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Exploring
By Wesley W. Lyon II, CPA, CFP
President Donald Trump signed the One Big Beautiful Bill Act into law July 4. With that in mind, learn about the tax law changes most likely to impact dentists.
By Carrie Pallardy
Dentists lead full, busy professional lives. When you dedicate your days to patient care and practice management, it can be hard to leave your work chairside and in the office. The boundaries between the personal and the professional can quickly blur. How much overlap is too much? The answer to that question is highly individual.
Whiskey and Dentistry
So many different types of whiskeys exist, and they can be drastically different — just like dentists. Flavors, proofs and colors all vary, and distillery location determines a lot. In the United States, the maximum legal whiskey strength is 160 proof. At a minimum, it must be 80 proof. It is aged for two years in new, charred barrels and has no additives. But there are also different types of whiskey, including bourbon whiskey, which is 51% corn, and rye whiskey, which is 51% rye. Scottish whisky (note that the “e” is dropped) is made from malt. If Scottish or Irish, blended whisky is aged for at least three years.
Distillers must follow many rules. Tennessee whiskey, a style of bourbon, uses sugar maple charcoal in the filtering process. Irish whiskey is lighter, malt-heavy and less smokey than Scotch. Different Scotches taste different depending on aging, the type of barrel they’re aged in and the grains they’re made from.
So what does all of this have to do with dentistry? Each dentist goes through rigorous training at a recognized dental school. Specific restraints are put on the education dependent on the school and the way competency is determined. Upon graduation, we are all dentists in name, just like whiskeys. However, we all practice a bit differently. When I finished dental school, I did a general practice residency, then associated for five years before building my own practice. Some of us went into specialty programs or teaching.
Today, there is an even wider variety of ways graduated dentists practice their trade. Solo practices are viable options, as are smalland large-group practices. Dental services organizations provide an opportunity for recent graduates to gain valuable clinical experience,
and ownership or ownership paths are available. Academia, traveling dentistry and military dentistry are all valid options. None are better or worse; rather, they need to fit the lifestyle and desires of the individual.
However, unlike whiskeys, we dentists can transcend our training and better ourselves. As time passes, our desires and motivations may change. We may find a better fit (or taste). Some offices create a boutique environment, like small-batch alcohol. Others blend or create a larger environment. As wonderful as it is, a Scotch will always be a Scotch. But a dentist can reinvent themselves three or four times (or more) throughout a career.
Whiskeys are precisely made to be called what they are and developed by master distillers. Dentists too are incredibly trained and hone their skills through trial and error with the help of master mentors. There is no replacement for experience — both whiskeys and dentists are better when aged properly. And dentistry and distilling both require equal parts of science and art.
Dentistry and whiskey may seem worlds apart, but each one — through care, expertise and a little bit of magic — has a way of making life just a bit smoother. Sitting back and enjoying the fruits of our labor, knowing that we did our best each day, is like relaxing and imbibing a bit of the spirit of your choice.
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.
POSTMASTER: Send address changes to AGD Impact 560 W. Lake St., Sixth Floor, Chicago, IL 60661-6600. No portion of AGD Impact may be reproduced in any form without prior written permission from the AGD. Photocopying Information: The Item-Fee Code for this publication indicates that authorization to photocopy items for internal or personal use is granted by the copyright holder for libraries and other users registered with the Copyright Clearance Center (CCC). The appropriate remittance of $3 per article/10¢ per page is paid directly to the CCC, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA. The copyright owner’s consent does not extend to copying for general distribution, for promotion, for creating new works, or for re-sale. Specific written permission must be obtained from the publisher for such copying. The Item-Fee Code for this publication is 0194-729X. Printed in U.S.A. © Copyright 2025, Academy of General Dentistry, Chicago, IL.
AGD Corporate Sponsors
Dental Practice Advocacy
Dental Practice Council Member Attends Academy of Dental Safety Annual Meeting
By Jennifer Clemmons, AGD manager, Dental Practice
John Gammichia, DMD, FAGD, member of the AGD’s Dental Practice Council, attended the Academy of Dental Safety (ADS) Annual Meeting in May 2025, an event focused on infection prevention and patient safety in dentistry. The meeting brought together professionals from dental support organizations, academia and public health, offering in-depth updates on emerging issues in infection control, occupational safety and clinical best practices.
The program featured keynote lectures and breakout sessions on topics including:
• Emerging infectious diseases.
• Workplace safety and wellness.
• Dental waterline management.
• Medical emergencies and antibiotic stewardship.
• Safety in private practice as well as 3D-printing hazards.
Gammichia attended multiple sessions and participated in a VIP event, where he engaged with ADS Executive Director Michelle Lee and board members. These discussions provided insight into ADS’s initiatives and its primary audiences.
He observed that while the annual meeting is geared toward experienced professionals, ADS also offers a “boot camp” program — a foundational, Centers for Disease Control and Prevention–and Occupational Safety and Health Administration–based course ideal for general dental practices and newcomers to infection control.
The ADS’s mission closely aligns with AGD’s commitment to evidence-based education and professional development, and it continues to be a trusted partner to general dentists in promoting dental safety.
Dental Quality Alliance Meeting Advances Oral Health Quality Measures with Strong AGD Representation
By Jennifer Clemmons, AGD manager, Dental Practice
The Dental Quality Alliance (DQA) was established in 2010 by the American Dental Association to develop standardized performance measures for oral healthcare. The DQA meets biannually and is comprised of 23 voting member organizations. AGD is actively represented by Ralph A. Cooley, DDS, FAGD, who served as chair from 2022 to 2023. In addition to its voting role, AGD holds seats on both the 11-member Executive Committee and the Education Committee.
The DQA is responsible for identifying and creating performance measures to evaluate the quality of oral healthcare. During the most recent meeting, the following actions were taken:
• 2025 Annual Measure Review Report: Approved.
• 2026 Pediatric and Adult User Guides: Approved.
• Oral Evaluation After Problem-Focused Episodic Care: Approved for public comment.
• Report 6: Topical Fluoride for Children: Approved for publication.
• Report 7: Sealant Receipt on Permanent First Molars: Approved for publication.
• Topical Fluoride for Adults at Elevated Caries Risk: Approved for public comment (contingent).
• Sealant Receipt on Permanent Second Molars: Approved for public comment (contingent).
During the meeting, Natalia Chalmers, DDS, MHSc, PhD, chief dental officer at the Centers for Medicare and Medicaid Services,
addressed the group, citing data showing oral disease is the second highest healthcare expense after diabetes. She emphasized the growing use of DQA metrics in informing national oral health policy and advancing access and equity in care.
A panel of speakers from health centers, dental services organizations and group practices also discussed the evolving landscape of quality measurement and highlighted how dental quality metrics are being used in clinical practice to improve care delivery.
A demonstration was given of the DQA’s interactive dashboard that analyzes data from state Medicaid programs to assess oral healthcare quality nationwide. These tools help identify areas for improvement and inform policy decisions. You can access the dashboard here: ada.org/resources/research/ dental-quality-alliance/dqa-improvement-initiatives
AGD’s involvement with the DQA helps ensure that quality measures truly reflect improved patient care and support providers. Our participation also gives us a direct voice in evaluating measures proposed by third-party payers. AGD’s contributions were recognized in both sessions for our consistent engagement, timely feedback and responsiveness in the measure development process.
The next DQA meeting is scheduled for Nov. 13–14, 2025, in Chicago. Those interested in becoming involved can email practicemanagement@agd.org for more information.
Governance
Proposal to Amend the Bylaws
There are four proposals to amend the AGD Bylaws at the 2025 House of Delegates (HOD) meeting Nov. 14–16, 2025.
A proposed amendment to Chapter IV Special Considerations would update the recent graduates’ language to include postdoctoral training.
A second proposed amendment would create a Minutes Approval Committee to review and approve the minutes for the HOD. The creation of this committee would expedite the approval of the minutes.
A third proposed amendment would transfer the selection of the parliamentarian from the president to the speaker of the HOD.
A fourth proposed amendment would redefine the allocation of the alternate delegates to the region rather than the constituent. Multistate regions may be able to send fewer people to the HOD, decreasing the travel costs without losing the opportunity for representation.
All Bylaws must be passed by a two-thirds majority of the HOD. The results of these resolutions will be printed in AGD Impact after the HOD annual meeting.
Advocacy
One Big Beautiful Bill Act Passes Without Harmful Pass-Through Entity Tax Change
On July 4, President Trump signed H.R. 1, the One Big Beautiful Bill Act (OBBBA). Sometimes an advocacy victory is what doesn’t end up in a bill. This was the case with a tax provision of the OBBBA.
Many dental and medical practices are constituted as passthrough entities so that business income is taxed at the individual level. When the House of Representatives passed its version of the OBBBA, it eliminated the ability of dental practices to deduct state pass-through entity taxes (PTET) on their federal tax returns. This would increase the tax burden on many dental practices and add to the financial pressures of keeping a practice viable.
AGD joined 31 other medical and dental organizations in a letter to Senate leadership outlining the harm to small businesses and to patients if the PTET deduction was not restored by the Senate. AGD also created an action alert, and AGD members sent almost 1,000 letters to the U.S. Senate. The other organizations involved also generated letters from their members. AGD sent out a press release in which President Chethan Chetty, DDS, MAGD, stated, “This is more than a tax issue — it’s a matter of economic stability. Our members shouldn’t be penalized simply because of how their businesses are structured.”
Our combined advocacy efforts were successful, and the Senatepassed version of the bill restored the existing PTET deduction. The bill contains other provisions on student loans that we were not as successful in altering, but AGD — and all of organized dentistry and medicine — can be proud of the win on PTET.
Letters to the Editor
On “The Role of Compassion in Healthcare” by Maggie Augustyn, DDS, FAGD, in AGD Impact, October 2024
I was finally able to read Dr. Augustyn’s wonderful article on compassion. I agree with her 100%, as I adopted that style of treating patients early in my career 50 years ago.
I am now doing only volunteer mission projects both in California and internationally. Years ago, I discovered a remedy for burnout that has to do with compassion. I recommend that colleagues experiencing burnout accompany me on a weekend or weeklong mission trip to cure their burnout. With the alteration in priorities that occurs when helping people that need it desperately, I have never had a case where my colleague did not return to work refreshed, with new priorities and the burnout gone.
Helping others and showing compassion is healing for the healer. I recommend it to anyone feeling burned out.
I think we need more articles on this topic for our colleagues.
Ronald E. Fritz, DDS, MPH, FAGD (emeritus member) Escondido, California, and Puerto Escondido, Oaxaca
On “A Struggle for Perfection: Embracing Our Human Side” by Maggie Augustyn, DDS, FAGD, in AGD Impact, June 2025
The article in the June issue of AGD Impact by Dr. Augustyn regarding perfection in dentistry is spot on. The topic is so important and has been often overlooked or just plain ignored in dentistry. Addressing this mental wear and tear is often called a “soft skill,” implying it’s simple, easy or unimportant — and this attitude is the cause of much suffering in healthcare in general and dentistry specifically.
And I would suggest Dr. Augustyn’s dive may not go far enough. There is no “perfection.” That should be taught from Day 1, but it is not. Restorations or periodontal treatments are not a cure — they are our best efforts at making a declining situation somewhat better or perhaps just delaying the inevitable decline. But, make no mistake: It’s not a cure. The dumbest tooth is smarter than the smartest dentist. It knows more about being a tooth than any dentist can ever know. And we make this effort while confined to a tiny room for eight hours or more a day, often working upside down and backward in an environment just short of a waterfall, around a moving tongue and on people who are often anxious, scared and do not want to be there. It often strikes me as a minor miracle that what we do works at all or as often as it does.
To dig deeper, today’s healthcare world has a real and not pleasant problem with “moral injury.” Moral injury is the stress we all feel inside from the conflict that comes from knowing the treatments we can do that are the better choices and that we’ve been educated and trained to do, yet, in the real world, we often cannot do because of financial, institutional or insurance barriers. We are constantly making difficult decisions by prioritizing the often limited resources of our patients, and, unfortunately, we dentists are not very well equipped mentally to manage this. Additionally, we often see “ideal” dentistry in magazines and journals, not considering that the clinician may have taken all day and a hundred different photographs just to
get the “perfect” shot or that the ceramic case had three different versions of shade and shape done in order to achieve the pictured result. We also do not know if the patient might have been given the treatment at no cost, eliminating the financial barrier. In the real world, no industry or profession has unlimited financial resources, and choices have to be made in planning and treatment.
These compromises themselves are not the entire issue; the issue more so is that we are not trained or educated to deal with that psychology, so we are left thinking we are less, we are inadequate and we are persistently flawed, even when we try our best given the constraints we face. That leads to much individual suffering. I think our profession can do better, and I remain cautiously hopeful it will.
Tim L. Goodheart, DDS,
MBA, FAGD Raytown, Missouri
Awards
AGD Impact Honored by ICD with Two Publications Awards
We are proud to announce that AGD Impact has been recognized by the International College of Dentists (ICD) in its 2025 Publication Awards.
Humanitarian Award
AGD Impact received the Humanitarian Award for Best Article or Series of Articles Highlighting Dental Humanitarian Service.
• April 2024, p. 11: “2023 Humanitarian Award Winner Dedicates His Life’s Volunteerism to One Region” by Caitlin Davis.
This recognition highlights the power of storytelling by showcasing the meaningful service and dedication of AGD members around the world. We are especially proud to receive this honor because not only does it honor AGD’s own 2023 Humanitarian Award winner, Dr. Michael Lacey, but his profile was written by AGD Impact Associate Editor Caitlin Davis.
Golden Pen Honorable Mention
In addition, AGD Impact earned an Honorable Mention for the Golden Pen Award, recognizing excellence in articles of current importance to the dental profession.
• October 2024, p. 10: “The Role of Compassion in Healthcare” by Maggie Augustyn, DDS, FAGD.
This recognition highlights how knowing more about patients and relating to them on a universal level can open a window into understanding why they get sick and how dentists’ proposed treatment can best be presented.
We extend our congratulations to our editorial team and contributors for their outstanding work and commitment to journalistic excellence in dentistry.
Upcoming
This Month’s CE Opportunities
Sept. 2: “Newer Strategies for Non-Opioid Management of Acute Postoperative Pain” with Arthur H. Jeske, PhD, DMD.
Sept. 9: “Finding Dangerous Mucosa: Identifying Potentially Premalignant and Malignant Lesions” with Tanya Marie Gibson, DDS.
Sept. 10: “ADHA Collaboration: Leadership to Discuss Lack of Jobs for Hygienists.”
Sept. 25: “Predictable Implantology in Your Daily Practice” with Marcus Cowan, DMD, FICOI, AFAAID.
Register for these webinars and more at agd.org/education/learn
Refusing the Red-Flag Patient — When Substance Use Complicates Treatment
By Jake Kathleen Marcus, Esq.
An AGD member recently wrote seeking guidance about managing a patient who arrived at his office apparently impaired. According to the dentist:
The patient has come to the practice for appointments while intoxicated and occasionally reeks of alcohol. At her last appointment, she admitted to taking tranquilizers before coming in.
Because the patient drives herself to and from appointments, I am concerned that she might harm herself or someone else.
How should I proceed?
Given the prevalence of substance use and abuse, this is a scenario that will likely happen to most dentists, and it presents legal, ethical and practical challenges.
Legal Considerations
Perhaps the most basic legal issue concerning patients impaired by drugs or alcohol is that they cannot provide valid informed consent. Any treatment performed therefore fails to meet the standard of care and exposes the dentist to malpractice action and dental board sanction.
From a medical standpoint, an impaired patient may have:
• Altered vital signs.
• Unpredictable drug interactions.
• Decreased pain tolerance or responsiveness.
• Complications due to drug interactions with local anesthetics or sedatives.
• Inability to follow postop instructions.
Treating an impaired patient therefore increases the risk of complications such as drug interactions, adverse reactions and aspiration. A poor clinical outcome may be deemed foreseeable and preventable, and therefore negligent, resulting in civil liability, disciplinary action by the state dental board or increased malpractice insurance costs.
However, if the patient requires emergency care (e.g., uncontrolled bleeding, infection or trauma), the dentist is ethically bound to perform limited treatment, which is a defense against civil or dental board action. The nonelective treatment should:
• Stabilize or provide minimal necessary treatment.
• Avoid medications that could interact with suspected drugs.
• Consider referring to a hospital or emergency clinic if impairment is severe.
Whether a procedure is emergent or elective, a dentist is potentially liable for both the danger a substance-impaired patient poses
to themselves and others. If an impaired patient injures either themselves or others after leaving the practice — for example, driving under the influence — the dentist could face third-party liability if they (1) were aware of the impairment and (2) took no reasonable steps to prevent foreseeable harm. For these reasons, performing an elective procedure on a substance-impaired patient violates the standard of care.
Ethical Considerations
A dentist can and should refuse to serve a patient under certain conditions, provided that the refusal does not violate the standard of care, dental regulations or professional ethical obligations. The American Dental Association (ADA) does not have a statement directly addressing treating patients impaired by drugs or alcohol. However, there is related guidance within the ADA Principles of Ethics and Code of Professional Conduct (ADA Code). Section 4.A. of the ADA Code, “Patient Selection,” states:
While dentists, in serving the public, may exercise reasonable discretion in selecting patients for their practices, dentists shall not refuse to accept patients into their practice or deny dental service to patients because of the patient’s race, creed, color, gender, sexual orientation, gender identity, national origin or disability.
But what is “reasonable discretion”? Section 4.B. of the ADA Code provides that a dentist may not refuse care to a patient when the situation is urgent or life-threatening. Therefore, the governing ethical considerations are the same as those governing the treatment of patients who are not on drugs or alcohol.
The ADA Code sets forth ethical principles governing dentists’ conduct that can be applied when considering treating substanceimpaired patients:
1. Patient Autonomy. (Self-governance.)
• Can a patient provide informed consent when substance-impaired?
2. Nonmaleficence. (Do no Harm.)
• Are you performing a harmful or unduly risky procedure when your patient is substance-impaired?
• Is a substance-impaired patient leaving your office potentially harmful to themselves or others?
Practical Consideration
If a dental patient arrives at an appointment apparently under the influence of illegal substances, misused prescription medications or alcohol, the dentist has both legal and ethical obligations to manage the situation safely and professionally. Even if, as in the situation presented in the member’s email above, the patient admits to being under the influence, the dentist cannot determine with certainty whether the patient is accurately reporting what they have consumed.
In such a situation, the dentist should assess the situation immediately by:
• Observing signs of impairment like slurred speech, unsteady gait, dilated pupils, confusion, aggression or unusual behavior.
• Determining the severity of the impairment by taking into account the patient’s coherency, whether they can give informed consent, and whether they are a danger to themselves or others.
If you determine the patient is impaired, calmly inform them that treatment must be rescheduled due to safety and legal concerns. The patient can be offered a new appointment with instruction that they will only be treated if they are sober. If the patient is belligerent, de-escalate, and safely involve a witness such as your office manager or another staff member.
In order to further ensure the patient’s safety and shield yourself from liability, do not allow them to drive. Offer to call a friend, family member or rideshare service. If the patient insists on driving, you should:
• Advise against it verbally, and document that you did so.
• Notify police if there is an imminent threat to public safety.
• If impairment puts a child at risk — for example, the patient is an impaired parent or guardian — consider a report to Child Protective Services, which, depending on your state, may be legally mandated.
While calling the police to report a patient leaving your office may seem like an extreme measure, the risks to the patient and to others on the road justify the call. You are potentially liable for any injury to a person or property caused by the impaired patient driving from your practice.
Finally, it is critical that illicit drug or alcohol use by a patient and any actions taken should be fully documented in the patient’s chart including:
• Observed signs of intoxication.
• Rationale for postponing or modifying treatment.
• Any conversations with the patient or companions.
• Any referrals or instructions given.
Additional risk management tips regarding patients impaired by illicit drugs or alcohol include:
• A written office policy for managing impaired patients.
• Training staff on how to recognize and respond to drug impairment.
Finally, remember that many people are prescribed anxiolytic or tranquilizing medications for a variety of medical conditions. Dental procedures can be triggering for patients who have experienced trauma, and they may take these properly prescribed medications to self-manage the anxiety. A comprehensive intake form for each patient that documents both legal and illegal drug and alcohol use as well as dental anxiety history can assist in a transparent exchange of information between dentist and patient. But, ultimately, dentists can and should refuse to perform elective procedures on patients impaired by drugs or alcohol. ♦
Jake Kathleen Marcus, Esq., has been an attorney primarily in the healthcare space for over 35 years. She owns Marcus Law in Pennsylvania, representing businesses and individuals with counsel and in litigation. To comment on this article, email impact@agd.org.
The Ethics of Well-Being — A Reimagined Professionalism
By Carlos Stringer Smith, DDS, MDiv, FACD
This column is a collaboration between AGD and the American College of Dentists.
Modern dental practice is quite literally evolving day by day. Advances in technology that include the daily integration of artificial intelligence, robotics and even virtual reality are making their way from lofty dreams to everyday realities and even articulated patient expectations. Likewise, the options for modality of practice are also expanding to include the ever-growing field of hedge funds and private equity firms acquiring, opening and operating practices. As dentists, we have an obligation to keep up not only with the newest technologies or practice opportunities, but also with the dynamic and ever-evolving definitions of the core principles that lay the foundation of our profession.
Ethical conduct toward patients and the care of patients has been prioritized throughout the history of the profession, even if healthy debate remains about the exact way in which dentistry — both as a collective and among individual providers — has upheld core principles of ethics such as autonomy, beneficence, nonmaleficence, veracity and justice. While patient care and societal trust must remain paramount, an often-overlooked aspect of ethical and professional duty is the actual well-being of dentists themselves.
The National Academy of Medicine launched the Action Collaborative on Clinician Well-Being and Resilience in 2017. Committed to reversing trends in clinician burnout, the collaborative has three goals: raise the visibility of clinician anxiety, burnout, depression, stress and suicide; improve baseline understanding of challenges to clinician well-being; and advance evidence-based, multidisciplinary solutions to improve patient care by caring for the caregiver.1
Self-Care Leads to More Care
The notion of self-care is nothing new. In the words of my recently deceased 106-year-old clergy grandmother: “You can’t pour from an empty vessel.” Even more colloquially, one may often hear “don’t burn the candle at both ends.” And across social media, there are clarion calls to check on your “strong friends.” All of these communicate the centrality of not merely practicing self-care as a provider, but also extending beyond self-care to cultivating and fostering environments that prioritize well-being and self-care across the oral health team. To be clear, self-care and well-being — while both important — are different, yet interrelated, domains. Self-care refers to the intentional daily actions individuals take to maintain their physical, emotional and mental health, while overall well-being encompasses the broader, sustained state of balance
and fulfillment across personal and professional domains.2 For healthcare providers, prioritizing well-being is not just a personal necessity, but a professional imperative — serving as a cornerstone for ethical, compassionate care and ensuring they can show up fully present, resilient and responsive to their patients’ diverse needs. This professional imperative, grounded in key principles of healthcare and bioethics, calls for a reimagination of how dentistry defines and understands professionalism, in particular its relationship to well-being.
Scholars across various health professions have called for a reimagination of professionalism.3-6 “Key to that reframing is an expansion of previous definitions to allow for intervention mechanisms, systems and practices — not simply refraining from doing harm but actively interfering or taking action if wrong is being witnessed.”6 Thus, if one thinks of professionalism as grounded in nonmaleficence, or to do no harm, that reduction of harm is not only applied to the patients served but also the team members and colleagues by which such service is carried out.
Even further, scholars have called for an expansion of beneficence beyond merely doing good, expanding the definition of doing good as specific intentionality to benefit patients, promote their welfare and remove conditions that cause harm.7 This connects back to the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience, where optimal patient care is laid bare as clearly hinging upon the clinician-patient relationship, which in turn is only optimized if clinician well-being is centered.
Removing conditions that harm patients would include healthcare systems (and dental practices) that do not prioritize the well-being of their provider workforce. To be clear, dentists have a professional duty to care for patients, themselves and even their teams.
Within dental education, both domestically and abroad, expected competencies of dental practitioners have emphasized the professional importance of managing personal and interpersonal well-being across the dental team.8 Furthermore, U.S. dental accreditation requires that “graduates must be competent in applying the basic principles and philosophies of practice management, models of oral health care delivery, and how to function successfully as the leader of the oral health care team.”9 There is no successful leadership of the oral healthcare team without incorporating well-being as key to ethical foundation, patient care and, yes, practice management. While many see calls for an ethics of well-being and a reimagined notion of professionalism as merely theoretical academic pursuits, there are several practical and actionable steps many across the oral health professions can undertake.
Well-Being Strategies and Team Dynamics
Perhaps time can be made for scheduled self-reflection and decompression. Allocate time for mindfulness, journaling or brief restorative breaks during clinical hours to reduce burnout and enhance emotional regulation. Dentistry can and should normalize humane pacing and work-life harmony by reevaluating appointment templates and time expectations. Encourage regular check-ins, and normalize professional counseling or coaching for emotional resilience. Mutual well-being fuels psychological safety — when all team members feel respected, supported, and free to express concerns or vulnerabilities, collaboration thrives, and error rates drop.10 Teams grounded in well-being show higher trust, reduced absenteeism and greater accountability — key markers for equitable care delivery.11 Even in daily huddles, every team member — from assistants to interpreters — should be able to voice challenges or insights without fear of reprisal.
Leadership and Management Styles
Leaders who model transparent communication, emotional intelligence and humility set the tone for a culture of care for all, not tyrant control and authoritarianism. Transformational leadership, which uplifts every team member’s voice and value, especially fosters inclusion and counters othering.12 Compassionate and equity-minded management creates space for processing trauma, acknowledging identity-based harm and ensuring that wellbeing isn’t merely reserved for those at the top of the hierarchy. Leadership must entail self-reflection and cultural humility.
Sexual Harassment and Safety Policies
Policies on sexual harassment are foundational to well-being — they are not just legal protections but ethical imperatives that defend team cohesion, personal dignity and trust.13 When these policies are paired with active bystander training, reporting pathways and trauma-informed responses, they protect both historically marginalized team members and patients, who disproportionately experience such harm.14,15
Creating Spaces That Heal
At the end of the day, dentists are more than talented and astute tooth technicians. They are full doctors, healers and physicians of the oral cavity (really of the entire head and neck). Practices must embed well-being as a collective, structural commitment — not just the responsibility of the individual. One can do as much individual yoga as their heart desires, but, if the work environment is toxic, then personal interventions without a corporate or practice responsibility are of little effect. Ensure that policies reflect intersectional realities; what supports well-being for a queer immigrant dental assistant may differ vastly from what’s needed for a white male provider, and both deserve tailored and relevant strategies. Dentistry must recognize that well-being is not just the “soft stuff” — it’s the ethical and operational scaffolding that holds up justice, professionalism and truly humane care. By anchoring well-being as core to ethics and professionalism, clinicians can transcend outdated norms of stoicism and hierarchy to embody a practice rooted in justice, compassion and collective care. In doing so, dentistry not only safeguards the health of its patients, practitioners and team members — it may also more aptly lay claim to a moral authority as a healing profession responsive to the complex humanity it serves. ♦
Carlos Stringer Smith, DDS, MDiv, FACD, is an associate professor and associate dean of ethics and community engagement at the Virginia Commonwealth University School of Dentistry, Richmond, Virginia. An actively practicing general dentist, he is also president of the American Society of Dental Ethics. To comment on this article, email impact@agd.org
References
1. “Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being.” National Academies of Sciences, Engineering, and Medicine, National Academies Press, 2019.
2. Kiefer, R.A. “An Integrative Review of the Concept of Well-Being.” Holistic Nursing Practice, vol. 22, no. 5, 2008, pp. 244-252.
3. Thurston, M.M., and D. Hammer. “Well-Being May Be the Missing Component of Professionalism in Pharmacy Education.” American Journal of Pharmaceutical Education, vol. 86, no. 5, 2022, p. 8808.
4. Smith C.S., S. Razack and P. Reynolds. “Advocating for Diversity, Equity, Inclusion, and Social Justice: A Reimagined Professionalism.” Medical Professionalism: Theory, Education, and Practice, edited by G. Merlo and T.D. Harter, Oxford University Press, 2024.
5. Saeed, S.G., et al. “Prioritizing Well-Being to Advance Dental Education.” Journal of the American College of Dentists, vol. 91, no. 1, 2024, pp. 25-33.
6. Smith, C.S., S.C. Stilianoudakis and C.K. Carrico. “Professionalism and Professional Identity Formation in Dental Students: Revisiting the Professional Role Orientation Inventory (PROI).” Journal of Dental Education, vol. 87, no. 5, 2023, pp. 646-653.
7. Smith, C.S., and L.E. Simon. “To Do Good and Refrain From Harm: Combating Racism as an Ethical and Professional Duty.” The Journal of the American Dental Association, vol. 156, no. 2, 2025, pp. 91-94.
8. Chan, C.C.K., E.H.W. Fok and M.G. Botelho. “An Analysis of Students’ Perceptions of Strategies to Improve Well-Being in Dentistry.” European Journal of Dental Education, vol. 29, no. 2, 2025, pp. 249-265.
9. “Accreditation Standards for Dental Education Programs.” Commission on Dental Accreditation, coda.ada.org/standards. Accessed 7 July 2025.
10. Clarke, E., et al. “Feeling Safe to Speak Up: Leaders Improving Employee Wellbeing Through Psychological Safety.” Economic and Industrial Democracy, vol. 46, no. 1, 2025, pp. 152-176.
11. Hungerford, C., and M. Cleary. “‘High Trust’ and ‘Low Trust’ Workplace Settings: Implications for Our Mental Health and Wellbeing.” Issues in Mental Health Nursing, vol. 42, no. 5, 2021, pp. 506-514.
12. Reina, C.S. Adapting Leader Behaviors to Achieve Follower Effectiveness: A Mindful Approach to Situational Leadership. Arizona State University, PhD dissertation, 2015.
13. Klein, M., and J.A. Gallus. “The Readiness Imperative for Reducing Sexual Violence in the US Armed Forces: Respect and Professionalism as the Foundation for Change.” Military Psychology, vol. 30, no. 3, 2018, pp. 264-269.
14. Raskin, S.E., et al. “Discrimination and Dignity Experiences in Prior Oral Care Visits Predict Racialized Oral Health Inequities Among Nationally Representative US Adults.” Journal of Racial and Ethnic Health Disparities, vol. 11, no. 6, 2024, pp. 3722-3735.
15. Fleming, E., et al. “American Indian/Alaska Native, Black, and Hispanic Dentists’ Experiences of Discrimination.” Journal of Public Health Dentistry, vol. 82, 2022, pp. 46-52.
The Need for Collaboration in Dentistry Today
By Brooklyn Janes
Just a few months ago, the American Dental Association (ADA) urged Nevada lawmakers to advance Senate Bill 495, Sections 77–79, which was a proposal that sparked significant debate across the dental community. 1 The bill would have allowed dentists to train individuals for dental hygiene roles through on-the-job instruction, bypassing Commission on Dental Accreditation- (CODA-) accredited dental hygiene programs altogether.
The ADA supported the bill as a response to Nevada’s pressing hygienist shortage, saying it would help expand access to care. In fact, according to the Assembly Committee on Commerce and Labor, Nevada currently has only about 1,500 licensed dental hygienists, which equates to roughly 45 per 100,000 residents, which is far below the national average of 64 per 100,000.2
However, many professional dental organizations, including AGD and the American Dental Hygienists’ Association (ADHA), opposed the bill.3,4 They argued that undermining CODA’s educational standards could compromise patient safety and erode the integrity of the profession. While the bill ultimately did not pass, its reintroduction remains a real possibility.
Here are a few thoughts about the recent movements and events taking place in the field. The difficulties and problems we face aren’t black and white, and they are very difficult and complex to solve.
Participate in Professional Organizations
Things can change quickly, especially at the legislative level. If you’re not staying informed through your professional organizations or monitoring your state legislature, policy decisions may be made without your input, and they can directly affect your career, scope of practice and patients.
One of the most effective ways to stay informed is to maintain an active membership in your professional organizations. By paying your dues, opening emails and staying engaged, you allow groups like AGD, ADA and ADHA to advocate on your behalf. These organizations act as your voice in legislative matters, but their influence depends on your member participation.
During the S.B. 495 debate, I watched the ADHA emphasize the importance of membership so strongly that it even lowered its dues in hopes of increasing engagement. Unfortunately, membership is declining across many dental organizations, as clinicians often don’t see the immediate value. This bill was a clear example of why membership matters. It affects real policies. It affects you.
Behind the scenes, countless professionals are working hard to protect and advance our field. But they need our support. There is power in numbers, and that power begins with each of us choosing to be engaged.
Friction Between Dentists and Hygienists
Dental insurance reimbursements have remained largely stagnant for decades. This reality often plays a major role in limiting access to preventive care and can also drive a wedge between dentists and dental hygienists. Dentists struggle to keep up with the rising financial demands of running a practice in the face of stagnant reimbursement rates. At the same time, hygienists often feel frustrated by a lack of support and validation from their employers and may feel that they are being pushed out of their line of work. In my experience, this seems to be a common theme I hear from both sides.
As both a dental hygienist and now a new dentist, I feel like I can understand the frustrations on both sides. I empathize with dentists who sometimes have to dip into their own savings just to keep up with rising overhead costs and employee salaries. At the same time, as a hygienist, I understand how it can feel to not be truly seen or heard.
This financial tension often contributes to friction between dentists and hygienists. Some hygienists have started advocating for independent practice models and have even opened their own clinics. While I respect the drive for autonomy and the goal of improving access to care, I’m not convinced this model truly addresses the root issue. Even in their own practices, hygienists will face the same low reimbursement rates and challenges with profitability. The economic realities don’t change just because the setting does.
In my opinion, the solution isn’t to split apart. In fact, if that becomes the direction of dentistry, I believe we will have lost the real battle. Comprehensive healthcare depends on a team that brings multiple perspectives to the table.
Staying Up to Date Pays Off
I do believe dental hygienists bring enormous value to the practice. However, like any part of a healthcare team, there are always opportunities to improve. One area that continues to be overlooked is proper periodontal documentation. Although the new periodontal classification system was created in 2017, many hygienists still aren’t correctly implementing it. I’ve seen periodontal charts that only include 4- or 5-millimeter pocket depths on a few of the teeth, missing other critical diagnostic indicators such as furcation involvement, mobility, clinical attachment loss, bleeding and suppuration. When we skip these important diagnostic assessments, we risk underdiagnosing disease and missing opportunities to provide needed care. If hygienists prioritized complete and accurate charting at least once a year, they would likely uncover more cases of periodontal disease that require treatment. Not only would this improve patient care, but it would also contribute to the department’s financial sustainability.
In addition to accurate diagnoses, preventive services like fluoride treatments for high-caries-risk patients are often underutilized. Many hygienists don’t routinely offer fluoride, sometimes out of concern that the patient might not want to pay for it. One lesson I learned early on is that we cannot project our own financial beliefs onto our patients. Just because a treatment plan feels expensive to us doesn’t mean it isn’t valuable or affordable to someone else. Our responsibility is to educate, offer the appropriate care and let the patient decide.
In my experience, many dental hygienists choose not to stay current with their local anesthesia skills. In most states, that ability to administer local anesthetic adds incredible value to the practice, but, if you aren’t staying current, it’s a lost opportunity to help the office’s profitability. If a patient doesn’t show, are you killing time? Or could you help start anesthesia? Even small things — like helping with sterilization or making sure the patients in the office feel comfortable — don’t show up as billable production, but they absolutely add value by making the office run more smoothly and supporting the rest of the team.
Consistent Communication
A major opportunity exists for stronger collaboration between the dentist and hygienist during diagnosis and treatment-planning. When I was working as a hygienist, I didn’t fully understand things like buildups or why they were important. If dentists take the time to teach their hygiene teams more about restorative care, hygienists could play a larger role in supporting comprehensive treatment planning. Hygienists can help co-diagnose by taking additional radiographs that may lead to root canal therapy if a patient is expressing pain or even taking additional intraoral photographs to help the patient understand the need for a new crown, etc. Too often, the dentist comes in, diagnoses a few cavities and leaves, only for the patient to turn to the hygienist and ask, “Do I have any cavities?” This common scenario highlights the need for better alignment and communication.
I believe dentists need to take a more active leadership role in their periodontal programs. Too often, dentists leave the direction of the hygiene department entirely up to the hygienist. But setting clear protocols, reviewing the latest classification systems and reinforcing periodontal messaging together make a big difference. After all, the dentist is ultimately responsible for the correct periodontal diagnosis, not the dental hygienist. For example, I’ve experienced situations where I might spend the majority of the appointment educating the patient about the need for scaling and root-planing, only for the dentist to come in and say, “Everything looks great, no cavities.” That kind of disconnect can completely undermine treatment acceptance. When both providers deliver consistent messaging both periodontally and restoratively, patients are far more likely to trust the recommendation and proceed with care.
In the end, I believe both the dentist and hygienist have valuable roles to play in creating a successful patient-centered practice. Collaboration, mutual respect and strong communication can help both professionals thrive, even in a reimbursement system that still needs serious reform.
Striking a Balance
I think the worst advice I ever received as a dental hygienist was to walk into an interview and demand a high salary to prove my value. I feel like more and more hygiene programs are teaching students to take a somewhat confrontational stance about pay. That honestly makes me pretty sad, because, to me, it signals that hygienists don’t feel valued or respected by the rest of the dental team. They shouldn’t have to demand their value or prove their worth. And when you look at this recent bill that was circulating, I can see why many hygienists might feel they’re not valued enough.
Looking back, instead of focusing on confronting employers about salary, I wish I’d approached those conversations a little differently by asking questions like: How can I be a team player? How can I help make the practice more profitable? How can I help create a friendlier, more enjoyable environment for everyone?
Now, as a dentist, I’d really appreciate that kind of approach from my hygienist. It shows me they want to be fully engaged with the team and the mission of the practice, rather than just showing up, doing their own thing, getting paid and leaving. If they had my back, I’d be sure to have theirs every time.
But, as dentists, maybe we need to be more open-minded about how we include hygienists in discussions about their pay structure. Instead of just setting a number, what if we shared some of the department’s numbers and asked for their input on what would be fair for both them and the practice? I believe that kind of collaborative approach would be helpful. There are many ways to run a hygiene department that can support profitability — like doing double hygiene with a strong assistant or including hygienists in production-based incentives. If the dentist and hygienist can come up with those ideas together, it fosters a true team approach.
Final Thoughts
Ultimately, our main concern in discussing all these points is to increase access to care and improve patient outcomes. I know there are bigger milestones we need to achieve in dentistry, both systemically and educationally. However, we can put a few of these ideas into practice right away to help ease some of the stress we’re all feeling. ♦
Brooklyn Janes is a resident in the New York University Langone advanced education in general dentistry program at Roseman University. To comment on this article, email impact@agd.org
References
1. Anderson, Olivia. “3 Things You Missed in Government This Week.” ADA News, 30 May 2025, adanews. ada.org/ada-news/2025/may/3-things-you-missed-in-government-this-week-2/.
2. “Nevada Assembly Considers Bill to Ease Dental Hygienist Licensure Requirements.” Citizen Portal, 15 May 2025, citizenportal.ai/articles/3332928/Nevada/Nevada-Assembly-considers-bill-to-ease-dental-hygienistlicensure-requirements.
3. “Letter to Chair Fabian Doñate Opposing Sections 77–79 of SB 495.” Academy of General Dentistry, 30 May 2025, adha.org/wp-content/uploads/2025/05/AGD_NV_SB495_Committee_Letter_final.pdf.
4. Haley-Hitz, Erin. “Open Letter Opposing Sections 77-79 of Nevada SB495 That Creates an Alternative Pathway to Licensure Without CODA Accredited Education.” American Dental Hygienists’ Association, 22 May 2025, adha.org/newsroom/letter-objecting-to-nevada-sb495/.
September Is Office Management Appreciation Month
This column is sponsored by CareCredit, an AGD Corporate Sponsor.
This month, dentists and their teams will recognize and celebrate all that the front office staff contributes to their practices’ growth and patients’ health. This year’s theme for Office Management Appreciation Month (OMAM) is “Accelerate Your Growth Journey — Personally and Professionally.” Everyone’s growth journey is different, and insights and direction often come from coaches, mentors, and a community of friends and colleagues — people who are your true partners. The key is to get connected to those who can accelerate your growth because they understand your challenges and opportunities and have shared similar experiences.
To help, CareCredit, in partnership with the American Association of Dental Office Management (AADOM), has refreshed the OMAM website (omam.carecreditvirtual.com) to include personal growth tips from AADOM leadership and members as well as professional growth strategies from dental thought leaders. Angela Martinez, vice president, strategic associations and dental health policy at CareCredit, and Penny Reed, executive vice president of membership and events at AADOM, discuss how important celebrating team and individual success is and how the “growth journey” theme is so relevant today.
Reed: Hiring struggles and a lack of qualified candidates continue to be challenges for dental practices. If a practice is short staffed, more than likely that work has been given to other team members who probably already had time-consuming responsibilities. I think of the phrase, “You cannot pour from an empty cup.” Most office managers are not only the glue at work, they’re also the glue at home. So they need to be healthy to manage a lot of responsibilities. And in order for that to happen, they need to feed their minds, bodies and souls and feel they are personally growing and getting better every day. Additionally, having the doctor and other team members recognize and celebrate their contributions to the practice’s success can be motivating, inspiring and very much appreciated.
Martinez: I agree. That’s why OMAM is the perfect time to focus on the office management team. Back-to-school time quickly turns into the holidays and the need to use end-of-year benefits. This is certainly a busy time personally and professionally for everyone, including the office management team. To help, we’ve updated the OMAM site (omam.carecreditvirtual. com) to include tips and strategies from AADOM members, consultants and other industry leaders that focus on personal and professional growth. Plus, we have resources and fun ideas for the team to help celebrate their office management teams all month long. CareCredit also has a variety of resources to help them grow professionally and accelerate practice growth. We’ve created
a new site (carecredit.com/providers/insights/industry/dental/) to make accessing resources easier. And I know AADOM has a bunch of resources available, too!
Reed: We sure do — from our online e-campus to live casts and webinars by our key opinion leaders and many of our sponsors. Our annual conference is also in September. There are many opportunities to learn not only from industry experts, but from each other. It’s so beneficial to build a community of people who know what you go through on a daily basis. I think knowing that someone cares about you and has your best interests at heart is a great inspiration to continue on that personal growth path.
Martinez: I hope all dentists, teams and especially those in management roles celebrate this September. ♦
Angela Martinez is vice president, strategic associations and dental health policy at CareCredit. Penny Reed is executive vice president of membership and events at the American Association of Dental Office Management. To comment on this article, email impact@agd.org
Exploring the Overlap of Personal and Professional Lives in Dentistry
By Carrie Pallardy
Dentists lead full, busy professional lives. All of a dentist’s responsibilities add up to a lot of pressure. You have to manage your finances, both personal and professional. You have to regularly check in on your mental health and ensure you aren’t headed down the road to burnout. You have to set the tone for professional relationships in your practice. When you dedicate your days to patient care and practice management, it can be hard to leave your work chairside and in the office. The boundaries between the personal and the professional can quickly blur.
How much overlap is too much? The answer to that question will be highly individual. Some dentists will find creating balance easier than others. Personal and professional lives inevitably influence one another, and, occasionally, they collide. Developing appropriate boundaries to manage that overlap can help dentists ensure holistic financial, mental and relational health.
Business and Personal Finances
Many dentists begin their careers with a substantial amount of debt; dental school graduates carry an average of $312,700 in student debt as of 2024, according to the American Student Dental Association.1
That debt can weigh heavily on dentists’ financial decisions in their personal and professional lives. In life outside of work, you may consider taking out other loans, such as a car loan and a mortgage. In the professional world, dentists with ownership ambitions may be considering the right timing for a business loan to launch or buy a practice.
No perfect formula exists to determine the right time to take out a loan or multiple loans.
“Some people want to get married first. Some people don’t want to get married at all. Some people have kids, some don’t,” said Joe Persichetti, head of healthcare business banking at U.S. Bank. “There’s no cookie cutter answer to, ‘Here’s what your financials should look like.’”
Education is the first step for dentists who want to figure out how and when to apply for loans. What are lenders looking for when you apply for a business or a personal loan?
“The trouble that dentists can sometimes get into is not asking those questions and then finding issues at the closing table or during the approval process,” said Persichetti.
Lenders on both the business and personal fronts are going to look at a dentist’s full financial picture. For example, a mortgage lender is going to want to see cash flow from an owner’s practice. On the flip side, a business lender is going to examine how a dentist’s mortgage payments and other debt impact their cash flow and ability to make payments on a business loan.
Lenders, for the most part, are cash-flow based. They look at what Persichetti calls the “three Cs”:
• Credit. Do you have a high enough credit score to qualify for the loan? Typically, lenders are going to want to see a credit score above 500. But a score of 670 or higher will get you better interest rates and loan terms.2
Lenders may evaluate both your personal and business credit scores depending on how long your business has been operating. However, if your business is still relatively new, such as your first dental practice, your personal credit score will likely carry the most weight in the decision.2
• Cash. When it comes to cash, lenders are looking to see that you have the money and financial habits that assure them you can and will make payments. “There’s no magic number of, ‘This needs to be in your checking account,’” explained Persichetti. “The biggest question is: Do the monthly payments make sense for your overall cash flow?”
• Collateral. If you are purchasing a practice or a piece of equipment, those assets will serve as collateral. On the personal side, your home serves as collateral for your mortgage.
Clayton Sorrells, DDS, owner of Glenwood Family Dentistry in Glenwood, Arkansas, and AGD Impact New Dentists columnist, bought a practice in his hometown in a deal financed by the original owner. While this kind of deal is rarer nowadays due to the number of group practices and dental services organizations growing each year, it does highlight the importance of building relationships.
Even if you don’t have direct connections with dentists looking to sell their practices, you can form valuable relationships with bankers. “If you can forge a relationship with a local bank or just anyone in banking, you can see what they are going to need from you when you go out and apply for that loan,” said Sorrells.
The relationship with a bank can span a dentist’s entire career. Building that rapport and track record with a lender can make it easier to get financing in the future, whether you need to buy more equipment or another practice.
Loans are a big part of managing your finances, but they are not the only piece of the puzzle. Practice owners have to contend with paying their employees and themselves, as well as personal and business taxes.
rental property now because you have a good deal, but you really don’t have any cash, you’re going to take out another loan that you weren’t planning on. All of it has consequences.”
While business and personal finances can benefit from some separation, they are ultimately intrinsically linked in a dentist’s life. Poor decisions on one side will affect the other.
“The leaks will eventually just run the ship dry,” Sorrells cautioned. “If you’re not seeing where the unnecessary spending is going, no matter what you’re producing, I believe there comes a time when you run out of money.”
Mental Health in and Out of the Office
Mental health is a core piece of our lives that affects us both professionally and personally. Stress and burnout are common in dentistry and are issues that have been exacerbated by the COVID19 pandemic.3 If you are feeling burnt out, there is no switch to flip that turns those feelings off when you go home for the day.
While there is more open discussion of mental health among dentists, the stigma has not been completely erased. It can still be difficult for dentists to admit to themselves — let alone other people — that they need help.
“The leaks will eventually just run the ship dry. If you’re not seeing where the unnecessary spending is going, no matter what you’re producing, I believe there comes a time when you run out of money.”
— Clayton Sorrells, DDS
Of course, how your practice performs directly impacts how much you earn and how you can spend in your personal life, but it is important to develop boundaries.
Patients drive income for a practice. But the ultimate goal should be to help them, not to build the most lucrative treatment plans possible.
Dentists do not have to manage their finances — business or personal — alone. They can build a team of financial experts who have established track records in dentistry. A certified public accountant (CPA) with other dental clients will know what kind of tax write-offs to leverage. A lender with healthcare experience will be able to walk you through the process of taking out a loan to buy a practice.
While separation of personal and business accounts is wise, dentists may find advantages in having experts who understand both aspects of their finances. “Having a CPA or a wealth adviser understand both your personal and business needs and what you’re doing with both will give them a full picture of the strategy,” said Persichetti. “It’s hard to give you a great recommendation without knowing the whole picture.”
Sorrells, for example, uses the same accountant to manage his personal and business taxes. However dentists opt to manage their finances — alone or with outside experts — it behooves them to build a plan, stick to it and routinely evaluate it.
“Be willing to have difficult conversations with yourself,” said Persichetti. “If you want a nice vacation or you want to buy a
Mahrukh Khwaja, BDS, is a dentist practicing in the United Kingdom. She is also a positive psychologist with a master’s degree in applied positive psychology (MAPP). But she wasn’t prepared for her first personal encounter with burnout.
“I had this textbook understanding of what burnout or depression would look like, but I had no idea really of what the experience would be like,” she said. “I was constantly ruminating and chewing over unhelpful thoughts and thinking about the future, which felt like an anxious place. I didn’t really have the psychological tools to support myself.”
She worked with a psychotherapist to learn how to use day-today tools, like mindfulness, to make sense of her emotions and find a sense of meaning again.
For many dentists, burnout is an ongoing condition. “A lot of us think that once we experience burnout, we will be done. But my finding has been that burnout is cyclical,” said Maggie Augustyn, DDS, FAGD, owner of Happy Tooth in Elmhurst, Illinois, as well as AGD Impact’s Wellness columnist.
It takes ongoing vigilance to prevent burnout and recognize the signs of it taking hold. “Check in with yourself on a daily and weekly basis and ask, ‘How am I really feeling?’” recommended Sweta J. Shah, DDS, FAGD, a dentist practicing in Wisconsin.
Shah is an advocate of mindfulness and meditation as tools for building mental and emotional resilience.
“Managing stress and burnout is different for everybody. Everyone is on a very individual journey, but having some key practices in place that you can incorporate in your daily life — whether it’s starting your day with meditation or going for a walk,
Balancing Personal and Professional Lives When Working with Family
‘Til Death Do We Part, While Practicing Apart
By Gerard Scannell, DDS
My wife and I are both dentists, but we don’t work in the same practice, and, honestly, that’s probably for the best. Dentistry is a demanding profession, and maintaining some separation between our work lives has helped us keep our personal lives balanced.
That’s not to say we don’t talk shop. We do, fairly often. It’s common for one of us to bring up a challenging case or a difficult patient over dinner. But instead of letting that dominate our time, we’ve learned how to be intentional about when and how we have those conversations. In many ways, it’s comforting to have someone who truly understands the emotional and mental strain of the job. We speak the same professional language, so we don’t have to explain why something is bothering us. My wife just gets it.
One major benefit of working separately is the flexibility it gives us. Because we each have one additional associate in our practices, we can take time off together for vacations or family needs without shutting down either office. We’re not tied to the same schedule. We don’t have to force our staff to take off, and the office can continue to bring in profit while we’re off.
Another benefit is that we avoid the common pitfalls that can come from working together. If we were in the same office, disagreements would be inevitable. And when business and personal lives are too closely intertwined, those disagreements have a way of creeping into your home life. Having our own separate spaces means we can support each other professionally without adding extra pressure to our relationship.
Lastly, there have been a few occasions when one of us ran out of a supply that was not readily available to order. The other was able to lend a few items in a pinch until that supply could be delivered.
Ultimately, sharing the same profession while keeping our practices separate has been a huge asset. We understand the unique challenges each other faces. We can offer honest feedback and advice. And we both have the freedom to grow our careers independently. It’s a balancing act for sure, but it’s one that works for us. And in a profession that can be all-consuming, that balance is something we’re both very grateful for. ♦
Gerard Scannell, DDS, is a general dentist practicing in his hometown of St. Petersburg, Florida.
Balancing Personal and Professional Lives When Working with Family
Working with My Father: Boundaries, Balance and Lessons Learned
By Amrita Feiock, DDS, FPFA, FICD, FACD
Working with my father has been one of the most rewarding — and, at times, challenging — experiences of my professional life. Growing up, I spent countless hours in the office, watching how he treated patients, handled emergencies and ran the business. So, when I became a dentist myself, joining the family practice felt like a natural step. But, as I quickly learned, working with a parent comes with its own unique set of dynamics.
One of the most important things we’ve had to navigate is setting boundaries between our roles at work and our relationship outside of it. At the practice, we’ve made it a point to define our responsibilities clearly — who makes which decisions, how we divide clinical time and how we handle disagreements. That clarity helps us treat each other as colleagues during business hours,
rather than falling into a parent-child dynamic that can cloud judgment or stall progress.
It’s also crucial to draw lines between our personal and professional lives. Do we talk about work at family gatherings? Sometimes. It’s hard not to, especially when something pressing comes up. But, over time, we’ve agreed on some boundaries — no discussing staffing issues during dinner, no business talk on holidays and certainly no debating treatment plans while out with extended family. It took a while to get there, but protecting family time has helped us maintain a healthier relationship outside the office.
So, is working with a parent a help or a hindrance? Honestly, it’s both. The trust we have is deep, and there’s a comfort in knowing we have each other’s backs. I’ve learned so much from watch-
ing how my father built our business from the ground up. But we’ve also had moments of tension, especially when we see things differently — whether it’s about technology, scheduling or how to manage a difficult staff issue. Those conversations can be harder because they’re so personal.
Still, I wouldn’t trade the experience. It’s incredibly special to carry on a family legacy and to share a purpose that spans generations. Working with him (and, hopefully soon, with my husband, too!) has taught me how to separate emotion from decisionmaking, how to communicate better, and, most of all, how to grow — both as a dentist and as a person. ♦
Amrita Feiock, DDS, FPFA, FICD, FACD, is in private practice with her father, endodontist Rohit Z. Patel, DDS, PC, in Westchester County, New York.
even if only for five minutes — that is something that you can take time for yourself to decompress on a daily basis,” she said.
Shah acknowledged that the prospect of taking up meditation can be daunting. Dentists frequently have busy minds and hands. Isn’t meditation one more thing to add to their plates?
But nearly anything can be meditative. It can fit into your existing day; habit-stacking allows you build mindfulness into your existing routine.
Shah offers brushing your teeth as an example. “When you’re brushing your teeth, really engage all of your senses,” she explained. “Listen to the sound of the water flowing. Count the strokes of your toothbrush. Really taste the toothpaste. Notice the color of the toothpaste to start the habit of mindfulness.”
It is up to dentist owners to create the culture at their practices, and that part of the job can be tough.
Khwaja still practices one day a week clinically, but she also leads Mind Ninja, a company that she launched to provide programs and resources focused on workplace wellness in dentistry and healthcare.
“Everyone is on a very individual journey, but having some key practices in place that you can incorporate in your daily life — whether it’s starting your day with meditation or going for a walk — that is something that you can take time for yourself to decompress on a daily basis.”
— Sweta J. Shah, DDS, FAGD
A big part of preventing and managing burnout hinges on shifting your mindset. Dentists highly value productivity. The more cases you take, the more you make. But there is value in slowing down, too.
“There isn’t a direct financial return on rest, but rest is essential in balance,” Augustyn pointed out.
During the day, rest might mean taking time between patients or leaving the office for lunch. Outside of work, it might mean going for a walk without any devices, taking time to enjoy your hobbies or spending time with the people you care about.
Everyone has heard the term “work-life balance.” Khwaja prefers “harmony” over “balance.” “You’re not going to have it balanced perfectly,” she said.
Taking vacations is part of that balance, but they cannot be the only balm for burnout.
“Taking vacations does not prevent burnout. We need to leave toxic workplaces and take proactive steps to increase our mental fitness, from increasing our diet of positive emotions to inviting activities that increase engagement and ‘flow,’ promote connection to others, and add meaning,” said Khwaja.
Harmony between work and life outside of work will look different for every dentist at different points in their lives.
Professional and Personal Relationships
Managing relationships is a third major component of the personal and professional lives of dentists. As an associate in a practice, you have to consider how to work with your peers and supporting staff members. Are you treating your colleagues with respect? Do you want to develop relationships with any of them outside of work?
Associates can determine those boundaries for themselves, but once you shoulder the responsibility for practice ownership, relationship management becomes an essential part of your job.
That doesn’t necessarily mean you cannot spend time with people outside of work. In fact, after-work socialization can be beneficial to team bonding. But you have to think about how you are perceived as a leader and the potential consequences of mixing personal and professional relationships.
“There are a lot of principal dentists and practice managers who have had little training in human resources (HR) matters, wellbeing and mental well-being — all key facets that help really build positive culture,” she said.
While maintaining appropriate boundaries between the professional and personal, some dentists have taken the wrong approach, in Augustyn’s experience. She has seen some owners set the expectation that people leave their personal issues in a metaphorical bucket outside the practice.
“You can’t unhinge yourself from your parent dying or from going through a divorce,” said Augustyn. “I have learned to change the way I am as a leader. It’s not just business. You can be a compassionate leader, but that doesn’t mean that you don’t hold people accountable.”
She strives to recognize that her staff members have good and bad days, just as she does. If someone on her team is having a bad day, the expectation is that they step away so they do not negatively impact patient care, and the rest of the team rallies around them.
Building that kind of culture — one that maintains professionalism while recognizing the human needs of employees — takes work. Dentists may need help to get there, whether through a dedicated HR leader or an outside consultant. But there is a business case to be made for doing that work.
“Happier, healthier teams equal increased profitability, increased staff retention, and reduced burnout, absenteeism and presenteeism,” said Khwaja. “The business case is solid.” ♦
Carrie Pallardy is a freelance writer and editor based in Chicago. To comment on this article, email impact@agd.org
References
1. “Dental Student Debt.” American Student Dental Association, asdanet.org/index/get-involved/advocate/ issues-and-legislative-priorities/Dental-Student-Debt. Accessed 27 June 2025.
2. Ziraldo, Katie. “Business Loan Requirements: 8 Things You Need to Qualify.” LendingTree, 20 March 2025, lendingtree.com/business/requirements/.
3. Negucioiu, Marius, et al. “Prevalence and Management of Burnout Among Dental Professionals Before, During, and After the COVID-19 Pandemic: A Systematic Review.” Healthcare (Basel, Switzerland), vol. 12, no. 23, 2024, p. 2366.
Following the 2024 election, the Republicans ended up controlling the House of Representatives, the Senate and White House. This avoided a major congressional showdown, instead culminating in President Trump signing the “One Big Beautiful Bill Act” July 4, 2025. I’m not a political person, nor do I name laws — my goal is to report the facts to you as they impact your life. With that in mind, keep reading to learn more about the tax law changes most likely to impact your livelihood.
Many Current Tax Law Provisions Made Permanent
The Tax Cuts and Jobs Act (TCJA) made many changes to tax law back in 2017. However, most of the changes impacting individual taxpayers, such as dentists, were only temporarily enacted since the bill was passed through reconciliation. These temporary provisions were set to expire at the end of 2025, reverting to the former tax law beginning Jan. 1, 2026. The latest law changes make many of these provisions permanent, rather than allowing them to expire.
1. Lower tax rates: The TCJA lowered the tax rates for six of the seven federal income tax brackets. These rates are 10%, 12%, 22%, 24%, 32%, 35% and 37%. These rates are now permanent with no future expiration date.
2. Increased standard deduction and elimination of personal exemptions: The TCJA doubled the standard deduction taxpayers receive in hopes of simplifying returns. You can either choose to itemize your deductions on Schedule A or take the standard deduction. By increasing the standard deduction, the government hoped to reduce the number of taxpayers choosing to itemize their deductions. To offset this change, the law also eliminated personal exemptions, which was a deduction for each taxpayer and dependent. Both these provisions are now permanent in the
What Dentists Need to Know About New Tax Laws in 2026
By Wesley W. Lyon II, CPA, CFP
law, with the standard deduction continuing to increase with inflation each year.
3. Qualified business income (QBI) deduction: The QBI deduction is an additional 20% deduction on the profits of your business, excluding C Corporations. This provision phases out as your income exceeds $394,601 and historically has been eliminated once your income reaches $100,000 more than the base threshold. However, the new law extends the phase-out range another $50,000 to a total of $150,000, allowing even more dentists to take advantage of the QBI moving forward.
4. Estate tax exclusion limits: The TCJA doubled the estate tax exemption limit when passed, which has now climbed close to $15 million per spouse with inflation adjustments. The new law sets the threshold at $15 million per spouse beginning in 2026, rather than reverting to the pre-TCJA limits of $5 million per spouse.
5. Increased section 168(k) bonus depreciation: Bonus depreciation was previously increased to 100% but began declining in 2023 at a rate of 20% per year. The new law brings bonus depreciation back to 100%. Many doctors may not have noticed this change, as equipment can be written off fully under Section 179 of the tax code. However, large sport utility vehicles (SUVs) are deducted under a combination of Section 179 and Section 168(k). This change allows up to 100% of the cost of an SUV with a gross vehicle weight rating (GVWR) of 6,000 lbs. or more to be fully deducted up to your business use percentage in the first year.
Changes to Tax Law
With the One Big Beautiful Bill weighing in at over 800 pages, I’m not going to cover every change. Instead, I have picked out some
of the most impactful changes and sprinkled in a few insights into some of the big ticket items that made their way into the bill.
1. State and local tax (SALT) limits increased: One of the more controversial pieces of the TCJA was the limit on the amount of state and local taxes that can be deducted on a taxpayer’s itemized deductions. The TCJA limited the amount to just $10,000. Since then, there has been a workaround many dentists can take advantage of called the pass-through entity (PTE) election. This allows business owners to pay a portion of their state income taxes through their business and deduct the taxes against the federal taxable income. Originally, this workaround was expected to be eliminated. However, in the final bill, the workaround has stayed. Not only is the PTE election still living, but the SALT limits on individual returns have been raised to $40,000 instead of $10,000 until 2030, with phaseouts beginning when modified adjusted gross income (AGI) exceeds $500,000.
2. Increased exemptions for seniors: Those of you 65 and older will now gain a personal exemption of $6,000 per qualifying spouse, so long as modified AGI does not exceed $150,000 for couples filing a married tax return. This is likely the government’s way of eliminating taxes on social security, but only for those with limited incomes.
3. Expanded uses for 529 accounts: The amount allowable for elementary or secondary education has doubled from $10,000 to $20,000, with books, curriculum, curricular materials, qualifying tutoring, nationally standardized test fees and classes, and dual enrollment expenses now qualifying. Furthermore, qualifying expenses have been expanded to postsecondary credentialling expenses, covering a much wider range of expenses outside of qualifying universities.
4. Domestic research able to be deducted: While the research and development (R&D) tax credit has not been eliminated, under the current law, R&D expenses must be amortized over five years rather than deducted in the same year the R&D tax credit is received. This left many taxpayers in a cash crunch, with more businesses opting out of taking the credit. The new law now allows for immediate expensing of qualifying domestic R&D expenses. Furthermore, this allows taxpayers to amend tax years 2022 through 2024 to claim the credit and related expenses. This is great news for those who qualify. However, you need to be careful. Most dentists will not truly qualify for this tax credit but will be swindled into believing they do by promoters claiming to know more than the certified public accountant community. Prior to filing any R&D credits, make sure you have a team of experts looking out for your best interests, not their own wallets.
5. Elimination of clean energy tax incentives: Under current law, most of the green energy tax incentives will be eliminated. Credits on purchasing electric vehicles will terminate at the end of September 2025, so hurry if you want to take advantage prior to
“Fortunately for most dentists, the new law does not bring sweeping reform. Unfortunately, most dentists still haven’t optimized their tax plan for the current law.”
expiration. The residential clean energy credit and energy-efficient home improvement credits are set to expire at year end, while both the energy-efficient commercial building deduction and the new energy-efficient home credit will expire June 30, 2026.
6. Enforcement for COVID-19-related employee retention tax credits (ERTC): Promoters who refuse to comply with auditors will now face penalties of up to $1,000 per each failure to comply. Additionally, the audit period has been extended to six years for the ERTC. Not only does the law address the extended assessment period, but it also applies the extended period to taxpayers who did not properly deduct wages from their business tax return if they received the ERTC for those wages. I expect audits to continue to increase, as fraud is rampant with the ERTC.
7. Notable changes unlikely to impact dentists: There are provisions that will eliminate the tax on tips for many, but these provisions are subject to income requirements and a deduction of $25,000 of qualifying tips. There is a deduction for overtime pay not exceeding $25,000 if married filing jointly, assuming modified AGI does not exceed $300,000. Interest payments on qualifying car purchases with final assembly in the United States will be deductible, of course barring income limits. There is also the creation of “Trump accounts,” which could provide an opportunity for investing even more funds tax-advantaged for your children. However, we want to see the final regulations before we get too excited with this one.
What Can You Do to Maximize Benefits?
Fortunately for most dentists, the new law does not bring sweeping reform. Unfortunately, most dentists still haven’t optimized their tax plan for the current law. The QBI deduction makes tax-planning complex, as the deduction applies only to business profits and excludes owner wages. Often, a dentist needs to increase retirement plan contributions to fall within the proper thresholds. Higher retirement plan contributions generally require higher salaries, working directly in contrast with your goal of maximizing your QBI deduction. Instead of hoping for the best, make sure you are working with a tax-planning professional who knows every tax strategy available to you, ensuring you pay the least amount of tax possible. ♦
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
Testing the Tools
By Ross Isbell, DMD, MBA
In my practice, my usual plan is to extract a tooth as atraumatically as possible and allow the site to heal. This is the least expensive treatment, and we know the body will heal in time. However, I am not always fortunate enough to have patients or sites that heal perfectly — luckily, there are a variety of ways to help heal them. While postoperative management of surgical sites is a commonly encountered situation in practices that extract teeth, past solutions haven’t always been as predictable and easy to deliver.
Your Neck and Shoulders Will Thank You
ErgoPrism Air Loupes 4th Gen (5×)
Lumadent lumadent.com
I would argue that, second to communication, the most difficult and important habit or skill to learn in any profession (and dentistry in particular) is posture ergonomics. I have been wearing loupes since the days of wax-ups in my dental school preclinical lab and started with a 2.5× magnification set of Designs for Vision Buddy Hollys that boasted a declination angle of 25 degrees. If you rewatch “The Fugitive” with Harrison Ford, you will notice that he was wearing the same style. As you can guess from the movie reference, the loupes were great and functional at the time but are no longer cutting edge. In pursuit of something better, I upgraded to the SurgiTel® EVK 3.5× with exchangeable working length front lenses and an increased declination angle of 35 degrees. While definitely a positive change with a wide field of view, I still found myself leaning more than I wanted. My newest set, the Lumadent ErgoPrism Air through-thelens loupes, have an angle that is about 50 degrees using an angled mirror system that truly allows for an upright seating position. The other interesting function is that you can alter your working length by simply twisting the lenses to bring your depth up or down by about five inches. I chose a 5× magnification, though Lumadent offers a range from 3.5× to 8×. Weighing in at about 38 grams, they are very lightweight and not as front heavy as I expected despite the size and projection of the optic apparatus from the frame and lens. They are heavy enough that you do need to wear a head strap to secure them, but it is not physically straining to hold your head position. When I first received my set, the measurement for my interpupillary distance was not perfect, which lead to headaches. I can’t say enough about how pleasant it was to work with the company’s support team, and, a couple weeks after my video conference repair consult, my loupes were adjusted to meet my needs. If you purchase Lumadent’s light kit to go with the loupes, it has a convenient on/ off touch button that mounts to the frame as well as the button on the battery. While altering my posture from leaning to sitting directly upright took some getting used to and required a stubborn commitment, my neck and shoulder muscles have definitely benefited.
Upgrade Your Periosteal Elevator
Orban Knife
Karl Schumacher karlschumacher.com
When I learned how to gain entry to a surgical site with a flap for an implant or an extraction and socket preservation, the instrument put in my hand was a molt periosteal. While that is a great and practical choice, I no longer consider it my favorite. Instead, I prefer using an Orban periodontal knife because it not only can lift, but the angled approach also makes it easier to engage underneath and leverage against tissue, which requires less force from me. This more delicate, but equally strong, separation of periosteum and gingiva from bone is also aided by the double-sided blade that is sharp enough to cut while also being dull enough not to accidentally slice. I typically still employ an ovoid periosteal immediately after my releasing incision to open an access hole but then swap to the Orban for sliding along the periosteum to release and lift. My brand preference for an Orban knife is Karl Schumacher because I have had great and long-lasting results from its products, but most surgical instrument manufacturers carry this style. If you are searching for an upgrade to your standard periosteal elevator, look to an Orban periodontal knife for an easily controllable and quickly effective blade to create a conservative surgical access.
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
Add Some Regenerative Abilities to Your Perio Arsenal
Emdogain® Straumann® straumann.com
As a general dentist in a small town, I am engaged in an extensive mixture of procedures, from restorative to surgical and everything in between. One area in which I believe myself to be lacking is regenerative therapies. I have always offered socket preservation for extraction sites but have not branched into other augmentation therapies until recently. As my practice has developed and we have begun to focus our hygiene team on more comprehensive periodontal diagnoses, I have begun looking into ways to treat soft- and hard-tissue defects other than just scaling and root-planing. A periodontist friend who is also a regenerative therapy lecturer recommended I try Emdogain® from Straumann®. This product has been on the market for more than 20 years and has extensive literature to back up its success aiding in periodontal attachment regrowth. Emdogain can be used in situations around teeth and implants such as gingival recession, infrabony defects and furcationinvolved vertical bone loss. It is a mixture of naturally occurring enamel matrix proteins that forms an extracellular matrix in the presence of tooth structure, and it stimulates angiogenesis and downregulates inflammatory processes while also having an antibacterial effect. The presence of Emdogain also significantly helps to decrease postoperative pain during surgical management of the aforementioned problems. Procedurally, you begin by gaining access to the site, with or without a flap, and thoroughly clean the defect of everything you can find except bone and tooth. The site must then be treated for two minutes with PrefGel®, a Straumann-developed ethylenediaminetetraacetic acid formula that removes the subgingival biofilm and smear layer from the tooth, aids in hemostasis, and encourages attachment of the Emdogain proteins. Next, rinse the PrefGel entirely from the site with sterile saline, and dry it with air or sterile gauze. Lastly, inject or place the Emdogain to fill the defect up to the level of the surrounding bone. Both PrefGel and Emdogain are loaded into a syringe with bendable delivery tips for easy placement into any site. If possible, cover the site and Emdogain gel with a membrane to maintain placement of the proteins, but this may not be necessary if soft-tissue closure can be gained with suturing or manual pressure. I currently do not have longterm results to brag about with this product, but I am thankful for a straightforward delivery and system that promises consistent regenerative capabilities.
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.
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Refer a Colleague, Get Rewarded
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Refer your colleagues to join AGD now, and they’ll get 50% off AGD’s 2025 dues.*
You’ll both also earn $50 in Referral Rewards once they join!
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Wyomissing, PA Member since 2014
*Half-year rate does not apply towards constituent and component portion of dues. Half-year rate does not apply for memberships that expired on Dec. 31, 2024, residents or new dentists who graduated in 2024 or 2025. Members who pay half year dues may record CE starting on July 1, 2025.
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