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

Laura Dorr

What if I Want to Keep Working in my Dental Practice (Past My Planned Retirement)? Photo courtesy of bernardbodo/stock.adobe.com.


The big “R” word: Retirement. While some dentists can’t wait for the day that they can put down the dental drill and ultrasonic scaler, many find it hard to imagine not being chairside. While some of these more retirement-reticent dentists choose not to retire for financial reasons, for many it’s inspired by more personal reasons.

“Retiring can be a tricky thing,” says Matthew White, cofounder of White & McGowan, a financial firm that specializes in strategies for dentists and physicians. “Being a dentist is an identity thing. You’re known as doctor in your community and it’s the way people identify you. You’re held in a certain regard because of your status as a doctor; you’re the person they come to with questions or to have pain taken care of. So, who are you outside of that?”

Because dentists work such incredibly long hours and the career can be so life-consuming (often leaving them little time to develop hobbies or interests outside of work), many times it is difficult to walk away, because there may be nothing to move toward that’s better than what they are moving away from. Compound that with financial concerns, and you may find dentists in the operatory well past retirement age. So how can dentists prepare for the eventual transition in a manner that leaves them the flexibility to decide whether or not to retire—or carry-on practicing—when the time is right.

“You’ve got to have a retirement plan,” says Bruce Bryen, CPA, CVA, dental practice valuation analyst at Baratz & Associates. “Dentists used to push back against it, or not think it was worth it. But I think if you start talking about retirement plans now, people pay attention to it because nowadays they understand what retirement plans are and everybody wants one.”

With a retirement plan and an exit strategy in place, dentists can be prepared to depart from the field whenever they want—even if it may be past the typical timeline.

“An exit strategy is critical to a successful retirement for the dentist,” White says. “Because they do reinvest so much in their businesses over time. They typically do start out with a larger debt load because they often buy a practice instead of starting one. They’re investing a lot of money and time into that business and they need to turn that into a significant retirement asset at some point. So, they need to have an exit strategy in place to do that.”

Today, dentists—particularly practice owners—are generally financially savvy professionals who are prepared for retirement.

“I would say that because a dentist is going into business for themselves and running a business, they tend to be a little more mindful of financial planning,” White says. “They have to look at what needs to be done.

“But, they may not start out that way as a young resident or somebody coming out as a young associate,” White continues, “They just aren’t thinking about it then. At the point that you transition into your own practice, into being a business owner, you can't ignore the numbers anymore. You can't ignore planning, you can't ignore organization, risk management, human resources—you know, those all become a part of your life and when that starts to happen, you see them take more interest in financial planning for themselves.”

Even if your financial plan is ironclad, if you end up working past that planned retirement, everything can change.

“You think that working longer automatically means more money, but that’s not necessarily true,” White says. “In some cases, it works out where it's better financially for them to retire early. For some, staying in the game too long can have financial repercussions.”

This seems counterintuitive, but it all boils down to the 1 thing that everyone dreads: Taxes.

“The way it works is that you have required minimum distributions if you have saved money in pre-tax retirement tools your entire life,” White explains. “You are going to have required minimum distributions starting in your 70s. And those distributions are going to come to you whether you want them or not, and be taxable to you whether you want them to be or not. If you are working at that point, it is now taxable at the highest marginal tax rate, because it’s added to the existing income that you’re making at your practice.”

In contrast, if you weren’t working in your practice any more at the point where the minimum distributions were taking place, you would be taxed at a smaller amount. And the dentists who have been planning ahead, being responsible, and making continuous contributions their entire career will be hit the hardest. Since these significant contributions are added on top of the income the dentist is currently making, these clinicians are paying unnecessary taxes at an unnecessarily high tax rate on top of the current income.

“From a tax planning standpoint, you saved all of that money, pre-tax twenty years ago, to avoid taxes at a high marginal tax rate,” White says. “And here you are during your peak income years, really paying at a tax rate that may be higher than the one you avoided initially. That doesn’t make sense. You almost would have been better off just paying taxes 20 years ago when your income was lower and you had a lower tax rate.”

“Basically,” White summarizes, “you’re now working against yourself.”

There are ways around this scenario for dentists that know they will want to continue working past that age. White advises that being aware of required minimum distribution timelines—and planning accordingly—can make a difference. For example, he encourages dentists to start planning 10 years out.

“If you’re planning in advance, you can begin making advantageous changes,” White says. “For example, it might be good if you had some years before the point where the required minimum contributions take place where you showed no income. We can convert some of your 401K and profit-sharing pre-tax money during those years into a Roth IRA. And we can go ahead and pay taxes on it at a lower income in those years where you don't have any income prior to those required minimum distributions happening.”

By going ahead and getting the money into the Roth IRA and paying taxes on this in advance before the required minimum distributions come into play, the money is able to grow tax-free from that point forward. And, White emphasizes, there is no required minimum distribution on a Roth IRA, which allows the money—that the clinician may not need for a long time if they are postponing retirement—to grow tax-free, and while they pay taxes on it during the years where they didn't have an income.

In the end, the dentist will pay a lesser amount of taxes, leaving them with more money.

If you’re considering working past your planned retirement, the “planned” part is key for not only your future, but that of your practice. Once you’ve got the financial plan sorted out for your personal finances, you’ll need to consider your practice. A well-defined plan for eventual retirement—or a scaling back of your work—can make a big difference when it does come time to retire and transition your practice (whenever that may be). To be successful in this financial planning means understanding your options, the value of your practice, and what working longer can mean for that valuation.

“The big difference for dentists from other professions is that when they retire, they have a sellable asset,” White says. “And some dentists don’t know the value of that asset and they don’t know how to optimize a clinic to make it worth more at the point of sale.”

Figuring out how to optimize this can be critical.

“Dentists should do everything they can to work as hard as they can to create as much revenue as they can,” Bryen advises. “Because in valuation, most buyers are looking at gross revenue. And you want your gross revenue to be as much as it can be, and the way you’re doing that is by working and creating more revenue.”

This doesn’t happen overnight. Once again, White stresses that foresight is key to success.

“You should be preparing at least 10 years in advance, because these things can take a while,” White says. “Obviously, your valuation can change a lot in 10 years, but I would at least begin identifying who your purchaser is going to be. Is it going to be a large DSO or are you not interested in handing this off to a big corporation, and want to sell it to another private dentist similar to you? It may take time to weigh those options.

“About 5 years out, you need to start discussing contracts and start having your initial evaluations,” White continues. “I would have a third party do those valuations so that you’re getting a proper and fair evaluation.”

White also cautions that waiting too long to sell could have repercussions for the practice value. Selling your business is a part of retirement planning and it’s not something you want to wake up and start 1 morning in your seventies.

“If you wait too long, you’re going to have to do a fire sale,” White says, “The last thing you want to do is to be in a situation where you’re in a hurry and you have to sell an asset for less than it is worth. And be assured that the DSO or private equity group that’s negotiating with you will notice this, and if you’ve waited too long, you’ll have no choice but to negotiate with them. I say begin the discussion in your early or mid-60s so you can find the right buyer at the right price. Then if you want to keep working, it’s up to you."

Whether or not you’re planning on staying on, once you’ve sorted out your timeline for your practice sale you need to make your practice as appealing as possible to potential buyers.

“You may want to increase your marketing budget during the last year or 2 before you’re ready to put the practice on the market,” Bryen says. “You’ll want to watch your expenses and get them as low as you can so your profit is as high as it can, because profit margin is another method used in a formal valuation to say how much a practice is worth.”

Making your practice attractive to new patients is just 1 side of the coin: It also needs to be attractive to potential buyers.

“Having state-of-the-art equipment is important,” Bryen adds. “If you have a lot of old equipment, an evaluator is going to say, ‘you’ve got all this old equipment that is going to have to be replaced, so the buyer will have to spend money on equipment, so we’re going to reduce our offer substantially.’ Bottom line, you want good, new equipment and you want the place to look good.”

When your practice has been made its most appealing and you’ve got a buyer nailed down, there’s still the matter of sorting out where to go from there. A slow handover can be a good transition that can allow you to continue to working while also phasing out.

“One way that you increase the value of your practice is by continuing to work for a couple years with that new partner,” White says. “And so it may be that the sale takes place before you finish working. It's often more valuable to someone if you will stay around during the transition and make sure patients are still seeing your face and your name on the door, even though the business has technically changed hands.”

White recommends a “dating period” while the transition is underway. By identifying a partner or DSO or private equity group but then maintaining majority stake for a few years, you can figure out if the relationship will work.

“Sometimes the initial successful plan may not work out,” White says. “So, give it a slow try, and if it seems like it works, then you can be happy to hand over the keys. But, having that dating relationship initially before everything is signed and done can be helpful and avoid some headaches down the road, especially if the new partner or group is expecting you to stay on for several years. Because you may find that post sale, the relationship isn’t working and it may be difficulty, but you’re contractually committed to be there for 2 or 3 years.”

Being aware of this possibility and determining if that’s something you want to agree to—or if you want to take a different approach for a transition can help you decide if you want to continue to work, or pass the practice off entirely. By starting a gradual transition, you can evaluate what’s best for you before there’s a contract in place that requires you to hand it off.

“The dentist can only make up their mind if they have all the information and know everything,” Bryen says. “If you have the information, you can decide whether or not you are willing to take the risk or make a certain decision about a practice sale or retirement.”

Articles

There are a few key things to keep in mind when preparing to retire from your dental practice with the intention of still working in the practice. 

What if I Want to Keep Working in my Dental Practice Past My Planned Retirement?

Wonderadmix is a concentrated debubblizer and hardener. It’s formulated to be simple to use. Dental technicians simply add water to dry stone, then shake well and mix as needed. Wonderadmix creates a smoother stone, increasing strength, hardness, and density while preventing chipping and fractures. It also controls shrinkage and expansion and increases material toughness. The mix is formulated for greater accuracy and fine margins.

Bubbles are the bane of every model maker’s existence, and it was no different for Jerri James, CDT, a dental technician at CenTex Dental Lab in Waco, Texas.

She was frustrated by the complications bubbles caused and was finding that traditional surfactants were not doing the job properly. She needed a true bubble buster. Enter Wonderadmix, from Dental Creations.

“We got Wonderadmix as a sample, tried it, and immediately noticed a big difference,” James says. “Now we use it in all of our gypsum products. We don’t get bubbles or anything else in our mix, which makes the model stronger.”

By preventing bubbles, Wonderadmix also increases the density of models, minimizes shrinkage and expansion, and makes for a smoother stone—and thus a finished product with finer margins, which is more accurate. It also helps models harden, preventing fractures and chipping, and eliminates the need for surfactants.

“Wonderadmix is an important tool for our lab,” says James. “We buy it every 2 weeks because we don’t pour a model without it. It’s our go-to, and we use it every day, all through the day.”

Because Wonderadmix comes as a concentrate in a syringe, it helps labs save on storage and shipping costs—an important consideration when purchasing it often. A 32 oz bottle is provided in which to mix the concentrate with water to create the solution. James’ lab orders several dozen syringes at a time, which take up negligible space in their stockroom.

She’s also quick to note that although you have to mix the product, the process is quick and easy.

“You just fill the bottle with water and add the Wonderadmix with the 20-mL syringe,” she explains. “One important step is to shake it really well; it mixes up really nicely, but remember to shake it because it does have a tendency to separate.”

Despite the need for a little vigilance while mixing, James hasn’t found any other product that gets the job done as effectively as Wonderadmix.

“Bottom line, Wonderadmix is the way to go,” she says. “I don’t know of anything comparable on the market. It works like a surfactant in that it breaks the surface tension and results in fewer bubbles. But it just works better.”

“All my experiences with Wonderadmix have been really good,” James continues. “It’s quick, easy to use, and saves so much time because you’re not repouring an impression or calling the doctor for new models.”

But that’s not all: Models without bubbles look better. “Putting out a nice product helps us build relationships with doctors and provides an opportunity to educate them as well. If they’re pouring models in their practice, we can say, ‘Hey, Wonderadmix can help you.’ It saves everybody time and money.”

Why one lab technician won’t pour a model without this Dental Creations product

Busting Bubbles for Cleaner, Stronger Models

Unlocking the Power Trapped in Your Dental Practice Data. Photo courtesy of Fectopus/stock.adobe.com. 

Back in the old days of paper charts and hardcopy forms (if those days aren’t already behind you, they should be), practice data was nearly impossible to compile in useful or efficient ways. But with the advent and adoption of electronic dental records (EDRs) and practice-management software, dental practitioners have been gifted a wealth of information, all right at their fingertips.

That’s all good and fine, provided a dental practice owner knows how to utilize and analyze the data.

“You need to data mine,” says Laci Phillips Newland, practice management speaker, coach, and founding partner at Practice Dynamics. “You have to ask the right questions and then know how to use those answers. You need to know how to use your practice management software to do it—because the software can do it.”

Knowing how to analyze and properly understand this data can provide valuable insights in not only the health and success of the dental practice, but also how to improve the level of patient care a practice can provide. Data mining can assist practices with everything from marketing and business strategies to determining which dental protocols are most effective—if the doctor knows how to analyze this information.

“Dentists were not set up to run a practice leaving dental school,” Gary Kadi, founder of Next Level Practice, says. “Many are frustrated that they have really great clinical skills, but now they’re staring at this monster called their business. So, the doctor needs to look at the measures and metrics, and reverse engineer what they need to do to be a successful practice.”

Data can be key to building this successful practice by measuring the efficacy of marketing and patient acquisition—critical aspects of practice growth and increasing your bottom line.

“First and foremost, you have to know who your demographic is,” says Phillips Newland. “You have to run some reports in your software and figure out, ‘okay, who's my patient base, where are they coming from, how are they finding us.’ I'm always shocked at how many dental practices don't track where their referrals are coming from. Knowing how your patients are finding your practice allows you to put your marketing dollars where they’ll be most effective. You’ve got to do a little bit of research before jumping in.”

And the data can be your diving board. In addition to helping pinpoint where marketing will be most effective, it allows you to conduct—and track—experiments to determine if your marketing is working. Did you see an influx of patients after a social media campaign? Did physical mailers increase your number of new patients?

“When we plug this information into our practice management software, we’re getting real-time data,” Kadi says. “Then we have an education system of how to fix where they numbers are going down, and focus on what’s making the numbers go up.”

By tracking these numbers, you can identify correlations that will allow you to target your marketing even more effectively and determine which techniques are yielding the best results.

“Every practice management system out there can do this, so there’s no excuse not to use it to identify which tactics are working” says Phillips Newland. “Certain demographics respond better to particular types of marketing. Print marketing is coming back for the demographics that are leaving social media. Once you identify the patient base you want, you can cater to what will be most attractive to them.”

However, attracting new patients isn’t the only way your practice data can become profitable. Tracking key performance indicators (KPIs) is vital to evaluate production and collection, costs, case acceptance, and patient retention.

“I think so many times we concentrate on the new patient instead of addressing patient retention,” Phillips Newland says. “Data mining is critical to finding out how many patients you’ve lost and how you can bring them back in. A patient you haven’t seen in 18 months is not an active patient, but you may be able to reengage them.”

Kadi agrees that the emphasis should be on retaining current patients, and getting those patients to accept treatment.

“99% of dentists are focused on the marketing for new patient business,” he says. “But the focus should be case acceptance, patient retention, and 

 new patients. Because what most people do is they throw new patients in to a business model where only 20% of their patients are coming back twice in their hygiene department, and, when they're there, only 28% of their patients accept treatment. So, if they just went to work on their patient retention and their case acceptance first and plug the holes, they would be so busy that they wouldn't even need new patients.”

Analytics can help plug those holes, but if you’re not using them blind spots can develop about your practice performance.

Understanding your practice data isn’t just about improving your bottom line. It provides critical opportunities to assess the efficacy of treatment, and areas that need improvement. Your practice data can help improve patient care, which should be the end goal for any dental practice. Data analytics techniques can help evaluate, and improve, oral health outcomes not only for your practice, but across the nation.

For example, in the summer of 2020, a team of researchers from the Indiana University School of Medicine and the Regenstrief Institute in Indianapolis, Indiana, assessed data from EDRs from nearly 100 dental practices across the United States. The study found that it was possible to mine data to determine which dental therapies were effective, and which ones were resulting in repeat visits or treatment failure. It also helped identify gaps in oral care between different populations.

Studies like these can help practices benchmark their own successes against national averages and metrics, to identify areas that may need improvement. For example, a Centers for Disease Control and Prevention (CDC) study found that 70.1% of adults over the age of 65 have periodontal disease.

 If rates in a particular practice are significantly lower than this, the clinician may want to evaluate if they might be underdiagnosing periodontitis in their clinic—potentially putting patients at risk of even more serious oral disease. This presents an opportunity to ensure that all the doctors and staff in a practice have a standardized diagnostic system, so that cases of periodontal disease aren’t falling through the cracks.

By properly utilizing aggregated data, and comparing their practice to others, clinicians can provide improved outcomes to patients, and stay abreast of the latest treatment successes and failures. Patient and demographic data can help identify which oral-health problems recur repeatedly, allowing them to provide patients with individually tailored suggestions backed by real-time numbers. In short, data-driven dentistry can be a key factor in how you effectively and successfully administer dental care and provide precision dentistry.

Practice data obviously provides a lot of room for practice improvement both from the clinical and business standpoints, but it’s all for naught if the technology and information isn’t being used correctly. One big step in being able to implement the benefits of practice-management systems, and the data contained therein, is to get the team on board.

“I find one of the biggest downfalls in in our dental practices is that we invest in technology and then we don't really know how to use it,” Phillips Newland says. “And then we get the pushback from the team that says, ‘I don't have time to learn how to use it or implement it.’ You have to take the time to train, which will make your practice more efficient and effective in the long run. You have to get your team to buy into the software and its value.”

Kadi adds that engaging with your team and tracking their personal KPIs and production data can also improve team performance. He believes that getting the team involved and invested in the success of a practice can be a make-or-break scenario.

“A big mistake that practices make is that they don’t incentivize and put measures in place for their team,” he says. “If the team is succeeding—and you’ll know from the data—they should be rewarded. If you have the controls in place, you can reward your team, which creates a positive environment. When you take care of your internal customers (your team) as well as external customers (your clients), the business owner always wins. And the numbers hold the answer to satisfying both.”

In short, data is the answer to practice success. From teambuilding to marketing, case acceptance to best clinical practices, data should be steering the ship that is the dental practice—not languishing uselessly in the depths of your practice-management software.

1. Eke PI, Dye B, Wei L, Thornton-Evans G, Genco R. Prevalence of Periodontitis in Adults in the United States: 2009 and 2010. Published online 30 August 2012:1–7. J Dent Res.

There is more to just gathering data to boost your dental practice. Analyzing and understanding data go a long way in improving practice management. 

Unlocking the Power Trapped in Your Dental Practice Data

Picture this: Business is booming at your dental practice. Your appointment calendar is full, the waiting room can’t hold any more people, and you’re so booked you’re referring out practically as many cases as you’re completing. By all accounts, your practice is a business success

But you could be doing even more. You’re losing potential revenue in new patients you’ve had to turn away because you don’t have the time. Referrals are taking your business elsewhere (and it might not be returning). Potential earnings are slipping out the door.

Sounds like it’s time to expand to a second location! Or is it? Before you dive into adding additional locations, there are some important things to take into account.

1. How is your current practice REALLY doing?

While the impulse to expand may seem to be the most reasonable when your schedule is full, practice owners should make sure their current practice is really succeeding before entering into a new endeavor. This means understanding your practice’s key performance indicators (KPIs) and making sure they are solid. Evaluating these metrics allow practitioners to make data-driven decisions that can best benefit their practice, and also offer the opportunity to evaluate areas that could use improvement.

“The fact is, healthcare is a business and we need to monitor the business and understand the KPIs,” Laci Phillips Newland, practice-management speaker and coach and founding partner at Practice Dynamics, says. “It’s so important for doctor-owners to understand the business side of dentistry and what the KPIs are telling them.”

This includes taking a look at not only profit and loss statements and average monthly revenue, but also evaluating overhead expenses and collection rate. Additionally, practitioners should examine key statistics such as hygiene pre-appointment rates, appointment cancellation frequency, patient retention, case acceptance, and new patient flow. If one of these areas is weak, any issues should be remedied before embarking on a new endeavor that will split your time and may double your problems.

For example, if patient retention is poor at your first location, what guarantees are there that they will be any better at the second? Patient attrition rates will probably not improve at your second location if you haven’t figured out a strategy to handle it at the first. These problem areas should be addressed—and processes effectively streamlined—before spreading your practice’s shortcomings across multiple locations. You want to be duplicating a well-oiled machine, not a sinking ship.

In adding a second location (and starting from scratch, rather than purchasing an existing practice), you’re not just adding a second lease: You’re doubling your staff, equipment, inventory, and associates. Remember that huge investment you just made in a state-of-the art CBCT system? You now need a second one. The expensive air-filtration systems you upgraded to during the COVID pandemic? Your second office will require that, too—and it will need it before you even open your doors.

You’ll also probably need to add an associate or 2 at the new location (which means dividing your profits), hire a second hygiene team, and staff the front desk. While the old adage may be correct that you need to spend money to make money, you need to ensure you’re not spending more than you will recoup.

To add a second practice, you’ll probably be leveraging your current practice investment to get a loan. This means if your second practice fails, your first one is likely going down with it. Practitioners need to weigh the return on investment carefully, and consider both the immediate and long-term costs.

Timing is everything, as they say, and that goes for opening a new dental practice as well. Not only does the timing need to be right financially, but you need to think about time in regards to your patient schedule—and your own.

Do you currently have the ideal number of patients at your practice? Are you overbooked and unable to fit patients in, or are there huge, gaping holes in your appointment schedule? If you have the time in your schedule to increase your patient load at your first practice, adding an additional location may not be a good idea. If you’re struggling to find time to treat all your current patients, it may be time to expand.

But it’s not just about your appointment schedule: You have to take your own schedule into account as well. Do you want to work more hours than you already are? Managing a new practice will eat up numerous hours each week. Do you have the time to get a new business set up (including the setup and design, hiring, marketing, and management required by starting a second location)? Getting the new practice off the ground is going to take a lot of upfront legwork that may pull you away from your clinical duties. If your days are already full, you may not want to add these time-consuming tasks to your schedule. In the end, do you even want to spend time commuting to a second location?

“If you’re trying to do too much, someone’s going to lose—and that someone will be the dentist,” Gary Kadi, founder of Next Level practice, says. “They lose because they end up working more hours, working harder and working longer, and not taking time off or ever leaving the office. And they suffer, and their kids and families suffer, and no one is happy.”

Location, location, location. Where you decide to set up your second shop could be the difference between success and failure. While you need to consider things like visibility, traffic, area dental-practice saturation, and even parking, you also need to factor in proximity to your first practice.

One way to maximize revenue between your 2 practices is to seek out an area that services a different demographic. You don’t want to be cannibalizing your existing patient base (or have your locations so close together that your patients drift back and forth between the 2 practices). By tapping into a new market, you can double your potential patient base and create a new opportunity for growth. Of course, this means adjusting your marketing strategies (and dropping some money on new marketing), but it will help draw new patients that haven’t already been targeted. If there is a good location nearby that won’t split your patient base, it may be a good time to make a move into that market.

Another thing to take into consideration when evaluating proximity to your current location is, how close is too close? Eventually, closer to retirement, you may want to cut back and sell 1 of the locations. If it’s located too near your original location, a potential buyer may see it as an oversaturated market and may have concerns about competition—particularly if you have a patient base that goes back and forth between the 2 locations, as in the event of a sale, they’ll probably choose 1 over the other (and odds are, they’ll stick with the doctor they know).

5. Is your staff ready for the expansion?

Preparing your staff for the new addition is critical to success. Staff needs to ensure patients know which location their appointment is at; supply orders or lab results need to be sent to the correct office; staffing needs have to be met at both locations; existing staff needs to understand what bringing on a new associate will mean for them and their workflow. By properly preparing your staff, you’re laying the groundwork for a smoother expansion. But first, the staff need to be on board.

“It's so important for practitioners to not only help the team understand the business side of dentistry,” Phillips Newland says, “but to also get them to buy in. You want to breed that ownership mentality that this doesn’t work without all of them, that every single member of the staff is important and every job is important.”

Building this sense of ownership can be a challenge, so any problems with staffing or company culture at the first location should be addressed before the stress of a second location is added to the mix.

“Team acknowledgement is number one,” Kadi says. “You need to say, ‘I’m asking you to join me on this journey. We are implementing change but it’s going to benefit us all. We’ve been producing results and it has taken all of us, as a team, to make that happen. And now we can take it even farther.’”

Keeping your team cohesive across multiple locations is also no easy feat, so regular training and communication will be imperative. Standardizing processes across both locations and creating standard operating procedures will simplify training and any staff crossover. Daily morning meetings to touch base, and more in-depth monthly meetings to cover goals and KPIs will keep everyone in the loop and bridge the gap between the 2 practices. While managing 2 practices can be a challenging endeavor that isn’t for everyone, for the practitioners than can balance the needs of multiple locations, it can be a lucrative investment.

What to take into account before adding additional dental office locations so that your business decisions pay off to the fullest.

Expanding Your Dental Practice Opportunities

Expect the Best, Plan for the Worst. Photo courtesy of chinnarach/stock.adobe.com. 

We’ve all heard the horror stories: Practices that are devastated by data-security breaches and cyber ransom attacks. In 2015, a practice in Minnesota was hit twice in one week by hackers. In 2019, a ransomware attack disabled nearly 400 dental practices across the country. Just three months later, a separate attack on an IT company in Colorado crippled more than 100 additional practices. Add on attacks in the Dallas area, Pacific Northwest and across Wisconsin, and it seems like no location is safe.

No one wants to be a practice in one of these stories. But dental practices are a prime target for hackers and ransomware-attack conspirators. While at first glance, it may seem that big box stores or lucrative chains would be a more logical target, dental practices have exactly what these cyber criminals are looking for.

“The reality is that health records are far and away the number-one commodity on the black market,” says Lorne Lavine, DMD, HIPAA and data security expert and founder and president of The Digital Dentist. “Health records contain the patient's name, phone number, date of birth, social security number, and credit card information. They are literal goldmines.”

To make it worse, the perpetrators of these cyber attacks know that dental practices can’t afford to be locked out of their systems, or have their patient data compromised—and that practices will do just about anything to get it back.

“Unfortunately, they know that dental offices for the most part have the ability to pay,” Dr Lavine says. “So, dental offices are absolutely a prime target.”

With this much attention on dental practices and their valuable data, practitioners need to take extra steps to avoid becoming a victim. This means disaster proofing your practice’s data and operations—and knowing what steps to take in the unfortunate event of a breach.

Bottom line: The threat is real. And while that doesn’t mean practices should panic, it does mean they need to be prepared. Very prepared.

“We’ve been preaching HIPAA compliance for well over a decade, but for various reasons, it just doesn’t seem to resonate with dental offices,” Dr Lavine says. “They seem to think the threat risk is relatively low. But it’s impossible to pick up a newspaper or go online and not hear about the latest ransomware breach of some major company—and dental practices are far from immune.”

And while practice’s can take individual precautions, they need to remember that not all of their data is in their hands. If their IT company doesn’t have the best practices, it is the practice that can suffer. Ultimately, if a ransomware criminal can get into the IT company’s portal, they now have access to every one of the computers and servers that the IT company manages. And at the end of the day, if the company suffers a breach, the dentist is responsible for that.

“I don't want to use fear mongering as a way of getting someone to do something,” Dr Lavine says. “But on the other hand, I feel like my obligation as an IT partner is to tell people what they're at risk of and what the consequences would be if something were to happen, as well as how best to deal with it and what their options are to deal with it would be—and what those options would cost. And then it's up to them.”

So, what steps should a practice take to safeguard their data? It all boils down to 1 thing.

“Ransomware, ransomware, and ransomware,” Dr Lavine says. “Just like the 3 most important things in real estate are location, location, location. There’s no question.”

When it comes to protecting data, ransomware protocols are far and away the most critical thing, says Dr Lavine. The first critical step is keeping the ransomware out. Step 2 is dealing with it if it does get in. And step 3 is having proper recovery protocols in place if steps one and two fail. 

Step 1—keeping the ransomware out—means putting the necessary precautions in place in advance. One critical component of these precautions is to implement a business-class firewall. Consumer-level firewalls (like Linksys, Netgear, or firewalls built into cable modems) are designed for exactly that—consumers—and shouldn’t be used in business settings like a dental practice; they simply aren’t effective enough.

“Get a real firewall,” Dr Lavine states. “A real business-class firewall is a must. They aren’t inexpensive—a decent firewall is going to run a practice somewhere in the range of $500 to $800—but this is the number-one thing you can do to protect your data.”

The second component of the ever-critical step one is patch management. Every software program out there has security holes in it, holes that companies are continuously finding and patching.

“It’s like a game of whack-a-mole,” Dr Lavine says. “They’re trying to keep on top of it, but they’re finding new holes every day, and just trying to stay in front of the people who might exploit those holes.

As an example, Dr Lavine references the Microsoft transition in the beginning of 2020, where the company informed everyone that they needed to switch from Windows 7 to Windows 10. It wasn’t that Windows 7 wouldn’t work anymore, but that Microsoft would no longer be patching those systems. And since patch management is also a HIPAA law (the law states that a practice’s software must be current and up to date) this means practices, like everyone else, had to make the switch, or not be HIPAA compliant. 

And while Microsoft Windows rolls out automatic patching, it’s not enough to keep a practice’s entire servers secure. Most practices have way more software than just Windows, and by law, all of that has to be kept protected by current ransomware.

“The most common way that ransomware gets into your system is through email,” Dr Lavine explains. “But the second most-common way to get it is through an unpatched operating system. So, it is really critical that they do this patch management. You can’t just load the software and not think about it again for a year or two. That’s just not safe. And, from the HIPAA standpoint, it’s a violation if you don’t have patch software.”

Despite a high-quality firewall and regular patching, sometimes ransomware can sneak into a system. Unfortunately, the days of just throwing some antivirus software on your compute and being done with it are over. Part of what makes ransomware so tricky is that a lot of the new viruses that are coming out are called zero-day infections—a virus that is so new that a firewall doesn’t know what to do with it. Essentially, your firewall and antivirus software don’t recognize it as a virus and don’t know what it is.

To combat this challenge, practices should have 3 things in place: Antivirus software, anti-ransomware software, and application whitelisting. While most practices have antivirus software in place, it’s also critical to have ransomware-specific defenses in place.

“There are tons of good antivirus software out there,” Dr Lavine says. “The challenge with antivirus software though is that even though the companies tell you that the software will do a good job against ransomware, in my experience that is often not the case. So, I always recommend that practice’s supplement their general antivirus software with ransomware-specific software. Some of the more best-known ones are Intercept X and HitmanPro, but there are a lot of good options out there.”

To further protect against the sneaky zero-day infections, practices should implement application whitelisting. An application whitelist is essentially a bouncer that stops uninvited guests at the door. If a program is not on the approved list, the software won’t allow it to run. If something does manage to get through your firewall, patch software, antivirus software and anti-ransomware software, the application whitelisting pretty much stops it in its tracks.

“I think application whitelisting is a game changer when it comes to viruses and ransomware,” Dr Lavine says. “We take an inventory or all the software that a practice is running, and if any program not on that list tries to run, it will literally get stopped. Since we started doing application whitelisting with our clients about six months ago, we have not had a single virus infection, which is not something we could say before that.”

In dentistry, dentists wouldn’t think of doing their own legal work, or attempting endo or orthodontic procedures they weren’t trained for—they would employ a specialist to get the job done. Cybersecurity shouldn’t be treated any differently, particularly as it becomes a bigger and bigger issue, but dentists should be focused on their practice and their skills, not spending time and energy trying to secure their systems. This means relying on the experts.

“One challenge with HIPAA compliance is not so much that you've got the systems in place, but that you can prove that you've got the systems in place and that you can document it all properly,” Dr Lavine says. “Most offices, even ones who are tech savvy, don't know how to do this stuff. You need to do a risk assessment—you wouldn’t treat a new patient without doing X-rays or charting and gathering your data—and you have to treat cybersecurity the same way. But you’ve really got to look and know where to look, and this requires a professional.”

And while no one wants to spend extra money where they don’t have to, in this case, hiring an expert could save practices a substantial cost down the road. Unlike a lot of HIPAA rules, which are somewhat ambiguous, the HIPAA Breach Notification Rule is very clear. It requires HIPAA-covered entities (such as dental practices) to provide notification to the U.S. Department of Health & Human Services (HSS) after a breach. Practices are also required to notify all patients and the news media, and are listed on the HSS website. Additionally, they could face tens, if not hundreds, of thousands of dollars in fines, penalties and lost revenue from the practice having to go through an audit.

“When you look at the penalties of a breach and compare them to the cost of having a really good dental IT company managing your practice, it’s a no brainer,” Dr Lavine says. “Find an IT company that really specializes in healthcare, specifically cyber security.”

This is particularly important to smaller practices that may not have the in-house resources to properly protect patient data. Most of the larger corporations and health groups, such as Anthem, hospitals, or large DSOs have high levels of cybersecurity in place; they can afford to have multiple people on payroll that specifically handle HIPAA and IT. But that isn’t true for most solo practices.

“Most dental offices don’t have that,” Dr Lavine says. “You’ve got an office manager, not a cybersecurity expert. But they are responsible for keeping the practice safe. Even the most tech-savvy practices don’t have the ability to install and manage this type of software on their own. If there is a breach, what will even a couple of days of downtime cost a practice? Without your system, you’re dead in the water. Even that will probably cost a practice more than hiring an IT expert to manage cybersecurity.”

Ultimately, Dr Lavine approaches having an IT team like having car insurance: It may seem unnecessary now, but if trouble arises, it will all seem like a good investment.

“There’s a good chance you may never need it, but the one time you do, you’re going to be awfully glad you’ve got it in place,” he says.

Being prepared for the worst can help your practice feel more confident when dealing with ransomware attacks.  

Expect the Best, Plan for the Worst: Disaster-proofing your Practice’s data and Operations 

Onwards and Upwards. Photo courtesy of Blue Planet Studio/stock.adobe.com.

Cloud-based software has permeated every-day life to the level where we rarely give it any thought. We send emails, store our photos online, and check in with friends via social media—all on cloud-based platforms. One would be hard-pressed to argue that the cloud hasn’t greatly simplified information sharing.

Yet within the dental community, opinions are split. Is cloud-based software the best solution for dental practices? Should you transition your practice management to the cloud? And what exactly does that mean?

“People kind of confuse what the cloud is, and a lot of terminology is out there,” says Lorne Lavine, DMD, founder and president of The Digital Dentist. “But for lack of a better term, is just putting your data on somebody else's server. Simple as that. But there are a lot of factors to consider before you make the transition.”

So, what should do before making the leap?

It seems like a no-brainer, but doing thorough research is critical before any big technology transitions. While switching to a cloud-based model may make sense for some practices, it could mean more trouble—and money—than it’s worth for others.

“Sales reps often use cost savings as a reason a practice should switch to the cloud,” says Dr Lavine. “They’ll say, ‘Hey, you know, if you go to the cloud, you're not going to need a server, you're not going to need all that stuff.’ Moving to the cloud is pitched as a great way to save money—but oftentimes, it’s going to cost the practice even more.”

For example, Dr Lavine says, a good server may run around $3,000—certainly a large upfront cost that can seem off-putting. However, if it lasts 5 or 6 years, the cost averages out to around $50 a month. In comparison, many cloud-based programs can run around $500 a month, which means that in the long run, a practice could be paying 10 times more for the cloud than it would if it had just stomached the upfront cost and bought the server.

“The appeal to some solo practitioner is that they believe that it's going to be less costly, but when you price it out, that may not be true,” says Dr Lavine. “In addition to avoiding upfront costs, practitioners believe they're not going to have to deal with HIPAA, they believe they're not going to have to deal with backup, and encryption, and you know, all this stuff that goes into running a modern practice. But most of them, unfortunately, find out the hard way that no, that's not really the case. 

In addition to paying more over the long run, using cloud-based software doesn’t always mean that a practice doesn’t also need a server. Most offices have email, QuickBooks, Word docs, etc.—and from a HIPAA standpoint, there are 18 different identifiers that make that data protected health information. This means that all that information kept within the practice will have to be housed in a HIPAA-compliant manner.

“Even if you're using a cloud-based practice management software, in most cases you still need a server,” says Dr Lavine. “While most of the patient information is in the practice-management software, certainly not all of it is. And you still need HIPAA compliance.”

In short, Dr Lavine says, practitioners should be aware of all the potential costs associated with a switch to the cloud.

“Dentists for the most part are tech savvy,” says Dr Lavine. “They want the latest and greatest, and they want to be on the leading edge. Unfortunately, however, sometimes it turns into the bleeding edge.”

In addition to performing a cost-benefit analysis, practices should ensure that their practice can support access to the cloud. After all, if the cloud isn’t accessible, a cloud-based practice is dead in the water.

“The first and most critical thing to think about before going to the cloud is, do you have a good internet connection?” says Dr Lavine. “Is it fast enough? Is it stable? The basic premise of cloud is that if your internet goes down, you go down. People need to make sure they got a good solid plan in place before they switch to the cloud.”

This means ensuring reliable internet will always be available, and that practices have an IT professional reliably on speed dial in the event of outages. And even if the internet is online and working properly, practitioners need to be sure that the internet will be fast enough to support the practice’s transfer of data—particularly when it comes to digital images. Dr Lavine says that one of the biggest issues he’s seen with the cloud, especially when it comes to bandwidth, is images.

“For most practice management software, it's just text, numbers, and letters,” explains Dr Lavine. “And with that, you're not going to see a huge difference in speeds, whether it's mobile or cloud based. But image files are significantly larger files than the data for the practice-management software, and so making sure your internet bandwidth can support those larger files is critical for storing any sort of digital images.”

Internet speed isn’t the only measurement that need to be taken into consideration. Cloud-based platforms rely on the practice-management companies’ servers, and their location can impact how quickly they can return information. Since this can affect the user experience, practices should know where the servers are located. Are they in the same city? Are they thousands of miles away? The farther the server, the longer it will take for a request to reach it—and the longer it will take for that server to return the requested information to you. And while we aren’t talking about the snail’s pace of the days of dial-up internet, even a few seconds in delay can affect productivity. 

“If servers are relatively close, we could be talking about fractions of a second,” says Dr Lavine. “If they’re far away, it could be multiple seconds. That can add up, and really slow a practice down.”

With on-site servers, for better or worse, a practice has complete control over the security of its database and network—meaning the practice also has comprehensive control over who can access the data within. A server with user accounts, and logging and auditing capabilities can keep track of just who is viewing what information. In contrast, with cloud-based software it can often be harder to track who accesses that data. And when it comes to HIPAA compliance, this could become a problem.

“One of the big reasons why I recommend a server is that you need to track who in the office access patient information, when they access it, and what they do in the practice management software,” says Dr Lavine. “An audit trail lets you do that. There are so many other sources of patient information you also need to track. We can better control and manage all those users with a server running a server operating system that can do that.”

With cloud-based platforms, practitioners also need to consider that they are essentially putting their data in someone else’s hands. If a practice-management company’s server is compromised, so is all of your practice’s data—which could have major repercussions for the practice, since it is ultimately the practice’s data, not the company’s, that was breached. However, an in-house server is only as secure as a practice makes it—and keeping up to date with the necessary safeguards, patches, and ransomware can be time consuming and costly.

Ultimately, while cloud-based software may be a good solution for some practices at this time, smaller practices should be meticulous in their research and evaluation before transitioning. That being said, the cloud can also bring the benefits, accessibility, and conveniences that we enjoy every day on private cloud-based platforms like Gmail or Facebook.

“In my opinion, the cloud is an excellent solution for multi-location practices or group practices,” says Dr Lavine. “It’s the perfect solution for information sharing between locations—way better than how we typically used to do it via VPN or remote desktops and things like that.”

However, Dr Lavine still remains cautious about the benefits for single-location practices. While cloud-based technology is appealing and new, it may not provide the most effective solutions.

“For a solo practitioner, unless they just love the software, they've got great Internet, and the company also offers a web-based imaging solution, it just may not have benefits that outweigh the investment,” explains Dr Lavine. “For a lot of people, it's just not the most cost-effective option for them.”

But as technology advances, inevitably a cloud transition will happen for all practices.

“At some point, everything's going to be cloud based, though whether it happens in our lifetime or not is anyone's guess,” says Dr Lavine. “But there's no doubt that we're headed in that direction. And when we get to that point, it will make life easier, because you're not going to have to worry about the HIPAA stuff as much and you're not going to have to deal with backup (since all the data will be in the cloud). You won’t have to worry about patching your systems, or ransomware, or all the things you have to deal with in a modern practice. Simply put, it’s going to be simpler.”

Making the transition from the server to the cloud requires a few steps and prep but is worth it for the benefit of the practice. 

Onwards and Upwards: Getting Your Practice Ready to go from the Server to the Cloud 

Designed to work as a tongue and void filler to fill in bubbles, air pockets, missing teeth, and undercuts, Wonderfill can also be used with a bleaching tray. It reportedly eliminates grinding out stone from lower impressions and there is no need to mix alginate filler. Wonderfill holds up under heat when making heat-shrink retainers and is said to enhance the fit of appliances and bleaching trays.

Jerri James, CDT, a dental technician at CenTex Dental Lab in Waco, Texas, can hardly remember a time before Wonderfill. Hard-pressed to say exactly how long she’s been using it in her lab, she can’t imagine going back to how things were before.

“We’ve been using it for at least 10 years,” she says. “I’m not really sure how long, because it’s just made the years since we began using it so much more streamlined. I would never go back to before.”

Priding herself on the quality of her work, James has found Wonderfill to be a reliable way to create perfect, well-fitting finished products. Premixed and easy to form, Wonderfill acts as a quick-use tongue-and-void filler that saves labs time and money, by quickly and easily creating more accurate and better-looking models—a huge departure from the days of alginate tongue fillers or plaster and stone models without a filler. Although Wonderfill can also be used for bleaching trays, James primarily uses it as a void filler for the lower tongue area and to fill in bubbles, air pockets, undercuts, and spaces left by missing teeth.

“The big benefit is we aren’t doing the old boxing method for models,” James says. “Wonderfill blocks out all undercuts and makes a neater-looking model. It’s a complete turnaround from the years past. When I went to lab school to learn how to box a model, we didn’t have all this. All we had was boxing models with wax—and this is definitely the way to go over that.”

With the boxing technique, which required extra steps such as pouring wax, James found the process took 20 to 30 minutes. With Wonderfill, she says it takes maybe 5 minutes to get it prepped and ready to pour. After a lower impression is taken, the tongue area is filled with Wonderfill. Once the plaster is poured and set, Wonderfill is easily removed for a clean, generally residue-free model.

“Residue depends a bit on the consistency,” James says. “Occasionally, you’ll get a situation where it sticks to the model, but not very often. [Dental Creations] finally has it perfected where it rarely does. But, in the off chance it does, it is water soluble so it washes right off perfectly—no matter what.”

This also means less of a mess. There’s no messy alginate tongue filler to mix and clean up, and technicians won’t be faced with the dust caused by grinding out stone, as Wonderfill eliminates the need for both of those methods.

“It’s too easy not to use,” James says. “It’s less mess, because you don’t have the big cleanup that you would when you pour a regular model or are boxing a model.”


Another benefit James touts is Wonderfill’s cost-effectiveness. In addition to being inexpensive, James says, Wonderfill is reusable, should technicians want to reuse it. Because it comes premixed and has a long shelf life, a little bit can go a long way, which is especially important when a lab uses it as much as James does.

“To me, it’s a perfect add,” she says. “When we go out to doctor’s offices [for] a job there, we take a bucket of it with us so we have it there to use. We wouldn’t go without it.”

Overall, James is hard-pressed to come up with any Wonderfill shortcomings. She’s had a great experience with not only the product but also with Dental Creations, and she says the company is easy to work with and simple to get a hold of. For labs that haven’t used Wonderfill yet, James has 1 piece of advice.

“They need to try it,” she says. “Once they try it, they’ll see it makes your product look so much nicer. It makes a better-looking product to send back to the doctor’s office. We care about what we send out, so we want our product to look nice. Wonderfill just makes a world of difference.”

How Wonderfill has changed one technician’s approach to model making. 

The Wonderfill Difference

Delegating Tasks to Practice Technology. Photo courtesy of HBS/stock.adobe.com. 

The ever-wise Oprah Winfrey once said, “Are we limiting our success by not mastering the art of delegation? … It’s simply a matter of preparation meeting opportunity.” In addition to doling out cars, this advice-giving legend also recommends doling out responsibility.

For dental practices, the ultimate opportunity for delegation is here—but not in the form you might expect. Yes, practitioners should rely on their teams to complete tasks so that they can focus on the business of dentistry. But there’s also another team member that can take a lot off your plate: automated technology. Taking advantage of it is akin to mastering the art of delegation, but many dentists have been slow to embrace this ultimate tool in their practices.

Taking a look at what tasks your practice should automate and how to get them up and running. 