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Dr Mark L Christensen
Heather Crockett
Dr Arman Farhadtouski
Dr Rich Fisher
Dr George McCully
Dr Robert McNeill
Dr Rodney Thornell
Utah Department of Health & Human Services
Dr Tyler Williams
Photo Credit: visitutah.tandemvault.com
Ancient Dunes and Lava Flows Snow Canyon State Park
Matt Morgan
The Utah Dental Association holds itself wholly free from responsibility for the opinions, theories or criticisms herein expressed, except as otherwise declared by formal resolution adopted by the association. The UDA reserves the right to decline, withdraw or edit copy at its discretion.
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PRESIDENT'S MESSAGE
FINDING GREATER ENJOYMENT AND FULFILLMENT IN DENTISTRY
Dear Colleagues,
My name is Rodney Thornell, and I am honored to serve as your new Utah Dental Association (UDA) president. I am a first-generation American and dentist, practicing general dentistry in a small practice in Herriman. It is a privilege to be part of this remarkable country and profession.
The role of UDA president is a one-year office, but it is part of a five-year term. During my tenure, I have served as secretary, treasurer, and most recently, president-elect. Next year will mark the conclusion of my term as past president. Additionally, I was honored to be elected by the ADA House of Delegates this past October to a four-year term on the ADA Council on Communications, where I will continue serving for two more years beyond my UDA term.
Representing you—the dentists of Utah—is a responsibility I take seriously. While I recognize the immense talent and capability among you, I am committed to serving to the best of my ability.
I want to express my gratitude to those of you who have served in your local chapters or on the Utah Dental Board. Your dedication often goes unrecognized, but it is essential for the betterment of our practices and profession. Thank you for your contributions and your commitment to advancing dentistry in Utah.
To my colleagues across the state, I am continually inspired by the work you do in your clinics. Your dedication to patient care and your pursuit of excellence elevate the dental profession. Utah is home to some of the finest dentists in the nation, evidenced by the consistent success of Utah students in dental schools across the country. This excellence extends to your practices and the care you provide to our communities.
I am also deeply grateful to the mentors and colleagues who have enriched my journey and instilled in me a greater purpose for this profession. Dentistry has its challenges, and while it may not always be easy, I feel privileged to be part of such a meaningful and impactful field.
However, I recognize that the challenges we face as dentists in Utah are significant. One of the greatest obstacles is the low reimbursement rates imposed by dental insurance companies. Utah’s dentists enable insurance companies to operate at higher profitability levels compared to other states, often at the expense of our own financial well-being. I hope to inspire you to reclaim control of our profession by demanding fair compensation for the exceptional care you provide. Your work, your staff, and your families deserve better.
As your president, I aim to strengthen the UDA’s role as a trusted resource for helping you run your practice more efficiently and profitably. While the UDA office staff may not have all the answers, I want to help build a network of trusted practice consultants, both locally and nationally, and create a guide to the resources available through the ADA. A simple search on the ADA site can connect you with valuable tools and support.
Above all, my goal is to help you find greater enjoyment and fulfillment in your work. As Frank Spear wisely said, “The key to enjoying dentistry and being successful is doing procedures that you like to do, on patients that you enjoy, with a team that you enjoy.” Together, we at the UDA want to help you achieve just that.
Let’s make this year one of growth, success, and happiness. Wishing you a fulfilling and prosperous year in dentistry!
Sincerely,
Rodney Thornell President, Utah Dental Association
DO YOU KNOW YOUR INDIRECT RESTORATIVE MATERIAL?
In 1993 I was introduced to our profession by way of a dental lab technician. I was studying business at the time with no thoughts of entering the medical profession. However, I enjoyed working with my hands and was drawn to the idea of mixing the two. In the beginning of lab school, class consisted of learning tooth anatomy and placing wax on articulated models. Once some mastery of shape was accomplished it became a matter of transforming wax into harder materials using the lost wax technique and layering porcelain. Back then our crown and bridge material choices were limited, you basically had gold or porcelain fused to metal (pfm). For simplicity I am only going to address posterior restorations in this article.
The selection of materials was based on two things, strength of material and aesthetics. Full metal (<1500Mpa) restorations were often used in the posterior where strength was preferred but it also required the least amount of tooth reduction, .5-1.0 mm occlusal reduction with a feather edge margin. In the more aesthetic areas, you had pfm (80-100Mpa), giving up strength for aesthetics, but it also required more of the tooth to be reduced 1.5-2.0 mm occlusal and a 0.8 mm shoulder/chamfer design at the margin. This was to allow space for metal, opaque, and porcelain (dentin and enamel) to provide good aesthetics and function, but again not nearly as conservative as margins were often extended below the gum line.
Today our posterior restorative options have increased. Full gold and pfm crowns are still great options that have found success in the mouth for decades. However, because of the cost of gold and the many steps required to fabricate pfm’s many labs are moving away from offering them and encouraging dentists to do the same. Zirconia and lithium disilicate (e.max) are two of the more commonly used posterior restorative materials. Simply using zirconia in name can be misleading based on the zirconia’s yttria composition; 3Y (1200 Mpa), 4Y(900Mpa), or 5Y(600Mpa). So, if choosing an aesthetic zirconia, one with 4Y and 5Y yttria used in its makeup, realize restorations can be significantly weaker. When selecting e.max in name one must understand if the material is pressed (<500Mpa) or milled (360Mpa), this can help with understanding what to expect from the material. Extremely important is following the manufactures recommended material thickness in how the crown is attached to the tooth.
The following examples are for monolithic restorations or restorations that have no layering of porcelain added to them. A 3Y zirconia crown, like the ones you have seen pounded into wood with a hammer, requires the least amount of reduction, 1.0mm occlusal and 0.5 margin but they are the least aesthetic. Translucent zirconia crowns, consisting of combinations of
"If you are ever unsure what method to use, you can measure the crown’s thickness with a pair of calipers to determine whether to bond or cement your restoration." – Rich Fisher, DMD
the different yttria zirconia’s, require up to a third more tooth structure removal, 1.0-1.5mm occlusal and a 0.8-1.0mm margin reduction but they have better aesthetics. E.max’s manufacturer thickness recommendations are based on if you are bonding or cementing the restoration to the tooth. If you cement e.max to the tooth the reduction recommendations are 1.5mm occlusal and 1.0mm margin. If you bond your final e.max restoration the recommendations are a 1.0mm occlusal and 1.0mm margin reduction. If you are ever unsure what method to use, you can measure the crown’s thickness with a pair of calipers to determine whether to bond or cement your restoration.
An additional benefit to choosing any of the above materials is you do not need to bury your margins below the gum line helping to conserve tooth structure and finishing them on enamel.
Other factors to consider once your manufacturer has been determined are: Do they recommend rounded internal angles? For lithium disilicate who is etching the intaglio surface for 20 seconds? For zirconia is the intaglio surface being air partial abraded and who is performing this step? If an occlusal adjustment is needed, is it performed with a coarse diamond or a fine diamond?
Keep in mind that technicians cannot master all materials and knowing what your lab uses the most and does their best work with is extremely important to know before you prepare a tooth and fill out a lab slip. Having an open conversation about indirect materials with your chosen technician should be easy and should create a healthy relationship where both parties not only improve but find greater joy in their work outcomes.
I hope this article leads many of you to make no changes at all, that you already know what materials your lab is using, and you know why you choose different materials given patient situations. Knowing what is required of you when selecting a material from the beginning should give you reassurance that your final restorations will be beautiful and long lasting. Creating protocols that lead to consistent minimal preparations is an article for another day, but do not worry I get to write many more articles for the UDA over the coming years.
Rich Fisher, DMD
UDA President Elect
REFLECTIONS ON MY YEAR WITH THE UDA: WHY EARLY-CAREER DENTISTS SHOULD GET INVOLVED ASSOCIATION
Over the past year, I have had the privilege of serving on the UDA Board as the guest member position as well as participating in the New Dentists Committee. This experience has been both professionally enriching and personally rewarding—one I wholeheartedly recommend to my early-career colleagues. Through this engagement, I have developed a deeper understanding of the challenges impacting our profession, cultivated meaningful connections, and witnessed the powerful role organized dentistry plays in shaping our field. My experience has shown me not only the value of engaging with the UDA but also how empowering it can be to take an active role in shaping our profession.
One of the most significant benefits of my involvement has been the opportunity to gain insight into the complex issues affecting our profession. While many of us are aware of broad issues affecting the profession of dentistry, serving on the UDA Board has provided a frontrow seat to the latest developments in our state. From legislative and regulatory updates to economic pressures affecting practice operations, I have significantly increased my awareness of the intricacies that influence our day-to-day work. This level of insight has been invaluable, equipping me with the knowledge necessary to support the UDA’s initiatives effectively. When early-career professionals possess an informed understanding of the issues, we are better positioned to advocate for the needs of our profession, our patients, and our practices.
Another highlight of my experience has been seeing the UDA’s dedication to building a community for all dentists, particularly through the work of the New Dentists Committee. This committee is focused on providing early-career dentists with opportunities to network, collaborate, and engage in informal yet valuable interactions with peers. Through various events and gatherings, I have been able to build relationships that have enriched my professional journey and created a sense of belonging. In a profession that can sometimes feel isolating, these connections have been instrumental in helping me navigate the initial years of my career with a stronger sense of support and camaraderie.
I must also express my appreciation for the welcoming environment fostered within the UDA. Initially, I had concerns about how my limited experience in organized dentistry might be perceived. However, those concerns quickly faded as I was met with open arms by the more experienced members who have readily shared their knowledge and offered mentorship on the nuances of organized dentistry. This camaraderie has emphasized that regardless of one’s experience level, every individual has something valuable to contribute.
Moreover, my experience has allowed me to witness the dedication of colleagues who contribute their time and expertise to advancing our shared interests. On the UDA Board, I have encountered individuals who go above and beyond, devoting considerable effort to securing legislative and regulatory progress that safeguards the future of our profession. These individuals are often unrecognized, yet they work tirelessly to uphold the values and standards that make dentistry an accessible and respected field. Their example is a reminder that no matter where we are in our careers, we all have the potential to make a difference.
Lastly, for early-career dentists contemplating involvement with the UDA, I strongly encourage you to take that first step. Engaging with organized dentistry not only enhances our professional development but also positions us to contribute actively to the future of our field. My experience has been immensely rewarding, and I am confident that others will find similar value in this endeavor. By stepping forward, we can collectively support the profession we are so passionate about, advocate for advancements that benefit our practices and patients, and help shape a thriving community for ourselves and future generations of dentists.
Arman Farhadtouski DDS ADA Alternate Delegate
Photo: Image licensed by Ingram Image
FLUORIDE USE PROTECTS TEETH
The Utah Department of Health and Human Services wants to remind clinicians to consider applying dental fluoride varnish for children younger than age 4 as part of a well-child exam at primary care and dental visits. Fluoride promotes healthy teeth. However, according to the All Payer Claims Database in 2022, only 1.9% of Utah’s children 0-4 years of age are receiving fluoride treatments at well-child visits.
Fluoride is a mineral that strengthens tooth enamel which helps prevent cavities. Fewer cavities means less mouth pain. Fluoride can also stimulate new bone growth.
While soil, water, plants, and food contain trace amounts of fluoride, fluoridated water, toothpastes, and rinses are the most common sources where people get fluoride. Besides fluoridated toothpastes and mouth rinses that are recommended for daily home use, fluoride can also be applied by a dental or medical professional during routine office visits. This topical application is in the form of a gel, foam, or varnish. Applying fluoride to the surface of the teeth is a safe and effective way to prevent tooth decay.
The American Academy of Pediatrics (AAP), the United States Preventive Services Task Force (USPSTF), and the American Dental Association (ADA) recommend the application of fluoride varnish to reduce the risk of tooth decay. The AAP, ADA, and USPSTF recommend fluoride varnish be applied 2 to 4 times a year for all children beginning at 6 months of age.
In the state of Utah, Medicaid reimburses for the application of dental fluoride varnish application for children from birth through 4 years as part of a well-child exam during primary care and dental visits. Reimbursement for the fluoride varnish application is allowed by Medicaid up to 4 times per calendar year. This limitation applies to the combined total of applications in medical and dental settings, until the child turns 5. Through the Patient Protection and Affordable Care Act (ACA) passed in 2015, most private dental insurance plans were required to cover fluoride varnish applications performed during pediatric (ages 1-4) well-child visits. Once the patient turns 5 years old, the fluoride needs to be applied in a dental office. Medical providers should file CPT code 99188 for this service. Medicaid and most private insurance also reimburses for the fluoride varnish application during a preventive dental visit. Both the ADA and AAP recommend that children have their teeth checked by a dentist by 1 year of age then every 6 months thereafter. Fluoride varnish should be applied on every child at 6 month intervals starting at their first visit, no matter the child’s risk for cavities. After age 5, fluoride varnish can be applied 4 times a year in a dental setting. The billing code for dental providers in a medical or dental setting is CDT code D1206. This code is reported on the ADA dental claim form.
The AAP has also recommended that a pediatrician perform a caries risk assessment on all children at well-child visits beginning at 6 months of age. A risk assessment looks at family eating habits, home care habits, access to dental care and insurance
(continued on page 10)
Photo: Image licensed by Ingram Image
PRACTICE
RIGHT OR WRONG FIT PATIENTS?
As a clinician and/or practice owner, you have the unique opportunity to shape not just your practice but also the lives of your patients. I’d like to share my own experience on how we have elevated patient interactions and outcomes, and how they may help you continually improve your thriving environment, for both your team and your patients.
A crucial for your success, but often overlooked key to this is: identifying and managing non-ideal patients. Trust me, this has been a game-changer for us, and it can change your practice too! It’s easy to get so “busy” that we get bogged down by wrong fit patients, that can hold us back from delivering better and more fulfilling care to our right fit patients. Because there are just so many hours in any one day...
If you seem to be a good fit to work together, and you aren’t afraid to set expectations on the way you work (instead of time consuming “follow up” calls), you can state:
“If you are open to it, it might make sense if we schedule another time to get together and discuss your options, that way we can avoid phone tag or letting your conditions worsen. I can make myself available to answer any further questions you might have... how does that sound?”
Here are the 5 Red Flags on Your Non-Ideal Patients:
1. The Indecisive Patient
You know that feeling when a patient walks in, and you just know that the day is about to get difficult? Here’s the deal: not every patient is the right fit for your practice, and that’s okay! In fact, recognizing this can be the key to unlocking your practice’s full potential.
WRONG FIT FREEDOM
But, what do you do if you have a new patient meeting and you determine they are not a fit with your treatment plan, personal values, or practice core values?
How do you handle that with respect and confidence, so you both part ways gracefully?
Learning to walk away may be the hardest part of treatment planning because we’ve been so conditioned to pursue any patient who we feel could benefit from our services.
Once you decide that you aren’t the Right Fit, here are two relationship building concepts to end the relationship positively:
“My goal today was to see if we are a fit together and if I can truly help you. It sounds as if in your particular situation, I’m not the best person for you, I still want to help you in another way, and I’m happy to refer you to an office who probably is a better fit.”
We’ve all been there. You’re explaining a treatment plan, and the patient just can’t seem to make up their mind. They’re nodding along, but you can tell they’re not really committed. Here’s a key tip: don’t fall into the trap of over-educating or complicating things. If they’re not ready to commit, it might be time to consider if they’re the right fit for your practice.
2. The Free Consultation Conundrum
Free consultations can be a great way to attract new patients, but beware of those who use them as a way to delay decisions. Focus on patients who are ready to commit to treatment, not just those looking for free advice. “Identifying and focusing on ideal patients can lead to increased satisfaction for both the dentist and the patient, resulting in better outcomes and a more successful practice.” - American Dental Association
3. The Price Shopper
We get it, everyone loves a good deal. But if a patient is more concerned about comparing prices than understanding the value of your treatment, they might not be your ideal patient. You know as well or better than most anyone else that quality health care is a long term relationship and investment in health, not just a price tag or procedure.
4. The Authority Seeker
Your practice should be seen as the go-to expert in your field. If patients aren’t viewing you this way, it might be time to reassess your marketing and communication strategies. Align everything from your website to your team’s scripting to attract the patients who value your expertise. “Practices that align their
Photo: Image licensed by Ingram Image
services with their ideal patient profile see a significant increase in patient retention and referrals.” - Professor Michael Chen, Harvard Medical Journal
5. The Insurance Dependent
We all hear about this one, and need to be sensitive to our patients’ needs. While insurance can be helpful, patients who only want treatments covered by insurance can limit your ability to provide the best care. Consider educating patients on the limitations of insurance and the value of comprehensive care.
Now, if you’ve had a busy week like I have, you might still be thinking, “But shouldn’t I try to help everyone?” Here’s the truth: trying to cater to every single patient can actually hurt your practice and career in the long run. It leads to inefficiencies, frustration, and can even impact the quality of care for your ideal patients.
“Understanding and catering to your ideal patient demographic is not just good business practice, it’s essential for providing the highest quality of care.” - Dr. Emily Rodriguez, Mayo Clinic
THE VALUE OF GOOD HEALTH
Health care is often seen as an expensive service, but when you compare it to other “lifestyle” expenses or even the cost of a car—something that needs replacement every few years—good health offers incredible value. It’s essential to communicate this value effectively to you patients. Many people don’t realize that
investing in their medical or dental health can prevent far more significant costs down the line.
UNDERSTANDING PATIENT FIT
One of the most critical aspects of running a successful clinic or practice is identifying the right fit between patients and your services. Not every patient will align with your practice philosophy or treatment style, and that’s okay. By focusing on the right patients, you can enhance satisfaction for both parties.
KEY CHARACTERISTICS OF IDEAL PATIENTS
Commitment to Health: Look for patients who take their health seriously. Those who come in after years without care but are willing to change their habits are often more rewarding to work with.
Financial Responsibility: Ideal patients are those who understand the value of the services provided (copays, noncovered services, etc.) and are willing to invest in their health.
Willingness to Engage: Patients who ask questions and seek understanding about their treatment options show they care about their health.
Long-Term Relationship Potential: Aim for patients who see you as a partner in their health journey, not just a one-time service provider.
To ensure you attract the right patients, consider implementing a pre-qualification process. This could involve asking potential
Practice Transition Specialists
“I have used the advice and services of Randon Jensen and CTC over many years. First, to form a partnership, and more recently to move out of complete ownership of the practice I started 43 years ago. I have the highest regard for Randon and his honesty and integrity. His knowledge and skill has made all the difference. I give him my highest recommendation and would surely encourage you to trust him with your practice transition.”
–Roger L. Farley, DDS
randon jensen
marie chatterley
ryan nolan
patients about their medical history, expectations, and willingness to invest in their care during initial consultations.
Your practice culture plays a significant role in patient satisfaction. As a leader, focus on servant leadership—supporting and inspiring your team rather than micromanaging them. A strong team culture leads to better patient experiences.
Encourage continuous learning among your staff. Regularly reflect on what works and what doesn’t in your practice. This approach fosters an environment where everyone feels comfortable sharing ideas and improving processes.
Sometimes, despite best efforts, certain patients may not be the right fit for your practice. Recognizing when to refer patients to another clinic or specialist is crucial for maintaining quality care and ensuring patient satisfaction.
WHEN TO REFER PATIENTS
Lack of Commitment: If a patient shows no interest in improving their medical or dental health, it may be time to refer them elsewhere.
Financial Disputes: Patients who consistently question costs or refuse necessary treatments may not be worth the effort.
Incompatible Treatment Philosophy: If a patient frequently disputes your diagnosis or treatment plan without valid reasons, it might indicate a mismatch.
Behavioral Issues: Patients who create a negative atmosphere can affect the morale of your team and the experience of other patients.
Instead of viewing each paid visit as a transaction, think of it as building a relationship with each patient. This mindset shift can lead to higher retention rates and increased referrals from satisfied patients.
Engage with your patients beyond appointments—send them follow-up messages after treatments, offer educational resources about hygiene or health, or simply check in on how they’re doing. These small gestures can significantly enhance loyalty and trust.
By focusing on building trust, attracting ideal patients, and fostering long-term relationships, you can ensure that your career and practice thrives while making a meaningful impact on your community’s health.
Here are two quotes I have thought about over the years in practice, that put this another way:
“Success is not just about what you accomplish in your life; it’s about what you inspire others to do.” — Unknown
“Quality is not an act; it is a habit.” — Aristotle
Have a great month,
Dr.
Tyler Williams Pinecrest Practice Growth
Flouride Use (continued from page 7)
and helps a provider determine a child’s risk for dental issues. The assessment can be used to establish a fluoride application schedule for each child. It is recommended that a child discovered to have a moderate to high risk for developing cavities receive a fluoride application 4 times per year. A child discovered to be at a low risk for developing cavities is recommended to have a fluoride application at least 2 times per year. This assessment can be done in the medical or dental office. The AAP recommends a risk assessment be done at the 6- and 9-month visits. A risk assessment only needs to be done if the child doesn’t have a dental home for the remainder of the well-child visits. Even though there isn’t a validated risk assessment tool, the AAP and ADA each created one. The AAP assessment tool can be found here and the ADA assessment tool can be found here. Check back later for a separate blog to learn more about caries risk assessments.
Fluoride can benefit patients of all ages, but it is important for children as they grow and learn how to take care of their teeth. Applying a fluoride varnish is a quick and easy way to help prevent cavities in young patients.
WHAT HAPPENED TO WREB? THE MERGER OF REGIONAL TESTING AGENCIES
ABSTRACT
The Western Regional Examining Board (WREB), a regional dental testing agency that, for almost half a century, developed and administered clinical examinations to support the licensing of dentists and dental hygienists, suddenly dissolved in a merger with CDCA in August of 2021. This article briefly recounts the development of regional testing agencies, the evolution of their growth, and the recent emergence of a national clinical examination in partial fulfillment of the licensing requirements for dentists and dental hygienists in of most of the United States. Why the merger occurred, what it signifies for the dental profession, and the potential impact on the remaining regional testing agencies are discussed.
THE RISE OF REGIONAL TESTING AGENCIES
During the first half of last century, states developed and administered their own clinical examinations for the dental professions. Regional testing agencies arrived in the 1970s as states began collaborating to lessen the burden associated with creating and administering the clinical examinations they required for dentist licensing.1 Regional collaboration offered many advantages, particularly for states lacking a dental school or convenient clinical facility to conduct an examination.
The Western Regional Examining Board (WREB) was one of several regional dental testing agencies that arose during this period. Other widely recognized regional testing agencies include the Northeast Regional Board of Dental Examiners (NERB), the Commission on Dental Competency Assessment (CDCA), the Central Regional Dental Testing Service (CRDTS), the Southern Regional Testing Agency (SRTA), and the Council of Interstate Testing Agencies (CITA).
Discussion and partnership between Utah and Oregon initially laid the foundation for WREB to become incorporated in 1976. Other states, including Arizona, Washington, and New Mexico joined soon thereafter. Alaska, Idaho, and Montana also joined to support the adoption of a common clinical examination for the licensing of dentists and dental hygienists in the West.
WREB was the regional testing agency that most Western states first joined. Many of these states did not have a dental school or facility to conduct a clinical examination. Member states without a dental school when WREB was founded included Alaska, Arizona, Idaho, Montana, Nevada, New Mexico, and Utah. These states sent students out of state to dental schools across the country. Some of these students wished to return to their home state to practice. For this reason, they frequently persuaded their school to host the WREB examination. Hence, WREB early on began to examine candidates in dental schools across the country.2
Approximately a quarter of a century later, in 2001, Oklahoma and Texas officially joined WREB, and WREB’s dental examination finally replaced the Texas Board of Dental Examiners’ state-specific clinical exam for dentist licensing. Increasingly, other states, too, began to recognize WREB exam results as satisfying their entry-level, clinical examination requirements.
In 2006, the California Dental Board and Division of Consumer Affairs began recognizing the results of the WREB Dental Examination for dentist licensing in California.3 For almost fifteen years afterward, WREB continued administering dental examinations at schools in the West and across the country for applicants seeking licensure in Western states, particularly California.
During its existence, WREB introduced or reinforced many innovations that advanced patient-based clinical assessment. These included strict candidate anonymity, robust examiner calibration, test specifications that include the specific criteria
against which candidate performance is judged, and a transparent scoring methodology. Regionalization also enabled a standardized and anonymous appeals process, and the use of a broad-based practice (occupational task) analysis to support examination content.
WREB continued to administer examinations until August 2021, when it merged with CDCA. Before the merger, WREB examinations were recognized for licensing in approximately 44 states.4 CDCA (ADEX) examinations were accepted for licensing in 48 states.
Why, after almost half a century of growth and successful operation, did WREB so suddenly disappear? And what does this mean for the other remaining regional testing agencies?
WHAT CHANGED
Certain sections of most clinical licensing examinations (endodontic treatment, for example) have long been conducted as a simulation. An initiative to move from a patient-based format to a more highly simulated format for all examination sections was already underway when the COVID-19 pandemic struck.5 However, in the spring of 2020, the pandemic suddenly made performing the clinical licensing examination with patients impossible. This accelerated development and enabled, of necessity, the creation and acceptance of an entirely simulated and more highly standardized clinical assessment.
Sometimes overlooked, is that in November 2019, a few months before the onset of the pandemic, California also began to accept the ADEX examination for dentist licensing. Thereafter, no state exclusively required the WREB examination. When the pandemic struck, both WREB and CDCA (ADEX) were testing at schools nationwide. Their examination results were recognized as satisfying the clinical examination requirements for licensing in almost all jurisdictions, and their examinations were offered at many of the same sites. Having both examinations was no longer needed.6
Having two different clinical examinations for the same purpose in the same space became confusing for students trying to decide which exam to take, dental education programs trying to determine which exam to host, and state boards tasked with meaningfully distinguishing the differences. The reasons for regional testing agencies had finally disappeared. The regional structure was no longer serving states, stakeholders, or the dental profession.
Recognizing this and that gaining or even retaining market share would require the development of a robust marketing department and the allocation of a significant portion of candidate examination fees to marketing that would not necessarily improve the quality of the examination or benefit the profession, WREB initiated a conversation with other testing agencies.
In the beginning, regional exams provided important benefits. They enabled:
• For states: sharing the burden of developing and administering exams.
• For students: increased standardization and exam results portability.
• For schools: simplified exam preparation of students.
• Better implementation of the Standards for Educational and Psychological Testing (candidate anonymity, examiner calibration, psychometric standardization, documentation, and the production of technical reports).
After 2020, multiple regional examinations competing for market share in the same space:
• Unnecessarily complicated things for states.
• Unnecessarily confused and complicated things for students.
• Unnecessarily complicated things for schools.
• No longer benefited the dental professions.
On August 3, 2021, CDCA and WREB merged to become a single agency: CDCA-WREB.7 A year later, on August 1, 2022, another regional testing agency, CITA, combined with CDCA-WREB.8 The resulting agency, CDCA-WREB-CITA (CWC), now uniformly administers the ADEX examination at every dental school nationwide. The results of this examination are universally portable and recognized for licensing by almost every jurisdiction, including Puerto Rico, Jamaica, and the U.S. Virgin Islands.9
Passing an ADEX hand-skills (psychomotor) clinical performance examination is currently a requirement or pathway for initial licensing in every state except New York and Delaware.10 Delaware has its version of a clinical licensing examination. New York requires completing a post-graduate residency program of at least a year. The ADEX Dental Examination administered by CWC has become the national clinical assessment standard for dentist licensing. Like CODA and the Joint Commission’s National Board Dental Examination, the ADEX Dental Examination is now also being administered internationally.11
The ADEX Dental Examination administered by CWC is now the national clinical performance examination for dentistry. This assertion depends on how “national” is defined, but consider that, as of this writing, the ADEX Dental Examination:
• Is administered at every dental school in the country
• Is administered to more than 6500 graduating student candidates every year.
• Satisfies the clinical exam licensure requirements in almost all licensing jurisdictions (~98%).
• Has multiple national offices and 800-900 examiners scattered across the nation.
• Is now explicitly codified as the required clinical examination for initial licensing as a dentist in approximately a third (17) of states!
• Is now being administered internationally and achieving international recognition like CODA and the Joint Commission’s National Board Dental Examination.
DISCUSSION
The shift away from patients to all-simulation and the consolidation of regional testing agencies signifies the beginning of a new chapter for initial dentist licensing. What does this mean for the remaining regional testing agencies: CRDTS and SRTA
who, in recognition of the sweeping change that has occurred, have now also merged or soon will.12
Regional innovation initially introduced new ideas. These ideas and practices were shared at national meetings, improving the quality of all exams. However, the regional testing agencies that now remain are operating in the same space and using rhetoric about the benefits of “competition” as an excuse to propagate the existence of entities that are no longer needed. Since students decide which examination to take, competition in the same space for candidates is geared toward making the exam more attractive to students, i.e., cheaper, easier to pass, etc. Competition for students now is not likely to improve the examination quality or even maintain the established standard.
The clinical licensing examination is not a consumer item like a washing machine, automobile, or computer; it is an assessment instrument for determining clinical competency or a measure of applicant quality that contributes to the standardized requirements for entry-level licensing. Standardized requirements protect the public. Licensing is a tool of regulation. Regulation is an aspect of government. Governmental regulation is best served by a single, uniform standard that is universally accepted, clearly identified, and readily addressed.
Most jurisdictions also require the completion of a CODA-accredited dental education. One entity, CODA, currently accredits dental education programs. It would not be better if two or
three accrediting agencies were competing for schools. Multiple accrediting agencies competing for schools in the same space would not likely improve dental education standards. Instead of proposing an additional accreditor, those concerned about the quality of dental accreditation should first work with CODA to improve the already existing, universally recognized accreditation process.
Having multiple manufacturers compete for contracts to supply parts for a manufactured product is preferable. But this discussion is not about parts suppliers; it’s about a professional standard—establishing and documenting a standard measure of competence or applicant quality—to support licensure. In this context, having a single, uniform standard that is universally recognized is preferable. Competition for establishing the standard in the same space where the test taker (student) is the decision maker is only liable to reduce the quality of the standard.
There also are ethical issues. Should the infiltration or manipulation of state boards be attempted in the interest of testing agency preservation? Should a substantial portion of candidate examination fees be spent on attorneys and lobbyists or on flying spokespeople around the country to make presentations to gain or hedge against the loss of market share? How does this benefit the profession? Such questions have become relevant for the smaller regional testing agencies that now may be struggling to remain viable.
CONCLUSION
The merger of WREB, CDCA, and CITA and WREB’s disappearance as regional testing agency signal the beginning of a new era. The era of regional dental testing agencies, which lasted approximately half a century and benefited professional regulation in its heyday, has now closed. The smaller independent clinical testing agencies that remain will likely struggle to retain market share. Some of their examiners may already be examining for CWC. The smaller remaining agencies will likely need to choose how they, too, will come together to support the preservation of a single national clinical (psychomotor) dental performance examination standard or redefine themselves and the role they will play in supporting dental regulation going forward.
Mark L Christensen, DDS MBA
END NOTES AND REFERENCES
1 Northeast Regional Board of Dental Examiners (NERB) in 1969, Central Regional Dental Testing Service (CRDTS) in 1972, Southern Regional Testing Agency (SRTA) in 1975, and Western Regional Examining Board (WREB) in 1976.
2 Christensen ML. The Changing Face of Dental Licensing Examinations. J California Dental Assoc 2023; 51:1. Accessed Oct 10, 2024, at: https://www.tandfonline.com/doi/full/10.1080/19424396.2023.2176578
3 Dental Board of California, Department of Consumer Affairs, Meeting Minutes, Jan. 27, 2006. Sacramento, CA. [cited 2022 Oct 20]. Accessed Oct 10, 2024, at: https://www.dbc.ca.gov/about_us/meetings/minutes/20060127_board.pdf
4 WREB examinations remain named or codified in the rules or regulations for the licensing of dentists in many U.S. jurisdictions. Applicants who passed a WREB examination before WREB’s merger with CDCA still have clinical examination credentials to satisfy the licensing requirements in most states.
5 Acadental DTX CompeDont™ development to simulate enamel, dentin, caries, and pulp tissue in simulated teeth. [cited 2024 Feb 24]. Accessed Oct 10, 2024, at: https://acadental.com/product_page. php?id=282084279-72592283
6 Dental Board of California Votes (Nov. 15, 2019) to Implement the ADEX Dental Examination for Licensure Immediately. American Board of Dental Examiners, Inc.; 2019 [cited 2022 Oct 5]. Accessed Oct 10, 2024, at: https://www.cdcaexams.org/wp-content/uploads/2019/11/ Press-Release-CA-Board-and-ADEX-Dental-Licensure.pdf
7 CDCA, WREB Announce Merger, The Commission on Dental Competency Assessments, Linthicum, MD; 2022 [cited 2022 Oct 24]. Accessed Oct 10, 2024, at: https://adextesting.org/cdca-wreb-announce-merger/
8 CDCA-WREB, CITA Announce Combination, The Commission on Dental Competency Assessments, Linthicum, MD; 2022 [cited 2022 Oct 24]. Accessed Oct 10, 2024, at: https://www.cdcaexams.org/cdca-wreb-cita-announce-pending-combination/
9 ADEX Dental Initial Licensure Acceptance (map) [cited 2024 Feb 24]. Accessed Oct 10, 2024, at: https://adextesting.org/
10Nebraska temporarily stopped recognizing the American Board of Dental Examiners (ADEX) exam for dentist licensing starting with the 2023-2024 testing cycle. Nebraska Governor Jim Pillen then urged the Board to reconsider and expand testing options to address the state’s
shortage of dentists. Accessed Oct 11, 2024, at: https://alliancetimes. com/gov-pillen-calls-on-state-board-to-expand-access-to-dentists-innebraska/ In its meeting on October 4, 2024, the Nebraska Board again approved recognition of the ADEX Dental Examination for initial dentist licensing beginning July 1, 2025 (for the 2025/2026 testing cycle). Accessed Oct 23, 2024, at: https://dhhs.ne.gov/licensure/LU%20Agendas%20Minutes/100424dentminutes.pdf
11 CDCA-WREB-CITA is now administering the ADEX Dental Examination at the University of La Salle Bajío located in Leon, Guanajuato, Mexico, and King Abdulaziz University in Jeddah, Saudi Arabia, a dental school already accredited by CODA. Accessed Oct 10, 2024, at: https://www.lasallebajio.edu.mx/oferta/idp_en.php and https://www. arabnews.com/node/2411191/saudi-arabia
12 In a press release dated July 22, 2024, the Central Regional Dental Testing Service (CRDTS) and the Southern Regional Testing Agency (SRTA) announced a merger aimed at improving the dental and dental hygiene licensure testing experience. The offcial integration of the two organizations was set to occur in late 2024. https://www.crdts.org/assets/ PDFs/CRDTS%20SRTA%20Press%20Release.pdf
2025
Utah Dental Association Board
President Rodney J Thornell DMD
President elect Richard G Fisher DMD
Treasurer Randell M Capener DMD
ADA Delegate Darren D Chamberlain DDS
Secretary Scott B Nilson DDS
Past president Len R Aste DDS
ADA Alternate Delegate Arman Farhadtouski DDS
ADA Delegate
James H Bekker DMD
ADA Delegate Laura Stewart Kadillak DDS
MY VIEW: HOW ARE YOU DOING REALLY? WELLNESS
One question. One question was all it took to eliminate a stigma.
Up until 2023, Texas dentists looking to renew their licenses had to check yes or no on a series of “have you ever” questions dealing with treatment for depression and substance abuse disorder. Check the “yes” box, and the stigma was there.
As chair of licensing for the Texas State Board of Dental Examiners, I can proudly report that this is no longer the case. Applications now include the following question, which is consistent with recommended language from the Federation of State Medical Boards that addresses current impairment: “Are you currently suffering from any condition for which you are not being appropriately treated that impairs your judgment or that would otherwise adversely affect your ability to practice in a competent, ethical and professional manner?”
Shortly after our change, one of my friends told me that he was finally able to get help for alcohol use disorder and suicidal ideations because he would no longer need to check the yes box on the renewal form.
The Texas State Board of Dental Examiners was the first state board of dentistry to be recognized by the Dr. Lorna Breen Heroes’ Foundation as a Wellbeing First Champion. The foundation, which was started by the family of an emergency room doctor who died by suicide in 2020 during the COVID-19 pandemic, champions licensure and credentialing reform for physicians and other health care providers.
As a Texan and as a dentist, I’m proud of the change we implemented. But nationwide, we need to do better.
According to the ADA Well-Being Index, 56% of dentists report feeling distressed or struggling. This year, we have a unique opportunity with ADA President Brett Kessler, D.D.S., who has been in recovery for substance use disorder for 26 years. Let’s make change happen, together.
I encourage my fellow state board members nationwide to evaluate their approach to mental health. Collaboration between organized dentistry, regulators, educators and clinicians is essential to addressing this issue. I am thankful that an ADA House of Delegates resolution put forth efforts to help promote change.
Dr. Kessler recently spoke to the American Association of Dental Boards, urging board members to be part of the solution. He highlighted how vague, stigmatizing “have you ever” mental health questions prevent providers from seeking care. “I was afforded the opportunity to get help with dignity,” he said. We must ensure others have the same opportunity. Data shows that removing these questions, as we’ve done in Texas, supports providers without compromising safety. This is an opportunity for regulators to be proactive and work with stakeholders toward a positive change.
The stress on dentists has only increased since the pandemic, with new challenges in patient care, financial stability, and navigating new safety protocols. It is essential that we prioritize self-care — whether it’s by taking vacations, focusing on our health, or simply taking time for ourselves. Without this balance, the risk to our mental and physical well-being rises.
Past ADA President George Shepley, D.D.S., stated on my podcast Between Two Teeth, “We need to put the oxygen on ourselves so we can care for our patients.” As a regulator, I witness the consequences when self-care is neglected. Now is the time to prioritize both public and licensee safety by being proactive, not reactive.
We’ve been aware of provider stress and mental health challenges for decades — it’s time to act. Dental associations must move beyond lip service, and regulators need to re-evaluate how we approach mental health. Data from the Well Being Index shows that well-being issues often correlate with an increase in dental errors, underscoring the need to protect both the public and our providers. Four states, including Texas, have achieved reform, and efforts are underway in four other states. A resource toolkit is available for interested state dental associations, state boards, credentialing organizations and individual dental providers to remove stigmatizing questions from licensing and credentialing applications.
To my colleagues, I encourage you to take the Well-Being Index and check in on your peers. When was the last time you asked a colleague how they’re truly doing? Rebuilding trust, communicating openly, and working together is the path to solving this complex problem. Many lives depend on it.
Dr. Robert McNeill ADA News
Photo: LoveTheWind via Getty Images
exclusive Wellness Resources for ADA Members and Dental Students
Find programs and resources to support your mental, emotional and physical well-being at ADA.org/Wellness.
Talkspace Go
ADA.org/TalkspaceGo
Well-Being Index (WBI)
ADA.org/Well-BeingIndex
Your well-being, your way. Talkspace Go, a self-directed therapy app, can help you address the challenges like work stress, relationships and burnout. Get your exclusive ADA access code for complimentary access at ADA.org/TalkspaceGo
Your health matters. The ADA provides members access to the Dental Well-Being Index (WBI), a validated, anonymous risk assessment tool invented by the Mayo Clinic. Log into your ADA account then set up your WBI account. In just one minute, you’ll have access to a personalized dashboard and resources, allowing you to track your well-being over time.
State Well-Being Program Directory
(updated in 2024)
ADA.org/WellnessDirectory
ADA Ergonomic Stretches
ADA.org/Stretch
After a Suicide Postvention Toolkit
ADA.org/Postvention
National Suicide Prevention Lifeline
Looking for help and guidance? Support may be closer than you think. This directory links you to local resources, state contacts, and ADA Wellness Ambassadors, ensuring you have the assistance you need right in your community.
Better ergonomics, stretching, and exercise help dental teams build long, healthy careers. Download the ADA Ergonomic Stretches infographic with 25 quick stretches or access the ADA Member app for more resources to keep you and your dental team healthy.
Developed in 2023 by the American Foundation for Suicide Prevention (AFSP) and the ADA, the After a Suicide Postvention Toolkit provides guidance for those responding to a suicide death for professional dental settings.
If you or someone you know is experiencing suicidal thoughts or a crisis, please text or dial 988 to be connected to the National Suicide Prevention Lifeline. This service is free and confidential. For a medical emergency dial 911.
CONGRATULATIONS TO THE UDA 2025 DISTINGUISHED SERVICE AWARD RECIPIENTS
David Okano
David K. Okano, DDS, MS graduated from the University of Nebraska Medical Center College of Dentistry (UNMC COD) in 1981. He completed a General Practice Residency at Wood VA Medical Center in Milwaukee, Wisconsin and returned to the UNMC COD for periodontal specialty training, receiving a certificate in periodontology and M.S. in 1985. Upon completion of specialty training in periodontics, David returned to his hometown of Rock Springs, Wyoming and was in private practice for 31 years. In 2015, David transitioned to full-time academics at the newly established University of Utah School of Dentistry (UUSOD) in 2015, where he currently serves as an Associate Professor and Section Head of Periodontics. He is now focused on the development of specialty residencies in periodontics, oral and maxillofacial surgery, endodontics and prosthodontics at the UUSOD.
David has served in several volunteer positions and elected leadership positions. He is a Past-President of the Wyoming Dental Association and was a Delegate to the American Dental Association (ADA) House of Delegates from 2000-2015. David also served on the ADA’s Council on Dental Practice (1998-2002) and Council on ADA Sessions (2008-2012). He has also served on numerous committees with the American Academy of Periodontology (AAP) and was President of the AAP in 2023. David is a Fellow of the International College of Dentists (serving as Regent for District 14 from 2018-2022), Pierre Fauchard Academy, American College of Dentists and Academy of Dentistry International.
David has enjoyed a long-standing relationship with the UDA for over two decades. He worked closely with Dr. AJ Smith and Executive Director Emeritus, Mr. Monte Thompson for several years prior to moving to Utah. David served as the Campaign Manager for Dr. Smith’s successful ADA 2nd Vice President campaign in 2009 and Dr. Smith’s ADA President-Elect Campaign in 2013 (Dr. Smith missed out on the opportunity to become ADA President by only 12 votes out of a total 464 votes). It is a great honor to receive the UDA Distinguished Service Award in 2025!
Rich Radmall
Rich S Radmall grew up in South Ogden He attended Weber State University graduating in 1978 with a double major in Zoology and Spanish. He worked as a Respiratory Therapist at McKay-Dee Hospital prior to entering dental school at the University of Washington, graduating in 1986. He started his own dental practice, from “scratch”, and worked 37 years in private practice, retiring in 2023.
Dentistry has provided a variety of opportunities that have enriched his career. It started with being actively involved in the Weber District Dental Society. He gave Dental Health presentations for 21 years at South Weber elementary and two area high schools and was Clinical Instructor at Weber State Dental Hygiene (1986-1990). That was followed by serving as WDDS president.
Other nonclinical appointments included serving as a board member at Ogden-Weber Applied Technology (1996-2002) and Dixie State College adjunct instructor for Dental Hygiene (1999-2002). Dr Radmall was subsequently appointed to the Utah State Dental Board (DOPL) in 2007 and served two terms. In addition, he has served as a dental board examiner for CDCA and WREB (2008-present).
He has provided time and skills to humanitarian causes. He participated in the Children’s Health Connection in Weber County, went to the Amazon in Peru with twenty Weber State University premed/predental students through Hope Alliance, and more recently has provided clinical care at the Ogden Rescue Mission dental clinic for 15 years.
Dr Radmall has been active in his church, enjoys the outdoors with family and friends, especially Lake Powell and snow skiing. Dr Radmall and his wife Terri are the parents of four children and have 16 grandchildren.
LaRisse Skene
Originally from Utah, Dr. LaRisse Skene graduated with a degree in Medical Biology from the University of Utah. She attended dental school at the University of Pennsylvania and graduated with highest honors when she completed her postdoctoral specialty training in periodontology and implantology
also at Penn. Dr. Skene is a diplomat of the American Academy of Periodontology and has practiced periodontics in Salt Lake City since 2008.
She began serving in the UDA on the Salt Lake District board in 2010. She was elected by the UDA to serve as a delegate from 2012-2016. Currently Dr. Skene serves on the board as the hygienist affiliate membership UDA liaison, and as part of the leadership for the Salt Lake District Give Kids a Smile event.
Dr. Skene found her love for serving children while she lived in West Philadelphia. She treated patients on the Penn Smiles Dental Bus where elementary children would board and receive free dental treatment during school hours. She carried that passion to Utah and has been volunteering for Give Kids A Smile since 2009.
Dr. Skene has helped organize the Salt Lake Give Kids a Smile since 2012 which has resulted in comprehensive treatment for approximately 300 children each year. She plays a primary role in recruiting doctors and hygienists to render treatment and has
been extremely successful. She credits the committee, many volunteers, providers and the University of Utah Dental School who selflessly give their time and resources. All of these individuals are vital in their service and together their passion has resulted in one of the best Give Kids a Smile events nationwide.
In 2022, the International College of Dentists inducted Dr. Skene for her service in the dental community. She has volunteered to lecture at SLCC, UVU and Fortis hygiene programs and the University of Utah and Roseman Dental schools over the past 16 years. She also leads a very active study club.
Dr. Skene has her own periodontal practice in Murray, an extremely supportive husband, and 3 precocious children—all of whom have served as honorary attendees to the UDA board meetings as infants in car seats. They are now appointed volunteers who help set up the events the night before—delivering supplies to the clinic chairs. In her spare time Dr. Skene enjoys painting, running and milkshakes. She looks forward to many more years of service with the UDA and her community.
FEBRUARY IS NATIONAL CHILDREN’S DENTAL HEALTH MONTH
More Than a Month
Every day should be about children’s dental health. This year, in place of the traditional posters, the American Dental Association is offering new materials to celebrate and promote children’s dental health, not only during the month of February, but all year long.
Posters are available for digital download in two designs and two sizes: 8.5”x11” and 11”x17”. Matching coloring sheets in two designs are offered in 8.5”x11”. All materials are available in English and Spanish.
In addition, the ADA’s 2025 Brushing Calendar is available now for digital download. This 12-month calendar is valuable yearround for promoting healthy behaviors like brushing twice a day with a fluoride
Thank you for Attending the
PRACTICE
3 WAYS TO FOSTER TEAM LOYALTY AND RETENTION
In the fast-paced world of talent acquisition and retention, maintaining a dedicated team has become more challenging than ever. Are you keeping pace with the evolving landscape? High turnover rates can signal issues within your practice when scouting top-tier talent. We’ve had the privilege of assisting numerous dentists in nurturing the loyalty and retention their teams desire. Here are three key steps to building a steadfast, long-term team.
1. Weekly Team Meetings - We recommend making weekly team meetings a cornerstone of your schedule. While many dentists adhere to the “patients first” philosophy, we firmly advocate for prioritizing the team. When your team is taken care of, exemplary patient care naturally ensues. Reimagine your approach to team meetings, introducing a structured agenda to infuse each session with productivity and effectiveness. These meetings gift your team with alignment, a thriving culture and the achievement of goals.
2. Frequent and Consistent Check-ins – If you haven’t explored the concept of check-ins, you’re missing out! A check-in involves intentionally scheduling uninterrupted time with each team member, fostering connections and individualized communication. These sessions focus on the team member’s highs and lows, both personal and professional, and how you, as a leader, can support them. Prioritize regular check-ins, and you’ll find yourself and your team eagerly anticipating this time together.
3. Express Appreciation Actively – How do you convey your appreciation for your team and their daily contributions? The “5 Languages of Appreciation in the Workplace” offer valuable insights. Acts of service, quality time, words of affirmation, tangible gifts and appropriate touch are the avenues through which your team members seek appreciation. Engage your team members in a conversation, perhaps during your first check-in, to determine their preferred form of appreciation, and then take proactive steps to demonstrate your gratitude. A simple “thank you” means more than you know.
Do you genuinely care about your team? What measures are you taking to convey this care? Would your team attest to feeling appreciated? Even if you’ve initiated weekly meetings, frequent check-ins and active appreciation, there’s always room for enhancement. If you haven’t adopted these practices, select one and start today. It’s the pathway to cultivating the loyalty and retention that are crucial to your thriving practice.
Heather Crockett, RDH WDAJ
ADVICE FOR NEW OR YOUNG DENTISTS PRACTICE
1. Hopefully, you are in this for the long haul! Regardless, it is important to take care of yourself physically, mentally, and emotionally. Being a dentist is hard work and I believe that it is important to make sure to take time for oneself. THAT MEANS TAKING VACATIONS!
2. Occasionally giving patients, a quick look at no charge helps to cement your relationship and builds practice. “You can shear a sheep many times, but you can only skin it once.”
3. Building personal relationships with patients is worth all the time and effort and it will take time, but it pays big dividends in the long run, both financially and emotionally.
4. You will have patients who do not pay. You will be “ripped off.” The most common cause for litigation or a board complaint is fostered by the ill will created by trying to collect that debt. How much is the “stomach acid” worth?
5. Pay your bills and your employees before you pay yourself. And do not buy all the new fancy gadgets until they have been proven useful. Upon refiring, I have a whole lab full of stuff that I had bought but had used only for a brief time.
6. Find a mentor to help guide you. Continue your education, especially hands-on courses. Do not be afraid to ask for help, guidance, or directions from your mentor. They will be glad to help.
7. I have been blessed and you are or will be also. Dentistry is a fabulous profession that will allow one to support a family and enjoy many opportunities that the average person cannot. Stay healthy, take care of yourself and your loved ones, and realize that you have chosen a profession where our patients become very attached. Yes, we are blessed.
Advice to Retiring Dentists
1. Keep working hard until the check is in the bank,
2. Keep working until you no longer enjoy it. If that is at 80, then great! But if it is at 30, then retire and go find something you will enjoy doing. Life is too short to be stuck doing work that you do not enjoy.
3. Working with a broker takes a big burden off your shoulders. However, it is costly. And do not expect the practice to sell immediately. So, keep working hard, and do your due diligence when selecting the broker.
4. I had no idea how long or time consuming it would be to shut down a business, and that includes transitioning to a new owner.
Dr George McCully ODA
At
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