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RETIREMENT IS A STATE OF MIND – NOT A DEADLINE
I read a quote the other day that really struck me:
“If you do something you love, you never have to retire.”
That made me pause and reflect. While I still consider myself mid-career with many years ahead, it made me think—what does retirement actually mean? When do I want to retire? Do I even want to retire?
Over the weekend, I saw the new Mission: Impossible movie. In it, Ethan Hunt has a poignant conversation with his close friend Luther who’s facing his imminent demise. Luther asks, “What are we going to do—retire?” The moment landed deeply. It made me consider how meaningful it is to be in a profession that brings us such fulfillment that the idea of retirement doesn’t feel necessary—because what we do gives us purpose.
But that’s not always the case.
Just recently, I watched a video from a young dentist who gave 19 reasons why she decided to leave dentistry. They ranged from the stress of dealing with patients who dread the dentist, to the exhaustion of fighting insurance companies, to the heavy emotional toll of addressing patients’ financial limitations,especially when people expect dentistry to be free. After 15 years in the profession, she simply couldn’t do it anymore.
While I deeply respect her decision—and applaud her for choosing her mental health over her job—I couldn’t help but wish that she had been able to find or create an environment that allowed her to continue doing what she once loved.
So, how do we do that?
How do we make our profession something we enjoy so much that it feels like we’re already retired?
That’s a tough question, and I imagine most of us wish we had the answer. I certainly don’t claim to know it all, but I’ll share what’s worked for me.
I’ve made it a priority to surround myself with like-minded people—people who care deeply about our patients, who respect each other, and who protect our work environment from unnecessary negativity. We’ve set clear boundaries: if a patient is treating us poorly or crossing a line, we don’t hesitate to refer them elsewhere. That small shift has made a big impact on our team’s morale.
We also try to keep the office atmosphere as low-stress as possible. I’ll admit this openly—even if it’s a little unconventional: if someone else can do something better than I can, I refer the patient to them. We refer out a lot of cases. Sure, that can be financially challenging, especially for young dentists
dealing with staggering student loan debt. I know how hard it is to balance production goals, financial survival, and personal well-being.
But for me, I’ve structured my practice in a way that works. I’m out-of-network with insurance providers. That decision allows me to charge appropriately for my work and to take the time I need with each procedure. As a result, I don’t feel rushed, I’m not burned out, and I actually look forward to my workdays. And when I go home, I’m not running on fumes.
That’s not just good for me—it’s good for my patients, my team, and my family.
In fact, I’ve created a practice that I’m proud of—one where I’d be happy to see my own children follow in my footsteps if they choose to enter the field. I want them to have a career they can love, not one they feel trapped by.
A Harvard study on happiness found that to be mentally healthy, we need healthy relationships. Those don’t always have to be deep or profound, but they do need to be genuine and kind. Dentistry offers a rare gift—we get to connect with people every day. Through small, sincere conversations with our patients, we build trust and community. When we treat them with compassion and deliver care that truly helps them, those interactions become deeply fulfilling.
So my message to you is this:
Think about how you can structure your practice and your mindset so that you’re not counting the days to retirement—but living as if you’ve already arrived. Find joy and purpose in the work you’re doing today. Design your practice in a way that supports your mental health, your values, and your love for the craft.
Let’s try to build lives where we don’t dream of stopping—but instead, wake up each day excited to keep going.
I’m grateful to be your colleague. I wish you continued success and happiness—both in your practice and in life.
Take care, Rodney Thornell
MANDIBLE DESTINY
I work in an office where my operatories have a view to the beautiful Wasatch Range to the east. The mountains sit just beyond the parking lot. It’s nice to see the sun rise each morning and hear the comments from our patients about how beautiful the view is. I used to have a pair of binoculars in each operatory so the patients could look at the deer or the scenery outside while they waited for me. They’ve all been stolen.
One day, in between patients, I noticed an old and bent woman heading across the parking lot. I wished to myself; “Please don’t let her come in here. Hopefully, she has an appointment with the periodontist in the next building. I can see with one eye she could use some scaling and root-planing. She’s probably got hives.”
Sure enough, she came to my place.
Dixie is short and her appearance is rough. All over. Reminded me of a horny toad that day. After filling out paperwork, she was brought back for me to meet her. I prepared for the worst. What I got was the best. She is the sweetest, most kind person I’ve ever met. She wanted new teeth. She even paid cash. We discovered we could help each other. I’ve become good friends with her and admire her clever wit and funny stories. She’s a beautiful angel all packed up in that crumpled body. I am too embarrassed to tell her what I thought that day before I met her. I don’t even see it now. She’s wonderful to me.
What I learned from Dixie, I’ve tried to put into practice. I’ve found joy in serving and not judging others, both professionally
and personally. There are many opportunities to serve as a dentist locally. Give Kids A Smile, the homeless shelter, Head Start programs, or providing to those without means are a few. I recently signed up to provide Medicare through the University of Utah. Dr. Bekker’s office staff made the application process smooth and easy. Service opportunities with the Utah Dental Association are available also. You can serve a little or a lot. It’s a great way to associate with our colleagues and peers. I’ve learned so many things that have helped my practice from those I serve with. Contact the UDA or me personally for opportunities. We would love to serve with you.
The other day, I was riding my motorcycle home from work. As I went across a bridge, I saw a little yellow dot hovering in the air. I dodged my head but not far enough to keep a wasp from flying into my helmet and sticking up against my temple. It started stinging me immediately. I drove as fast as I could to the Maverik station, parked next to the pumps and ripped my helmet off and danced around swatting at my head. I wonder what the other customers thought. “You kids stay away from that guy! He’s a lunatic!”
Don’t judge me. I’m really a mild-mannered dentist who enjoys his career. I promise.
Dr. Nilson may be reached at snilson745@gmail.com
Dr Scott Nilson UDA Secretary
THE STATE OF FLUORIDE IN UTAH ASSOCIATION
This past legislative session, at the recommendation of state Republican leadership, Representative Stephanie Gricius of Eagle Mountain sponsored HB 81 — legislation that prohibits municipalities in Utah from adding fluoride to public water systems.
When the Utah Dental Association (UDA) became aware of the bill, leadership immediately engaged Rep. Gricius, urging her to reconsider. Despite our efforts, she remained determined to push the bill forward.
Unexpectedly, the bill was assigned to the House and Senate Natural Resources, Agriculture, and Environment Committees. Both proponents and opponents of fluoridation testified. Those opposed claimed fluoride causes cognitive decline, disrupts gut microflora, and contributes to systemic illnesses. Municipal water employees testified about the logistical and health challenges of handling fluoride, including one worker who attributed headaches and other symptoms to exposure. Even the mayor of Brigham City expressed frustration, citing cost and maintenance concerns — despite the fact that just over a year earlier, citizens of Brigham City had voted by a 2-to-1 margin to keep fluoride in their water.
UDA leadership, along with members of the broader medical and dental community, countered these claims with evidencebased research. However, scientific data failed to match the emotional sway of anecdotal testimony. In reality, fluoride at levels allowed in U.S. public water supplies has never been shown to cause the alleged harms. Community water fluoridation remains the most cost-effective public health measure in dentistry, typically costing just $0.50 to $1.00 per person annually.
HB 81 was born from concerns about government overreach — a belief that citizens should have a say in what is added to their water. Ironically, we argued that the bill did the very thing it claimed to oppose: it removed the ability of communities to choose fluoridation for themselves. It also ignored the most vulnerable members of our society — infants and children — who depend on public health measures for protection.
Despite our advocacy, the bill advanced through committees and both legislative chambers. On the Senate floor, it was noted that 76% of the testimony included demonstrably false claims. Yet with no mechanism to correct the record, HB 81 passed both chambers with over 60% support.
Throughout the process, the ADA worked in close coordination with UDA leadership. Paul O’Connor, state liaison from the ADA Council on Government Affairs, helped us leverage national resources. The ADA’s media team created an
awareness campaign and submitted letters to local publications. ADA President Brett Kessler also penned a powerful letter to Governor Cox urging a veto of HB 81.
Ahead of the governor’s decision, representatives from the UDA, Utah Oral Health Coalition, and other healthcare professionals met with Governor Cox’s staff. We outlined the public health consequences of signing the bill, including concerns about pharmacist prescribing practices and inconsistencies with the Governor’s own “Healthy Utah” agenda. While the Governor’s team listened respectfully, they were not encouraging. Governor Cox’s comments to the press were telling:
“It’s not a bill I felt strongly about; it’s not a bill I care that much about, but it’s a bill I will sign.”
Our fears were confirmed on March 27 when the governor signed HB 81 into law
In the aftermath, Utah became a symbol of the anti-fluoride movement. The national spotlight followed. UDA leaders were featured in interviews across all major Utah networks and contacted by national outlets including CNN, MSNBC, Reuters, the Associated Press, and The Washington Post. We consistently voiced our concern for the future of oral health in Utah.
Soon after, I began noticing a change. Parents — many of whom had never raised the topic before — started asking questions. For the first time in my 21-year career, fluoride became a common subject of conversation. If there’s a silver lining to this situation, it’s that public interest and awareness have never been higher.
On April 7, Robert F. Kennedy Jr. visited Utah to praise lawmakers. Standing beside the EPA Administrator, he claimed that eliminating fluoride from public water could boost national IQ scores by two points — drawing a direct comparison to the removal of lead from gasoline. According to Kennedy, removing fluoride from U.S. water was his administration’s top priority.
Shortly after, the FDA announced that it would halt its recommendation for prescription fluoride as of October 2025, citing concerns about the gut microbiome. The studies referenced in their statement, however, offered no conclusive evidence of harm — and the FDA acknowledged that more research is needed.
Where Are We Now?
In response, the UDA has compiled data on natural fluoride levels in communities formerly served by fluoridated water. This resource, published at UDA.org, provides prescribing guidance to dentists, physicians, and pharmacists across the state.
We’re actively working with the Division of Occupational and Professional Licensing (DOPL) and the pharmacy community to clarify prescribing practices. We’ve increased communication with local dental districts through weekly and monthly updates and quarterly Zoom meetings. Our goal: to make sure this crisis leads to positive, lasting change.
What Comes Next?
Looking ahead, the UDA will launch a large-scale public education campaign in partnership with the Utah Oral Health Coalition and University of Utah School of Dentistry. This effort will stress the importance of routine dental care and topical fluoride application — and will guide patients toward trusted UDA-affiliated providers.
Meanwhile, the University of Utah will begin collecting DMFS (Decayed, Missing, and Filled Surfaces) data from previously fluoridated communities to establish a baseline. Long-term
research will help us track the eventual impact, as we’ve already seen in places like Juneau, AK; Calgary, Canada; and Buffalo, NY. Recent polling shows that 95% of dentists in Utah share our concerns. And while many patients have asked, “Wouldn’t the removal of fluoride just mean more business for dentists?” — not a single one of my colleagues sees it that way. We are united in our commitment to our patients’ overall health. Fluoride is a proven, simple, and effective way to prevent dental decay, and that’s why we advocate for it so strongly.
We are one of the most trusted professions in the country — and we intend to earn and maintain that trust by doing what’s right for our patients.
Dr Darren Chamberlain ADA Delegate
TALKSPACE GO COMPLIMENTARY FOR ADA MEMBERS
ADA MEMBER BENEFIT: TALKSPACE GO
You have access to Talkspace Go as a complimentary member benefit.
Access code: ADAGO2025
You can utilize these resources at your own pace, covering a variety of common challenges like anxiety, burnout, stress and more.
Need more support?
Talkspace Therapy connects you with a licensed therapist in your area.
Talkspace Go is a suite of self-guided resources such as counseling programs, live classes, and mental health tools. After a brief assessment, you will be given access to a personalized dashboard of mental health resources.
The ADA announced a new resource available for all ADA members and dental students: Talkspace Go, a self-guided therapy app to support mental well-being.
The app provides tools to manage work stress, relationships and overall balance in life. In as little as five minutes a day, Talkspace Go can support well-being through personalized courses around topics like work stress, financial stress, burnout,
depression, conflict and relationships.
Users can also participate in therapist-led live workshops, courses, daily journaling and more. The app is available at no cost to members and students.
This comes after the 2024 ADA Council on Communications Trend Report found that more than 82% of dentists report major career stress. In a Jan. 15 message to the membership, ADA President Brett Kessler, D.D.S., acknowledged the pressures of dentistry often lead many people to struggle in silence with anxiety, depression and burnout. He said that keeping the dental “professional community well is among my top priorities as your ADA president.”
“I’ve used Talkspace Go myself, and I can tell you — it’s not just another app. It’s a powerful tool that can help you take those small, impactful steps toward living your best life,” Dr. Kessler said.
To get started:
• Visit ADA.org/ TalkspaceGo to log in with your ADA information and receive a member-only access code.
• Download Talkspace Go on iOS or Android.
• Create an account and enter the ADA organization code.
• Answer 25 questions to help identify areas of support and growth to begin the self-guided experience.
For more information about Talkspace Go or to sign up, visit ADA.org/TalkspaceGo
For more information and resources on overall wellness, visit ADA.org/Wellness
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PRACTICE
6 CDT CODES YOU SHOULD KNOW
When it comes to CDT codes, many dentists tend to have the same questions: How is this different from other similar codes? Can I report this procedure on the same date of service as other procedures?
In an effort to help clear up these questions and explain new codes that may be unfamiliar to dentists, below are six codes dentists should know and details about how to use them.
D0150 comprehensive oral evaluation — new or established patient
The ADA frequently receives questions from members about this commonly used code, particularly about how it differs from codes D0120 periodic oral evaluation and D0180 comprehensive periodontal evaluation. Code D0150 is used for new patients, established patients who have experienced a significant change in health conditions or established patients who have been absent from active treatment for three or more years. On the other hand, code D0120 is used for established patients returning to determine any changes in their dental and medical health status since a previous comprehensive or periodic evaluation, and code D0180 is used for new or established patients returning for treatment who show signs or symptoms of periodontal disease.
D2940 placement of interim direct restoration
The nomenclature for this code was revised in CDT 2025 from “protective restoration” to “placement of interim direct restoration.” This revision is related to the deletion of code D2941 interim therapeutic restoration — primary dentition. These actions together were made to simplify the documentation and reporting of interim restorations. Based
on its revised descriptor, code D2940 now serves as a single code to capture the placement of any restorative material as an interim direct restoration using any method as long as the delivering provider is acting within their scope of licensure.
D2956 removal of an indirect restoration on a natural tooth Also new in 2025 is this code for a crown removal procedure. The code does not specify the method of or reason for removal, but it cannot be used for the removal of a temporary or provisional restoration.
D4355 full mouth debridement to enable a comprehensive periodontal evaluation and diagnosis on a subsequent visit This is another code that often elicits questions, specifically about whether or not it can be reported on the same date of service as other procedure codes. For example, it can be reported on the same date as code D0120 periodic oral evaluation or code D0150 comprehensive oral evaluation, but it cannot be reported on the same date as D0180 comprehensive periodontal evaluation. Also, because the purpose of code D4355 full mouth debridement is to enable the dentist to complete the comprehensive periodontal evaluation, it cannot be reported at a second visit after the evaluation was already completed at the initial visit.
D6089 accessing and retorquing loose implant screw — per screw and D6193 replacement of an implant screw Code D6089 was new in CDT 2024, and code D6193 is new in CDT 2025. Here’s an example of how to use them from the CDT 2025 Coding Companion: If a dentist is completing a D0120 periodic oral evaluation and finds an implantsupported crown is loose and the screw needs to be retorqued,
that procedure would be coded separately from the periodic evaluation as code D6089. If the dentist determines the implant screw cannot be retorqued and instead needs to be replaced, the procedure code would be D6193.
Full entries for all CDT codes, including their nomenclatures and descriptors, are published annually. The 2025 update includes 24 total changes: 10 new codes, eight revisions, two deletions and four editorial changes. Staying updated with CDT codes from each version is crucial for dental practice efficiency, compliance and patient care.
CDT 2025: Current Dental Terminology and the CDT 2025 Coding Companion are available for purchase from the ADA Store. The ADA website also offers coding education guides to help dentists understand coding scenarios. Any coding questions can be directed to dentalcode@ada.org or the ADA Member Service Center at 1-800-621-8900.
Mary Beth Versaci
ADA
PRACTICE
MANAGING OZEMPIC TONGUE
Experts, including Tricia Quartey, D.M.D., a spokesperson for the ADA, acknowledged that one reported adverse effect noted by patients using glucagon-like peptide-1 receptor agonists is known as Ozempic tongue.
Individuals with Ozempic tongue may experience a persistent bitter, sour or metallic taste in their mouths, according to a news report from Verywell Health. Dr. Quartey noted that this side effect is not unique to GLP-1 receptor agonists and can occur when the drugs or other types of drugs are absorbed and released into the saliva, thereby altering the sense of taste. A small study of fewer than 100 participants published in Physiology & Behavior found that GLP-1 receptor agonists may also alter the perception of sweet, sour, salty, bitter, and umami (savory) tastes.
The experts suggested that ceasing the use of GLP-1 receptor agonists would likely resolve Ozempic tongue; however, individuals who desire to continue treatment should stay hydrated, follow an oral hygiene routine involving daily flossing and brushing, use spices to enhance flavor and eliminate unpleasant tastes with rinses.
ADA News
What is ‘Ozempic Tongue’?
Some people using GLP-1 drugs say they have a persistent bad taste in their mouth, an effect some have dubbed “Ozempic Tongue.”
A lingering bitter, sour, or metallic taste isn’t unique to GLP1 drugs. For instance, Paxlovid, an antiviral used to treat COVID-19, may also cause a metallic taste in the mouth.
Why Do People Get ‘Ozempic Tongue’?
During clinical trials for Ozempic, about 0.4% of people who used the drug reported developing dysgeusia, a disorder that alters someone’s sense of taste.1
Bad tastes linked to medications can happen when a drug is absorbed and then released into the saliva, according to Tricia Quartey, DMD, a Brooklyn-based dentist and spokesperson for the American Dental Association.
Quartey said some medications can also reduce saliva production, leading to dry mouth, which may intensify bitter or sour flavors.
GLP-1 drugs may have an additional effect. A study published in Physiology & Behavior in January found that these medications can alter the perception of sweet, sour, salty, bitter, and umami (savory) tastes.2
The small study found that about 85% of those using GLP-1
drugs experienced “significantly reduced taste perception” compared to the control group.
Taste Change Might Explain Reduced Appetite
Many of the study participants taking GLP-1 drugs had both a “distorted” and “diminished” sense of taste, although some only noticed changes when they were asked, said Richard Doty, PhD, a co-author of the study and a professor of otolaryngology at the University of Pennsylvania School of Medicine.
“That’s probably another route of why [the medications] cut down on appetite,” Doty said.
Excess weight can also affect the brain and tongue, making people less sensitive to flavor.3 This reduced sensitivity may lead people to eat more to get a greater sense of reward from food, said Mert Erogul, MD, a bariatric medicine specialist at the Maimonides Medical Center in Brooklyn.
“And then when people eat less, they become more sensitive to flavors. So, before you may have wanted a bag of Doritos, but now it may be too flavorful,” Erogul said, adding it’s unclear whether the perceived changes in taste are due to the medication itself or the weight loss outcome.
Erogul, who prescribes GLP-1 drugs to patients, said he hasn’t received complaints about taste changes, but suspects many patients are so pleased with their weight loss that they may not consider the change significant.
What Can You Do If You Have ‘Ozempic Tongue’?
Erogul said that stopping the medication would likely resolve any taste issues.
However, for those who want to continue using GLP-1 drugs, there are some tips to deal with taste changes, according to Britta Reierson, MD, an obesity specialist and primary care doctor at Knownwell.
These include:
1. Stay hydrated. Maintaining moisture in your mouth will optimize the function of taste buds.
2. Practice good oral hygiene. Brushing, flossing, and using a tongue scraper can remove bacteria and improve taste perception.
3. Enhance flavor with spices. Trying different seasonings may help compensate for muted tastes.
4. Use rinses. Swishing with diluted apple cider vinegar, baking soda and water, or lemon juice may help eliminate unpleasant tastes.
Fran Kritz
Verywell Health
WHAT COULD SALIVA TESTING MEAN FOR DENTISTRY?
Emerging technology may have applications in oral health care
During the COVID-19 pandemic, saliva-based tests gained attention for their ability to detect SARS-CoV-2, and this emerging technology may have applications in oral health care as well.
“As a complex biofluid containing biomarkers such as proteins, antibodies, genetic material and hormones, saliva has the potential to be used to detect other systemic and oral diseases too, but more research is needed to establish the clinical validity and reliability of these tests,” said Ashraf Fouad, D.D.S., chair of the American Dental Association’s Council on Scientific Affairs and professor at the University of Alabama at Birmingham School of Dentistry.
The ADA Forsyth Institute is among those developing saliva tests that could be used in oral health care. Its scientists are also conducting research to validate new biomarkers related to dental diseases.
“There are demands for rapid, point-of-care diagnostic tools with high sensitivity and specificity,” said Wenyuan Shi, Ph.D., CEO of ADA Forsyth. “Advanced technology today is finally getting to a stage to make this a true reality.”
Innovations on the horizon
“Saliva contains DNA from your body and also genetic information from viruses or bacteria if you’re sick. That means it’s a gold mine of information — you just need the right tool to dig out what you’re looking for,” said Benjamin Wu, D.D.S., Ph.D., chief scientific officer and chief operating officer of ADA Forsyth.
For scientists at the institute, that tool is CRISPR — or clustered regularly interspaced short palindromic repeats — a technology that enables users to selectively modify the DNA of
living organisms. In the case of saliva testing, the scientists can engineer CRISPR to search for specific DNA or RNA sequences in a saliva sample.
“CRISPR is like a pair of molecular scissors that scientists can program to find and cut genetic materials into visible signals,” Dr. Wu said. “It’s a tool that can look for very specific genetic instructions — like finding one sentence in a giant book.”
For example, scientists can use CRISPR to look for a virus like human papillomavirus in saliva based on its genetic code. Once CRISPR finds the target virus, it can trigger a signal that can be read by a cellphone or other device.
“AFI scientists will initially develop the tests for common oral diseases while working closely with ADA expert clinicians to identify additional targets that provide valuable insights into oral and systemic health,” Dr. Wu said.
In the lab
With some saliva tests already available and others in development, it is important for dentists to understand how these tests are regulated and what the regulations indicate about their clinical validity.
Saliva testing performed by laboratories is generally regulated by the Clinical Laboratory Improvement Amendments of 1988, according to the ADA’s Oral Health Topics webpage on salivary diagnostics
CLIA established quality standards for laboratory testing and an accreditation program for clinical laboratories, according to the Food and Drug Administration, which administers the CLIA program with the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention. Through CLIA, clinical labs are certified before they can accept human samples for testing to ensure test results are accurate and reliable.
“Being a CLIA-approved lab validates that a lab is using accepted best practices and meets specific standards with respect to how they perform a test, i.e., you do the same thing every time for every specimen you receive,” said Mark Lingen, D.D.S., Ph.D., oral and maxillofacial pathologist, professor of pathology at the University of Chicago Medicine and former member of the ADA Council on Scientific Affairs. “That is a good thing because you have some assurance that different results from different patients for the same test are real and not the result of random differences because each sample was handled or processed differently.”
Certified labs may design, manufacture and use their own tests. Although the FDA has the authority to regulate these lab-developed tests, it generally has not done so as a matter of policy, according to the agency. However, the FDA issued a final rule in
2024 to increase its oversight of lab-developed tests by 2028 to help ensure their safety and efficacy.
Currently, when a lab develops a test without receiving FDA clearance or approval, CLIA prohibits it from releasing any test results without first evaluating the test’s analytical validity, meaning its ability to accurately and reliably detect and measure the biomarkers it is supposed to detect and measure. This validation is limited, however, because it only applies to the conditions present in that specific lab, according to a CLIA fact sheet from CMS
CLIA regulations do not address the clinical validity of tests, meaning the accuracy with which they identify, measure or predict the presence or absence of a clinical condition or predisposition in a patient. To make a claim of clinical validity, the manufacturer has to submit the test to the FDA for evaluation outside the scope of CLIA, according to the ADA.
“CLIA focuses on the variables of ‘test performance,’ such as lab processes, personnel, quality control, proficiency testing, and quality and accuracy of reporting of results,” Dr. Lingen said. “However, CLIA does not focus on the issue as to whether there is evidence that the results are clinically meaningful, i.e., efficacious/clinically actionable. So, in theory, you can actually have a saliva test that is performed in a CLIA lab that has zero diagnostic accuracy for a specific disease in question.”
The FDA’s role within the CLIA program involves categorizing commercially available tests based on their complexity, which determines the applicable CLIA requirements for performing the tests. Simple tests with little risk of producing an incorrect result are considered to be “waived” tests, meaning the sites that perform them are waived from meeting most CLIA testing requirements. Lab-developed tests, which often rely on high-tech instrumentation and software, default to the high-complexity category, according to the CDC.
When being certified by CMS as part of the CLIA program, labs that only perform waived tests receive a CLIA Certificate of Waiver. These labs must follow the manufacturer’s instructions for the tests but do not need to meet CLIA quality standards, according to the CDC, which develops the standards.
Like labs, health care offices that perform in-office testing are regulated under CLIA, which means dentists who administer waived tests at the point of care need to obtain a waiver certificate for their office, according to guidance from the CDC and CMS on obtaining a certificate. The office requires a certificate regardless of how many tests it performs and whether or not it charges the patient or bills insurance.
Most point-of-care tests are waived. Providers and labs with a waiver certificate must only perform waived tests
Practice Transition Specialists
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–Roger L. Farley, DDS
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marie chatterley
FDA oversight
While several SARS-CoV-2 saliva tests received emergency use authorization from the FDA during the pandemic, the only diagnostic test involving saliva or oral fluids that has received FDA approval is one that detects HIV, Dr. Shi said.
“There are many tools that have been developed in the past 10-plus years,” he said. “The key challenge is still getting through the FDA approval process with proper clinical validation data. I am hopeful as there are various saliva-based new products that are going through the process.”
No saliva tests have been approved by the FDA for evaluating patients’ risk of periodontal disease, dental caries, or head and neck cancer, according to the ADA, but an FDA database shows the agency has cleared saliva tests related to caries risk in the past.
The FDA classifies medical devices as Class I, II or III depending on the level of regulatory control that is necessary to reasonably ensure their safety and effectiveness. Class I devices have the lowest level of risk and are therefore subject to the least regulatory control while Class III devices have the
highest level of risk and face the most stringent regulations. Saliva tests can fall into any of these classes depending on their intended use.
All device classes are subject to general controls, such as requiring manufacturers to register with the FDA and provide a list of all their products, banning labeling that is false or misleading, and requiring production methods and facilities to conform to current good manufacturing practices. General controls are the baseline requirements of the Food, Drug and Cosmetic Act, which gives the FDA its authority to regulate medical devices. However, exemptions can apply to these and other device regulations, according to the FDA.
Manufacturers of Class I or II devices are required to submit a 510(k) premarket notification to receive clearance from the FDA to market their devices unless the devices are exempt. A 510(k) must demonstrate the device to be marketed is as safe and effective as, or “substantially equivalent” to, a legally marketed device.
The FDA determines whether the device is as safe and effective as the predicate device by reviewing the scientific
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methods used to evaluate their differences in technological characteristics and performance data. This performance data can include clinical or nonclinical data, according to the FDA.
“In the FDA clearance paradigm, the applicant does not have to definitively demonstrate efficacy for the new test or device,” Dr. Lingen said. “This is extremely important as the practical real-world implication is that a company can market an FDAcleared test/device without ever providing definitive peer-reviewed evidence of the diagnostic accuracy of the test being marketed or the claims being made about the product.”
The FDA may also determine a 510(k) is not required to provide reasonable assurance a device is safe and effective, and the device is therefore exempt from the premarket notification process. Most Class I and some Class II devices are exempt, according to the FDA
Some examples of Class I or II dental products include toothbrushes, which fall under Class I, and dental impression material and curing lights, which are considered part of Class II.
Premarket approval is required for Class III devices, which are devices that sustain or support life, are implanted, or present potential unreasonable risk of illness or injury, according to the FDA.
Premarket approval is the most stringent type of device marketing application required by the FDA. Approval is based on a determination by the FDA that the application contains sufficient valid scientific evidence to ensure the device is safe and effective for its intended use.
“FDA approval is a rigorous process that requires demonstration of both safety and efficacy, typically through multiple phases of clinical trials,” Dr. Lingen said.
Examples of Class III medical devices include pacemakers, cochlear implants and breast implants. The HIV oral fluid test approved by the FDA is also a Class III device because it carries distinct performance considerations and risks as a homeuse test, according to the FDA. It is the only home-use HIV diagnostic test approved by the agency, which issued a final rule in 2022 to reclassify other HIV diagnostic tests that are not for home use as Class II devices.
The FDA states there is a unique link between safety and efficacy when it comes to tests since their safety is not generally related to their contact with patients. The agency determines their safety based on the impact of their performance — especially false negative or positive results — on patient health.
At the ADA
Changes related to saliva testing are coming to the CDT Code in 2026.
The Code Maintenance Committee, a standing committee of the ADA Council on Dental Benefit Programs, met in March to accept, revise or decline more than 50 proposed code changes.
One new code approved by the committee addresses point-ofcare saliva testing. In the code, “point-of-care” reflects the use
of the tests both at dental offices and other care sites such as assisted living facilities.
The committee also voted to amend two existing codes related to saliva testing. The changes reflect the use of the codes for lab-based tests.
In February, the ADA convened leaders in dentistry and medicine for the Oral Cancer Summit, which addressed dental and medical collaboration in the fight against oral cancer. One of the panels discussed saliva tests in development that could potentially help evaluate patients’ risk of head and neck cancer.
“However, as they say, the proof is in the pudding,” said Dr. Lingen, who participated in the summit.
He said the companies need to perform the appropriate studies and publish their results in peer-reviewed journals to demonstrate their tests have sufficient diagnostic accuracy and are therefore valuable to clinicians and patients — which is what FDA approval would require.
“At this time, there is insufficient evidence that any of the salivary oral cancer screening tests have sufficient diagnostic accuracy to be included in everyday clinical practice,” Dr. Lingen said. “I am hopeful that new tests and platforms in the near future will demonstrate sufficient diagnostic accuracy.”
Mary Beth Versaci ADA
PRACTICE
CONGRATULATIONS TO THORUP DENTAL
Dental offices take home top prizes in 2024 ADA Design Innovation Awards
Contest showcases esthetic appeal, function
The winners of the 2024 ADA Design Innovation Awards include a modern orthodontic office in California, a dental office with a natural esthetic in Utah and a dental practice that was remodeled in Ohio with an eye on efficiency and collaboration.
The annual competition showcases the best dental practices in esthetic appeal, function and design. A panel of judges selected the three finalists in each category — new build, large new build and remodel — and then the dental community voted for their favorites.
The 2024 competition saw a total of 3,605 votes from 2,704 voters — both figures a substantial increase from 2023.
Thorup Dental in South Jordan, Utah, won the large new build category. The runners-up were HT Complete Family Dentistry in Overland Park, Kansas, and The Dental Bar in Aurora, Colorado.
The competition was sponsored by the ADA, ADA Member Advantage and Panacea Financial. To read more about each finalist, visit ADA.org/DIA.
READJUSTING PATIENT PRIORITIES
Dentists face the professional obligation to correct the problem, yet patients refused to accept the treatment plan.
Frustration abounds for both patient and practitioner when an elaborate case presentation falls on deaf ears. Face it --- dentists are in competition for the discretionary consumer dollar. Patients see the pleasure of home stereos and face lifts, or maybe simply food on the table, more easily than their lasting health due to a restored dentition. And when the dentist mumbles dental terms or elaborately describes dental procedures, patients retreat . . . unless it is done effectively.
Take, for example, three different patients. Mr. Dunn has four kids and unsightly fluorosis that keeps him from smiling. His kids’ friends ask why their dad has “dirty teeth.” When he visits the dental office, he learns that he can choose from veneers, crowns, whitening . . . or go out of the country where care is less expensive. Mr. Dunn is a carpenter. He leaves thinking about veneered countertops, crown molding, and white paint because that is his frame of reference. He tells his wife that the dentist talked too fast and confused him, but he does know that he cannot get it fixed without leaving the country. Mr. Dunn further secured this outcome by telling her the cost of care. Both had sticker shock! Instead, they went out to buy a widescreen to entertain the kids for years to come.
New patient Mr. Myers has different priorities. A telephone sales manager, he arrives with asymptomatic, active periodontitis that has created several 7 to 8 mm pockets. He has excessive tissue recession, some mobility, and malocclusion because several teeth are missing. Mr. Myers has no pain and does not care about esthetics and, therefore, considers the diagnosis preposterous. He cannot believe that many teeth of his teeth require removal. Upon departure, he agrees to call back after his heart surgery.
Finally, Ms. Takez visits a dental office after an 18-month lapse. She needs some soft-tissue management, four to five simple extractions and three full crowns, but she only wants to do a little at a time and only procedures that are completely covered by insurance. Since her annual maximum is $1,000, it will take several years to complete treatment, and she must pay a portion of each procedure. Her treatment cannot wait without risk of serious consequences. She says that she will talk to her husband, but never returns.
In these three different situation, dentists face the professional obligation to correct the problem, yet patients refuse to accept the treatment plan. Instead, they sit around with active disease and untreated problems, watching their widescreen. What is the dentist’s responsibility? How can we communicate our experience with similar cases, predict the future in terms that are relevant to patients and establish good oral health and well-being? How can we compete with a widescreen television? With a well-run team. This cannot be emphasized enough.
Dentists may pride themselves on perfectly organized protocol and fabulous marketing, yet these are worthless if the scheduler mishandles a patient on the first call. The value created in that first call actually influences case acceptance. The first visit influences it, too, before the doctor even enters the room. The team must reflect value for the procedure and level of care, rather than the medical history and insurance card. Forget them, for the time being. Who cares about an insurance card before treatment acceptance? Rather, seat the patient within five minutes and put energy into the discussion, normally initiated by questions such as, “How can we help you?”
Make eye contact with the patient and then listen, which is different from hearing. When providers listen, really listen, they understand their patients’ needs and connect with them. Ask probing questions to ascertain the problem, then ask enough questions to decipher the real problem, rather than just the first one they suggest. Remember that dentists are most comfortable talking about science and techniques, but consumers do not care about these things. Patients are most interested in learning about the reason for a procedure that improves the situation, and they want a brief explanation about how the treatment will be performed. Expert patients to find dental lingo confusing; we need to have patience with them! Realize that a very detailed explanation will just cause confusion, and confused people cannot decide anything!
Once the dialogue has shown the direction of interest, ask about allergies, get a medical history, and then perform an initial screening. Copy the insurance care once patients actually accept treatment. Besides, it is often important to seek a physician’s medical clearance for subsequent operative treatment. Patients historically fail to see the relevance of radiation therapy, for example, as it relates to dental treatment. Physicians’ blessings ensure patient safety.
What does all this have to do with a well-run team? Team members make the first impression of professionalism, exude the quality of treatment received and solutions offered, and streamline the communication process. Dental team members have a lot of influence on patients. If done properly, the patient in the chair is willing to accept treatment before the dentist even enters the room.
It does not matter if the case is $5,000, of $45,000, the technique is the same. Case presentation and patient acceptance of treatment consist of the FIVE T’s: Trust, Timing, Technique, Tolerance and a Trained Team.
Trust
Here is a bold statement: If any professional has to pronounce his honesty, it automatically forces the patient to consider that the dentist may actually not be honest.
People “sense” both honesty and integrity. Dentists have a very short time to reflect their integrity to a patient. But it will help dramatically if they promise patients only what they can reasonably deliver. A patient should never leave a consultation thinking that the dentist will grant any wish, just because the dentist listened to his or her dreams and failed to interject the realities. Dentists have a tendency to avoid disagreeing with patients. If patients receive a guarantee of specific results when there is no way the dentist can provide that, patients’ intuition can “sense” this as well.
Does this make dentists liars? No. There are several reasons that case presentations fail. First, dentists do no want to lose any patients, so they try to be everything to everybody. They politely smile while a patient says that he or she wants new front teeth, which are five times whiter, for less than $1,000, in the next two weeks, for a daughter’s wedding, because the patient has put it off for the last four years.
Second, dentists do not like to bear bad news. Most people would agree that it is easier to attempt to fix problems in the short un and remain the “hero,” rather than face the long-term reality of any situation, especially when it pertains to body parts. Why is liposuction or a tummy tuck the cure of overweight people, rather than diet or exercise?
Third, most patients do not embrace long-term thinking when faced with short-term needs and wants. Telling patient that they “will lose their teeth someday” is akin to telling smokers that they will die of cancer. In their minds, the problem has yet to arrive, so there is no need for a solution. Finally, as professionals, enthusiasm for Implant No. 1,322 is difficult to muster.
Dentists spouting all the data and naming all the oral and physical structures involved in treatment do little to set the patient’s mind at ease, particularly when spoken in a detached monotone. One must realize the No. 1,322 is routine, from a dentist’s vantage point, but appears as surgery and an unbudgeted expense from the patient’s perspective. The entire team must exude commitment, interest, and confidence in the patient’s treatment, as the patient considers the treatment.
Timing
This is the number one deal killer. One would think that the more time that is committed to case presentation, the higher the case acceptance. I have found the opposite to be true, to a point. When I spent 90 minutes on very thorough explanations in the past, my acceptance rate was 35% to 40%. In contrast, I now spend 20 minutes really listening to my patient’s needs and providing simple explanations that stress the benefits of care, and my case acceptance has risen to the 70% to 80% range. I have also found that the more I thought of myself as a dentist or dental specialist during case presentations, the worse this percentage became.
Similarly, patients should not wait long in the reception room. They just have more time to observe and look for reasons to postpone care or become more apprehensive. I have actually
documented that the rate of case acceptance decreases as the length of waiting time increases.
Technique
Conventional wisdom for large case presentations have already indicated a need for diagnostic casts, radiographs, diagrams –and possibly an education-based PowerPoint. Dentists usually hit the high spots of treatment, from the vantage point of problem solving. This causes confusion. In contact, nonconventional wisdom includes dialogue aimed at mutual understanding of the end product, using a wax-up or photo for explanation, and includes the goal of optimal oral health and esthetics. This contributes to overall health and better quality of life. Statements about treatment always offer a solution from the vantage point of the “benefits of care,” rather than solving a problem. In addition, that solution cannot be, “You’ll still have your teeth in 25 years.” That is too intangible! Procedures explained as analogies to real life always help patients understand the significance and urgency of treatment. For example, compare the periodontium to the foundation for a home, and then it is easy to understand that it must be sound for long-term support.
What about the nonverbal cues during case presentation? The dentist’s position and posture communicate as much as the words. It is easy to lapse into a submissive, almost agonizing and frame of mind when repeatedly faced with rejected treatment plans. Face those fears! Systematically present the complete treatment needed, referencing the patient’s needs and interests in life and focusing on the benefits of treatment. It is easier said than done. It takes practice. It often requires coaching.
A different perspective of technique applies to one’s level of expertise. If a patient presents with Tooth No 8 missing, should the dentist suggest a three-unit bridge just because they do not perform implants? Do they look at what is best for the patient, even if that requires a referral? It could be easily argued that one lacks integrity if they overtreat with bridgework, undertreat periodontal conditions, or perform patchwork dentistry.
Tolerance
Be prepared. Patients may have no awareness of dental diseases or modalities. Moreover, their interest level may be low. Keep descriptions simple and explain only things that are valuable to them. When patients later ask questions to clarify the procedures or financial details, do not get restless or dismiss the patient. Patients must feel genuine interest on the part of the provider.
Many consultants declare that dental professionals need scripts to communicate. However, this is robotic and emotionless. Effective dialogue revolves around the dentist’s capacity to listen to patient needs and their perceived solutions. Effective decisions stem from a heartfelt interest in understanding from bother patient and provider perspectives.
Handling dental treatment takes on new meaning when one discusses the benefits of care vs. the problems that require correction. Do not talk about treatment objectives; instead talk about
what the specific treatment will do for the patient. Talk about the consequences involved if treatment is delayed, and discuss how this affects the patient’s quality of life.
Dentists must state this clearly with confidence, and not just as “It will get worse,” which is meaningless. Remember that dentist cannot control patient’s financial situations, their time, or lifestyle. All they can do is emphasize the value of dental care that patients need.
Why do patients hesitate to accept a treatment plan? Their reasons fit in one of four categories:
1. They do not understand the presentation but will not admit it.
2. They do not believe the dental practice has their best interest in mind.
3. They feel commanded to act.
4. They do not have a sense of urgency about the situation.
Notice that “money” is not part of the equation, though it is the excuse given. People find ways to afford something when they are legitimately convinced that they need it.
Trained Team
Every team member must know which procedures are performed, why they are done, and how the patient will benefit. It is imperative that training occurs at least three times a year to explain new or changing procedures. This creates team strength, increases employee trust, and develops the synergy necessary for clear communication with patients.
Similarly, every dentist must know the power of “BUT,” the first word in the sentence when attempting to justify something. All have heard, “But insurance does not cover . . .” and “But you do not understand.” “But” means an excuse is on the way! Patients are guilty, but so are dentists. Do any of the following excuses sound familiar?
• But my patients are dependent on insurance . . .
• But my team is not as trained as yours . . .
• But this patient never accepts any treatment, so why bother?
What about one’s professional responsibly to present treatment, regardless of the outcome? No dental book states that one should only present treatment covered by insurance. Make all “buts” small and nonexistent and focus on the value – that is the best starting point for success. Using non-conventional thinking, how can the three examples presented earlier yield a favorable case acceptance? Let’s reexamine the scenarios.
Mr. Dunn’s children are his focus. He should recognize that sacrifices are made as a family. For example, if his son broke an arm, the family must do with-
out something else. His self-esteem is low, he never smiles, and his children are embarrassed when friend consider their dad a “crab.” Mr. Dunn must realize that he deserves physical improvement, just like his client who senses safety from newly installed doors. Perhaps a payment plan would make it easier.
Mr. Myers does not care about his smile, but he has mentioned his heart surgery in passing. This patient does not realize the ramifications of periodontal disease on the heart. Urge him to schedule a cardiology conference and determine whether a periodontal scaling and select extractions are needed well before surgery to positively affect the outcome.
Ms. Takez clearly has no sense of urgency about her care. If she had maximized her insurance benefits each year in the past, she could have reduced her overall outlay for treatment. In this situation, she must mend her ways and schedule treatment while there is viable tooth structure available and little risk of endodontic involvement, which is even more costly. The dentist must explain the way the insurance reimburses for procedures, stressing the urgency involved now that there are signs of disease.
Use these methods to take the futility out of case presentations and, in doing so, increase case acceptance. This will improve the quality of life for consumers and they may just do without that widescreen.
Anil K. Agarwal, DDS, MS Board Certified Prosthodontist
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STUDENT LOAN SPOTLIGHT: HOW DENTISTS CAN QUALIFY FOR STUDENT LOAN FORGIVENESS
Student loan debt can have a major impact on your career decisions and quality of life as a dentist. Since the average medical school graduate owes more than $227,000 in student loan debt and dental school graduates average even higher with more than $296,000 in student loan debt, managing this high level of debt and the resulting monthly student loan payments is often a challenge.
The good news is that dentists have several potential paths to student loan forgiveness, as well as programs that will make their monthly payments more manageable during their earlycareer years. Let’s explore how dentists can qualify for student loan forgiveness through federal programs, such as incomedriven repayment plans.
How can dentists qualify for student loan forgiveness?
Whether you work in public health or the private sector, you could be eligible for student loan forgiveness as a dentist. Let’s take a closer look at income-driven repayment plans for dentists.
Income-driven repayment is a federal repayment program that can stabilize your monthly student loan payments and provide forgiveness on your remaining student loan balance after 10, 20 or 25 years of repayment, depending on which plan you choose and how much student loan debt you have.
Unlike some other federal programs, you do not have to work for a government or nonprofit organization to be eligible; in other words, if you work in private practice, you could enroll in income-driven repayment.
What are the types of IDR plans?
The income-driven repayment program offers different plans that use varying formulas to calculate your monthly student loan payment amounts based on your discretionary income and family size. Current income-driven repayment plans include income-based repayment, income-contingent repayment, Pay
As You Earn and Saving on a Valuable Education, formerly Revised Pay As You Earn.
Note, while the new Saving on a Valuable Education plan was introduced in 2023, multiple legal challenges made by states to the SAVE plan could impact implementation of key aspects of the plan. In addition, some of the plans above are not currently accepting new applications. For the most up-to-date developments, visit studentaid.gov.
Pros and cons of IDR plans
The pros and cons of income-driven repayment will vary for each individual borrower based on your circumstances, but benefits may include:
• Lower monthly payments, even as low as a zero payment for some borrowers
• Potential loan forgiveness after meeting program requirements.
• Financial benefits for those who have high debt-to-income ratios or low income.
On the other hand, some drawbacks could include:
• Increases in the total interest over the life of the loan caused by extended repayment.
• The possibility of larger payments in the future if you experience salary increases.
• Loan forgiveness through income-driven repayment being a taxable event.
Is IDR right for you?
To learn more about income-driven repayment and how to apply, contact a Laurel Road student loan specialist for a free 30-minute phone consultation and analysis of your student loans. Our specialists are well versed in the details of incomedriven repayment and can help you understand the right plan for you based on your unique financial profile.
by Alyssa Schaefer — Laurel Road
Ms. Schaefer serves as the general manager and chief experience officer of Laurel Road. She oversees all aspects of the business, including marketing, operations, risk, and profit and loss management, with particular attention to its digital products and customer experiences. Laurel Road is a brand of KeyBank National Association.
At
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