Dr. Michael Sanders Redefines

a Group PracticeEagle Summit Dental Group

in Eagle River, Alaska

Protect Your Success:Special Mechanical

Room Section

Using Social Media in Your Practice

Issue 1 | 2012

Change Your FocusDoes your light pattern look like this? If not,

3x6”- that’s the light pattern you’ll be looking at with a Helios 3000 LED operatory light from Pelton & Crane. Crisp edges and consistent intensity ensure that the entire oral cavity is illuminated equally, no adjustment is needed due to hot spots or washout, and eye fatigue is absolutely minimized. Let Helios 3000 change your focus for the better.

HELIOS LIGHT PATTERNHALOGEN LIGHT PATTERN

Enter to Win A Helios 3000 LED light!Scan the QR code to register for an in-office demo and enter to win. www.pelton.net p/n 061960 rev0 11/11

Burkhart Dental | CATALYST MAGAZINE | Issue 1, 2012 1.

IN TOUCH

visit us online!burkhartdental.com

F or many years, Burkhar t has been recognized as a company that places its focus on delivering great customer care. This is part of our DNA as five generations

of Burkhart family leadership has made this an expectation for the associates of the company. In particular, Everett Burkhart and Perry Burkhart, Sr. grew the company in the 50’s, 60’s and 70’s around their passion for taking care of our clients.

In 2011, we were recognized by the Customer Service Institute of America as Small Business of the Year. This global award recognizes outstanding customer service and is a testimony to the hard work and servant attitude that our associates exhibit each day. They understand that the strength of our brand is based on the service that we provide and that our growth will be a natural offshoot. This belief has been confirmed over the past three years, in particular, as Burkhart has grown our presence in each of the markets that we serve, despite the recession. Dentists who are switching to Burkhart are telling us that during times like this they want a business partner that will be accountable and will be focused on helping them succeed. They want the best service.

So just when you think that winning a prestigious international award would be enough to allow a company to rest on its laurels, our current leader, Lori Burkhart Isbell, has challenged us to begin a journey to elevate our service to even greater heights. We call it the Exceptional Client Experience (ECE) and over the next three years we will put in place a number of customer care items with the goal of being business and life changing for our clients. It is not good enough to be better. We want to be better by a long shot. We want to be a magnet that continues to draw in doctors that value exceptional service and new employees that are passionate about delivering it.

Thanks so much for allowing Burkhart the opportunity to serve you. We look forward to hearing your stories of how we have provided you with an Exceptional Client Experience.

Greg BiersackVice President of OperationsBurkhart Dental Supply

Serving the Dental Profession since 1888...At Burkhart we realize that our clients are both dental professionals and business owners. It is our goal to help them be successful at both aspects of their careers. Catalyst is fully dedicated to that success. The articles in this publication vary from product use and selection to business management topics and provide information and guidance that can lead to a more successful practice. Throughout the publication are stories of Burkhart clients who have succeeded in the areas that are highlighted. We hope that you enjoy!

If you have a request for a topic that you would like for us to cover in Catalyst, please contact Holly Kean at: hkean@burkhartdental.com

Catalyst Magazine is published by Burkhart Dental Supply 2502 South 78th Street Tacoma, WA 98409 Tel. 253.474.7761 Fax 253.472.4773

PuBlisher Greg Biersack

PrinciPal editor Holly Kean

GraPhic desiGner Sara Wisely

advertisinG Nicole Wade

All rights reserved. Reproduction of any part of this publication without written permission from the Publisher is strictly forbidden. Images are not necessarily to scale.

Customer Service:

800.562.8176

Account Manager Matt Milligan and Doctor Kyle Kern. Burkhart’s new Exceptional Client Experience aims to go above and beyond for each of our valued clients.

All theright stuff!

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Accutron_Burkhart Catalyst Ad_Layout 1 11/9/11 9:49 AM Page 1

Burkhart Dental | CATALYST MAGAZINE | Issue 1, 2012 3.

The New Palodent Plus Sectional Matrix System from Dentsply By anDrew coste, Dentsply professional

Assistant Superstar: Erin Anderson

For Our Dental Assistant Clients Burkhart Announces ADAA Sponsorship

Supply Savings Guarantee: Controlling Overhead with Great Customer Service By KimBerly thomas, BurKhart account manager

Front Office Superstar: Colette Fontaine

Improving Gingival Symmetry: Three Case Examples By rhys spoor, DDs, fagD, faDia, accreDiteD memBer of the american acaDemy of cosmetic Dentistry

About Electronic Prescribing By Dawn christoDoulou, presiDent, XlDent™

The Life Blood of Your Practice By Dentalez

US EPA Due to Issue Proposed Dental Rule By solmeteX

Optimize Your Utility Room with Air Techniques By air techniques

What Are We Really Dumping Down the Drain? By reBec

Eagle Summit Dental Group: Turning a Group Practice on Its HeadDr. Michael Sanders

By JuDi griffin, customer service manager photos By miKe meyer photography

From Scrubs to Army FatiguesBy JuDi griffin, customer service manager

18

6

25

10

1213

14

26

3032

36

3841

16

15

FEATURE

PRACTICE MANAGEMENT

WEALTH MANAGEMENT

TABLE OF CONTENTS

ASSISTANT SUCCESS

CLINICAL SUCCESS

FRONT OFFICE SUCCESS

TECHNOLOGY

MECHANICAL ROOM: PROTECT YOUR SUCCESS

What Does Your Staff Expect? The Intangibles Count By tim twigg anD reBecca crane, Bent ericKson anD associates

What is Your Online Status? Using Social Media in Your Practice By Karen Burnett, rDh, practice consultant, practice leaDership, BurKhart consulting

Wealth Enhancement: Income Taxes May Be Your Largest Investment ExpenseBy sam martin, cpa, cfp®

INDEx OF ADvERTISERS: A-Dec: Agile ................................. 5

Accutron: Nitrous Oxide Conscious Sedation ........... 2

Acteon: p5Xs, SoproLife and Sopix2 .....3

AIrBeX: Nomad Pro ....................11

AIr technIqueS, Inc.: Optimize Your Utility Room ...37

BurkhArt: Service ............................ 35 Quality Repair & Maintenance ...40

DentAlez: Exclusive Spceials from Ramvac & Custom Air® ..31

DentAlGrouP llc: Is Your CPA a Dental Specialist? ........... 44

InStrumentArIum: Orthopantomograph® OP300 ........... BacK cover

jmorItA: Veraviewepocs 3De ... insiDe BacK cover

mIDmArk: Powervac® G ................... 28

Pelton & crAne: Change Your Focus. ............ insiDe front cover

PrActIce leADerShIP, BurkhArt conSultInG: Under Pressure ................. 9

reBec Amalgam Separators .......39

SolmeteX: SolmeteX® Hg5® Series.... 34

XlDent: Practice Software ........... 27

Cover Photo: Dr. Michael Sanders in his practice in Eagle River, Alaska. Photo by Mike Meyer Photography.

8

Dr. Spoor maintains a private practice in aesthetic and restorative dentistry in Seattle, WA and can be contacted at www.RhysSpoor.com.

CONTRIBUTORS

Judi Griffin, Customer Service Manager, Burkhart Dental Supply

Judi Griffin is the Burkhart Dental Supply Customer Service Manager, overseeing the team of dedicated associates who support clients and fellow associates with ordering, shipping and product information. Judi is also responsible for managing the Burkhart Handpiece Repair Center. Judi holds a Bachelor of Arts in Business Administration and a Masters of Business Administration both from the University of Washington, Tacoma.

Sam Martin, CPA, CFP, Dental Group, LLC

Sam Martin is Director of Wealth Management Services and Advanced Tax Planning for the Dental Group, LLC / Martin Boyle PLLC / Dental Wealth Advisors, LLC, a CPA, practice advisory, financial planning and Wealth Management services group exclusively serving dentists and their practices. Sam is a Certified Public Accountant (CPA), a Certified Financial Planner (CFP), and holds a Masters Degree in Federal Income Taxation. Located in Kirkland, WA—Sam can be reached at 425.216.1612 or Sam@cpa4dds.com.

RHYS SPOOR, DDS, FAGD, FADIA, Accredited Member of the American Academy of Cosmetic Dentistry

Rhys Spoor, DDS, has a private practice in aesthetic, restorative and implant dentistry and is a 1983 graduate of the University of Washington School of Dentistry. He is an Accredited Member of the American Academy of Cosmetic Dentistry, and a Fellow of the Academy of General Dentistry, the American Dental Implant Association and the Pierre Fauchard Society. He welcomes comments or questions at spoordds@msn.com.

Karen Burnett, RDH, MA, Practice Consultant, Practice Leadership, Burkhart Consulting

Karen’s long-time enthusiasm for dentistry includes 29 years of experience both in chairside assisting and dental hygiene. A Master’s degree in Psychology provides the foundation for her comprehensive, hands-on coaching. Inclusive of client input, Karen provides results-oriented business solutions within Practice Leadership’s customized coaching programs to participate in the growth and development of each team.

People who drink 3 or more sugary sodas daily have

62% more dental decay, fillings and tooth loss. (CDC, 2010)

78% of Americans

have had at least one cavity by age 17

(CDC, 2008)

78%

>More people use blue

toothbrushes than

red ones.

SOME THINGS TO

cheW on In this issue

4.

Agile

© 2011 A-dec Inc. All rights reserved.

A-dec now offers the ergonomics and comfort of the A-dec 500 chair with the new option of A-dec 300’s Radius-style delivery. The result? Outstanding access, premium patient comfort, and nimble integrated delivery. Robust yet agile.

Contact your local A-dec dealer and discover how the industry’s leading chair gives you more maneuverability than ever.

Call 1.800.547.1883 or download

the brochure at a-dec.com/agile

A-dec_Agile_BurkhartCatalyst.indd 1 8/15/11 3:53 PM

How do you attract quality employees? And more importantly, how do you retain quality employees?

Understanding what staff expect and want is an important first step. Interestingly, while certainly pay levels and the generally accepted benefits (vacation, holidays, sick leave, etc.) matter, the statistics from many employee surveys indicate that many other factors play into staff satisfaction. In fact, many of them are more important factors than pay and basic benefits.

Consistently, employee surveys show similar rankings for the following motivational factors related to job satisfaction:

1. Interesting and challenging work

2. Recognition, acknowledgement and appreciation

3. Ability to contribute, make a difference and be included

4. Sense of job security

5. Compensation and benefit package

6. Opportunity for promotion and/or growth

7. Positive working environment and good working conditions

8. Personal loyalty and commitment to employees by employer

9. Consistent, fair and tactful disciplining and management

10. Support, care and help with personal problems

Note that many of the listed items are “intangibles.” Note also how the majority of the items are more related to leadership and basic management principles, as well as communication and people skills, rather than financial costs.

Bottom line: Your employees want and need to be recognized for the work they do.

Compensation and benefits need to be competitive and commensurate with the job duties, performance and service provided. Employees tend to view compensation as a right, but take a more emotional position regarding benefits. To the employees, benefits, particularly the “intangible benefits,” represent how much an employer cares about them.

Benefits such as vacation, health insurance, holidays, sick leave, disability insurance, retirement plans, life insurance and dental insurance are the most common employee

benefits. But there are also a number of less common benefits that can be offered to increase employment satisfaction and contribute greatly to camaraderie and team development. Examples of these are:

• Direct deposit of paychecks

• Implementing wellness-related plans

(fitness, smoking cessation, stress reduction, etc.)

• Providing discounts on products or services

• Providing business cards & job titles

• Community/voluntary service hours—with corporate recognition of quality representation within the community, i.e., for a volunteer event in which the employee is participating

• Bonus and incentive plans

Rather than encouraging complacency, effective leaders and managers need to recognize and reinforce desired performance attributes and accomplishments so that employees will strive even higher.

Recognition can be as simple as a compliment, which ranks very high in employee surveys. A myriad of other options are available: gift certificates, a note about

great work, or subsidization of services such as manicures, etc. All of this should be done sincerely and sensitively and not as a substitute for fair pay.

Performance reviews, or continuous feedback, are a key communication vehicle. Evaluating job performance, providing

By reBecca crane anD tim twigg, Bent ericKson anD associates

WhAT DoES Your STAff ExpECT?The Intangibles Count!

Bottom line: Your employees want and need to be recognized for the work they do.”“

6.

employees with constructive feedback, and jointly discussing and addressing areas for improvement are essential for ongoing improvement. Equally important is having a true picture of each person’s performance, or lack thereof.

Performance reviews should include a positive dialogue between the employer and the employee. Focus on ideas and solutions for improvement, using a current job description as an objective perspective on the employee’s duties and responsibilities.

Nothing included in a formal performance review should come as a surprise to the employee, so don’t wait until the review to provide feedback. Use ongoing opportunities to advise employees of their progress and share compliments and/or constructive guidance/criticism.

Throughout the year, keep notes related to each employee’s performance. This practice will enable you to prepare a comprehensive evaluation consisting of praise, critique, and a more accurate analysis of the employee. When appropriate, also relate evaluation appraisals to those made in previous years.

New employees should receive two performance evaluations in the first 90 days: one after four weeks and a second after 11 weeks. This approach compels you to observe the new employee’s performance closely. For legal and managerial reasons, it’s better to let someone go during the orientation and training period rather than later.

For consistency and ease of preparation, use specific performance evaluation forms covering items such as quality and quantity of work, job knowledge, and staff and patient relations. Resist the temptation to give everyone high marks. Be fair and honest in your analysis.

A key component of leadership is dealing with poor performers. Lack of motivation can occur among top-performing employees

when employers condone or allow poor performances from other employees. All this impacts the success of the team. In addition, employers who choose not to decisively deal with those lower-performing employees are essentially stating that no one’s performance gets adequately recognized. Therefore, take disciplinary action or even terminate an employee if need be.

Finally, communicate fully with your employees. All too often employers keep employees on a “need to know” basis. Unnecessarily restricting the flow of information can be damaging. One of the most negative findings expressed in employee attitude surveys is the absence of adequate communication. Also, there is a strong need to be open and honest; employees can see through any bluff you may try. Start by asking employees what they want or need to know, and then follow up to ensure the message has been understood. This is a powerful sign of respect, and it helps employees do their jobs more effectively.

ConClusionEffective management of staff can seem complex. Certainly, it is more than just throwing money at employees and expecting that to fix everything. Employers need to take the necessary steps to learn what motivates

their employees and apply those principles in a motivating way. Remember that motivation includes intangibles, like recognition, compliments and acknowledgement. All these have a significant impact on staff satisfaction and retention. Keep in mind that so much can be gained from eliciting employee feedback and communicating openly and honestly. Do so consistently, and you will start enjoying a more stress-free work environment with motivated employees.

Tim Twigg is the President of Bent Ericksen & Associates, and Rebecca Crane is a Human Resources Compliance Consultant with Bent Ericksen & Associates. For over 30 years the company has been the leading authority in human resources and personnel issues, helping dentists successfully deal with the ever-changing labor laws.

PRACTICE MANAGEMENT

Practice Leadership, Burkhart Consulting

is pleased to have three team members

certified through Bent Erickson and

Associates to implement a customized,

compliant Personnel Policy Manual for

your practice as well as conduct facilitated

staff performance reviews in your office.

We can also provide you with up-to-the-

minute geographic salary compensation

comparisons for each of your team

members. To learn more, contact us at

800.665.5323 or at practiceladership.com.

Burkhart Dental | CATALYST MAGAZINE | Issue 1, 2012 7.

When talking about a post, do you automatically think about what you use to increase retention

of a clinically short crown? For most of your patients, it means something entirely different—an online entry. So, what is the perfect balance in terms of using social media? You might start by determing where your practice needs an online presence—a website, a blog, a Facebook account, a Twitter account—by thinking about where patients and potential new patients might be online.

Where are you? Evaluate the location of your practice and the demographics of your area. An office in a more rural setting might be dependent on the Internet for products and services that are not in the immediate area; an online search could be u s e d t o

save gas and driving time. On the other hand, a rural setting might mean fewer cell towers and less reliable Internet service. Are people using the phone book, or their smart phones? A military town’s demographics are likely skewed toward a younger patient population that grew up using electronic devices.

Who are your patients? The health of your practice depends on diversifying your patient population. If your marketing efforts focus only on tech-savvy hipsters, that may mean your current restorative schedule will be light, especially if your patient base isn’t mature. Accurately tracking your new patient sources and running a demographic report for the practice can give you the information you need to direct future marketing efforts. Referral sources might mean your website,

a PPO website, or a Google search— be specific.

Are you new here? The marketing needs of a

new dentist are different than

those of an e s t a b l i s h e d d e n t i s t . Dentists who are new (or new to the

area) need to focus on making

themselves known in the dental community.

Established dentists may want to spread the word that

they are still accepting new patients. A well-established practice may still need new patients because it is trying to grow, or because it failed to actively replace those

patients that have moved, died, or completed their restorative dentistry.

How can I find you? Do people in your community frequent websites and online reviews to choose services? Is this their primary or secondary source of information? At very least, be aware of any online reviews of you and your practice. Check sites such as Dr. Oogle, Yelp, and Angie’s List.

What makes you special? Differentiation consists of how prospective patients pre-select themselves for your practice. Can they tell that your practice will provide what is important to them by viewing your online presence? Focus on specific benefits to patients rather than merely listing features such as brand of whitening or a list of restorative procedures.

Lastly, think about the potential benefits of using social media. Defining the desired end result will help you decide what to do. Depending on your purpose, your online presence may be strictly informational, supportive, or interactive. Is your purpose to stay competitive in your dental community? Increased name recognition or brand awareness? Generating new patients? To be a resource for your existing patients? Do you want to provide post-op instructions (extractions, root canal therapy, whitening, evulsed tooth) to help your patients after hours and prevent some late-night calls to you?

By really evaluating your practice and the intended purpose of social media marketing, you can optimize what and how you use social media. Then, you’ll be ready to talk about optimization and keywords—but that’s a topic for another time!

WhAT IS Your oNLINE STATuS? Using Social Media in Your Practice

PRACTICE MANAGEMENT

By Karen Burnett, practice leaDership, BurKhart consulting

Tweets aren’t just for birds anymore.

8.

UNDERPRESSURE?FEELING PRESSUREto do performance reviews?

FEELING PRESSUREto give raises?

Set Measurable GoalsEncourage Professional Growth

Communicate Expectations...Relieve Pressure Call PLBC today!

800.665.5323www.practiceleadership.com

Take the pressure off... As a business owner you can’t ignore it any longer. Get the support and guidance you need with our side-by-side Staff Performance Review meetings, and

an up-to-the-minute geographic Salary Compensation Report for each team member!

• Navigate potentially uncomfortable conversations and learn how to handle them confidently

• Gain an objective comparison of your staff’s wages and benefits for your area to remain a competitive employer and retain high performers

• Ensure necessary documentation is completed to comply with labor laws

• Standardize your reviews with our comprehensive, time-tested format

• Convey your specific expectations with the help of our expert coaching team

• Increase team member contributions toward your practice goals

“

V irtually every restorative dental office has some form of matrix band and retainer on-hand for Class

II direct restoration procedures. There are numerous configurations available, some with designs dating back decades. As restorative materials have evolved, so have matrix systems. Dentists now placing posterior composites are finding challenges related to contact creation, surface contour and anatomy, flash and time spent on finishing when using systems designed when amalgam was the direct restorative material choice.

The new Palodent® Plus Sectional Matrix System from Dentsply Caulk employs a Nickel-Titanium retaining ring, interproximal wedge, WedgeGuard and sectional matrices

for placement of restorations in the posterior region. The system components are available in various sizes and configurations, such that it is applicable to the vast majority of posterior cavity preparations that involve at least one proximal surface.

The WedgeGuard is an innovative device. Because the guard prevents bur damage to the adjacent tooth during prep, pre-operative placement allows the operator to prep class II & III cavities, veneers and crowns significantly faster as the potential for damaging the neighboring tooth is eliminated.

Once the prep is completed, the guard detaches, leaving the wedge confidently in place. Thus, the wedge stays in place to protect gingival papillae and minimize the possibility of bleeding typically associated with removal and replacement of the wedge in other systems.

The matrices are available in a variety of widths and lengths to accommodate wide and deep cavity extensions. The significantly greater curvature on the horizontal plane helps the matrix wrap around the tooth, allowing the system to be used even when a cusp is missing. These super-thin, 0.0012” matrices allow the system to consistently achieve accurate contacts with a pronounced marginal ridge for accurate occlusal embrasure anatomy.

For secure, fast placement and removal, the WedgeGuard, wedge and matrix have innovative grip holes, which are positively gripped by the pin tweezers providing control upon placement and easy removal. The naturally closed position of the pin tweezers minimizes the risk of dropping a matrix or wedge.

Once the matrix is placed, the retaining ring is placed securely with the forceps. The nickel-titanium ring composition allows the ring to return to its original shape after use, without distortion, and provides consistent separation force and ring stability. Even when over-stretched, the rings/tines can be reset to provide acceptable separation force and stability using the convenient built-in grooves in the forceps.

The New Palodent® Plus Sectional Matrix System from Dentsply

By anDrew coste, Dentsply professional

As restorative materials have evolved, so have matrix systems.”

10.

With the cordless handheld NOMAD Pro, there’s

no need to hide from your intraoral x-ray. NOMAD

Pro offers the highest level of safety, quality, and

patient care for your dental practice. Providing

hundreds of images from one battery charge, the

NOMAD goes easily from operatory to operatory,

in or out of the office. And you can stay with the

patient through the entire procedure. So why hide?

Call your Burkhart Account Manager for more information

or to arrange for a demo.

Handheld X-ray System

®

®

For more information:1-866-340-5522www.aribex.com

Are you still hiding from your x-ray?

Contact your Burkhart Account Manager for Details

ASSISTANT SUCCESS

Due in part to the “fork” design of the Palodent® Plus ring tines, the ring is exceptionally stable during and after placement, as the tines engage both the working tooth and the adjacent tooth. This tine design also allows placement of the ring over the wedge if already in place, or wedges can be placed after ring placement without removing the ring while maintaining stability of the system. The ring stabilizes the matrix against the proximo-buccal and proximo-lingual margins of the proximal box and can be stacked for multiple restorations simultaneously.

The V-shaped ring tines accommodate wedge placement from both buccal and lingual sides. The hollow underside of the wedge allows another wedge to be placed confidently and securely from the opposite

side, without displacement of the first wedge, and minimizes impingement on the gingival tissue—problems encountered often with solid wedges. The wedges’ fine wave-shaped wings compress on entry and flare again upon exit for easy placement and a true fit and seal.

In minimal Class II cavity preparations, The Palodent® Plus System’s advanced technology provides accurate contour and a tight seal to minimize flash and required finishing. In wide and/or deep Class II cavity preparations, even when a cusp is missing, the Palodent® Plus ring tines engage the gingival zone of significantly damaged teeth which eliminates the need for buccal lingual build up.

This ability of the system to adapt to a variety of cavity widths, as well as the utility of the system’s individual components give the Palodent® Plus Sectional Matrix System wide applications for sectional matrix system use. The combination of the separation provided by the ring, the contour and minimal thickness of the matrices, and the secure gingival sealing of the wedges provide the clinician with predictable results, whether using composite, amalgam or other direct restorative materials.

Dr. Andrew Coste received his DMD and Certificate in Prosthodontics from Temple University School of Dentistry. He has practiced in Swarthmore, PA for 26 years, and is currently Clinical Assistant Professor at the Kornberg School of Dentistry-Temple University and Senior Dental Associate for Dentsply/Caulk.

Burkhart Dental | CATALYST MAGAZINE | Issue 1, 2012 11.

Hobbies:

What i like about my job:

success at our office means:

My greatest challenge is:

What Burkhart means to me:

Dental Assistant, Advanced Dental serviceslongview, WA

Erin Anderson

superstarAssistant

Crafting, fiddle playing, sewing, canning, camping, hiking, gardening

and photography

The honest impact that I make on people’s lives, to help them improve

their health through dentistry. To see the smile that they have been

hiding for years!

Helping people to VALUE the services that we have to

offer our community.

We are all passionate about what we do... ultimate success means

delivering a superb dental experience for our patients.

One word... FAMILY. We have been with Burkhart for 28 years

and would not be who we are withouth them!

We are pleased to announce that Burkhart is providing Platinum level sponsorship of the American Dental Assistants Association for 2012. We recognize the value of the work carried out by dental

assistants and the ADAA and are honored to support its mission to enhance the contributions that dental assistants make to the dental profession.

The dental assistants that we serve in our clients’ offices every day are a critical component of their dental teams. We are excited that our partnership with this organization will help all dental assistants, but we are especially

pleased that we will be able to bring additional benefits to our clients. As part of our partnership with the ADAA, we will be extending free memberships to all of the dental assistants in the offices of our platinum level clients. We will also extend a 25% discount on membership to two assistants in each of our gold level client offices.

These memberships will enable the assistants to complete most of their annual continuing education credits for free through the ADAA online education website featuring over 60 courses. It will also provide them with $50,000 in professional liability insurance, a subscription to the award-winning journal The Dental Assistant, and eligibility to participate in the ADAA’s Fellowship/Mastership program. It is truly a pleasure to be able to provide this benefit to our clients.

We are also excited by the information that will be shared between the ADAA and Burkhart. The ADAA publishes The Dental Assistant journal, which is a great resource for our assistants. We will be contributing articles to this journal that help assistants understand the role of a dental supplier in their office and educate them on how they can strengthen that relationship. The writers of The Dental Assistant will also be contributing articles to Burkhart’s Catalyst magazine. This will further strengthen the information that Catalyst brings to assistants.

In addition, the ADAA does fantastic research on all facets of the dental assisting industry, and this information will enable us to tailor our services. Our partnership will also allow us to learn from assistants through surveys and round table discussions that will help us better identify their needs.

This partnership provides one additional opportunity that we are really excited about. We will be able to liaison directly with the department directors of the dental assisting schools in each of our markets. We will be working with them to identify ways that Burkhart can help with dental assistant education by interacting in the classrooms and providing additional support to the educators.

Our collaborative efforts throughout the year will be a benefit for the assistants that we serve, the ADAA and Burkhart. We look forward to working with them throughout the year.

Sincerely,

Lori Burkhart IsbellPresident

For our Dental Assistant clients Burkhart announces adaa sponsorship

MESSAGE FROM LORI

Burkhart Dental | CATALYST MAGAZINE | Issue 1, 2012 13.

“

Dr. Jack Stevens graduated with honors from the University of Texas Dental Branch at Houston in 1984 and began a practice shortly thereafter. Dr. Rob Gatewood graduated from the University of Texas Dental Branch in Houston in 1996, went on to serve three years in the Navy and then joined Dr. Stevens at his practice in 1999. Several years and a new office later, the two continue to practice dentistry at Stephens and Gatewood Dentistry in Spring, Texas. What was it that made you want to work with Burkhart? We were first introduced to Burkhart during the process of building our new office. We had started working with our supplier at the time on plans for the build-out and we just felt like a number. Burkhart listened to our needs and provided a positive experience every step of the way. This level of customer service is what first attracted us to Burkhart and is why we have continued to do business with them for over 10 years.

What was it about the Guarantee that originally caught your attention? It was the first time we felt like someone was on our side in a true partnership.

What part of the SSG do you find most valuable to you and your practice? When you are running a business, overhead is very important and knowing your percentage for supplies is a huge value to a business person. Burkhart becomes accountable for this part of the equation and

guarantees that your costs are going to be controlled for dental supplies. We really like that accountability.

How does your Burkhart Account Manager help you reach your goals as a dentist and business owner? Our Account Manager Kimberly Thomas, really understands our office and introduces ideas and products that will benefit our practice and give us the best value. She truly has our best interest at heart when she makes a recommendation.

How has the SSG helped your business?Through the SSG Burkhart becomes a business partner with the dentist and takes responsibility for cost off of the assistant. When we started the SSG we were buying from a company that claimed to give us the best price, but we were at 8.92%. The first year with the SSG we saved $72,101 and each year Burkhart has continued to improve our savings. Last year we were at 4.7% which means our overhead on supplies has almost been cut in half.

How has the SSG helped your staff be more efficient? Our Burkhart Account Manager, Kimberly Thomas, makes our staff more efficient by saving us valuable time. We do not have to shop through catalogs, call direct companies, or follow up on things. Kimberly takes care of all of our needs and has implemented an inventory control system that keeps just the right amount of supplies on the shelf.

What would you say to a doctor considering the SSG program?From a management standpoint overhead is one of our biggest concerns. Burkhart’s guarantee provides a solution to dentists who want to control their overhead with a company that excels at customer service.

SuppLY SAvINGS GuArANTEE:Controlling Overhead with Great Customer Service

The first year with the SSG we saved $72,101, and each year Burkhart has continued to improve our savings.”

Left to right: Dr. Rob Gatewood, Dr. Jack Stephens, Kimberly Thomas (Burkhart Account Manager)

ASSISTANT SUCCESS

By KimBerly thomas, BurKhart account manager

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CATALYST MAGAZINE Issue 2 2010 15.

Hobbies:

What i like about my job:

My greatest challenge is:

success at our office means:

What Burkhart means to me:

My main joy is my family – spending time sharing and traveling. I currently became (padi) scuba diver certified and enjoy the water world. Keeping up with my handsome son, Cole (4th Grade).

I truly enjoy the everyday challenge of fixing problems, getting the answers my team needs and advocating for quality care for all patients seen.

My greatest challenge is stretching my time to accommodate all avenues of the ever-growing practice needs.

Success at our office means success for all – Dr. Lew and his family, which extends to our teams’ families all to benefit our patient’s health and confidence.

Burkhart has given us stable caring and resourceful representation, as well as consistent service when needed. Always!!

office Manager, Glenn lew D.M.D General Dentistry Redwood City, CA

Colette Fontaine

superstarFront Office

T wo of the key components for an attractive and successful aesthetic case are bilateral symmetry and

rendering the shape of the final teeth within a range of normal proportions. Teeth that are too wide or too short, especially if asymmetric, often will be pointed out as one of the main reasons why patients aren’t satisfied; they won’t be smiling about their smiles. Patients get used to what they see in the mirror each morning; unless there has been some dramatic recent change (for example, trauma) they get used to the way they look and eventually don't see the asymmetry any longer. If we can show them what their smiles can look like with the asymmetry resolved (via a mock-up or imaging), they will respond positively to the idea of enhancing their teeth.

Controlling the gingival contours is an important part of the picture. Yet even though doing so is as important as the shape and size of the teeth themselves, it is an area that is often overlooked. Here are examples of three different cases where the gingival symmetry has been altered and improved via augmentation, lengthening or both. With proper training, this is well within the skill set of any dentist.

The first case involved gingival augmentation with a subepithelial connective tissue graft to correct an area of recession (Figure 1). The procedure aimed at improvement of the health of the gingiva and the aesthetics, by increasing the width of the band of attached gingival tissue and giving a more symmetric display of the teeth when smiling.

A closed flap was made using an ophthalmic scalpel, and was blunt dissected to release the attached tissue apical of the receded site (Figure 2). Connective tissue was harvested from the palate on the ipsilateral side using a "door" approach wherein the surface epithelium was maintained over the donor site to aid in post-op pain control and more rapid healing. The connective tissue was immediately placed into the graft site after harvest (Figure 3) and stabilized using a single sling suture with 6-0 Prolene (Figure 4). Tightening the suture coronally repositioned the displaced flap (Figure 5) for two weeks of healing before removal of the suture. The donor site was then sutured with the same 6-0 Prolene (Figure 6) and the patient took 600 mg of Ibuprofen qid for pain and inflammation management. I find that if using gentle surgical techniques, most patients find NSAID analgesics more than adequate.

The second case highlights osseous crown lengthening in a young healthy patient who had small teeth with diastemata through the first bicuspids (Figure 7). He had excellent function, with no TMD signs or symptoms, nor restored anterior teeth (Figure 8). He was an actor and felt his teeth needed to look more prominent on camera. The final restorations were to be directly fabricated in composite. It made most sense to gain the proper proportions by extending gingivally instead of incisally (Figure 9).

A laser was used to perform a gingivectomy on the cuspids. Then, lateral and central incisors gingival composites were placed to create the proper facial contour of the final shape and to support the healing

tissue. A flowable composite was used and polished before any bleeding started from the incision with the scalpel (Figure 11). An ophthalmic scalpel (Figure 12) was used to do an intrasulcular incision without breaking through any of the papillae (Figure 13). The tissue was tunneled and blunt dissected until the attached tissue was loose and gently stretched to the facial. A #2 round bur on a slow speed handpiece and copious irrigation with saline was used to do the appropriate marginal ostectomy. The amount of reduction was the same as the height of soft tissue removed with the gingivectomy. Sling sutures with 6-0 Prolene (Figure 14) were performed. Two knots were tied to tighten the stretched tissue back against the bone (Figure 15). Care should be taken to ensure the lingual of these sutures are positioned apical of the cingulum to keep everything tight (Figure 16). This suture design also has the advantage of no need for lingual anesthesia.

Two weeks later, the sutures were removed. The patient showed excellent contours (Figure 17). Eight weeks were allowed for further healing and direct composite veneers were created for all maxillary anterior teeth. This is an excellent non-invasive technique that results in beautiful aesthetics and tissue health (Figure 18).

In the third and final case, augmentation on the right lateral and central incisor and was combined with crown lengthening on the left central lateral and cuspid (Figure 19). The intrasulcular approach was used again (Figure 20) as was blunt dissection without breaking any of the papillae (Figure 21).

rhys spoor, DDs, fagD, faDiaaccreDiteD memBer of the american acaDemy of cosmetic Dentistry

IMprovING GINGIvAL SYMMETrY: Three Case Examples

16.

1. Maxillary right cuspid with common gingival recession. 2. Intrasucular incision and blunt dissection of surrounding tissue released flap. 3. Palatal subepithelial connective tissue graft in place. 4. Graft stabilized by passing 6-0 Prolene through the graft with a lingual sling suture. 5. Graft sutured with one suture and flap coronally repositioned. 6. Graft donor site sutured with the same 6-0 Prolene and the epithelial surface tissue retained, for faster and more comfortable healing. 7. Pre-op of a case with short clinical crowns and multiple diastemata. In treatment planning, keep in mind the goal of an anatomically proportional result. 8. Since the plane of occlusion was acceptable and working, gingival crown lengthening was a better choice than lengthening the incisal edges. 9. Laser-assisted gingivectomy completed on the right lateral and both central incisors. The cuspids

and the left lateral were yet to be completed and the floss worked well as a reference line. 10. Acid etching with 37% phosphoric acid was completed prior to applying gingival composites to create a new height of contour for the CEJ on the facial. This supplied a healing matrix for the soft tissue post-operatively. 11. Gingival composites in place on the incisors. 12. Ophthalmic scalpel used for intrasulcular incisions for closed flap procedure. 13. Sharp dissection down to the boney margin was then carefully extended subperiosteally beyond the attached tissue. 14. After a blunt dissection and tunneling of the closed flap the boney margin was increased the same amount as the gingivectomy with a slow speed #2 round bur and isotonic saline irrigation. The flap was retightened with 6-0 Prolene sling sutures. 15. Two sling sutures and two knots. 16. Lingual view of sling sutures apical to

cingulum. 17. Post-operative healing at two weeks after removal of sutures. 18. Completed direct composite veneers with healing gingiva at 8 weeks, post-gingival surgery. 19. Pre-operative example of a case where gingival augmentation and crown lengthening were done simultaneously. 20. An intrasulcular incision was done with an ophthalmic scalpel for the augmented area. 21. Blunt dissection of the area for subepithelial connective tissue augmentation (on left) and laser assisted gingivectomy (on right) was completed in the areas to be crown-lengthened. 22. Post-surgical suturing with 6-0 Prolene. Three sling sutures were placed. 23. Two-week post operative healing stage before suture removal. The Prolene sutures have typically very little inflammatory response.

CLINICAL SUCCESS

The augmentation and lengthenings were completed simultaneously and 6-0 Prolene was again used (Figure 22). Two weeks later, the sutures were removed (Figure 23) and the tissue will be allowed to heal for 8 weeks before bonded ceramic veneers are placed to complete this case.

In summary, gingival contours matter as much to the final aesthetic result as do the teeth. Creating healthy and attractive symmetry is within the capability of any competent dentist. It requires attention to detail, careful surgical technique and appropriate materials.

Dr. Rhys Spoor is a regular contributor to Catalyst Magazine. Read more about his background in our Contributors section on page 2.

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Pictured: (Front) Dr. Sanders, Dr. Land, Dr. Nickravesh, Dana Gray (Middle) Bri Porter, Amy Sanders, Brenda Moore, Jenni Dickey, Stacy Wesolowski (Back) Breana Richardson, Angie Meahan, Tina Nelson, Lanie Gresham, Sonya Smith

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Turning A Group PracticeEagle Summit Dental Group:

It is not unusual for dentists to expand their practices by hiring Associate Dentists. Many seasoned dentists have done so in order to grow their practices and perhaps train a successor who will want to purchase the practice when the owner considers retirement. The Associates have an opportunity to grow their dentistry skills under the watchful eyes of their seasoned mentors while learning about the business side of private practice. Dr. Michael Sanders has turned this model on its head.

ON ITS HEAD

By JuDi griffin | photos By marK meyer photography

Burkhart Dental | CATALYST MAGAZINE | Issue 1, 2012 19.

D r. Sanders completed his D.M.D. at Boston University’s Goldman School of Dental Medicine in 2001.

He took a residency with the U.S. Army at Fort Sill, Oklahoma and a tour of duty in Iraq (see story on page 23). After an honorable discharge in 2005, his young family settled in his wife’s hometown of Eagle River, Alaska. He worked as an Associate in Wasilla while looking for a practice to buy.

His wife Amy knew a co-worker whose husband, Dr. Michael Fuller, had a local practice. She suggested that they invite him to dinner so they could learn more about private practice. During dinner, Dr. Sanders asked Dr. Fuller if he had ever thought about retiring and selling his practice. “I think he had already been thinking about it and my question made it a real possibility,” he recalls. They talked it through and agreed on a deal.

Dr. Sanders immersed himself in the four-operatory practice and begin updating some of the equipment. “It was a well-maintained practice that had been built in the mid 1980s,” he says. Working

with his Burkhart Account Manager, Arne Valdez, and Burkhart Equipment Specialists Joe Martin and Carter Barnes, he quickly transformed the office with digital radiography, intraoral cameras, and computers with dual monitors in all of the operatories.

GRoWinGThen Arne Valdez tipped him off that Dr. Alfred Land III was thinking about retiring and selling his practice next door. Dr. Land agreed to sell his practice to Dr. Sanders, but he wanted to stay on after the sale for three months before retiring in Oregon. Three months turned into six months, and he is still there working three to four days each week— as an Associate—four years later.

After completing the purchase of Dr. Land’s practice, Dr. Sanders contacted Dr. Fuller to see if he was interested in coming back to

work as an Associate in the practice for a couple of days each week. Dr. Sanders said, “When I originally bought the practice, Dr. Fuller was going to semi-retire and work part-time in public health. He had gotten a

little bored with retirement and had started working for a private office in Anchorage.”

Dr. Fuller agreed to join the practice as an Associate on a part-time basis. He is still there today, working two to three days each week. Both Dr. Land and Dr. Fuller enjoyed practicing dentistry, but didn’t enjoy a lot of the things that went along with owning the practice.

WoRkinG ToGeTHeRIt is pretty rare to have a younger dentist hiring Associates out of retirement. But Dr. Sanders says, “The situation just works. If I had four people just out of dental school that were still trying to get life figured out, this wouldn’t work. There are no egos here. There is no ‘I need to do this case to prove that I can do it.’ We refer cases around all of the time. That’s another advantage. You can really concentrate on the areas that you really want to concentrate on. I don’t enjoy dentures, but Dr. Land loves dentures. Dr. Land needs implants placed…great, I’ll sink them and he can put the dentures over the top.”

He adds, “We can sit down and have a cup of coffee and go over a case. With each having their area of expertise, if I ask Dr. Land, ‘Hey, how would you treat this as a denture?’, he knows how to treat this as a denture. They have three times as much experience as me.” At the same time, Dr. Sanders has training and expertise that the Associates don’t have. He attained Diplomate status from the International Congress of Oral Implantologists in 2010, so an Associate may ask him, “What do you think about putting implants here?” According to Dr. Sanders, “Everything is based on trust and the respect that we have for each other’s work.”

When asked if he feels like his Associates are mentoring him, Dr. Sanders replies, “I think it absolutely goes both ways. I have learned a ton of stuff from all of the doctors here. They will say the same thing. We all learn a lot from each other. It is ironic being the owner that gets mentored by the

FEATURE

Dr. Sanders working on a patient

20.

“Everything is based on trust and the respect that we have for each other’s work.”

Burkhart Dental | CATALYST MAGAZINE | Issue 1, 2012 21.

Associates, but it’s an amazing advantage. I’ve walked Dr. Fuller, who has been doing dentistry for 30 years, through his first sinus lift, his first bone graft, and some soft tissue techniques. Likewise, if there is a complex occlusal case, I will sit down with him and we will go through the equilibration together and I will say, ‘How do you know all of this stuff?’ It’s great. I would say the mentoring absolutely goes all the way around.”

Dr. Sanders did make one traditional addition to the team. Dr. Sheva Nickravesh was a local pedodontist who had just completed her specialty training in 2009. She asked if he would consider adding pediatrics to his practice. They agreed and she joined as a part-time Associate in 2010.

PeRsonAl VAlueThanks to his Associates, Dr. Sanders has the flexibility to pursue his outside interests. He enjoys hunting, fishing, and rafting in the Alaskan wilderness. He is also heavily involved in youth soccer and is currently coaching three teams. “Without the Associates, I wouldn’t have the flexibility needed to coach soccer teams. The teams need to do a lot of travel. One of the biggest problems when I was in practice by myself was, ‘What does my staff do when I take a week off?’ I either pay them even though they aren’t coming in, or I don’t pay them, but they still have to feed their kids. It’s one of the draws to this office. We have four doctors and we are always open. That really is an advantage for our assistants, but it is also an advantage for me. I don’t have to

worry about if my assistant can pay her bills this week.”

Having multiple doctors with differing specialties is an added challenge for the staff at Eagle Summit. Dr. Sanders boasts, “The staff here is great. It wouldn’t work without a great staff. The learning curve is a little bit steeper because they don’t just come in and learn one system. They need to learn three or four systems. Our assistants are very smart, and I think they like the challenges here. They are doing different things every day. One day you are making a denture, the next day you are doing five implants, and the next day you are seeing a two-year-old. It keeps it a little more interesting.”

We all learn a lot from each other. It is ironic being the owner that gets mentored by the Associates, but it’s an amazing advantage.”“

Dr. Michael Sanders, Dr. Land, Dr. Sheva Nickravesh

22.

Having a busy group practice has also allowed Dr. Sanders to make investments in new equipment and modernize the office to make it more efficient and comfortable for everyone. “You have to work in a place that is comfortable,” he says. “You have to have computers in every operatory—that’s a given. You have to have two computer screens in every operatory. I can sit here and look at x-rays and say, ‘Mrs. Jones, here is what I am seeing.’ All she knows is that I am a new dentist and her previous dentist didn’t say she needed that filling. Or I can say, ‘This is your x-ray on the screen and here is what I see. And here is an intraoral photo of it on the screen.’”

Asked how he makes the decision to buy a new piece of technology, Dr. Sanders says that it must meet these criteria: “Is it going to help me educate my patients? Does it make my life easier? Does it make my staff’s life easier? Does it make me a better dentist?” He used these criteria when he made the decision to purchase a Soredex Scanora® 3D cone beam last year. “The cone beam absolutely makes me a better dentist,” he declares. “You see things with a cone beam that make you a better, safer dentist. I know the exact location of the nerve or artery and the adjacent vital structures.” Cone beam imaging enables him to provide his patients with a comprehensive exam to determine the proper treatment options; there is no longer the need to visit another location for imaging. With the 3D imaging, he is able to plan and complete a wide range of surgical, endodontic, and implant cases without costly or untimely surprises. “If I am going to do the surgery here, it doesn’t make sense to send them to another office to get that x-ray,” he points out. “We do use it often enough that it pays for itself over time.”

This group practice model is a benefit for the patients. They get the convenience of having a wide range of skills and treatments available in one location. “They love it. Nobody wants to go somewhere else to get a procedure done,” says Dr. Sanders. “They would have to drive all the way to Anchorage, go to a new office, new front

PARTNERING WITH BURKHARTDr. Michael Sanders on why he works with Burkhart: “Someone gave me this piece

of advice: That early in your career—when you don’t know anything about business

or private practice—you need to surround yourself with talent. Surround yourself with

great people who know their stuff. Arne was one of the first calls I made when I was

thinking about buying Dr. Fuller’s practice. I knew him from his work with Dr. Jim

Cerney, my mentor in Fairbanks, Alaska. I asked him to evaluate the equipment in

the office I was buying and tell me what I would need to fix or replace in the first few

years. I have a great insurance agent, I have a great financial advisor, and I have a

great dental supply and equipment team. I don’t see them as a vendor or a supply

company. I really do see Arne, Carter, and Joe as partners.

After I bought Dr. Fuller’s practice, it was probably just a year before I added the digital

components—digital x-rays, intraoral cameras, computers in all the ops. Between

Arne, Carter and Joe, they really helped me get set up. And then less than a year

later, when I was buying Dr. Land’s practice next door, I called them up again and

said, ‘You know that work we did? Well, we have some more to do. Now it’s going

to get bigger. We are going to tear down walls and merge everything together.’ I kept

them pretty busy for about a year. Without the Burkhart team, none of this would have

been anywhere near what it is today. I know that they’re not just looking to sell me

stuff. They really are looking to help build things that work with my practice—meaning

the entire office’s systems and how things flow. They will explain how a piece of

equipment is going to work with the other equipment in the office and give me my

options. We almost take them for granted, and we shouldn’t. They had a significant

amount of influence on how the office looks today.”

Arne Valdez is the office’s Account Manager, Carter Barnes is their Equipment

Specialist, and Joe Martin is their Technology Specialist.

FEATURE

Burkhart Dental | CATALYST MAGAZINE | Issue 1, 2012 23.

I really think patients appreciate the fact that we can do just about all aspects of dentistry here.”

“

desk, new billing system, or a new dentist they don’t know from anyone else. With us, they hear that our Associate Dentist can do that procedure here. Same chair, same practice, same friendly front desk, same assistant, and they have probably seen the Associate around anyway. I really think patients appreciate

the fact that we can do just about all aspects of dentistry here.”

ConClusionThe group practice that Dr. Sanders has created offers an environment where all the dentists can benefit from each others’ training, experience and expertise. They

can focus on the areas that interest them or gain knowledge in a new area. They can afford to invest in the equipment that makes them better dentists and makes the practice more comfortable for everyone. The dentists can take time off to enjoy activities in their private lives, yet the staffers are still able to work all year and enjoy the enrichment that comes from having a variety of duties throughout the week. The patients also benefit from having a variety of skills all in one place and the reassurance that they will always find a dentist on hand for their emergencies. Dr. Sanders didn’t plan to create an “upside-down” group practice, but the results have been extremely successful.

Dr. Sheva Nickravesh, Dr. Alfred Land III , Dr. Michael Sanders and Dr. Michael Fuller

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Dentistry can be stressful in the best of circumstances. Dr. Michael Sanders experienced added stress associated with some of the least appealing circumstances: performing dentistry on detainees at prison camps in Iraq.

In 2004, Dr. Sanders was stationed at Fort Wainwright in Fairbanks, Alaska with 12 months of Army service remaining. He and his family had settled in and he was coaching youth soccer and hockey teams. He was also working part-time for Dr. Jim Cerney and making plans to join the practice full-time as soon as he was discharged from the Army. Then he received a call out of the blue, notifying him to report to Seattle for training in five days. He would be deployed to Iraq two weeks later.

He arrived at Camp Bucca—a detention facility maintained by the U.S. Army in Southern Iraq—and was assigned to the medical facility. After the Abu Ghraib prisoner abuse scandal came to light in early 2004, many of its detainees were transferred to Camp Bucca, and the military pledged to improve medical conditions for them. Dr. Sanders’ unit was brought in for that purpose.

Dr. Sanders expected his main role at Camp Bucca to provide dentistry services for the detainees and military personnel. He was surprised to learn that it was much more. He says, “The dentist’s wartime role is as a triage officer. Well, they tell you that when you sign up, but what does it mean? I found out. Anytime we had more than a few casualties, the dentist—as the triage officer—goes out to help triage the initial response.” He worked in the emergency room during busy times, helped prioritize the injured and initiated their emergency stabilization treatments.

The needs of the injured stretched Dr. Sanders’ abilities. “The only medical training we received was in surgical phases such as oral maxillofacial surgery. Nobody said ‘this is how we are going to train you to be a wartime triage officer.’ We went through a combat casualty care course in San Antonio for first aid, but all of the rest of my residency [program at Fort Sill, Oklahoma] had been about dentistry.”

He also spent time at Camp Ashraf in northern Iraq as part of the team that set up a medical facility—picture a M*A*S*H unit from the TV series. The facilities were primitive at best and the doctors and staff were stretched thin. From the fly-paper hanging over the operating tables to the dust sifting down from frequent shelling, conditions were less than sanitary.

Today Dr. Sanders thinks of the experience as an opportunity that improved his dentistry skills and while letting him learn new medical skills. He recalls, “I had opportunities to work on cases that I never would have at home.” During slower periods, he performed lower-priority procedures on the detainees. Many of them had never been to a doctor, much less a dentist. They had extensive dental decay and medical issues that they had suffered with for years. He was involved in an odd assortment of procedures, from removing palate tumors to treating intestinal hernias. The team sometimes had to call medical personnel in other locations to ask for instructions on how to use specialized equipment during a procedure. They learned to solve problems under pressure. He even recalls the team members reading from the instruction manual while using equipment that perforates a piece of skin to prepare it for grafting.

He points to his service in Iraq as one of his proudest accomplishments. “We made a difference,” he states matter-of-factly. He also says that the surgical experience he gained and the creative problem-solving skills he used in Iraq definitely make him a better dentist today. In addition, the daily difficulties and inconveniences that he experienced in Iraq make him appreciate his current environment and help him keep minor issues in perspective.

From Scrubs FEATURE

to Army FAtigues By JuDi griffin

Burkhart Dental | CATALYST MAGAZINE | Issue 1, 2012 25.

Electronic Prescribing improves patient safety, reduces healthcare costs and increases efficiency. It is an informed

way for doctors and pharmacists to make better clinical decisions. With ePrescribing, doctors have direct acess to clinical decision support information such as Patient Medication History, Patient Formulary and Eligibility, Drug-Drug Interaction Alerts, and Drug-Allergy Interaction Alerts from the point of care.

When you have more comprehensive and accurate information at the time of prescribing, your practice can improve the quality of patient care and reduce the number of call-backs from the pharmacist to clarify prescription information. When the practice

and the pharmacy are both connected to the Surescripts® Network, the prescription renewal authorization process can also be streamlined. This improves practice efficiency and the timeliness of medication delivery to the patient.

Electronic prescriptions arrive directly into the pharmacy's computer system, so pharmacy technicians can spend less time interpreting handwriting and re-keying information. The risk of medication errors is reduced, as are phone- and fax-based communications between clinicians and pharmacies.

Eliminating the use of handwritten and printed prescriptions reduces the potential for fraud or tampering (in terms of pills or refills) before reaching the pharmacist.

E-prescribing not only offers peace of mind—it’s easy to use. Once connected to the Surescripts® Network, you begin by accessing the patient's prescription benefit information—both in terms of formulary

and eligibility – and choose appropriate medications that are covered by the patient's drug benefits. You can also choose lower-cost alternatives such as generic drugs. Dispensing pharmacies are less likely to receive prescriptions that require changes based on the patient's drug benefits, which

reduces unnecessary phone calls from pharmacy staff regarding drug coverage.

With the patient's consent, the next step is to electronically access that patient's Medication History to review critically important information about current and past prescriptions. This information can be used to become better informed about potential medication issues such as harmful drug interactions.

Finally, electronically route the prescription to the patient's choice of pharmacy. The digital exchange of prescription information between prescribers and pharmacies improves the safety, accuracy, and efficiency of the prescribing process. If

your clinic is already utilizing a paperless charting system or looking to transition to one, an integrated electronic prescribing system is a vital key that will help elevate that system into an electronic healthcare record base.

About Electronic Prescribing

TECHNOLOGY

By Dawn christoDoulou, peB/XlDent

26.

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You spend time managing a busy practice. You and your staff provide quality patient care. But who is looking after your equipment? Shield your investments by making sure your mechanical room is current and ensure your office is at the top of its game. Let Burkhart help you get there.

Call your Burkhart Service Department to schedule your complementary mechanical room assessment today!

Burkhart Dental | CATALYST MAGAZINE | Issue 1, 2012 29.

Each year dental practices must have their utility room equipment serviced, repaired, and/or replaced. Just like

performing the annual maintenance to your automobile to ensure optimal performance, the same must be done to the equipment in your utility room.

Tucked away in a closet or in the basement are two of the most important pieces of equipment to the dental practice and without them you can not practice dentistry. The vacuum pump and air compressor are the “life blood” of the dental practice and without suction or air the doctor could lose $5K–$8K of revenue a day.

The first step that a doctor can take to ensure they get optimal performance from their vacuum pump is make sure that their vacuum lines are cleaned on a daily basis. This will help prevent dental by-products from building in the vacuum lines. If neglected,

your vacuum levels will fall, jeopardizing the ability to evacuate the oral cavity efficiently. If you have a “Wet” system or “Wet-Ring” pump there is a collection filter that captures debris before it can get to the impeller. This should be cleaned daily to ensure proper

vacuum levels. If the “Wet Ring” system utilizes a water recirculator, adding recycler cleaner once a month will also ensure proper vacuum levels.

Most compressors require the change-out of air intake filters and exhaust filters on an annual basis and the change out of a desiccant or membrane media after 7-10 years. Neglecting the air intake filters will make the compressor work harder and produce more heat. Put off the change- out of your compressor’s drying media and you will have moist air getting to your handpieces and bacterial growth in the holding tank.

Everybody and everything works more efficiently in a comfortable setting. The same can be said of your utility room equipment. Heat is a killer of utility room equipment so make sure that there is proper ventilation for your utility room. If the ambient air in the utility room is too hot or damp, most manufacturers offer remote air intakes kits which offer the capability to go outside the utility room to find a clean and dry source of air for the compressor.

We all realize that the utility room is “out of sight, out of mind” so let your Burkhart service technician give your utility room an evaluation. If your utility room performs efficiently, so does your practice.

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The United States Environmental Protection Agency announced on September 27, 2010, their intention

to write rules requiring dental facilities to practice Best Management Practices (BMP’s). This proposed rule would include the required installation of amalgam separators. There are currently ten states, many counties and municipalities around the U.S.with regulations in place requiring amalgam separator installations.

Local sewage treatment plants are required under permits to test and treat for mercury. Noncompliance with U.S. EPA or state environmental departments can result in significant fines for the municipality. Mercury from dental facilities has been documented at 50% of the total mercury loading for sewage treatment plants. An amalgam separator, when installed, has shown dramatic reduction in mercury levels entering into treatment plants. Where mandatory amalgam separator programs have been in place, 30-70% reduction in mercury levels have occurred. There is a report from Europe, where they have required these devices for more than 15 years, showing reductions of up to 95% of the mercury delivered to sewage treatment plants.

Environmentally, sewage treatment plants are not designed to remove mercury or other dissolved materials. Sewage treatment plants mainly remove all the solids from the waste delivered to the plant. Once the solids are removed sewage treatment plants discharge this water to lakes, rivers and other surface waters. There has been an increase of mercury in fish tissue in recent years. The U.S. EPA recently adopted and new methyl-mercury limit for fish tissue and have required local sewage treatment plants to use a more sophisticated testing methodology standard 1631E. This standard can detect mercury levels down to single parts per trillion detection limits. Mercury is more visible now than it ever has before. Utilizing amalgam separators has dramatically reduced mercury loads to these treatment plants bringing about a dramatic reduction in mercury concentrations entering these surface waters.

U.S. EPA Due to Issue Proposed Dental Rule proviDeD By solmeteX

PROTECT YOUR SUCCES

Mercury from dental facilities has been documented at 50% of the total mercury loading for sewage treatment plants.”

“32.

Amalgam separators are glorified solids collectors, capturing amalgam by default. These devices collect all the solids flowing through the vacuum line, it is not possible to segregate the amalgam as the name would suggest. An amalgam separator is more efficient than chair-side traps and vacuum pump filters. A 2005 report commissioned by the ADA, states that chair-side traps and vacuum pump filters (using a weighted average) collect 78% of the amalgam/mercury going down the drain. This 78% capture assumes that dentists practice BMP’s, which were first published by the ADA in 2003. A similar study from the Canadian Dental Association suggests a 40-60% amalgam/mercury capture using chair-side traps and vacuum pump filters. In 2007, the ADA amended the BMP’s to include

the use of amalgam separators. Amalgam separators are required to be certified to remove 95% however; almost all on the market in the U.S. are certified at greater than 99% removal rates. Amalgam separator technologies have been around for over fifty years. They have two functions, first to separate the liquids and solids allowing for the vacuum air to continue moving and second to capture the solids while decanting the liquid from the solids. Most separators use sedimentation to capture the solids, some use filters and some use a combination of technologies. Each is required to meet the International Standards Organization (ISO) 11143 standard for efficiency and physical requirements. ISO designates system

Types, 1 through 4. Type 1 is centrifugal, Type 2 sedimentation, Type 3 filtration and Type 4 and combination of 1, 2 or 3. Systems other than Type 2 are required to have alarms to warn when a collection container is 90% full and an audible alarm for when the system is completely full. There are some Type 3 and Type 4 systems on the market which do not meet the alarm requirement.

In the United States, amalgam separators are almost exclusively located on the central vacuum system and placed in the mechanical room, near the vacuum on the suction side. Because amalgam separators capture all solids, hygiene produced solids will also be captured within the collection containers. Regulations only focus on amalgam. If the option is available, only lines

PROTECT YOUR SUCCESS

Burkhart Dental | CATALYST MAGAZINE | Issue 1, 2012 33.

from restorative chairs need be plumbed to the amalgam separator. This could save a significant amount of capacity in the collection containers of the separators.

The pH balance of vacuum line cleaning solutions with the use of amalgam separators has become important. Sewage treatment plants require discharge pH ranges from 5.5 – 10 or 12 depending on the treatment plant. Limitations on pH, such as 6.5 – 9 in the Massachusetts regulation have appeared. Oxidizing agents were found in some cleaners. Oxidizers can breakdown and dissolve amalgam, freeing the mercury bound in the amalgam. Requirements for only non-oxidizing line cleaners are in almost all amalgam separator regulations. Manufactures of line cleaners have developed new products to be non-oxidizing with relatively neutral pH ranges.

Most practices perceive amalgam separators as an added cost. However, if a practice was recycling their vacuum pump filters as suggested by the ADA’s BMP’s, the cost of an amalgam separator and recycling of the collection containers does not add costs. After the installation of an amalgam separator, the vacuum pump filters do not fill and will no longer need to be recycled. There is less down time due to vacuum pump filters shutting down the vacuum system. Because of the efficiency of the amalgam separators, more solids are captured thus minimizing the amount of solids reaching the impellors on wet ringed pumps. This will provide longer life for the vacuum pump an additional savings. Sewage treatment plants, the U.S. EPA and many states are requiring amalgam separator installations instead of having dental offices meet commercial and industrial discharge limits. Costs associated

with discharge limits can include permit fees, costs of test monitoring and fines if the mercury limits are not met. Amalgam separators alone will not reduce mercury levels to meet most if not all mercury discharge limits. They are not designed to capture mercury they are designed to capture solids. Rules which require only the installation of amalgam separators are far simpler and less expensive than a dental office having to meet discharge limits.

Amalgam separators have proven to be an economic solution for removing mercury from dental wastewater. The installation of amalgam separators is good for the dentists, good for the patient and good for the environment.

PROTECT YOUR SUCCESS

1-800-216-5505www.solmetex.com

All services and products of Layne Christensen Company are subject to change.Trademarks are the property of their respective owners.

Hg5 Collection Container KitSolmeteX provides the complete recycling solution:• Replacement container • Proper packaging• Proper shipping to certified recycler• Recycling• Certificate documentation after container is recycled

Amalgam Recovery• Removed teeth with amalgam fillings• Expended amalgam capsules • Non-contact amalgam• Contact amalgam• Vacuum filters• Chairside trap• Recycling

The proven answer to your amalgam separation concerns.SolmeteX Hg5 Series of Amalgam Separators® ®

SolmeteX provides the complete solution:• ISO 11143 certified at greater than 99%• Professionally engineered, robust, simple design.• Easy to operate and maintenance free.• Flexible design for hard-to-fit applications.• Functional for wet or dry vacuum systems (install before pump on wet vacuum system, install before tank on dry vacuum system).

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34.

Never underestimate the importance of a healthy and protected mechanical room!

We would be happy to stop by and schedule a quick complementary checkup to make sure your practice is operating in top shape. Give us a call today!

Call your Burkhart Service Department Today to Schedule your FREE Assessment!www.burkhartdental.com

Your Mechanical Room is the Heart of Your Practice.

Let us help you protect it.

AirStar®: A Revolutionary Compressor with Membrane Dryer Technology.Air Techniques was the first major U.S. dental company to introduce oil-free compressors with desiccant drying over 40 years ago and is now the first and only dental manufacturer using membrane dryer technology.

What is Membrane Dryer Technology and Why is it Important to You?Air provided by every AirStar equipped with a membrane dryer is quadruple filtered—once at the compressor head, twice at the dryer and again as it leaves the tank—to ensure it is cleaner and drier than ever before. With such a sophisticated design, the membrane dryer greatly reduces the chance of bacteria or other microscopic particles entering your patient’s mouth.

A low-pressure dew point—less than that required by NFPA standards—eliminates damp conditions and lowers humidity levels. AirStar stores compressed air at a humidity level of about 20%—significantly lower than hazardous levels.

Where is Your Air Filtered? 1) Intake: Treats the air entering the

compressor head assembly.

2) M e m b r a n e Bottom: Captures moisture in the air stream.

3) M e m b r a n e Top: Filters fine

particles before the membrane element and the storage tank.

4) Main Storage Tank: Filters the air after it leaves the storage tank and before it enters the dental facility. Comes with a service indicator to alert you when the filter needs to be changed.

VacStar®: More Performance. Less Water.VacStar dental wet vacuums have been trusted by dentists since 1986 and still deliver the best-in-class performance. Air Techniques continues to make the most reliable and efficient wet-ring dental evacuation systems. VacStar allows dental offices to consistently obtain the highest performance while maintaining a space-saving, compact design. With knowledgeable dealer service technicians and support personnel, VacStar models can be installed in tandem and customized for even larger practices. As always, you can depend on Air Techniques for the best customer service and technical support.

The Heart of VacStar: Different Components Can Make a Difference in Your Practice. 1) Built for longevity with a custom-

designed motor and precision fabricated components.

2) Bearing load and wear is reduced by the dynamically balanced impeller, machined from naval bronze.

3) Maintain consistent, optimum range of vacuum in each operatory with the highly efficient, patented relief valve.

4) The possibility of leaks is reduced with corrosive-resistant, Bronze-Ryton pump housing.

5) Avoid leaks and extend the life of your product with the ceramic composite rotating PAC seal assembly.

An air compressor and vacuum are important investments and integral parts of your

practice—the reason why Air Techniques puts so much thought into making sure you get the most out of your purchase. Our specialized engineers put every AirStar Compressor and VacStar Dental Vacuum System—constructed from parts made in our 200,000 square foot Melville, New York facility—through rigorous and repetitive testing at our in-house laboratories.

AirStar and VacStar come with a 5-year limited, extended warranty—the best of its kind in the industry. They are products you can count on for years to come and we will be the company that takes the journey with you. From design to installation, Air Techniques is there every step of the way.

To order or for more information, please contact your local Burkhart Account Manager.

opTIMIZE Your uTILITY rooM with Air Techniques

PROTECT YOUR SUCCESS

proviDeD By air techniques

Air can be filtered through several different places to ensure patient safety.

Air Technique’s VacStar is built with quality inside and out.

36.

To order or for more information please contact your local Burkhart Dental representative.

AirStar Compressor System

The Patented Membrane Drying Technologygives you the driest possible compressed airat all times.

� VacStar Wet Vacuum SystemThis high performance vacuum uses less water

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Optimize YourUtility Room

W e all use batteries, but what do we do when the time comes to dispose of them? Do you throw

them out? Recycle them? Flush them down the toilet? Flushing them seems strange, right? But that is what most dental clinics have done with waste dental amalgam without much concern. And chemically, the difference between a battery and dental amalgam are not that great at all.

Dental amalgam does serve a useful purpose; the problem is that once it is removed from the mouth and flushed into the sewer system, it is no longer in a stable environment. It can come in contact with industrial chemicals, commercial chemical products, and a wide variety of bacteria that cause degradation. This degradation begins in the pipe on the way to the treatment plant and does not stop there. Treatment plants remove most toxins, but they in turn release a very high volume of bio-solids, which are bacterially digested sewage products.

Amalgam separators are a simple means to separate metals out of the sewer discharge and dispose of them properly. The technology has been around for decades and is proven to greatly reduce the level of mercury in bio-solids and wastewater treatment plant discharge. It helps keep the treatment plant in compliance with their discharge permits, saving communities considerable amounts of money they won’t have to spend on upgrading treatment technology or having to pay penalties for violation of the Clean Water Act.

But what is an amalgam separator? In nearly all models of amalgam separators the objective is to take out the particles of solid, heavy amalgam. It relies on the weight of the particle to assist in this removal process. By slowing down the fluid flow in a vacuum

pipe, the heavy amalgam sinks to the bottom of the chamber making removal easier. Most amalgam separators are complex settling chambers using this method. Some amalgam separators use filters or even centrifugal technology, but most rely on the weight or size of the particle to effect its removal.

Most amalgam separators are placed within the vacuum line upstream of the vacuum pump. This means that the liquid is effectively slowed down, but doesn’t always mean the best vacuum flow for the clinic. Finding the balance of these two things is what makes most amalgam separators complex.

Although most separators are installed upstream of the vacuum pump, some are not. Some can be installed after the vacuum and should not interfere with the vacuum flow. Although it will not impact the vacuum power, this may not be as beneficial as it might seem. An amalgam separator removes all solids, not just amalgam particles. This means that a separator installed in the vacuum line can and will remove solid particles, therefore reducing the frequency of the pump filter needing replacement. As well, it reduces the abrasive particles that will potentially wear down the pump itself. Since vacuum plumbing is different in each and every clinic, the choice of location of the separator is always dependant on the specifics of the clinic and the need of the doctor and/or clinic.

So, how can you tell if an amalgam separator is working properly? Since each clinic sees a different number of patients and uses different chemicals, there is no way to test these systems case-by-case.

Instead, there is an international testing evaluation called the ISO11143 standard accepted worldwide. This testing method uses amalgam particles to determine the efficiency. It determines how well each separator operates under ideal and repeatable conditions.

The federal Environmental Protection Agency (EPA) regulates pollutants to our waters through the Clean Water Act. These pollution limits are scientifically evaluated to protect

WhAT ArE WE rEALLY dumping down the drain?

proviDeD By reBec

Are harmful amalgam particles being sent to our waters from your practice?

PROTECT YOUR SUCCESS

38.

human health as well as the environment. It is meant to keep our drinking water safe and our recreational waters healthy. Because these pollution limits are continually challenged in court, it has been necessary for the EPA to show a need for these limits and for years have successfully shown the need to reduce the mercury levels.

As it appears, there will soon be a standardized discharge limit set by the EPA for each and every dental clinic that places or removes amalgam nationwide. Here are some facts:

The ADA commissioned a study and found that dental clinics contribute up to 50% of the mercury load released into sewage treatment plants. The EPA estimates that 3.7 tons of mercury is sent to those treatment plants annually by dental clinics. A quick calculation based on 160,000 dentists in the United States shows that each dentist could contribute on average, 21 grams of mercury per year to the sanitary systems across the country.

Remember when I used the example of discarding a battery into the toilet for

disposal? Safe and useful alkaline batteries contain manganese and zinc. Manganese, even in low levels, has been shown to cause neurological symptoms in adults and neurobehavioral effects in children according to the Linus Pauling Institute at Oregon State University. Perhaps it is time we found a way not to flush all of that dental amalgam down the drain as well.

MECHANICAL ROOM SECTION

Burkhart Dental | CATALYST MAGAZINE | Issue 1, 2012 39.

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“

Most of my dentist clients and their families strive to earn incomes that will provide them financial

security. Beyond actual income level, there is “quality of life,” which is greatly enhanced by the reassurance of financial security. However, income alone does not create financial security or qualify of life. These desirable goals are affected by how you deploy and manage excess income.

One of the largest obstacles to translating income into financial security consists of income taxes. No doubt you understand this well when it comes to dental practice income and deductions; my good friend and mentor Bob Creamer often writes about this topic here in Catalyst Magazine. Often overlooked, however, is the impact that taxes have on your long-term investments.

IF YOU DON’T GET TO KEEP IT, DID YOU REALLY EARN IT?Most dentists, like other professionals, tend to begin their financial careers with only tax-deferred dollars. Since we are stuck with the fact that most, if not all, of our income comes in the form of “earned” income through salary or net profits from our practices, we tend to be highly taxed. Consequently, it is understandable that as we first begin to invest, we opt for the available retirement plan vehicles that allow us an income tax deduction—simply by shifting money from one pocket (taxable) to another pocket (tax deductible retirement plan). The plans available run the gamut from Individual Retirement Accounts (IRAs), to “simple” employer plans such as SEP-IRAs and SIMPLE-IRAs, to the more complex 401k and Profit Sharing Plans, to the very complex plans such as Cross-Tested, Cash Balance and/or Defined Benefit Pension Plans.

As a result of practicing tax avoidance, many dentists by mid-career tend to have most if not all of their long-term savings deployed in tax-deferred vehicles. If this is the case, there is not much to think about in the short term regarding tax management or savings within the investment portfolio.

The most successful dentists will tend to begin depositing after-tax dollars into long-term investments by mid-career. Why? The one thing that all of the tax deductible/deferred vehicles mentioned above have in common are limits. The limits come in two forms. The first is that each vehicle has a hard statutory (by law) limit. For example, IRAs are limited to $5,000 ($6,000 for those

who have attained age 50 or more by year-end). SIMPLE-IRA plans allow a maximum deferral of $11,500 ($13,000 if age 50 or more) plus a 3% of salary or earnings match. 401k plans limit deferrals to $17,000 (2012) or $22,500 (2012) if age 50 or more. Defined contribution plans (most common is a 401k combined with a “profit sharing plan”) limit out at a maximum of $50,000 ($55,500 with 401k and age 50 or better). Defined Benefit plans can have much higher limits, but are ultimately limited nonetheless.

There are also practical limitations. The most obvious is when staff funding outpaces the tax savings from additional funding. With our dentists, it is often the case that funding

WEALTh ENhANCEMENT: Income Taxes May be Your Largest Investment Expense

By sam martin, mBa (taX), cfp®, cpa

Income alone does not create financial security or qualify of life. These desirable goals are affected by how you deploy and manage excess income.”

Burkhart Dental | CATALYST MAGAZINE | Issue 1, 2012 41.

the full $50,000 into a 401k + Profit Sharing plan is contraindicated when additional profit sharing contributions cost more in staff funding than they do in tax savings. Here’s a simple example: A client and spouse both contribute the maximum $22,500 each into the 401k (they are over the age 50). They then make a matching contribution of, let’s say, 4% under a safe harbor provision, which they must also make for participating staff (the match percentage is less for those staff members who defer less than 5% of their pay). To fund beyond this point we must move to a “profit sharing” contribution. Although there are various ways to favor the doctor, in many cases there is a point at which the cost of funding for staff exceeds the income tax savings from the additional contribution (for staff and doctor). At that point we are working against ourselves in order to fund any additional dollars through this vehicle.

This is the point at which we may have a desire (or need) to save more dollars than we can save effectively through a tax deductible/tax deferred plan. Therefore we begin to put our long-term retirement funds into after-tax accounts. Eventually, we will add our after-tax practice sale proceeds to these same accounts. The minute you find yourself with a significant sum in your taxable long-term investment account, income tax can become your single largest investment cost.

This long-winded prelude is necessary to establish the reason that we may (or should) have after-tax long-term investments and consequently, why tax management is so important to your bottom line return.

ENLIGHTENED TAX MANAGEMENT:Unfortunately, most of Wall Street—including the vast majority of mutual funds, and even more disappointingly, most independent advisors—don’t really appreciate the significant value of enlightened tax management. This is unfortunately true for several reasons:

• Large organizations (major brokerage houses) apparently don’t have the time or

the patience to manage your portfolio in a tax-efficient manner. Most plow blindly ahead and act as if all accounts and portfolios are tax-deferred and/or belong to large institutions. Tax management is apparently just a huge headache and therefore should simply be ignored.

• Many brokers and advisors are very poorly trained in federal income taxation and simply would not know how to optimize after-tax returns, even if asked.

• Some advisors understand the implications of taxation but give it short shrift, as enlightened tax management is very hard work and requires additional client education. Let’s avoid that, eh?

TAX MANAGEMENTJust as unnecessary taxes can hurt your returns, managing your portfolio with attention to tax efficiency can make a significant positive impact on your long-term returns.

This is carried out through various tax-management techniques, such as:

• Practicing proper asset location (locating assets appropriately within tax-free, tax-deferred and taxable accounts)

• Harvesting tax losses throughout the year

• Minimizing short-term capital gains

• Using tax-managed funds where appropriate

• Remaining sensitive to mutual fund distribution dates

• Implementing specific lot identification to minimize realized gains

• Maximizing the advantages when charitable giving opportunities are desired

• Maximizing the Federal Estate Tax Basis Step-up Rules

I could write a volume of pages on this topic but I will limit the discussion regarding the power of the tax management tools listed above to just one example:

Asset Location: Most brokers and advisors, when faced with a typical dentist client who has a number of long-term investment accounts that include both tax-deferred accounts (401k, IRA, etc.) and taxable accounts (your individual or joint investment account), create duplicate portfolios out of each account like this:

Stocks Bonds

I refer to this as the “Pac Man” syndrome. If you’re familiar with the game, you need only look at these duplicate portfolios and imagine them chasing each other around the screen (do you hear that arcade music?). One major tax inefficiency here: failing to take into account the fact that you have available both taxable accounts and tax-deferred accounts. The tax-enlightened advisor or investor realizes that all of the accounts together (assuming they are all aimed at the same goal—presumably funding your retirement years) represent a single portfolio; the individual accounts are just that.

Since we have tax-deferred accounts, let’s put all of the tax-inefficient assets into those accounts first. These include bonds (or CDs) that pay out income tax at ordinary income tax rates (your highest marginal tax bracket) or any other asset classes that tend to be tax-inefficient (commodities, real estate, Treasury Inflation Protected Securities (TIPS)).

Let’s put tax-efficient asset classes like equities (stock mutual funds) into the taxable account. Further, by using tax-managed funds and better yet, tax-managed passive asset class funds, we can bring the taxable income on the taxable account down to a very dull roar. Further, most if not all income that is disgorged comes in the form of either

WEALTH MANAGEMENT

42.

qualified dividends or long-term capital gains taxed at a maximum of 15%.

But my broker fixed this problem by putting tax-free municipal bonds into my taxable account. Ha! On average, municipal bonds pay a rate that is discounted by around 28% versus a comparable taxable bond. Although the discount fluctuates, generally, taxpayers with a tax rate of greater than 28% would prefer the tax-free municipal bond, whereas the taxpayer with a tax rate of less than 28% should purchase the taxable bond – even though they pay taxes, they have more left after-tax than they would have with the tax-free municipal bond. That said, even the high-bracket taxpayer would come out with a 28% higher return on his or her bonds if simply locating them in a tax-deferred account.

Another advantage of proper asset location relates to estate taxes and the income

tax treatment for your heirs. The federal government (and your state, if it has an estate tax) does not care if your five million dollars is in your IRA, your 401k or your taxable account. They will include it in your estate whether you pay estate taxes or not. Alternatively, how your heirs are treated is very different. Assets in your IRA or 401k will be taxed at ordinary income rates when your heirs withdraw, or are required to withdraw, the proceeds. This means they will be taxed at their highest marginal income tax rate. Alternatively, assets in your taxable account(s) receive a “step-up” in income tax basis upon death. Consequently, your heirs pay no income tax whatsoever on the date of death value. So let’s stop and think about this for a second—which do we expect to appreciate over the long haul? Bonds? Not so much. Equities (stocks, stock funds)? Well, that is certainly the expectation. So we have one more very important reason to practice proper asset location.

The other tax management tools are also quite important. Taken all together, they can make a profound positive impact on your after-tax return (the only return that actually counts).

CONCLUSIONPracticing proactive income tax management of your investment portfolio takes a bit of work and knowledge; however, taking the time and trouble is well worth it. Imagine if you could increase your net after-tax return by even a single percentage point—the results over lengthy periods of time will be more than significant. Whether retirement is a long time coming, or whether you are about ready to retire, keep mind that retirement itself, particularly with a couple, is expected to be a lengthy time period. In fact, a healthy, non-smoking couple at age 62 has an average joint remaining life expectancy of almost 30 years—and that is just the average.

WEALTH MANAGEMENT

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The Dentist’s CPASM

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(425) 216-1612

The Dentist’s CPASM

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Dental Practice Advisors

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Integrated Financial Services to Enhance Your Income and

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mail@cpa4dds.com

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