Integrity isn’t an innovation. It’s a series of conscious choices that defines Agenics and the future of safe dentistry.

Every patient that leans back in a dental chair trusts that the water is clean and safe. Usually, it is. When it’s not, the complications can be life changing.

In 2016, for example, more than 70 patients of an Orange County, California, children’s dental practice experienced infections that were later traced back to unclean water at the practice. As a result, some children lost parts of their jaws, adult teeth, and even some hearing.

Dental water infections are far more common than they should be. That they happen at all speaks not to our ability to keep water clean but instead to a lack of organizational rigor and the prioritization of profits over people.

Having learned at the feet of a clean water pioneer and evangelist for a people-first business approach, I know that every instance of dental water infection can be traced to misplaced priorities, lax protocols, and flawed understanding. Thankfully, the technology available now gives dentists the tools to virtually eliminate dental water infections.

“Clean water isn’t just about safety—it’s a reflection of values.”

A Legacy Rooted in Service

While most people in the developed world don’t think twice about water quality unless they’re unfortunate enough to get sick, I can scarcely remember a time when it wasn’t part of my life.

My father, Brad Downs, was a chemical engineer who, in the 1990s, signed on to an Army Corps of Engineers project in Colorado, where our family would soon live. The ambitious project goal was to purify 3 million gallons of contaminated groundwater from the Rocky Flats nuclear site north of Denver. Of all the bids submitted, only Dad’s proposed purifying the water instead of hauling it to a nuclear waste site. That water was eventually purified so well it was safely returned to local rivers and streams.

The success of the Army Corps project convinced my father he could adapt the technology and scale it down to meet the needs of missionaries in Papua New Guinea who were regularly getting sick from biocontaminated water.

Buoyed by his faith, experience, and enthusiasm, he set off with a backpack full of equipment for the South Pacific island nation. Before long, he fashioned both a purification system and a solar-powered microbiological test lab to confirm water safety.

Discovering a New Mission

Dad returned home still buzzing from his recent successes and looking for a new way to make a difference. He found it in early 2000 when ABC News’ 20/20 ran a story called “Dentistry’s Dirty Little Secret,” which highlighted a dental practice biocontamination water problem that was surprisingly common.

Only months later, dental water purity expert Dr. Shannon Mills published an article in the Journal of the American Dental Association (JADA) entitled, “The Dental Unit Waterline Controversy: Defusing the Myths, Defining the Solutions.” Dr. Mills described the ideal water treatment agent in terms of efficacy, safety, and cost, and concluded that no such agent had been discovered.

For my parents, the JADA article presented a worthy challenge and a purpose they could not ignore.

I still remember sitting with my father in the crawl space of our home as he worked to develop the ideal water treatment solution Dr. Mills had outlined. Recognizing the need to pair technology with user-friendly design, my mother, Theresa, did all she could to understand the needs of dental practitioners. She even trained as a dental assistant and worked in a clinic to see how treatment products could fit seamlessly into existing workflows.

At a young age, I could not then accurately describe the feeling that permeated our home, but now I know that it was purpose. Always present and attentive to their children, my parents were also driven to make a societal contribution and improve the world they lived in; they were moved by higher principles and values.

“The goal should be zero dental water infections.” 

Driven by Science and Service

After months of research and experimentation, my father identified silver as the ideal water treatment agent and created a novel process to produce it in a usable form factor. Not long after, my parents’ company Sterisil was born and throughout the first decade of this millennium, they developed a leading line of patented dental waterline treatment technologies.

Sterisil still creates the only products recognized by the Environmental Protection Agency (EPA) that treat and maintain water purity at a level of 10 colony-forming units (CFUs) per milliliter of water, which is 50 times cleaner than the 500 CFU/mL standard established for drinking water by the Centers for Disease Control (CDC) and embraced by the ADA.

In 2011, my parents started Agenics Labs as an independent dental waterline testing company. I worked various jobs in the family business growing up but formally started my dental career alongside my parents after obtaining a bachelor’s of science in engineering. My husband-to-be Greg Niederschulte and I joined the company together and spent the next several years learning all there is to know about dental water purity. In 2022, Sterisil was sold to private equity without Agenics, and my parents entered semiretirement to run their new foundation, Our King’s Way.

In 2023, Greg and I acquired Agenics and are now putting all our efforts into maintaining the legacy my parents created.

Profit as an Outcome, Not a Goal

Thinking back to those 73 kids in Orange County, as troubling as the infections were, there is another aspect of that case that I think might be more disturbing.

After the outbreak led local public health authorities to the dental practices, a more thorough investigation discovered that the practice had performed more than 1,000 pulpotomies (root canals on children) between January and September of 2016.

Subsequent lawsuits filed on behalf of the children’s families alleged “predatory dentistry” and “production quotas” that ultimately sacrificed the children’s health on the altar of greater profits.

Were all those 1,000 plus pulpotomies necessary? It’s difficult to say definitively, but clearly the families of those impacted didn’t think so. I’ve imagined the trauma of a root canal performed on a toddler, and it makes this entire episode that much more troubling and shines a bright light on the priority of water quality.

Did the practice owners rely on municipal water quality and think testing was unnecessary? Perhaps, and they wouldn’t be alone. Many practices adhere to the “good enough” principle when it comes to water quality and nothing bad ever happens, until something does.

The Orange County outbreak also illustrates for me exactly what my parents were guarding against when they explained—with emphasis and passion—the unassailable hierarchy of business priorities: people, product, and then profit. The first two are the constant focus, and the third is the reward.

If dental practices cut corners, even with the best of intentions, at the expense of patient safety, they’re potentially putting both patients and practice at risk.

Good Intentions Aren’t Enough

Even if most or all dental water infections are the product of error, not avarice, that probably doesn’t matter to the infected patient. The goal should be zero dental water infections.

Our philosophy is that the best intentions are close to worthless without proper training, rigidly adhered-to protocols, and robust technology.

Consider Atul Gawande’s The Checklist Manifesto for a relevant comparison. Gawande’s book illustrates how even the most dedicated, well-trained, and compassionate surgeons and surgical teams make mistakes without robust protocols in the form of simple posted checklists that include no-brainers like “wash hands.”

Perhaps it would be different if states conducted periodic water-quality tests that practices had to prepare for. Currently, however, only Georgia and Washington state mandate regular testing.

And those infections do keep happening. According to the CDC in 2022, multiple outbreaks of nontuberculous mycobacteria infections have occurred in children who received treatment at practices with water contaminated with high levels of bacteria.

“Dental providers should be familiar with these recommendations on how to properly maintain and monitor their dental equipment to ensure that dental treatment water is safe for patient care,” the CDC says.

“People, product, and then profit. The first two are the focus. The third is the reward.”  

Protecting Your Patients and Your Practice

The cost of defending a negligence lawsuit and paying damages would be too high for most practices to survive.

But before an infection scenario ever gets to this extreme, most providers are simply concerned with properly and professionally caring for patients, which is a priority we share.

Agenics is dedicated to ensuring that patients don’t suffer devastating infections from routine procedures. While only Washington and Georgia have mandated water testing with a specified frequency, 43 states have codified the CDC guidelines for water quality into law, and all states recognize maintaining and monitoring dental water as the standard of care.

Agenics’ services begin with water testing but extend through comprehensive support, including protocol development, failure remediation, and extensive training. Bacteria testing is most commonly performed via the gold standard EPA Method 9215c using Reasoner’s 2A (R2A) agar—a venerable approach particularly effective at growing the bacteria common in dental waterlines. We’ve branded this our StandardCheck service, and it is a reliable baseline for whether a practice meets the basic EPA standard for drinking water.

When evaluating water samples with StandardCheck, Agenics uses a digital reader, which rapidly counts the number of bacterial colonies on a given sample. By removing the potential for human error, Agenics establishes confidence in both the reports we provide and the solutions we recommend.

Continuing the legacy of innovation, Agenics also offers RapidCheck: the most advanced bacteria detection method available. Agenics developed this specialized process in-house using thousands of real-world dental samples to create the most extensive and reliable test results available. With results in just 24 hours thanks to flow cytometry, this test meets the intense demands of high-throughput practices.

If a test reveals a bacteria level above the EPA minimum, Agenics looks deeper into potential sources, which may not be obvious. Water sources may be an issue, as might a dental chair’s frequency of use. (If narrow waterlines are not flushed and treated frequently, biofilm forms and quickly multiplies.) The water quality reports we provide are comprehensive and include data on alkalinity, total dissolved solids, and potential inhibitors of treatment agents.

From a generation of water treatment expertise, we’ve also learned to recognize unique water quality patterns such as the changes from spring to fall in municipal water or the differences in types of bottled water. As the only independent lab in the industry—Agenics does not sell any treatment or shock products—we can honestly review the effectiveness of any given product for a specific dental practice.

These are all things that most dentists don’t have the time or training to understand, but they can have an impact on clinical quality and patient safety. Instead of putting their livelihoods at risk, dentists can make water quality the responsibility of professionals who concentrate on nothing else.

Built on Principle, Leading with Purpose

I share my family’s story because it’s a reminder that an inherited legacy must still be protected every day or it will die. My parents built their professional lives on faith, integrity, and a simple truth: When people come first, success naturally follows.

That conviction drives Agenics today as much as it did when my parents were running the company. They taught me that embracing belief and service—purpose and meaning—is a better way to live. My parents never let us forget that seeing money as a primary objective would eventually cheapen our lives.

Growing up, my mother told us her goal was to raise children who cared about other people more than financial or business success. Our goal is for Agenics to succeed because we put first things first and trust the reward to come from consistent, values-driven business principles. Every sample Agenics tests, every partnership we embrace, is an act of legacy stewardship that honors where we came from and defines where we are going. Greg and I could think of no better way to honor my parents than to carry on as they taught us.

DR. RANIA SALEH IS ON A PERSONAL AND PROFESSIONAL MISSION TO UNITE THE CLINICAL AND BUSINESS SIDES OF DENTAL PRACTICES IN ONE SOFTWARE PLATFORM

In the early 2000s, newly minted dentist Dr. Rania Saleh faced a dilemma: she knew how to be a great dentist, but she found herself in an environment where it was almost impossible.

“I was working in an extremely busy practice as an associate, and I couldn’t continue the way that practice demanded, knowing that there was a better way to do it,” she says. “I wanted patients to understand their conditions, how their general health was affecting their oral health, and their diagnosis before we committed to a treatment.”

So, Saleh struck out on her own, ready to do things her way, opening a practice near Washington, DC. But even after opening her own cosmetic dental office and implementing an in-depth, diagnosis-focused approach to examining and treating patients, she found that the available dental software on the market was more hindrance than help, particularly in terms of getting her entire team on the same page when doing examinations.

Saleh knew technology could empower dentists to better serve their patients with enhanced clinical care and education. She also knew she had a Kois Center-inspired examination protocol that worked, and that modernized technology could only make it better.

Guided by an undaunted attitude informed by a childhood shuttled between war-afflicted Lebanon and Canada, a strong belief in her own abilities, and an extensive knowledge of the dental industry, Saleh decided she could create what the industry lacked. In 2016, she founded Oryx Dental and began developing the platform, starting with her clinical approach to patient exams.

The vision behind Oryx is clear and direct: give dentistry the technological support and innovation it has lacked for so long—and watch the industry reach its full potential.

Dental Health Is Healthcare

Saleh developed the detailed examination protocol she would later apply to her practice and to Oryx after she was introduced to the Kois Center and completed the program in Seattle. The Center’s comprehensive, evidence-based methodology upended her view of traditional, procedure-based dentistry. It also posed a fundamental question in terms of treating patients.

“Would dental patients have the patience for an exam that might stretch to hours if they knew it would significantly improve their outcomes?” she recalls asking herself.

Indeed, she discovered, they would.

As Saleh’s private practice in DC rapidly grew and her patients embraced extensive, detailed exams and information, Saleh started getting feedback on her somewhat unusual methods.

“I would get calls from the GI department at Georgetown,” Saleh says. “They’d say, ‘Thank you so much for referring these patients. We were able to discover early cancers. We didn’t know that dentists could find these things.’”

The Kois Center-derived approach was working. As her thriving practice grew to two locations, Saleh hired associates to meet demand. But when she became pregnant with twins and was put on bed rest for five months, her associates were unable to maintain the standard of care and the business suffered.

Saleh found herself at a crossroads. The bed rest finally gave her time to reassess her strategy and revise her exam protocol, which she began teaching in earnest to her associates to try to boost her practice. Still, she couldn’t be in the clinic looking over their shoulders.

At this point, she started discussing with her husband, an engineer for a healthcare IT company, how she could duplicate the exam protocol using software. Clearly, there must be a better way to get consistent results through technology, even if dentistry had yet to discover it.

That’s when the beginnings of Oryx Dental went from concept to reality.

“Dentistry has been underserved by software for decades.”

Putting Clinical Care at the Core of a Broader Platform

“There was no clinical component at all,” Saleh says of dentistry software back in the day. “You could complete an exam by just writing two lines, or by entering a few data points. Nothing was guiding the dentist to go through a very thorough process.”

Dentists also juggle marketing, billing, and business management alongside clinical work, often falling back on manual, disconnected processes just to get things done. Previously, the software available to help with those tasks was neither integrated nor efficient. In terms of pace and pizzazz, the existing solutions were like a horse-drawn carriage.

“There were a lot of workflow inefficiencies in the software on the market in 2016,” Saleh says. “Software functioned more like different data entry points that you had to put together, and the output was not a treatment plan but just a procedure code and a price.”

Saleh envisioned something precise and responsive—a sports car instead of a carriage. Thinking of systems used more broadly in healthcare, she set out to develop a platform that both drives clinical evaluation workflows and improves the efficiency of those workflows.

Conceptually, the solution also had to be a fully integrated platform that included messaging, scheduling, billing, and other front-desk functions automatically generated by a triggering event like the completion of a patient exam.

“Oryx is about having an amazing workflow from start to finish, making sure you’re delivering the best clinical care, and, on the business side, taking care of everything you need to,” says Saleh.

It’s been more than a century since horse-drawn carriages were considered advanced technology. Perhaps it’s time to stop thinking that the software equivalent is useful.

Smarter Providers and Patients

“My goal has always been to empower dentists and also to empower patients—and to create an amazing relationship between them,” says Saleh.

As the starting point for her clinical protocol, Saleh relied on the Kois Center’s foundational four-part examination methodology: gum health, condition of teeth, bite and jaw joint, and overall smile.

“You assign a risk in each area, so when you explain the patient’s dental health to them, they understand the risks involved,” Saleh says. “Patients really liked that, even though it was time-consuming.”

Indeed, this clinical approach is what makes Oryx a unique platform that elevates the way dentistry is practiced. Saleh highlights the educational materials the system makes readily available to providers at the point of care, which are updated regularly.

These materials drive the thorough and detailed explanations patients receive during exams, which increase engagement and understanding. That improved understanding, Saleh emphasizes, is the product of a system that looks at the big picture and focuses on the confluence of factors that impact overall health.

“Traditionally, dentistry has been procedure-focused, at least in part because of how insurance is paid.” Saleh explains. “Dentists become conditioned to look for problems rather than looking at the patient’s general health. Oryx enables them to see the full picture.”

7 Minutes to Better Heath

Dental providers need effective software to improve clinical performance and patient satisfaction.

Consider how Oryx uses images to ensure that both the clinician and the patient clearly see what’s happening. Where dentists have typically used a digital SLR to take high-quality images, Oryx supports an iPhone app to take photos that go straight into the chart.

“We saw compliance skyrocket in data collection with the introduction of this app,” Saleh says. “And users are saying the reports generated for patients have more value with the photos.”

Of course, a busy dental practice still doesn’t have hours for each check-up, as Saleh originally envisioned the ideal patient examination. In developing Oryx, and in working with John Kois, Saleh and her team have created a standard, templated exam that incorporates the Kois Center’s evidence-based treatment protocols and employs clinical decision support.

“There’s a very structured exam,” Saleh says. “It takes about seven minutes to do on any patient, and this is the best seven minutes you can spend. When you’re done with the exam, the next steps for diagnosis and treatment are clear.”

That Oryx can support a diagnosis after seven minutes is in part enabled by how the platform can be configured for specific practices and patient bases. For example, Oryx includes pediatric exams, questionnaires, and photos; prompts for questions about fluoride; and unique workflows to accommodate specialty practices.

“What we wanted was to be able to focus on just the clinical stuff that simplifies everybody’s life and makes things easier for patients,” explains Dr. Christopher Baer, a Colorado clinician and Oryx user. “We’ve seen a dramatic improvement in case acceptance because of the way that we can present the information.”

Better Tools, Better Dentistry

As with health care generally, software as a service (SaaS) and AI innovations are key to bringing the dental industry up to date in terms of what is technologically possible.

Because Oryx is implemented using a SaaS approach, the platform can be segmented to meet the needs of multioffice practices or DSOs with multiple locations. The SaaS model also eliminates the need for on-premise data centers and makes future expansion to accommodate growth a simple process that negates local data center demands and requirements.

What will really enable dentistry to evolve from the antiquated technology of just a decade ago to the cutting-edge potential of now is AI and the functions it makes possible, such as ambient listening and image scans.

“It’s going to make clinicians and front-office workflows a lot more efficient,” Saleh says, “but most importantly, it is going to improve the patient experience. Clinicians in our offices who use AI tell us, ‘I can look the patient in the face. We can have a conversation.’ I think dentists and patients will have a much better relationship once all the clutter is gone.”

Oryx objectively represents a leap forward in an industry that has relied on old-fashioned legacy software for decades. Just as hospitals and clinics made the jump to the digital age two decades ago, dentistry is having its own digital moment now.

“Dentistry has been underserved by software for decades,” Saleh says. “Some offices were reluctant to adopt certain tools because the benefit was not clear, but when software is clearly built for specific purposes and provides documented benefits, the decision is much easier to make.”

The Future of Dentistry Is Now

Saleh knew dentists and patients deserved better, and she had the confidence to believe she could deliver. From more consistent protocols to better education to more structured exams, Oryx enables dentists to practice in a way that is a huge leap forward from even a few years ago.

And the practices that have moved to Oryx have quickly noticed the business benefits and improvements to patient treatment.

“We had a DSO that moved to Oryx, and they doubled their production in one year,” Saleh recalls. “Their case acceptance and referral rate more than doubled because they had this consistency. It didn’t matter if it was the lead doctor or the new junior doctor seeing a patient. Everyone was doing the same exam, everyone was doing the same treatment plan.”

The funny thing about the future is how hard it is to know when you’re in it. Appreciating the difference between a horse-drawn carriage and a sports car, however, is very easy. Saleh is confident that dentistry can recognize this significant moment—that now is the time for groundbreaking change— and appreciate the increase in velocity.

Across Amy McCarthy’s professional journey, her passion for innovation and entrepreneurial spirit have been driving forces behind her success. They have defined her career and are now shaping the future of Envista. As the newly appointed leader of Envista’s DSO initiative, she is spearheading a transformation designed to elevate how DSOs operate, scale, and deliver exceptional patient care.

Building a Foundation

Amy’s entrepreneurial journey began early. At 17 years old, she founded a mail courier service in Everett, Washington, which served over half of the local medical community. Her innovative service cut delivery times for medical records in half, streamlining workflows for countless healthcare providers.

“I was creating solutions that added value. I didn’t realize it then, but that experience taught me the importance of identifying pain points,” Amy shares. Over the next decade, she grew this business while pursuing a college degree, a career, and later an MBA. This hands-on experience laid the foundation for professional work in the pharmaceutical industry where she quickly made her mark. At 25 years old, Amy became one of the youngest district sales managers in the company’s history.

“I focused on understanding my customers’ goals and needs. By aligning my efforts with their objectives, I was able to build trust and long-lasting relationships. That approach has been a cornerstone of my leadership philosophy,” she explains.

But Amy’s career trajectory shifted when she chose to leave her high-pressure role to focus on raising her two young children.

“On my youngest child’s first birthday, I quit my role as Regional Sales Manager at Sanofi-Aventis Oncology. I was traveling constantly and felt like I wasn’t doing anything well — being a mom or a manager. No matter what adjustments I tried, I couldn’t find balance or happiness. It was one of the hardest decisions I’ve ever made. I loved my career, but I felt a lot of pressure—and pull—to be with my kids. My family always valued stay-at-home parenting, so I decided to give it a try,” Amy recalls.

Yet even during this work hiatus, Amy’s entrepreneurial drive could not be stopped. She soon launched a photography business, a passion project that allowed her to balance motherhood with work through a creative outlet.

“It filled my constant need to learn and improve. I built a custom website, grew a thriving client base, and enjoyed the flexibility. But after a few years, I found myself wanting more,” Amy reflects.

That desire led her to consulting, where she advised small businesses on strategic planning, operations, and marketing. Consulting ultimately connected her to Premier Periodontics, a Seattle-based DSO who brought Amy on to scale operations. Amy was pivotal to the organization’s success.

“I started as Director of Operations and moved into marketing, and eventually I became COO. During my time there, we expanded Premier to eight locations and helped launch Evident Alliance, a 25-location multi-specialty DSO,” Amy explains.

She credits much of her success to the trust her colleagues placed in her.

“They let me make decisions and run with them, which is how I work best. Dr. Will Fernyhough and Dr. Issa Dkeidek remain great friends to this day,” she adds.

Joining Envista

In 2021, Amy joined Envista, drawn by the opportunity to combine her expertise in innovation and healthcare.

“Envista’s portfolio is unmatched. I knew that it would be an opportunity to grow personally and offer endless opportunity to innovate and create value for customers,” Amy says.

Amy shared her vision for the future of Envista’s place with DSOs last spring with CEO Paul Keel. Paul saw the importance, shared Amy’s excitement for the opportunity and added DSO to the strategic planning process. As a result, extensive voice of customer interviews were completed, new resources allocated, and restructuring occurred to suit the needs of these very important customers. All focused on leveraging Envista’s vast customer-centric solutions and portfolio.”

The Secret Sauce

Envista’s success with DSOs boils down to three key elements: solutions, simplicity, and scale.

Envista’s portfolio includes best-in-class solutions, products and technologies across categories: diagnostics/imaging, implants, consumables, and ortho. What sets the company apart, however, is its ability to integrate these offerings into tailored solutions for DSOs.

“We’re not just selling products. We’re partnering with DSOs to help them operationalize and scale their businesses. This means creating training programs, offering fleet management tools, and collaborating on innovations that improve efficiency and patient care,” Amy explains.

Envista offers simplicity for DSO partners. The advantages of working with one manufacturing partner for multiple solutions / across multiple categories is enormous. Having a single point of contact, one contract, a partner who knows your goals and paint points and who is proactively working on your behalf to help you grow, across initiatives, is invaluable. The time savings and peace of mind are invaluable. Envista has the resources, expertise and experience to help our DSO partners and scale.

“Amy has a deep understanding of market dynamics, coupled with an innovative approach to partnership development. Her ability to identify new opportunities, negotiate mutually beneficial agreements, and align partnerships with the company’s broader objectives has directly resulted in significant achievements for Heartland. Her leadership has had a profound impact on DSOs,” adds Dr. Anna Singh, Senior Vice President of Clinical Operations at Heartland Dental.

I saw a chance to apply everything I’ve learned to an organization with incredible potential. Envista’s portfolio is unmatched, and I knew that by bringing everything together strategically, we could create a new kind of value for our customers.

A Vision for the Future

Amy envisions continued growth and innovation for Envista. A significant focus is on advanced training and education, with customized programs for partners like Heartland Dental and Smile Brands to help providers grow their implant practices.

“Envista has been a great partner to Smile Brands for many years and has evolved with our changing needs, always with long-term success in mind for our providers, their patients, and us as an organization. We look forward to continuing this journey together,” shares Steve Bilt, CEO of Smile Brands.

Fleet management technology is another area of focus. Envista’s suite of tools helps DSOs track and optimize equipment usage, improving efficiency and effectiveness. The DTX Studio Imaging Suite is also revolutionizing workflows by integrating diagnostics, imaging, and treatment planning into a seamless experience.

“It’s changing the way dental offices operate. The best part is, it’s an open platform that works with any existing technology, making DSOs more agile and effective,” Amy says.

For Amy, Envista’s success is about more than business — it’s about solving problems and growing relationships.

“I’m never satisfied with the status quo. There’s always room to grow, innovate, and improve. That’s what keeps me going,” she says.

Under Amy’s leadership, Envista is setting a new standard for partnership in the dental industry — offering DSOs not just the tools
to succeed but a vision for growth, innovation, and meaningful collaboration that drives long- term impact.