November/December 2020

Cover Story: Servant Leadership

The Future is Now

DEO Case Study: Building Up – Best practices for creating alliances, and new owner buy-in, for DSOs.

Leadership: Maximize Potential – Addressing the confidence gap

Year in Review

People News

Training and Compliance: Emerging OSHA Guidance – COVID-19 has raised the stakes for providers and patients

2021 OSAP Dental Infection Control Boot Camp™ Registration Now Open

Health news and notes

Infection Control: The Need for a Respiratory Protection Program

Trends: ADA: Dentists have knowledge and skills to deliver COVID vaccine

Publisher’s Note: A Season of Gratitude

14 Thoughts About Building A Great Culture

Bold Predictions for 2021

Bold Predictions for 2021

Some trends to keep an eye on as you formulate your plan for next year.

By Nick Partridge

Prognostication is a tricky business. Pollsters are under fire for their inaccurate results this election season … and who could have possibly predicted what 2020 had in store for us? 

While we cannot know the future, there is of course tremendous value in thinking about and preparing for it. Most organizations undertake an annual planning effort to allow for an examination of the business while preparing a plan for the road ahead. As a result, we endeavor to help guide you in your annual planning process, highlighting emerging trends and anticipating new ones. Therefore, here are my bold predictions for 2021. 

Dental networks will shrink

I believe dental networks will be smaller in 2021 for a variety of reasons. Dental networks experienced record growth on the advent of network leasing. The result is dental networks now look very similar. There is significant overlap as the average provider is now in over 9 networks. Moving forward, payers will be focusing on improving their networks to be more cost effective. 

Dental networks’ focus on becoming more cost-effective will force dental practices to make decisions about insurance participation. More active efforts to maintain or even reduce reimbursements frustrate providers still grappling with staffing turnover as a result of the shutdown in addition to reductions in capacity and demand. Plus, while nearly all PPE reimbursement programs have ended, dental practices are absorbing the ongoing costs to protect patients and staff within new PPE guidelines. Recognizing the overlapping nature of networks and facing these financial realities, dentists will likely shed participation in some plans.  


As mentioned above, payers are focusing on building more cost-effective networks. One of the primary ways to accomplish this, is to exercise discretion in picking up providers through leased networks. As network leasing proliferated over the last 5-6 years, providers were largely certain to be picked up through partnerships. Thus, while enduring some indigestion to make contracting changes, the outcome was usually worth the effort. This effort to selectively restrict access is called suppression. Providers while available through a leased partnership will be actively suppressed from accessing that network based on criteria like cost and claims history.

Suppression stands to create tremendous problems for practices with meaningful provider turnover as new providers become contracted differently from existing providers. Certain providers may be picked up through partners while others may not and the criteria for such decisions is proprietary and confidential. Contracting inconsistencies are problematic in building strong patient relationships as the cost of care for patients differs by treating provider. At the same time, providers should not acquiesce by accepting lower reimbursement rates. 

Your team and your strategy matter more than ever

As payers methodically enhance their networks with cost-effective providers, each insurance company will likely approach this challenge differently to meet the needs of their clients. In addition, at least four networks are in the process of building a national footprint. These networks represent new opportunities. With varying approaches and new opportunities, navigating the insurance landscape requires active management. For example, teams tasked with case presentation, payment posting or other revenue cycle functions will need to be organized and communicative about contracting inconsistencies between providers and fee schedule differences between offices.

As part of the annual planning process, revenue cycle teams should be evaluating participation decisions, fee schedules and contracting inconsistencies to improve the patient experience, reduce administrative effort and ultimately to help formulate priorities in negotiations with payers. 

Likewise, these considerations should be part of the integration of new practice acquisitions.  More than ever, dental groups are going to need to be strategic about their insurance participation.

DSOs will continue to steal market share

The good news for DSOs is that through 2020, patients have increasingly migrated to affiliated practices. DSOs are taking market share in an environment where patient visits have not returned to pre-COVID levels. We expect this trend to continue. Practices that experienced turnover or were closed completely during the shutdown are at a greater risk for losing patients. Patients looking for new dental homes as a result of job loss, might also be looking for more cost-effective options and/or for in-network providers. With the benefits of scale and investments in technology, I believe DSOs are well-positioned to compete for patients in 2021.

Delta Dental has peaked

There, I said it. In 10 years, when we look back … I believe 2019/2020 will be the apex of Delta Dental as an association of 39 independent companies. I believe Delta is facing major headwinds that will require meaningful change. Many Delta plans have worked to eliminate a provider’s ability to participate exclusively in their flagship Premier network with better reimbursements. This has forced providers into the PPO network with generally lower rates. Secondly, in many states, Delta has kept rates constant for most of the last decade where in others Delta has worked to actively reduce rates. Collectively these efforts have eroded goodwill and pushed Delta to the breaking point for many practices. Add in the class action lawsuit and I think they will slowly lose their ranking as the top dental network unless changes are made. 

Regardless of the accuracy of my bold predictions, the business of dentistry will be increasingly important in 2021 and beyond. Have a safe and happy holidays and best wishes for 2021.

14 Thoughts About Building A Great Culture

By Jon Gordon

1. Great leaders build and drive great cultures. They know it’s their number one priority. They can’t delegate it. They must lead and be engaged in the process.

2. Culture is the reason why great organizations have sustained success. Culture drives expectations and beliefs. Expectations and beliefs drive behavior. Behavior drives habits. Habits create the future.

3. Culture beats strategy. Strategy is important but it is your culture that will determine whether your strategy is successful.

4. If you focus on the fruit of the tree (outcomes and numbers) and ignore the root (culture) your tree will die. But if you focus on and nourish the root you always have a great supply of fruit.

5. When building a team and organization you must shape your culture before it shapes you. A culture is forming whether you like it or not. The key is to identify what you want your culture and organization to stand for. Once you know the values and principles that you stand for, every decision is easy to make; including the people you recruit and hire.

6. A culture of greatness doesn’t happen by accident. It happens when a leader expects greatness and each person in the organization builds it, lives it, values it, reinforces it and fights for it.

7. Culture is dynamic, not static. Everyone in your organization creates your culture by what they think, say and do each day. Culture is led from the top down, but it comes to life from the bottom up.

8. “Your culture is not just your tradition. It is the people in your building who carry it on.” – Brad Stevens, Head Coach, Boston Celtics

9. When leading a new team or organization, it will take longer to build a new culture if you allow negative people from the previous culture to contaminate the process.

10. When you build a strong, positive culture most of the energy vampires will leave by themselves because they don’t fit in. But you may also have to
let a few energy vampires off the bus.

11. Creating a culture where people are afraid to fail leads to failure. Allowing people to fail and learn from failure ultimately leads to success.

12. Change is a part of every culture and organization. Embracing change and innovating will ensure that your organization thrives.

13. Progress is important but when innovating and driving change make sure you honor your tradition, purpose and culture. This generates power from your past to create your future.

14. Culture is like a tree. It takes years to cultivate and grow and yet it can be chopped down in a minute. Protect your culture.

Jon Gordon’s best-selling books and talks have inspired readers and audiences around the world. His principles have been put to the test by numerous Fortune 500 companies, professional and college sports teams, school districts, hospitals, and non-profits. He is the author of 20 books including 8 best-sellers: The Energy Bus, The Carpenter, Training Camp, You Win in the Locker Room First, The Power of Positive Leadership, The Power of a Positive Team, The Coffee Bean and his latest Stay Positive. His clients include The Los Angeles Dodgers, Campbell’s Soup, Dell, Publix, Southwest Airlines, Miami Heat, The Los Angeles Rams, Snapchat, BB&T Bank, Clemson Football, Northwestern Mutual, West Point Academy and more.

Publisher’s Note: A Season of Gratitude

I always look forward to this time of year. The holiday season gives us a time to reflect on the things that are important and that we need to be thankful for. 

More than likely everyone reading this has said “I am ready for 2020 to be over.” I say it at least once a week.  Given the year we’ve had, it may be difficult to think about the things that we should be thankful for and remember. Here are a few of mine:

1. I am thankful for the health of my family.

2. I am thankful that I was able to shelter in place for a few months with my youngest son Nicolas. As much of a pain as it was being stuck at home, those few months with him will be with me forever.

3. I am thankful our business has survived the most difficult year in its 27 years of existence, and we are starting to thrive again thanks to you!

4. I am thankful 2020 is coming to a close and the “BLACKJACK” year 2021 is near. 

Here’s hoping you have a happy, restful, and joyful close to the year. We believe next year is going to be an amazing year full of hope. 

Happy Holidays,

R. Scott Adams

Scott Adams

Trends: ADA: Dentists have knowledge and skills to deliver COVID vaccine

The American Dental Association offered its support to dentists who are seeking to administer vaccines, including – when it becomes available – a safe and effective vaccine for COVID-19, according to a resolution passed by the ADA House of Delegates on Oct. 19 and reported by ADA News.

Resolution 91H-2020 states that dentists have the requisite knowledge and skills to administer critical vaccines that prevent life- or health-threatening conditions and protect the life and health of patients and staff at the point of care.

“The pandemic has highlighted the potential benefits of an expanded role for dentists in preventive health care, including access to and the administration of vaccinations,” said Duc M. Ho, D.D.S, chair of the ADA Council on Dental Practice.

COVID-19 & Lab Testing Requirements Toolkit

The ADA also announced that in consultation with its Advisory Task Force on Dental Practice Recovery, it has released a toolkit to help guide dentists interested in offering their patients rapid response, point-of-care COVID-19 testing within their practices, according to ADA News.

The COVID-19 & Lab Testing Requirements Toolkit includes information for dentists on applying for the federal certification required to offer this type of testing. Any dental practice that performs tests on human tissue, including saliva, plaque, blood or hard or soft tissue, must comply with regulations set by the Clinical Laboratory Improvement Amendments law, according to the toolkit. The law establishes quality standards for all laboratory testing to ensure accuracy, reliability and timeliness of patient test results regardless of where the test was performed.

Some dentists have expressed interest in offering patients rapid response COVID-19 testing in their practices once reliable point-of-care testing is available at a level that makes it feasible for it to be used in individual dental practices, according to the toolkit, the ADA News report said. Two benefits of offering testing in practices are that it makes it quick and easy for patients to be tested and provides staff members with some reassurance about the health status of the patients they treat, the toolkit states.

The toolkit features an FAQ on in-office testing and CLIA requirements, an interactive map with additional laboratory testing requirements by state and steps to follow when applying for a federal certificate of waiver to offer patients point-of-care testing. The toolkit also includes compliance requirements, tips for developing a waived testing program in dental practices, COVID-19 test reporting requirements, an FAQ on responding to patient questions and guidance on medical benefit plan claim filing for in-office COVID-19 testing.

Infection Control: The Need for a Respiratory Protection Program

Dental group practices must have a clear understanding of the standard and its rationale to provide a sound respiratory protection program for all employees.

By Katherine Schrubbe, RDH, BS, M.Ed, PhD

The global pandemic of SARS-CoV-2 has had a huge impact on the dental profession regarding dental health care personnel (DHCP) safety and the safe delivery of dental care to patients. On March 16, 2020, the American Dental Association (ADA) recommended dentists nationwide postpone elective procedures for the next three weeks, stating that concentrating on emergency dental care will allow dentists to care for emergency patients and alleviate the burden that dental emergencies would place on hospital emergency departments.1 The closures went for much longer than three weeks and the recommendation that dentists restrict their practices to all but urgent and emergency care finally expired on April 30 and was not extended. At that point, the ADA stated, “oral health is an integral part of overall health and treatment of dental disease, as well as prevention, is important to help keep people healthy.  The longer dental practices remain closed to preventive care and treatment for early forms of dental disease, the more likely that patients’ untreated disease will progress, increasing the complexity and cost for treatment down the road.”2

Dental practices were not only guided by ADA, but also had to follow state and local guidelines and mandates prior to reopening. However, in early to mid-May dental practices began to reopen to comprehensive procedures in states where government mandates began to lift. But it was not business as usual. Due to the many unknowns of the SARS-CoV-2 virus came new interim guidance from the Centers for Disease Control and Prevention (CDC) as well as the ADA on everything from patient screening, to operatory protocols and new recommendations for personal protective equipment (PPE). New interim guidance built upon the already strong infection control protocols in place in dental offices and called for the highest level of PPE to help protect patients and the dental team when re-engaging in providing the full range of oral health care.2

Since May 2020, there have been numerous revisions of interim guidance from the CDC, ADA and the Occupational Safety and Health Administration (OSHA) making compliance to new recommendations and protocols an ongoing daily activity – and challenge. The most significant change to dentistry practice during the SARs-CoV-2 pandemic is related to PPE and respiratory protection. Dental providers have always dealt with respiratory hazards in the workplace (i.e., spray, spatter and aerosols) and are the best at utilizing PPE under the premise that every patient is infectious. However, SARS-CoV-2 has generated a new level of concern given the high infectivity of the virus, the known risk of droplet transmission, as well as the potential for airborne transmission,3 thus, a higher level of PPE is recommended.  

Current guidance

At the time of this writing, the most current CDC guidance for dentistry states, during aerosol generating procedures DHCP should use an N95 respirator or a respirator that offers an equivalent or higher level of protection such as other disposable filtering facepiece respirators, powered air-purifying respirators (PAPRs), or elastomeric respirators;

  • Respirators should be used in the context of a comprehensive respiratory protection program (RPP), which includes medical evaluations, fit testing and training in accordance with OSHA’s Respiratory Protection standard (29 CFR 1910.134).4

In March, OSHA released Guidance on Preparing Workplaces for COVID-19 and outlined very high exposure risk jobs as those with high potential for exposure to known or suspected sources of COVID-19 during specific medical, postmortem, or laboratory procedures; workers in this category include healthcare workers (e.g., doctors, nurses, dentists, paramedics, emergency medical technicians) performing aerosol-generating procedures (e.g., intubation, cough induction procedures, bronchoscopies, some dental procedures and exams, or invasive specimen collection) on known or suspected COVID-19 patients.5 This guidance document highlighted the risk of transmission of SARS-CoV-2 to DHCP. 

Although OSHA standards are federal law where employers must comply in order to maintain a safe workplace, during this unprecedented pandemic, in May, the agency created a webpage specifically for Dentistry Workers and Employers, stating, “this guidance is not a standard or regulation, and it creates no new legal obligations. It contains recommendations as well as descriptions of mandatory safety and health standards; the recommendations are advisory in nature, informational in content, and are intended to assist employers in providing a safe and healthful workplace.”6 With that, OSHA’s current respiratory protection PPE for dentistry during procedures that may or are known to generate aerosols include a NIOSH-certified, disposable N95 filtering facepiece respirator or better used as part of a comprehensive respiratory protection program that meets the requirements of OSHA’s Respiratory Protection Standard and includes medical exams, fit testing, and training.5,6  The ADA also refers to OSHA guidance for selection of respiratory PPE during the COVID-19 pandemic.6,7

The incorporation of OSHA’s Respiratory Protection Standard and the implementation of a Respiratory Protection Program (RPP) is a new area for dentistry and has created the need for more education, training as well as administrative tasks in the practice. If DHCP are donning respirators for aerosol generating procedures, then as OSHA has indicated, they must be used in the context of the standard and RPP.5,6,7 

Reviewing the program

Without going into a great deal of discussion, let’s review the elements of a respiratory protection program for dental practice. According to OSHA, a respiratory protection program is a written program that includes procedures specific to the worksite to prevent inhalation of hazardous materials that cannot be controlled by other measures (i.e., engineering, or administrative controls).8,9 Along with the written RPP, OSHA requires the dental practice to designate the RPP administrator. This staff person may also be the safety officer for the practice and must be familiar with the Respiratory Protection Standard and the use and application of respirators in the workplace. Also, they are responsible to ensure DHCP are provided with an appropriate and suitable respirator that is provided at no cost by the employer to the employee, training, and medical evaluations to protect DHCP from inhaling harmful contaminants (contaminants could include biologic agents such as bacteria and viruses).8,9

The RPP includes the following elements:

  • Procedure for selecting respirators for use in the workplace,
  • Medical evaluation of employees required to wear respirators,
  • Fit testing procedures for tight fitting respirators,
  • Procedures for proper use of respirators in routine and reasonably foreseeable emergency situations,
  • Procedures and schedules for cleaning, disinfecting, storing, inspecting, repairing, and discarding and otherwise maintaining respirators,
  • Procedure to ensure adequate quality, quantity, and flow of breathing air for atmosphere-supplying air respirators,
  • Training of employees in the proper use of respirators, including putting on and removing them, any limitations on their use and their maintenance,
  • Procedures for regularly evaluating the effectiveness of the program, and
  • Procedures for ensuring that workers who voluntarily wear respirators (excluding filtering facepieces) comply with the medical evaluation, and cleaning, storing, and maintenance requirements of the standard.8,9

There are a few key items that should be emphasized within the RPP. A written plan is required and should reside in the practice’s office compliance manual; with the program being reviewed regularly.8 DHCP have been sort-of thrown in to using respirators per CDC and OSHA guidance and practices are now finding there are additional tasks that need to be completed to comply with this standard. OSHA requires initial and annual fit-testing of respirators to ensure proper fit and seal, however, to preserve and prioritize the supply of respirators, OSHA has currently suspended its annual fit-test requirement, but continues to enforce an initial fit-test.10 Even before fit-testing is accomplished, DHCP must complete a medical evaluation to determine their eligibility of wearing a respirator.8,9 This medical evaluation consists of a lengthy health questionnaire evaluated by a physician or other licensed healthcare professional who provides a written recommendation regarding the ability to use respirators.9 For instance, if the DHCP has respiratory conditions such as asthma or severe allergies, they may not be able to obtain eligibility to wear a respirator. The practice should make every effort to comply with the fit-testing requirements to ensure DHCP safety. However, if it
is difficult to obtain a fit-test, the practice should document all attempts made to secure fit-testing services and continue to seek out this assistance. 

As always, training is a vital component of any safety program, and the Respiratory Protection Standard mandates respirator training be provided prior to requiring an employee to use a respirator in the workplace. The training must be comprehensive, understandable, and recur at least annually – or more often if necessary.8,9

OSHA identifies the following as minimum knowledge a respirator user should have upon completing respirator training:

  • Why the use of a respirator is necessary (e.g., the respiratory hazards and how improper fit, usage, or maintenance can compromise the protective effect of the respirator),
  • Limitations and capabilities of the respirator,
  • How to use the respirator effectively in emergency situations, including when
    the respirator malfunctions,
  • How to inspect, don (put on) and doff (remove), use, and check the seals of the respirator,
  • The procedures for maintenance and storage, and
  • How to recognize medical signs and symptoms that may limit or prevent the effective use of the respirator.9

There has been a lot of conversation in dentistry regarding OSHA’s enforcement of the Respiratory Protection Standard since the start of the pandemic. Although OSHA is a complaint-driven agency, based on current information as of October 2, 2020, there appears to be plenty of complaints as OSHA has cited 37 establishments for violations, resulting in proposed penalties totaling $484,069 where employers failed to implement a written respiratory protection program, provide a medical evaluation, respirator fit test, training on the proper use of a respirator, and personal protective equipment.11 In September, OSHA cited a dental practice in Georgetown, Massachusetts for violating respiratory protection and other standards with proposed penalties of $9,500. The citation included failure to provide medical evaluations and fit testing for employees required to wear N95 respirators as protection against coronavirus and lack of written programs related to respiratory protection among other violations.12

Dentistry has been driven into a  new “normal” of providing patient care that has added another layer of OSHA compliance to daily practice – the utilization of respirators for aerosol generating procedures requires the implementation of a respiratory protection program per the Respiratory Protection Standard. Employers and management teams must have a clear understanding of the standard and its rationale to provide a sound respiratory protection program for all employees. It should not be the potential for an OSHA citation that drives a dental practice to compliance, rather, it is the right thing to do to ensure DHCP safety.


1. American Dental Association. ADA news. Available at Accessed November 6, 2020.

2. American Dental Association. Available at Accessed November 6, 2020.

3. Centers for Disease Control and Prevention. How covid-19 spreads. Available at Accessed November 6, 2020.

4. Centers for Disease Control and Prevention. Guidance for dental settings. Available at Accessed November 6, 2020. 

5. US Department of Labor. Occupational Safety and Health Administration. Guidance on preparing workplaces for covid-19; March 2020. Available at Accessed November 6, 2020.

6. US Department of Labor. Occupational Safety and Health Administration. Dentistry workers and employers. Available at Accessed November 6, 2020.

7. American Dental Association. OSHA guidance summary: dentistry workers and employers; September 21, 2020. Available at Accessed November 6, 2020.

8. US Department of Labor. Occupational Safety and Health Administration. Respiratory protection. Available at Accessed November 6, 2020.

9. Centers for Disease Control and Prevention. The national personal protective technology laboratory; respirator trusted source information. Available at Accessed November 6, 2020.

10. US Department of Labor. Occupational Safety and Health Administration. Temporary enforcement guidance – healthcare respiratory protection annual fit-testing for N95 filtering facepieces during the COVID-19 outbreak.   Available at Accessed November 6, 2020.

11. US Department of Labor. Occupational Safety and Health Administration. OSHA national news release. Available at Accessed November 7, 2020.

12. US Department of Labor. Occupational Safety and Health Administration. OSHA national news release. Available at Accessed November 7, 2020.

Health news and notes

Teeth grinding prevalent in election season

This year’s political arguing has apparently contributed a significant amount to teeth gnashing, according to the Washingtonian. According to dentists interviewed, America, overwrought and under-rested, is grinding its choppers away. “The collateral damage has just been incredible,” says DC dentist Brian Gray of the pandemic-meets-election season’s effect. Part of that damage is due to stress-related clenching and grinding, which causes people to come in complaining of headaches, jaw pain, or cracked or broken teeth. Antidepressant medications can cause teeth-grinding too. Gray estimates he’s making about 30 percent more night guards than he usually would. And it’s not just adults. Half of orthodontist Jill Bruno’s clients are teenagers, and their teeth are taking a beating, too. “I’m not a psychologist or psychiatrist, but the stress of this time period, it manifests in different people in different ways,” says Bruno. “The oral cavity, the mouth, takes a lot of the brunt.” Bruno estimates that about 25-to-30 percent of her patients have come in after grinding through their night guards, retainers, or aligners.

Protect your immune system

It’s critical to protect your immune system as we face both the COVID-19 pandemic and the 2020-2021 flu season, according to a Piedmont Living Better blog. Jemese Richards-Boyd, MD, a Piedmont primary care physician, shared ways you can boost your immune system and protect your health:

  • Exercise. “Moderate exercise can boost immunity by increasing blood flow and helping to reduce chronic stress,” says Dr. Richards-Boyd.
  • Proper diet. “In general, a poor diet and lack of nutrients can interfere with the activity of your immune cells and possibly even the production of different immune cells,” she says. “If you lack the necessary nutrition and become exposed to an infection, your body may not be able to mount the response it needs to fight the infection.”
  • Sleep. “Lack of sleep can negatively impact your immune system,” says Dr. Richards-Boyd. “It is important to practice good sleep hygiene to make sure you avoid common pitfalls that disrupt your ability to get restful sleep.”
  • Get a flu shot. “Getting a flu shot during the pandemic is important because it is possible to get both influenza and COVID-19, as they are two separate viruses,” she explains.
  • Wash your hands regularly.
  • Stay home if you are sick.

Read the full recommendations at:

Sniffing out COVID

A recent Time article highlighted how dogs might play a role in detecting COVID-19 infections. One hint – their noses. Steve Lindsay, a public health entomologist at Durham University, along with collaborators at the London School of Hygiene & Tropical Medicine (LSHTM) and the U.K.-based nonprofit Medical Detection Dogs, are working on a U.K. government-funded study that will test dogs’ ability to detect COVID-19. Their goal: to train coronavirus-sniffing dogs, which could then be deployed at schools, airports and other public venues to reinforce existing nasal swab testing programs. A similar study is underway at the University of Pennsylvania. “We’re not just doing the proof of concept work, we’re also working out actively how to deploy this and scale it up as well, because we want to hit the ground running once we’ve gotten our results,” says James Logan, the head of LSHTM’s Department of Disease Control and the project lead on the U.K. study. Read about the studies at:

A golfer’s guide to low back pain

Golf is often thought of as a low-impact sport, but it can be associated with several musculoskeletal injuries due to its repetitive nature, according to U.S. News and World Report. One of the most common complaints reported by golfers is low back pain, with reported rates varying from 26% to 52%. Low back pain is also a major health issue among adults in the general population. Given the high prevalence and high cost of low back pain care, it’s worthwhile to consider how to prevent golf-associated low back pain.

While the golf swing seems like a relatively easy motion, it is actually an extremely complex series of motions that involve most of the muscles and joints in the body. As with all things, the golf swing’s frequent repetition – compounded over years of playing the sport – places significant stress on those muscles, joints, and tendons. Over time, this may result in injury.

Understanding the mechanics of the golf swing, along with education and training, can help prevent golf injuries. It’s important to use proper posture and proper sequencing, and not to over-swing. Swinging too hard may increase the stress placed on the spine and surrounding structures… Read the full article.

Training and Compliance: Emerging OSHA Guidance

COVID-19 has raised the stakes for providers and patients.

In years past, dental providers have generally been adamant about utilizing personal protective equipment and adhering to OSHA and CDC guidance. The onset of COVID-19, however, has raised the stakes for providers and patients. As new safety protocols have emerged, infection control leaders are working hard to keep the industry informed.

Efficiency in Group Practice spoke with training and compliance expert Katherine Schrubbe, RDH, BS, MEd, PhD, about evolving OSHA guidelines and how they will continue to impact dental practices.

Efficiency in Group Practice:  How has COVID-19 changed OSHA’s concerns about potential safety hazards in the dental setting?

Dr. Katherine Schrubbe: OSHA has issued guidance on COVID-19 for dentistry on a new page entitled Dentistry Workers and Employers. OSHA states that “this guidance is not a standard or regulation, and it creates no new legal obligations. It contains recommendations as well as descriptions of mandatory safety and health standards. The recommendations are advisory in nature, informational in content, and are intended to assist employers in providing a safe and healthful workplace.” (

Although dentistry has always dealt with respiratory hazards in the workplace (i.e., spray, spatter and aerosols), SARS-CoV-2 has generated a new level of concern given the high infectivity of the virus and the known risk of droplet transmission, as well as the potential for airborne transmission. Dental providers are the best at utilizing personal protective equipment (PPE) and have been taught to consider every patient infectious; but now they must utilize a higher level of PPE per OSHA and CDC guidance. 

On October 5, 2020, the CDC issued an update on their page, How COVID-19 is Spread. According to the update, “under certain conditions, people with COVID-19 seem to have infected others who were more than 6 feet away. These transmissions occurred within enclosed spaces that had inadequate ventilation. Sometimes the infected person was breathing heavily, for example while singing or exercising. Under these circumstances, scientists believe that the amount of infectious smaller droplet and particles produced by the people with COVID-19 became concentrated enough to spread the virus to other people. The people who were infected were in the same space during the same time or shortly after the person with COVID-19 had left.  However, available data indicate that it is much more common for the virus that causes COVID-19 to spread through close contact with a person who has COVID-19 than through airborne transmission.” (

OSHA – as well as the CDC – points out that respirators (NIOSH-certified, disposable N95 filtering facepiece respirator or better) should be worn if dental providers are completing aerosol-generating procedures (AGPs) to ensure the highest level of protection.

Efficiency in Group Practice:  Has OSHA changed its approach to conducting inspections, responding to complaints or issuing citations as a result of COVID-19?

Dr. Katherine Schrubbe: This is difficult to say, given that OSHA is a complaint-driven agency and does not have the manpower to check up on every healthcare facility without good cause. However, there seem to be a new crop of OSHA citations and fines related to COVID-19, and many have to do with lack of compliance to the Respiratory Protection Standard, 1910.134.  Since the start of the coronavirus pandemic, OSHA has cited 85 establishments for violations, resulting in proposed penalties totaling $1,222,156. (These figures were current at press time and may continue to change. Providers can stay current by visiting

Recent OSHA inspections have resulted in the agency citing employers for a number of violations, including failures to:

  • Implement a written respiratory protection program.
  • Provide a medical evaluation, respirator fit test, training on the proper use of a respirator, and personal protective equipment.
  • Report an injury, illness or fatality.
  • Record an injury or illness on OSHA recordkeeping forms. 
  • Comply with General Duty Clause of the Occupational Safety and Health Act of 1970.

As an example, on September 16, 2020, OSHA cited Georgetown Dental LLC for violating respiratory protection and other standards at the Georgetown, Massachusetts, location. OSHA cited the dental practice for six serious, and one other-than-serious, violations, with proposed penalties totaling $9,500. OSHA cited the dental practice for failing to provide medical evaluations and fit testing for employees required to wear N95 respirators as protection against coronavirus; lack of written programs related to respiratory protection, bloodborne pathogen exposure control and chemical hazard communication; insufficient bloodborne pathogen training and controls; and inadequate eyewash stations.


Efficiency in Group Practice:  What are the most significant changes dental practices or DSOs have made, as a result of new OSHA guidance and citations?

Dr. Katherine Schrubbe: In my experience, the most significant changes to dental practices and DSOs have been the incorporation of OSHA’s Respiratory Protection Standard and its requirements. If dental providers are utilizing respirators, they need to be worn in the context of the Respiratory Protection Standard. A written plan is now required as part of the practice’s compliance manual, and dental practices must incorporate the various elements of the standard as part of their SOPs, as well as train all team members on this standard and its requirements.

Efficiency in Group Practice: In addition to the coronavirus pandemic, the U.S. continues to experience climate-related disasters, such as hurricanes, flooding and wildfires. Moving forward, how can dental practices better prepare for pandemics or natural disasters?

Dr. Katherine Schrubbe: The United States has had a horrendous 2020 thus far, with wildfires, hurricanes, flooding and a global pandemic. Dental practices have had to step up their compliance to safety guidance very quickly, and many did not plan ahead for extraordinary natural disasters. If this pandemic has taught us anything, it’s that it’s not if, but when, the next thing will happen! That said, there are already tools in place for future planning. OSHA has an excellent webpage on Emergency Preparedness and Response and states, “preparing before an emergency incident plays a vital role in ensuring that employers and workers have the necessary equipment, know where to go, and know how to keep themselves safe when an emergency occurs.” The site addresses how to prepare and train for emergencies, as well as the hazards to be aware of when an emergency occurs, and offers e-tools, fact sheets, quick cards and guidance documents for everything from disease pandemics to nuclear threats. (

2021 OSAP Dental Infection Control Boot Camp™ Registration Now Open

The Organization for Safety, Asepsis and Prevention (OSAP) announced registration is now open for the 2021 OSAP Dental Infection Control Boot Camp™. OSAP will host the course virtually from January 25 – 28, 2021.

The 2021 OSAP Dental Infection Control Boot Camp™ will provide a comprehensive review of all the basics in dental infection prevention and control, including employee and patient safety. Due to the continued COVID-19 pandemic, the curriculum will also cover interim guidance and any related regulations. OSAP has designed this course for:

  • Infection Control Coordinators and Dental Practice Managers
  • Educators/Program Directors
  • Consultants/Lecturers
  • Military/Federal Service Personnel
  • Federally Qualified Health Center (FQHC)/Public Health Personnel
  • IHS/Tribal Health Organization/Tribal Urban Clinic Personnel
  • Sales representatives, customer service personnel, service technicians, and other professionals who work for the companies that manufacture or distribute products, equipment, or services to the dental profession
  • Those who inspect or investigate dental settings for compliance with the guidelines and standards on behalf of the government, regulatory, accrediting, or public health authorities

“This year, participants will leave with a deeper understanding of Standard Precautions as addressed in guidance documents for dental providers published by CDC in 2003 and 2016 and the OSHA Bloodborne Pathogens Standard. Additionally, speakers will address the most up-to-date interim guidance and any related regulations in each topic area,” states OSAP Executive Director, Michelle Lee, CPC. “The 2021 agenda includes several new sessions focusing on topics such as transmission-based precautions, optimization of PPE, and developing a respiratory protection program.”

Upon completion of this course, participants will be able to:

  • Describe disease transmission and principles of infection prevention and control in a variety of oral healthcare settings
  • Identify relevant infection control laws, regulations, guidelines, standards, and best practices
  • Use quality assurance measures (e.g., direct observation and feedback) to ensure accurate implementation of recommended infection control practices

“Our goal is to ensure that participants leave Boot Camp feeling educated and empowered to be infection control champions when they return to their dental offices. We also understand that everyone in the dental community has been affected by COVID-19. With this in mind, OSAP is offering a 30% discount on registration fees to help make this important education accessible!” Lee said.

For more information, visit:

About OSAP

The Organization for Safety, Asepsis and Prevention (OSAP) is a growing community of individual clinicians, group practices, educators, researchers, consultants, trainers, compliance directors, policymakers, and industry representatives who advocate for safe and infection-free delivery of oral healthcare. OSAP focuses on strategies to improve compliance with safe practices and on building a strong network of recognized infection control experts. OSAP offers an extensive online collection of resources, publications, FAQs, checklists, and toolkits that help dental professionals deliver the Safest Dental Visit for their patients. Plus, online and live courses help advance the level of knowledge and skill for every member of the dental team. For additional information, visit

People News

Founder, former CEO of Mortenson Dental Partners retires

Wayne Mortenson, DMD, who founded Mortenson Dental Partners with his wife, said he would retire from the DSO September 30. Dr. Mortenson and his wife, Sue Mortenson, opened their first dental practice, Mortenson Family Dental, in Middletown, Kentucky, in 1979. The DSO now includes 140 practices across nine states and employs nearly 1,800 people. The retirement announcement comes two years after Dr. Mortenson stepped down from his CEO role to serve as an executive adviser. He plans to stay an active member of the DSO’s board of directors and lead the Mortenson Charitable Foundation’s efforts with his wife, the company says. DSOs, Dental Providers, & Insurance

Dental Care Alliance names former Walgreens exec as new president

Dental Care Alliance named Jeffrey Koziel as its new president. Most recently, he served as senior vice president, pharmacy and retail operations, with responsibility for day-to-day operations supporting Walgreens’s more than 9,300 locations.

“As DCA looks ahead to our fourth decade of creating healthy smiles, I am confident that Jeff has the experience and vision to lead Dental Care Alliance into the next stage of growth,” stated Jerry Rhodes, Chief Executive Officer for DCA. “The demonstrated way in which he cares for the business and its people are distinctively aligned with our mission and values. He has an unbridled passion for healthcare and innovation, and is committed to driving results for the future at DCA.”

“I’m thrilled to join the Dental Care Alliance family,” Jeff shared. “We are undoubtedly in challenging times, but as it goes, I believe it will enable our greatest opportunities. Already, I’ve learned much about the commitment and dedication of DCA’s affiliated practices and the patients and team members that we serve. I sincerely look forward to contributing to and taking this already great organization to the next level.”

Hinman Dental Meeting executive director retiring in May

The Thomas P. Hinman Dental Meeting announced that its longtime executive director, Sylvia Ratchford, will retire in May 2021, following her 25th Hinman meeting. Ratchford has led the Hinman Dental Meeting and Hinman Dental Society since 1996, growing it to its peak of more than 23,000 attendees and 430 exhibiting companies, according to the organization. She will be succeeded by Annette Sullivan.

“For the past 24 years, Sylvia has been the lifeblood of Hinman and has played a very critical role in making Hinman the success it is today. She has been a tremendous leader who has been instrumental in growing Hinman and maintaining its position as the premiere dental meeting in the country,” said Dr. L. Maxwell Ferguson, Chair of the Hinman Board of Trustees. “We are sad to see her retire, but greatly appreciate her many contributions over the years, including the capable team she has developed. We are fortunate that she is able to stay on through May to work alongside and share her experience with Annette.”

Ratchford has more than 40 years of experience in the hospitality, meeting planning and association management industries. Prior to assuming the role of Executive Director at Hinman, Ratchford worked in sales management for nine years at The Westin Peachtree Plaza. She then worked another nine years at AmericasMart, including the pre-opening of INFORUM, where she was responsible for the marketing and sales of the exhibits and meeting space in all four buildings. Ratchford has served on the board of the Atlanta Convention and Visitors Bureau and as President of the Southeastern Chapter of the Professional Convention Management Association. She is also a long-time member of the International Association of Exhibitions and Events. She earned her bachelor’s degree in fine arts at the University of Georgia. Ratchford looks forward to moving near her hometown of Gastonia, N.C. and spending time on Lake Wylie with family and friends. “The past 24 years have been a blessing for me both professionally and personally. My hope is that the many relationships I’ve formed with colleagues and friends, as a result of Hinman and my career in Atlanta, will be lifelong,” said Ratchford. “Annette is well respected in the Atlanta hospitality community and I feel confident that Hinman is in very capable hands going forward. I know that the Hinman leadership, members and staff will support her as well as they have me over the years.

Native Atlantan Annette Sullivan began working full-time recently with the goal of transitioning many of Ratchford’s duties by the end of year. Sullivan brings more than 20 years of experience in the hospitality and meeting planning industry. Her most recent position was with the Georgia World Congress Center where she was a member of the national convention sales team. She also has worked on the sales team for the Atlanta Convention & Visitors Bureau in Atlanta and spent 10 years in Washington, D.C. working with associations. She worked for the Sacramento Convention & Visitors Bureau and Chicago Convention & Tourism Bureau bringing associations to each of those destinations. Prior to being on the sales side, her association experience includes management roles with the National Association of Computer Consultant Businesses and Associated Builders & Contractors. “We are thrilled to have Annette join Hinman as our new Executive Director and lead the meeting into the future. Her experience and unique perspective will play an important role in positioning Hinman for years to come,” said Dr. J. Sedgie Newsom, President of the Hinman Dental Society. “While she certainly has big shoes to fill, we are confident that Annette has the expertise to guide and shape Hinman and successfully navigate the challenges that the pandemic has created.”

ADA installs Daniel Klemmedson as new president

Daniel J. Klemmedson, DDS, MD, assumed the position as president of the American Dental Association, effective October 19. Dr. Klemmedson has been actively involved at the ADA for many years, serving on the ADA Council on Dental Benefit Programs from 2007 to 2011 and a strategic planning committee from 2009 to 2012. From 2019 to 2020, Dr. Klemmedson served as president-elect of the ADA. 

In addition to Dr. Klemmedson’s achievements at the ADA, he is a past president of the Arizona Dental Association, Southern Arizona Dental Society, Western Society of Oral and Maxillofacial Surgeons and Arizona Society of Oral and Maxillofacial Surgeons. Throughout his career, Dr. Klemmedson has earned multiple awards, including the Dentist of the Year Award and the Hall of Fame Service Award from the Arizona Dental Association. In 2018, he received the Gerald E. Hanson Outstanding Service Award from the Oral and Maxillofacial Surgery Foundation.

Dr. Klemmedson is a fellow of the American Board of Oral and Maxillofacial Surgery, as well as a member of the Academy of Dentistry International, American Cleft Palate-Craniofacial Association and American Medical Association. He has received fellowships from the American College of Dentists, International College of Dentists and Pierre Fauchard Academy.

President-elect Cesar R. Sabates, Second Vice President Maria Maranga, and five new trustees also assumed office on October 19.

AAOMS names new president

The American Association of Oral and Maxillofacial Surgeons (AAOMS) (Irving, TX) named Dr. B.D. Tiner, DDS, MD, as its new president. He officially began his one-year term on Oct. 11. Dr. Tiner served as president-elect for AAOMS last year, serving as VP the year prior to that. He has been an active member of the organization for 37 years. Dr. Tiner is a surgeon with Alamo Maxillofacial Surgical Associates, a partner practice of U.S. Oral Surgery Management (USOSM).

Mid-Atlantic Dental Partners promotes Pamela Holder to chief revenue officer

Mid-Atlantic Dental Partners announced the promotion of Pamela Holder to chief revenue officer. In her new role, Holder will oversee revenue operations companywide and the growth and expansion of Mid-Atlantic Dental. Holder brings more than 12 years of dental and healthcare revenue experience to her role at Mid-Atlantic Dental. She joined the company in January 2019 as VP of revenue cycle and was promoted to SVP of Revenue Cycle Management the following year. Prior to joining Mid-Atlantic Dental, she headed her own consulting firm where she worked with DSOs and solo practices to analyze all aspects of the revenue cycle.

“Pam is one of the best examples of how you can accomplish anything you desire if you are dedicated, humble and willing to work hard,” said Leigh Feenburg, Chief Operating Officer of Mid-Atlantic Dental Partners. “Pam has touched the lives of literally thousands in her career, leaving the most positive impressions on those she supports and advancing so many careers of those she has led.”

Holder holds a Bachelor’s Degree in Political Science, with a concentration in Foreign Policy of the Middle East, from Oakland University in Rochester, Michigan. As a former executive of one of the country’s largest DSOs, Holder has been a member of ADSO, NDEDIC, AADGP, NADP and sat on the DSO Advisory board for NADP. In 2015, Holder was a Stevie Bronze Medal winner for National Businesswoman of the Year and a Rising Star Award nominee for the National Dental EDI Council in 2016.

Western Dental promotes Patricia Himpelmann to SVP, Specialty Services

Western Dental appointed Patricia Himpelmann as SVP, Specialty Services. Himpelmannis expanding her role to include responsibility for operational support of all dental specialties, including oral surgery, periodontics, endodontics and pediatric dentistry. Himpelmann joined Western Dental in 2015 as VP of Soft Tissue Management, a role in which she developed a hygiene program and recruited and deployed nearly 150 hygienists across the company. She has also developed and launched key initiatives for dental implants and a variety of other oral health care products and services.