Executive Vice President and Chief Financial Officer at Henry Schein
Okay. Thank you very much, Stanley. Thank you for those kind words, and good morning, to everyone. Before I review our financial results, as this will be my last, more than 100 quarterly conference calls as CFO. I'd like to acknowledge the relationships I have built with so many of you in the investment community, our investors and analysts. I would also like to express my deep appreciation to the finance team here at Henry Schein and other colleagues with whom I have worked closely with over the years. While I'm looking forward to life's next chapter, it's those relationships that I will remember most. I thank you for those memories and for your friendships.
Now, turning to our review of financial results, I'd like to point out that I will be discussing our results from continuing operations as reported on a GAAP basis and also on a non-GAAP basis. Our fourth quarter non-GAAP results for 2021 and 2020 exclude certain items that are detailed in Exhibit B of today's press release as well as in the supplemental information section of our Investor Relations website.
Turning to our financial results. Total net sales for the quarter ended December 25, 2021 were $3.3 billion, reflecting growth of 5.2% compared with the prior year. Internally generated sales were up 1.4% in local currencies, acquisition growth was 4.3% and foreign exchange impacted sales growth by minus 0.5%. Excluding sales of personal protective equipment or PPE and COVID-19 related products as well as prior year sales to Covetrus under the transitional services agreement, our internal growth in local currencies was 6.3%.
As you may recall, in 2020, prices for PPE products and specifically gloves increased due to some -- increased due to some supply chain disruptions that we experienced. However, prices of those products along the COVID-19 test kits have since declined, and this pricing volatility is driving the negative year-over-year sales growth in PPE and COVID-related products. You could look at the details of our sales performance contained in Exhibit A of our press release that was issued earlier today.
On a GAAP basis, operating margin for the fourth quarter of 2021 was 6.02%, representing an increase of 30 basis points compared with the prior year. On a non-GAAP basis, operating margin of 6.16% for the fourth quarter of 2021 also expanded 30 basis points compared with the prior year. Operating margin expansion was driven by increased profitability in our dental specialty products and technology businesses as well as lower inventory adjustments and improved customer supplier rebates -- sorry, improved supplier rebates.
Turning to taxes, our reported GAAP effective tax rate for the fourth quarter of 2021 was 22.5%, this compares with 17.3% GAAP effective tax rate for the fourth quarter of 2020. On a non-GAAP basis, our effective tax rate for the fourth quarter of 2020 was 22.5% compared with 17.5% for the quarter last year. The lower effective tax rate for the fourth quarter last year in 2020 was favorably impacted by income tax resolutions both in the US and internationally.
Moving on, GAAP net income from continuing operations attributable to Henry Schein for the fourth quarter of 2021 was $147.2 million, or $1.05 per diluted share, this compares with the prior year GAAP net income from continuing operations of $141.9 million, or $0.99 per diluted share. On a non-GAAP basis, net income from continuing operations for the fourth quarter of 2021 was $150.7 million, or $1.07 per diluted share, and this compares with the non-GAAP net income from continuing operations of $143.6 million, or $1 per diluted share for the fourth quarter of 2020.
Our amortization from acquired intangible assets for Q4 2021 was $32.6 million pre-tax or $0.15 per diluted share. This compares with $25.3 million pre-tax or $0.11 per diluted share for the same period last year and that excluded the non-cash intangible asset impairment charge that was $18.1 million. For the full-year 2021, amortization from acquired intangible assets was $122.9 million pre-tax or $0.54 per diluted share, and this compares with the prior year that was $102.1 million pre-tax or $0.46 per diluted share. That also excluded the combined non-cash asset impairment charges in Q1 and Q4 of the prior year of $20.3 million. I'll note that foreign currency exchange positively impacted our Q4 2021 diluted EPS by approximately $0.005 [Phonetic].
Let's now look at some of the details of our sales results for the fourth quarter, starting with Global Dental, which had sales of $2 billion and increased 9.4% compared with the same period last year, with internal sales growth of 6.4% in local currencies. Global dental consumable merchandise internal sales increased 6.6% in local currencies in the fourth quarter of 2021 compared with the prior year. Excluding sales of PPE and COVID-19 related products, internal sales growth in local currencies increased 7.4%.
Our North American Dental internal sales growth in local currencies was 9.3% compared with Q4 of last year and was driven by solid growth both in our consumable merchandise as well as our equipment product categories. Our North American dental consumable merchandise internal sales and local currencies increased 10.3% compared with Q4 of 2020 were 10.1%, again when excluding sales of PPE and COVID-related products. North American dental equipment internal sales growth in local currencies was 6.6% compared with Q4 of 2020. We had strong growth in our high-tech product offering, specifically CAD/CAM in the US, which received a boost from the DS World event, which we saw modest growth in traditional equipment and also which remains impacted -- the traditional equipment remains impacted by manufacturing and office construction delays.
International dental internal sales growth in local currencies was 2.5% compared with Q4 2020. And we had really strong sales growth in the prior period with sales growth of 14.2% in Q4 2020 in local currencies. International dental consumable merchandise internal sales in local currencies increased 1.9% compared with Q4 of 2020 were 4%, excluding sales of PPE and COVID-related products. Again as a reminder, Q4 2020 the prior year international dental consumable merchandise sales growth was quite strong at 16.7% in local currencies. International dental equipment internal sales growth in local currencies was 4.2% and that is also against a bit of a difficult comp in the prior year when the growth was 6.8%.
If we look at our dental specialty products, sales of dental specialty products were approximately $244.8 million in the fourth quarter with internal growth of 15.1% in local currencies compared with the prior year. Growth was strong in each of our dental specialty categories, including all surgery, which consists of implants and bone regen products as well as endodontic and orthodontic products, with all three categories performing well globally. For the full-year 2021, our dental specialty products were $928.6 million, with growth of 27.2% in local currencies over the prior year and contributed $186.3 million to our operating income.
Turning to Global Medical, our Global Medical sales during Q4 of $1.1 billion, was a decline of 3.2% compared with the same period in 2020 and internal sales growth in local currencies declined 7.1%. Internal sales growth declined in North America 6.6% and international sales declined also at 24% year-over-year. The medical sales decline was driven primarily by lower sales of PPE and COVID-related products, mainly COVID test kits. If we exclude the sales of the PPE and COVID test kits, our global medical internal sales growth in local currencies increased 3.6% compared with Q4 of 2020.
I'll also note, we sold approximately $185 million of COVID test kits in the fourth quarter of 2021. That includes about $40 million in multi-assay flu and COVID-19 combination test kits. And this compares with approximately $270 million in test kits that was sold in Q4 of 2020. We expect continued volatility in sales of test kits in the upcoming quarters.
Now turning to technology and value-added services sales during Q4 were $177.2 million, an increase of 27.8% compared with the prior year and that includes internal growth in local currencies of 13.4%. North American technology and value-added services internal sales growth was 12.6%. Backlog was primarily driven by our revenue cycle and claims management revenue products. Internationally, the tech and value-added services internal sales increased 17.8% compared with the prior year. And this growth was driven primarily by strong sales in EMEA, including sales growth in the UK, which benefited from a favorable comparison due to last year's prior year lockdown.
For the full-year 2021, technology and value-added services sales were $640.9 million, an increase of 24.6% compared with the prior year, and included internal growth of 13% in local currencies, and had operating income of $125.6 million. We continue to repurchase common stock in the open market during the fourth quarter buying approximately 2 million shares at an average price of $75.50 per share for a total of $150 million. The impact of this repurchase on our fourth quarter diluted EPS was immaterial. For the full-year, we spent $400 million to repurchase 5.5 million shares of our stock. And I'll note, at the year-end, Henry Schein had approximately $200 million available for future stock repurchases.
Turning to our balance sheet and cash flow, we continue to have access to significant liquidity providing flexibility and financial stability. Our operating cash flow from continuing operations for the fourth quarter of 2021 was $276.6 million that compared to $345.1 million for the fourth quarter of last year. And this decrease in operating cash flow was attributable primarily to increased inventory, including COVID test kits, year end investment inventory and reserve stock due to delay in lead times for manufacturers. For the full year, our operating cash flow from continuing operations was $709.6 million and that compares to $593.5 million in 2021 -- in 2020, sorry.
I will conclude my remarks by noting that we are updating our 2022 EPS guidance. The guidance is for GAAP EPS only. We are not providing non-GAAP EPS guidance for 2022, as we do not currently anticipating using non-GAAP financial measures for the year. Although this decision could change in the future. For 2022, we expect EPS from attributable to Henry Schein will be in a range of $4.75 to $4.91, reflecting growth of 7% to 10% compared with our 2021 GAAP diluted EPS of $4.45 and growth of 5% to 9% when compared with our 2021 non-GAAP diluted EPS of $4.52.
Our guidance for 2022 has a number of key assumptions, I'll review some of those. 2022 assumes that our total sales growth will be somewhere in the range of approximately 6% to 8% over 2021, and that includes sales of COVID tests declining approximately 10% from 2021 levels that were approximately $650 million. I'll also note that 2022 includes one extra selling week compared with 2021. This is our 53rd week year, and that occurs in the fourth quarter of 2022. For 2022, we are also expecting to achieve operating margin expansion. Our guidance assumes a range of 20 basis points to 25 basis points over the 2021 non-GAAP operating margin of 7.06% and operating margin expansion, 39 basis points to 44 basis points over the 2021 GAAP operating margin of 6.87%.
Lastly, we expect the effective tax rate to stay in the 24% range, and of course, that assumes no significant changes in tax legislation. Our guidance for 2022 diluted EPS is for continuing operations as well as completed or previously announced acquisitions, but does not include the impact of future share repurchases, future acquisitions or restructuring expenses, if any. Our guidance also assumes that foreign currency exchange rates are generally consistent with current levels that end markets remain stable and are consistent with current market conditions. And there's really no material adverse market changes associated with COVID-19.
Last, I'd like to note that we anticipate our first quarter EPS first quarter of 2022 will be slightly lower to flat compared with the first quarter of 2021 non-GAAP EPS, and this is due to really a very strong prior year and a difficult prior year comparison that we're seeing in Q1.
With that, I'll turn the call over to Ron South.