IDPH's Interim Guidance: Routine Oral and Dental Care
Bob Haney • May 15, 2020
In anticipation of the expansion of permitted oral and dental health care services, the Illinois Department of Public Health (“IDPH”) issued its Interim Guidance: Routine Oral and Dental Care
(the “Guidance”), a summary of which is provided below.
As they reopen, dental offices and their providers should be balancing a patient’s healthcare needs, the benefits of any particular procedure and the risk of exposure to that patient and staff. In addition to appropriate screening for COVID-19, dental professionals should always: (i) include optimized use of administrative controls, engineering controls, and use of PPE as described by CDC Infection Control for Dental Setting, ADA Interim Guidance for Minimizing Risk of COVID-19 Transmission, and ADA’s Return to Work Interim Guidance Toolkit; and (ii) when performing aerosol-generating procedures on patients who have, or are suspected to have COIVD-19, use CDC’s Transmission Based Precautions, OSHA COVID-19 Control and Prevention guidance and airborne isolation rooms. Per the CDC, “when practicing in the absence of Airborne Precautions, the risk of SARS-CoV-2 transmission during aerosol generating dental procedures cannot be eliminated.”
Aerosolization of COVID-19
To minimize the risks of aerosolized COVID-19, dental offices should take the following steps:
- Reduce aerosolization through techniques such as high-volume evacuation, etc.
- Use portable operated HEPA filters of appropriate size, placement, and maintenance.
- Use a properly designed and maintained UV system that takes into account the design of fixtures, lamp type, lamp placement, airflow amount and mixing, etc.
Testing
Dental offices should consider incorporating COVID-19 testing as outlined in the Guidance into its provision of dental services and development of treatment plans while keeping in mind that tests can provide false-negative results, and an individual could begin shedding virus the next day after the negative test result.
Current Guidance
- Case Selection and Care Plan. If possible, patients with increased vulnerability to COVID-19 should defer elective oral and dental care. For patients with unknown COVID-19 statuses, procedures treating active diseases and that are minimally invasive should be prioritized, with hand instruments being used whenever possible. As aerosol generating equipment increases the risk of transmission, dental offices should consider the following in determining patient treatment plans:
- Risks vs. benefits of each procedure
- If possible, 24-48 hours prior to the appointment, administer a symptom screening from the CDC to the patient by telephone.
- This screen should be repeated upon the patient’s arrival at your office.
- Upon arrival, use a non-contact thermometer to check the patient’s temperature.
- Reschedule the appointment if the symptom screening is positive or if the temperature is over 100 degrees.
- While screening for COVID-19 through questionnaires and body temperature is helpful, it is not definitive as COVID-19 infection cannot be ruled out by a negative symptom screening and a normal temperature. Patients incubating the virus are usually infectious for 48-72 hours prior to exhibiting symptoms.
- Risk Mitigation. Transmission risk can be decreased through treatment selection and consideration of individual steps mitigating the creation and spread of aerosols and droplets (e.g., dry-field isolation, fourhanded dentistry). For a structured risk decreasing process, please refer to the ADA’s Interim Guidance for Minimizing Risk of COVID-19 Transmission, which addresses the risk of exposure and transmission before, during, and after planned oral and dental care.
- Protective Equipment. Dental offices should ensure that adequate PPE is available to provide patient care to best reduce the chances of spreading COVID-19 to its patients or staff. This must include appropriate PPE and treatment area safety procedures implemented with the specific type of procedures to be performed by the dental office in mind.
- Infection Control. In determining which services to offer and when, dental offices should, from the perspective of aerosol generation, consider a risk-sensitive approach with a limited set of services. Those procedures that involve the patient and staff to be close in contact but do not generate aerosol may be considered lower risk.
- For these lower-risk procedures, minimal PPE for protection of the airway includes American Society for Testing Materials Level 3 surgical mask and full-face shield.
- For moderate or high-risk procedures, either due to the generation of aerosol or close contact, minimal PPE for the protection of the airway includes a fit-tested N95, or higher-level respirator, with full face shield protection and a gown.
- For patients with COVID-19, an airborne infection isolation room should be used for aerosol-generating procedures.
- For patients whose COVID-19 status is unknown, dental offices should adhere to standards and practices at least as stringent as those recommended by the CDC, ADA and OSHA when performing aerosol-generating procedures.
- Aerosol Risk. For a list of oral and dental procedures by relative risk level, please refer to the Guidance. This list is not exhaustive for oral and dental treatments. While this list should be considered in determining treatment, dental offices should continue to take in as many other factors as possible in order to best determine the most appropriate plan of action for each patient.
As the as the dental services permitted and the guidelines for providing those services is continually changing and involving, it is important to be aware of what your practice may do and should do with regard to treating patients and putting proper safeguards in place. Our team is keeping up to date on these on-going developments and will be sure to advise you accordingly. Should you have any questions, do not hesitate to call or email us.
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As a 17 th -century French playwright, actor, and poet, Molière probably received his fair share of stinging, negative reviews of his work. While we may not know exactly how he felt about such critiques, he did offer some sage advice that dentists should heed when confronted with a patient’s scathing, hurtful, or untrue online review: “ A wise man is superior to any insults which can be put upon him and the best reply to unseemly behavior is patience and moderation .” Human nature being what it is, patience and moderation can be in short supply when a dentist reads a review that casts doubt on their competence, integrity, or professionalism, especially if they believe that the review’s content contains abject falsehoods or misrepresentations. Not only can such online comments make blood boil and bruise the ego, but even one negative review can have a devastating impact on a practice and its reputation. 84% of the public trusts online reviews to help them make consumer decisions, including those involving healthcare providers. According to some surveys, more than 70% of patients say they read reviews before selecting a healthcare provider, and nearly half would not consider a provider with fewer than four stars. Negative reviews can disproportionately influence perception, even if they represent a small fraction of feedback. Given that a single negative review can stand out in an otherwise glowing profile and, if left unaddressed, may deter potential patients, dentists understandably will want to respond, correcting misstatements or otherwise neutralizing the misrepresentations or assertions contained in the review. But those responses, if made reflexively and without careful consideration of legal and ethical boundaries, can make a bad situation worse or make the dentist appear petty and vindictive. Additionally, dentists who do decide to respond to a patient’s negative review publicly may inadvertently reveal confidential patient information in their attempts to refute allegations of poor or substandard care. Such transgressions can have catastrophic licensing and regulatory consequences for dentists. So what should dentists do when faced with a horrible review that every prospective patient can see? As discussed below, responses can, and often should, be made, but with the patience and moderation Molière recommended. Hitting Back v. Hitting HIPAA Perhaps the biggest risk dentists take when publicly responding to a patient’s negative review is inadvertently violating their HIPAA patient privacy obligations. Unlike other businesses, dentists cannot freely discuss the details of a patient’s complaint in a public forum. The HIPAA Privacy Rule prohibits disclosing protected health information (PHI) without patient authorization. Even acknowledging that the reviewer is a patient may constitute a privacy violation. For example, if a patient writes, “I had a terrible root canal here,” the dentist cannot reply with, “We offered you antibiotics, but you refused.” That would be a clear HIPAA violation. Instead, dentists should respond in general terms that neither confirm nor deny treatment specifics. Best Practices for Responding to Negative Reviews When deciding how and whether to respond, dentists should keep the following principles and tips in mind: Cool Off Before Going Off. The worst thing a dentist can do with a bad online review is to immediately post a response in the throes of anger and indignation, however justifiable those emotions may be. Before deciding whether and how to respond, take the time needed for your professionalism and rationality to come back to the fore. Stay Professional and Neutral. Never respond defensively or emotionally. A hostile reply can escalate the issue and further damage your reputation. Even if the review feels unfair, professionalism is key. Acknowledge Without Confirming. Responses should not confirm that the reviewer is or was a patient. Instead, use neutral language such as: “We take all feedback seriously and strive to provide excellent care. We encourage you to contact our office directly to discuss your concerns.” Take the Conversation Offline. Invite the reviewer to call or email the office to resolve the issue privately. This demonstrates attentiveness while protecting confidentiality. Highlight Practice Values. Use responses as an opportunity to reaffirm commitment to patient care. For example: “Our goal is to make every patient feel comfortable and well cared for. We welcome feedback to help us improve.” When Silence May Be Golden Not every negative review needs a reply. If the comment is clearly unreasonable, inflammatory, or fraudulent, sometimes the best response is no response—or a simple flagging of the review for removal. Consider not responding in the following circumstances: Abusive or Fake Reviews. If a review contains profanity, slander, or appears fraudulent, flag it for removal instead of responding. Ongoing Legal Disputes. If the complaint relates to malpractice or litigation, responding publicly can backfire and give the patient more ammunition for their claims. Obvious Spam. Automated or irrelevant reviews do not require acknowledgment. Can You Sue for Defamation? Sure. Will You Win? Probably Not. On more than one occasion, a panicked and indignant dentist or other client of mine has called me to ask whether they could and should sue their former patient for defamation for a harsh online review. The answer, of course, is that you are well within your rights to sue “YourDentalPracticeSucks123” or whoever it is that is trying to take a wrecking ball to your career. You can sue anybody for anything. Whether such a lawsuit will be successful or has any legal basis is another matter entirely. The fact is that even the most scathing negative online review, if susceptible to the principle of “innocent construction” (meaning the allegedly libelous statement is given a non-defamatory interpretation because it is deemed ambiguous) or is composed of opinions rather than demonstrably false allegations of misconduct, will likely not qualify as actionable defamation in most jurisdictions. Furthermore, such lawsuits can expose the offended dentist or other professional to backlash, ridicule, and bad publicity in the fast-moving and fickle world of social media. If you look to hold online review sites and other platforms responsible for false and defamatory information posted by reviewers, you won’t get terribly far. While you may be able to get a website to remove a particularly egregious post, Section 230 of the federal Communications Decency Act largely immunizes such sites from claims based on comments or reviews posted by third-party users. Is It a Subjective Opinion or a Factual Allegation? The most common issue that arises in defamation cases based on online reviews is the question of whether or not a statement was false. Only false statements of fact can form the basis of a defamation claim, not opinions, no matter how histrionic or counterfactual they may be. A statement of fact is one that can be objectively proved or disproved. Consider the two following hypothetical reviews of a dentist: “She was rude, impatient, and treated me disrespectfully. It was perhaps the worst experience I’ve ever had with a dentist in my entire life. She is horrible.” “He stole money from my purse and touched me inappropriately while I was under sedation.” The former is a non-actionable opinion, as the dentist will not be able to objectively prove whether or not she was, in fact, rude, disrespectful, and the cause of one of the worst experiences in the patient’s life. Contrast that with the latter statement that accuses the dentist of specific actions and misconduct that can be proven or disproven with evidence. Proactive Reputation Management The best defense against negative reviews is a steady stream of positive ones. Dentists can encourage satisfied patients to leave feedback by: Sending follow-up emails with review links Placing QR codes in the office for easy access Training staff to request reviews after successful appointments A high volume of positive reviews will dilute the impact of the occasional negative one and provide a more accurate picture of patient satisfaction. As infuriating as negative online reviews can be, it is the rare dentist who can make it through their career without leaving at least one patient dissatisfied or unhappy with their treatment. When a patient shares those feelings with the world, it can be easy to let it get under your skin. But sometimes, restraint can speak louder than a retort. If you have questions or concerns about negative online reviews or reputation management for your dental practice, please contact Grogan Hesse & Uditsky today at (630) 833-5533 or contact us online to arrange for your free initial consultation. We focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices, and this blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
On July 4, 2025, the One Big Beautiful Bill Act (OBBBA) was signed into law. One may question whether this sprawling piece of legislation deserves to be called “beautiful,” but it undoubtedly earns the “big” in its name, especially for small businesses like dental practices. That is because it contains several provisions that could have a significant impact on the tax obligations of practices and their owners. Most notably, the OBBBA solidifies significant tax reforms and exemptions that were part of the 2017 Tax Cuts and Jobs Act (TCJA). Here are seven aspects of the OBBBA that are of particular interest to dental practices and their owners. 1. Permanent Qualified Business Income (QBI) Deduction The 20 percent small business tax deduction (also known as the section 199a deduction) for sole proprietorships, partnerships, S-corporations, and LLCs, which was scheduled to expire at the end of 2025, is made permanent and extends the amount of income subject to the phase-out rules. Specifically, the income threshold for single taxpayers is expanded by $25,000 and for joint filers by $50,000. The bill also includes a new minimum deduction of $400 for taxpayers with at least $1,000 of qualified business income from one or more actively conducted trades or businesses in which they materially participate. 2. Expanding Section 179 Expensing The bill increases the Small Business Expensing Cap from $1.22 million to $2.5 million. It also brings back and makes permanent “bonus depreciation,” which allows for an immediate write-off of 100 percent (versus 40 percent) of the cost of new qualified property acquired after January 19, 2025, such as equipment, vehicles, and software. 3. Qualified Small Business Stock The OBBBA modifies the Qualified Small Business Stock (QSBS) provisions contained in Section 1202 of the Internal Revenue Code by increasing the amounts that can be excluded from gross income, raising the size limit for QSBS investments, and shortening the holding period so investors can take advantage of the provision's benefits earlier than before. Specifically: For QSBS issued after OBBBA's July 4, 2025, effective date, the per-taxpayer gain exclusion cap for the sale of QSBS is raised from $10 million to $15 million, with that threshold being adjusted for inflation starting in 2027. The exclusion amount will now be $15 million or 10x the basis in the stock, whichever is greater. The aggregate gross assets a C corporation may have for its stock to qualify as a qualified small business is now $75 million – up from $50 million - for stock issued after July 4, 2025, with the new limit to be adjusted for inflation beginning in 2027. For QSBS acquired after July 4, 2025, the holding period required to qualify for the QSBS gain exclusion drops from five years to three years. After three years, a 50% exclusion is available, increasing to 75% after four years, and reaching 100% exclusion after five years. 4. Enhancing the Employer-provided Childcare Credit Section 45F of the tax code, which is designed to incentivize businesses to invest in childcare, now provides qualifying small businesses (gross receipts of $25 million or less for the preceding five years) with a maximum tax credit of up to $600,000 per year on up to 50 percent of qualified childcare expenses provided to employees. This credit is effective beginning in 2026. 5. Employer-provided Student Loan Repayment Assistance The OBBBA makes the employer-provided student loan repayment benefit permanent, allowing employers to contribute up to $5,250 per year towards employees' student loans, tax-free for both the employer and employee. This annual limit will be adjusted for inflation starting in 2026, ensuring the benefit keeps pace with rising education costs. 6. Permanent, Inflation-Indexed Estate & Gift Tax Exemption The OBBBA permanently increases the unified federal estate and lifetime gift tax exemption to $15 million per individual ($30 million for married couples), indexed for inflation starting in 2026. If the TCJA’s exemption provisions had expired, the threshold would have dropped to approximately $7 million per individual. This stability allows ultra-high-net-worth individuals to accelerate lifetime gifting and fund trusts efficiently. Techniques such as SLATs (Spousal Lifetime Access Trusts) are now more powerful planning tools given the increased exemption scope. The generation-skipping transfer (GST) tax exemption is now also aligned with the $15 million per individual exemption, also indexed for inflation. 7. SALT Deduction Raised – For Some The law increased the state and local tax (SALT) deduction cap from $10,000 to $40,000; however, this cap is not universally available. If your modified adjusted gross income (MAGI) exceeds certain thresholds, the $40,000 cap will be phased out. For single filers, the phase-out starts at $250,000 MAGI. For joint filers, the phase-out starts at $500,000 MAGI. The deduction is reduced by 30% of the amount exceeding these thresholds until it reaches the original $10,000 cap for the highest earners. The income thresholds for the phase-out will increase by 1% annually from 2026 to 2029. If you have questions about the OBBBA and what it means for you and your practice, please contact Grogan Hesse & Uditsky today at (630) 833-5533 or contact us online to arrange for your free initial consultation. We focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices, and this blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
Dental practices that choose to lease rather than purchase and own their business location have several options for setting up shop. While plenty of practices operate out of stand-alone buildings, even more lease space in retail shopping centers, professional buildings, or office complexes. The terms of that lease – from the rent to the term to build-out, termination, or assignment rights – can have an outsized impact on the growth and success of a practice. But one lease provision, in particular, can determine whether your practice faces stiff and unwanted competition from another practice just steps from your office’s front door: the exclusivity (or exclusive use) clause. What Is An Exclusive Use Provision in a Dental Practice Lease? As the name implies, an exclusive use clause in a lease limits the landlord’s ability to lease space in the same complex or building to another tenant engaged in the same type of business. Think about why you would choose a particular location for your practice. Aside from the features of the space itself, it is likely because of favorable characteristics like foot traffic, accessibility, parking, and the lack of other similar practices in the surrounding area. If, after conducting demographic research and spending time and resources selecting the perfect location for your practice, your landlord could wipe out those efforts with the stroke of a pen by leasing space nearby to a competing practice, it could be a devastating blow. Negotiating an Exclusive Use Provision Most commercial leases are initially prepared by the landlord. As such, they are unsurprisingly skewed in favor of the landlord’s interests. It is unlikely that a landlord would voluntarily and preemptively tie their hands by limiting the pool of potential tenants. That is why the burden is usually on the tenant to push for and negotiate an exclusivity provision. When negotiating the terms of your dental practice lease (which you should only do with the help and counsel of an experienced attorney), the goal will be to get your landlord to agree not to rent space to other dental practice tenants. If your landlord refuses to limit their ability to lease space to other dentists generally and you nevertheless want to pursue the desired space, you may be able to be more specific and agree to a provision that restricts the landlord’s ability to lease to a particular competing specialty such as pediatric dentists, orthodontists, periodontists, etc. Protecting Yourself From a Landlord’s Breach of an Exclusivity Clause The contracts most likely to be broken are those with few, if any, consequences for violating their terms. That is why the value of an exclusivity provision is directly related to the price that the landlord will pay for entering into a lease with a competitor despite the clause in your lease. Given the potentially catastrophic impact of having a neighbor in the same building siphoning off your patients and diluting your hard-earned goodwill, that price should be significant. Several different penalties can serve to protect your practice from a breach of an exclusivity provision: Rent Abatement. One of the most straightforward and commonly used remedies is rent abatement. If the landlord allows a competing business to open in violation of the exclusive use clause, an abatement penalty can entitle you to a full or partial reduction in base rent or other charges. This abatement typically remains in effect until the violation is cured or the competing tenant leaves. The lease should specify the amount of rent to be abated (e.g., 50% of base rent) and whether the abatement applies to other charges such as common area maintenance fees or percentage rent. Termination Right. A strong lease will give the tenant the option to terminate the lease entirely if the landlord fails to cure the violation within a specified period after notice. This is a significant penalty that underscores the seriousness of the exclusive use protection. Liquidated Damages. Liquidated damages provide a pre-agreed amount that the landlord must pay if it breaches the exclusive use clause. This can be calculated based on the tenant’s projected loss in revenue, estimated lost profits, or some other measurable metric tied to the tenant’s business performance. Injunctive Relief. Ideally, the lease should give you the right to seek injunctive relief from a court to stop the violation of the exclusive use provision, such as requiring the landlord to terminate the lease or evict the competing tenant. Getting a landlord to agree to a strong exclusivity provision with equally strong penalties for breaches of it requires deft and persuasive negotiating skills, and is yet another reason why dental practice owners should never enter into or negotiate a lease without the assistance of experienced counsel. If you are considering a lease for your practice, please contact Grogan Hesse & Uditsky today at (630) 833-5533 or contact us online to arrange for your free initial consultation. We focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices, and this blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
As a 17 th -century French playwright, actor, and poet, Molière probably received his fair share of stinging, negative reviews of his work. While we may not know exactly how he felt about such critiques, he did offer some sage advice that dentists should heed when confronted with a patient’s scathing, hurtful, or untrue online review: “ A wise man is superior to any insults which can be put upon him and the best reply to unseemly behavior is patience and moderation .” Human nature being what it is, patience and moderation can be in short supply when a dentist reads a review that casts doubt on their competence, integrity, or professionalism, especially if they believe that the review’s content contains abject falsehoods or misrepresentations. Not only can such online comments make blood boil and bruise the ego, but even one negative review can have a devastating impact on a practice and its reputation. 84% of the public trusts online reviews to help them make consumer decisions, including those involving healthcare providers. According to some surveys, more than 70% of patients say they read reviews before selecting a healthcare provider, and nearly half would not consider a provider with fewer than four stars. Negative reviews can disproportionately influence perception, even if they represent a small fraction of feedback. Given that a single negative review can stand out in an otherwise glowing profile and, if left unaddressed, may deter potential patients, dentists understandably will want to respond, correcting misstatements or otherwise neutralizing the misrepresentations or assertions contained in the review. But those responses, if made reflexively and without careful consideration of legal and ethical boundaries, can make a bad situation worse or make the dentist appear petty and vindictive. Additionally, dentists who do decide to respond to a patient’s negative review publicly may inadvertently reveal confidential patient information in their attempts to refute allegations of poor or substandard care. Such transgressions can have catastrophic licensing and regulatory consequences for dentists. So what should dentists do when faced with a horrible review that every prospective patient can see? As discussed below, responses can, and often should, be made, but with the patience and moderation Molière recommended. Hitting Back v. Hitting HIPAA Perhaps the biggest risk dentists take when publicly responding to a patient’s negative review is inadvertently violating their HIPAA patient privacy obligations. Unlike other businesses, dentists cannot freely discuss the details of a patient’s complaint in a public forum. The HIPAA Privacy Rule prohibits disclosing protected health information (PHI) without patient authorization. Even acknowledging that the reviewer is a patient may constitute a privacy violation. For example, if a patient writes, “I had a terrible root canal here,” the dentist cannot reply with, “We offered you antibiotics, but you refused.” That would be a clear HIPAA violation. Instead, dentists should respond in general terms that neither confirm nor deny treatment specifics. Best Practices for Responding to Negative Reviews When deciding how and whether to respond, dentists should keep the following principles and tips in mind: Cool Off Before Going Off. The worst thing a dentist can do with a bad online review is to immediately post a response in the throes of anger and indignation, however justifiable those emotions may be. Before deciding whether and how to respond, take the time needed for your professionalism and rationality to come back to the fore. Stay Professional and Neutral. Never respond defensively or emotionally. A hostile reply can escalate the issue and further damage your reputation. Even if the review feels unfair, professionalism is key. Acknowledge Without Confirming. Responses should not confirm that the reviewer is or was a patient. Instead, use neutral language such as: “We take all feedback seriously and strive to provide excellent care. We encourage you to contact our office directly to discuss your concerns.” Take the Conversation Offline. Invite the reviewer to call or email the office to resolve the issue privately. This demonstrates attentiveness while protecting confidentiality. Highlight Practice Values. Use responses as an opportunity to reaffirm commitment to patient care. For example: “Our goal is to make every patient feel comfortable and well cared for. We welcome feedback to help us improve.” When Silence May Be Golden Not every negative review needs a reply. If the comment is clearly unreasonable, inflammatory, or fraudulent, sometimes the best response is no response—or a simple flagging of the review for removal. Consider not responding in the following circumstances: Abusive or Fake Reviews. If a review contains profanity, slander, or appears fraudulent, flag it for removal instead of responding. Ongoing Legal Disputes. If the complaint relates to malpractice or litigation, responding publicly can backfire and give the patient more ammunition for their claims. Obvious Spam. Automated or irrelevant reviews do not require acknowledgment. Can You Sue for Defamation? Sure. Will You Win? Probably Not. On more than one occasion, a panicked and indignant dentist or other client of mine has called me to ask whether they could and should sue their former patient for defamation for a harsh online review. The answer, of course, is that you are well within your rights to sue “YourDentalPracticeSucks123” or whoever it is that is trying to take a wrecking ball to your career. You can sue anybody for anything. Whether such a lawsuit will be successful or has any legal basis is another matter entirely. The fact is that even the most scathing negative online review, if susceptible to the principle of “innocent construction” (meaning the allegedly libelous statement is given a non-defamatory interpretation because it is deemed ambiguous) or is composed of opinions rather than demonstrably false allegations of misconduct, will likely not qualify as actionable defamation in most jurisdictions. Furthermore, such lawsuits can expose the offended dentist or other professional to backlash, ridicule, and bad publicity in the fast-moving and fickle world of social media. If you look to hold online review sites and other platforms responsible for false and defamatory information posted by reviewers, you won’t get terribly far. While you may be able to get a website to remove a particularly egregious post, Section 230 of the federal Communications Decency Act largely immunizes such sites from claims based on comments or reviews posted by third-party users. Is It a Subjective Opinion or a Factual Allegation? The most common issue that arises in defamation cases based on online reviews is the question of whether or not a statement was false. Only false statements of fact can form the basis of a defamation claim, not opinions, no matter how histrionic or counterfactual they may be. A statement of fact is one that can be objectively proved or disproved. Consider the two following hypothetical reviews of a dentist: “She was rude, impatient, and treated me disrespectfully. It was perhaps the worst experience I’ve ever had with a dentist in my entire life. She is horrible.” “He stole money from my purse and touched me inappropriately while I was under sedation.” The former is a non-actionable opinion, as the dentist will not be able to objectively prove whether or not she was, in fact, rude, disrespectful, and the cause of one of the worst experiences in the patient’s life. Contrast that with the latter statement that accuses the dentist of specific actions and misconduct that can be proven or disproven with evidence. Proactive Reputation Management The best defense against negative reviews is a steady stream of positive ones. Dentists can encourage satisfied patients to leave feedback by: Sending follow-up emails with review links Placing QR codes in the office for easy access Training staff to request reviews after successful appointments A high volume of positive reviews will dilute the impact of the occasional negative one and provide a more accurate picture of patient satisfaction. As infuriating as negative online reviews can be, it is the rare dentist who can make it through their career without leaving at least one patient dissatisfied or unhappy with their treatment. When a patient shares those feelings with the world, it can be easy to let it get under your skin. But sometimes, restraint can speak louder than a retort. If you have questions or concerns about negative online reviews or reputation management for your dental practice, please contact Grogan Hesse & Uditsky today at (630) 833-5533 or contact us online to arrange for your free initial consultation. We focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices, and this blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
On July 4, 2025, the One Big Beautiful Bill Act (OBBBA) was signed into law. One may question whether this sprawling piece of legislation deserves to be called “beautiful,” but it undoubtedly earns the “big” in its name, especially for small businesses like dental practices. That is because it contains several provisions that could have a significant impact on the tax obligations of practices and their owners. Most notably, the OBBBA solidifies significant tax reforms and exemptions that were part of the 2017 Tax Cuts and Jobs Act (TCJA). Here are seven aspects of the OBBBA that are of particular interest to dental practices and their owners. 1. Permanent Qualified Business Income (QBI) Deduction The 20 percent small business tax deduction (also known as the section 199a deduction) for sole proprietorships, partnerships, S-corporations, and LLCs, which was scheduled to expire at the end of 2025, is made permanent and extends the amount of income subject to the phase-out rules. Specifically, the income threshold for single taxpayers is expanded by $25,000 and for joint filers by $50,000. The bill also includes a new minimum deduction of $400 for taxpayers with at least $1,000 of qualified business income from one or more actively conducted trades or businesses in which they materially participate. 2. Expanding Section 179 Expensing The bill increases the Small Business Expensing Cap from $1.22 million to $2.5 million. It also brings back and makes permanent “bonus depreciation,” which allows for an immediate write-off of 100 percent (versus 40 percent) of the cost of new qualified property acquired after January 19, 2025, such as equipment, vehicles, and software. 3. Qualified Small Business Stock The OBBBA modifies the Qualified Small Business Stock (QSBS) provisions contained in Section 1202 of the Internal Revenue Code by increasing the amounts that can be excluded from gross income, raising the size limit for QSBS investments, and shortening the holding period so investors can take advantage of the provision's benefits earlier than before. Specifically: For QSBS issued after OBBBA's July 4, 2025, effective date, the per-taxpayer gain exclusion cap for the sale of QSBS is raised from $10 million to $15 million, with that threshold being adjusted for inflation starting in 2027. The exclusion amount will now be $15 million or 10x the basis in the stock, whichever is greater. The aggregate gross assets a C corporation may have for its stock to qualify as a qualified small business is now $75 million – up from $50 million - for stock issued after July 4, 2025, with the new limit to be adjusted for inflation beginning in 2027. For QSBS acquired after July 4, 2025, the holding period required to qualify for the QSBS gain exclusion drops from five years to three years. After three years, a 50% exclusion is available, increasing to 75% after four years, and reaching 100% exclusion after five years. 4. Enhancing the Employer-provided Childcare Credit Section 45F of the tax code, which is designed to incentivize businesses to invest in childcare, now provides qualifying small businesses (gross receipts of $25 million or less for the preceding five years) with a maximum tax credit of up to $600,000 per year on up to 50 percent of qualified childcare expenses provided to employees. This credit is effective beginning in 2026. 5. Employer-provided Student Loan Repayment Assistance The OBBBA makes the employer-provided student loan repayment benefit permanent, allowing employers to contribute up to $5,250 per year towards employees' student loans, tax-free for both the employer and employee. This annual limit will be adjusted for inflation starting in 2026, ensuring the benefit keeps pace with rising education costs. 6. Permanent, Inflation-Indexed Estate & Gift Tax Exemption The OBBBA permanently increases the unified federal estate and lifetime gift tax exemption to $15 million per individual ($30 million for married couples), indexed for inflation starting in 2026. If the TCJA’s exemption provisions had expired, the threshold would have dropped to approximately $7 million per individual. This stability allows ultra-high-net-worth individuals to accelerate lifetime gifting and fund trusts efficiently. Techniques such as SLATs (Spousal Lifetime Access Trusts) are now more powerful planning tools given the increased exemption scope. The generation-skipping transfer (GST) tax exemption is now also aligned with the $15 million per individual exemption, also indexed for inflation. 7. SALT Deduction Raised – For Some The law increased the state and local tax (SALT) deduction cap from $10,000 to $40,000; however, this cap is not universally available. If your modified adjusted gross income (MAGI) exceeds certain thresholds, the $40,000 cap will be phased out. For single filers, the phase-out starts at $250,000 MAGI. For joint filers, the phase-out starts at $500,000 MAGI. The deduction is reduced by 30% of the amount exceeding these thresholds until it reaches the original $10,000 cap for the highest earners. The income thresholds for the phase-out will increase by 1% annually from 2026 to 2029. If you have questions about the OBBBA and what it means for you and your practice, please contact Grogan Hesse & Uditsky today at (630) 833-5533 or contact us online to arrange for your free initial consultation. We focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices, and this blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
Dental practices that choose to lease rather than purchase and own their business location have several options for setting up shop. While plenty of practices operate out of stand-alone buildings, even more lease space in retail shopping centers, professional buildings, or office complexes. The terms of that lease – from the rent to the term to build-out, termination, or assignment rights – can have an outsized impact on the growth and success of a practice. But one lease provision, in particular, can determine whether your practice faces stiff and unwanted competition from another practice just steps from your office’s front door: the exclusivity (or exclusive use) clause. What Is An Exclusive Use Provision in a Dental Practice Lease? As the name implies, an exclusive use clause in a lease limits the landlord’s ability to lease space in the same complex or building to another tenant engaged in the same type of business. Think about why you would choose a particular location for your practice. Aside from the features of the space itself, it is likely because of favorable characteristics like foot traffic, accessibility, parking, and the lack of other similar practices in the surrounding area. If, after conducting demographic research and spending time and resources selecting the perfect location for your practice, your landlord could wipe out those efforts with the stroke of a pen by leasing space nearby to a competing practice, it could be a devastating blow. Negotiating an Exclusive Use Provision Most commercial leases are initially prepared by the landlord. As such, they are unsurprisingly skewed in favor of the landlord’s interests. It is unlikely that a landlord would voluntarily and preemptively tie their hands by limiting the pool of potential tenants. That is why the burden is usually on the tenant to push for and negotiate an exclusivity provision. When negotiating the terms of your dental practice lease (which you should only do with the help and counsel of an experienced attorney), the goal will be to get your landlord to agree not to rent space to other dental practice tenants. If your landlord refuses to limit their ability to lease space to other dentists generally and you nevertheless want to pursue the desired space, you may be able to be more specific and agree to a provision that restricts the landlord’s ability to lease to a particular competing specialty such as pediatric dentists, orthodontists, periodontists, etc. Protecting Yourself From a Landlord’s Breach of an Exclusivity Clause The contracts most likely to be broken are those with few, if any, consequences for violating their terms. That is why the value of an exclusivity provision is directly related to the price that the landlord will pay for entering into a lease with a competitor despite the clause in your lease. Given the potentially catastrophic impact of having a neighbor in the same building siphoning off your patients and diluting your hard-earned goodwill, that price should be significant. Several different penalties can serve to protect your practice from a breach of an exclusivity provision: Rent Abatement. One of the most straightforward and commonly used remedies is rent abatement. If the landlord allows a competing business to open in violation of the exclusive use clause, an abatement penalty can entitle you to a full or partial reduction in base rent or other charges. This abatement typically remains in effect until the violation is cured or the competing tenant leaves. The lease should specify the amount of rent to be abated (e.g., 50% of base rent) and whether the abatement applies to other charges such as common area maintenance fees or percentage rent. Termination Right. A strong lease will give the tenant the option to terminate the lease entirely if the landlord fails to cure the violation within a specified period after notice. This is a significant penalty that underscores the seriousness of the exclusive use protection. Liquidated Damages. Liquidated damages provide a pre-agreed amount that the landlord must pay if it breaches the exclusive use clause. This can be calculated based on the tenant’s projected loss in revenue, estimated lost profits, or some other measurable metric tied to the tenant’s business performance. Injunctive Relief. Ideally, the lease should give you the right to seek injunctive relief from a court to stop the violation of the exclusive use provision, such as requiring the landlord to terminate the lease or evict the competing tenant. Getting a landlord to agree to a strong exclusivity provision with equally strong penalties for breaches of it requires deft and persuasive negotiating skills, and is yet another reason why dental practice owners should never enter into or negotiate a lease without the assistance of experienced counsel. If you are considering a lease for your practice, please contact Grogan Hesse & Uditsky today at (630) 833-5533 or contact us online to arrange for your free initial consultation. We focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices, and this blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
