The practice of clinical dentistry employs a wide array of materials. Just about every procedure requires at least one specialized formulation, and while one product might be accomplishing the task at hand, this doesn’t mean something more effective isn’t in development or already available.

Even as innovative technologies create new ways of diagnosing and treating patients, this often simply means switching from using one type of dental material to another. So while practices using intraoral scanners are likely capturing fewer impressions with physical materials, the act of restoring a tooth will require some material to be affixed in the mouth.

Dental material innovations take many forms, but the end goal is to create something that looks and functions as much like the material it is replacing as possible, and every generation of dental materials gets closer to that objective. Today many material options are designed to both mimic natural esthetics and to provide patients with added protection from recurrent decay. To showcase these innovations, we spoke with a number of clinicians, who shared their thoughts on the types of products making a huge impact in their practices and for their patients.

Direct Restoratives, Preventive Materials, and Bioactive Materials

Articles

The rapid innovation of dental materials creates new possibilities for treatment, results in easier workflows for clinicians, and improves outcomes for patients. But just how far have things progressed, and what new materials are making an 
impact on dental practices?

Breaking Material Boundaries 

I’ve had the pleasure of writing this column for close to 7 years. In that time, I’ve discussed many high-tech advances in dentistry such as 3D printing, imaging, artificial intelligence…the list goes on and on. One thing that often gets lost in the discussion is that to run these applications, you need the proper infrastructure. Over the next few columns, I want to take a step back and review my recommendations for that infrastructure.

Many offices are unaware that the need to overhaul your computers and network will often exceed the cost of these advanced applications, and nobody likes those types of surprises. For this month, I am focusing on the server.

One question I often get from clients is whether they even need a server. In almost all cases, the answer is yes! Certain aspects of a server make it more “bulletproof.” The server usually contains your most critical patient information; you must do everything, within reason, to protect and secure that data. As I discussed in a recent column on cloud computing, even if you are using a web-based practice management software (PMS), you still will need a server. There are often multiple sources of patient information in your practice beyond the PMS, such as images, emails, explanations of benefits, QuickBooks, Invisalign…you get the idea.

There are certain features to look for when designing a server. The first is a server operating system, such as Windows Server 2019 or 2022. One aspect of HIPAA regulations is that you must control and manage access to patient information. This is much easier to do with a server operating system rather than workstation software such as Windows 10 or 11.

I always recommend using an Intel Xeon processor, which is designed to handle the multitasking that most servers do every day. You should consider using 32 GB of RAM (memory). For the hard drives, I typically recommend using a pair of 4 TB drives in a RAID 1 configuration. What does that mean? RAID is a way of mirroring drives to provide redundancy. That means the server will continue to operate even if one of the hard drives fails. There are plenty of variations of RAID, such as RAID 5 or RAID 10; I prefer RAID 1 because it only requires 2 drives and is easier to manage and recover.

Large vendors such as Dell offer different levels of warranty for servers. I typically only buy servers with a 3-year warranty. Most servers should provide 5 to 7 years of use, but if a server makes it to year 3, it’s highly likely it will go to year 6 or 7 without issues. In other words, it’s difficult to justify paying extra for a warranty that is longer than 3 years.

What does a server cost? Well, there are a lot of options and variables. You can get a good Dell server that should provide 5 to 7 years of service for approximately $3500 to $4000, but there are certainly practices that spend more or less than this, depending on their needs.

Any time you are considering adding new technology to your practice, you should reevaluate your server. The server is the lifeblood of the practice; the hardware always has to match and exceed the demands of the software for things to run smoothly. Any good dental information technology provider can recommend an appropriate server for your practice.

Practices require a lot of data management, and a dedicated server is the best way to keep data safe, secure, and under control.

Server Plays Key Role in Dental Data Management

In 2016, one of my patients—a frustrated mom who was about the same age as myself—humorlessly asked me, “Isn’t there, like, a magic coating you can put on my teeth so I don’t get any more cavities?”

Her husband, who never flossed, snacked on Twizzlers, and would only brush for a minute with a manual toothbrush, just received the good news: He had no cavities. In contrast, his wife, who was in the operatory room just next door to him, had 3 cavities. What’s worse, 1 of these 3 cavities was recurrent decay at the margins of a filling I had done only a few years prior. She has excellent at-home habits; she meticulously and properly uses all the tools when she wakes up and before she goes to sleep, yet she continues to receive bad news at her dental visits while her less-responsible husband is delighted to receive the news that he would be granted another 6-month reprieve from any visits to our office.

As any dentist who has practiced for any length of time would agree, sometimes meticulous home care is not enough. Some people just have unlucky oral environments. Some people, like the dear patient described above, have a less-than-optimal oral pH, or a poorly balanced diversity of oral microbiota, or even an inability to produce certain enzymes in their saliva.

Reducing Incidences of Secondary Decay with Bioactivity

I knew that my approach to her fillings had to be different. Without a doubt, I knew that however thorough and conscientious I intended to be when restoring her teeth with traditional class I, class II, and class V bonded restorations, she would inevitably return to my office with ugly discolorations at the margins, and I would inevitably question my own clinical expertise.

Fortunately, around that same time, I had attended a continuing education (CE) course in Chicago, Illinois, in which some of the most incredible minds in general dentistry shared innovative and not-so-well-known techniques and products with the audience. It was at that course where I learned about bioactivity. By now, you have probably heard the word, but I would like to describe bioactivity the way I understand it best.

Our enamel is a bunch of rods held together by a highly mineralized cement substance. This is like holding a bunch of Nerf bullets together in your hand, and then squirting superglue all over the bullets. Demineralization, which is caused by acid from bacteria, sugar, and bad luck, weakens the superglue. If the glue weakens enough, you lose some of the Nerf bullets, or you then have enamel cavitation. Dentin is made of similar hydroxyapatite crystals but is arranged in a much more porous grouping, such as a really hard block of Swiss cheese, allowing for branches of the pulp to occupy the tubes within the cheese.

Certain minerals act on the dentin, the enamel, and those branches of the pulp in a really convenient way. Fluoride is like superglue to the hydroxyapatite rods in the enamel and hydroxyapatite crystals in the dentin, holding them together and inhibiting demineralization and eventual cavitation. Additional ions, such as strontium, silicate, aluminum, borate, and sodium, all act either independently or in combination with one another to neutralize the demineralization of acid and inhibit plaque formation. Moreover, they work together to elicit the growth of new hydroxyapatite. They don’t allow bacteria to grow; instead, they remineralize enamel and dentin that have been subject to acid and elicit growth of new solid healthy tooth structure. If only there was a product that constantly released these ions.

It was at this same CE course that I had the opportunity to try Beautifil composites from Shofu in both packable and flowable options. These are restorative solutions that have bioactive Giomer as its filler particles. What was incredible for me, though, was the fact that this product behaves just like all the other packable and flowable restorative products that I was already using. It isn’t too hard, flaky, sticky, or any of the other negative characteristics that make me shy away from certain composites. Beautifil II is a pleasure to work with clinically, and the outcome after curing and polishing is almost always fabulous.

Inspired by the taste tests that I remember from my childhood—blindly pitting Coca-Cola vs Pepsi, or a Whopper vs a Big Mac—I decided to take all the composites I had in my office and ask an assistant to cover any identifying features. Every composite that I used in this test was highly rated and had been used with satisfaction at one time or another in my own office. I then ordered a bunch of typodont teeth and prepped simple class I’s in each tooth. Myself and 2 other dentists all were tasked with restoring the fake cavities, evaluating each composite on its handling. The unbiased winner was Beautifil II.

Recently, this product was given to several members of the Catapult Education product review board. This is a group of general dentists coming from a diversity of clinical environments. The group was asked to use the product during everyday clinical scenarios, including anterior and posterior restorations.

Most respondents said that they most appreciated Giomer bioactive products’ ability to reduce/eliminate the incidence of secondary decay, whereas several others cited its ability to reduce/eliminate postoperative sensitivity. They appreciated its natural-looking esthetic, ease of use and handleability, predictable shade stability, and, of course, its Giomer bioactive features. “This is a no-brainer,” one respondent said.

It is incredibly rare for a product that is tested among the Catapult Education board to acquire a 100% positive response rate when asked, “Do you intend to continue using this product?” and “Would you recommend this product to a colleague?” Beautifil II is just such a rare product.

So, now I have a composite product that is a pleasure to work with, and it happens to be bioactive. I think I found my magical restorative product

Beautifil II from Shofu is a composite material that harnesses biochemistry to reduce secondary decay without sacrificing esthetics. 

Reducing Incidences of Secondary Decay With Bioactivity

In the past year, Middlesex College has made great strides with the incorporation of teledentistry into our dental hygiene curriculum. We have proudly graduated one class of teledentistry-trained hygienists in 2023 and will graduate our second class this year. They are the first to benefit from the implementation of teledentistry in our hygiene curriculum program. The classes consist of approximately 53 students well versed in virtual care made possible by the use of teledentistry.

We are proud to be pioneers in including teledentistry into our hygiene curriculum and are advocates for seeing more hygiene and dental schools take our lead—especially those in New Jersey.

For example, the New Jersey State Board of Dentistry authorizes health care providers to engage in telemedicine and telehealth. This includes licensed dental hygienists.

All New Jersey dental hygiene programs have a responsibility for implementing teledentistry. The challenge is to do so in a way that is seamless and does not require additional hours.

However, with our successful model as an established guide, I do foresee many more hygiene schools implementing teledentistry into their curricula. I also foresee the Commission on Dental Accreditation placing emphasis on this in the future.

As part of our advocacy for including teledentistry in the curricula of all New Jersey hygiene schools, in October 2025 Middlesex College will be presenting at the New Jersey Dental Hygienists’ Association meeting and discussing teledentistry during an educators’ workshop. I am confident that this will have a positive impact on the future of dental hygiene education in New Jersey and hopefully other states as well.

Taking Teledentistry From the Classroom and Into the Wild


Since we introduced teledentistry into our curriculum, we have been taking it from the classroom to the community. We began by conducting simple screenings, but today we are engaging in external community outreach rotations by utilizing asynchronous (store and forward) teledentistry. This form of teledentistry involves recording a patient’s clinical information and transferring the data to another dental professional at a separate location.

One example of our community outreach efforts occurs at the onset of each fall and spring semester, when faculty members, students, and clinic dentists collaborate to perform screenings for more than 200 children in the Educational Services Commission of New Jersey (ESCNJ).

Following these screenings, a faculty member and 2 students are selected to rotate to ESCNJ locations (Piscataway, New Jersey, in the fall and Sayreville, New Jersey, in the spring) to administer preventive dental care.

During these rotations, MouthWatch intraoral photos and radiographs using a NOMAD handheld x-ray system are taken and shared asynchronously (stored and forwarded) via MouthWatch TeleDent software with our clinic dentists for review. Manufacturer MouthWatch is headquartered in the neighboring town of Metuchen, New Jersey. Subsequently, our clinic dentists formulate treatment referrals, which are then forwarded to ESCNJ and provided to the respective parents or guardians.

Since we have expanded community outreach rotations, we now have 8 MouthWatch intraoral cameras and maintain 60 MouthWatch TeleDent software licenses. This investment has been very effective in providing more children with oral health screenings and clinical care.

In a 1-year span, we have been able to increase the number of children screened from 66 to over 200 and the number of children who receive preventive dental care to 70. (We did not provide clinical care in the past academic year. This is the first year we tracked it.)

Hygienists Bridging the Medical-Dental Gap


Teledentistry’s impact on the nation’s oral and systemic health can play a vital role in expanding access to preventive oral health care to underserved communities. It also will help bridge the gap between dentistry and medicine.

Currently, our hygiene students have multiple interactions with members of other health professions via participating in the Students’ Perceptions of Interprofessional Clinical Education interprofessional collaboration session with Rutgers School of Dental Medicine. During these sessions, they work with students from Rutgers medical, dental, nursing, pharmacology, nutrition, and social work schools. Together, they review a case and discuss it with the assistance of a faculty facilitator.

One of the main things we have learned during the past year is that we always need to evaluate our process and look for room to improve it. We need input from all who participate to help us make these improvements.

The Middlesex College Hygiene program’s teledentistry program will always be a work in progress. The possibilities of teledentistry are endless and we are thankful for the support we receive from the college, faculty, external sites, and MouthWatch.

In May 2023, Dental Products Report featured Edison, New Jersey’s Middlesex College, and took a deep dive into how the college successfully incorporated teledentistry into its curriculum and community outreach efforts. One year later, Michelle Roman provides an update about the hygiene school’s progress in education and public health.

The Middlesex College Teledentistry Program: One Year Later

In the realm of modern cosmetic dentistry, the pursuit of optimal esthetics and durability often requires meticulous planning and the integration of innovative materials and techniques. This case study highlights the successful restoration of multiple zirconia veneers using the innovative KATANA™ Zirconia ONE layered zirconia (Kuraray Noritake). By leveraging digital technology, advanced materials, and evidence-based protocols, the clinician is able to address the patient’s concerns while delivering a functional and esthetically pleasing outcome that exceeds expectations.

A woman with good overall oral health presented with concerns about the condition of her existing porcelain veneers on teeth #6 through #11. She reported a fracture on the lingual surfaces of veneers #8 and #9, as well as dissatisfaction with staining, black triangles, and lack of luster in the same area (

). The patient sought a comprehensive solution to restore the natural beauty and integrity of her smile.

A thorough clinical assessment was conducted, including periodontal probing, occlusal evaluation, and diagnostic radiographs (

). Her periodontal health was found to be within normal limits, but the occlusion revealed a tight bite relationship with some misalignment of the opposing mandibular incisors, contributing to the breakage on the lingual surfaces of veneers #8 and #9. Radiographic examination revealed porous porcelain veneers #6 through #11 with microfractures throughout.

Based on the findings, 2 primary treatment options were considered:

IPS e.max veneers (Ivoclar) made of lithium disilicate. While offering esthetic appeal, this option would require more extensive tooth reduction and provide less strength and longevity compared with the alternative.

KATANA Zirconia ONE veneers made of layered zirconia. This innovative material, known for its beauty, strength, and longevity, emerged as the preferred choice due to its ability to address the patient’s concerns while minimizing tooth reduction.

The treatment process began with a detailed digital impression using the CEREC Primescan (Dentsply Sirona) system’s BioCopy mode, which captured the existing porcelain veneers #6 through #11. This digital impression served as a blueprint for the new restorations, ensuring a seamless transition and maintaining the patient’s familiar smile esthetics.

Patient comfort and satisfaction were prioritized throughout treatment. Prior to the administration of local anesthesia, a cotton roll with lidocaine gel was applied for 5 minutes to enhance patient comfort. Buccal and interproximal infiltrations were performed using 2 carpules of lidocaine with 1:50,000 epinephrine. A putty impression was taken before the anesthetic administration to facilitate the fabrication of temporary veneers.

Next, the affected teeth were prepared for the new veneers. The existing porcelain veneers were carefully removed using a coarse diamond bur, and the teeth were prepared with a coarse chamfer bur, creating a wraparound “San Francisco–style” veneer preparation. A red fine diamond bur was used additionally to smooth the surfaces. This preparation design, with an upside-down smiley face on the lingual aspect, is preferred for its ability to conceal the margins in the anterior region, minimizing the risk of interproximal long-term staining. Opposing teeth #22 through #27 were also smoothed with a red fine diamond for optimal contours of teeth #6 through #11.

After the tooth preparations were completed, digital impressions were taken (

) and the margins for each veneer were outlined (

). A full-arch scan was performed using the CEREC Primescan, capturing both the upper and lower arches, along with an intraoral bite registration. This comprehensive digital scan provided the necessary data for the design phase. During the design phase, the CEREC Software’s proposal was meticulously adjusted to meet the case’s specific requirements. The BioCopy of the previous veneers was utilized as a starting point, with manual adjustments made to extend the incisal edges, narrow the interproximal black triangles using the shape tool, and set light contacts using the software’s form tool (

The material chosen for the restorations was the KATANA Zirconia ONE layered zirconia block in an A1 shade. Six blocks in size 14Z were used for teeth #6 through #11. This block size was selected for its ability to accommodate the dimensions of the anterior teeth effectively. The restorations were milled using the CEREC Primemill (Dentsply Sirona), with each block taking several minutes to mill at a fine speed setting. Subsequently, the milled restorations underwent sintering in the SpeedFire oven (Dentsply Sirona), following the recommended settings and firing cycles.

After sintering, the restorations were characterized and glazed. IPS e.max Glaze (Ivoclar) was applied using fine art brushes, with the inner portions of the veneers stuffed with a putty matrix and supported on a plastic stand. The glazing process was carried out in the CEREC SpeedFire oven, following the KATANA Zirconia ONE glazing mode parameters.

During the try-in phase, the fit and occlusion of the restorations were carefully assessed. The veneers were tried in pairs, and floss and articulation paper were used to ensure proper seating and occlusal harmony. For the final cementation, the intaglio surfaces of the veneers were sandblasted to enhance the adhesive bond, while the prepared tooth surfaces were etched and coated with CLEARFIL™ Universal Bond Quick (Kuraray) bonding agent. PANAVIA™ SA Cement Universal (Kuraray) in an A1 shade was applied to the veneers, which were then seated and spot-cured for initial stabilization. After removing excess cement and flossing, each veneer was cured for 40 seconds to ensure a secure bond. Occlusal adjustments were made as needed, ensuring a comfortable and balanced bite.

Challenges and Unique Aspects of the Case

One notable challenge during the treatment process was selecting the right shade for the restorations. With a considerably darker stump shade, a lighter block shade was chosen to offset the underlying darkness. Additionally, communicating with the dentist who performed the original veneer treatment proved beneficial in attaining the correct shade match. Achieving a seamless blend with adjacent porcelain restorations can be demanding, but the KATANA Zirconia ONE layered material excelled in this aspect, providing the best blend among available zirconia blocks for anterior restorations.

Treatment Outcome and Long-Term Follow-Up

Since completing the treatment, the patient’s oral health has remained excellent. A follow-up appointment was scheduled 1 week after the delivery appointment to assess occlusion and make any necessary adjustments or refinements to the incisal edges. The fabrication of a soft night guard may also be recommended at this appointment to protect the veneers from occlusal forces. Regular recall appointments with prophylaxis are recommended to maintain optimal oral health and prevent future issues. KATANA Zirconia ONE veneers provided a fresh, improved, and naturally beautiful appearance, restoring the patient’s confidence in her smile (

How to Revitalize Smiles with Advanced Zirconia Veneers

This case highlights several key takeaways and recommendations for dental professionals. The layered zirconia material, combined with a digital workflow, offers a streamlined and efficient solution for delivering high-quality anterior restorations in a single clinical setting.

Careful shade selection, communication with previous treating dentists, and the use of customized shade guides can facilitate achieving a seamless blend with adjacent restorations.

The San Francisco–style veneer preparation design, with an upside-down smiley face on the lingual aspect, effectively concealed the majority of the margins in the anterior region, minimizing the risk of long-term staining.

Implementing advanced materials and techniques can enhance patient satisfaction, treatment outcomes, and the long-term viability of dental practices. Continuous education and a willingness to embrace modern technologies and materials are essential for dental professionals to stay at the forefront of their field and provide their patients with the best possible care.

This clinical case study exemplifies the remarkable outcomes that can be achieved through the synergistic integration of digital technology, innovative materials, and evidence-based protocols in cosmetic dentistry. By leveraging the exceptional properties of layered zirconia material and following a meticulous treatment approach, the clinician successfully restored the patient’s porcelain veneers, achieving a beautiful, functional, and long-lasting solution that exceeded expectations.

Navigating the challenges of modern veneer restoration leads to enhanced esthetic outcomes.  

How to Revitalize Smiles With Advanced Zirconia Veneers

Head and Neck Cancer Awareness Month occurred in April, and the facts show that oral cancers cannot be ignored. The American Society of Clinical Oncology estimated that in 2023 in the US, 39,290 men and 15,250 women received a diagnosis of oral or oropharyngeal cancer. The 5-year relative survival rate in the US is 68%, but if diagnosed at an early stage, the 5-year relative survival rate jumps to 86%.

Vigilant Biosciences® has developed an accurate method of detecting oral cancers by identifying biomarkers chairside in the dental office. The BeVigilant™ OraFusion™ System has been granted FDA breakthrough device designation and is expected to receive FDA approval in the coming months. I spoke with Bill Brodie, CEO of Vigilant Biosciences, to find out more.

How did you get involved with Vigilant Biosciences?

 I’ve been in the dental medical space for 34 years and ran my own dental supply equipment company that was subsequently bought by Benco Dental, which was a small regional company at the time. As vice president of sales, I helped grow the Southeast region for 7 years. After that, I shifted to the medical area, working with cutting-edge artificial intelligence (AI)–driven technologies. The Vigilant Biosciences board saw me as uniquely qualified because of my experience in both medical and dental areas. I’ve been with the company for 5 years.

What is the company trying to accomplish?

 The company was originally founded by an attorney whose parents both died of oral cancer. He connected with a biomarker researcher, and they began exploring how salivary biomarkers can predict oral cancer. The first 6 years were spent researching and improving biomarker accuracy. In the past 4 years, after studying thousands of biomarkers, specific biomarkers that focused on the goal of early detection were chosen. In all our studies and trials, at least 50% of the cohort was early stage or precancer stage 0.

 We believe the most benefit is achieved if the dentist can move the decision of whether the patient needs a specialist to when that patient is still sitting in the dental chair. A good example is lichen planus. There is a less than 4% chance of lichen planus turning cancerous. But if it does, it is very aggressive, and the patient can be dead in 18 months.

 The lateral flow cassette looks similar to home COVID-19 tests. The dentist or hygienist puts 4 drops of saliva on each side. The cassette is then put in the little drawer of the reader, and the software produces a result and gives you a report. The reader has an onboard battery so it can be moved among operatories.

It takes about 10 minutes to get a result. The reader measures the exact concentration of 2 proteomic biomarkers and a control. These proteins become elevated as tissue becomes cancerous.

The control measures the amount of the saliva and the viability of the sample.

The first biomarker, a transmembrane biomarker, detects rapid reproduction of the cells, a hallmark of cancer. This biomarker is shed by the cell membrane as the cells reproduce.

The second biomarker becomes overexpressed as the body attempts to suppress that cellular activity. The relationship between these 2 biomarkers provides information that produces the accuracy.

Combine that with clinical risk factors, such as sex, age, and tobacco and alcohol use, in intelligent machine-learning software, and the ultimate result indicates whether the patient needs to be referred to a specialist. The report can then be emailed.	

 Testing is recommended if a dentist or hygienist sees some abnormality in the patient’s mouth—it could be leukoplakia, lichen planus, red spots, white spots, or anything out of the ordinary. Knowing whether to wait and monitor or refer to a specialist is very hard in the early stage. About 25% to 30% of patients have an oral abnormality. The report shows the relative concentration of the biomarkers, signifying whether the abnormality in the mouth is starting to exhibit cancerous behavior.

 Suggested retail for the machine is around $1000 and each cassette is $60 to $70 individually, but they are sold in packs of 12. We are working with reimbursement experts who have suggested an insurance code that is used by light-based devices—CDT 0431 (assessment of oral abnormality). When dentists start using the product in the US after final FDA approval, they can use this code.

In March 2023, we were awarded FDA breakthrough device designation, a program by the FDA that designates the product as truly unique under the current standard. As we speak, there is legislation pending that all breakthrough products will get reimbursed. We hope for this legislation to come to fruition and also to have FDA approval in the US by summer 2024. When we receive approval, Henry Schein and Benco are ready to be distributors.

The ability to improve is the beauty of a machine-learning algorithm. We hope to develop a future iteration that indicates how far along the cancer is on a scale.Interested clinicians go to vigilantbiosciences.com to learn more and be notified when available.

It’s a shame that basically about 73% of oral cancers get diagnosed late stage. And with those, there is a less than 50% 5-year survival rate.

 The signs should not be ignored until [the disease is] obvious. Vigilant Biosciences has given dentists the opportunity to save patients’ lives with early detection of oral cancer and make a big difference in healthcare.

to learn more and be notified when available.

1. American Society of Clinical Oncology. Oral and oropharyngeal cancer: statistics. Cancer.net. February 2023. Accessed April 8, 2024. 

https://www.cancer.net/cancer-types/oral-and-oropharyngeal-cancer/statistics

2. Saka-Herrán C, Jané-Salas E, Mari-Roig A, Estrugo-Devesa A, López-López J. Time-to-treatment in oral cancer: causes and implications for survival. 

. 2021;13(6):1321. doi:10.3390/cancers13061321

Vigilant Biosciences has developed a method to help dental clinicians accurately detect oral cancers chairside, with the goal of early cancer diagnosis and better survival rates. 

Biomarker Reader Helps Catch Oral Cancers Earlier

I hope the title of this article got your attention because that was my intent. We all expect a title like that to use the high price of something, but that is not always the case. Especially when you are thinking about your office information technology (IT) security.

A couple of decades ago I had just finished giving a lecture on taking your office totally digital. As the audience was packing up and leaving the room, a well-dressed and obviously successful doctor walked up to me. At the time, practice operating systems were undergoing many frequent changes. Digital charts were a new thing, and most of the larger software companies were working on ways to integrate digital radiographs directly into their platform.

“How easy is that to do?” the doctor asked. I told him it wasn’t really that difficult but that it depended on the software. I asked him what practice management software he was using. “Heck, I don’t know,” he replied. “That’s the gal at the front desk’s department.” I was a little taken aback by the answer, but honestly also a little irritated by the way he said it.

My response? “You know that beige box with the keyboard and the mouse that sit on your front desk? That’s where all of your money is,” I said. All these years later, that statement is thousands of orders of magnitude greater.

I mentioned this in my April 2024 column. Dentists, as business owners, are always walking a tightrope between money coming in and money going out. Profitability is how we continue to pay our bills. Also, if you cannot stay in business, you can’t help those who depend on you. Patients, as well as our teams, count on us to be there for them.

Every month, doctors are looking at their costs and trying to figure out a way to minimize them while still delivering the best care and best wages possible. Lowering costs and not overpaying are things we look at all the time…and you should.

However, I think that sometimes when we don’t really understand the importance of something, we tend to not understand why it’s valuable. It’s similar to a patient who asks, “Can’t you just do a filing?” when presented with the need for a crown. As doctors, we understand why a filling is not the right choice, but often as business owners, we hesitate to spend money on something when we don’t comprehend its value. IT security in the dental office isn’t a “want” or a “nice to have” item. It is now, more than ever, a 

There are a couple of points I want to make. The first is that security is absolutely critical. I once had a friend ask me, why would anyone want to know that “Mrs Brown had a crown done last March on tooth #30” and why it was critical? I agree that probably no criminals would want to know that. However, what they would like to know are things like Mrs Brown’s date of birth, her address, and her Social Security number…among lots of other demographic information. Once they have all of that, they can very easily perform identity theft and convert that stolen data into ill-gotten gains.

The second point is that your server has become that “box where all of your money is.” If your computer is hacked and your data encrypted, you are now completely dependent on restoring your system from backups. Good backups are critical to success, but even if you have pristine backups, your practice is going to be down until your systems are restored. That is going to mean closing the office for business until your network is back up and running.

That is why I’m such a big fan of DDS Rescue (ddsrescue.com)—they help you continue to operate with all your data accessible remotely and keep the doors open if a problem occurs. Yet, even if you have DDS Rescue service, you are still going to be out the money it will cost to restore your local system, and that can be expensive. And even if you are using a cloud-based system, odds are that you have lots of data that need to be protected on your local network.

Ransomware attacks are common. Tech security company NinjaOne estimates that ransomware attacks occur 19 times per second.¹ Plus, health care ransomware attacks have increased significantly in the past few years. You may have recently seen news of the Change Healthcare attack. That company (which is owned by UnitedHealth Group) paid a $22 million ransom to get their systems back up and running. We also saw a huge data breach at the American Dental Association in 2022, and in September 2023 supply company Henry Schein suffered a massive breach of their system.

I’m sure many of you are thinking that you are just a small fish in a big pond. Why would anyone want to bother with you when there are much bigger fish to go after? The answer to that is part of why I’m writing this column. Cybercriminals know that small health care offices are underprotected and easy targets. It’s much easier to break into systems that don’t have large IT departments tasked with protecting the network. If you are just buying some equipment from Amazon and hooking your office up to the internet, it’s akin to going on vacation, posting it on Facebook, and then leaving your doors unlocked.

If it is easier to get $100,000 from 10 offices than it is to get $1 million from a large company, odds are that the criminals will look for the low-hanging fruit.

If you are still having doubts, let’s talk about getting the US Department of Health and Human Services (HHS) involved. You are required by federal law to protect your patient data. If you have a data breach, you are required to notify the authorities. The HHS Office of Civil Rights is the enforcement arm of the Health Insurance Portability and Accountability Act (HIPAA), and its fines are severe. To ensure that health information is truly protected, severe fines are meted out when breaches happen. In addition to lost income and the expense of restoring your system, you then have to factor in a very large fine.

The next step is to notify your patients, which is also required by HIPAA. At that point, the loss of goodwill and trust of your patients must be factored into this equation. You will also, of course, have to pay for the notification letters and postage, but that is a drop in the bucket compared with all the other problems and expenses you will face.

I feel the best way to look at IT security is through the lens of an insurance policy. We all have malpractice insurance. No practitioner should think, “I’m just a small office and a good doctor; no one will ever sue me.” You also don’t think, “I’m a good driver. I’ll never have an accident.” We have these insurance policies in place because we want to be protected if something bad happens. Of course, we’d save a lot of money if we didn’t pay for those policies, yet we all still have them.

So look at security as a business expense. Put it into your budget. Similar to a percentage of production being spent on wages, supplies, etc, your accounting firm can help you determine what percentage of production should be spent on IT security. Once you know that, you can then get bids and determine the best solution for your individual situation.

There are even health care–specific security companies such as Black Talon Security (blacktalonsecurity.com) that have solutions for dental offices.

This is a difficult subject, but theft and extortion have been around almost since Adam and Eve were kicked out of the Garden of Eden. There will always be a small percentage of the population that thrive on crime. Unfortunately, it’s a reality.

However, planning for the future and the long-term viability of your practice now requires vigilance in the IT security space. You don’t need to be an expert to deal with this. Instead, what you need to do is find the experts and let them do what they do best. In a similar way that patients don’t understand and perform their own dental procedures, you don’t need to understand and implement your own security profile. However, that doesn’t mean you don’t need it. Part of my job as “Technology Evangelist” is to give you the straight scoop on how tech impacts dentistry, and security is having a major impact.

Implement what your experts recommend. You’ll be better off in the long run, trust me. See you next month!

1. Crowe J. Must-know ransomware statistics, trends and facts. NinjaOne. Published March 18, 2024. Accessed April 8, 2024. https://www.ninjaone.com/blog/must-know-ransomware-statistics/

With cybercrime flourishing, you need to protect your network and data. Try viewing it as a business expense.