ASSOCIATION LEADERSHIP CAN TAKE ON MANY FORMS

Leadership in the dental field takes on many forms. From leading our own team members in the office every day to our involvement in organized dentistry and in our communities, we find ourselves called to be leaders more often than we realize. Effective leaders are passionate, committed, inquisitive, solicitous and available. They lead with integrity, handle conflict fairly and maintain confidentiality where required. While some of these qualities are inherent to the individual’s personality, many of these traits and abilities can be improved through learning opportunities and practice.

Leadership within a dental practice is frequently combined with management, and the lines are commonly blurred between the two. Leaders formulate ideas and motivate their teams to understand the vision they have set forth. Managers focus on the day-to-day activities, setting measurable goals to report success. In small businesses, these two roles often are combined and frequently overlap. My partner, Dr Ryan Caudill, and I own and manage our office, and we work hard to be as organized and clear as possible to our 18 team members. We spend time training them, outlining expectations and cultivating problem-solving skills to improve self-awareness. Our morning huddles, monthly team meetings, and yearly staff reviews keep everyone focused on common goals and ensure processes are consistently followed. We also take each team member to lunch one a year on their own with the doctors to get to know each other better. Our yearly patient appreciation parties and team-building days outside the office setting are some of our favorite memories together and help strengthen these relationships. I am a more effective leader when I better understand the person I am leading.

Leadership outside the office in our communities and professional organizations can be a challenge with varying personalities and leadership styles. Staying positive and focusing on the task at hand are helpful in achieving a favorable result that benefits everyone. At Dentists’ Day on the Hill each year, I am reminded that community leaders are looking to us for guidance on critical issues, and actively listening to understand others is the first step.

I’ve found that the most important piece of leadership is cultivating personal relationships. Becoming genuinely interested in others and getting to know them on a personal level builds trust and rapport. I aim to bring others into the conversation as much as possible, creating a safe space to voice opinions while encouraging others to listen and reflect attentively. This is especially important in our virtual (Zoom) meeting spaces, where having your camera on, being engaged and calling on those who may be more reserved is essential for ensuring everyone’s perspectives are heard and team decisions are made. As a leader, I also strive to be as available and responsive as possible, ensuring fellow colleagues and community members have my cell-phone number so they can really reach me at any time. Responding to emails, texts, phone calls and social media messages in a timely manner (aka as quickly as possible) is a vital sign of respect.

I strive every day to improve my own leadership skills through building relationships, communicating clearly and showing integrity. Reflecting on your leadership strengths as well as areas that need improvement will help you become the best leader you can for your team, your colleagues and your community.

Dr Angie McNeight Today’s FDA

Practice

I FOUND A LUMP, IS THIS NORMAL?

A Modern Approach To Clinical Oral Pathology

We’ve learned so much about ourselves and our healthcare system over the past two years and one thing is clear: Dental practitioners are essential and adaptable.

I treated a patient from out of state for oropharyngeal cancer – a tonsillar squamous cell carcinoma. He, like many people, fell victim to the fallout of the COVID-19 pandemic. His diagnosis and treatment were delayed for months as he couldn’t get in to see his primary care physician. Fortunately, his dental hygienist noted a tonsillar abnormality and made an expeditious referral for a biopsy.

This patient was planned for concurrent chemoradiation therapy to treat his tonsil cancer – a viable but “shotgun” approach to many throat cancers. At age 48, he was wary of the long-term effects of cancer therapy as they relate to xerostomia, osteonecrosis, trismus, fibrosis, and renal failure. Of course, treating his cancer was paramount, but so was maintaining long-term quality of life. Like many patients, he educated himself and found some of our publications on robotic surgery and de-escalated therapy to treat his cancer with excellent outcomes and minimal side effects. He wondered if he would qualify for this.

Through a streamlined process of virtual visits, we were able to complete his workup from a distance and collaborate with his referring dentist to coordinate in-person needs. He was an excellent candidate for TransOral Robotic Surgery (TORS) to remove his throat cancer without the need for major open surgery, radiation, or chemotherapy. This was not available in his home state.

He underwent surgery with me in Portland. We were able to clear his cancer in a single operation just two weeks after we met via Zoom. He returned to his home state one week after surgery and has remained cancer free without radiation or chemotherapy. His general dentist, primary care physician and I coordinate telehealth and in-person visits so he doesn’t have to travel to Portland for follow-up care. Prior to 2020, this sort of collaboration and coordination was cumbersome and generally avoided. Out of necessity, it has been efficient, effective and safe.

Despite these advances oral pathologic conditions can still create anxiety for patients and dental practitioners. Oftentimes, incidentally discovered oral lesions alter the timeline of comprehensive dental treatment due to the time required for diagnostic workup and inability to access the oral cavity secondary to pain and irritation. In an era where we are limiting in-person visits and personal protective equipment may be scarce, developing a decision tree for which patients should be seen and treated urgently is paramount.

“Oral pathology” is an umbrella term for the diagnosis and study of diseases affecting the mouth and surrounding structures, but colloquially has become synonymous with oral lesions not directly related to teeth. This broad discipline of dentistry encompasses hundreds of conditions ranging from common variants of normal such as Fordyce granules to rare malignancies of jaws including odontogenic sarcoma. As dental practitioners, we see conditions within this range on a daily basis. Fibromas, mucoceles, and papillomas are common and can be diagnosed via clinical exam with reasonable accuracy. The problem lies in conditions such as leukoplakia or erythroplakia, where clinical evaluation often doesn’t reflect what is happening at a microscopic level. There are four essential goals for dental practitioners to consider when they encounter oral lesions:

1. Accurately clinical characterize oral hard and soft tissue lesions to develop a differential diagnosis.

2. Use our clinical skill set to risk stratify lesions.

3. Develop a treatment plan and timeline for treatment based on the above criteria.

4. Know when to refer to a specialist for further management. As dentists, we are proceduralists and often live by the adage, “A chance to cut is a chance to cure.” Even in oral pathology, many roads lead toward a procedure or surgical intervention to diagnose and treat disease. The often-challenging component is creating a surgical prescription based on our history, physical exam, and diagnostic imaging. There are many branches in a clinical decision tree, which can be overwhelming to both patients and providers, particularly when decisional fatigue sets in. Harnessing our knowledge of the oral cavity, local and systemic diseases, and pathologic conditions allows us to use our skill set and expertise in diagnosis and treatment planning to make the right decisions for our patients.

Dr Ashish Patel Oregon Dental Association

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WHAT ARE THE ETHICAL CONSIDERATIONS OF USING VIDEO SOCIAL MEDIA PLATFORMS SUCH AS TIKTOK IN YOUR DENTAL PRACTICE?

society that its members will adhere to high ethical standards of conduct.” Furthermore, the Preamble to the ADA Code states that “dentists should possess. traits of character that foster adherence to ethical principles. Qualities of honesty, compassion, kindness, integrity, fairness. help to define the true professional.” Although these sections were developed long before the advent of TikTok and other social media applications, the message they convey is still applicable and relevant.

Question: Some of my colleagues are using social media platforms like TikTok to create short videos to appeal to a larger patient population, to build their practice bases, and to educate patients. Some of these videos can be shared in the form of duets whereby other dentists can opine on the post. So, if 1 dentist posts a video of their treatments, a second dentist can repost the video and comment if this feature is enabled by the content creator, giving their “professional” opinion, without the full knowledge of the patient’s dental history, consent, or specific case details. These “TikTok Dentists” are providing generalized treatment recommendations and have no specifics of the patient in question. I do not want to be left behind, but I wonder what the ethical considerations of this social media platform are in the world of modern dentistry.

Answer: Social media video applications offer free and potentially viral forms of communication that appeal to everyone, from Generation Z to baby boomers. In addition to reaching new audiences with generalized and viral video content, this form of communication also allows users to duet other content creators’ videos and share their own opinions or advice on the topic. When videos on platforms like TikTok are liked or viewed, the platform’s algorithm fills the user’s feed with similar videos based on the topics with which they have interacted.1 For example, if you are an avid reader and watch videos about book reviews, you will be targeted with content created by creators who also love books. Some users dub these genres as BookTok, DentalTok, and so on, depending on the topic of videos viewed regularly.

Social media is used widely among both patients and providers. TikTok, in particular, seems to be gaining momentum and, like other forms of social media use, presents both risks and opportunities. In recognition of that, consideration of some of the ethical parameters of dentists using TikTok are worthy of consideration. The Introduction to the American Dental Association Principles of Ethics and Code of Professional Conduct (ADA Code) states that “the profession makes a commitment to

The ADA Code Section 1 addresses Patient Autonomy (“self-governance”), including the patient’s privacy and confidentiality of their information. “The dentist has a duty to respect the patient’s rights to self-determination and confidentiality.” Dental care professionals who post videos that are meant to influence and educate patients about particular treatments without knowing the patient’s history or specific information about the patient may be unduly influencing patients in their decision making and therefore interfering with true self-determination. Care also must be taken to protect the confidentiality of patients when using a case history or patient’s images in these videos. In fact, in sharing this information, the dentist must be aware of not only potential ethical implications but legal implications as well, including applicability of the Health Insurance Portability and Accountability Act 3 and any relevant state laws regarding patient privacy.

Furthermore, Section 2 of the ADA Code, Nonmaleficence (“do no harm”), states, “The dentist has a duty to refrain from harming the patient.” 2 Specifically, Section 2.G., Personal Relationships With Patients, may apply when a dentist posts a video that includes a particular patient. This may “risk the possibility of exploiting the confidence placed in them by a patient” if the dental care professional posts videos in instances that could be considered unprofessional or questionable or that might portray the patient in an unfavorable light.2 Again, the dentist, if using a video regarding a specific patient, must be sure that the patient has provided their informed consent in adherence with the principle of Patient Autonomy. The dentist also must be mindful of not potentially harming other patients. When the information in the video is used in a generalizable way, without sufficient acknowledgment that each patient’s circumstances may differ, it is potentially harmful to other patients. The dentist viewing the TikTok should be mindful that although the material may have some educational benefit to how they might manage a similar situation, what is presented on TikTok is general and should not replace sound professional judgment.

Section 3, Beneficence (“do good”), is also applicable. “The dentist has a duty to promote the patient’s welfare.” This directive may support use of social media platforms if the information is educational. These types of social media platforms could be used to provide a community service such as encouraging dental health, dental education, or overall community service.

The ADA Code obligates dentists to “use their skills, knowledge and experience for the improvement of the dental health of the public.” However, we must always keep in mind that “dentists in such service shall conduct themselves in such a manner as to maintain or elevate the esteem of the profession.” So, when using a platform like TikTok, the dentist should be careful to be accurate, truthful, and protective of individualized patient information.

The principle of Justice (“fairness”) obligates dentists “to treat people fairly.” This obligation of dentists is not only toward patients but peers and the dental team as well. Section 4.C., Justifiable Criticism, might be applicable in the context of dueting. Any dentist commenting on or responding to the recommendations and work of another dentist should be careful to not disparage another dentist publicly. “Dentists issuing a public statement with respect to the profession shall have a reasonable basis to believe that the comments made are true.” If critical of the work of another dentist, airing that criticism in a public forum such as TikTok may not be appropriate without first addressing the concern with the dentist in question or, if necessary, discussing with one’s constituent or component society

Finally, Section 5, Veracity, addresses issues related to “truthfulness”: “The dentist has a duty to communicate truthfully.” Specifically, dentists are responsible for “communicating truth- fully and without deception, and maintaining intellectual integrity.” For example, making unsubstantiated recommendations would be considered unethical as would any type of advertising or marketing that is false or misleading.

Social media platforms are here to stay. They are an effective method of communication for existing and prospective patient engagement. A 2021 article by Zenone and colleagues4 acknowledges that “public health is served by paying urgent attention to the potential health-related implications and opportunities of TikTok” and suggests “a research agenda to inform decision-makers, health providers, researchers and the public.” Dentists should be mindful of these questions. The ethical dentist and, by extension, auxiliary dental staff members must take measures to ensure adherence to the ADA Code in day-to-day practice as well as when engaging in social media in their professional capacity. Although giving generalized oral health care tips may be beneficial to social media users, specific treatment recommendations should be made only once a dentist-patient relationship has been established. In addition, dentists engaging with the social media of another dentist must be sure to avoid unjustifiable criticism of peers, protect patient privacy, and maintain the integrity of the profession as a whole.

Kathleen Nichols, DDS JADA