Cliff's Notes

The Business of Dentistry

Dental OSA Screening, The Bridge to Primary Care

You have been to all the seminars and the experts told you how much mon-ey you could make fabricating an OSA oral appliance but they don’t bring up the patient deductible that usually leads to a nontreatment plan. The effort in screening and patient rejection made the program irrelevant when mixed in with the rest of the day so after a couple of months you forgot all about it. If this happened to you, you missed the big picture.

The Big Picture … A dental sleep medicine program is part of “Total Systemic Health”. Your patients think of you as just a dentist when you should be part of their personal healthcare team. The screening process for OSA takes about 2 minutes of a hygiene exam and it should be part of your preventive protocol.

Prevention Protocol … Medicine is reactive, dentistry is proactive. The average healthy patient sees their dentist 4 to 6 times more often than they see their primary care provider. People go to their medical doctor when they have symptoms and need to be treated but dentistry is positioned to identify abnormalities before symptoms develop. It’s all about screening. The possibility of early detection has been noted by the insurance industry.

The Insurance Industry … Most large insurance carriers have more money than banks. Delta Insurance is the only one that is dental only, the rest offer medical insurance. If a dental practice can identify abnormal systemic conditions before symptoms develop, treatment would save tens of thousands of dollars per incident and tens of millions annually. You will start to notice that as insurance reimbursements continue to decline, new diagnostic codes will become available for processing. Dental practices will be rewarded for preventive medicine. It all starts with patient screening.

Patient Screening … This is a team task. The screening process is nothing more than asking a few simple question while your team is taking the patients blood pressure. I hope you are check-ing BP because that is the ground floor of any total systemic health program. Questions about head aches, indigestion, snoring, or any aches and pains should be discussed with your patient.

Your Patient … Yes, they are your patients and just like your MD counterparts you need to be able to direct them to other specialist and provide your insight to their primary care providers. In the next few months you will be hearing about salivary tests that can gage the probability of your patient developing all sorts of systemic conditions. Imagine being able to inform a patient that they have a 70% chance of developing heart disease and providing that information to their primary care provider. You could save lives. But OSA screening is also a practice builder.

OSA Practice Building … Medical deductibles are high and dental OSA treatment plans are usually rejected but a condition has been diagnosed. With the patient’s permission the results of the test should be forwarded to their primary provider via registered mail and revisited at their next appointment. The chances are that the CPAP prescribed is not being used opening the door for the oral appliance. Please feel free to contact me for more details on systemic programs.



October 24, 2017 Posted by | Uncategorized | Leave a comment

Beware the Tax Man … Q4 is Here!

Did a tax advisor tell you that you made too much money and have to pay the government “real money”. You got got smacked for being successful. Well, this may be your last chance to do it right. Hopefully, you will have to write a check because you had a good year, but who’s name is on the check is the question. If you haven’t scheduled your Q3 review I suggest you do it today. You also need to know how your business will be effected by the impending changes in tax reform.

Tax Reform … It’s coming and you should prepare now for next year or figure out what to do if it is retroactive to the beginning of this year. One thing for certain is that federal money will not be giving freely to states and that means that the states will have to find the lost revenue in other places or begin trimming services. Trimming services is political suicide so don’t expect that to happen. The federal attempt to plugging up some of the holes in the ship (the low hanging fruit) may start with the investment tax credit.

The Investment Tax Credit … Was put in place to stimulate factory production by allowing the buyer to claim several years of depreciation on certain durable goods in a given tax year if those items are used to conduct business . The US congress needs to reauthorize this special rule (IRS Sec. 179) every year and if not done by December 31st the deduction will go away in 2018. Everyone needs to reinvest in their business so it is important that you have this conversation with your tax advisor. The federal government’s tax package will also have a dramatic effect on the States.

The States Low Hanging Fruit … The Consumer Use Tax is a large part of the states lost revenue. In NJ as a general consumer you are required to report all tax liability after exceeding the $500.00 ceiling. That allows for around $7000.00 in out of state purchases. However, a NJ business of any kind is liable after $1.00. The hard part is understanding what is considered non-taxable in the state being as there is no published list. Any seller that collects state sales tax assumes the non-taxable liability. It is important that you discuss the Use Tax requirement with your tax advisor.

Your Tax Advisor … If you are reading this publication the chances are that you own a business or are involved in running one. A quality tax advisor (accountant) is essential in running a business. If your accountant just crunched numbers and tells you what you owe, your probably leaving real money on the table. Quality consultants in all areas of business can be expensive so do your due diligence and ask question. Accountants are not expenses, they are investments and should produce a measurable ROI.

ROI (Return on Investment) … When running a business every thing you do, every check you write, every new patient you spend time with is an investment. The monetary return over an annual time frame needs to be measurable or the investment may not be worth the time or energy. I have seen clients change accounting services because they were too expensive. Maybe they just never utilized services or maybe services were never offered, either way both effect the ROI. One of the most common mistakes a business owner makes is to giving into emotion and the fear of change. A quality leader will invest time in gathering information and making difficult informed decision.

Informed decisions … Making informed decision is essential for success. Please feel free to contact me with any questions or concerns.


October 17, 2017 Posted by | Uncategorized | Leave a comment

What are Bioactive Materials and why are they important?

Larry Clark is Coming to NJ

If you are in the oral healthcare field, You can’t afford to miss this event.

To register call Asteto Dent Labs @ 1-800-447-7750

Bioactive Dental Materials Are The Future!

Larry Clark is one of the top bioactive researchers in the world and he is coming to New Jersey

The bridge between living tooth and a manufactured material has been discovered!

Thursday evening, October 19, 2017, Moonachie, NJ

October 8, 2017 Posted by | Uncategorized | Leave a comment

“Everyone has a plan, Until they get punched in the face!” … Mike Tyson


We all have plans to protect ourselves and our families but unfortunately most of us have that plan in our heads or a written plan that is several years old. As we have seen in the south over the last several weeks, things happen and disaster is real!

Disaster comes in all forms … When we think about a disaster we think about storms, fires and floods but what about all of the other scenarios that can develop. As a business owner everything you depend on has a disaster liability. From the electric to turn on your lights to death and disability, there needs to be a written and updated plan. One of the most overlooked and misunderstood disasters is the partnership buy/sell agreement.

The Partnership Buy/Sell Agreement … You may become a partner or take one on for a variety of reasons but is there a planned separation agreement? Taking on a partner is like getting married, everything is community property unless outlined by a legally bind-ing agreement. Unforeseen things happen all the time. What if your partner had a car accident that left your him/her permanently disabled or worst. Do you want their spouse or estate to be become your new partner? Guess what, unless you have an agreement in place they already are. Now you have to buy out the other side while dealing with, understandably, irrational emotions. You have to buy back your business.

Buying Back Your Business … Transitions are never easy. Money and emotions do not mix well. Predetermined values are essential to formulate a buy/sell agreement and funding that agreement should be put securely in place. If you have a business that is valued at $1M, you would need $500k to buy out a partner or an estate. But what about key personnel?

Key Personnel … The ultimate disaster for a business is the death of an owner, principle partner or manager. Replacement of that person can be difficult and expensive. Key per-sonnel insurance policies should also be part of a disaster recovery plan.

Disaster Recovery … I can’t tell you how important it is to prepare for that day that you get punched in the face and have to get up quick. You need professional advice and yes, it will cost a little money. Please feel free to contact me at any time with any concerns.

September 21, 2017 Posted by | Uncategorized | Leave a comment

Cliff’s Notes Team Contacts

Please be advised, I will not be available the week of August 28th. Below is contact information for my support team.

Merchandise Orders

1-800-707-5678 … Andrea  ext. 222-8858 or Kevin Solomon ext. #222-8444

Robin … 1-631-454-3168

 Andrea, Kevin & Robin all know your discount structure from your history.

 Equipment service 1-800-645-6594

You can email our service dispatch at for a fast response. Make sure your name and office phone number are included with the problem.

Henry Schein Dental Metro Center, Moonachie, NJ   201-440-7004


August 24, 2017 Posted by | Uncategorized | Leave a comment

My Feet Hurt! But I’ve Been Sitting all Day? “Dental Office Ergonomics”

It’s 3:00 in the afternoon and your feet and back are starting to hurt, your neck is stiff, and you’re getting a headache. Maybe it’s the stress of running a dental practice or maybe time to look at your working environment as the cause. My advice to my clients is simple, you can try to save money in a lot of places but there are three where price should not matter, your handpiece, your stool, and your overhead light.

Your Handpiece … A craftsman does their best work with the best tools. Your handpiece is your #1 tool. You use it on almost every patient and there is a difference between a $200.00 and a $1200.00 handpiece. Yes, quality handpieces are expensive but so is your time. Quality preforms better and in the long run will cost less but the big advantage is a smooth cut and lower noise. It’s the noise that effects your health. The highspeed squeal is only inches from your ear. We are talking about hearing loss and it is a real problem in dentistry.

Your Stool … This may have been the most misunderstood piece of equipment of the last generation. Back problems, leg problems, foot and neck issues can all be attributed to your stool and positioning. You know who doesn’t have any of these problems? The dentist that works standing up. So, if standing is not an option then you need to look into quality seating and learn about “positioning”. Todays operatory seating is designed to compliment the new patient chairs. The patient’s head position can be adjusted to fit the dentist’s posture when seated correctly in a quality stool. You need to bring the patient to you, not adjust yourself for the patient.

Your Overhead Lighting … This is about your eyes. LED Lighting is the best and there is no excuse not to upgrade your current light to LED with a simple adapter. Your counter tops should be well lit with the same type of light (LED) so eye strain is minimized when looking away from the oral cavity. The focusing and adjusting your eyes have to do during the day will lead to eye muscle fatigue. Got a head ache?

The 80/20 Rule … I can tell you that eight out of ten dentists and hygienists complain to me about aches and pains but they don’t do anything about it. OMG! It’s going to cost some money to make you feel better. So, let’s talk about the cost and you can think about it while your driving home in your $40,000.00 car…..

1) Your Handpiece (air driven) $800.00-$1200.00(depending on brand)

2) Your stool (Drs.) $400.00-$1200.00 … (Asst.) $600.00-$1200.00

3) Overhead light conversion Halogen to LED $350.00 (most brands)

Ask your friends about their chairside health. This is about you and your team and your working environment. A healthy and happy team improves production. A work environment and flow evaluation can be arranged free of charge but to fix any problem you will need to invest in your health. Please feel free to contact me with any questions or concerns.



August 13, 2017 Posted by | Uncategorized | Leave a comment


We all know that the internet is a dangerous place. We employee security com-panies and utilizes encrypted data. Unfortunately the consumer mentality that has been bred into us since childhood tends to take over. The world of commerce has changed dramatically over just the past 3 years. Amazon, Wayfair, Walmart and other are competing for your dollars by offering a good price and convenience, but a healthcare provider needs to understand the “unseen” dangers in the unregulated internet.

The UnRegulated Internet … Healthcare providers are regulated by state and federal agencies, therefore, everything they do is subject to interpretation. What would happen if a procedure fails and the result is litigation? Was the failure due to an inadequate clinical procedure or was it due to product failure? Your defense team will blame the material manufacturer but their defense team will want to know where and when the materials were purchased. If the materials used were not obtained from an authorized U.S. distributer, you are on your own. The original manufacturer will not support your defense. Now you need to prove that the materials used during the clinical procedure were acceptable for use, that they were not counterfeit.

Counterfeit Dental Materials … If something sounds too good to be true, it usually isn’t. In today’s world market there is a counterfeit everything and dental materials are no different. Companies like 3M, Dentsply/Sirona, Kerr Sybron pursue and litigate unauthorized distribution internationally on a regular basis. You can receive updates and information on grey market and counterfeit issues as well as authorized distributors by calling the manufacturers directly.

Authorized Distribution Channels … There is a reason that only certain companies are authorized to distribute a manufactures products. The requirements are based on the product line and inventory storage capability. An authorized distributor must have inventory rotation systems and be able to purchase a large opening order covering the manufacturers entire product line. As an example, Dentsply Sirona has about 35 authorized dental distributors in the US and one, locally, is under a federal indictment due to a Dentsply investigation into the handling of there product. However, a quality distributor will have some requirements from the manufacturer, and that is product liability.

Product Liability … You automatically think that product liability is the manufacturer’s problem, that is a consumer mentality. In the eyes of the law your patient is the ultimate consumer and you are responsible for the products you use and the source of supply. If the product in question was not obtained from an authorized distributor, the manufacturer’s insurance company will claim no liability and you will be between a rock and a hard place.

Liability Insurance … Your malpractice insurance covers you to the extent of the policy but what about the source of your payables? Do you have liability insurance conformation from your I.T. Company, electrician, plumber, dental supply, lab, etc? Henry Schein, like most regulatory compliant companies, requires proof of product liability before they will release a product into the market from any distribution center. This should be part of your risk management program.

Risk Management … There is so much you don’t know. Your concentration is on patient care and treatment planning and you have insurance backing you up incase of litigation. However, there is a good chance that you are setup to loose. Record keeping is the #1 defensive strategy and it is so much more than accurate charts. You don’t know what you don’t know. From product liability to patient communication to employee management and sales tax liability, it’s your responsibility.

August 7, 2017 Posted by | Uncategorized | Leave a comment

Office Culture? What’s That?

Your business culture is so important to your success that it will break you if not controlled and directed from the top. As most of my clients know I am a big fan of the Disney culture. I read their blog and have attended a program on Team Management that was offered by the “Disney Institute”. When I joined Henry Schein eleven years ago I was impressed at the way they had developed a similar culture and emphasized the team approach. The Disney Institute is a real place in the Magic Kingdom, but it is not for kids. You have a vision of what you want and now you have to learn how to energize your team and get them to believe.

Believe in the Dream … Leadership is getting your team to understand your vision and adopt it as theirs. Leadership is getting people to do what they don’t want to do (work) and enjoy doing it. All of my clients have a vision and they all follow their dreams in different ways, but how you speak to your team on a daily basis will define the organizations culture. Where most leaders fail is when they forget how to encourage and your patients sense it.

Encourage don’t Discourage … People are different and their personalities will effect their job performance. Understanding personalities and focusing on the positives is essential for a quality business culture. Encourage the positives, train the negatives and keep an open door to suggestions and ideas, manage by walking around.

Management by Walking Around (MWA) … The phrase was created by IBM back in the 1980’s. The concept was based on the idea that a department manager would get up from their desk and walk around the department so they could interact with their team and develop a winning culture. Disney changed the phrase to “Management by Wandering Around” because when you wander you are relaxed and approachable. At the time I attended the institute’s program I owned a small company that employed around 45 people. The first day back I tried the Disney version of MWA and was amazed at the instant results. My team entire team responded in a very positive way and an enhanced team work culture began to develop. Throughout my career I have seen all types of business owners. Some are respected and some are feared. The real culture killer that will hurt your business and breeds discontent is a strict regiment and fear.

The Regiment … I believe that people get up in the morning for one of three reasons, fortune, glory, or the betterment of humanity. For most of us, fortune comes first. Your team members show up every morning because they need to support their lives. Your office is not where they want to be, it is where they have to be so management has to develop a culture of growth, advancement and achievement. Your team needs direction and continuity or you will have team turnover and that puts the breaks on any organization. In a recent email I saw, a manager use the word “punish”, wrong, wrong, wrong. By “cracking a whip” you are not fostering the vision. You need a blend of empathy and accountability.

The Vision … It is hard to develop, implement, and travel the path through your career. The first question to ask yourself (being realistic) is what exactly do you want. I asked that question to a young dentist after a practice acquisition. The answer was “I want it all, the houses, cars and boats, how do I get there?” I like to think that my job is to help my clients chart their path so their dreams come true. Please feel free to contact me with any questions or concerns.

July 24, 2017 Posted by | Uncategorized | Leave a comment

Is Your Consultant a “Dutch Uncle”? Do You Have One?

  I know it may not sound politically correct, but it is a term of endearment and love. My dad used to say to me “let me talk to you like a Dutch Uncle and tell you what you don’t want to hear”.

A quality dental business consultant tells their clients where their weak points are. It’s not being just another yes man or woman.

The Yes People … All is good in the world when you hear from a consultant what you want to hear, it’s human nature. However, what if your trusted consults always agreed with you? Think about it, did they ever bring up negative situations that you were not aware of? Have they criticized any of your systems, procedures and protocols? What do they cost you in real time? Or are you lucky and have a Dutch Uncle?

A Dutch Uncle … It is politically correct, it is a term of endearment. My dad was my 1st Dutch Uncle. He always told me what I was doing wrong and why. It’s the “why” that makes it good. Throughout your career you may have several confidants specializing in different areas of your business and life. You don’t know everything and if you think you do your just fooling yourself. The most successful people listen and seek information. As one of our great past president said “When I am not an expert on something and don’t know what I don’t know, I ask the people who do and I listen”. When I hear a dentist client is taking advise from another dentist it’s time for me to become the Dutch Uncle, what works for someone else most probably won’t work for you. Consulting with other dentists on clinical procedures and treatment planning is a good thing because that it what they do everyday, but every dental practice (business) is different and a good professional will customize the management.

Customized Management … The very first question any quality consultant should ask is “what do you want”. That is not asking what do you want me to help you with, it’s asking “what do you want your life to look like”. Then all future plans are built around that vision. I have had the fortune to meet and associate with a lot of very smart people. I have learned a lot and continue to. Professional guidance in running a business is essential for success especially in today’s competitive market. As a business owner you do not have time to reinvent the wheel, the systems are there but you need to invest some time and money to put them in place. You were trained in clinical dentistry and not business management. You can’t survive if you think like a general consumer.

A General Consumer … Once again I will go to the 80/20 rule. 80% of the dental professionals I work with run their business like they run their home, as a general consumer. The remaining 20% develop very successful practices that address the competitive market in all areas of the organization because they listen to “experienced” professional consultants.

Professional Dental Practice Consultants … There are so many to choose from. All claim to be the best and they all teach you how to dot the “I’s” and cross the “T’s” but each has it unique method in establishing the business culture. Culture is so important when dealing with patients and especially team members. There are offices I walk into that you can feel the tension. We’ll discus culture in the next issue of Cliff’s Notes.

July 18, 2017 Posted by | Uncategorized | Leave a comment

O.S.H.A. / HIPAA … It’s A Lot More Than Just Training!

You did your due diligence and the entire team has received their annual updated on OSHA & HIPAA and all is good in the world. Or is it?

Most dental offices that I walk into are not in compliance with federal regulations that are required by law. Sure, most have had OSHA updates for the team, but what about the facility? What about software? What about sign-in sheets?

Sign-In Sheets … I can’t tell you how many offices still use sign-in sheets. If you are exposing a patient’s first and last name in a public forum, you are in violation. If a patient’s information or name is visible on a chart or computer screen, you are in violation. These things are easy to fix but the biggest concern today may be your software.

Software … If you are using any of the popular email servers such as AOL or Yahoo, you may be in violation by not having your data encrypted. A number of specialty practices now supply encrypted portals for their referring offices to use. The recent outbreak in cyber invasion has put software and on-line security on the front page. This is an area that a dental office needs professional support and your brother-in-law’s 2nd cousin is not the answer. You need certified a IT group with a lot of resources. Your software security also needs to address your emails so you comply with the HIPAA Omnibus Rule.

The HIPAA Omnibus Rule … This requirement was an amendment to existing HIPAA regulations. It was added several years ago but not many dental offices adhere to it, know about it, or understand it. To sum it up, you are responsible for your patient’s personal information throughout the entire treatment process. You are required to insure HIPAA compliance form every professional or organization that comes in contact with the treatment plan. Specialists, labs, and insurance companies are all part of the part of the healthcare chain and you have a shared responsibility should any of their systems be breached. Your HIPAA liability is on the patient side of your business and the employee side is OSHA compliance.

OSHA Compliance … I have not found one dental office that is 100% OSHA compliant. Although it is almost impossible to fully comply, many of my clients don’t put forward enough effort to look good. OK, your team is trained but what about the facility? Do you have MSD sheets available at a moments notice? Do you have a chemical inventory list? Are all of your product labels filled out and correctly displayed? OSHA inspections can be requested by anyone. In dentistry the most common complaint comes from former employees and OSHA is obligated to investigate. The inspectors tend to understand the nature of the complaint and as long as you showing effort to comply they will work with you. However, if you are overly relaxed about compliance the fines can be big. The best defense is to have a complete office inspection along with team training. For an office inspection, free of charge, please contact me at any time.

July 9, 2017 Posted by | Uncategorized | Leave a comment