By Eric G. Jackson, DDS, MAGD, FICOI, FASD, FICD, FADI
Social media is flooded with quick-fix dental tricks — from charcoal toothpaste to do-it-yourself veneers. But, as dentists, we must stress to patients: Shortcuts often lead to permanent damage. Let’s break down the latest viral hacks and explain why a visit to the dentist is always a safer bet.
By Ross Isbell, DMD, MBA
“Green” and “holistic” are two buzzwords in the health industry in recent years, and they primarily focus on the sourcing and implementation of products that naturally occur or protect nature in some way. While often used interchangeably because there is a significant crossover in these categories, there are important nuances between the two. Learn about ideas or products that fit within a green or holistic definition and that will be helpful in your practice.
Self-Instruction article, 1 CE credit
A Recap of AGD2025 in Montreal AGD2025 offered attendees a wealth of activities, from cutting-edge education with a focus on hands-on learning to exciting and unique learning activities to a host of world-class restaurants and entertainment options around the city.
Constructive vs. Counterproductive Criticism
Recently, I overheard colleagues complaining that other dentists were criticizing past dental work on their patients. It may have been a perceived faulty crown margin, a less-than-ideal dental implant placement or less-than-ideal esthetics. When another dentist presents their concerns to the patient in a negative context, it can cause issues. Patients may present back to their original offices upset and belligerent.
This seems to be occurring more often recently, and I’m unsure why. Maybe the economy is affecting dental practices. Maybe advanced digital technology is detecting small discrepancies more easily. I am certain, however, that we all try to do the best we can under the circumstances presented to us daily. A patient who underwent treatment years previously may present with complaints and request new work at no fee. It is easy to make negative judgments about the work of others when there is no way to understand the circumstances involved in a previous treatment. Patients expect our dentistry to last forever, which may not be possible. The patient must also take responsibility for their health and well-being, which means routinely evaluating and maintaining a healthy oral environment. Myriad reasons could be to blame. Maybe it was substandard work the first time, but it’s just as likely that neglect resulted in changes to their oral condition. These interactions can be stressful for the dentist and the entire dental team.
Social media outlets easily serve as forums to criticize and complain, and the dentist can become discouraged, angry or sullen. It is important to keep moving forward. Earnest Hemingway once wrote, “The hardest lesson I have had to learn as an adult is the relentless need to keep going, no matter how broken I feel inside.” In dentistry, our empathy often gets the best of us. Being criticized by anyone, whether a patient or a colleague, affects our psyche negatively. We must respond knowing that we treat our patients to the best of our abilities with the tools available to us.
Some days may feel unbearable, but small steps in a positive direction mean that just keeping going is the answer. It is imperative that
we always stive to improve, get better and learn from errors. No one has all the answers early in their career, but the story is just beginning. Often, more questions present than we have answers for. This is where mentorship, and especially our AGD, provides a positive resource. We are not alone, but rather part of a family built on support. There are times when we just don’t know something because we don’t have the experience. The potential for tremendous growth is there when we set our goals to the highest standards and truly love what we do.
Professional courtesy comes into play here, and we should consider our actions before throwing someone else under the bus. If something is obviously insufficient, a call to the practitioner would be more productive and reduce the stress, anxiety and potential for litigation. Understanding the process of what transpires in our dental chairs can go a long way. If constructive criticism is appropriate, proper communication skills become important. Overthe-top criticism means judging others and will result in a defensive comeback.
I challenge our AGD members to think before acting and realize that, for all of us, positive criticism may lead to positive improvements. Confrontations are not the answer and can evoke feelings of helplessness, anger or embarrassment. It may be best to step back, analyze what has occurred and deal with it ethically. Try to see the other person’s point of view. I have redone enough dentistry in my career to realize that my reputation is important to me. Short-term financial rewards are not the end-all to a satisfying long career. No matter what, keep growing, improving and moving forward. Getting better at our trade is the answer.
Timothy F. Kosinski, DDS, MAGD Editor
DISCLAIMER: The Academy of General Dentistry does not necessarily endorse opinions or statements contained in essays or editorials published in AGD Impact. The publication of advertisements in AGD Impact does not indicate endorsement for products and services. AGD approval for continuing education courses or course sponsors will be clearly stated. AGD Impact (ISSN 0194-729X) is published monthly by the Academy of General Dentistry, 560 W. Lake St., Sixth Floor, Chicago, IL 60661-6600. Canadian Mailing Information: IPM Agreement number 40047941. Change of address or undeliverable copies should be sent to: Station A, P.O. Box 54, Windsor, Ontario, N9A 6J5, Canada. Email: impact@agd.org. Periodical postage paid at Chicago, IL and additional mailing office.
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.
FDA Holds Meeting on Oral Ingestible Fluoride Products for Pediatric Populations
By Jeanie Kennedy, AGD manager, Regulatory Affairs and Policy
The Food and Drug Administration (FDA) hosted a meeting July 23 that featured a robust discussion on prescription fluoride drops and pills for the pediatric population. The FDA contends that these products, in use since the 1940s, were never approved and is now seeking safety and effectiveness data.
Critics of fluoride consumption cite potential changes to the microbiome that in turn cause allergies, cognitive decline in children, thyroid disease or changes to bone development. During the meeting, the dental community was virtually united in stating that fluoride use helps to reduce tooth decay and has not been proven to cause the harms that opponents allege. Speakers stated that untreated dental disease can lead to deadly consequences. The meeting was contentious, with participants lacking agreement on scientific methods, study composition and the interpretation of study results.
There has been a rise in communities and states that are forgoing water fluoridation, recent examples of which are Utah and Florida. The rationale for removing water fluoridation in Utah was
that fluoride would be available in other applications. It appears that, in the future, the availability of fluoride products may be at serious risk. Participants agreed that there are no alternatives.
The FDA anticipates a decision on oral ingestible fluoride prescription products in October 2025. If products are taken off the market, manufacturers may file a new drug application (NDA) to receive FDA approval. However, the costs to file an NDA in FY 2025 are:
• $4,310,002 for an application requiring clinical data.
• $2,155,001 for an application not requiring clinical data.
• $403,889 for a Prescription Drug Program Fee.
These fees are part of the Prescription Drug User Fee Amendments (PDUFA) and are effective until Sept. 30, 2025. Fees are adjusted annually. The fees listed above would not include the costs of a clinical trial, which would likely cost additional millions of dollars.
The FDA received over 5,000 comments to its docket. AGD’s comment can be viewed at agd.org/advocacy/agd-priorities/ advocacy-center
AGD in Support of DQA’s Interim Report on Oral Evaluation Measure
By Jennifer Clemmons, AGD manager, Dental Practice
In July, AGD formally responded to the Dental Quality Alliance’s (DQA’s) call for public comment on its “Interim Report: Oral Evaluation Following Problem-Focused Episodic Care Visit.” The measure focuses specifically on children who have had a problemfocused care visit. Data from seven states was evaluated, and procedure code D0140 (limited oral evaluation – problem focused) was used to identify these visits.
After thorough review by AGD’s Dental Practice Council (DPC), in consultation with Ralph A. Cooley, DDS, FAGD, AGD’s representative to the DQA, the organization found that the proposed quality measure meets essential criteria of feasibility, reliability, validity and usability.
For some children, the initial or only point of contact with the dental care system is problem-based care. These visits can present an opportunity to establish children into more routine patterns
that shift care from treating problems to preventing future disease. While the measure is categorized as a pediatric dental measure, it is important to recognize that the majority of children receiving dental care in the United States are treated by general dentists, not pediatric dental specialists. As such, this measure has significant implications for general dentists, who often serve as the primary entry point into the dental care system for children.
AGD recognizes the importance of this measure in addressing the ongoing gap in dental care for children whose first dental visit is prompted by an emergency, rather than through a preventive dental care visit. Having this quality measure in place can support program- and plan-level efforts to move pediatric patients from problem-based care to a lifetime of preventive care.
More information on the Dental Quality Alliance is available at ada.org/dqa
AGD Submits Comments to ADA’s Council on Dental Education and Licensure
By Jennifer Clemmons, AGD manager, Dental Practice
In July, AGD’s Dental Practice Council (DPC) submitted formal comments in response to the American Dental Association Council on Dental Education and Licensure’s proposed revisions to two key documents: “ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists” and “ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students.”
These revisions stemmed from discussions held during the ADA’s Anesthesia Dental Provider Summit in May, where AGD
was represented by Brooke Elmore, DDS, MAGD, DPC vice chair, and Bryan T. Moore, DDS, DPC consultant.
Regarding the “ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists,” AGD expressed concern with the proposed requirement for the mandatory use of supplemental oxygen during moderate sedation procedures. AGD maintains that oxygen use should be determined by the dentist based on the specific clinical circumstances.
Additionally, AGD opposed the proposed requirement for quarterly emergency drill rehearsals for moderate sedation. Instead, the DPC recommended that the frequency of such training be determined by the provider’s professional judgment and aligned with the guidance for minimal sedation, which advises that drills be conducted “frequently.”
For the “ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students,” AGD disagreed with a revision stating that any use of airway intervention, such as a head tilt/chin lift, automatically qualifies the procedure as beyond moderate sedation. AGD contends that such interventions may be necessary in certain clinical scenarios, even during minimal or moderate sedation. For example, patients with macroglossia or anatomical variations may require a head tilt/ chin lift without the sedation level exceeding that of moderate. AGD appreciates the opportunity to provide input on these important guidelines and remains committed to supporting safe, evidence-based sedation practices that reflect the realities of clinical care.
Membership
Timely Offer Could Lower Your 2026 Dues
As the year winds down, many AGD members are planning ahead for their 2026 renewal, and a time-sensitive offer could help.
Now through Dec. 31, new members who join AGD for 2026 will receive the remainder of 2025 at no cost. While this offer helps new members get a head start, current members can benefit, too. By sharing this opportunity with your colleagues, you could give them the nudge they need to become a member while earning yourself $50 in Referral Rewards for each one who joins and lists you as their referrer. Rewards can be applied toward your own renewal dues, and there’s no limit to how much you can earn. To learn more and submit referrals, visit agd.org/refer.
Get Social and Connect with
AGD
Upcoming
This Month’s CE Opportunities
Oct. 7: “When Bad Things Happen to Good Implants” with Adam Saltz, DMD, MS, MPH
Oct. 14: “Orofacial Pain Disorders” with Shanna Kim, DDS
Oct. 23: “Hidden Damage of Everyday Dentistry: Perfect Crowns, Bad TMJ” with Agatha Bis, DDS
Register for these webinars and more at agd.org/education/learn.
Inside General Dentistry
Look for the following articles in the September/ October 2025 issue of AGD’s peer-reviewed journal, General Dentistry.
• What every dentist needs to know about cannabis use and head and neck cancer
• Nonodontogenic cysts and pseudocysts of the oral cavity: a retrospective study of 218 cases
• Malignant transformation of oral lichen planus after 6 years: a case report
Read these articles and more at agd.org/generaldentistry
See Pictures & Updates
Instagram: @academyofgeneraldentistry
Facebook: Academy of General Dentistry
X (Formerly Twitter): @AGDdentist
Meet the Candidates for the 2025–2026 Executive Committee
Candidate for Vice President: Richard A. Huot, DDS, FAGD, ChFC
A Maine native, Richard A. Huot, DDS, FAGD, ChFC, graduated from Northwestern University Dental School and was then commissioned into the U.S. Air Force, during which time he served at Osan Air Base in South Korea. After two more years of active duty in Arizona, Huot separated and started a de novo practice on Main Street in his hometown of Biddeford, Maine, eventually buying two other practices of retiring dentists before leaving for Florida in 1994. In his last two years in Maine, he served as the president of the Maine Dental Association and as a delegate to the American Dental Association (ADA) House of Delegates.
While in Florida, Huot maintained his affiliation with the Air Force Reserve, with assignments at Patrick Space Force Base (Florida), the Air Force Surgeon General Office (Washington, D.C.), Lackland Air Force Base (Texas) and the Pentagon. He then became the medical commander of the 920 Aeromedical Staging Squadron. This 240-member group deployed worldwide and supported the war effort in Iraq, Afghanistan and other contingency areas and was based with the 920 Rescue Wing in Cocoa Beach, Florida.
“Advocacy
isn’t just about legislation — it’s about communication. We need to become a more connected and communicative organization, especially in today’s fast-paced, digital and increasingly diverse world. That means making space for more voices at the table — women, minorities, and professionals from all races, cultures and practice settings.”
In private practice for another 14 years, Huot purchased an existing practice in Vero Beach, Florida, and successfully merged three others in that timeframe, finally selling to his associate. He
maintains his clinical skills currently by doing per diem work in Vero Beach, Maine and Vermont.
Working part time enabled Huot to serve on three ADA councils (Government Affairs, ADPAC and Insurance/Retirement Plans), and he was appointed to the AGD Legislative & Governmental Affairs Council, which he will chair until November 2025. He has also represented Region 20 at the AGD House of Delegates.
A few years ago, Huot was approached by Velmeni, an artificial intelligence (AI) firm, and he currently serves as its chief of business development and lectures nationally and internationally on how AI can assist dentists in the diagnosis of dental disease. He also lectures on practice management/financial-planning topics and has had a consulting business for over 20 years.
Huot and his wife, Joanne, have a son, Patrick, who lives in Alexandria, Virginia. They enjoy traveling, spending time with family, tennis, biking and hanging out at the beach reading a good book.
Personal Statement
“As a newly commissioned Air Force dentist, I knew my continuing education would mostly come through the military — but AGD offered something more: a community and a voice. I joined, and I’ve been a member ever since.
“After completing active duty and continuing as a reservist, I earned my Fellowship just four years later — an achievement that reinforced my belief in lifelong learning and professional growth. Since then, I’ve owned practices in Maine and Florida, and, along the way, I’ve seen how much our profession, and the world around it, has changed.
“As chair of the AGD Legislative & Governmental Affairs Council, I’ve seen firsthand how critical it is to have a strong voice advocating for general dentists. But advocacy isn’t just about legislation — it’s about communication. We need to become a more connected and communicative organization, especially in today’s fast-paced, digital and increasingly diverse world. That means making space for more voices at the table — women, minorities, and professionals from all races, cultures and practice settings.
“The next generation of dentists expects not only continuing education and advocacy, but also transparency, inclusion, and opportunities to be heard and represented. If AGD is to grow and lead in the years ahead, our vision must evolve to meet those expectations.
“When elected vice president, I’ll bring a modern, inclusive approach that is rooted in experience but focused on the future. I’m not part of the old guard. I believe in building bridges, fostering open dialogue, and ensuring that every general dentist — whether you’re starting out, mid-career, or planning your legacy — feels seen, supported and empowered.
“Thank you for the opportunity to serve. I hope to earn your support and vote as we move AGD forward together.”
Candidate for Vice President:
Kimberly R. Wright, DMD, MAGD
Kimberly R. Wright, DMD, MAGD, became involved in organized dentistry during her time as a dental student in the mid-1980s and never looked back. The moment she received her license, she became involved in organized dentistry in a wide variety of areas and roles, from committee member to committee/ council chair to trustee in the Oregon Dental Association.
Actively participating in many Oregon AGD study clubs, Wright became a known entity and was asked to join the Oregon AGD board. It’s here where her most passionate journey in organized dentistry truly began. Her involvement at the constituent level has been extensive — she has been involved in every aspect of Oregon AGD leadership and at one time was the interim executive director during an emergent need.
But her involvement in what has become the Oregon AGD Foundation Center education facility is, hands-down, her most joyful and satisfying accomplishment. Alongside a small, committed group, Wright helped raise $1 million in donations and another $1 million in donated equipment for the 7,000-squarefoot state-of-the-art facility, which was completed in 2019. Oregon AGD enjoys one of the highest percentages of general dentist members in the country. Wright believes this clearly demonstrates that dentists join AGD primarily because of what the local constituent offers its members.
Wright’s perspective of strong constituents is invaluable to her candidacy for AGD vice president. Her involvement as a delegate and member of several councils, and ultimately chair of the PACE Council, brings knowledge of how important grassroots member voices are in shaping AGD’s growth.
Wright also served on the 2022–2023 AGD Budget and Finance Committee. This appointment expanded her knowledge of AGD and the financial health of the organization. Organizational fiscal literacy is a key requisite for all members of the Board but, most particularly, for Executive Committee members.
Wright currently serves as AGD secretary. In addition to the duties of secretary, she has educated herself on the aspects of
AGD she didn’t have direct experience with as a council member. All aspects of what AGD does are extremely important to its mission and vision — specifically, the issues and challenges that the Legislative & Governmental Affairs and Dental Practice councils manage. Their work to protect our profession as we know it is incredibly important, and she has spent time educating herself about these issues.
Her other significant focus has been on modernizing the policies that govern the Board and its operations. She has led the effort to reorganize and update these documents, specifically the Board Policy Manual. It is a work in progress and will likely take another one to two years to completely renovate. Her leadership in this task has been instrumental.
Wright is married to Dr. Noel Tenoso, a physical therapist. They have two grown daughters who are successful in their own careers. In her rare free time, she loves to travel, cook and garden.
“I welcome the challenges ahead and am confident that the leadership experience I’ve gained throughout my professional life will serve us well.”
Personal Statement
“My commitment to advancing AGD’s strategic initiatives and strengthening our presence within the profession, as well as my deep appreciation for AGD’s unique culture, fuel my desire to embrace the stewardship of AGD for the next three years. I welcome the challenges ahead and am confident that the leadership experience I’ve gained throughout my professional life will serve us well.
“My professional track record shows:
• A proven ability to lead through change and see projects through to completion.
• A balance of visionary thinking with practical, detail-oriented planning to deliver meaningful results.
• A thoughtful, data-informed approach to evaluating options.
• A commitment to seeking input from stakeholders to ensure better decisions and stronger outcomes.
“Together, we can ensure AGD not only thrives today but continues to grow into the future.”
Candidate for Secretary: Joseph A. Battaglia, DMD, FAGD
Joseph A. Battaglia, DMD, FAGD, began his academic journey with a Bachelor of Science in biology from Villanova University in 1973, followed by a Master of Science in biochemistry from Fairleigh Dickinson University in 1977. He earned his Doctor of Dental Medicine degree from the University of Medicine and Dentistry of New Jersey (UMDNJ)-New Jersey Dental School in 1979. He completed a general practice residency at Hackensack Medical Center from 1979 to 1980.
Battaglia possesses experience in education, clinical practice and professional service in the field of dentistry.
“My journey has given me a thorough understanding of AGD’s operations, the importance of clear, transparent communication, and the need to critically listen to our members and staff.”
In his clinical career, Battaglia has maintained his private dental practice in Wayne, New Jersey, since 1983, with prior associate positions in private practice dental offices from 1979 to 1988. He is a clinical associate professor in the department of restorative dentistry at Rutgers School of Dental Medicine and held similar positions at its predecessor, the UMDNJ-New Jersey Dental School, since 1986. As dental education director at the UMDNJ Department of Continuing Education from 2004 to 2014, he contributed significantly to dental education. His hospital appointments included Hackensack Medical Center, St. Joseph’s Hospital and Wayne General Hospital. Battaglia began his career with active research, publishing articles on dental techniques and biochemistry. Additionally, he has contributed his expertise as an editorial adviser for dental journals.
His roles in the testing and licensing community include serving on the New Jersey State Board of Dentistry, as a member of the American Board of Dental Examiners (ADEX), on the ADEX board of directors for District 9, and as the chair of the American Association of Dental Boards (AADB) East Caucus. Currently, he is active with the AADB, serves as the New Jersey State Dental Board representative to the ADEX House of Delegates, and is a member of the ADEX Quality Assurance and Discipline & Grievance committees. He continues to serve as an ADEX examiner.
Battaglia’s membership and leadership within dental organizations, such as Omicron Kappa Upsilon, New Jersey AGD and the New Jersey Dental Association, are notable. Battaglia has held numerous leadership and membership positions within prominent dental organizations from 1979 to the present, including at both the state and national levels of AGD, the New Jersey Dental Association and the American Dental Association (ADA). His distinguished service includes serving as president of New Jersey AGD, member and chair of multiple AGD councils — including two terms as chair of the Dental Practice Council as well as chair of the Legislative & Governmental Affairs Council — and participation on the AGD Dental Education Council and Professional Relations Committee. He maintains fellowships in AGD, the American College of Dentists, the International College of Dentists and the Academy of Dentistry International. He will be inducted as a Pierre Fauchard Academy Fellow in 2025.
Battaglia served as a general dentist representative on the inaugural National Commission on Specialty Recognition and Certifying Boards, participated in the ADA Elder Care Workgroup and serves as an alternate delegate to the ADA House of Delegates. He presently serves as the AGD trustee from Region 4, New Jersey.
His professional achievements have been recognized through numerous honors, such as the AGD Distinguished Service Award and the Mark Ritz Advocacy Award. He has earned Life Membership in Omicron Kappa Upsilon, AGD, the New Jersey Dental Association and the ADA.
Married for 45 years to his wife, Debra, Battaglia resides in North Haledon, New Jersey.
Personal Statement
“I am deeply committed to advancing the mission and goals of AGD and supporting the needs of general dentists across the nation and Canada.
“Throughout my career, I have been privileged to serve in significant leadership roles within the AGD, working collaboratively to mentor and promote excellence in dental education, advocacy and patient care. My journey has given me a thorough understanding of AGD’s operations, the importance of clear, transparent communication, and the need to critically listen to our members and staff.
“If elected secretary, I pledge to:
• Maintain accurate and timely records of all AGD meetings and proceedings.
• Foster open lines of communication between the Board, committees, councils, and our valued members and staff.
• Increase transparency and uphold the integrity of our organization’s processes and reporting.
• Advocate for the interests and professional development of general dentists nationwide.
“I am excited about the opportunity to serve you, to ensure AGD thrives and to help guide AGD toward continued growth and success.”
Candidate for Speaker of the House of Delegates: Robert M. Peskin, DDS, FAGD, CP-T
Robert M. Peskin, DDS, FAGD, CP-T, was a member of the inaugural graduating class of the Stony Brook University School of Dental Medicine. He went on to complete both general practice and dental anesthesiology residencies at Long Island Jewish Medical Center. Since 1983, he has maintained a private practice on Long Island, New York, with a focus on treating anxious, apprehensive and special needs patients.
Throughout his career, Peskin has held multiple academic appointments, including in the Department of Oral and Maxillofacial Surgery’s Division of Hospital Dentistry at Stony Brook and, most recently, in the Department of Preventive and Restorative Sciences at the University of Pennsylvania School of Dental Medicine.
His professional honors are extensive. He earned AGD Fellowship in 1984, followed by fellowship in the American Association of Hospital Dentists in 1989. He is also a fellow of the American College of Dentists (1991), the International College of Dentists (1994) and the Pierre Fauchard Academy (1994). His many awards include the New York Section Pierre Fauchard Distinguished Service Award (2010), Stony Brook’s Distinguished Alumnus Award (2012), the New York State Dental Association’s Distinguished Service Award (2016) and the Herbert L. Taub Distinguished Service Award from the Nassau County Dental Society (2022).
Education has been central to Peskin’s career. He has taught predoctoral students at Stony Brook, postdoctoral residents at Penn Dental Medicine, and dental hygienists seeking certification in local anesthesia and nitrous oxide at Farmingdale State University. He has lectured nationally on pain and anxiety control at major events such as the Hinman, Greater Long Island, Greater New York and California Dental Association dental meetings, and, for more than 30 years, has presented extensively on risk management for professional liability insurers.
Peskin has also been a leader in organized dentistry. A member of the American Dental Association House of Delegates for 34 consecutive years, he has played a key role in shaping governance at both state and national levels. He has served as speaker of the house for the American Dental Society of Anesthesiology and for the New York State Dental Association, where he helped redesign the organization’s governance structure in 2008.
In 2021, he was elected Speaker of the House of Delegates for AGD, where he has worked closely with the Board to streamline procedures and enhance efficiency. Now running for his third and
final term, he remains committed to strengthening the effectiveness of the House.
Beyond dentistry, Peskin has dedicated himself to the study and practice of parliamentary procedure. Elected to the American Institute of Parliamentarians Board of Directors in 2014, he went on to serve as secretary (2016–2020) and vice president (2020–2023), and he is currently president (since 2023). Among his proudest accomplishments are becoming credentialed as a certified parliamentarian in 2021 and earning his “teacher” designation earlier this year.
“In reflecting on my own background, it is clear to me that no office is better suited to my abilities or passion than this. Over the years, I have come to recognize that, more than politics, my passion is the process.”
Personal Statement
“Throughout my career, I have had the privilege of participating in countless business meetings — studying their intricacies, observing accomplished presiding officers, and learning from both successes and challenges. These experiences, combined with my years of service as a speaker and parliamentarian, have given me a deep appreciation for the art of presiding and the responsibility it carries. I am confident that this breadth of experience uniquely qualifies me to continue serving as AGD speaker of the house.
“Whenever one contemplates running for office, it is important to ask: What does the office require at this moment, and how well do my skills align with those needs? In reflecting on my own background, it is clear to me that no office is better suited to my abilities or passion than this. Over the years, I have come to recognize that, more than politics, my passion is the process.
“The AGD House of Delegates observes parliamentary rules and traditions. As speaker, it is my duty to interpret them impartially, to maintain order, and to defend the rights and privileges of each and every member. And, while the significance of this task cannot be overstated, it is equally important to be mindful that no set of rules can take the place of tact and common sense. I have found calm insistence — together with a little good humor — are some of the qualities essential to the success of a skilled presiding officer.
“It has been my honor to serve as your speaker of the house for the past four years. If reelected, I pledge to continue facilitating your deliberations with fairness, efficiency and respect — ensuring that the valuable time you dedicate away from your families and practices is both meaningful and worthwhile.”
Financial Management
What Are the Key Differentiators of a Fee-for-Service Practice?
By Wesley W. Lyon II, CPA, CFP
The most common driver of a low profit–margin dental practice is not excess overhead, but rather insurance write-offs. From a logistical perspective, it takes the same amount of space, employees, supplies, etc., to perform a certain amount of dentistry — regardless of what you collect for each procedure. As I have documented in this column previously, too many accountants go after the expense line without understanding the relationship with production, when they should really be looking at collection. Lab companies are not lined up offering 50% discounts for lab work if your patient is in-network. While this is common sense to most dentists, many others are stuck in the trap of overbearing insurance write-offs and don’t know how to get out. The answer is to go out of network and become a fee-for-service practice. But if you take this step, you have to ensure that you stand out from the crowd. Below are the most common key differentiators of a fee-for-service practice.
Location
The most important factor is simply how visible your practice is. Are you tucked in the back of a strip mall with no signage or visibility? Or are you in a freestanding building on the main street? Is your practice in a major metropolitan area with a dentist on every corner? Or are you in the countryside with limited employersponsored dental insurance and few competitors? These decisions will have a dramatic impact on the difficulty of practicing out-ofnetwork. For dentists who already own their practice, these factors are hard to change. For those who don’t own a practice yet or who are renting and can move in the future, consider the following points when choosing where to locate your practice:
Dentists per capita: According to the American Dental Association Health Policy Institute, South Carolina has 46.4 dentists per 100,000 residents, while California has 77.7 dentists per 100,000 residents.1 This explains why many of my clients report hiring associate dentists to do hygiene work in California. The number of dentists looking to work in the most desirable parts of California exceeds the demand, leading to associates working at lower pay rates in some of the most expensive places in the country to live. While we have this data on the state level, you can apply it to suburbs, towns and cities as well. If you are entering a market with too many dentists, distinguishing your practice from the rest and going out of network will be challenging simply due to the amount of options available to patients.
Population base: Is the population full of corporate employees with dental insurance as a benefit, or is the population more blue
collar? While many dentists think that higher incomes near city centers such as Charlotte or New York City will provide better patients with higher incomes, the results don’t match expectations. The population base of major metropolitan areas tends to live paycheck to paycheck and expects their employer-provided dental benefits to cover 100% of all costs. On the other hand, the population bases of more rural areas tend to pay cash and not worry as much about in-network versus out-of-network status.
Visibility: Not everyone will have control over being in a rural area versus a large metropolitan hub, but every practice owner needs to be concerned with visibility. The ideal location for any practice is on a main road in a freestanding building, with convenient parking and great signage that can be easily viewed from the road.
Patient Experience
Does your patient experience mimic a hospital or a mom-and-pop business? If you treat your patients like a commodity, they’ll treat your practice the same way as soon as you go out-of-network. Here are the first steps to delivering a 10-out-of-10 patient experience:
Easy to schedule: I don’t recommend going overboard and allowing online scheduling, but patients should be able to see the dentist within a reasonable amount of time. The key to having an easy-to-schedule experience is having the right personality at the front desk.
Easy to pay: Expectations need to be clearly defined ahead of time, especially when dealing with insurance. Telling a patient they owe $87 today and billing them $13 once insurance comes back with no explanation leads to an upset patient. Patients do not understand that their payment portion is an estimate unless you clearly explain both the estimate and the expectation for future payment of the remaining balance. For a 10-out-of-10 patient experience, make sure credit cards are stored securely at the processor with the ability to charge again upon insurance making final payment — of course, with the patient’s permission. You will be surprised how many patients prefer to just be charged so long as the amount doesn’t exceed $25 or $50. The frustration is not the amount of money owed, but rather the lack of clear expectations and the surprise second bill.
On time: No one enjoys waiting an extra 30 minutes to see a doctor running behind, only to visit with the doctor for five minutes. This may be standard protocol at many medical offices, but going to the dentist needs to feel different. Patients should be seen on time almost every time. Furthermore, if you are running five minutes late, have a stack of $10 gift cards ready behind the front desk. Turn a negative experience into a positive by having your staff ask if it is OK that the dentist is behind by five minutes and thanking them with a gift card for their patience. Five minutes is not a big deal, but the anxiety that it could be 30 minutes is.
Clear treatment explanations: I grew up with a military father and have been to at least 20 different dentists throughout my life. Of those, only a handful spoke to me in terms I truly understood. When patients turn you down, it may not be because of price, but rather because the patient did not see the need for treatment. Many dentists are also reporting great success utilizing artificial intelligence treatment-planning applications such as Pearl (hellopearl.com) to present treatment to patients.
Friendly staff: Your staff should promptly greet patients by name and ensure personal notes are left in the practice management system or elsewhere for easy access and reminders next time. Having a mom-and-pop feel will help keep patients loyal, even if there is a less expensive option.
Not every dentist will be able to change locations, but every dentist can and should implement policies to make their patient experience a 10 out of 10. Even in the most densely packed urban areas, fee-forservice dentists can be found thriving. Make sure to read my next column to find out how you can make practice changes to help hire and retain top talent, all while boosting your bottom line. ♦
Wesley W. Lyon II, CPA, CFP, is president and CEO of McGill and Lyon Dental Advisors. For more information on his firm’s comprehensive tax and business planning services for dentists and specialists, contact Danielle Fitzgerald at 877.306.9780, or email consulting@mcgillhillgroup.com. To comment on this article, email impact@agd.org
Reference
1. “U.S. Dentist Demographics.” American Dental Association Health Policy Institute, ada.org/resources/ research/health-policy-institute/us-dentist-demographics. Accessed 8 July 2025.
Earn CE at Your Convenience with Self-Instruction
Now is the time to take advantage of AGD’s SelfInstruction program that includes exercises based on AGD Impact articles. These exercises contain 10 questions and are worth 1 CE credit. It’s the perfect complement to General Dentistry.
AGD Impact
1 exercise = $15
2 exercises = $25 (save $5)
4 exercises = $50 (save $10)
General Dentistry
1 exercise = $30
3 exercises = $70 (save $20)
6 exercises = $120 (save $60)
12 exercises = $180 (save $180)
LEARN MORE agd.org/self-instruction
Marketing
A Decade of Dental Marketing
By Jackie Ulasewich Cullen
This year marks the 10th anniversary of My Dental Agency, and, naturally, a significant milestone like this has prompted me to reflect on the changes I’ve witnessed since starting my company. Dental marketing has evolved over the last decade, but, for those of us who have been in the industry longer, we know it goes far beyond that.
When I first started my career, marketing in dentistry was considered taboo. Back then, word-of-mouth referrals were standard. The prevailing attitude in the industry was that marketing did not rise to the level of professionalism dentistry demands. Fast forward to today, and that mindset has all but vanished. Now, with the internet and social media, marketing has become essential for survival in dentistry.
Breaking into the Digital Age
Ten years ago, digital marketing was still gaining acceptance in dentistry and in general. A simple website and a basic knowledge of search engine optimization could get a practice noticed. Patients at that time were just starting to rely on websites, social media and online reviews to choose their dental practice.
In 2025, a polished digital presence is the bare minimum if a dental practice wants to compete for high-quality patients. With endless information and choices at their fingertips, today’s patients are discerning, digitally fluent consumers accustomed to researching every purchase they make. And now that reviews are available for nearly everything under the sun, patients expect the same level of transparency and attention from their dentist as they would from a fine dining experience.
Throughout my career — and especially during the last decade — I have witnessed a significant shift toward local search visibility, mobile-first website design, and, most notably, online reviews and social media. These digital portals are the new baseline, replacing the proverbial “shingle.” If a patient goes online and does not like what they see, they will simply move on to the next practice in the search results.
Speaking of Reviews
Online reviews have gone from “nice to have” to an essential part of a practice’s marketing strategy. For patients, Google reviews hold as much weight as referrals from close friends or family members. Therefore, the number, quality and recency of online reviews are big factors in determining if a practice will earn a patient’s business. In response, dental practices have learned the art of reputation management. They know better than to attempt to game the system by curating their reviews. Instead, they focus on delivering a consistently positive experience and making it easy for patients to leave reviews.
Trust Before the First Appointment
One steadily growing trend that continues to impress me is the amount of work patients will do before even requesting an appointment. Before making contact, a patient will research a practice extensively by looking at its website, social media channels and online reviews and, of course, asking around, because word of mouth still counts. They want to know what services a practice provides, the dentist’s philosophy and approach to care, the practice’s personality and what type of experience to expect.
As a consequence of this extra research, a practice’s marketing needs to do a lot more than simply get its name out there. Over the last 10 years, marketing has taken on the additional duties of educating patients, building trust and establishing rapport. The most successful practices are using authentic, educational content, including patient testimonials, behind-thescenes videos and blogs featuring popular treatments to speak directly to their patients and make a connection.
In addition to understanding that marketing must resonate with patients, dentists have come to realize that cookie-cutter websites and generic ad campaigns will no longer work if they want to
raise the quality of their patient base. While templates may have been acceptable at one time, in today’s crowded digital landscape, authenticity is the name of the game. The most effective dental practices are tailoring their marketing strategies to highlight their uniqueness. Practices that showcase their patient experience and clinical excellence instead of focusing on insurance networks attract high-quality patients who remain loyal.
Tracking What Matters
As more dental practices have begun to understand the power of marketing over the last decade, I have seen dentists’ reactions go from “don’t waste my time” when I mention performancetracking to “absolutely.” Digital marketing — and marketing in general — is no longer just about clicks and impressions. Dentists are seeking engagement, like phone conversations, online form submissions, email, text messages or appointments in the schedule — activities that lead to revenue. Tracking these metrics and taking a data-driven approach to marketing allows practices to make smarter decisions, refine their strategies and ensure that their investment is yielding measurable results.
The Big Picture
Looking back, I believe the most important lesson of the last 10 years is that every touchpoint matters. From a Google ad to a website visit, review response or follow-up email, each interaction with a patient should demonstrate the same attention to detail as the most intricate clinical work. Patients notice consistency, and that builds trust. Marketing is no longer a side effort. It’s an extension of a practice’s culture and patient care philosophy. When done right, it doesn’t just attract patients, it attracts the right patients.
As we look ahead to the next 10 years, one thing is clear: Authentic, patient-centered marketing will remain at the heart of practice growth and success. And for those of us who’ve watched the evolution firsthand, from taboo to essential, it’s exciting to think about what comes next. ♦
Jackie Ulasewich Cullen is co-founder and CEO of My Dental Agency, a dental marketing agency. An experienced speaker and writer, Cullen is passionate about helping dentists attract the patients they want and build thriving practices. To comment on this article, email impact@agd.org
No Travel. Just CE!
Corporate Sponsor
Invest Your Time Wisely to Empower Patients to Get Care
By Jennifer Steadman, BSDH, RDH, DAADOM
This column is sponsored by CareCredit, an AGD Corporate Sponsor.
Helping patients maximize their dental benefits is the goal for many practices in the last few months of the year. Developing an effective and efficient end-of-year recall strategy, though, begins the previous year by analyzing previous efforts and clearly defining what worked and what didn’t so that you build upon success. Here are a few proven strategies to consider for end-of-year recall.
Block Your Schedule for Hygiene
Today, many practices may be looking to fill open positions, especially for hygiene. This may make year-end scheduling particularly challenging, as many patients will want to take advantage of their benefits. The last thing you want is for a patient to want to return for hygiene or incomplete dentistry but you end up not having time available. Strategically blocking your schedule for same-day dentistry, past-due treatment and past-due hygiene may help keep appointments available, the team aligned and the schedule full.
Gather Your Information
First, do your homework. You want to have all the information you or the patient may need to help move them forward to treatment. To identify patients who need to be invited back to the practice, run the incomplete and past-due hygiene reports from your practice management software, then identify available insurance benefits that may expire by the end of the year. Another report to consider pulling is CareCredit’s Cardholder Available Credit Report. There are millions of CareCredit cardholders, and this will tell you if they have CareCredit and the available credit that can be used for out-of-pocket costs. Armed with this information, you can present a comprehensive financial solution to patients.
Make the Call Early
In your patient files should be two key pieces of information: a patient’s contact method with permission to use it and their preferred appointment days/times. In today’s world of artificial intelligence and automation, it’s important that communication sounds personal and friendly. If you’re using a software program to send texts or calls, use their preferred name to make sure it does not sound robotic.
Once you’ve identified patients for whom you have written permission to send recurring marketing texts, proactively reach out as early as possible to get them on the schedule. You know there are going to be patients who will wait until the last minute, so try to get as much of the schedule filled, especially in November and early December.
First, text the patient (if their file indicates it is their preferred contact method and you have permission to send them marketing and appointment reminder texts).
Example text: “Hi Jen. I noticed you have benefits available to use before the end of the year. Our schedule fills up early, and we’d like to help you secure an appointment before your benefits expire.”
Then, about seven days later, give them a call.
Example call: “Hi Jen, it’s Sara from [doctor’s name] office. I noticed you have benefits available.”
Pause and let them respond, which often is, “What do mean?” Then explain.
“According to your file, you have benefits that will contribute to the cost of the dentistry the doctor recommended. As we discussed, with your insurance, that leaves $850 as your portion to pay. We noticed you have a CareCredit credit card you may be able to use, which offers promotional financing on purchases of $200 or more. We still have next Tuesday at 3 p.m. and Friday at 10 a.m. available. Which would work best for you?”
If the patient is not ready to commit to an appointment, offer to put them on a VIP callback list to let them know of any last-minute changes in the schedule.
Educating, empowering and enabling patients to maximize their dental benefits so they can enjoy a healthy and beautiful smile not only makes for happy patients, but also a healthy practice. ♦
Note: Laws applicable to you may restrict or prohibit certain communications by text message. You are urged to consult with your individual advisers with respect to any information presented.
Jennifer Steadman, BSDH, RDH, DAADOM, has had a career that has allowed her to be a dental assistant, hygienist, practice manager, director of operations of a midsized DSO and director of operations for Inspired Hygiene. In 2020, she was named the American Association of Dental Office Management’s Practice Administrator of the Year. To comment on this article, email impact@agd.org
Dr. Pouresa’s Path to Becoming One of AGD’s Youngest Fellows
For Sep Pouresa, DMD, FAGD, dentistry has never been just about teeth — it’s about transformation. Known as one of Beverly Hills’ rising names in cosmetic dentistry, Pouresa blends clinical precision with an artistic eye, turning smiles into statements and patients into friends.
But his path to success wasn’t always lined with Hollywood glamour. “Like most dentists, I started with a simple goal: to help people feel better about themselves,” Pouresa shared. “I never imagined that, years later, I’d be working in Beverly Hills, treating public figures or earning my AGD Fellowship.”
Growing up, Pouresa was drawn to both healthcare and design — a unique mix that ultimately shaped his approach to dentistry. “Dentistry allows me to work hands-on, help people and bring in my esthetic sensibility,” Pouresa said. “That blend of science and artistry really clicked for me.”
Born in Montréal, Canada, Pouresa completed both his BS and DMD degrees at McGill University, where he was also awarded the prestigious Lieutenant Governor’s Medal for academic excellence and community involvement. After earning his dental degree in 2021, he moved to San Francisco and completed an advanced education in general dentistry (AEGD) residency program at the University of the Pacific.
“I focused on building a strong clinical foundation through an AEGD program and numerous conferences and continuing education (CE) courses,” he said. “I became obsessed [with learning]. That obsession with detail early on shaped who I am as a clinician.”
While many dentists view CE as a requirement, like many AGD dentists, Pouresa saw it instead as an opportunity. His decision to pursue the AGD Fellowship was motivated by his desire to challenge himself and deepen his skills. “Fellowship isn’t just about the letters after your name,” he said. “It’s a statement that you’re committed to excellence — not just for your patients, but for yourself.”
Completing over 500 hours of CE and 4 a.m. study sessions while balancing Men’s Physique competitions internationally was no small feat — in addition to being a top dentist, Pouresa is also a competitive bodybuilder. “There were definitely long nights and weekends spent in courses when friends were out enjoying themselves,” he said. “But I always believed that if you want to be one of the best, you have to keep learning.”
Today, Pouresa is proud to be among the youngest dentists worldwide to receive the prestigious AGD Fellowship — a milestone he doesn’t take lightly. “To me, this represents the foundation for everything else. Fame fades, trends change, but skill and integrity last.”
Dr. Pouresa earned his FAGD at AGD’s 2025 Convocation Ceremony, just four years after graduating dental school.
Establishing in Beverly Hills meant entering one of the most image-focused markets in the world, something Pouresa quickly realized wasn’t just about marketing — it’s about trust. “In Beverly Hills, your reputation is everything. People here care about results, but they also care about how you make them feel,” he said.
Over time, Pouresa has built a loyal clientele that includes models, entrepreneurs and, yes, celebrities. “Working with public figures has taught me something important: Everyone wants to feel seen, heard and cared for, no matter their status.”
One fun story: “I once had a celebrity client who was nervous about coming in because they didn’t want paparazzi outside. So, we set up early-morning appointments and used a back entrance.
Dentistry can feel clinical, but, in Beverly Hills, it’s a little bit of Hollywood behind the scenes.”
Another memorable moment: “I had a famous musician literally freestyle rap about their new smile while sitting in my chair. That’s not something they teach you in dental school.”
While celebrities may grab headlines, Pouresa says it’s the everyday transformations that keep him passionate. “Seeing someone be emotional after a smile makeover and watching their confidence change — that’s what fuels me.”
He views smile design as both a science and an art form. “Every patient’s face is unique. Their smile should enhance — not overpower — their natural features. That’s where having an eye for esthetics really matters.”
What’s next? With AGD Fellowship achieved, Pouresa has no plans to slow down. “I feel like I’m just getting started,” he said. He’s currently developing educational content to help young dentists refine their esthetic dentistry skills and hopes to lecture internationally in the coming years.
And as for celebrity clientele? “I appreciate the exciting cases, but I’ll always value the person in my chair, famous or not. My goal stays the same: to create healthy, beautiful smiles and treat every patient like they’re a VIP.” ♦
“Working with public figures has taught me something important: Everyone wants to feel seen, heard and cared for, no matter their status.”
Dr. Pouresa with actor and television host Mario Lopez.
Dr. Pouresa with actor Frank Grillo.
GREEN PRODUCTS Testing the Tools
By Ross Isbell, DMD, MBA
“Green” and “holistic” are two buzzwords in the health industry in recent years, and they primarily focus on the sourcing and implementation of products that naturally occur or protect nature in some way. While often used interchangeably because there is a significant crossover in these categories, there are important nuances between the two.
Products that are considered “green” are designed to minimize environmental impact and waste at any or every point in their creation or entire life cycle. Companies that follow a green ideology search for sustainable practices that are ecofriendly, or they at the very least engage in programs that offset their activities, such as carbon credit balancing and footprint reduction. They are concerned with planetary wellness and the wellness of its inhabitants and therefore want to minimize negative products entering human or organic systems.
Products considered acceptable in “holistic” or “biological” dentistry attempt to address the long-term effects of each action, product or by-product on your entire body instead of focusing on just their success in the mouth. Holistic practitioners often utilize naturalistic courses of treatment with alternative therapies such as aromatherapy, homeopathy and herbology. “Biomimetic dentistry” also technically falls under the umbrella of holistic, since the goal is to replicate natural function and appearance; biomimetics is especially relevant in digital restorative dentistry.
Both green and holistic healthcare have research, experience and historically based evidence as their foundation. However, their accepted practices often oppose the use of manufactured and chemical products and treatments that are more mainstream due to the exclusion
of unnatural interventions. Green and holistic healthcare professionals also question potential interactions, side effects and aftereffects of these products and treatments.
Some obvious examples of differing opinions on green versus conventional dentistry concern amalgam restorations, fluoride application and ingestion, and root canal therapy. Another issue that often pits wellness and healthcare companies against providers is false advertising, often called “greenwashing,” which is a type of marketing that targets green or holistic providers/ consumers even though the products or companies advertised do not adhere to the fundamental principles of natural and earth-friendly manufacturing or function.
AGD does not have specific policies concerning green or holistic dentistry, nor does it have a scientific branch devoted to studying the safety or efficacy of specific products. Policies governing the use of products in dentistry currently fall under the Dental Practice Council (DPC). The DPC does not maintain a subcommittee dedicated to efforts relating to dental products, but the DPC did help craft a policy that states that the use of research-backed and safe products is supported by AGD. A former policy that specifically mentions amalgam has been sunset and is no longer in effect. Policy supporting appropriate use and application of fluoride as a caries prevention method is still in place. Other AGD articles on this subject include:
• “Holistic Dentistry: Finding a Balance” by Carrie Pallardy, February 2022 AGD Impact
• “The Latest in Eco-Friendly Dentistry” by Dan Kolen, May 2020 AGD Impact
• “The Green Dentistry Landscape” by Kelly Rehan, August 2017 AGD Impact
In this article, I will highlight some ideas or products that fit within a “green” or “holistic” definition and that will hopefully be helpful in your practice. I will discuss some of the pros and cons and alternative product selections as part of the review of multiple product categories. I have sampled most of these products over at least a few weeks, and, while I can report anecdotally
how each tasted and made me feel, I personally can’t offer evidence of success or failure. While I have tested these, I don’t utilize every product listed here on a regular basis. Many of these companies have had studies conducted on their products and others in their category and have found that there is a tangible benefit to using or
Best Practices
recommending them as part of an oral care regimen compared with a control. As with all my articles, my primary purpose is to provide an overview and to showcase categories and products that may be worth investigating for use in your practice.
No matter what your philosophical or political leanings are concerning the
Just as we do with our clinical skills, we should be constantly searching for updates and improvements to the environment in which we practice. Innovation and renovation can be costly, but there can also be cost savings associated with reducing utility, supply and replacement costs if you shop for the right products or create the right management systems. Establishing a team and system to implement simple maintenance processes, typically at the beginning and end of the day, can have immense value for your bottom line. Simple tasks such as adjusting the thermostat; utilizing a cutoff for water flow; and turning off all lights, computers and appropriate powered devices are big cost-savers. Small purchase choices such as LED lights, motion sensors in seldom-used rooms and low-flow faucets can add up over time. Larger purchases should also be evaluated for energy and utility efficiency, such as deciding the size, type and
Software
Software advancements have allowed for a significant decrease in the use of paper and office consumables. Digital charting, communication and marketing are significantly more common and effective than they once were. For example, my offices have been primarily digital for more than a decade; however, we recently upgraded to a cloud-based multilocation practice management software, and that change has significantly cut our paper use and administrative work times. (I’ll leave the discussion of the environmental impacts of cloud storage data centers for another article.) With the rate of change we are witnessing now with artificial intelligence, it is worth re-evaluating each of your programs of choice and comparing their efficacy to that of a market newcomer every couple of years. Software has the power to focus your physical efforts and
environment and how to choose products or procedures, the most important and sustainable ideology for dentists and dental patients over the long term is prevention of dental disease through proper education, exemplary personal hygiene habits, and professional maintenance or intervention if needed.
number of heating, ventilation and air conditioning units; evaluating water-cooled versus waterless vacuum systems; and committing to air-driven versus electric handpieces. These decisions have long-term effects yet need only a momentary choice to increase your savings and decrease your office’s environmental impact.
Daily or routine consumables are also a low-hanging fruit for instituting sustainable practices. Plastic patient self-care bags can easily be exchanged for paper ones. Most metal instruments, such as those used for oral surgery or hygiene, can be repaired if a tip is broken or dull. Glass containers can typically be refilled instead of replaced with new plastic ones. As part of your strategic planning, you should include a plan for ordering supplies and consider buying quarterly or biannual inventory refills in bulk because it can reduce your shipping costs, environmental impact and per-item cost.
impact with thorough analytics and more effective delivery systems.
Teledentistry and remote diagnoses can be considered a green technology due to the decreased carbon footprint of transportation to a physical visit. A 2017 study by the National Health Service in England looked at single patient visits and found that 64.5% of visit-related emissions are associated with travel (both staff and patients), 19% with procurement and 15.3% with energy use.1 In my practice, I have many patients and team members who routinely travel 30 minutes or more to reach our office. While it is impossible to diagnose someone perfectly over the phone, we do routinely prescribe antibiotics and refer patients to specialists based on their reports and on previously charted issues. We also routinely make follow-up calls to assess the need for an in-person visit after a surgery or major procedure and
conduct phone consults to schedule treatment after receiving estimations of benefits or finalizing a treatment estimate. Requirements, regulations and capabilities in the communication of dental conditions have changed dramatically. It is worth incorporating digital imaging and photography simply to share with colleagues and display conditions to patients. From a sustainability standpoint, digital imaging is a significant upgrade over film due to a lack of processing liquid or disposable films. However, there is still an environmental cost since semiconductor manufacturing is not clean. Typically, sensors or plates are made with a plastic chassis, and a plastic barrier is often utilized to cover the sensor during use. I have had one of my Dexis Platinums for 15 years and can testify that, in the right conditions, a well-protected sensor can last decades.
OraMD is an herbal mouthwash designed to be a replacement for toothpaste and mouthwash. Instead of chemicals, it uses all-natural botanical and essential oils and ingredients such as sweet almond, spearmint oil, peppermint oil and others to disrupt oral bacterial activity. This plant-derived product is effective at dispersion when used with topical application through toothbrushing or mouth-rinsing after dilution and can reach interproximally and into crevicular areas of the mouth due to its oily composition and recommended swishing technique. While it is an oil, it does not leave a residue feeling in your mouth but instead a lasting flavor that feels fresh and peppermint-y, though a little bitter, that lingers more than most over-the-counter mouthwashes. Its use is indicated for oral hygiene regimens of all ages and needs, but it is particularly noted to be effective with gingivitis and the many inflammatory and periodontal issues that come with it. To use, add five or fewer drops of OraMD to your toothbrush, and brush regularly morning and night. To use as a mouthwash, mix one to two drops per ounce of water, and rinse for 30 seconds prior to spitting.
BioGaia Prodentis® Probiotic Lozenges
biogaia.com/products/prodentis
BioGaia Prodentis® lozenges are probiotic dissolving tablets that are recommended for one or two doses daily. Possessing a lightly minty flavor, they will dissolve fully within about three minutes. This product utilizes two specific strains of Lactobacillus reuteri (DSM 17938 and ATCC PTA 5289), a bacteria species that is known to reduce the production of pro-inflammatory cytokines, enhance antimicrobial activity and reduce bacterial translocation across membranes. Enhancing the colonization of L. reuteri can therefore allow for a healthier balance of naturally occurring bacteria both in the mouth and throughout the digestive system. This bacteria has been researched in more than 60 studies. Ingredients used in the lozenges are minimal; they contain only isomalt, xylitol, L. reuteri and flavoring. This is a great start for supercharging your body’s own cleaning crew and reducing your inflammatory load.
Dr. John’s Dream Candies
drjohns.com/pages/dream
There are few healthy options in the world of candy and sweets, but I believe Dr. John’s Dream Candies have accomplished
everything we as dentists have hoped for. Finally, we can be like all the other doctors’ offices and give out a lollipop to a good
child without a guilty cariogenic conscience. Coming in a variety of flavors, such as vanilla, chocolate, butterscotch and various fruits, these treats are actually dento-positive because they increase oral pH to 8+ and deliver alkaline ions through calcium carbonate and tricalcium phosphate. Deriving their sweetness from erythritol and stevia, they are also vegan, gluten free and allergy friendly. Erythritol has a significantly lower glycemic index compared with xylitol and is safe for accidental animal consumption. These are a great option to recommend to parents as well as to dry-mouth patients who need a salivary flow initiator and a chemical aid for remineralization.
Dr. Heff’s® Remarkables drheffs.com
Dr. Heff’s® Remarkables are small mints or tablets that dissolve in about 10 minutes and benefit patients with calcium phosphate, peppermint oil and green tea extract. They are flavored with xylitol. The calcium phosphate increases bioavailability of alkaline ions in saliva and aids in remineralization. The peppermint oil has anti-inflammatory and antimicrobial effects as well as a fresh taste. The green tea extract is high in antioxidants and also reduces inflammation. These tablets are for multiple daily use and are an easy addition to your preventive and breath-freshening regimen.
Mouthwashes, Toothbrushes and Floss
When evaluating personal hygiene habits and the ideal way to monitor our environmental impact at home, it is important to study not just our waste, but also what we are exposing ourselves to in our personal environment. Regular replacement of toothbrushes, especially powered toothbrush heads, is important for minimizing our exposure to molds and bacterial aggregation that grows in the
Dental Herb Company Travel Kit shop.dentalherb.com/shop/travel-kit/
For an all-natural home hygiene kit, the Dental Herb company does it right. Using a botanical formula for its mouthwash and toothpaste and a sustainably sourced and manufactured bamboo toothbrush handle and bristles, this kit respects your oral and global environment. Both the toothpaste and mouthwash are gluten, fluoride, alcohol and sodium lauryl sulfate free as well, and they are made with essential oils and herbs such as echinacea, peppermint, eucalyptus, aloe vera and cinnamon.
Direct-to-Dentist Products
Direct Restoration
One of the more common procedures in general dentistry is direct restoration after caries removal. In holistic dentistry, there is significant concern over the placement and removal processes of amalgam restorations especially, but also the materials contained in some composites. Careful and proper removal of amalgam to minimize exposure to the dust and aerosol typically created includes utilizing rubber dam isolation, high-volume suctions, oxygen masks, eye protection, air-capture hoods or apparatuses, and a border-and-sectioning technique. Ideal replacement of these restorations can be
bristles and moving parts of our equipment. Some of those issues can be mitigated with ultraviolet light cleaners and ultrasonics, but replacement is the most effective. There are not good renewable replacement options for power brush heads since most rely on metal and plastic machinery, but manual brushes and floss do have sustainably sourced options.
A bamboo fiber-based floss with activated charcoal, Snow Charcoal Floss comes in 50-yard packs so you won’t run out as often and will always have exceptional plaque removal. While not as smooth as polytetrafluoroethylenebased floss, a wax coating still makes this product glide smoothly between contacts. It is slightly fluffy but nowhere near as fluffy as SuperFloss™ by Oral-B.® It is strong enough not to tear easily when encountering ledges. Containing a hint of peppermint, this product will help remove plaque aggregation without spending a lifetime in the landfill.
completed with materials that are bio-inert and have minimal or no by-products that are released during function. Milled ceramics like zirconia, lithium disilicate or precured composites are considered to be the best option for reducing chemical by-product exposure, but even those require resin cements. The process of polymerization during the curing of most composites causes some minor release and the consequent formation of an oxygeninhibited layer (OIL). During placement and curing, there are some techniques that can reduce the amount of remaining OIL and patient exposure to monomer
by-products, such as utilizing a rubber dam, curing for twice the recommended length of time and utilizing a glycerin gel during final curing. Following those steps with comprehensive polishing and thorough rinsing can reduce bisphenol A (BPA) and residual monomer presence on the exterior surface of resins by up to 90%.2 Not only will these processes reduce potential BPA exposure, but they will also significantly increase the bond strength of the restoration. Below are some restoration materials that have minimal negative impacts on the oral environment.
The Filtek line of restorative materials has been on the market for many years, and the Supreme Ultra product has improved on an already-great thing. Both the packable and flowable versions use aromatic urethane dimethacrylate (AUDMA) and addition fragment monomers (AFM) to create a particle matrix that contains nanofiller particles smaller than 100 nanometers and is BPA-free. These monomers work cooperatively to reduce polymerization stress and the corresponding composite shrinkage during a full-cure process. As a nanocomposite, it is highly polishable and easily adapts to all sizes of defects. This is not a bioactive material and therefore does not contain fluoride or have any ion-releasing properties. It is fluorescent under light, radiopaque, and available in 36 shades and four opacities.
Implant Solutions
Admira Fusion by VOCO voco.dental/in/products/direct-restoration/ composites/admira-fusion.aspx
Admira Fusion is a universal nanohybrid organically modified ceramic
(ORMOCER) restorative material. ORMOCERs are different from traditional composite resins because they do not utilize the same classic types of monomers such as AUDMA, BPA or bisphenol A glycidyl methacrylate (bis-GMA) and instead utilize three-dimensionally crosslinked polysiloxane matrices. This results in significantly less shrinkage stress, correspondingly less microgap formation and no residual monomers upon curing. While compatible with all bonding agent types, it works best when paired with VOCO’s Admira Bond. The lacking monomer exterior makes the material very bioinert and resistant to staining from food or aggregated plaque.
I have been placing implants for about 10 years now and have always placed titanium. I have limited restorative experience with zirconia implants, but, as part of researching this article, have found that most major implant companies offer a zirconia implant option, and there are some companies that exclusively manufacture zirconia. Some examples are the Nobel Biocare Pearl, Straumann Pure, Camlog Ceralog and Swiss Dental Solutions Bright. These products are not the only ones on the market but illustrate many of the design characteristics available. Zirconia implants are important to biological dentistry for a variety of reasons. Manufacturing and production of zirconia implants is considered to be a less environmentally damaging process, but there are methods of recycling both titanium and zirconia. Zirconia dioxide is a biologically inert material and is metal free and hypoallergenic. From my experience with custom abutments and subgingival crown margins, polished zirconia is significantly more favorable to epithelial tissue attachment than polished metal or glazed ceramic. The same is true of zirconia
Tetric® by Ivoclar ivoclar.com/en_us/products/composites/ tetric-line
The Tetric® line of composites from Ivoclar is a highly esthetic nanohybrid material with a wide range of shades and translucencies, along with a convenient chameleon effect. Using urethane dimethacrylate (UDMA) as the primary monomer, it is creamy in consistency and easy to handle. Highly polishable, it is a great material for esthetic restorations.
implants and how bone and tissue respond to monolithic zirconia implants, and there is minimal occurrence of periimplantitis. Some companies report a 97% integration success rate. 3 This high success rate is likely due to a significantly lower incidence of bacterial and plaque aggregation and a correspondingly reduced inflammation response when compared with titanium surfaces.
Historically, most zirconia implants have been single stage/ single piece, so they have not been as customizable for overcoming angular restoration challenges. Another issue is that zirconia is more brittle than titanium and subject to fracture instead of bending or deforming upon breakage-level forces. There are now some options for two-stage restorative platforms with screw-retained abutments that utilize other materials to overcome the challenges of screw-thread tightness and microgap issues. For abutment screws, some brands use alternative materials such as polyether-ether-ketone (PEEK) and polyetherketone-ketone (PEKK) polymers, but those are not as strong as
titanium. Most implants use antirotational internal anatomy, such as hex or star designs with a single or double notch to ensure a specific insertion path. While some ceramic implant companies manufacture their implants through an injection process, most use precision milling followed by specialized surface-roughening techniques after fabrication. With any style of fabrication, integration and bone interface connectivity seem to be similar. Titanium abutments often require anodizing or blockout to cover the dark metallic color, whereas zirconia abutments are already white and bright tooth–colored, thereby more easily achieving a natural esthetic result.
Nobel Biocare™ NobelPearl™ nobelbiocare.com/en-us/nobelpearl
The NobelPearl™ is a two-stage implant with both abutments and implants milled from aluminatoughened zirconia (ATZ) blanks with no sintering after milling to ensure exact design accuracy. This material is biocompatible and radiopaque. The abutment screws are made from carbon fiber–reinforced PEEK to ensure that the entire apparatus is strong while still being entirely metal-free. Using their standard connection, there are plenty of restorative options for single- and multiunit restorations.
Straumann® PURE straumann.com/en/dental-professionals/dental-implants/dentalimplant-materials/zirconia.html
Straumann ® PURE implants are produced from yttrium oxide tetragonal zirconia polycrystals (Y-TZP) and test with higher fatigue strength than grade 4 titanium implants. After milling the implants, Straumann completes a special surface treatment to roughen the surface and encourage bone interface connection. Straumann individually tests each implant prior to packaging to confirm no fracture defects. The implants are made in three types: single-stage 3.3 millimeter (mm) diameter, single-stage 4.1 mm and two-stage 4.1 mm. Site preparation is conducted using the same titanium drill set and prosthetics as standard Straumann implants. Zirconia healing abutments are available but still use a titanium screw, and the same goes for restorative abutments. The titanium in this situation is entirely contained within the implant and not in contact with the patient, though technically contained within their body. Straumann also owns Neodent, which has a zirconia implant system called Zi.
Ceralog® implants are fabricated using ceramic injection-molding and are composed of yttrium oxide–stabilized tetragonal zirconium oxide. After they are pressed into the design mold, they are sintered, but the exterior surface is not treated with a roughing or abrasive process. The two-stage implants are made with a flower-shaped “Hexalobe” for internal connections with prosthetics. Abutments are fabricated from PEKK, which is strong yet flexible and has similar flexural characteristics to teeth.
Swiss
Dental Solutions swissdentalsolutions.com/us
The Swiss Dental Solutions implant system is metal-free from start to finish, utilizing ceramic drills created from ATZ that have sharp and consistent edges to prepare surgical sites and offering one- and two-stage implants. The abutments, which the company calls “tulips,” can be customdesigned depending on restoration type and are easily captured with digital or analog impressioning. Composed of tetragonal zirconia polycrystal type A (TZP-A), the implant body has an aggressive thread at the apex, followed by microthreading for soft tissue attachment at the ridge height, followed by a smooth emergence profile. The implants are available in a variety of diameters, from 3.25 mm to 5.4 mm, and lengths ranging from 8 mm to 14 mm.
“Whether or not you adhere to holistic or green philosophies, many of these products can offer cost savings as well as a reduction in waste.”
For reducing postoperative pain, I haven’t come across a more effective and less invasive method than following the StellaLife® protocol with the VEGA® Oral Care Recovery kit. In my experience, beginning use with the antimicrobial peppermint mouthrinse three days prior to surgery and then using the three-part system three times daily afterward significantly reduces the need for medication-based pain management. During each of the treatments postoperatively, first utilize the mouthrinse, then apply the sublingual spray, and finally coat the surgical site with the topical gel. The ingredients found in StellaLife products are all natural and included in the “Homeopathic Pharmacopeia” of the United States (hpus.com) and include plantderived substances such as chamomile and echinacea that have anti-inflammatory, anti-anxiety and antimicrobial properties.
Disposables and Sterilization
VistaApex Air/Water Syringe Tips
vistaapex.com/product/air-water-syringe-tips/ Air/water syringe tips functionally speak for themselves, but what isn’t as obvious is your cost savings by eliminating plastic. A five-pack of these metal autoclavable water tips can cost what you normally pay for a bag of a couple hundred plastic tips. So, within a couple hundred patient visits (250 tips divided by six daily patient visits equals 42 business days), you can reach a break-even cost point and reduce your trash and ordering burden, too.
VistaApex and Hu-Friedy Surgical Aspirators vistaapex.com/product/surgical-aspirators/; hufriedygroup.com/en/surgical-aspirators/b1-byrd-self-cleaningaspirator
The same argument for replacing air/ water tips can be made for suction tips, and these stainless steel ones are a great replacement for your high-volume evacuator. The tapered tip helps reduce clogging in the tube in VistaApex’s models. If you are still having trouble with surgical debris clogging the suction or causing extra cleanup efforts postoperatively, you can opt for a self-cleaning suction like the Byrd option from Hu-Friedy.
Septodont OraSoothe® “Sockit” Gel
septodontusa.com/product/pain-management-orasoothe-sockit-gel/ Septodont’s Orasoothe® “Sockit” Gel is a simple solution for a common problem. This wound-healing and pain-soothing gel is composed of six food-grade ingredients, including water; xylitol; mannose polysaccharides from aloe vera; and a tiny amount of essential oils of cinnamon, clove and thyme. The gel is preloaded into an easy-todeliver syringe, and each box contains multiple syringes. With enough material for five or six uses per syringe at a standard extraction site, each syringe is recommended to be coded as D9630 (drugs for home use) and sent home with the patient after demonstration on how to inject the material into the recent surgical site. It is safe to consume or swallow and has no side effects other than covering an open wound and providing some temporary relief. This is an ideal way to provide your patients with some relief and to hopefully reduce their need for postoperative pain management medication.
Sterilization bags are critical to maintain a safe environment for patient care, but the commonly used paper and plastic disposables are not your only options. The EnviroPouch® is a cloth and film combination system that can last a minimum of 200 uses and is available in a variety of sizes.
Purchasing 200 sterilizer bags costs around $35 at minimum and takes up at least 120 cubic inches of both office storage and eventually landfill space, as compared to $25 for a single EnviroPouch that takes up only 3.5 cubic inches (and no landfill space).
Eco Gloves™ Nitrile Gloves
ecogloves.co/pages/biodegradable-nitrile-gloves
Patients often ask how many gloves I go through in a day, and my best guess would be around six pairs an hour. That means I use a pair every 10 minutes on average. My office moved from latex to nitrile gloves due to an increasing number of latex-sensitive and -allergic patients to reduce our risk of irritations and reactions. While latex can break down in a landfill in 5–10 years, standard nitrile gloves take a 100 years or more. Eco Gloves™ has developed a type of nitrile that can biodegrade in just a couple of years, after which they are converted to water, humus and biogas instead of microplastic. This is a major shift toward sustainable infection control.
For a full-office system to filter your waterlines for amalgam as required by the U.S. Food and Drug Administration, the Solmetex® NXT system is an easy-to-monitor solution. The initial kit (not counting install costs) is $910, and then it is $400 for replacement containers and to ship the old, full one back to the company for disposal. It is Environmental Protection Agency (EPA)–compliant, and Solmetex has systems for small and large offices. We typically have to replace our container once or twice a year, and, while it is effective and compliant, I definitely notice that it fills up with debris and sediment such as prophy paste that is visibly not amalgam.
A smaller option for a more specific amalgam removal is the Capt-all® system from Dove® Dental Products. Costing only $7 per tip, this system is for use only when removing amalgam restorations and fits conveniently into your high-volume suction system. You should confirm that it is compliant with your state’s regulations because, although it is EPA-approved and highly effective at amalgam removal, it doesn’t cover your whole office and therefore may not pass building inspection requirements.
ProEdge Dental Water Labs
QuickPass
proedgedental.com/product/quickpass/ The QuickPass in-office water-testing system costs about $25 per test, and it is recommended that you test each operatory’s water supply on a regular basis, either quarterly or biannually. Simply fill up the QuickPass container with water from your air/water tip, and it will indicate which colony-forming unit (CFU) range is present so you will know if further testing is required or if your water is within acceptable ranges. A measurement of 0–200 CFU/milliliter is the ideal range, and you can continue to treat your lines regularly and test on a routine basis; 200–500 CFU/mL is within Centers for Disease Control and Prevention (CDC) guidelines, but you should shock your lines to reduce exposure; at 500+ CFU/mL, you are beyond safe CDC-recommended levels and need to seek immediate treatment options. ProEdge also offers water treatment options and mailin testing for a more comprehensive understanding of what is in your water and the best ways to manage, filter or treat.
Conclusion
The information included in this article is intended to be a helpful starting point for studying ways that your practice can alter its standard protocols in order to diminish the environmental impact of your operations. Whether or not you adhere to holistic or green philosophies, many of these products can offer cost savings as well as a reduction in waste. Others can boost or enhance the oral environment without harming your patients and so should be part of your recommendations for homecare. No matter what, continue to prioritize your patients’ best interests.
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
References
1. Duane, B., et al. “An Estimated Carbon Footprint of NHS Primary Dental Care Within England. How Can Dentistry Be More Environmentally Sustainable?” British Dental Journal, vol. 223, no. 8, 2017 Oct. 27, pp. 589-593.
2. Dursun, E., et al. “Bisphenol A Release: Survey of the Composition of Dental Composite Resins.” Open Dentistry Journal, vol. 10, 2016 Aug. 31, pp. 446-453.
3. Fernandes, P.R.E., et al. “Clinical Performance Comparing Titanium and Titanium-Zirconium or Zirconia Dental Implants: A Systematic Review of Randomized Controlled Trials.” Dentistry Journal (Basel), vol. 10, no. 5, 2022 May 12, p. 83.
Self-Instruction
Basic Sciences
(Subject Code: 010)
The 10 questions for this exercise are based on information presented in the article, “Testing the Tools: Green Products,” by Ross Isbell, DMD, MBA, on pages 18–25. This exercise was developed by members of the AGD editorial team.
1. _____ dentistry technically falls under the umbrella of holistic, since the goal is to replicate natural function and appearance.
A. Bionatural
B. Biomimetic
C. Bioesthetic
D. Bioregenerative
2. Teledentistry and remote diagnoses can be considered a green technology due to the decreased carbon footprint of transportation to a physical visit.
A 2017 study by the National Health Service in England looked at single patient visits and found that 45.6% of visit-related emissions are associated with travel (both staff and patients).
A. Both statements are true.
B. The first statement is true; the second is false.
C. The first statement is true; the second is false.
D. Both statements are false.
3. BioGaia Prodentis® lozenges are probiotic dissolving tablets that utilize two specific strains of _____, a bacteria species that is known to reduce the production of pro-inflammatory cytokines, enhance antimicrobial activity and reduce bacterial translocation across membranes.
A. Lactobacillus plantarum
B. Lactobacillus reuteri
C. Ligilactobacillus salivarius
D. Streptococcus salivarius
Reading the article and successfully completing the exercise will enable you to:
• understand the overlap between green and holistic dentistry and the nuances that differentiate them;
• evaluate the potential benefits and limitations of incorporating green dental products into your practice; and
• communicate with and educate patients on green oral healthcare products that are available to them.
This exercise can be purchased and answers submitted online at agd.org/self-instruction
Answers for this exercise must be received by Sept. 30, 2028.
4. _____ has a significantly lower glycemic index compared with xylitol.
A. Sorbitol
B. Lactitol
C. Erythritol
D. Malitol
5. All of the following milled ceramics are restorative options that reduce chemical by-product exposure except one. Which is the exception?
A. borosilicate ceramics
B. lithium disilicate
C. precured composites
D. zirconia
6. The process of polymerization during the curing of most composites causes some minor release and the consequent formation of an _____.
A. oxygen-saturated film
B. air-polymerized coating
C. oxygen-inhibited layer
D. anaerobic polymerization zone
7. The acronym BPA stands for _____ A.
A. biphenolic
b. biphenyl
c. benzophenone
D. bisphenol
8. The acronym ORMOCER stands for _____ ceramic.
A. oxide-reinforced monomeric
B. organic matrix oxide
C. optically reactive molecular
D. organically modified
9. Which of the following best describes how ORMOCERs differ from traditional composite resins?
A. ORMOCERs use monomers such as bis-GMA and AUDMA for crosslinking.
B. ORMOCERs utilize threedimensionally crosslinked polysiloxane matrices instead of classic monomers like bis-GMA or BPA.
C. ORMOCERs do not contain any inorganic filler particles.
D. ORMOCERs rely solely on siloranebased monomers for polymerization.
10. Ceralog implants are fabricated using ceramic injection-molding and are composed of _____ oxide–stabilized tetragonal zirconium oxide.
A. cerium
B. yttrium
C. terbium
D. neodymium
Debunking the Latest Dental Hacks Why You Should Never DIY Your Smile
By Eric G. Jackson, DDS, MAGD, FICOI, FASD, FICD, FADI
Social media is flooded with quick-fix dental tricks — from charcoal toothpaste to do-it-yourself (DIY) veneers. But, as dentists, we must stress to patients: Shortcuts often lead to permanent damage. Let’s break down the latest viral hacks and explain why a visit to the dentist is always a safer bet.
Charcoal Toothpaste
One of the most popular trends circulating on TikTok and Instagram is the use of charcoal toothpaste to whiten teeth and “detoxify” the mouth. Proponents claim that the black paste removes stains and bacteria better than traditional products. However, this trend is deeply concerning. Charcoal is highly abrasive, and frequent use can lead to the erosion of enamel, the tooth’s protective outer layer. Once enamel is worn down, it cannot regenerate. This exposes the yellow dentin underneath, making teeth appear duller and more sensitive over time. Moreover, many charcoal toothpastes do not contain fluoride, an essential mineral that helps protect teeth from decay. The American Dental Association (ADA) does not approve charcoal pastes, largely because many have not undergone rigorous testing for safety and effectiveness. While some users report temporary whitening effects, this is often due to the abrasive nature of the product removing surface stains — along with protective enamel.1 A safer and more effective option is professional whitening under dental supervision, coupled with the use of a gentle fluoride toothpaste.
DIY Composite Veneers (Cheap Kits)
Another hazardous trend gaining popularity on platforms like Facebook and YouTube is DIY composite veneer kits. These kits promise a Hollywood smile at a fraction of the cost of professional treatment, but they are riddled with dangers. The materials included in these kits are typically substandard and fail to bond properly with natural teeth. The results are not only unesthetic but also structurally unsound. Poorly fitted veneers can cause gum irritation, misalignment of the bite and even infection. There are reported cases of these temporary veneers detaching while eating or speaking, sometimes leading to choking hazards. More alarmingly, incorrect application can result in irreversible damage to the underlying tooth structure. Some users attempt to file down their teeth to fit these veneers, which significantly increases the risk of sensitivity and decay. Unlike over-the-counter kits, profes-
sional veneers involve detailed planning, including radiographs, impressions and customization to suit each patient’s mouth. This ensures not only a beautiful smile, but also a healthy one.
Social Media–Sponsored Toothpaste
Scrolling through Instagram or TikTok, it’s easy to be lured by influencers promoting pricey, esthetically pleasing toothpaste brands.2 These products often claim to offer superior whitening, enamel strengthening or sensitivity relief. However, independent studies and dental experts have found that many of these costly pastes offer no additional benefits compared with standard fluoride toothpaste.3 In some cases, they may even be harmful. Certain formulations include intense abrasives or unregulated ingredients that can irritate the gums or weaken enamel. Furthermore, the marketing around these toothpastes can be misleading. Just because a toothpaste is endorsed by a celebrity or social media personality doesn’t mean it’s been clinically tested or approved by dental associations. Consumers end up paying more for style than substance. For effective daily care, a simple ADAapproved fluoride toothpaste used with a soft-bristled toothbrush twice a day is more than sufficient.
‘Natural’ Toothpastes
The trend toward “all-natural” products has extended into oral care, with many social media posts touting the benefits of herbal toothpastes, baking soda mixtures and other homemade remedies. While the idea of avoiding synthetic chemicals may seem appealing, natural doesn’t always mean safe. Many of these alternatives lack fluoride, which remains one of the most critical ingredients in preventing tooth decay. Additionally, unregulated abrasives like baking soda or sea salt can erode enamel when used frequently or improperly. Some natural ingredients can also trigger allergic reactions or cause gum irritation in sensitive individuals. Unlike regulated dental products, these natural mixtures are not tested for safety or efficacy. It is important to remember that the mouth is a delicate environment requiring balanced care. Opting for reputable, fluoride-based toothpaste brands that have passed clinical evaluations is a far better route for maintaining long-term oral health.
Long-Term Use of Over-the-Counter Nightguards
Many patients suffering from bruxism turn to over-the-counter (OTC) nightguards available at pharmacies. These boil-and-bite guards are widely promoted on social media as affordable
alternatives to custom-made ones from the dentist. While OTC guards may offer short-term relief, they are not designed for long-term use. These products typically do not fit well, leading to uneven pressure distribution, which can exacerbate jaw pain and even misalign the bite. Additionally, the materials used in these generic guards are less durable, often wearing out in just a few months. Hygiene is another major concern, as soft OTC guards can be difficult to clean thoroughly and can harbor bacteria. Perhaps most critically, using an OTC guard masks the symptoms without addressing the underlying cause of the teeth grinding, such as stress, sleep disorders or alignment issues. Custom-fabricated nightguards from a dentist are molded to patients’ teeth, offering superior comfort, protection and longevity. They also allow a dentist to monitor changes and adjust treatment as needed.
DIY Bonding
Some social media influencers have begun promoting DIY toothbonding kits to repair chips or close gaps. These kits typically include a resin material and basic application tools, claiming you can perform cosmetic dentistry from home. Unfortunately, the risks far outweigh the benefits. The resins used in these kits are not as strong or long-lasting as professional materials. More importantly, most users lack the training to properly prepare the tooth surface, apply the bonding agent evenly or polish the final result. The outcome is often unsightly, uneven and structurally weak. Improper application can trap food particles and bacteria, leading to decay or gum inflammation. Furthermore, attempting to remove or redo the bonding at home may result in damage to the tooth enamel. In contrast, professional bonding performed by a dentist involves careful surface preparation, precise resin sculpting and thorough curing, ensuring both esthetic appeal and functional durability.
Oil-Pulling
Oil-pulling is a trend rooted in ancient Ayurvedic medicine that has found new life on platforms like TikTok. The practice involves swishing oil — typically coconut or sesame — in the mouth for 10 to 20 minutes to “pull out” toxins and bacteria. Enthusiasts claim it whitens teeth, reduces plaque and improves overall oral health. While limited studies suggest oil-pulling may reduce certain
types of oral bacteria, the evidence is neither robust nor conclusive.4 Moreover, oil-pulling should never replace brushing and flossing. It does not remove plaque effectively and lacks fluoride, which is crucial for cavity prevention. The extended swishing time also poses a choking hazard or risk of aspiration, especially for children or individuals with swallowing difficulties. For those who enjoy oil-pulling, it may be used as a supplemental practice, but it should not be viewed as a substitute for traditional dental hygiene methods.
Final Word: Your Smile Isn’t a TikTok Trend
The allure of viral dental hacks is understandable: cheaper, faster and seemingly convenient. But professional dental care is irreplaceable. It’s not just about esthetics — it’s about long-term health. These social media trends often provide superficial solutions while masking underlying problems. Enamel once lost cannot be regained. Infections can become systemic. And untreated dental issues can lead to expensive and invasive treatments down the line. What should patients do instead? Visit their dentist regularly for professional cleanings, evaluations and personalized care. Ask providers about safe whitening options, nightguards and cosmetic procedures. Stick to tried-and-true practices like brushing twice a day with fluoride toothpaste, flossing daily and maintaining a balanced diet. And, most importantly, be skeptical of anything that promises too much with too little effort. Your oral health is too important to be left to trends. Trust professionals, not influencers. Smiles are investments, not fads. Protect them wisely. ♦
Eric G. Jackson, DDS, MAGD, FICOI, FASD, FICD, FADI, owns and operates Jackson Family Dentistry in Downers Grove, Illinois. To comment on this article, email impact@agd.org
References
1. Tomás, D.B.M., M.P. Pecci-Lloret and J Guerrero-Gironés. “Effectiveness and Abrasiveness of Activated Charcoal as a Whitening Agent: A Systematic Review of In Vitro Studies.” Annals of Anatomy, Jan. 2023, vol. 245, no. 151998.
2. Al-Khalifa, Khalifa S., et al. “Instagram's Impact on Dental Consumers: Analyzing Toothpaste Hashtags.” Frontiers in Oral Health, 7 Jan. 2025, vol. 5, no. 1420500.
3. Marinho, Valeria C.C., et al. “One Topical Fluoride (Toothpastes, or Mouthrinses, or Gels, or Varnishes) Versus Another for Preventing Dental Caries in Children and Adolescents.” Cochrane Database Systematic Reviews, 26 Jan. 2004, no. 1, p. CD002780.
4. Peng, Tzu-Rong, et al. “Effectiveness of Oil Pulling for Improving Oral Health: A Meta-Analysis.” Healthcare (Basel), 11 Oct. 2022, vol. 10, no. 10, p. 1991.
The Premier Meeting for General Dentists Goes to Canada A Recap of AGD2025 in Montréal
This past summer, AGD took its annual scientific session north for the first time in two decades to historic Montréal, Quebec, July 9–12. Hosted at the internationally renowned Palais des congrès de Montréal in downtown Montréal, AGD2025 offered attendees a wealth of activities, from cutting-edge education with a focus on hands-on learning to exciting and unique learning activities to a host of world-class restaurants and entertainment options around the city.
This year, AGD’s scientific session focused on taking its established foundation of high-quality continuing education (CE) and kicking things up a notch to create a spectacular experience for attendees. From the glitz and glamour of the President’s Reception, AGD Carnivale and Convocation Celebration to the more casual
fun of daily virtual golf challenges in the Exhibit Hall, New Dentist Lounge networking events, and a return of Scoops and Scores, AGD2025 elevated the typical meeting experience to one that blended equal parts work and fun for a truly rewarding experience.
“When we planned AGD2025, our goal was to bring back the fun and create an enjoyable event for both attendees and their families,” said AGD President Chethan Chetty, DDS, MAGD. “We wanted to highlight the AGD culture and reinforce the importance of our community and members.”
AGD will continue raising the bar for its annual scientific session at AGD2026 at Caesars Palace in Las Vegas. We hope to see you there!
Meet us for AGD2026 agd2026.org
June 24-27, 2026, in Las Vegas!
AGD2025 Perspectives: Bruce L. Cassis, DDS, MAGD, AGD associate editor
Bonjour! Montréal a été l’une des meilleures sessions scientifiques AGD de tous les temps! (Good day! Montréal was one of the best AGD scientific sessions ever!)
The scientific session and Montréal produced an energy that was palpable and vibrant. It was a special treat to see the distinction between the modern architecture of new Montréal and the European flair of old Montréal. I was able to see the city on a four-hour bus tour with some special friends, and we were not disappointed. Montréal is steeped in history, from its formation in the 1600s to the present day, and is named after Mount Royal, three hills near the center of the city. Much of old Montréal is reminiscent of being in Europe, with its magnificent cathedrals and cobblestone streets lined with small shops and cafes. An underground city with walkways spanning about 20 miles is used extensively in the winter to keep commerce moving, as snow totals reach 7 feet, but it’s also useful for getting out of the summer heat. One of the highlights of any meeting is the cuisine, and Montréal’s offerings were outstanding. French-influenced eateries were plentiful and within walking distance of the hotel, which was across the street from the convention center. My two most memorable dinners were at Holder — French cuisine at its best — and Portus, a Portuguese-influenced European-style restaurant with a 360-degree view of the city.
The courses at AGD2025 were outstanding for those seeking to increase their knowledge and skills. Many of the hands-on courses
were sold out, which speaks to which types of CE are in highest demand for dentists. I spoke with course instructors and attendees and found a high satisfaction with the blend of lecture-based and hands-on choices. A new feature — the wellness lecture series — was well received. The Learning Labs available in the Exhibit Hall showed a good variety of topics, and attendance was very good. This was one of the busiest Exhibit Halls I can recall in recent scientific session history, with new and established vendors as well as activities, including food service and virtual golf, designed to benefit our members.
The President’s Reception and AGD Carnivale were both exceptional, complete with acrobatic artists, music, and food and beverage service. Both events were well attended and kicked the meeting off on a festive note. Meanwhile, Convocation continues to be the pinnacle of our scientific sessions, where awardees are recognized for their accomplishments. Nearly 360 doctors received their vetted awards this year: 218 new Fellows, 75 new Masters, and 39 Lifelong Learning and Service Recognition recipients. Newly American Board of General Dentists–certified members were also recognized, and Jane F. Martone, DDS, MAGD, was presented with the Thaddeus V. Weclew Award for her outstanding contributions to dentistry.
We owe a debt of gratitude and praise to our team in Chicago for their work in making this session magnificent!
Au revoir pour l’instant, Montréal! (Bye for now, Montréal!) See you all in Vegas next year!
As chair of the Local Advisory Committee (LAC) and a member of the Scientific Meeting Council (SMC), I was privileged to help bring the recent AGD gathering to life in Montréal. Hosting this event in Canada for the first time in two decades was a milestone, and it was especially meaningful to welcome colleagues to my hometown. I am thrilled to reflect on the success and highlights of this extraordinary event.
Planning began more than two years ago, with AGD staff, the SMC and the LAC meeting regularly and engaging in in-person and monthly virtual sessions to ensure every detail was thoughtfully prepared. The dedication of this team resulted in a seamless experience from start to finish. We were also fortunate to have the support of the local Canadian dentists, McGill University faculty members and dental students who volunteered during the AGD oral cancer screening, reflecting the generosity and collegial spirit that define our profession.
AGD2025 was a showcase of excellence, featuring worldrenowned speakers whose expertise and invaluable insights left attendees energized and motivated to advance their professional growth. Equally inspiring was the research presented by dental students. Their e-poster presentations were carefully evaluated and judged by the SMC, who selected winners in various categories. The work showcased fresh thinking and innovative approaches that will contribute to the advancement of our field.
We also broke with tradition this year, under the leadership of
President Chetty, by embracing Montréal’s creative spirit with a carnival-themed party inspired by Cirque du Soleil. AGD Carnivale was a resounding success. It was an evening of fun, connection and celebration, offering attendees an unforgettable and immersive experience that reflected the vibrant culture of our host city.
The Convocation Ceremony remains, for me, the most moving part of each scientific session. It celebrates the dedication, perseverance and pursuit of excellence exemplified by our FAGD, MAGD and LLSR recipients. It was a privilege for me to lead the procession as LAC chair alongside our honorable dignitaries, which included past, present and future presidents; officers; and flag bearers. Receiving my second LLSR in my hometown — in the presence of my family, staff, mentor and friends, many of whom were also recognized — was profoundly meaningful. I celebrate and congratulate all the recipients of this year’s awards.
Our time together in Montréal reminded me that dentistry is not only a profession, but also a community bound by shared purpose, mutual respect and the relentless pursuit of excellence. Looking ahead, we eagerly anticipate welcoming you to Las Vegas next year for another enriching and memorable experience.
I am deeply grateful to all those who contributed to the tremendous success of the AGD2025 annual scientific session in Montréal, with special acknowledgement to my dedicated LAC, to Canadian leaders for their unwavering support, and to my SMC co-chairs for their exceptional leadership and collaboration. I look forward to standing alongside you at the next meeting as we write the next chapter of this journey.
Refer a Colleague, Get Rewarded
AGD Referral Rewards Program
Refer your colleagues to join AGD now for 2026 and they’ll get the rest of 2025 free.
You’ll both also earn $50 in Referral Rewards once they join!
Learn More agd.org/refer
“AGD has been pivotal in shaping my career through its quality education and relationships among the members. I wouldn’t be where I am today without AGD!”
