Kellie Nock is the assistant editor for Dental Products Report. She graduated from Kent State University in 2018 with a Bachelor's in Journalism. Kellie enjoys multimedia content creation with a focus on audio and video storytelling. 

DPR Top 100: Top 5 Equipment Products of 2023

Articles

Equipment is the backbone of any good dental practice, and 2023’s dental equipment offerings provided ample opportunity to strengthen this key element in the dental practice. Here are the top 5 equipment products of 2023.  

DPR Top 100: Top 10 Practice Management Products of 2023

Top 10 Practice Management

Practice management tools play a pivotal role in orchestrating and optimizing all the essential processes within a dental practice. As we delved into the landscape of 2023, we noted several standout practice management tools, each designed to address the evolving needs of dental professionals and enhance the overall patient experience. As technology continues to advance, the tools listed here are poised to play an increasingly integral role in shaping the future of dental health care administration.  

John Flucke, DDS, is in private practice in Lee’s Summit, Mo. He also serves as chief clinical editor and technology editor for 

® and keeps an active blog filled with thoughts and tidbits on the world of technology at blog.denticle.com.

DPR Top 100: Dr Flucke's Top 5 Test Drives of 2023

Hey, gang, guess what time it is? That’s right. Unless you missed the headline above the article—and I’m guessing you didn’t—it’s time for my Top 5 Test Drive rundown. I have led a charmed life, there is no doubt about that. I say that because I love technology and I love telling all of you about the latest and greatest gear in our profession. I am fortunate because my job here at 

 allows me to see a lot of products that are either on the profession’s “near horizon” or are newly available. I get a chance to try and tinker with some amazing things and then I get to tell all of you about them. Other than treating patients, this is my dream job. One quick thing before we get started: This is not an all-inclusive list or an endorsement of one product over another. Also, this list is not in any order of preference. The products here are simply the ones that impressed me the most. And, we’re off!

1. Amber Mill Direct Powered by Roland and Chairside Zirconia Powered by Roland

Some of you may remember that one of my Top 5 from last year was Roland DGA’s DGSHAPE DWX-42W in-office mill. I did more than a trial. I have been using the mill in my office for 18 months. Like other dental practices, we frequently use lithium disilicate and zirconia materials for everyday fixed prosthetics. However, the one drawback to these materials has been the need to sinter or crystallize them in an oven for extended periods. These are some of the best materials available, but the extended finishing time they required impeded same-day dentistry, making it more of a challenge in real time.

To the rescue come 2 new CAD/CAM material blocks from Roland DGA. Chairside Zirconia, a fully sintered zirconia, and Amber Mill Direct, a precrystallized lithium disilicate. The game-changing thing about these 2 new materials is the simple fact that neither requires any sintering or crystallization, which means no oven time. Both materials are multigradient for optimal translucency and esthetics. Restorations come out of the 42W in-house mill at full strength and are ready to seat. The workflow is simple: scan, design, mill, polish, and cement. Now dentists can utilize 2 of the most popular materials on the market today and deliver the final prosthesis the same day. We are having amazing results with both new high-quality materials. Chairside Zirconia and Amber Mill Direct, powered by Roland DGA, allow us to provide the time savings that patients want as well as the strength and esthetics that doctors demand. Material science rocks.

More general dentists are using clear aligner therapy to improve their patients’ smiles. However, the one part of this treatment that doctors often dread and struggle with is interproximal reduction (IPR). Slenderizing the teeth to gain the necessary space for proper alignment is important but can be difficult for the doctor to accomplish. That is where DentaSonic comes in. This Switzerland-based company makes all the abrasive strips a doctor needs to perform IPR. However, the best part is that there also is a handpiece system to do the job. The DentaSonic handpiece is a reciprocating device that moves the amazing abrasive strips in a back-and-forth motion that allows the doctor to reduce the interproximal areas smoothly, easily, and quickly. The strips are flexible, which allows the doctor to maintain proper contour and shape of the teeth while easily accomplishing the task. The strips come in multiple thicknesses and there is even a polishing strip that lets the doctor bring the enamel back to a smooth surface after the IPR is accomplished.

DentaSonic sells kits that contain everything needed to get started. The handpiece-ready DiaStrips also are sold individually so you can replace them when needed. The handpiece can be purchased as air-driven DS-Twist or (my favorite) the cordless rechargeable IPR-EVO, which can be used for IPR or as a cordless endo motor. My office does a fair amount of clear aligner therapy and DentaSonic makes the process much easier—and it is much more comfortable for patients. If you are performing IPR, you need this.

3. Medidenta ACE (Advanced Cordless Endo) Motor

To do it well, endo requires a pretty significant armamentarium. Because we need a lot of things to do the treatment, our counters get cluttered. In the dental operatory, we have limited countertop space and the more things we add, the more crowded things become. Wouldn’t it be nice if someone could produce a way to do more with less? Well, someone has, and it is called the ACE Motor. It was developed for Medidenta by an endodontist named Carlos Spironelli Ramos. The product name really says it all. ACE stands for Advanced Cordless Endo, but cordless is just the tip of the tech iceberg when it comes to this device.

The ACE not only performs rotary instrumentation, but reciprocating (watch winding) instrumentation as well. It also has an incredibly nice feature of allowing you to connect the motor to the base with a thin, flexible cord, and this allows the doctor to use the apex locator as you use the motor to instrument the canal. That’s right—you can see where the file is in the canal as you instrument it. Those features are amazing and justify the product’s inclusion in this list, but wait…there’s more. The ACE is also fully programmable. You can program the correct parameters for any file system. This feature means that no matter who manufactures the file, you can set the motor to accommodate it. Also, an operator often does not want a simple 30° clockwise and 30° anticlockwise oscillation. The ACE can be programmed to perform many different degrees in both directions, giving the doctor an unprecedented amount of control. This might be the only endo motor you need for years to come.

This year I began working with CandidPro as a bit of a trial and was so impressed that it has become my go-to clear aligner partner. I made that decision for a few different reasons. The most important to me was the high degree of communication. A CandidPro staff orthodontist is assigned to your case and is there to provide guidance and support. The Candid team is available and reliable, helping you from start to completion.

One of the other big winners for me was the less likely need for attachments. Sometimes they are a necessary part of treatment, but we are placing significantly fewer attachments than in the past. Depending on the case, the number of attachments, and the patient, placing attachments can be the most difficult part of the process. Needing fewer attachments benefits doctor, assistant, and patient.

Polymer chemistry is a tremendously evolving science and CandidPro has kept up. Its aligners are made of Zendura FLX, a material that provides gentle but steady force to move the teeth. This means that when the next aligner in the series is placed, the teeth are much less tender, which increases adherence and makes for a happy patient.

On top of those benefits, the biggest reason I have become a fan is because of ScanBox pro. Every patient receives a special device that attaches to their mobile phone. The device works with the phone’s camera as a lip retractor as well as providing a constant uniform distance from the teeth. Using the CandidPro app, the patient routinely takes video of their mouth/teeth. That digital information is uploaded to CandidPro, where the company’s artificial intelligence (AI) system analyzes the file. The AI knows which aligner the patient is wearing and where the teeth should be at that point. If the case is not tracking correctly, the system will also notify the patient and the doctor so that correcting steps can be implemented. ScanBox pro checks the patients at regular intervals and ensures the case is progressing exactly as expected. How amazing is that?

Prior to the COVID-19 pandemic, the smart minds at Vista Apex released their RE-GEN bonding agent, which is bioactive. Rather than rest on their laurels and bask in the glory of a successful bioactive bonding agent, the company went back to work on even more products for the RE-GEN line. This past year saw the introduction of RE-GEN Endodontic Sealer.

One of the best advancements in endodontics in recent years has been the introduction of bioceramic sealers. The RE-GEN sealer uses Bioglass 45S5. Bioactive glass is an interesting material. It kills pathogens due to high alkalinity, has osteogenic properties, and is extremely biocompatible. Those are all great properties for an endo sealer to have. Add things such as high dimensional stability, low solubility (washout resistance), and high radiopacity and you can see why I am excited about this material. It is packaged in premixed syringes that allow the doctor to simply deliver the material with a gentle push of the plunger.

I am also really pleased with the delivery system. The company has created small cannulas it refers to as the MST (Material Saving Tip). These very slim and flexible tips allow the user to deliver the material into the canals easily, and because the tips are slim with a minimal reservoir, little sealer is wasted just filling the tip. This means that in addition to all the other benefits, RE-GEN Endo Sealer also helps reduce waste and the resultant cost that comes with all that extra material that is not left in the tip. I was a prerelease tester of the final material before it was launched, and I have used it exclusively since then with very good clinical results.

As one of the winners of the Cellerant Best of Class awards this year, VOCO Retraction Paste was loved by me and the other voting members. It is an aluminum chloride–containing paste that aids in hemostasis and tissue retraction. It is packaged in capsules like composite, and the tip of that capsule is long and narrow, which really aids in getting the material right into the sulcus. It expresses easily and as it sets it thickens and expands, which allows for tissue retraction without needing to use a cord.

It is a turquoise color, so it is easy to see, yet washes away easily when rinsed and does not stain the teeth. One of the things I really love about it is that aluminum chloride is also used in antiperspirants, which means it absorbs fluids. That means it not only retracts, but it helps with secretions in the gingival sulcus. Often Class V composites in the esthetic zone suffer from staining at the gingival margin. That is because those gingival secretions (which are clear) creep over the margin during bonding and affect the long-term marginal stability. Using VOCO Retraction Paste and then rinsing it away before placing the composite keeps those fluids from being a problem. I use it even if I do not need retraction or hemorrhage control, simply because it works so well.

It is a great little tool. You will be glad you have it around—trust me.

Although it was not a Test Drive for 2023, I continue to be impressed with the Bien-Air Nova electric handpiece. I began testing the Nova in December 2021 and have used it since then in a variety of cases and applications. The handpiece has cylcro gears, which give it a transmission like a Formula 1 car. In the time I have used it I do not think I have ever sent it in for service, and that is with daily use in some very demanding situations. It has 4-port water spray and a PVD (physical vapor deposition)-coated chuck that extends its life. It also is the first handpiece constructed of stainless steel.

Electric handpieces will change the way you practice. If you are not using a Bien-Air system, you should be.

So, another Top 5 Test Drive column is in the books. As always, thanks for reading and rest assured that I will spend 2024 testing and breaking all the gear I can get my hands on. I will
be back next year with another list of my favorite Test Drives. Remember,
I break the stuff so you don’t have to.

Dental Products Report® Technology Editor John Flucke, DDS, discusses his favorite test drives this year, offering insight on what makes these products and techniques so special. 

Focused on showcasing the forefront of implant dentistry, The Ditron Dental USA Symposium is an opportunity for 2 days of knowledge-sharing and skill enhancement with leading implant dentists from around the globe.

Taking place at the Gaylord Resort & Convention Center in National Harbor, Maryland, February 2-3, 2024, this event is designed to benefit dental professionals seeking the latest insights and techniques in the field.

With a stellar faculty of distinguished educators, attendees will have the unique opportunity to learn from the brightest minds in implant dentistry. Along with Ole T. Jensen, DDS, MS, Chairman of Ditron Dental USA, the speakers scheduled for the symposium include, Bach Le, DDS; Simon Oh, DDS; Edward Goldin, DDS; Alvaro Gracia, DMD; Michael Block, DDS; Aldo Leopardi, BDS, DDS, MS; Ervin Weiss, DMD; Don Ross, DDS; Dr. David Cochran; Dr. Lyndon Cooper; Dr. Frank Lamar, DDS; Michael Katzap, DDS; John Schwartz, DDS; and Daniel Gelbart, DDS.

Attendees will gain mastery of the latest methods for digital implant treatment planning and orchestration, focusing on fabricating both single and multi-unit restorations. The symposium promises 11 Continuing Education (CE) credits over the course of 2 days.

CT planning for time-effective means for temporization and final restoration

Step-by-step algorithms for full arch maxillary treatment

Optimizing patient and staff workflow to integrate time-efficient care and reduce stress

When to choose a restoration that mimics teeth with minimal flange and no bone reduction

Custom-milled abutments for screw-retained crowns and prosthesis

Shaping the gingiva from placement to final restoration

Digital workflow for single and multiple teeth

Seating for this symposium is limited, so interested participants are encouraged to register by visiting 

Leading dental implant experts will be presenting at the February 2-3 event being held at the Gaylord Resort & Convention Center National Harbor, Maryland.

Ditron Dental USA Symposium Set for February

Providing Restorative Care for People in Need. Image credit: © InsideCreativeHouse - stock.adobe.com

As the surgeon general said in 2000, you can't be healthy without good oral health. Nevertheless, many patients try to do just that for various reasons. However, some patients would like to get the oral healthcare they need but don't have access to care, again, for a variety of reasons.

We look at what the industry believes about access to care, why some patients don't have access to care, the problems that can lead to, and some successful programs that get patients the care they need.

Oral Health Care is Essential to Overall Health

The research established links between oral health and other systemic conditions. So, 3 years ago, the American Dental Association (ADA) passed Resolution 84H-2020, emphasizing dentistry's essential role in public health, particularly during the COVID-19 pandemic. The World Dental Federation (FDI) echoed this message in 2021, advocating for oral health's recognition as an integral part of overall well-being.

The surgeon general agrees. The 2021 update to the Surgeon General's report builds on the original 2000 report, emphasizing social and behavioral disparities that limit access to oral care. It calls for collaborative efforts among policymakers, health care professionals, and communities to integrate oral, medical, and behavioral healthcare and address systemic inequities affecting oral health behaviors and access to care.

Low-Income Adult Patients Don't Have Access, But Do Have Consequences

One of the reasons patients who want oral health care but don't have access to it is affordability. Medicaid, the primary healthcare program for low-income individuals, offers an extensive and mandatory benefit package for children, which covers oral health screening, diagnosis, and treatment services. Over the last decade, through combined efforts at the federal and state levels, Medicaid and the Children's Health Insurance Program (CHIP) have significantly improved access to dental care for low-income children, increasing their utilization of preventive and primary dental services.

In addition, the American Dental Association (ADA) has its charitable branch called the ADA Foundation. It manages programs like Give Kids A Smile® (GKAS), along with associated programs such as Tiny Smiles and Give Veterans A Smile. Since 2003, GKAS has given free oral health care to children. Every year, around 6500 dentists and 30,000 dental teams volunteer at GKAS events, providing screenings, preventative and restorative treatment, and oral health care education to over 300,000 kids.

However, fewer programs exist for low-income adults. Without dental benefits, there is a significant cost barrier for these patients. Also, a long-term lack of access to dental care or connection with providers can lead to low-income adults having low expectations regarding oral health or delaying seeking dental care until something hurts.

Unfortunately, not getting care when they need it can have a lot of adverse effects on these patients' lives, including:

Changes in appetite and the ability to eat

Tooth loss, which can cause nutrition problems

Chronic pain impacting speaking and sleeping

Work-related problems: i.e., employed adults lose over 164 million work hours annually due to oral health problems or dental visits, and people who do not have professional positions lose more of those than those who do

Negative effects on job prospects due to damaged teeth or tooth loss.

Some states have responded to these needs. For example, the California Department of Health Care Services (DHCS) has Medi-Cal Dental. They encourage their members to call them for help finding a provider and for dentists to register their practices with the program. The program treats patients for things like:

Periodontal maintenance, scaling, and root planing

Orthodontics for kids who qualify for it.

People with Special Needs Also Struggle with Access to Care

Another patient population that suffers from access to care is those patients who have special needs. People with developmental disabilities like autism, cerebral palsy, Down syndrome, or other conditions face challenges in taking care of themselves, especially their oral health. For example, the following can interfere with their ability to take care of their teeth:

might make it difficult to understand and follow instructions at the dentist or home.

 contribute to patients feeling anxious, making dental treatment uncomfortable.

 make getting in and out of the dental chair harder, and appointments might take longer.

 can interfere with the patient's ability to eat or swallow.

 can make it challenging to get dental care safely.

 might require antibiotics before the patients receive dental treatment.

 can have symptoms that affect their teeth.

can happen, which can harm their teeth or mouth.

 can make it hard to communicate during dental visits.

 are more common in these populations, too.

This population often has problems with their oral health, like tooth decay and gum disease, because of problems with their home care. They also sometimes have harmful habits, like bruxism, food pouching, mouth breathing, and tongue thrusting. In some cases, children with developmental disabilities experience late tooth growth. Other people can suffer mouth injuries from falls, accidents, or seizures. Sometimes, the medication these patients take for their conditions can cause dry mouth or other issues that lead to problems with oral health care.

Penn Dental Medicine Care Center for People with Disabilities at the University of Pennsylvania treats people with disabilities who don't get proper dental care. They're also training students, dentists, and caregivers worldwide to improve the care for people with disabilities.

The Care Center has been running for 2 years, and it's getting busier. From September 2021 to September 2022, they had 1793 patients and almost 9000 appointments. The dental school also uses telemedicine to help patients, sharing their knowledge at conferences, teaching practicing dentists, and opening new places to treat people with disabilities and others in the community

DSOs Help Provide Restorative Care for People in Need in Many Ways

Despite the challenges, some patients who need (and want) access to care get it from dental professionals. Dental Support Organizations (DSOs) have many organized programs that give back to their communities.

For example, Aspen Dental opened the TAG Oral Care Center for Excellence (OCC) to treat low-income patients in the Chicago area, free of charge. The 25,000 sq. ft. clinic opened in July 2022 and has 16 dental care rooms, including 14 operatories and 2 surgical suites. The TAG OCC is a global center of excellence for continuing dental education while providing comprehensive quality care to those in need, including veterans and other underserved populations. The TAG OCC has donated over $4 million in free dental care to over 500 patients, with another 500 on a waitlist.

Julie Frantsve-Hawley, PhD, CAE, Executive Director of the TAG Oral Care Center for Excellence, describes it as the next evolution of the charitable giving Aspen calls the Healthy Mouth Movement, which they started in 2014. The TAG OCC is the year-round program serving Aspen's overall mission to break down barriers to quality care and bring better care to more people.

"We developed a strong partnership with the state of Illinois to help us provide this free dental care. A team of dentists and support staff provide care at the TAG Oral Care Center for Excellence who are wonderful, compassionate people who think and live our mission," Frantsve-Hawley says.

Aspen also uses the TAG OCC to train their team on their technology for 3D printed dentures and advances in implant placements. During this training, their teams provide access to care with the latest technology, which can give patients a new outlook on life, Frantsve-Hawley says.

"It's been inspiring and touching when we see many of our patients come to us in a state of despair and fear and shame and leave with a new smile and courage and a great outlook on life," Frantsve-Hawley says. "It's not just changing their teeth and smile, but it's changing their lives."

The combination of the efforts on behalf of the Healthy Mouth Movement, which also includes Aspen Dental’s Dental Service Day, where many of the practices nationwide provide free dental care to Veterans and their families, and the Overseas Outreach Program, which Frantsve-Hawley also leads, have led to over $23 Million in donated dentistry since 2017.

Heartland Dental established the Heartland Dental Foundation in 2018 with the vision to “

give supported doctors, team members, support professionals and the communities they serve more reasons to smile through passionate, thoughtful, and generous assistance

.” The Foundation raises money through various fundraising efforts and applies those funds to individuals in the Heartland support network experiencing hardship.

Heartland Dental also partners with the Heartland Dental Foundation on programs that reach outside the United States borders. Over the last 2 years, Heartland Dental has partnered with Mission Lazarus in several areas of Honduras to provide much needed dental care to the communities. This population, through no fault of their own, has zero access to the level of care that the Heartland supported team can provide, he says. David Foster, DDS, practices near Nashville at Gallatin Dental Care as a Heartland-supported doctor has participated in mission trips with the Heartland Dental Foundation.

"We have had 3 groups travel down to provide care, including our CEO, Pat Bauer," Dr Foster says. "Our goal is to provide more than extractions, which is the typical model of humanitarian work. We want to save teeth and provide consistent care so that our patients in Honduras can keep their teeth and their dignity long-term. So, in addition to extractions, we are placing fillings, providing cleanings, and even performing root canal therapy. The results are better than expected so far."

In 2023, 25 Heartland Dental supported doctors, delivered over $230,000 in dental care across two trips to Mission Lazarus. The teams provided 325 exams, 399 extractions, 170 fillings, and 18 root canals. These treatments likely would not have happened otherwise, Dr Foster says.

"Remember, our patients in Honduras must decide between paying for dental care or putting food on their tables. They always choose food, but because of Heartland Dental, Mission Lazarus, and our supply partners Henry Schein, they do not have to make that choice," Dr Foster explains, adding that the benefits to the Heartland team are significant, too. "I am always blown away by the quality of character our Heartland Dental doctors have on these trips. While serving others, we are developing life-long relationships and sharing dental knowledge. We are growing together as an organization while making the world a better place."

In 2024, Heartland Dental and the Foundation have additional mission trips planned, both to Mission Lazarus and to serve underserved areas in Appalachia.

Heartland Dental supported offices also participate in Free Dentistry Day, an initiative that has provided over $14 million in free dental care to patients over the years. This year, supported doctors have provided care for 5233 patients, resulting in $2,122,122 in donated dentistry, which is even more than they had the year previous. Many Heartland Dental supported doctors also participate in community outreach and local events, giving back to the communities they serve.

At Pacific Dental Services, they recognize the vital role they play as leaders in the health care industry within the communities they serve, says Carli Casey, Senior Manager of Corporate Social Responsibility and Service.

"Providing donated restorative dental care to those in need is one of the primary ways we choose to serve," Casey says.

Pacific Dental Services established several key initiatives and partnerships to address the critical needs of underserved populations, which include:

 Since 2011, they have actively participated in Smile Generation Serve Day, a nationwide campaign of giving that focuses on providing donated dentistry to underserved patients.

 Collaborating with local nonprofits and community health centers ensures their services reach individuals who may face challenges accessing dental care.

 Their clinicians regularly participate in community events and health fairs, offering free consultations and educating individuals on the importance of maintaining oral health.

 Their international service program takes their clinicians and team members to countries like Guatemala, where residents have limited access to dental care. There, team members generously volunteer their time and skills, providing donated dental care, education, and community service.

"Since our first international service trip in 2010, PDS team members have traveled to countries like Guatemala, Ethiopia, and Fiji, providing over $11 million in dental care and positively impacting the lives of thousands of patients," Casey explains.

our participation in Smile Generation Serve Day over the past 13 years has allowed us to make a significant impact on underserved communities here in the U.S. We've provided over $57 million in donated dental care, encompassing essential procedures like cleanings, fillings, extractions, and more complex treatments, such as root canals and dental implants, on that annual day of service alone," Casey says.

Pacific Dental Services' most recent Serve Day was a remarkable success, Casey says, resulting in over $10.6 million in care for those who need it most, serving over 3500 patients nationwide.

“And through meaningful partnerships we’ve made with dental laboratories and other organizations, patients receive 100% pro-bono care, further amplifying our impact."

These projects have impacts on the organization as well. Casey says serving those in need brings substantial benefits, not only to the patients they serve but also to their team members providing the service. Research shows that the act of giving boosts the production of 3 brain chemicals–dopamine, serotonin, and oxytocin, often referred to as the "happiness trifecta."

 This increase in brain chemicals improves the overall mood and well-being of those serving others, Casey explains.

"Engaging in acts of giving through their core competencies enriches our team members' lives, providing them with a profound sense of purpose and fulfillment," Casey says. "This transformation in their daily routines enhances their dedication to their work throughout the year, creating a win-win situation for everyone involved."

Oral Systemic Health. American Dental Association. Published 2023. Accessed October 25, 2023. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/oral-systemic-health

Hinton, E. and Paradise, J. Access to Dental Care in Medicaid: Spotlight on Nonelderly Adults. KFF. Published 2016. Accessed October 25, 2023. https://www.kff.org/medicaid/issue-brief/access-to-dental-care-in-medicaid-spotlight-on-nonelderly-adults/

About Give Kids a Smile. About Give Kids a Smile | ADA Foundation. Accessed November 2, 2023. https://www.adafoundation.org/give-kids-a-smile/about-give-kids-a-smile

. Accessed October 31, 2023. https://www.dhcs.ca.gov/services/Pages/MediCalDental.aspx

"Developmental Disabilities & Oral Health” 

National Institute of Dental and Craniofacial Research

. U.S. Department of Health and Human Services. Published 2023. Accessed October 31, 2023. https://www.nidcr.nih.gov/health-info/developmental-disabilities

Unger Baillie, K. "A growing focus on equitable oral care for people with disabilities." Penn Today | The University of Pennsylvania. Published 2022. Accessed October 31, 2023. https://penntoday.upenn.edu/news/penn-dental-medicine-growing-focus-equitable-oral-care-people-disabilities

The power of a smile: what helping others does for you. Benefits of Helping Others|Why Should I Help Others|Grin! Magazine. Accessed November 3, 2023. https://www.grinmag.com/archive/en/ddpa/2020/spring/wellness/what-helping-others-does-for-you/

We look at what the industry believes about access to care, what are some reasons that patients don't have access to care and the problems that can lead to, and some successful programs that get patients the care they need. 

Providing Restorative Care for People In Need

Bruce Bryen is a certified public accountant with over 45 years of experience and is a part of Baratz & Associates CPAs. He specializes in deferred compensation, such as retirement planning design; income and estate tax planning; determination of the proper organizational business structure; asset protection and structuring loan packages for presentation to financial institutions. He is experienced in providing litigation support services to dentists with Valuation and Expert Witness testimony in matrimonial and partnership dispute cases. He is also a financial writer for several dental journals. You may contact him at 609-502-0691 or at 

What to Know About Dental Practice Valuations During Divorce Proceedings | Image Credit: © alex - stock.adobe.com

For dentists involved with divorce proceedings, the first question asked of an evaluator often involves what the cost of the dental practice valuation will be.

This may be better off asked at the end of the interview with the evaluator. Finding out about the evaluator’s credentials, experience, expertise in the court room and the number of times dental practice valuations have been prepared may be better questions to ask at the outset prior to getting to the cost of the valuation.

As most people realize, price can be misleading. A low price for the preparation of the valuation may be because the evaluator does not have the experience necessary to present the practice in an independent format so that the judge or mediator will not laugh him or her out of the room. The evaluator should not be an advocate for the dentist. That is the job of the attorney.

The evaluator’s job is to present the dental practice in such a way as to maintain his or her independence and not be led by the dental client or the client’s lawyer. Just like the dentist wants the best dental CPA for his or her business services, the best evaluator of the dental practice will present a sometimes financially life-changing report that will dominate one with facts that is prepared at a lesser cost.

Is price the object or is the best evaluator the object?

Price is certainly an important consideration when determining which evaluator to choose but it should not be the sole criteria for determining who is chosen to prepare the valuation. The dentist and his or her spouse will probably both retain attorneys. They will be advocating exclusively for their client. They will also be relying on the valuation prepared by the independent evaluator.

The lawyer’s proof when making his or her presentation about the value of the dental practice will be swayed by the supporting documents in his or her possession. The valuation report should be the most important document that the attorney is relying upon to support the dentist’s case about the value of the dental practice. If the spouse is getting an evaluator with the expertise needed who understands what is required from him or her, the lack of the best evaluator because of the cheapest price will hurt the dentist probably to the extent of hundreds of thousands of dollars over the long term.

It is analogous to the use of a computer and the results obtained when someone in the know remarks, “junk in, junk out.” When the valuations are exchanged for their critique during discovery, the dentist’s attorney may be surprised by the inclusions in the spouse’s expert’s valuation compared to what is in place for reliance by the dentist’s own attorney. You can also be assured that the dentist’s attorney is not hedging on legal fees while the case is ongoing.

What credentials should be assessed when determining the choice of dental practice evaluator?

Since it is rare for an attorney to know a great deal about dental practices, and even more unusual for the lawyer to admit a lack of knowledge, relying on the dental CPA is probably the place to start the search or dialogue regarding which evaluator should be retained. Hiring a CPA for the dental practice who does not have any dental clients is probably a bad decision.

Once the dental CPA is engaged, the dentist should easily see the difference between the general-type CPA and the dental CPA based on experience, advice about percentages of costs compared to gross revenue, and knowledge of appropriate dental practice evaluators as well. The dental CPA will have knowledge of evaluators to interview probably well in excess of the attorney’s knowledge as experience creates wisdom as well as the ability to have more contacts in a particular field of endeavor.

Some of the interview process should include but not be limited to the following questions: How many dental practices valuations have you completed? How often have you testified in court? What is the number of mediations or settlement conferences that you have attended? How about attendance at depositions? Have you ever worked in the geographic area in which the dental practice is located?

Since cost is a question, what are the additional costs for attending the mediations, settlement conferences and trial if necessary? The dentist and the lawyer do not want to have any surprises. What information is needed to be provided to the evaluator and what is the estimated time of completion of the valuation once the information is presented to the evaluator?

Are there other reports besides the valuation that are important?

There are only about 10 states that are not what is known as “equitable distribution states.” That means that at least 40 states do use the method of “equitable distribution,” to determine the amount to be distributed from an asset value to the spouse and to the dentist. Equitable does not mean equal. Many feel that it does mean a 50% division of the assets including the dental office. That is not true.

There are numerous factors that are presented in a report that many evaluators do not prepare to assist a court or mediator in determining what amount the dentist and the spouse are to receive. The most important factor in these 40+ states for the dentist is the amount of personal goodwill that is attributed to him or her. Those evaluators who do not prepare an allocation of goodwill are hurting the dentist and attorney for the dentist with the presentation of the case.

It is rare to find a court where the judge is not an attorney. Since most lawyers have had little experience with dentists, the judge will also need assistance in determining what the presentation means. When the evaluator of the dental practice includes an allocation of the goodwill between the personal and enterprise ratios, the judge and the dentist’s attorney will be greatly helped in being able to decide to render an opinion of the distribution of the value that he or she determined. Some of the criteria for assisting the court and the dentist’s attorney are found in the Multi Attribute Utility Method, commonly known as MUM. This discourse highlights many of the attributes used to determine how much is personal goodwill, which is not a marital asset, and how much is enterprise goodwill, which is a marital asset.

Examples are how much is produced by the dentist compared to other producers in the office such as hygienists? Where is the location of the office and how important is that for patients to access easily? What information is included on the website? What is the work ethic and health of the dentist? What type of marketing is being used? There are many other attributes to be included under the MUM method. Each of these gets a weight which is used for assisting the court in decision making about the distribution to each party.

Suppose the spouse’s evaluator understands and includes this report in addition to the valuation and the dentist’s evaluator does not? The judge and the attorney for the spouse will have a tremendous advantage over the more cheaply priced evaluator chosen by the dentist based solely on the price of the dental practice valuation.

The cost of the dental practice valuation is seldom the right way to select the best evaluator.

What to Know About Dental Practice Valuations During Divorce Proceedings

DentalXChange Launches Artificial Intelligence Platform to Automate Front Office Benefits Verification. Image credit: © DentalXChange

Dental claims and payment solution company DentalXChange has announced the launch of its new artificial intelligence (AI)–powered platform EligibilityAI. EligibilityAI was created to automate pre-appointment eligibility and benefits verification processes to streamline front office operations, according to a press release from the company. By harnessing the power of AI, EligibilityAI synchronizes with the dental practice’s pre-existing schedule to ensure verification is completed before the patient’s appointment. The user interface then displays the patient’s eligibility information in easy-to-read datapoints that are standardized across all patients and practices.

This beneficial technology is said to eliminate the hassle of reaching out to insurance companies, making front office workflows smoother and more efficient, according to DentalXChange CEO Paul Kaiser.

“Payer-provider transparency in the dental industry leaves a lot to be desired,” Kaiser said in the press release. “The only way to truly understand the complete eligibility and benefits picture for any patient is for valuable front-office staff to either hunt and peck through various independent payer portals or spend time calling payer after payer.”

Eligibility AI aims to get rid of these antiquated methods as well as any errors that can accompany manual claims checking. This also ensures that patients receive the care that they need and are covered for, adding to peace of mind for the practitioner.

“While most practice management systems connect with a clearinghouse for all-payer EDI-based eligibility capabilities, the lack of detailed patient benefit data payers make available causes a myriad of pain points for dental offices. Offices put their reputation at risk with inaccurate patient estimates, they have revenue risk with denials and rejections that could be avoided, and they incur more cost to run their business. At the same time, payers also incur pain points in the form of expensive call center staffing and provider network dissatisfaction. Our Eligibility AI platform solves all these pain points,” Kaiser said in the press release.

To learn more about EligibilityAI, visit the 

This new artificial intelligence software automatically checks patients’ benefits and eligibility before the appointment, streamlining front office workflows. 

DentalXChange Launches Artificial Intelligence Platform to Automate Front Office Benefits Verification

In daily dentistry, practices produce waste. If not properly disposed of, some of this waste can have adverse effects on the environment.

Waste takes other forms. What you order and how much produces waste. How the materials you use are packaged produces waste, too. Even the light bulbs you choose or the paper you recycle (or do not) produces waste. This article looks at problems with material waste in dentistry, ways of employing green policies, and strategies for reducing waste in your practice this year.

Taking advantage of purchasing deals on materials you use often makes sense for your bottom line. However, for products with an expiration date, buying more than you can use before that date can backfire. You probably have thrown out some of that product you got for “free” before you could use it; if not, you probably know someone who has. Avoiding that problem starts with how much you order and when.

Another area where material waste occurs is package sizing. Sometimes leftover material in these larger packages or tubes goes unused and is thrown out. The American Dental Association (ADA) recommends buying sealants, adhesives, and other restorative materials in package sizes that ensure use of all the product during the procedure to avoid this problem.

One of the most significant areas of concern regarding dental material waste is dental amalgam. Dental amalgam contains mercury, a toxic and bioaccumulative material. Therefore, it is essential to manage dental amalgam waste properly. A European journal had the following suggestions for dental practices:

Reduce waste by limiting the amount of dental amalgam used in procedures. Consider alternative materials like resin, ceramic, or other metal alloys when suitable.

If you do need to employ amalgam material, use precapsulated dental amalgam to avoid spills and clinic contamination from liquid mercury.

Install chairside filtration devices and secondary filters in vacuum pumps to trap larger amalgam particles and prevent contamination. Chairside traps remove around 68% of amalgam particles, whereas vacuum filters are around 40% effective.

Use these filtration devices to separate fine particles generated during procedures, preventing their release into wastewater.

Treat collected mercury and amalgam waste as hazardous waste, ensure staff are trained in disposing of it, and use protective gear. Store contact and noncontact amalgam waste separately.

Collect waste storage containers for reclamation by a registered agency, aiming for recycling, although not all agencies can do this.

Avoid flushing contaminated wastewater down sinks, rinsing chairside traps or vacuum filters in sinks, or disposing of amalgam material in general waste. These practices release mercury into the environment, undermining efforts to reduce mercury contamination.

Material waste occurs when using traditional x-rays and related chemicals. There are concerns regarding silver and lead pollution. Silver can get into the water system with improper disposal of dental x-ray fixer and into landfills through disposal of undeveloped film. When thrown into the general waste system, the lead foil around the x-ray film can leach lead into the landfills. In both cases, using an approved waste carrier or switching to digital x-rays can avoid these problems.

In addition to the risks with silver and lead, the constant exposure to radiographic developer and fixer solutions in dental settings can pose potential health risks to dental personnel. These solutions contain chemicals like hydroquinone, acetic acid, and glutaraldehyde, known for their volatile and irritating properties. Continuous exposure to these chemicals, as mentioned in the Material Safety Data Sheets, may lead to respiratory tract irritation and aggravate preexisting asthma conditions. Additionally, some components, like hydroquinone, are linked to chromosome breakage, although the human risk is uncertain. Furthermore, the incompatibility warnings, such as the release of sulfur dioxide or ammonia when in contact with acids or bases, respectively, raise concerns.

These chemicals, which operate together in the same x-ray developer apparatus, are poured in and out of containers. Given the small, confined spaces of x-ray developer rooms, repeated exposure, even with proper ventilation, may pose long-term health risks over a span of 20 years. The cumulative effects of exposure to these volatile and potentially harmful chemicals warrant careful consideration for the safety and health of dental personnel—and perhaps switching to a digital radiography option.

Problematic areas also include energy waste and chemical waste. There are other ways in which a dental practice can create waste, such as multiple shipments from the same supplier in a given week or not recycling products when appropriate.

, a dental monitoring app company that allows dentists to monitor their patients remotely, had the following suggestions for reducing waste in your dental practice:

Use a dimmer system for lights to save energy. It adjusts light based on how much natural light is already in the room. Add motion detectors and timers to turn off lights when no one is around.

Instead of chemicals, use steam to clean and sterilize items.

Dental offices produce lots of trash with single-use products. Try using stainless steel trays and reusable items like glass irrigation syringes and cloth bags. Use disposable barriers only when necessary.

Switch to a vacuum without water and with a special trap for amalgam.

Ask suppliers to pack orders together to make fewer delivery trips. Reuse the boxes.

Look into aligners made from reusable plastic. Some companies reshape them so they can be used 3 times.

Recycle as much paper, aluminum, and plastic as possible using bins. Some services recycle shredded medical paper.

Try going paperless. Use software to manage appointments, bill patients, and keep records without printing anything.

In addition, there are things your staff can do to reduce waste and conserve energy in a dental practice, including the following:

Use reusable plastic containers for cleaning and disinfecting solutions to reduce waste.

Opt for products made from recycled or partly recycled materials like cotton or wool rolls, and paper towels.

Install energy-efficient lighting to reduce energy consumption.

Regulate office temperature effectively to conserve energy.

Old equipment is another area of opportunity regarding waste in a dental practice. When you replace a broken or aging dental equipment component, it can be tempting to dump the old one. However, instrument company

encourages dental practices to recycle (ie, pass on) old equipment instead.

For example, outdated dental equipment, like an x-ray machine, does not have to end up in a landfill. Explore programs that accept old equipment and repurpose it to set up dental clinics in developing nations, like 

, or experts in dental equipment recycling and decommissioning, like 

By partnering with such initiatives, you can dispose of your outdated machine responsibly while giving it a new life to serve communities in need. This allows your office to upgrade to modern equipment and reduces landfill waste. Moreover, when you donate functioning equipment that the organization can ship to a clinic that needs it, your contribution aids in providing essential oral care to vulnerable populations worldwide.

Surprising Facts Regarding Recycled Paper

These suggestions might seem like small things and many are. However, small does not mean insignificant. Small changes accumulate into big impacts.

For example, it might seem like a small thing to have those blue bins for recycling paper. But the impact the cumulative contents of those bins can have might surprise you. Recycling 1 ton of paper saves trees, conserves resources like water and oil, reduces air pollution, and prevents landfill space consumption. It also saves

This represents a 64% energy savings, 58% water savings, and reduces 60 lb of air pollution.

Moreover, the 17 saved trees can collectively absorb 250 lb of carbon dioxide from the air annually. By contrast, burning a ton of paper releases approximately 1500 lb of carbon dioxide.

There are a few things you can do to reduce paper usage in the practice, 

. Ask to stop receiving unwanted office mail. Choose recyclable options for letterhead, envelopes, fax paper, and business cards and send appointment reminders via email or text message. Also, consider going paperless by using a virtual system for patient records, billing, and x-rays. In addition, reduce the number of printers in the practice and print double-sided when feasible. Reuse shredded paper as packaging material.

1. 80 ways to make your dental practice green. American Dental Association. Accessed December 7, 2023. https://www.ada.org/en/resources/practice/practice-management/office-design/80-ways-to-make-your-dental-practice-green

2. Muhamedagic B, Muhamedagic L, Masic I. Dental office waste - public health and ecological risk. 

The dental industry cannot avoid producing its share of material waste, but steps can be taken to employ green policies in your practice this year. 