Laura Dorr is the former executive editor of DPR's Modern Dental Network and a regular contributing author.

Laura Dorr

	Are DSOs the future of dentistry? Group practices and DSOs are a certainly a growing trend in the dental industry-one that has many solo practitioners and practice owners a little nervous.

But what does the growth of DSOs really mean for the dental industry? How will it affect solo practices? Are solo practices doomed? Is a DSO the right solution for your practice? The bottom line: Whether you are for or against the evolution of group practices and DSOs, you have to keep up with the latest industry trends to be able to navigate the changing landscape and make educated decisions for your practice.

	To help, we compiled a list of the top six articles about the DSO revolution that we feel all dental professionals should read.

	Continue to the next page to see the must-read articles.

	It’s hard to find many businesses that still operate under the same model that they did 30, 20, or even 10 years a go. Airlines are different; cable companies are different; and it should come as no surprise that dental practices are different.

	A major trend in dental is the growth of 

 (DSOs), and being affiliated with one seems to be the normal for dental practices.

, Dental Products Report conducted a survey of 404 dentists to gauge their opinions of various issues involving practice operations. For the greatest concerns, DSO membership appears to offer solutions.

	The one question dentists need to ask about DSOs

	DSOs are not going away. They are growing between 13 percent and 15 percent per year. They are well financed. They are well led and well managed. They have powerful infrastructures and very accountable people. Young dentists don’t want to own a practice. Older dentists are tired of managing and owning. DSOs will flourish in this ecology.

	If the future is DSOs, and it is inevitable that it is the future, it is best to get on this train because it is leaving the station. The DSO tracks are laid for dominating the industry. They’ve got the money, the people, the processes, the infrastructures, the metrics. In essence, they have the wind at their backs and the sun on their face. So, what should dentists be asking about DSOs, given that they will dominate the future?

	There's been a lot of doom and gloom about the end of private practice-but is the future really so bleak?

	Recent Dental Practice Management articles have identified a significant number of potential problems that dental private practice appears to have with the apparent takeover by DSOs.

	They are better funded, organized, and staffed, while wielding buying power that we could never imagine in a solo practice. The growth of 

 seems to be at a pace which would scare any dentist into thinking that the end of practice as we know it, is in its death knell. But is it really as bad as it appears to be? Can dentists find happiness in our profession without being part of a large dental conglomerate? Let’s take a look at the issues and see if it is all doom and gloom.

	How solo practices can survive as DSOs continue to grow

	The definition of inevitable is incapable of being avoided; certain to happen; unavoidable. It is inevitable that DSOs will continue to grow.

	And if solo practices want to survive, learning how to change tactics and mindset is critical. Here are five things solo practitioners need to stop doing if they want to succeed in a changing industry.

	The juggernaut successes of the meta DSOs such as Heartland, Aspen and Pacific left a slipstream for others to rapidly grow like Deca and North American Dental Group. Their continued growth and success seems unstoppable. But many DSOs more than likely will follow the path of other companies that had meteoric rises to success only to nosedive.

	DSOs may be the future-but as radical changes occur, many DSOs will be stuck in the past.

	Why managed group practice will dominate the future

	This article is about solo practice, managed group practice and dentist-entrepreneurs, and my opinion that, inevitability, managed group practice will be the dominant form of dental practice in the future. Presenting this future to dentists, it is not uncommon for dentists to find themselves in one of four places: those who are “already there,” those who are strongly interested but unsure of what to do next, those that are uncertain about the validity of this future, and those who are in denial. As a dentist, more than likely you are either in one of these four places.

Articles

What you need to know about the future of the dental practice, how solo practices can thrive in a changing industry and determining whether a DSO is right for you.


Are DSOs the future of dentistry? Group practices and DSOs are a certainly a growing trend in the dental industry-one that has many solo practitioners and practice owners a little nervous.

6 things you need to know to survive the DSO revolution

What you need to know about the future of the dental practice, how solo practices can thrive in a changing industry and determining whether a DSO is right for you.


	You’ve probably got a whole practice full of perfectly nice, normal patients who behave predictably. But then there’s that one who is full of … surprises. 

Whether it’s something they said or something they did, these out-of-the-ordinary patients never cease to shock and amaze as they take outlandish to a whole new level. The upside? We’re left with some pretty unforgettable stories.

Other ridiculous stories: The top 16 worst dental patients ever

	We polled you, our readers, for your tales of the patients that will always stick out in your memory-for the weirdest reasons. From the bizarre to the disgusting, the unbelievable to the hilarious, your anecdotes did not disappoint. Here are the weirdest of the strange stories that we compiled.

	Continue to the next page to read the stories.

	I had a patient that used to bring her pet parrot to her appointments with her, stuffed into her bra and shirt. One time she was having a filling done and midway through the bird popped its head out and tried to bite me! We were quite surprised to see that bird had no feathers from the neck down.

	I had a patient that came in and we went through the entire appointment like normal. Then, at the end of the appointment, he dramatically handed me a magazine that had aliens on the cover. He warned that we were going to be taken over one day and that I should prepare myself. 

	A patient called the dental practice demanding to get in ASAP, saying she had severe pain. We managed to squeeze her in, because she said it was an emergency. When she came in, I asked her where it hurt, but she said none of her teeth were sore at all.  I said, "But when you called you had pain." She looked at me strangely and said, "I did. My stomach hurt. But I've had two bowel movements since then. Can you start cleaning my teeth now?” 

	My very first patient told me I wasn't probing her hard enough because it wasn't hurting. She took the probe away from me and probed her own pockets to "show me how to do it right." It was insane. 

	I was asking a female patient some medical history questions, and she proceeded to describe the parasitic skin infection she had been dealing with for many months-in graphic detail. She then jumped out of the chair, pulled her pants down and exposed her backside to me to show the evidence! NO WORDS.

	I had a new patient come in, seemed like a nice guy. We chatted about his medical history, made some small talk. As I started to begin the exam, he suddenly stopped me. I asked him if there was a problem. He said in a seductive voice, “If I pay you, will you do the exam without gloves on? I think that would be really hot.” 

	I kept the gloves on, and he didn't come back again. Good riddance.

	One day, right after I first started practicing, I was working on a mentally disabled patient who kept very politely calling me ma'am. I said, “Oh, you don't have to call me ma'am! That’s very kind of you though.” She responded cheerfully, “OK, bitch!” I couldn’t help but laugh, and said, “You know what, let's go back to ma'am.” 

	I was cleaning a patient mandibular anterior linguals. She stopped me and told me that her daughter has a bird as a pet. I was thinking OK, random but cool, I guess-until she said the bird will take its beak and peck at her daughter’s teeth to remove her calculus. I was totally grossed out and changed the subject.

	I had a patient come in with a huge swollen jaw. We were obviously worried there was something very wrong. When we were ready to begin the exam, he took out his upper denture and there were roach eggs. Evidently, he had fallen asleep and a roach crawled in his mouth and laid eggs. 

	I had a new patient come into the office for a cleaning. We were talking and he seemed very nice and smart. Once he opened and I saw how red his gums were I immediately asked what happened. He then proceeded to tell me a friend of his told him to whiten his teeth using Comet bathroom cleaner! 

	He then told me he put it on his teeth but some got on his gums causing them to hurt and become red. But that wasn’t all; he had been pretty certain that that was not good, so he rinsed it all off and put more back onto his teeth, this time being extremely careful not to get any on his gums again. You know, since it hurt and made them red.

Sometimes things get pretty weird in the dental practice. These are those stories.

You’ve probably got a whole practice full of perfectly nice, normal patients who behave predictably. But then there’s that one who is full of … surprises. 

The 10 weirdest things patients have done in the dental practice

Sometimes things get pretty weird in the dental practice. These are those stories.

The 10 weirdest things a patient has ever done in the dental practice

	Knowing the ins and outs of EHR could make a huge difference for your dental practice.

The transition to EHR may seem daunting for a lot of practices, but it doesn’t have to be. In the ever-evolving world of dentistry, adaptability is crucial for success-not to mention that many of the new developments in the dental industry will make your practice run much more smoothly in the long run. By streamlining processes, making communication simpler and generally helping your practice function more efficiently, making the switch to EHR is a crucial next step for group and solo practices alike.

Related reading: The DPR archives: Everything you need to know about EHR

	The bottom line: EHR could save your dental practice. But we know dipping your toes into the EHR pool (or changing vendors, or renegotiating contracts, or staying HIPAA compliant) can feel overwhelming. To help, we compiled a list of the top five EHR articles by our software editor, Mike Uretz, that we feel all dental professionals should read.

	Continue to the next page to see the must-read tips.

	Knowing your way around an EHR proposal can pay off big time for your bottom line. Everyone loves a good deal, but too many times vendors convince groups that they're getting the best deal possible-and that there's no wiggle room. But in a competitive situation, if you are important to the vendor, then all bets are off. The goal is to establish a win-win situation so that you are getting a great price and the vendor is getting something in return for working with you.

	EHR can play a positive role in group practices in more ways than one. There are several reasons both financial and clinical, but one reason that I hear consistently from group practice CEOs and COOs is that with numerous providers and locations in the organization it is important to try to standardize on various parts of their operations; with none more important than clinical data. So, with that goal in mind, where does one start?

	What you need to know about the EHR Incentive Program

	Though some portions of the subsidy program are now closed, groups and DSOs can still take advantage of the EHR Incentive Program. But because of all the misinformation and misunderstanding about the rules behind this program, many groups and DSOs will miss out on millions of additional payments over the next five years if they don’t truly understand what their ongoing rights are. So, it’s important to know which aspects of the subsidy program are closed and how groups and DSOs can still take advantage of the part of the program that allows for continuing payments. 

	How to protect your dental EHR from cyber attacks

	There has been some recent publicity regarding an online scheme where practices are having their patient database accessed by unauthorized individuals. Based on this, some providers have been worried about potential dangers of using electronic health records (EHR) that store patient data on a server database.Worries like this have been vocalized for a number of industries over the past few years. There have been instances of financial databases being hacked. So does that mean that banks and financial institutions should go back to keeping all their customer records on paper?

	How dental EHR can streamline referral processes

	Coordinating with outside specialists or referrals can be complicated and cumbersome-but EHR could make it easier. It is becoming possible that, with a state-of-the-art EHR, while with the patient in the exam room, the provider could choose the specialist that needed to be seen, and send the referral along with the pertinent records for that referral. As  we are increasingly looking at EHR that have the capability to support electronic referral features, here are a few of the features of EHR-based electronic referral networks that you should know.

What you need to know about transitioning to EHR, negotiating contracts and how to stay HIPAA compliant.

Knowing the ins and outs of EHR could make a huge difference for your dental practice.

5 EHR tips that could save your dental practice

What you need to know about transitioning to EHR, negotiating contracts and how to stay HIPAA compliant.

So, you're having a great day. Everything is going smoothly.

And then… THAT patient walks in. The one who seems absolutely determined to ruin your day, totally tick you off, leave you dumbfounded or absolutely gross you out! 

Trending article: The top 13 weirdest dental horror stories

We polled you, our readers, for your stories of the patients that will always stick out in your memory—for all the wrong reasons. From the infuriating to the disgusting, the bizarre to the absurd, your tales did not disappoint. (In fact, as there were so many ridiculous anecdotes, keep an eye out for another installment of the weirdest things seen in a dental practice, coming soon!) Here are the worst of the worst stories that we compiled.

The top 16 worst dental patients ever

We polled you, our readers, for your stories of the patients that will always stick out in your memory-for all the wrong reasons. From the infuriating to the disgusting, the bizarre to the absurd, your tales did not disappoint.

The Top 16 Worst Dental Patients Ever

	Back pain after a long day? Cramping hands? Aching neck?

Every dental professional has been there at one point or another. From poor posture and heavy loupes to stressful sustained grips and uncomfortable seats, there are numerous ways to wear down your body in the dental practice. It may feel like chronic pain is just a part of the job-but it doesn’t have to be.  

Trending article: 3 ergonomic mistakes that could end your dental career

	These ongoing aches and pains may be the result of poor ergonomic practices. The bottom line: Ergonomics could save your career. There are several simple tweaks that could prevent the chronic pain that often ends careers prematurely.

	To help, we compiled a list of the top five ergonomics articles by our ergonomics editor, 

, that we feel all dental professionals should read.

	The ergonomic benefits of saddle-style stools

	Saddle up! Research has shown that a saddle-style stool could save your health-and your career. Saddle-style stools are becoming increasingly popular in dentistry-and for good reason. The benefits of this positioning are numerous, and research supports the positive impact on the musculoskeletal system. For those unfamiliar with saddle-style stools, they may seem unconventional, if not radical, compared to traditional flat operator stools.

	The top exercises that can worsen dental professional’s health

	Crossfit, P90X, Pilates, gym machines: exercise regimens are good for you, right? Wrong! Due to dental professionals’ predisposition to unique muscle imbalances, certain exercises and gym machines should not only be modified, but eliminated altogether! Unfortunately, most healthcare professionals do not realize this, and they give dental professionals the same exercises they give everyone else who walks in their door. This can throw dentists into the “vicious pain cycle.”

	Hand pain in the dental practice: When it's not carpal tunnel

	Your hands are integral to your work. Because of sustained grips and prolonged awkward postures dental professionals must employ throughout the day, they experience nearly four times the prevalence of hand, wrist and arm pain found in the general public.

	Are dental loupes improving or worsening your neck health?

	Selecting the correct loupes can make a big difference for your health. Imagine spending a bunch of money on new loupes, and you suddenly begin to develop neck pain, or, your existing neck pain worsens. This is an all-too-common problem that I frequently encounter in my dental ergonomic consultations. So how do you know if your loupes are improving or worsening your health?

	Demystifying pain among women in dentistry

	The percentage of women pulling up chairside in the operatory is increasing. And studies show that women in dentistry experience a higher frequency and severity of pain than their male counterparts, with the thumbs, hands, hips, neck, and shoulder being particularly problematic.

	When considering interventions for the female dental professional, there are dozens of gender-specific considerations: workplace ergonomics, specific exercise, daily activities, clothing, and much more.  Following are a just a few of the most important considerations.

These simple tweaks may prevent the chronic pain that often ends careers prematurely.

5 ergonomics tips that could save your career

	Root canals are bad enough without the threat of secondary infection and multiple follow-up visits. Now, thanks to a new device, researchers believe they can eradicate the need for numerous appointments-and cut down on treatment failure.

approximately a quarter of root canals fail

 over time due to secondary infections, the ability to detect potentially hazardous leftover bacteria at the time of treatment could be extremely beneficial. It could also cut down on the number of visits, as most procedures currently require one or two secondary visits to the dentist. The new device, called SafeRoot, was created to detect any remaining bacteria at the completion of root canal treatment to reduce the need for reintervention or extraction

	“The resilient nature of bacteria, combined with often complex root canal structures, make disinfection challenging, leading to a considerable number of persistent infections,” explains Professor Francesco Mannocci, one of the 

 authors and a professor of endodontics at the Dental Institute at 

. “This is one of the main causes of root canal treatment failures.”

More emerging research: Could this drug meant the end of dental fillings?

	Created by Mannooci and group of fellow researchers at King’s College London, SafeRoot detects residual live bacteria in the root canal area using Calcein acetoxymethyl, a florescent dye, and fluorescence microscopy/spectroscopy. In clinical trials, the process, which is performed during the root canal treatment and uses standard sterile endodontic paper points for sampling, successfully detected bacteria after three minutes of testing.

	Professor Tim Watson of the Dental Institute believes that the short amount of time the testing takes is a huge benefit. “SafeRoot will reduce the time for root canal completion and will increase the success rate of treatments by letting the dentist know when it’s safe to proceed with filling the tooth,” he says. “This should produce fewer acute ‘flair-ups’ and failed root treatments, as any residual infection in the root canal will be identified.”

	With over one million root canal treatments conducted in England every year, preventing the need for secondary appointments could save the National Health Service, England’s publicly funded national healthcare system, a significant amount of money. The monetary savings would be substantial in the United States as well: According to the 

	“The treatments are not only time consuming and painful for the patients, but cost … a significant amount,” summarized lead researcher Dr. Frederic Festy. “If we could reduce the number of root canal treatments and re-treatments required, it could mean sizeable savings.”

	But as Dr. Festy mentioned, money isn’t the only issue: reducing the risk of secondary infections could make procedures less painful-an attractive incentive to patients, 

67 percent of which say pain is their biggest fear when it comes to root canals

Trending article: How to simplify endodontics with technology

	In addition to root canals, SafeRoot could also be used for infection detection in other medical situations, such as wound treatment or implant-related infections. “This technique could be applied to antimicrobial research and disinfection control in clinical settings,” the 

 from UCLA published in the journal ACS Nano also explored how to eliminate the risk of secondary infection, using gutta percha infused with nanodiamonds.  

, tiny particles formed as byproducts of diamond refining and mining, are thousands of times smaller than the width of a 

. They have been widely explored for use in dentistry, 

 and regenerative medicine, among other uses.

	The nanodiamonds were loaded with amoxicillin, a broad-spectrum antibiotic, and infused into the gutta percha. Although the nanodiamond-infused gutta percha did leave small gaps in the canal, it was found to fill the space as effectively as the traditional formula-with the added bonus of effectively preventing bacteria growth.

Rapid bacterial detection during endodontic treatment

The new method of detecting bacteria during root canal treatments could eliminate secondary infections and the need for follow-up visits.