly requested hard copies of both publications. There is much pride in creating our publications, and the response from AGD members has been consistently positive.
Dr. Cassis and I are devoted to making education paramount. We would love to provide opinions and comments to any AGD member in need. Our entire AGD is centered on making each member a better person and more competent practitioner, along with creating a general dentistry camaraderie unparalleled in the profession.
Timothy F. Kosinski, DDS, MAGD Editor
Bruce L. Cassis, DDS, MAGD
I joined AGD in 1986, a full six years after my graduation from the West Virginia University School of Dentistry. What took me so long to realize AGD was the organization to propel me to where I wanted to go with my career? In the first place, there was no mention of AGD during my formal education that I can recall. Second, there was very limited CE available in our area that would help me provide better care to patients. While plenty of social interactions were available, my thirst for providing better care was not being met. At some point, I started looking at more regional and national CE courses, and then I discovered AGD, an organization whose forte was CE. The interactions with other members, whose passion matched my own, led me to follow the pathway to success, including AGD Fellowship and Mastership.
Volunteering at the local level was key to developing my skills as an AGD organizer and promoter. When I was appointed to the Fellowship Exam Committee, I began to see the depth and breadth of AGD’s influence, which really fueled my passion for the organization. After having chaired many councils and committees — and serving as president of the organization — my passion is stronger than ever.
In my current role as associate editor, I have seen the culmination of the teamwork and passion required to produce award-winning publications to serve our members. Strong leadership from Dr. Kosinski and our team in Chicago will continue to provide our members the best that organized dentistry has to offer.
Our AGD is made up of loyal and hard-working individuals. The entire focus is to provide better care for our patients and make dentistry fun and profitable. We are proud to be called leaders, but we know that we rely on the team and our AGD family to make us more competent and effective.
Bruce L. Cassis, DDS, MAGD Associate 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.
AGD members receive AGD Impact as part of membership; annual subscription rates for nonmembers are $80 for individuals and $120 for institutions. Online-only subscriptions are $85 for individuals and $110 for institutions. All orders must be prepaid in U.S. dollars. Single copies are available upon request. Please contact our Membership Services Center at 888.243.3368 for more information.
What makes AGD so special?” “Why would anyone want to be a member?”
“What have they even done for me?”
Trust me, I’ve heard it all, and I get it — I’m not offended. The world of dentistry is much more complicated these days, from dozens of organizations wanting you in their ranks to the ever-expanding options for dental education. When asked why I am an AGD member, I like to share my story.
When I graduated from dental school in 2000, I had mixed emotions. First, I was ready to be done with school and get on with my life. But I did not feel ready or confident enough to actually practice dentistry. The thought of even giving a mandibular block gave me anxiety! There is nothing more humbling than getting into practice and realizing how much you don’t know. I was fortunate to have mentors like my dad — also an AGD member — to help guide me (and bail me out on occasion). But what I can confidently say is that my AGD education saved me.
One of my favorite sayings is, “If you aren’t moving forward, you’re moving backward.” As a dentist, this rings in my head when I think about how I can be a better dentist. Your dental education doesn’t end when you graduate from dental school. To me, this is where my education began. This is when I realized my salvation was to find high-quality continuing education (CE). I was a member of AGD since dental school, so this organization is where I first turned. It was easy then because there were not a lot of choices for high-quality CE 25 years ago. It was as true back then as it is now — AGD’s educational offerings are second to none.
But the CE landscape has changed. If your inbox is like mine, you get at least five to 10 emails a day offering low-cost, “high-value” dental CE, not to mention what shows up on your Instagram feed. It is tempting to spend less, but here is where you can fall into the all-too-common trap of spending way too many hours attending courses and not really getting anywhere. In many of these courses, we learn some great tips and tricks, but, for the most part, we return to our offices and go back to our comfort zones. Or, worse, we spend a day off attending an eight-hour infomercial.
If I’m going to spend time away from my family and my office, I want it to count. I want to say that I learned something of value
“I have made friends and developed relationships that will last a lifetime. These are ‘my people.’”
that will improve my skills as a dentist and that I am moving forward. This is why I think AGD is special. I say this not just because I’m the president; I am also a member. I say it because I believe in what we do. The process of getting my AGD Fellowship was great because it justified the 500+ hours of courses that I took — it ensured that they were worth something. It moved me forward. Passing the Fellowship Exam validated my knowledge base and proved to me that I am a better dentist for doing so. Further, pursuing my AGD Mastership truly changed the trajectory of my practice. Over the course of four years, my MasterTrack cohort and I were exposed to some of the greatest minds in dentistry — both speakers and our fellow students. I have made friends and developed relationships that will last a lifetime. These are “my people.”
I encourage you to keep moving forward. Continue to challenge yourself and reignite that spark. Your patients will thank you for being the best you can possibly be. And know that AGD will be there for you every step of the way — through every step of your career. I have always believed that in order for our profession to grow, we must support one another in that growth. If you know someone who is not an AGD member, invite them to join the AGD family so that they too can be part of a community of dentists who truly care about being the best of the best.
Chethan Chetty, DDS, MAGD President
Advocacy
2024 Virtual Advocacy Conference Recap
By Jay Fisher, JD, AGD manager, Government Relations
The sixth annual AGD Advocacy Conference was held virtually for the second year in a row, with two half-day sessions Dec. 20 and 21, 2024. Almost 300 AGD members participated in the online event and learned about the many ways advocacy can help their practices. As a member benefit, all of the sessions will be available for free on AGD’s Online Learning Center.
The AGD Advocacy Conference attendees heard presentations on how legislative, regulatory and intradentistry advocacy can advance oral health in the country and improve their practice environments. Learning objectives were to: “Gain insights and perspective on various state and federal oral health issues; develop an awareness of how intradentistry collaborations can impact advocacy efforts; discover how you can influence legislative and regulatory conversations; and discuss the advocacy efforts AGD is undertaking on behalf of our members.”
The first day highlighted the ways that advocacy can affect how you deliver high-quality patient care. Arlene O’Brien, DMD, FAGD, member of the AGD Legislative & Governmental Affairs (LGA) Council and AGD’s alternate member to the American Dental Association’s (ADA’s) Code Maintenance Committee, spoke about the long and involved process that is involved in amending and adding new CDT codes. CDT stands for “Code on Dental Procedures and Nomenclature,” and O’Brien represents the interests of general dentists during the process. AGD works to ensure that the code set accurately represents what general dentists do.
There was a session on the importance of intra-dentistry advocacy. AGD President Chethan Chetty, DDS, MAGD, discussed how important relationship-building is for all aspects of advocacy. George Shepley, DDS, MAGD, ADA past president, spoke about the ways that AGD and ADA work together on behalf of organized dentistry. Laura Sharbash, DDS, FAGD, member of the AGD Dental Practice Council (DPC), discussed how AGD interacts with the National Association of Dental Plans to advocate for our members directly to benefit plan providers. Lastly, Tyler Scott, DDS, FAGD, AGD regional director for Region 7, highlighted how AGD represents general dentists with the American Association of Dental Consultants.
Additionally, Robert Faiella, DMD, MMSc, MBA, discussed how artificial intelligence (AI) is impacting dentistry, a topic that always generates a lot of interest, as the positives for improved care are balanced with the negative ramifications from insurers’ use of AI. Brooke Elmore, DDS, MAGD, AGD DPC member, informed the attendees of AGD’s discussions with other dental organizations on proposed anesthesia guidelines. For over a year, AGD representatives have been working to ensure that general dentists can utilize the proper level of sedation in their practices. Also on Friday, Brian Lee, JD, of Alston & Bird, discussed how the changes in administrative law can affect the practice environment, and Richard Huot, DDS, FAGD, chair of AGD’s LGA Council, spoke on the deficiencies of the government’s determination of health professional shortage areas.
Saturday’s program opened with a review of AGD’s activity in Congress in 2024 by J.P. Paluskiewicz of Alston & Bird, AGD’s
lobbyist in Washington, D.C. One of the actions he discussed was testimony given by Gordon R. Isbell III, DMD, MAGD, on behalf of AGD before the U.S. Senate Committee on Health, Education, Labor and Pensions in May 2024 on ways to improve access to oral healthcare by recognizing the importance of private practice dentists.
Next, Vermont State Rep. Eileen Dickinson discussed best practices regarding advocating to state legislators. Rep. Dickinson has worked in her family’s dental office and stressed the importance of building relationships with your legislators. She left attendees with an important message: “If you are not at the table, you are on the menu.”
As you are likely aware, there has been a concerted effort by opponents of community water fluoridation (CWF) to remove fluoride from water systems. AGD was honored to have Johnny Johnson, DMD, MS, president of the American Fluoridation Society, present on the reality of CWF. The studies that the opponents rely upon to argue that CWF is unsafe have many issues, which Johnson discussed in detail.
AGD supported Massachusetts Ballot Question 2, which was enacted in 2022. Ballot Question 2 created a dental loss ratio (DLR) that requires insurers to spend 83% of revenue on care or they must refund the difference to the policyholder. Mouhab Rizkallah, DDS, MSD, CAGS, drafted the ballot question language and is a strong proponent of DLRs. In his presentation during the conference, he discussed Massachusetts’ new rules to enforce the DLR, the benefits of DLRs and the best strategy to enact DLRs around the country.
Matt Shafer, deputy program director, Council of State Governments, discussed the status of the Interstate Dental and Dental Hygienist Compact that has been passed in 10 states and will go into effect later this year.
The AGD Advocacy Conference is a great opportunity for any AGD member to learn about the issues affecting general dentistry and the techniques of effective advocacy. Watch the 2024 conference sessions through the AGD Online Learning Center platform, and sign up for the 2025 AGD Advocacy Conference, which is tentatively scheduled for Nov. 7–8, 2025.
Dental Practice Advocacy Request for Comments on Two Proposed New Federal Rules
By Jeanie Kennedy, AGD manager, Dental Practice and Policy
Two Federal Register notices published recently are of note for AGD members. First, comments are due March 7 on a proposed rule to strengthen cybersecurity areas of the Health Insurance Portability Accountability Act. The rule is located at govinfo.gov/ content/pkg/FR-2025-01-06/pdf/2024-30983.pdf.
Second, the Food and Drug Administration is proposing a tobacco product standard that would establish a maximum nicotine level in cigarettes and other combusted tobacco products. The rule is located at govinfo.gov/content/pkg/FR-2025-01-16/pdf/202500397.pdf. Comments are due Sept. 15. At press time, AGD was still reviewing both rules.
Dental Practice Advocacy
AGD Submits Requests for Three New CDT Codes
By Cindy Kluck-Nygren, AGD manager, Dental Practice
AGD’s Dental Practice Council (DPC) has submitted three requests for new listings in the Code on Dental Procedures and Nomenclature (CDT Code) to the American Dental Association’s Code Maintenance Committee (CMC). The proposed nomenclatures and descriptors are:
1. Nomenclature: 3-D printed duplicate complete denture –maxillary; descriptor: Does not involve all steps used in initial fabrication.
2. Nomenclature: 3-D printed duplicate complete denture – mandibular; descriptor: Does not involve all steps used in initial fabrication.
3. Nomenclature: cleaning and inspection of occlusal guard –per arch; descriptor: This procedure does not include any adjustments.
The code suggestions were developed after the DPC’s 2023–24 Subcommittee on the Comprehensive Review of the CDT Code conducted a thorough review of the 2024 CDT Code. Its analysis of that information resulted in the identification of several areas in which AGD members — and other dentists — would benefit by having additional codes available to record patient treatment.
The CMC will review and vote on all proposed changes to the CDT Code at its meeting March 7, 2025. Since decisions on those recommendations were not available at the time this article was submitted, an update will be shared after the meeting.
AGD’s most recent request for a new CDT Code, D6089, “accessing and retorquing implant loose implant screw – per screw,” was adopted in 2023 and became effective Jan. 1, 2024.
In 2024, the CMC approved 24 changes to CDT code entries in CDT 2025: those included 10 additions, eight revisions, two deletions and four editorials. Details of each accepted action request (code number; nomenclature; descriptor) as submitted or as amended by the CMC were published in the CDT 2025 manual.
The CMC meets annually to discuss and vote on proposed changes to the CDT Code. Decisions under the CMC’s purview consist of adding new nomenclatures and descriptors, revising existing nomenclatures or descriptors, and deleting full CDT Code entries (nomenclature and descriptor or descriptor only). AGD is one of 20 organizations that vote on the recommendations. AGD’s voting member and primary delegate to the CMC is Ralph A. Cooley, DDS, FAGD, of AGD’s Legislative & Governmental Affairs (LGA) Council; Arlene O’Brien, DMD, FAGD, also a member of the LGA Council, is AGD’s alternate to the CMC. Each year, both representatives review each suggested code change and offer independent recommendations. They then discuss their responses and develop consensus recommendations that are presented to the DPC. That council’s members then discuss the recommendations and determine what stance AGD should take in response to each code action request.
AGD members interested in requesting changes to the CDT Code are encouraged to visit ada.org/cdt and review the information on that page, including the information relating to “Request a Change to the Code.” That resource includes instructions and the forms
that must be completed in order to request a change. Members interested in requesting that the AGD review, or possibly endorse, their recommended change to the CDT Code should submit that information to dentalpractice@agd.org as soon as possible, preferably by May 1. The DPC will review the information, offer feedback and advise whether the organization is able to take an official position. Code action requests received by the CMC by Nov. 1 will be considered at the CMC meeting the following March.
Upcoming
Look for these articles and more in the March/April 2025 issue of General Dentistry:
• Solitary intraosseous myofibroma: a rare case diagnosed from mandibular fracture
• Polyetheretherketone materials for removable partial dentures
• Comparison of incidental findings on CBCT and 2D imaging
In the April issue of AGD Impact:
• Wellness: Mind, Body and Social
• The Latest in Oral Cancer Research
Enhancing Your Career Through AGD Membership and Leadership Development
By Amrita Feiock, DDS, FPFA, FICD, FACD
Joining a professional association like ours offers dentists numerous opportunities for growth, networking and professional development. With a strong emphasis on continuing education (CE), clinical expertise and leadership opportunities, AGD membership equips general dentists with tools to elevate their careers and make a meaningful impact on the profession. Among the many advantages of joining AGD is the unique focus on leadership skills development, which can profoundly shape your career trajectory.
One of the most notable benefits of being an active AGD member is access to comprehensive and high-quality CE programs. Dentistry is a dynamic field, with technological advancements, treatment methodologies and industry standards evolving constantly. AGD offers members exclusive opportunities to engage in courses, workshops and seminars that provide the latest information in clinical dentistry. Through AGD’s programs, members can stay abreast of the newest evidence-based treatment options, cutting-edge technologies and innovative approaches to patient care. Members are encouraged to earn their Fellowship, Mastership and other advanced designations through coursework, which deepens their expertise and strengthens their professional credentials.
Leadership is integral to every successful career, and AGD places a unique emphasis on cultivating these skills among its members. When you join AGD, you’re not simply engaging in professional development — you’re stepping into a community that prioritizes leadership training as part of its mission. Leadership goes beyond managing a team or organization; it encompasses problem-solving, decision-making, communication, teamwork and adaptability. Being part of AGD provides dentists with opportunities to develop leadership competencies through structured programs, mentorship opportunities and volunteer roles. Members learn to lead both in their personal practices and in broader professional settings by collaborating with peers and participating in AGD’s organizational initiatives.
Leadership in dentistry involves more than skill — it requires connection. AGD offers members the chance to network with thousands of peers, from seasoned professionals to new graduates. These relationships can foster mentorship, collaboration, partnerships and new opportunities, both professionally and personally. As an AGD member, you join a diverse community of general dentists who are passionate about advancing their careers and supporting one another in their shared goals. One of
the most exciting aspects of being an active AGD member is the opportunity to assume leadership roles at both local and national levels. AGD offers members numerous opportunities to participate in leadership through committees, governance positions and chapter activities. Whether you’re interested in serving as a local chapter leader, contributing to policy development or mentoring other members, AGD provides platforms for members to step into formal leadership positions.
Serving in these roles allows members to develop confidence, strengthen organizational management skills and create meaningful changes within the profession. Leadership within AGD also allows members to influence broader healthcare policies, advocate for professional interests and shape the future of general dentistry. By engaging with members on committees, attending AGD events and collaborating on initiatives, members naturally strengthen their interpersonal and team management skills. These leadership capabilities are crucial for any successful general dentist, as managing a dental practice effectively requires clear communication, conflict resolution, teamwork and empathy. The community provides a low-pressure, supportive environment to learn these vital skills. Members gain insight into how to motivate teams, resolve challenges and build collaborative, productive working relationships, which are skills that translate directly to their day-today practice.
Active membership in AGD isn’t just about personal or professional development; it’s also about contributing to the collective voice of general dentists. AGD serves as a powerful advocate for its members by engaging with policymakers and other organizations on important issues affecting the profession, patients and the healthcare system. As a member, you can take an active role in this advocacy by participating in campaigns, contributing to strategic decision-making or stepping into leadership positions within advocacy groups. This involvement empowers members to advocate for fair reimbursement rates, access to care, technological innovation and other critical policy priorities, enhancing both their leadership skills and their ability to effect systemic change. The journey toward professional success is enhanced by collaboration, innovation and leadership. By stepping into this supportive community, you invest in your career and demonstrate your commitment to the future of general dentistry. ♦
Amrita Feiock, DDS, FPFA, FICD, FACD, is in private practice with her father, endodontist Rohit Z. Patel, DDS, PC, in Westchester County, New York. To comment on this article, email impact@agd.org.
Financial Management
Supercharge Your Finances by Tracking Key Performance Indicators
By Wesley W. Lyon II, CPA, CFP®
Each week, I receive multiple calls from dentists frustrated with generic advice, or, even worse, no advice. As a business owner, this can leave you feeling like you’re on an island. Many dentists feel even more frustrated that they have a dental certified public accountant (CPA) providing advice that just doesn’t make sense. CPAs can use benchmarks to provide generic advice, but, in order to be effective, one must understand how to optimize practice operations. To gain control over your practice finances, begin tracking these seven key performance indicators.
New patient phone calls. New patient phone calls are the direct result of both your internal and external marketing efforts. While both are important, patient referrals are the gold standard (internal). A healthy practice will have 20–25 new patients per month per full-time dentist. Below 15 can indicate trouble on the horizon, and above 30 can indicate a need for change to accommodate growth.
If you aren’t receiving at least 20 per month, the root cause is often that your patients do not realize that you accept new patients. A gentle nudge for referrals or a sign that you are now accepting new patients can do wonders to fix this. Make sure to have your staff trained with quick responses anytime they receive a compliment.
Example: “Thank you for the kind words, we take pride in what we do, and it means a lot to us. Just so you know, we are currently accepting new patients if any of your friends or family would benefit from the same experience you have had.”
If you are receiving more than 30 new patients per month, it may be time to reduce your PPO exposure by eliminating one of your worst insurances. If you are already collecting 85% of your
production or more, consider raising fees or planning for an associate.
New patient exams. Marketing is what makes the phone ring, and sales is what drives patients in the door. Every doctor should aim to see at least 85% of their new-patient phone calls in the chair for an exam. Patients leave to go elsewhere when they can’t be seen in a timely manner or the front desk turns them away.
If hygiene is booked, invite the patients in for their exam first, which often leads to a better patient experience and increased loyalty. This is usually due to the patient’s concerns being addressed by the dentist rather than being an afterthought in the hygiene schedule. This strategy also allows the dentist to explain the urgency or lack of urgency for a cleaning and schedule the patient appropriately.
The biggest killer of new patient conversions is how the front desk handles the insurance conversation. This needs to be a positive experience, even if the patient is out of network. Your staff should be trained to always let patients know that they are lucky to have insurance. They also need to educate patients that no insurance covers everything, but that the office will make sure they receive the maximum benefits possible.
Treatment acceptance rates. The goal for a general practice is 90% or better. If your numbers are lackluster, concentrate on your treatment presentation and having greater collaboration with the hygienist. The hygienist can help patients understand what they are seeing, if there are any issues and what the doctor typically recommends. This helps remove anxiety from the patient, as expectations have been set. As a bonus, make sure you are fully utilizing your intraoral cameras — patients are more likely to accept treatment when they can clearly see the problem.
Production adjustments (write-offs). The No. 1 profitability killer of a dental practice is not collecting what you produce. Practices should aim for 85% of total production being collected. Many practices choose not to track this, entering their reimbursable fee rather than their usual, customary and reasonable (UCR) fee into the practice management software. Kick this bad habit to the curb and begin entering all production at the UCR fee and adjusting afterward. While it may be painful, the truth allows you to make the changes necessary to increase profits.
Hygiene patients seen. It’s no secret that cancellations have increased substantially since the COVID-19 pandemic, with consumers being too comfortable cancelling appointments of any kind. Each hygienist should see a minimum of one patient per hour, with adjustments being made for child appointments (onehalf full appointment equivalent) and root scaling and planing (1.5 full appointment equivalent). Since the hygiene department serves as a feeder for doctor production, decreased hygiene will have a larger impact on overall practice production and profitability. If goals aren’t being reached, consider incentivizing the staff to increase last-minute fill-ins or schedule an additional appointment each day.
Total lab, clinical supply and labor expenses (direct costs). If insurance isn’t your profitability killer, it likely sits in one of these three categories. Since different practices can have different procedure mixes, the industry standards will not always work. However, the combination of the three should not exceed 39% of collections. High-end procedures bring higher fees, but also higher lab and
supply bills. This should be offset by lower staff costs. Keeping the three under 39% will keep your practice profitable each year.
Net operating income before dentist compensation (profit). In other words, how much did you make? Many dentists don’t know how to find this, with their profit-and-loss statement being structured for their CPA’s benefit. Instead, have your CPA create a dentist compensation and benefits line, which includes all discretionary expenses, salaries and other benefits paid on behalf of the dentist as subcategories. This should be the last line item of your profit-and-loss statement, allowing you to easily identify your take-home pay. Moreover, there should be a line item prior that states “net operating income before dentist compensation.” Every practice should profit at least 40% of collections prior to doctor compensation. This includes associates, so make sure there is an associate compensation and benefits line right before the doctor line item, if necessary.
With these metrics at your fingertips, you should be able to easily identify areas of concern and address them promptly. While these metrics don’t cover every aspect of a dental practice, in my experience, they will cover over 90% of issues in a practice. Make sure to collect these data points and review monthly to spot concerns before they become problems. ♦
Wesley W. Lyon II, CPA, CFP, is president & 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.
Legal Matters Legal Matters Legal Matters
Keeping a Risk-Free Dental Team: The General Dentist’s Responsibility for Dental Assistants and Hygienists
By Jake Kathleen Marcus, JD, PGDip
While general dentists focus on maintaining their own licenses and knowledge about their own scope of practice, they do not always pay careful attention to the state requirements governing their assistants and hygienists. Licensure (where required) and regulatory compliance are obligations of the individual dental auxiliary. However, the employing dentist and dental practice is ultimately liable for adverse outcomes attributable, in whole or part, to the acts of dental assistants and hygienists. For this reason, it is important that dentists and dental practice owners are both knowledgeable about the regulations, including scope of practice, of their staff and that they maintain careful records of staff compliance with governing laws and regulations.
The scope of practice for dental assistants and dental hygienists varies depending on the laws and regulations of the state(s) where they work. The following is a general overview of their roles and responsibilities.
Dental Assistants
Dental assistants provide support to dentists and help ensure that dental practices run smoothly. Their duties often include clinical responsibilities such as:
• Preparing patients for dental procedures.
• Sterilizing and setting up dental instruments and equipment.
• Assisting the dentist during procedures by handing instruments and using suction devices.
• Taking and developing radiographs (with proper certification, if required by state regulation).
• Applying dental sealants or fluoride treatments (if allowed by state regulation).
• Making temporary crowns or impressions for study models (if permitted by state regulation).
The Dental Assisting National Board, in addition to overseeing voluntary certification and examination of dental assistants, maintains a detailed compilation of state regulations of dental assistants that can serve as a useful resource (danb.org/state-requirements).
In addition to clinical responsibilities, dental assistants may be given administrative duties such as scheduling appointments, maintaining patient records, and handling billing and insurance claims.
While administrative duties may seem secretarial and without legal risk, it is important to remember that patient records are subject to HIPAA and other privacy regulations. Inaccurate patient records can also lead to harmful clinical decision-making. Errors in billing and insurance claims can lead to the loss of insurance
coverage and allegations of fraud, both of which carry grave consequences for dentists and dental practices.
Remember that dental assistants typically work under the direct supervision of a dentist, and they are not allowed to perform procedures that involve diagnosing, treatment-planning or irreversible dental work.
Dental Hygienists
Dental hygienists are licensed professionals whose work focuses on preventive oral healthcare and patient education. Their duties include clinical responsibilities such as:
• Cleaning teeth, including scaling and polishing to remove plaque, tartar and stains.
• Conducting oral health assessments, including examining for signs of gum disease and oral cancer.
• Taking and interpreting radiographs.
• Administering local anesthesia (with proper certification if required by state law).
• Applying dental sealants and fluoride treatments.
• Educating patients on oral hygiene techniques and preventive care.
In some states, dental hygienists can perform advanced tasks, sometimes called “expanded duties,” such as:
• Placing temporary fillings.
• Prescribing fluoride or antimicrobial rinses.
• Performing laser therapy for gum disease.
• Working independently in community settings without direct dentist supervision.
Hygienists are typically not permitted to diagnose dental conditions, perform invasive dental treatments or create treatment plans beyond preventive care.
Key Differences Between Dental Assistants and Dental Hygienists
Dental hygienists require more extensive education (associate or bachelor’s degree and licensure) than dental assistants, who may complete shorter certification programs. Hygienists often have more autonomy in patient care, while dental assistants work more closely under a dentist’s supervision. Hygienists focus primarily on preventive care and patient education, whereas assistants focus on support of the dentist performing procedures and preparing patients for procedures.
The exact tasks allowed for each role depend on state regulations. Always check the laws and guidelines of your state for accurate information.
Dentists’ Legal Exposure for Acts of Dental Assistants and Hygienists
A dentist’s legal exposure for the acts of dental assistants and hygienists depends on several factors, including the level of supervision, the scope of practice regulations in their state, and whether the acts were within the assistant’s or hygienist’s legal authority. Potential liability falls under several legal categories.
Vicarious liability: Dentists can be held legally responsible for the actions of dental assistants and hygienists under the principle of vicarious liability (also known as respondeat superior). This principle means that employers are responsible for the acts of their employees if those acts are performed (1) within the scope of employment, and (2) during the course of their professional duties. For example, if a dental assistant improperly sterilizes instruments, leading to a patient infection, the dentist may be liable. If a hygienist performs a task outside their legal scope (e.g., diagnosing a condition without proper qualifications), the dentist may also face liability for allowing it. Vicarious liability is
a common idea under which dentists and dental practice owners are sued for malpractice.
Negligent supervision: Dentists have a duty to properly supervise their staff. Failing to provide adequate supervision, especially for tasks requiring oversight, can lead to liability. For example, if a dental assistant administers local anesthesia (which is often outside their legal scope) without direct supervision, the dentist may be liable for any resulting harm. Dentists and dental practice owners can be sued for malpractice under both vicarious liability and negligent supervision in the same lawsuit.
Failure to train or delegate properly: Dentists are responsible for ensuring that their staff are adequately trained and only assigned tasks they are legally allowed to perform. A dentist could be exposed to legal consequences if an untrained assistant causes harm while performing a procedure or by delegating tasks outside the assistant’s or hygienist’s scope of practice. Knowing the training requirements and scope of practice in the state is critical for both the dentist and the dental practice owner.
Direct liability: Dentists may face direct liability if they fail in their own duties, such as by failing to establish protocols for dental assistants and dental hygienists to prevent errors. Dentists may also be liable if they ignore signs that an assistant or hygienist is performing tasks improperly or by continuing to employ someone who has demonstrated incompetence or negligence. Proving that the dentist and dental practice owner has appropriately followed state regulation requires maintaining detailed records of staff training and practice protocols.
Independent liability of dental hygienists: In some states, dental hygienists may work independently or semi-independently.
In such cases, hygienists may bear primary legal responsibility for their actions, and dentists will not be held liable unless they contributed to the issue (e.g., by failing to review the hygienist’s actions when required). However, an employer dentist or dental practice owner is potentially liable for any harm done within the practice even if the dental hygienist has independent liability. In cases in which hygienists are found independently liable, the employer can, and likely will, be sued as well. Whether the suit is successful does not alter the expense of defending in such litigation.
Acts outside the scope of employment: If a dental assistant or hygienist acts outside their legal authority or scope of employment (e.g., performing procedures they are not trained or licensed to do), the dentist may still be liable if they permitted or failed to prevent such acts. However, if the act was entirely unauthorized and unforeseeable, the employee might bear sole liability.
Mitigating Legal Exposure
Few dental hygienists and dental assistants carry malpractice insurance of their own. When an attorney representing a patient is formulating a lawsuit, the attorney will consider where the “deep pockets” are; that is, who has the most money. Remember that medical malpractice claims are handled on a contingency basis, meaning the attorney only receives payment if the lawsuit is successful. An uninsured defendant is not going to have the funds to pay a successful award. This makes the insured dentist and/or dental practice owner the more inviting targets in litigation. Dentists can mitigate their legal exposure by:
• Maintaining clear documentation of delegated tasks, training and supervision.
• Ensuring all team members are licensed if licensure is required by state law and are practicing within their scope.
• Regularly reviewing and updating office policies to comply with state regulations.
To reduce legal exposure, dentists should:
• Include the acts of staff under the dentist or dental practice malpractice insurance.
• Ensure compliance with all state laws governing dental assistants and hygienists.
• Provide adequate supervision, especially for assistants.
• Not delegate tasks that are outside the staff member’s legal scope of practice.
• Require and document ongoing education and training for all staff.
By adhering to these practices, dentists and dental practice owners can protect themselves while maintaining high standards of patient care. The provision of dental care is a team effort. It is critical for all dentists and dental practice owners to remain diligent when employing, training and documenting the work of the entire team. ♦
Jake
Is Your Practice Seeking Dental Professionals?
AGD’s Marketplace & Career Center allows you to search for candidates and post open positions. Find the Perfect Fit for Your Office Today marketplace.agd.org/employers
Kathleen Marcus, JD, PGDip, has been a regulatory lawyer primarily in the healthcare space for over 35 years. They were recently awarded a postgraduate diploma in technology, media and telecommunications by Queen Mary University of London School of Law. To comment on this article, email impact@agd.org.
Up and Away
How AGD Elevates Your Dental Career
Dentists join AGD for many reasons, but two of the most common are top-notch continuing education (CE) and CE tracking. Once they join, many dentists realize that the organization is so much more than CE. It offers practice management resources. Members can take advantage of discounts on vital products and services. AGD provides a pathway to become a top-tier dentist through Fellowship. And, maybe most importantly, it connects members with
others like them, fellow dentists who have a thirst for knowledge and a continuous drive for self-improvement. In celebration of all that the organization has to offer, AGD Impact reached out to four members and asked them to tell their AGD stories. AGD has shaped their careers in different ways, but, like so many dentists across the country, they all agree that they would not be where they are today without AGD — and that they love their AGD family.
How AGD Helped Shape My Career: From Struggling New Graduate to Successful Practice Owner
By Puneet S. Aulakh, DDS, MAGD
For me, AGD has been more than an organization — it has been the foundation of my professional growth and success. Early in my career, I was a new graduate struggling to find my footing. Opening a practice from scratch in 2007, with no local connections and minimal business experience, was a daunting challenge. I found myself overwhelmed and unsure how to navigate the complexities of running a dental office.
The support I received from Washington AGD was instrumental in those formative years. Through its events and educational programs, I found mentorship, camaraderie and invaluable advice that helped me navigate the challenges of starting and sustaining a practice. Programs like MasterTrack and OrthoTrack provided not only exceptional education but also the opportunity to form lasting relationships with dentists in my community who genuinely wanted to see me succeed.
At the national level, AGD reinforced the importance of lifelong learning and professional excellence. The organization connected me with industry leaders and peers from across the country, inspiring me to continually raise the bar in clinical skills, business acumen and patient care. Together, local and national AGD helped me through some of the toughest moments in my career, including the financial crisis of 2008. Without AGD’s resources and community, I doubt I would have achieved the level of success I enjoy today.
How My Membership Progressed
Initially my focus was on clinical improvement and continuing education (CE). I was eager to gain hands-on experience and practical knowledge, and the CE courses offered by Washington AGD were invaluable resources. These local events provided not only top-tier education but also a chance to network with other dentists in my area.
As my career progressed, I began to see AGD as more than just an educational resource. My involvement deepened when I participated in MasterTrack, Washington AGD’s program that lays out a path to Mastership, and it grew further as I started contributing to the organization’s mission. Through Washington AGD, I found opportunities to give back at the local level — mentoring younger dentists, serving on committees and advocating for the profession in my state.
At the national level, AGD expanded my perspective on dentistry. It became a platform for me to connect with colleagues across the country, share ideas and influence policies that impact our profession. Now, AGD is an integral part of my professional life, offering opportunities to learn, lead and make a difference both locally and nationally.
Surprising Benefits
While many dentists join AGD for its excellent CE programs, I’ve discovered benefits that extend far beyond education. One of the most valuable is the network of peers and mentors I’ve built through Washington AGD. This local network has been a lifeline on numerous occasions, providing timely advice and support when I’ve faced clinical or business challenges.
For instance, a patient came to me with an unusual implant placed overseas. I reached out to colleagues in my AGD network, and, within hours, I had detailed responses and actionable advice. This kind of support highlights the unique value of being part of a professional community where trust and collaboration are paramount.
Another benefit I’ve come to appreciate is AGD’s advocacy work. Both the national organization and Washington AGD work tirelessly to protect and advance the interests of general dentists. Staying informed about legislative changes and having a voice in shaping policies has been critical.
Personal Recommendations
For any dentist, I cannot recommend the MasterTrack program highly enough. Offered through local constituents like Washington AGD, this program is an investment in your career that pays dividends for years. The combination of lectures, hands-on training and peer collaboration helps you tackle even the most complex cases with confidence.
For younger dentists, getting involved in your local AGD chapter is one of the best ways to build a network and find mentors. Washington AGD, for example, organizes regular meetings and CE events that foster community and professional growth.
Additionally, AGD’s practice management resources are a hidden gem. Whether you’re looking for advice on staffing, billing or marketing, AGD offers tools that can help you run your practice more effectively.
When AGD Has Really Helped Me Out
In the early years of my practice, the mentorship and support I received through
Washington AGD were crucial to overcoming challenges that could have easily derailed my career. Opening a practice in 2007 was risky enough, but, when the financial crisis hit in 2008, I was truly tested.
Patient schedules were sparse, and I was struggling to keep the lights on. The guidance and encouragement I received from local AGD mentors kept me going. They shared practical tips on patient
retention, managing overhead and maintaining a positive outlook. Their support gave me the resilience to push through those tough years.
Conclusion
Whether you’re a new graduate seeking guidance, a mid-career dentist looking to expand your skills or a seasoned professional wanting to give back, AGD has something to
offer. The connections I’ve made and the lessons I’ve learned through AGD have shaped not only my practice but also my perspective on the profession. For anyone considering joining or getting more involved, I can say without hesitation: It’s worth it.
How AGD Paved the Way for My Career and Mentorship Journey
By Carson Henley, DDS, FAGD
Growing up in Texas, I figured I would be a Texan my entire life. I went to college and dental school in Texas. It just made sense that I would buy a practice near where I grew up. But this path was not meant to be. I ended up in West Virginia, and I can truly say that AGD is the reason I have the position I have. And for that, I love AGD. I heard about AGD in dental school. However, I did not participate in Fellowship activities that were offered. There was no reason; I simply did not know much about AGD at the time. But the organization was about to impact my life in a big way. On March 16, 2016, my wife and I opened her residency match envelope and found out we were moving to Charleston, West Virginia. My wife was to begin a five-year combined medicine/psychiatry program in a state we had never visited, much less lived. We were both excited and scared, but I was most worried about where I was going to get a position. As we had never lived in West Virginia, I had no leads on dental positions. That’s where AGD comes into frame.
A few weeks after the envelope-opening day, I was talking with one of my University of Texas School of Dentistry at Houston professors, Ralph A. Cooley, DDS, FAGD. I mentioned my family was moving to West Virginia after I graduated and I was unsure where I would get a position. Cooley mentioned he knew some people from West Virginia. Specifically, he knew Steven A. Ghareeb, DDS, FAGD. They served on
mentored me and sent me on continuing education trips. The courses he sent me to laid a foundation of knowledge that allowed me to run my current practice, a Ghareeb Dental Group location. The best advice I can offer to young dentists is to look for mentorship. The easiest way to find a mentor is to look within AGD for a Fellow, Master and/or Lifelong Learning and Service Recognition recipient in your area.
“I can truly say that AGD is the reason I have the position I have.”
an AGD council together years prior. That night, Cooley sent an email to Ghareeb, and the following day Ghareeb and I spoke on the phone. Within five minutes of speaking with him, he offered me a position. This started a working relationship that turned into a dental practice partnership that continues to this day. Without AGD, I would not have my current position.
Ghareeb was a fantastic boss for the many years I served as his associate. He
The only reason I was able to join an AGD council, be the Region 6 regional director and now be the Region 6 trustee was because of the people I met along the way. Simply put, AGD is an organization that is set up to grow young dentists into advanced dentists who mentor future generations of young dentists.
Carson
Puneet Aulakh, DDS, MAGD, is the owner of Bannerwood Family & Cosmetic Dentistry, Bellevue, Washington.
Henley, DDS, FAGD, practices in the Kanawha City location of the Ghareeb Dental Group.
Why I’m Most Proud to Be an AGD Member
By Emily Bujnoski, DMD, MPH
When I graduated from dental school in 2020 in the midst of the COVID-19 pandemic, I was excited to start my career. Yet, as the weeks and months progressed, I began to feel a sense of loneliness. Maybe it was the abrupt way my dental school education was cut short by an unprecedented global public health event — or maybe, I thought, it was because of the nature of general practice dentistry. I realized rather quickly that day-to-day dentistry can be pretty isolating. Enter AGD — I was at the right place at the right time when a former dental school instructor approached me about getting involved with AGD. As an eager new grad, I thought it couldn’t hurt to get involved with organized dentistry. I couldn’t imagine, at the time, that joining AGD would turn out to be one of the most formative decisions of my early dental career. Five years later, I can confidently say that AGD has positively impacted my career through extensive continuing education (CE), challenging yet rewarding leadership opportunities and a great variety of benefits, both official and unofficial.
The first and most profound way that AGD has improved my career is through extensive offerings of CE. Most importantly, as someone with the hefty weight of student loan debt, AGD offers quality affordable CE. Despite many other CE offerings available to dentists, AGD
remains the premier provider of CE that won’t break the bank. This was imperative for me as I tried to chip away at my student loan payments. I’ve grown to appreciate that AGD is so conscious of cost efficiency for new dentists. AGD understands the economic burden of dental school today and has tried to make it affordable for new dentists to become involved. It does this not only with affordable CE, but also through membership discounts for dentists less than five years out of dental school. This allowed me to really dive headfirst into AGD CE as a new dentist member, broadening my scope of practice and introducing me to other like-minded AGD dentists.
As I began to attend more AGD CE, my involvement as an AGD new dentist member began to change. I noticed that AGD dentists were driven, attentive and dedicated to being better practitioners. I wanted to be more like them — I wanted to be more involved! In the years that followed, my membership in AGD evolved from a “new dentist member” to a member of various constituent, regional and national committees within AGD. In this way, I was able to use the organization as a vehicle to serve my profession while also developing my leadership skills. Through attending the scientific session
and Leadership Development Symposium, I was able to immerse myself in the world of AGD. These meetings are some of my favorite benefits and are offerings that I highly recommend to young dentists looking to find their place in a seemingly daunting world of organized dentistry. You will learn more about AGD, yes, but you will also learn so much about yourself.
Perhaps the greatest benefits of AGD are “unofficial.” These benefits aren’t listed on AGD’s website, but they are what drives my membership the most — the benefits of friendship! The camaraderie available is truly unique. I have made friends and gained valuable mentors around the country. These are people I can turn to for advice on everything, from root canals to business ownership — people who get it. I recognize these relationships are rare and to be cherished, and I am so grateful to AGD for supplementing my life and career with such fantastic people. This hidden benefit is what makes me most proud to be an AGD member.
Emily Bujnoski, DMD, MPH, is a general dentist at Fox Family Dental, Peoria, Arizona.
AGD Has Shaped My Career and Fueled My Growth As a Dentist
By Mackenzie Schneider, DMD
Since my time in dental school, AGD has played a pivotal role in my dental career. Initially, AGD provided an essential foundation for me as a student, offering networking opportunities with other student leaders passionate about general dentistry. It introduced me to the importance of continuing education (CE) — not just as a learner, but as someone who could organize educational experiences for others. AGD helped me understand the kind of dentist I wanted to be, and its impact has been profound throughout my journey.
As I reflect on my career, a few key lessons stand out. One of the most important is my fear of complacency. Dentistry is ever evolving, and there are countless ways to approach procedures. Without a commitment to constantly ask questions, seek new answers and challenge the status quo, we limit our ability to excel. Dental school provides the foundation necessary to practice, but it is only through CE that we truly begin to
learn and refine our skills. This mindset allows us to provide the highest level of care to our patients.
I also recognize the responsibility we hold as leaders. Both patients and staff look to the dentist for guidance, and it’s essential to lead by example through hard work, dedication and a commitment to education. The principles of mentorship and leadership have been central to my development as a dentist, and AGD has been an incredible resource in this regard. Whether through mentorship opportunities or accessible CE courses, AGD has supported me throughout my early years in practice.
After entering the workforce in 2020, I found myself missing the structured learning environment of dental school. While I was taking CE courses, I yearned for a deeper review of some of the more fundamental aspects of dentistry — topics that we use every day in our practices. This led me to pursue AGD Fellowship, which I completed this year. The process of studying for and passing the Fellowship Exam has undoubtedly made me a better dentist. The topics covered in the Fellowship requirements are not only foundational, but also practical, and I was able to immediately implement many of them in my practice. I strongly encourage all dentists to pursue AGD Fellowship, as it has been one of the most rewarding experiences in my career.
Achieving the 500 hours of CE required for Fellowship can be a challenge, but AGD offers incredible resources that make this goal more attainable. I’ve found the free online courses, in particular, to be underutilized benefits that provide high-quality education at no additional cost. As a Premium Plus member, I’ve also benefited from the additional webinars, which offer flex-
ibility and accessibility when in-person events are not feasible. While I prefer in-person CE when possible, I’ve come to appreciate the value of webinars as a convenient alternative for those seeking top-notch education on their own schedule.
One of my first major AGD events was the 2018 scientific session in New Orleans, where I was just starting at the student chapter level. Since then, the New Dentist/Student Lounge has become a central hub for me at every AGD scientific session. It’s been a place to connect with old friends, meet new colleagues and attend enriching CE courses. As I’ve gained more experience in my career, I’ve started transitioning from being a new dentist to becoming a mentor for others who are beginning their professional journeys.
Starting my career as a sole provider in a dental practice brought its own set of challenges, particularly in areas unrelated to clinical dentistry. Navigating insurance and coding, for example, can often feel like learning a new language. AGD’s practice management resources can be invaluable in helping tackle these obstacles. Even simple tools, like discounts on insurance coding books, have made a difference in streamlining the gray areas of insurance.
In conclusion, I am incredibly grateful for the support and opportunities AGD has provided me throughout my career — both as a student dentist and as I’ve transitioned to full-time practice. AGD has been instrumental in helping me grow as a clinician, a mentor and a leader in the dental field, and I look forward to continuing this journey with the AGD community.
Mackenzie Schneider, DMD, owns Schneider Family Dentistry, S.C., Burlington, Wisconsin.
Reports from AGD Exclusive Benefits Providers
AGD understands the needs of general dentists and works tirelessly to bring its members exclusive benefits with special offers on various insurance, business, personal and practice management products and services. This month, two benefits providers, Dentist’s Advantage and Hagan Insurance Group, provide updates on the various types of insurance that dentists might want to consider in order to protect themselves and their practices. To view the full lineup of AGD Exclusive Benefits providers, visit agd.org/my-agd/benefits/exclusive-benefits/
Dental Professional Liability Claim Report: Root Canal Therapy
By Dentist’s Advantage
Dentist’s Advantage’s mission is to educate dentists and dental practices on liability risk–related issues. Our goal is to help dentists enhance their patient-safety practices and minimize professional liability exposure by identifying loss patterns and trends. Information in this article is from our dental closed claim report, “Dental Professional Liability Claim Report: 2nd Edition.”
This article focuses on our analysis of injuries associated with root canal therapy (RCT). Nerve injury
is among the top injuries in four of the five top dental procedures that are associated with professional liability claims. Figures 1 and 2 below (which can be found on page 12 of the report) find nerve injury is the highest proportion of claims at 17.9% and also has the highest average total incurred cost at $239,045.
Review of nerve injury claims associated with RCT frequently involve extruded endodontic materials or canal disinfectant solutions. Alleged damages include long-term or permanent physical and/or chemical nerve
Fig. 1: Root Canal Therapy — Distribution of Top Injuries
Fig. 2: Root Canal Therapy — Average Total Incurred of Top Injuries
injury, pain, ongoing medical expenses, and lost wages, all of which can contribute to a higher-than-average settlement or indemnity payment. The top allegation of inadequate precautions, at 25.5%, is often associated with both types of RCT/nerve injury claims. Learn about managing the risks of nerve injuries in Dentist’s Advantage’s Risk Management Spotlight at dentists-advantage.com/RCT.
The following example describes a serious nerve injury outcome:
A 35-year-old male patient with widespread dental caries required RCT on several anterior teeth. The general dentist conducted an informed consent discussion and obtained a signed consent form. During the procedure, the patient had no complaints of pain or swelling, though a purulent discharge was present during canal instrumentation. Upon irrigation with sodium hypochlorite solution, the patient experienced “tingling” and discomfort. Due to this reaction and the observed discharge, the dentist did not proceed with completion of RCT. The patient later reported excruciating pain and moderate swelling and saw an endodontist for a second opinion — whose findings included paresthesia, allegedly from a chemical nerve injury. Expert opinion did not support the dentist’s care due to issues such as excessive root instrumentation, no documented root length measurements or imaging, and inadequate follow-up. The plaintiff asserted that the dentist’s failure to observe these clinical- and safetyrelated requirements led to permanent nerve injury. This case resulted in total incurred costs exceeding $500,000.
Although dental/oral infection may be associated with any procedure, this injury is among the top three most frequent for RCT and extraction procedures. It is not unusual for a patient to develop an infection associated with RCT, either before or after treatment. Infection may occur with no breach in the standard of care, as it is a recognized risk of RCT that may require extraction and treatment plan reassessment. Dentists may mitigate the risk of RCT infection by performing a thorough assessment and following recommended infection control practices, including isolation of the tooth with a dental dam. Dentists also may wish to consult the American Dental Association Clinical Practice Guideline, “Antibiotic Use for the Urgent Management of Dental Pain and Intra-oral Swelling.”
In the following case example involving infection, the dentist proceeded with RCT against his better judgment.
A 35-year-old female patient sought care for pain in the posterior mandible. Obvious severe decay was noted on examination, and treatment options were discussed. The dentist recommended extraction due to the extent of decay and the possibility of root fracture. The patient preferred to save the tooth, and RCT was completed without complications. Two days after the procedure, the patient presented with complaints of continued pain, slight swelling and trismus. Upon examination, the dentist advised that these symptoms were not unusual and should improve progressively over a few days. The patient did not return for a follow-up visit and did not respond to telephone calls. However, the patient sought care at a local hospital for increased swelling several days after the last dental office visit. The lawsuit described a hospital stay with antibiotic therapy, incision and drainage, as well as ongoing medical care after discharge and lost time from employment. Expert review found the records to be incomplete, and radiographs lacked sufficient quality. A root crack was suspected, but no imaging, such as cone-beam computed tomography, was employed to confirm or rule this out prior to treatment. The dentist preferred to settle the case rather than proceed to a jury trial, resulting in payment and expenses of more than $100,000.
Dentist’s Advantage and CNA have collaborated on this closed claim analysis to help dentists working in education; solo, group or corporate practices; hospitals or ancillary healthcare facilities; institutions; and other practice locations in order to enhance patient safety. To read “Dental Professional Liability Claim Report: 2nd Edition,” go to dentists-advantage.com/dentalclaimreport ♦
Dentist’s Advantage offers individual professional liability insurance for dentists and their practices, with coverage limit options, claims management services and a dedicated claims consultant. For more information, visit agd.dentistsadvantage.com
Protect What's Most Important with the AGD Insurance Member Benefits Program
By Hagan Insurance
The AGD member benefits insurance program includes an array of products that provide financial security for you and your family as well as your dental practice.
Safeguarding What’s Most Important
You’re probably no stranger to having insurance for expensive physical items, like your home or car. However, what if you consider your most valuable asset not those things or your savings and investments, but rather your ongoing ability to provide for yourself and your family as a dentist? Your personal financial protection begins with understanding the importance of being prepared for unexpected — but possible — events.
The Twin Cornerstones of Personal Financial Protection
Aside from basic health insurance, the two most fundamental kinds of insurance protection for most families are life insurance and disability insurance. Life insurance helps those who depend on you, such as your spouse and your children, if you were no longer there to provide for them. Disability insurance helps protect the standard of living that you, or you and your family, enjoy today.
Safeguarding Your Loved Ones’ Futures with Life Insurance
According to the American Council of Life Insurers (ACLI) “2024 Life Insurers Fact Book,” almost $150 billion in life insurance benefits were paid out in 2023 alone.1 Right now, the foresight of those who took out that insurance is helping their families make mortgage payments, cover daycare or tuition costs, pay for everyday living, and realize their long-term goals.
According to the Life Insurance Marketing Research Association, the top three reasons people give for having life insurance involve protecting their loved ones, whether it’s replacing lost income, leaving an inheritance or paying for final expenses. And 38% of Americans say their household would face financial hardship within six months if a wage earner died unexpectedly (30% within a month).2
Protect Your Family Even If You’re Not There to Protect Them
Some households, however, continue to be uninsured or underinsured — in 2024, 102 million American adults (42%) said they needed to either get life insurance or add to their existing coverage. 3
The Insurance Information Institute (III) recommends that, if you have dependents, you should buy enough life insurance to replace the income you now generate for them
plus provide enough to offset any additional expenses they might incur.4
It’s also important to plan for expenses such as bills that may be left behind and final expenses such as funeral costs, taxes and administrative costs related to passing property to heirs; the III recommends planning a minimum of $15,000 for such expenses.4
Closing the Gap Between What You Have and What You Need
When you consider these facts and compare these recommendations to the life insurance protection you now have, you may find that your family would not be adequately protected should they lose you and your income.
If there’s a gap between the amount of life insurance you have and the amount your family would need, term life insurance might be the most economical way to close it. Term life insurance is just what the name implies — coverage intended to be in place for a specified time, such as until the kids are grown and out of college. Term life is the most basic kind of life insurance and generally provides the most insurance protection for the money. It can become even more affordable when purchased at a group rate.
According to the ACLI’s “2024 Life Insurers Fact Book,” 3.9 million of the new individual life policies purchased in 2023 were term life insurance, totaling 72% of the coverage value issued. The most popular form of term life is level term life insurance, which provides the security of knowing that rates are guaranteed not to increase for the period chosen by the purchaser, in some cases up to 20 years.1
Why Do People Buy Life Insurance?
People purchase life insurance for a variety of reasons; however, the acquisition of life insurance is commonly tied to significant life events, such as marriage, buying a house and the birth of children.
What to Look for in Term Life Insurance
When evaluating term life insurance, here are some factors to consider:
• For what period do you need coverage?
• Should you also get coverage for your spouse?
• Is the underwriting company highly rated and financially strong?
• And — maybe most important — what amount of coverage can you buy at a cost you can comfortably afford? Adding any amount of life insurance will leave your family better protected, and so is preferable to taking no action out of concern about choosing the “right” amount of coverage.
Disability Insurance: Preparing for the Potential Financial Impact of a Disabling Injury or Illness
The second pillar of personal financial protection is disability insurance, which helps replace lost income if an illness or accident were to prevent you from working. Should you suffer a covered disability, you would receive benefits paid directly to you that you can spend on mortgage payments or rent, other ongoing obligations, extra medical bills, or other living expenses — including medical expenses related to the disability — and everyday expenses.
The Social Security Administration reports that one in four U.S. workers will experience a disability at some point during their careers.5 Forty-eight percent of families without disability insurance would have to use their personal savings, and 26% would have to use their retirement savings if a wage earner became disabled.6
Also consider this fact: In 2022 alone, there were 63 million medically consulted injuries in the United States — about one for every five Americans.7 That statistic from the National Safety Council is another good reason to take stock of how you would continue your standard of living should a disability keep you out of work for several months or more.
Is Your Lifestyle At Risk if You Suddenly Couldn’t Work?
In its publication, “Disability Income Insurance: Financial Protection for You and Your Family,” the American Council of Life Insurers outlines what resources to consider to help you determine how you and your family would fare financially during a period of disability:8
• First, evaluate your income needs, as well as the benefits you may be eligible for from your employer, the government or other programs. Consider additional savings or other family resources you might have, including a spouse’s salary, short-term emergency savings, investments or help from your family.
• If the total of these benefits is not enough to pay your living expenses on a long-term basis, or if a disability would eat away at your retirement savings or children’s college fund, the council notes that a long-term disability income insurance policy may meet your needs.
Employer Disability Coverage Versus Personal Coverage — Be Aware of the Tax Effect
If you don’t have employer disability insurance, or if your coverage through work would replace only 50%–60% of your current income (typical of a work policy), you may need additional disability insurance to help you keep up with your expenses should disability strike.
It’s important to know whether your disability benefits would be subject to income taxes, as is generally the case with employerprovided disability coverage.9 For example, if you were to receive 60% of your current income in disability benefits through an employerpaid policy, but you were on the hook for federal and state income taxes on that benefit amount, you could be left with far less than half of your predisability income actually available to you.
If you purchase and pay for your own coverage, such as the coverage available through an AGD group policy, the benefits you
receive while disabled would not be subject to income taxes, although you should consult a tax adviser.10
What to Look for in Disability Insurance
Other factors to consider when examining specific disability insurance policies include:
• Whether benefits will be paid if you are unable to perform the duties of your own occupation versus any job for which you are reasonably qualified — for a highly skilled profession like dentistry, this is a crucial distinction.
• The total benefits you will receive from all sources, which are typically limited to 50%–70% of your predisability income.
• What are your choices of waiting period, or the time between onset of covered disability and when you would start to receive benefits? The longer your waiting period, the lower your cost.
• What is the maximum amount of time over which benefits would be paid?
• Is the coverage being underwritten by a financially strong, reputable insurance company?
Is today the day for you to take steps to better protect yourself and your family with life and/or disability insurance? Life happens, and it’s best to be ready for it. ♦
Hagan Insurance Group offers a variety of insurance products for AGD members, including group life insurance, group disability income insurance and cyber enterprise risk management. For more information, visit myagdinsurance.com
References
1. 2024 Life Insurers Fact Book. American Council of Life Insurers, acli.com/aboutthe-industry/life-insurers-fact-book/2024-life-insurers-fact-book, 8 Nov. 2024.
2. “2023 Life Insurance Fact Sheet.” Life Insurance Marketing Research Association, 2023, limra.com/siteassets/newsroom/fact-tank/fact-sheets/0859-2023-liam-fact-sheet-2023_final.pdf.
3. “2024 Life Insurance Fact Sheet.” Life Insurance Marketing Research Association, 2024, limra.com/siteassets/newsroom/liam/2024/2024-life-insurance-fact-sheet. pdf.
4. “How Much Life Insurance Do I Need?” Insurance Information Institute, iii.org/ articles/how-much-life-insurance-do-i-need.html. Accessed 13 Jan. 2025.
5. “Disability.” Social Security Administration, ssa.gov/news/press/factsheets/basicfact-alt.pdf. Accessed 13 Jan. 2025.
6. “Disability Insurance Awareness Month: Protecting Your Paycheck and Your Future.” Life Insurance Marketing Research Association, 2 May 2024. limra.com/ en/newsroom/industry-trends/2024/disability-insurance-awareness-monthprotecting-your-paycheck-and-your-future/.
8. Disability Income Insurance: Financial Protection for You and Your Family. American Council for Life Insurers, April 2014, acli.com/-/media/acli/files/consumerbrochures-public/disabilty_consumer_brochure_4-30-14.pdf.
9. “Will My Employer Provide Disability Coverage?” Insurance Information Institute, iii.org/article/will-my-employer-provide-disability-coverage. Accessed 13 Jan. 2025.
10. “Is the Long-Term Disability I Am Receiving Considered Taxable?” Frequently Asked Questions, Internal Revenue Service, irs.gov/faqs/interest-dividendsother-types-of-income/life-insurance-disability-insurance-proceeds/life-insurance-disability-insurance-proceeds-1. Accessed 13 Jan. 2025.
Is Your Practice a Great Place for Dental Assistants to Work?
Tips from award-winning dental practices
By the Dental Assisting National Board
Creating a great workplace is essential for the success of any business. As dental practices face the challenges of a growing dental assistant workforce shortage, it’s more important than ever to show support for these key employees during Dental Assistants Recognition Week — March 2–8, 2025 — and all year long.
In 2024, the Dental Assisting National Board (DANB) launched the Great Practice for Dental Assistants to Work award to recognize dental practices that are committed to fostering supportive and fulfilling work environments for dental assistants. Of the nine winning practices, four of the dentists are AGD members:
• Thomas R. Dooley, DMD, Cedar Village Dentistry, Mason, Ohio.
• Mark McDonough, DMD, Mark McDonough Orthodontist LLC, Pennington, New Jersey.
• Bradford S. Rowe, DDS, FAGD, Thunder Bay Community Health Service, Inc., Atlanta, Michigan.
• Cole Sutak, DMD, Lone Star Smiles, Lubbock, Texas.
“We have received a number of awards over the past 30 years, but this one was special since it was submitted by one of our assistants,” said McDonough.
In honor of Dental Assistants Recognition Week, here are five ways these AGD members are putting dental assistants first.
1. Strong Pay and Benefits
Everyone wants to be paid what they feel they’re worth, and dental assistants are no different. Dental assistants are integral to the success of practices, performing a variety of tasks to keep the office on track and provide high-quality patient care. The recipients of the Great Practice for Dental Assistants to Work award offered dental assistants pay and benefits that reflect the value they bring, showing that their practice regards them as individuals rather than just employees.
“Remembering to encourage a healthy work-life balance through paid time off (PTO), benefits, continuing education (CE), and competitive pay to encourage our assistants to enjoy and grow their lives outside of the office is so important,” said Sutak.
According to DANB’s 2024 Dental Assistants Salary and Satisfaction Survey, higher pay was the biggest factor in dental assistants’ decisions to stay in the profession. The report also shows that the most common benefits dental assistants receive are PTO, paid holidays, retirement savings plans, dental care and health insurance. Ultimately, strong compensation and benefits boost dental assistant job satisfaction significantly and make them more likely to stay with their practices.
2. Appreciation and Respect
Dental assistants want to feel respected by their bosses and teammates. Hearing “thank you” can go a long way, but expressing appreciation shouldn’t end there.
“It all starts with the team leader, the dentist,” said Leeann McCullough, COA, a dental assistant with Mark McDonough Orthodontist LLC. “Dr. McDonough shows his appreciation in many ways. He makes sure we get our annual CE and CPR certification, he celebrates our birthdays, and he rewards work anniversaries. The entire team feels valued in so many ways.”
The dental practices that received the Great Practice for Dental Assistants to Work award empowered their dental assistants by listening to their ideas, thoughts, opinions and concerns. This not only fosters a culture of strong communication that helps the team work better together, but it also helps dental assistants buy into the practice’s mission and core values.
“Dr. Dooley bought the practice and had a meeting where we all worked together to establish our mission statement and core values,” said Amy Mitchell, CDA, an expanded functions dental assistant with Cedar Village Dentistry. “Seven years later, they’re still a part of our daily growth as a
practice. These core values helped us create our culture of inclusivity, positivity, celebration, community and leadership.”
3. Emphasis on Work-Life Balance
Dental assisting is fulfilling, but it’s hard work. From the time they arrive in the morning, often before everyone else, to the time they leave in the evening, dental assistants are busy preparing exam rooms, sterilizing instruments, communicating treatment plans, stocking supplies, talking with patients and helping the dentist during procedures. But dental assistants also need time to unwind and tend to their lives outside the office.
“If time is needed for family, everyone works together to make it happen,” said Catie Lis, CDA, a dental assistant with Thunder Bay Community Health Services Inc. “I can confidently say that if I went to any manager in our organization and said I was struggling with work-life balance, they would immediately ask what they can do to help.”
The award-winning practices offer PTO and encourage their staff to take breaks and leave on time each day.
“Dr. McDonough appreciates a healthy work-life balance,” said McCullough. “We never work on Fridays or weekends. On Tuesdays in the summer, we take a short lunch break, and he brings in lunch so we get done early to enjoy the sunshine. He is always supportive if someone on the team has a family issue. He says, ‘Family first. Work will be here when you’re back.’”
4. Positive, Team-First Culture
Office culture can make or break a practice. Every member of the dental team works together in some capacity, and it’s critical for everyone to be in sync. The award-winning dental practices focused on developing a culture of collaboration and open, respectful communication where all team members are treated equally.
“Never once has Dr. Sutak made me feel less than him for being an assistant. He constantly compliments our decision-making
5 Ways to Celebrate Dental Assistants
Here are a few opportunities to show appreciation for the dental assistants in your practice during Dental Assistants Recognition Week and beyond.
1. Thank-you notes. Write a personalized thank-you note for each dental assistant highlighting their specific contributions and how they positively impact the practice.
and our dental knowledge,” said Kaci Christy, lead registered dental assistant with Lone Star Smiles. “Rarely do we run into drama surrounding our work environment, but, if concerns do come up, we can communicate with our employers freely and without judgment. They take these concerns and do whatever they can to resolve them.”
It’s also important to celebrate individual and team accomplishments, such as a dental assistant earning their Certified Dental Assistant (CDA) certification or the practice hitting a goal for new patients. When team members are invested in each other’s success, it makes work more enjoyable for everyone, aligns the team and allows the practice to provide better patient care.
“We have goals, such as the number of new patients, reappointments or patients helped daily,” said Mitchell. “When goals are met, we celebrate! We have kayaked, attended Cincinnati Reds and FC Cincinnati games, taken a trip to Cancun, and more.”
5. Support for Professional Goals
Many dental assistants aspire to take on new responsibilities or positions as they gain more experience. The recipients of the Great Practice for Dental Assistants to Work award demonstrated exceptional commitment to supporting dental assistants’ professional growth, such as
2. Team outing. Treat your dental assistants to a meal at a restaurant or a fun teambuilding activity, such as an escape room or bowling.
3. Professional development opportunities. Cover the cost of a CE course or certification to demonstrate your investment in their career growth.
4. Gift baskets. Assemble gift baskets with items that dental assistants will appreciate, such as snacks, tea, gift cards or self-care products.
5. Recognition wall. Create a “Wall of Appreciation” in the office where you post notes, pictures and messages of gratitude for dental assistants.
giving them opportunities to lead team meetings, paying for CE and certifications, or encouraging them to pursue credentials.
“We have great career opportunities that are not easily available in our region,” said Lis. “The organization has paid all expenses for employees to become certified and registered dental assistants, including on-the-clock study and homework time.”
When dentists are invested in their dental assistants’ success, it keeps them motivated, builds trust and makes them more likely to stay at the practice. Plus, expanding dental assistants’ knowledge and skills can improve patient care and efficiency in the office.
“So often we talk about the patient experience, but what about the experience our assistants have being on our team? I believe if my team loves walking into my office and spending time here, so will my patients,” said Sutak. “We celebrate dental assistants every chance we get. Our office would not function without them, and it’s important to make sure they know I appreciate them every day.” ♦
The Dental Assisting National Board (DANB) is recognized by the American Dental Association as the national certification board for dental assistants. DANB exams and certifications are recognized or required by 39 states and the District of Columbia. To comment on this article, email impact@agd.org
Dental assistants at Cedar Village Dentistry.
Mark McDonough (right) and staff.
The staff of Lone Star Smiles.
The staff of Thunder Bay Health Service.
Broaden Your Horizons by Attending AGD2025 in Historic Montréal
This summer, AGD heads to Montréal, Quebec, for what is sure to be an unforgettable experience for all. Whether you’re looking to stay ahead of industry trends, sharpen your clinical skills or build valuable connections, AGD2025 has everything you need:
Cutting-edge education: With a robust lineup of lectures and hands-on courses, AGD2025 will dive into the latest advancements in general dentistry. Topics will cover the hottest trends and emerging technologies, so you can deliver the highest standard of care to your patients.
Exclusive networking: AGD2025 brings together dental professionals from around the world for unique networking opportunities. Meet colleagues, exchange ideas, and forge relationships with peers who share your passion for advancing the profession.
Tailored exhibit hall: Explore an exhibit hall curated specifically for general dentists, featuring the latest products and innovations to help you elevate your practice. It’s the perfect opportunity to discover new tools, techniques and services that can make a real difference in your daily work.
When and Where?
AGD2025 will take place July 9–12, 2025,
at the Palais des congrès de Montréal in downtown Montréal, Quebec. Known for its European flair and vibrant culture, Montréal offers the perfect blend of work and leisure. Enjoy Parisian-style cafés, incredible cuisine and a city full of history — all without the need for a transatlantic flight. From the cobbled streets of Old Montréal to the bustling downtown scene, you’ll experience the best of both worlds.
10 Musts for Your Visit to Montréal
1. Climb Mount Royal (the lookout). Climb the summit at Montréal’s most popular selfie spot — a “mountain” landmark designed by Frederick Law Olmsted, the same architect who crafted New York’s Central Park.
2. Go shopping on Sainte-Catherine Street , one of the longest commercial strips in Canada.
3. Eat emblematic Montréal cuisine, from the juicy smoked-meat sandwiches at Schwartz’s deli to the wood-fire bagels at Fairmount Bagel Bakery or St-Viateur Bagel to the notorious poutine at La Banquise.
4. Take in the historic architecture of Old Montréal. With architecture dating back as far as 1685, the city’s old district
offers visitors a glimpse of the past with charming cobblestone streets and sights like the Notre-Dame Basilica and historic Place Jacques-Cartier.
5. Visit Saint Joseph’s Oratory. Saint Joseph’s Oratory is a Montréal masterpiece, with its magnificent Rudolf von Beckerath organ and a basilica dome second only in height to Saint Peter’s Basilica in Rome.
6. Go “underground.” While Montréal’s climate promises a temperate experience in July, visitors can still get out of the sun by taking advantage of a vast network of pedestrian walkways below street level.
7. Visit a public market. Grab a snack and a souvenir at one of the city’s numerous local public markets. Marché Jean-Talon — located in the heart of Little Italy — is the largest and most culturally diverse market in Montréal. The smaller yet equally delicious Marché Atwater offers an array of specialty products and delicatessen treats and an art deco-style and is located beside the picturesque Lachine Canal.
8. Visit the colorful Plateau neighborhood. Walk along Avenue Mont-Royal, grab a pastry at Kouign Amann Bakery, eat at stylish bistro Chez Victoire, or grab a picnic and lounge beneath the trees in peaceful Parc La Fontaine.
9. Go east to Hochelaga-Maisonneuve. Montréal’s eastside neighborhood is home to a handful of attractions, all within walking distance of each other. The Olympic Stadium from the 1976 summer games is arguably the most recognizable architectural structure in the entire city. For a more nature-based experience, visit the Montréal Botanical Garden and the Biodôme.
10. Visit an art museum. Montréal is not lacking in art museums, so be sure to add the Montréal Museum of Fine Arts, le Musée d’art contemporain de Montréal, and the Phi Centre to your to-do list.
For a full guide to food and activities, as well as public transportation information, visit experience.mtl.org/en/agd. ♦
Registration Is Open
Registration for AGD2025 and courses are officially open! Dive into a dynamic learning experience with a variety of hands-on CE courses led by industry experts, where you can practice and refine your skills in real-time. Connect with dental professionals from across the world, exchange valuable insights and stay up to date on the latest advancements in oral health. Visit agd2025.org for more information and to register.
Getting to Montréal
Scan the QR code to learn how to get to Montréal and what documents U.S. citizens need to enter Canada.
Essential Quebecois French Phrases
English French
Hello.
Bonjour
Yes. Oui.
No.
Non
Thank you (very much). Merci (beaucoup).
Please. S’il vous-plaît. You’re welcome. De rien
Goodbye. Au revoir.
Excuse me.
I’m sorry.
Excusez-moi
Je suis désolé
Do you speak English? Parlez vous anglais?
I don’t speak French. Je ne parle pas français
Where is the restroom?
Où sont les toilettes?
I don’t understand. Je ne comprends pas.
Where is [place name]?
Hospital.
To the right/left.
Straight ahead.
I am lost.
Où est [place name]?
Hôpital.
À droite/à gauche
Tout droit.
Je suis perdu
Where is the ATM? Où est le gichet?
I would like [food you would like to order].
Je voudrais [food you would like to order].
What is the house specialty? Quelle est la spécialité de la maison?
The check, please. L’addition, s’il vous plaît
How much does this cost?
Combien ça coûte?
Help! Au secours!
I need a doctor. J’ai besoin d’un médecin.
Testing the Tools
By Ross Isbell, DMD, MBA
In my practice, my usual plan is to extract a tooth as atraumatically as possible and allow the site to heal. This is the least expensive treatment, and we know the body will heal in time. However, I am not always fortunate enough to have patients or sites that heal perfectly — luckily, there are a variety of ways to help heal them. While postoperative management of surgical sites is a commonly encountered situation in practices that extract teeth, past solutions haven’t always been as predictable and easy to deliver.
Go with the GLO
GLO® Whitening
GlO Science Professional glosciencepro.com
As I’m sure is the case for most general dental offices, we always have a whitening product as part of our available services. Our preferred brand was Phillips Zoom for in-office treatment, and we made custom whitening trays to allow for at-home whitening with Opalesence™ from Ultradent™ to maintain the results. Those are great products, but all the work that went into provision of the service just felt cumbersome, and our results weren’t always predictable or comfortable for patients. About a year ago, we swapped to the GLO® whitening system, and it is so much simpler to deliver similar results on the day of treatment and better long-term results. This system is designed to be a dual-whitening system and combines in-office treatment with take-home whitening kits. Using hydrogen peroxide with a double-barreled delivery syringe, the in-office treatment is strong enough at 30% to cause tissue damage unless gingival blockout is applied. However, this proprietary gel mixture, when paired with the closed mouthpiece system, doesn’t require lengthy treatment times and results in significantly less reported sensitivity. The closed mouthpiece I am referencing applies to both the single-use one that we use in the office as well as the reusable one that the patient takes home. It is important to note that it is a closed system because a tightly conforming fit is critical to prevent oxygen-free radicals from escaping after they are activated by the gentle heat and light. You must also limit the introduction of peroxidases from saliva. By maintaining an efficacious level of functioning hydrogen peroxide byproducts for a longer period, the concentration is lower (many other products use 35%) and treatment cycle times are shorter (eight minutes compared to 30) than competitors. Since in-office whitening alone can lose its effects after a week, it is important that your patients commit to continuing the process. Assuming that you have good patient compliance with the at-home regimen of 16 minutes per day for four days, the shade change results actually amplify over time while not having adverse effects. In our office, we recommend a cleaning — or at least a prophy polishing with pumice only and no bioactive materials like fluoride — prior to treatment to remove extrinsic staining and biofilm. Then, we
place the included retractors for initial placement of the gingival block-out resin. The gel is painted directly onto the teeth prior to placement of the mouthpiece. Don’t forget to preheat the mouthpiece since heat is important for the whitening reaction. Cycles last for eight minutes each prior to swapping out the gel. Most patients stop after three cycles due to time constraints, but the kits allow for up to five. Usually, we schedule these appointments as two-hour time blocks for a standalone whitening, but that is to allow for conversation, pre-op photography and pumicing. If scheduled appropriately, this can be completed as a one-hour appointment or less after a hygiene visit. Since we began using the system, GLO has partnered with vVardis to increase rebuilding of healthy enamel mineral structure after removal of intrinsic staining. The GLO whitening system transition has been an easy one for my team, and we are having better and easier results along with decreased chair time.
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
A Royally Good Crown Remover
Max Crown Spreader™
Artcraft Dental, Inc.
artcraftdental.com
Crown removal processes and instruments that aren’t lasers are all fairly standard in their shape, typically a flatter and more reinforced version of an eleva tor. There are some notable exceptions, such as WAMkey® by GoldenDent most utilize an average shape with different handles or materials. The Max Crown Spreader™ from Artcraft Dental takes the idea of leveraging with a flat surface and offers it in all three dimensions instead of just one. It has a cross-shaped tip that is off-angled from the axis of its long handle but also has the fins of the cross extending farther down the shank. This extended fin design allows for establishing a purchase point from a wide variety of angles, which can be useful in separating crown fragments from coronal tooth structure after sectioning. Artcraft sells two burs, one carbide and one diamond, designed and sized specifically to optimize the use of the Max Spreader. I use its burs sometimes, but I more often utilize a crown prep diamond size 16 or 25 or a crosscut 557. Most of my crown prep burs have a chamfer tip, so, after initial sectioning, I sometimes need to go back for another pass with a flat-ended bur to eliminate the chamfer curve. This will create a flatter butt joint to allow for a greater force to be exerted in the crown when torquing the Max Spreader. If sectioning a porcelain-fused-to-metal crown, I prefer to leave about 1 millimeter of the metal margin intact on one side of the crown so that I can hopefully remove it in one piece. But for all-ceramic restorations, I usually just prep all the way through to minimize my fight. This has become my go-to instrument for crown removals, and, if you are looking to restock or upgrade, you will find this to be a highly predictable tool for crown removals.
Score a Touchdown with this Football
OccluShaper 370 Komet kometusa.com
My philosophy on crown prepping continues to shift through my practice career, and, with it, the burs that I use more quickly adapt to these new styles. My current occlusal reduction process starts with depth cutting burs, either a 1.5- or 2.0-millimeter depth, then I use a coarse football to eliminate remaining vertical ridges. After decay removal, a circumferential prep (if needed) and buildup of core structures, I was using a standard-shaped red or yellow diamond football to finish the occlusal prep until I stumbled across the OccluShaper 370 from Komet. Now, this is my preferred bur for occlusal reduction and shaping after depth cuts. This bur comes in a coarse or fine grit and in both premolar and molar sizes. I am currently only using the molar-size red stripe diamond because I like having a regular football on my standard block for other applications. Unique from a standard ovoid football design, the diamond coating extends in a prolate direction outward from the ovate center in a smooth parabolic curve until it approaches the center of the axis of the bur and remains about 0.5 mm thick. Since the diamonds extend about 10 mm from one end to the other, you can simply set the bur on the occlusal surface and move it in a mesiodistal direction until you have achieved your desired reduction while simultaneously creating ideal anatomy. Since all-ceramic restorations require smooth and rounded contours to minimize fractures of the monolithic crystalline structure, this bur set is perfectly designed for ideal shaping. Komet also offers a comprehensive onlay kit that includes prep burs and others that work well for a minimally invasive preparation technique. The other burs in the kit are similar to what I already used, so I haven’t chosen to swap any others, but the OccluShaper is a true game-changer and will quickly earn a place of honor on your personal block.
Deepening Your Knowledge
Experience a comprehensive selection of lecture courses designed to elevate your dental expertise.
Enhancing Your Career
Students and new dentists can take advantage of a range of resources designed to support early career growth.
Sharpening Your Skills
Explore hands-on participation courses that provide practical experience to refine your techniques.
Expanding Your Network
Take advantage of multiple networking opportunities to connect with peers, mentors and industry experts.
