The Utah Dental Association holds itself wholly free from responsibility for the opinions, theories or criticisms herein expressed, except as otherwise declared by formal resolution adopted by the association. The UDA reserves the right to decline, withdraw or edit copy at its discretion.
UDA Action is published bi-monthly. Annual subscriptions rates are complimentary to all UDA members as a direct benefit of membership. Non-members $30.
UDA Action is published by Mills Publishing, Inc. 801-467-9419; 772 East 3300 South, Suite 200, Salt Lake City, Utah 84106.
WE CAN’T DO IT ALONE
This summer I attended the white coat ceremonies for the first year dental students at the University of Utah and Roseman University. I couldn’t help but notice as each student came forward to be fitted with their white coat that there was a loud roar of support and approval from different sections in the audience. These cheering sections were clearly voicing their pride for the student’s accomplishments. It reminded me that the journey through the dental profession is not made alone. Whether it is parents, a spouse or a significant other, we all rely on the support of others to make it successfully through. I was again reminded of that when I sat down to write this article. My wife, seeing me struggle to find a topic to write about, suggested that it might be fun and different to hear from someone other than the dentist, but rather from someone who was a supporter of our dreams and ambitions. I thought it was a terrific idea and asked her if she was willing to share her experience, which she agreed to do. The following is her account of an unexpected journey.
“It’s apropos to begin by saying that each and every journey begins with a single step or event. That first step, is a leap of faith into an unknown future. My dental journey began when I met Len Aste back in 1982. Soon after we were married Len decided that he’d like to pursue a career in dentistry. Not knowing what a future married to a dentist would look like, I fully committed and jumped into the deep end with both feet.
Soon after that decision was made, the endless hours of studying began. We were both pursuing our Bachelor degrees at the U of U at the time so we moved into a duplex in the Avenues in SLC. The duplex was ugly, cramped and small. It was cold in the winter, deathly hot in the summer and had insane amount of cockroaches when the lights turned off. But at the time we really didn’t mind too much. The kitchen became our office. The kitchen table became our desk. We sat in two chairs opposite each other as we poured over text books, notes and wrote papers. The hours were slow to pass, but expectations were high and energy was at a surplus. We managed to have fun despite the endless hours of study that were required to pass difficult classes and fill out admission paperwork that never seemed to end. Almost three years later, it all seemed to have paid off as we were accepted into the RDEP program offered through Creighton University.
That first year of dental school was brutally demanding. Not too many months into that first semester, all of the dental student’s wives were coerced into service. I was to be a practice victim of impression taking. Len said it would be fun, he said it would be easy and he would never pass without practice. I sat in the chair with my mouth wide open willing to accept a tray that was so overfilled with alginate that it soon slipped down my throat in slimy globs. As I puked and gagged over the sink as Len pulled that giant slug out of my throat, I momentarily thought that
his dental career would be a very short one. Thankfully, he got much better.
We moved to Omaha and began life as starving students for real. We worked crazy jobs, got a semi-blind dog, bought the cheapest little house in the city, endured brutal winters and melting humidity, but we trudged on. After three years when Boards rolled around I thought the pressure would kill us both. The intensity of it all was oppressive and it weighed heavy on Len. But as always, Len did great and we were ever so proud of day when he walked across the stage to accept his diploma. I felt I deserved a diploma too, after all, I had been through it all with him.
Starting a practice was thrilling, exhausting, perplexing and overwhelming. We had four little children when we purchased our first practice in rural Utah. Around town I soon was known only as the new dentist’s wife. At first I resented that I had no identity of my own, so I actively sought to establish myself in the community in ways that served my family’s best interests.
I was often recruited to fill in at the practice. I began to realize that the long hours Len spent taking care of patients and the business end of things were above and beyond what many others might do. It helped me to support his efforts even when they took him away for long hours and left me home with a house full of busy active kids, dirty dishes and other chores. He truly gave his blood, sweat and tears to his practice, patients and tothe community.
His dental practice allowed me to choose to be a stay at home mother. A choice I was grateful for then and more grateful for now. It provided a steady income, security and plenty for all the things that we needed. It provided us with a way to know and love the citizens of our community. It helped us to grow as individuals, learn greater compassion and provide a necessary service to those in need. Len was able begin a nonprofit humanitarian group that has traveled extensively to serve the poor and the needy. He has brought pain relief, better health and much joy to many throughout the world through his service. The road wasn’t always smooth or without challenges. But we grew through those challenges and became better, more compassionate people. Dentistry has blessed us in ways that we never could have imagined. It has blessed our children. All those hours studying at the kitchen table certainly paid off and we are grateful for the path that dentistry has lead us down.”
Ellen Aste, wife Len Aste, DDS, President of the UDA
1. Do you have or have you considered an exit strategy?
2. How long do you plan on being a practice owner? If your health allows, would you like to continue practicing after that point?
3. Do you know what your practice is worth today? How do you know? When was your last Practice Valuation done?
4. Have you met with a financial planner and have a documented plan? Have you established a liquid financial resources target that will enable you to retire with your desired lifestyle/level of income?
A JOURNEY TO EDUCATION: THE BENEFITS OF TEACHING
On the road to becoming a dental professional, we all have teachers who inspire us and leave an impact as we navigate our careers in the dental field. As a young dentist, it was hard to picture myself as being one of those knowledgeable educators. Now, a decade later, I can’t imagine ever not becoming a teacher to those who have come after me. Starting out, most new dentists are eager to begin practicing in the “real world”, and I was no exception. Working hard with a busy, consistent schedule at a thriving practice was what I thought the next, and final, step was supposed to be—the end game. But the beautiful thing about dentistry is that there are many different pathways and places to work as a dentist, and private practice is not the only destination. There are many advantages to working in education, even as a part-time or occasional teacher, or even a mentor to novice dentists. My own journey has proven to me that there is something to be gained for anyone willing to teach.
During the pandemic, dentistry as a whole took a hit, with many businesses temporarily or even permanently closing. As an associate in a very large practice, I was essentially unemployed for several weeks until our office could open up again with enough patients to fill the schedule. During this time of forced leave, I realized I had been grinding away at a very physical job, without much energy left to enjoy my spare time. I was working 50-hour weeks, for a business that I did not own or plan to buy. My back hurt, I still had crushing student loan debt, and I felt like I had hit a stagnant point in my career. It was then that a friend and colleague suggested that I spend a couple of days teaching at a dental school, if nothing else but to take a rest. I never would have guessed that I would become a fulltime professor, starting off my career in higher education.
I started out as only a 1 or 2 day a week part-time faculty at Roseman Dental School, to alternate with my days working as an associate in private practice. I quickly found that I enjoyed teaching, and it was more fulfilling than I expected. It didn’t take long for me to discover the other perks as well. I would spend all day talking about dentistry, passing on any pearls I could to the students, who quickly consumed it all. Dentistry is a profession that is very difficult if you don’t love what you do; as a result, most of us tend to be very passionate about our field. I loved that I could spend all day speaking with colleagues and aspiring dentists about all aspects of what makes dentistry great. Students are eager and excited to soak up as much information as I can give. Private practice can sometimes be a lonely place without fellow peers to commune with. I found that as an educator, I can discuss interesting cases with students, but also have a building full of other experienced dentists to discuss ideas, treatments, and new techniques. I get to learn just as much as I teach. The patients are grateful as well, since
most of them are unable to go to private practices due to their difficulties in access to care or financial constraints. Caring for patients without the stress of meeting a production threshold or worrying about overhead relieves a burden that is often heavy in many practices. The more time I spent teaching in the clinic, the less I felt the effects of the burn out that were clearly creeping in from years of over work.
Once I discovered the tangible perks of education, I decided to switch to become a full-time faculty at Roseman. The great thing about being an employee is the benefits that exist, especially in education. Rarely do dentists get things such as retirement accounts, insurance coverage, or maternity leave. I have been lucky enough to receive all of the above. Not only are benefits an incentive, but as a grad with massive student loans, I can qualify for Public Service Loan Forgiveness by working at a dental school, in addition to the other types of programs that exist for educators. While the income potential may be higher in private practice, I feel that the perks and loan repayment opportunities make teaching a competitive job opportunity even for younger dentists. In addition, most dental schools encourage their faculty to continue working part time in a faculty clinic or other practice treating patients, so that they can stay sharp with their clinical skills. I love that I am able to work some days in a private practice as a treating dentist while still being considered a full-time faculty member at a school. I feel that I can have the best of both worlds, with the flexibility to take on different roles.
After working for a couple of years as a faculty member in the clinic, I would absolutely encourage all dentists to spend a few days teaching at some point in their career, whether it be in a position at a dental school, a clinic that includes rotating dental students, or even just as a mentor in practice. Often, people plan to teach as a retirement option, but I would argue that there are many advantages for even newer dentists to contribute. Novice dentists can relate well to students, and can continue expanding their own knowledge while they are still new in their career. PSLF and other loan repayment programs are great financial incentives, and benefits can offset a lower pay. There are built in holidays and vacations, and almost never a need to go in after hours for emergency patients. I am so happy to have recovered a fantastic work-life balance, which I personally found to be more difficult prior to teaching. I don’t know what the future of my career entails, but I do know that becoming an educator has been very fulfilling, and opened up many more opportunities for me in the world of dentistry. I can only hope the same for all of my peers who choose to teach.
Laura Kadillak, DDS UDA Alternate Delegate
RESEARCH
A WORLD OF OPPORTUNITIES
Good things can happen when cultures come together. The Olympic Games raise the bar in athletics; bring athletes, staff, and fans together both on and off the field; are a source of national pride for participating and winning teams; and allow the host country to showcase their culture and accomplishments, and through that provide an enriching experience for all countries in attendance.
On a smaller but more commonly attainable scale, enrichment also occurs at international conferences, international travel, and multi-center research. For the enrichment to occur, individuals from different cultures and countries must interact.
Schools appreciate this and set up exchange programs accordingly. Like international sporting events, they have various benefits.
Interacting with students from different counties opens our eyes to different educational systems. For much of the world, the undergraduate and dental school curriculum are combined, starting after the equivalent of high school, and spanning six years. It is up for debate whether that system or the United States’ system is superior or simply different, but meeting students from both systems allows for an experiential exchange of ideas that can lead to improvements in those systems.
Sometimes the student exchanges include involvement in research. In preparation, the student must study the past discoveries and current research methods and areas of investigation of the researchers they are visiting. Such preparation trains the student to better understand research articles, which clinicians should be using as reliable sources of information.
A natural part of sending and hosting foreign students is a strong effort to present our best, to put our best foot forward. The student represents the sending professor, the school, and the country and culture. That student is motivated to become fully qualified in knowledge and ability. The motivation is stronger, and more fun and energizing, than preparing for an exam. This is a pleasant way to raise the bar.
At UOP, the first student that went to Japan inspired the host university to send a student to us. Less than a year later, another of our students made the trip. We required our students to prepare heavily for the experience by studying the background research and current research protocols for the areas they would be joining, and subjected them to rigorous oral examinations confirm their preparedness. The privilege’s reputation for high academic standards will inspire future students to similar levels.
This collaboration can also progress research and clinical practice and policies. Different countries and cultures have different healthcare delivery systems, demographics, and
diets, and can therefore offer new insights into etiologies, prevention, and treatment. For example, the lists of approved drugs differ by country.
Dentists outside of the school setting can become involved with foreign dentistry as well. International conferences bring dentists from many countries under one roof. Even many national academies have a significant number of nonUS-practicing dentists in attendance. At these conferences, interactions between countries can occur formally and informally, and often lead to future collaborations. Taking a leadership role in those academies can take the international collaboration even further.
Participating in research can also create international connections, as much research is done between institutions from different counties. Research is frequently done at schools, but can also be done in hospitals, community clinics, and as part of the Public Research Network, which private practices can join (https://www.nationaldentalpbrn.org/.)
Opportunities await, big and small.
Andrew Young, DDS, MSD
KEEPING YOUR TEAM SAFE: HOW TO DE-ESCALATE ENCOUNTERS WITH AGGRESSIVE
During her 25 years of practice as a periodontist, Ann Blue, D.D.S., has encountered fearful and upset patients, but she and her staff are trained to de-escalate these situations to resolve them in a calm manner.
“Managing these patients and keeping my team and other patients in the practice safe is definitely an important skill to develop,” said Dr. Blue, a member of the ADA Council on Communications.
Recent violence against dentists, including the fatal shooting of a California dentist by a former patient in February, underscores the dangers dentists may face in their workplace.
PATIENTS
Survey data from the 2024 ADA Council on Communications Trend Report found more than half of responding ADA member dentists sometimes or often encounter aggressive patients.
The survey was conducted this spring and included responses from about 560 member dentists who are part of the Advisory Circle research panel. Generally representative of overall ADA membership, the panel is made up of members who participate in surveys typically focused on practice-related topics. The report will be published this fall.
Encounters with aggressive patients were more common among dentists younger than 35 and dentists working at federally qualified health centers and dental school clinics, according to the survey. About 30% of respondents reported they have felt their safety threatened by a patient. These instances were more common among female dentists, dentists working at FQHCs and dentists working as employees or associates at dental support organizations.
While health care workers make up 10% of the workforce, they experience 48% of nonfatal injuries caused by workplace violence, according to 2023 data from the Bureau of Labor Statistics. The most common perpetrators of this violence against health care workers are patients, patients’ family members, visitors, colleagues and supervisors, according to the National Institute for Occupational Safety and Health. Health care workers may also experience violence from someone they know personally, such as an intimate partner or family member. The Occupational Safety and Health Act’s General Duty Clause requires employers to provide their workers with a workplace free from recognized hazards that are causing or likely to cause death or serious physical harm. OSHA also requires employers to establish an emergency action plan for workplace emergencies such as workplace violence, natural disasters, fires and more.
For employers with more than 10 employees, the plan must be in writing, kept in the workplace and available to employees for review. An employer with 10 or fewer employees may communicate the plan orally to employees. The plan must include emergency escape procedures and route assignments, such as floor plans, workplace maps and refuge areas.
OSHA’s Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers call upon employers to establish a workplace violence prevention program as part of their overall safety and health program. The violence prevention program should have clear goals and objectives for preventing workplace violence, be suitable for the size and complexity of operations, and be adaptable to specific situations and facilities, according to the guidelines.
The guidelines encourage employers to conduct surveys to determine if employees feel threatened, solicit employee input to reduce the threat of violence, make structural and procedural changes that protect employees from enraged clients or customers, and provide training and education in the early warnings and prevention of workplace violence as part of their violence prevention program.
OSHA is considering establishing a standard for the prevention of workplace violence in the health care and social assistance sector that would include requirements rather than guidelines for employers. A May 2023 report on the proposed standard by the Small Business Advocacy Review Panel — which includes representatives from OSHA and other federal agencies — identified dentists and dental hygienists as direct care occupations that are at risk of workplace violence.
“Sadly, our reality as dental professionals is that what should be a safe place at our office is no longer the case,” said Kami Dornfeld, D.D.S., chair of the ADA Council on Dental Practice’s Dental Team Wellness Advisory Committee. “We must pivot and provide our teams with de-escalation techniques to safely manage aggressive or upset patients and prevent workplace violence. Training on these techniques could keep the entire dental team prepared to defuse aggressive behavior through proven communication methods or other safety and security measures.”
At her practice, Dr. Blue and her team regularly practice patient management skills, including communication and conflict resolution. She offers the following advice for dealing with upset patients:
Photo: Image licensed by Ingram Image
1. De-escalation: Employ active listening, maintain a calm demeanor, use nonconfrontational language and acknowledge the patient’s feelings. It is important to maintain empathy and avoid reacting defensively when a patient may be accusatory.
2. Maintain communication: As a team, attempt to explain diagnoses, treatment recommendations, alternative options and potential negative outcomes as clearly as possible in layman’s terms. A well-informed patient who understands what is being recommended and the possible side effects of treatment will be less likely to be upset when a negative outcome does occur.
3. Be observant for signs of patient agitation: Dentists and their teams need to be able to recognize the early signs of agitation or aggression in patients. These signs may include frustrated facial expressions and demeanor, snide comments, raised voice volume, clenched fists, pacing, or threatening body language. By identifying these signs early, dental teams can attempt to intervene before the situation escalates.
4. Establishment of boundaries: It is important for dental practices to have clear policies for proper professional behavior. Teams should show respect for patients and their concerns while also establishing boundaries for patients and encouraging them to maintain acceptable behavior and avoid offensive remarks.
5. Team collaboration: Team members need to work together to solve problems to avoid escalation. If a situation escalates, a colleague should be nearby to help, including by contacting on-site security or law enforcement if needed. Role-playing potential conflicts can help to develop team members’ confidence in dealing with patient concerns and disruptive behavior and avoid escalation to violence.
6. Ability to seek assistance: Ensure team members know it is always acceptable to ask for help if they feel overwhelmed or unsafe. Calling law enforcement may be necessary if they believe they are in danger.
“Following these steps and continuously refining your communication and conflict resolution skills will help you manage upset or aggressive patients in your practice and keep you, your team and your patients safe,” Dr. Blue said. Mary Beth Versaci ADA News
ADVOCATING FOR DENTISTRY: WHY DENTISTS SHOULD BE THEIR OWN BEST ADVOCATES ASSOCIATION
In a world where healthcare professions are continuously evolving, it’s crucial for dentists to take an active role in advocating for their field. Here’s why it’s essential for dental professionals to champion the importance of dentistry and what they can gain from it.
• If you are silent, then others who may not share your interest will have a louder voice and influence over elected officials impacting your profession.
• You are the dental expert – use your voice to help educate elected officials (local, state and federal) on policies that will have an impact on your patients and your profession.
• People do not understand the level of training required to practice as a licensed dentist. Do not leave your skill level to the imagination of others – be vocal about your profession.
• National groups are spending time and money advocating to change the way dentistry is practiced. You must be pro-active and develop relationships with your elected leaders, who will come to you first as their dental resource.
• Scope of practice is pitched as a solution when groups try to address access to care issues – it is important for policymakers to get the facts about why expanding scope may have a negative impact on patient care.
• We must speak with one voice. We need to show legislators that you believe in your profession and are willing to get involved to protect it.
• If you are not at the table, then you are on the menu.
Joe Ann Hart
TRANSFORMING DENTISTRY WITH CHATGPT A guide to optimizing patient care
ChatGPT is a groundbreaking artificial intelligence (AI) model developed by OpenAI, based on the GPT-4 architecture. It leverages advanced AI technology to understand and generate humanlike text, making it capable of carrying out complex tasks and engaging in meaningful conversations with users. It can also understand and generate images, although this cannot yet be done directly through the ChatGPT interface. In the next year or two, it is expected to understand and generate video and audio. This AI tool is transforming various industries, and dentistry is no exception. Although the technology has yet to be integrated into health-related fields as barriers of privacy, integration and accuracy remain in place, envisioning a future place for ChatGPT in the dental field will allow us to prepare for its potential benefits and associated limitations. ChatGPT holds the promise of revolutionizing the way we provide dental care. As dental care professionals, students, and innovators, we have a responsibility to harness the power of emerging technologies and stay informed about the latest advancements to ensure we optimize patient experiences and promote the ongoing growth and development of the oral health care field. However, to deliver the best possible care, we must be aware of the limitations of this technology and the harm that can come from its irresponsible use. Errors within the dental care field can be costly; we must capitalize on the technology while remaining cautious of its limitations.
The following are potential use cases of ChatGPT in the clinical setting that can be implemented in the coming years, alongside the necessary precautions that must be addressed before use in clinical practice.
Preliminary Patient Assessment
ChatGPT can gather essential patient information, like medical and dental history and patient concerns, before an appointment. This can save time and provide dentists with valuable insights. ChatGPT can be integrated into chatbots or virtual assistants on dental practice websites, mobile apps, or messaging platforms, allowing patients to interact with ChatGPT through text or voice. ChatGPT can then process responses and generate a summary or report for the dentist to review before the appointment. Information from filled-out PDFs can be converted into a format that ChatGPT can understand and process, allowing it to compile and analyze the data. Despite the great potential of ChatGPT’s providing key insights in a succinct manner, we must always prioritize the privacy of our patients and the need to acquire a complete, accurate, holistic medical and dental history before engaging in any treatment. We must take necessary HIPAA (Health Insurance Portability and Accountability Act) precautions and understand that if we rely solely on ChatGPT to gather medical and dental history and give a preliminary patient assessment, we can risk gathering incorrect or incom-
plete information from the medical and dental history from ChatGPT’s output.
Oral Hygiene Education
ChatGPT can offer personalized oral hygiene instructions to help patients maintain good oral health and prevent common dental problems. This tailored guidance can help patients prevent cavities or gingival disease and foster a better understanding of the importance of oral hygiene. The limitations with this application stem from the specific information used to train the model and how all transmitted medical and dental advice must be verified by a licensed dental care professional. We must ensure that the data used to train the models are consistently up to date with academic articles and findings. Most importantly, however, all information delivered to patients contained medical and dental advice must be verified by a licensed dental care professional. To potentially address this limitation, engineers can program ChatGPT to avoid answering risky questions, limiting liability.
Post Treatment Care Guidance
ChatGPT can support patients during their recovery by providing postprocedural care instructions, medication reminders, and answers to common questions. Based on the specific treatment received, ChatGPT can generate customized guidance on how to care for the treated area, manage pain, or maintain oral hygiene. However, because of the risk associated with incorrect advice regarding medications and postoperative maintenance, limitations are once again present in that a licensed dental care provider must verify all medical and dental information sent to patients. Although ChatGPT has potential in providing postoperative care, the accuracy of guidance given to patients must always be prioritized.
Dental Anxiety Support
Many patients experience dental anxiety, which can have a negative impact on their overall dental experience and lead to avoidance of necessary care. ChatGPT can offer various relaxation techniques, coping strategies, and information about dental procedures to address this fear. For example, it can teach patients breathing exercises, visualization techniques, or progressive muscle relaxation to help them stay calm during appointments. Furthermore, by providing clear and easy-to-understand explanations of dental procedures, ChatGPT can help alleviate patient’s fears and concerns. Video-generating capabilities that are expected to enter the market in the next year can create tailored video explanations and relaxation strategies for each patient. In anticipation, we must make sure that direct patient support is given, and that any medical or dental advice delivered to patients is verified by a licensed dental care professional.
Conclusions
By responsibly embracing this AI technology, dental care professionals can offer their patients more tailored and efficient care, leading to improved treatment outcomes, greater patient satisfaction, and overall better oral health. As we continue to witness rapid advancement in AI, it is essential for dental care professionals to remain at the forefront of these innovations and provide the highest quality of care in an increasingly digital world. However, because of the great risks that come from inaccuracy and poor health care delivery in dentistry, we must ensure that the limitations of ChatGPT are considered before we begin its implementation.
In the coming years, it is important for researchers to study the real-world implementation and success of these potential use cases and ChatGPT as a whole. This commentary is intended as a spark to ignite the conversation, and envision a more digitalized future of dentistry, with the intention that future studies evaluate how well the technology integrates into real patient care. If used cautiously and responsibility, ChatGPT presents an opportunity not only to revolutionize the way we deliver care, but also to make a lasting positive impact on the lives of our patients.
Camila Tussie, BS JADA April 2024
PRACTICE
PATHOLOGY PUZZLER
A 16-year old male patient presents to your clinic with a desire to remove his wisdom teeth. He reports having some dental work done in the past and that he has “something in his jaws” that his previous dentist discussed with him but has no other medical history to report. You take the following panoramic radiograph.
What disease or pathology do you suspect?
A) Multifocal Idiopathic Osteosclerosis
B) Florid Cemento-Osseous Dysplasia
C) Multiple Osteomas Associated with Gardner Syndrome
D) Intramedullary Osteosarcoma
(continued on page 22)
Equipped with the right tools to provide quality care with a smile. Just like you.
Your patients count on your expertise to evaluate and care for healthy smiles. Let your independent insurance agent do the same for you when it comes to recommending coverage options to help protect your practice.
Find an independent agent representing The Cincinnati Insurance Company by visiting cinfin.com or by calling Mike Terrell, 800-769-0548.
ASSOCIATION
I HAVE A CONFESSION TO MAKE
I have a confession to make. After being an active, dues-paying member of the ADA for over 18 years, I began to feel disenfranchised with the organization and started to wonder if continued membership was really worth the money. I found myself wondering more and more if the organization was really fighting for me, a sole practitioner in a small town. Then the pandemic came and further fed my doubts about the importance of the organization and the value of membership. I never quite took the step of officially opting not to renew, but I came very close. I am so glad that I never relinquished belonging to the American Dental Association. Last year, local elected officials in my town voted to add a ballot initiative to allow the citizens to vote on whether or not to continue to fluoridate the community’s water supply. I was amazed at the resources that were immediately available, free of charge, through the ADA and their partners that helped us educate the community and influence them to recognize the health and economic benefits of fluoridation. Due to a concerted effort of the dentists of our local district and the resources of the ADA, the citizens of Brigham City voted to keep fluoridating the water supply and will continue to reap the benefits thereof. Our national umbrella organization directly helped my small community.
Having now served as the UDA Secretary for just a few months, I feel as though the curtain has been pulled back and I have had a backstage pass to see just how much the ADA truly does for dentistry as a whole and how tirelessly the UDA fights for dentistry here in Utah. I’m amazed at the efforts of the UDA staff, the Board, the local ADA delegates, and the countless
volunteers that head different committees that I, quite honestly, didn’t even know existed. I have seen countless examples of how the power of united dentists is elevating the profession, advancing oral health research, improving access to care, and creating healthier communities. I have seen and can now appreciate how strong state and national bodies are much more difficult for political and legislative bodies to ignore. In retrospect, I see that my sense of disenfranchisement from the ADA came more from my personal ignorance and tendency to self-isolation than it ever did from an actual lack of benefit from the ADA.
I recently read an article that discussed how society as a whole is shifting away from belonging to large groups. This is reflected by plummeting memberships in once-strong organizations as society is tending to focus more on the individual rather than on community. In the early 1950’s about 75% of US physicians were reportedly members of the American Medical Association. Today, less than 15% of practicing physicians now belong to the AMA. The ability of the AMA to advocate for physicians has been radically diminished. I hope to never see that happen to our professional organization.
Certainly, our organization is not perfect, and it must adapt and change with the changing times, but who better to effect that change and guide its transformation than us, its members, and those we’ve chosen to lead it into the future. After getting to know many involved in the running of the UDA, I’m impressed by the intelligent, hard-working men and women who freely give of their time and energy. I’m confident that the organization is in good hands and positive changes are being made. I see the desire to adapt and to eschew rigidity and unwillingness to change…those very characteristics that are relegating so many other organizations to irrelevance and impotence. I’m learning that the ADA/UDA is “ours”, not “theirs”. My continued membership empowers and enables the positive changes to continue to happen. My updated perspective is that, even though the ADA has flaws and imperfections that are irksome at times, we would be foolish to allow the foundational strength and positivity of the ADA to wane. Our need for unity has not outlived its usefulness and is not outmoded. Our unity will help to keep that ADA relevant and strong.
Benjamin Franklin is quoted as saying, “We must all hang together, or assuredly we shall all hang separately.” I am convinced that by working in concert and embracing the unity that is provided in our ADA/UDA, we can be assured that we have an advocate looking out for our profession and, ultimately, our patients.
Randy Capener, DMD UDA Secretary
REACTION VS. PREVENTION
In the classic public health parable credited to medical sociologist, Irving Zola - You and a friend are having a conversation at a narrow park by the side of a river. Suddenly you hear a shout from the direction of the water – a child is drowning. Without thinking, you both jump in, grab the child, and swim ashore. Before you can recover, you hear another child cry for help. You and your friend are quickly back in the river to rescue her as well. Then another struggling child drifts into sight . . . and another . . . and another. The two of you can barely keep up.
Suddenly you see your friend wading out of the water, seeming to leave you alone. “Where are you going?” you demand. Your friend answers, “I’m going upstream to see why so many kids are falling into the water.”
This story illustrates the tension between mandates to respond to emergencies - help people caught in the downstream current; and prevention - understanding the behaviors which keep people safe and healthy, a business sustainable, and relationships constant.
In his 2020 book, Upstream, Dan Heath wrote:
“I prefer upstream to preventive or proactive because I like the way the stream metaphor prods us to expand our thinking about solutions. Upstream efforts are intended to prevent problems before they happen or, alternatively, to systematically reduce the harm caused by those problems. Downstream action (reacting) is more tangible- easier to see and measure. There is a maddening ambiguity about upstream efforts. How do you prove what did not happen?
Surely we would all prefer to live in the upstream world where problems are prevented rather than reacted to. What holds us back? Organizational systems can blind us to the awareness of inefficiency. So often in life we get struck in a cycle of response. We put out fires, deal with emergencies, handle one problem after another, but never get around to fixing the system that caused the problems.”
In 2023 the U.S. healthcare industry was a $4.8 Trillion business, constituting nearly one fifth of the American economy with $478 Billion (10%) being spent on dental care. Utah’s economic impact from dentistry in 2023 was $5.2 Billion, employing over 35,000 individuals. (ADA/HPI)
Going Upstream For Your Patients
Preventive dentistry has its origins in the early 1900’s with published papers and public lectures on dental decay prevention, establishing schools to train dental hygienists, and the marketing of fluoride containing products. By the 1950’s the modern toothbrush was invented and water fluoridation introduced. Did you know that the good old brush twice a day and see your dentist at least twice a year was originally an ad campaign for Pepsodent in 1929? Beginning in 1929 and continuing until 1937, “Amos ‘n’ Andy” announcer Bill Hay would conclude
each of his commercials with that slogan, and the idea of appointments every six months was embraced by the dental profession as a standard from then on. Some insurance companies even use that interval to define their standards for payment. (This isn’t actually an appropriate interval for many of our patients who need more frequent continuing care for controlling their perio disease or less frequent because of excellent home care and awareness of cariogenic potential of foods and beverages)
ADA resources are numerous. Sharing your ADA.org log in credentials with your dental team can help us communicate consistently as we educate our patients.
Key Points to strategize “Upstream” systems with your team:
• Systematic methods of caries detection, classification, and risk assessment, as well as prevention/risk management strategies, can help to reduce patient risk of developing advanced disease and may even arrest the disease process.
• Attachment and bone loss associated with periodontal disease are results of the body’s immune response to plaque biofilm and its metabolic byproducts. While associations between periodontitis and various systemic conditions and diseases have been suggested by research, evidence of causality is mixed and the strength of the evidence differs for various conditions. The goal of periodontal treatment is to eliminate dysbiotic plaque biofilm from the tooth surface and to establish an environment that allows the maintenance of health.
A few years ago when “new teeth in a day” implant centers were advertising with frequent TV commercials, I overheard an endodontist remark, “If these patients had spent the same $4060 thousand dollars over the last 20 years having professional cleanings several times a year, restoring tooth fractures and large restorations with a crown and maybe a root canal or two –they would still have their natural teeth.”
Again to quote Dan Heath: “Downstream action is more tangible- easier to see and measure.”
No one is the witness to the frequent tooth brushing and cleaning between teeth at home that preserves a natural smile. Everyone sees a “perfect new smile” from an all-on-4.
System changes start with a spark of courage, but a spark can’t last forever. Eventually the need for courage needs to be eliminated - made unnecessary because it has forced a change within the system. Success comes when things happen by default. Systems in a dental practice that are managed with an Upstream lens will more likely to facilitate healthy patients and less stress for our team members and doctors.
Scott Theurer, DMD ADA Delegate
BURNOUT AMONGST DENTISTS
Why is it so prevalent and how can we avoid it?
Hey there, so happy you found this because it contains extremely valuable information on burnout that will have a huge value for you! After you finish watching this you will be sure to have a much better understanding of what burnout is, why we as dentists tend to be even more prone to experiencing it than other professions, and how we can best avoid it!
Depending on where you are in your dental career, you have invested a minimum of eight years of education and many more years practicing dentistry. You have sacrificed so much of your time, energy, and finances to build your career. The last thing any of us wants is to experience a lack of interest or enjoyment in a profession that we have devoted so much to. After all, being a dentist consistently ranks in the top ten jobs out of all of the professions out there. If being a dentist is such a great thing, why then, do dentists experience such a high rate of burnout and suicide in comparison to other white collar professions?
Dentistry requires precision. The success of a crown margin is measured in tenths of millimeters. Occlusal discrepancies of
the same measurement can be the difference between having pain or being pain free in patients. Not only are the procedures based in precision but the population that is drawn to dentistry is driven with the same desire for perfection. From the time we are first in dental school, we are taught that only the best is acceptable. This perfection is ingrained into each of us through the four years of dental school and is constantly reinforced as we see the successes of others in continuing education courses. Another trait that increases the likelihood of burnout is that many of us isolate ourselves from our colleagues. Think of the other dentists in your area, how much interaction do you have with them? Finally, another source of burnout amongst dentists is the way that our practices operate. So many of us are so busy with treating patients that we often don’t control the direction of our practices. This causes us to work too many hours, do procedures we don’t enjoy doing, and doesn’t allow us breaks to get away from the continual grind. Not only does this affect us, but it also affects all of our dental team which can cause burnout in them too!
Practice Transition Specialists
“Randon Jensen from CTC Associates handled the transition for our practice and did an amazing job. Randon was an experienced, settling influence during the entire process. He provided a thorough, data based practice valuation as well as timely advice to me and the new dentist on all relative matters up through and including the closing. In short, his services were well worth the fee, and I would highly recommend him to anyone considering a practice sale or transition.”
–Dr. Tom Johnston
randon jensen
marie chatterley
larry chatterley
Since burnout is so prevalent in our profession, let’s make sure we are all on the same page and understand what burnout is. Not too many years ago, burnout was a term that was rarely even heard of but it has now become part of our work force’s everyday vocabulary. Burnout was originally described in 1974 by a German-American psychologist, Dr Herbert Freudenberger. He defined it as “Becoming exhausted by making excessive demands on energy, strength, and resources”. More recently, in 2022, the World Health Organization (WHO) included burnout as a syndrome in the International Classification of Diseases 11 (ICD-11). They defined it as: “A syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and 3) reduced professional efficacy.”
So when was the last time that you felt depleted of energy or exhausted at work? Do you ever mentally feel distanced from your job or feel cynical? Do you have negative feelings related to dentistry, patients, or your practice? If so, it is likely leading to a reduced level of professional efficacy. Recent reports from the National Institute of Occupational Safety and Health (NIOSH) ranked dentists only second to physicians in suicide rates. Dentists, as a whole, have a 1.67 times higher suicide rate than the general population. The Harvard Business Review reports that higher suicide rates are consistently found in passion-driven and caregiving profession which often are the most susceptible to burnout and these trend even higher in the female populations in these professions.
So what can be done? How do we prevent or minimize the risk of us being affected by burnout in dentistry? There are really two schools of thought out there when it comes to decreasing our risk for burnout and the accompanying problems that follow. One of those focuses on changing the environment we work in and the other focuses on improving our ability to combat burnout by improving our own capability of handling those environments when they are present.
What can we do to alter our environment to make it a less likely place for us and our teams to experience burnout? There are a variety of different ways that we can control the dental environment but this will depend on our role in the practice. As a practice owner, you have the most control, but regardless of your position, you can always positively affect your working environment.
The first would be controlling our schedules. For example, ask yourself these questions. What days of the week is your practice open? How many hours a day are you working? How many different operatories are you working out of? Are you allowing yourself and your team breaks? Do you have a lunch break? If so do you consistently work through it? How often are you working past the time your last patient is supposed to be out the door? Contrary to popular belief, we can control all of these things and when we do, we will actually be more productive than when we let them control us. There are numerous studies
out there that show the importance of taking breaks between focused areas of work. In fact most show that our abilities tend to waver following four hours of focused work if there isn’t a break. Another important question to ask yourself is, who controls your schedule? Some of us have just allowed our practices to grow and the patient demand in our practice has dictated our schedule. Others of us often hire consultants to come in and dictate how our schedules should run. Controlling the amount of time we work each week, when we work, and how often we get a chance to step away from patients during our work schedules, contribute greatly to the amount of stress and burnout we will experience as dentists. Unfortunately, this often affects our team and creates additional problems for them personally which will only add to the problems in your practice.
Performing the procedures that you enjoy is the second way that we can help control our environment to help prevent burnout. Again, this can be something that you have 100% control over or very little control over depending on your practice’s situation. A practice owner can completely control this by utilizing specialists or associates to perform the procedures they don’t enjoy. An employee dentist may have less ability to control this but would still be worth a conversation to see what options exist. When we are doing the things that we enjoy, we decrease the likelihood of experiencing burnout. Dan Sullivan from Strategic Coach refers to this as our “Unique Ability”. Joe Polish of Genius Network refers to it as your “Zone of Genius”. You have likely heard of people being “in the zone”. The more time we can spend on the procedures we love, the more productive, fulfilled, and less stressed we will be. As with our schedules, this also applies to our dental teams. The better we position our team in doing the things they enjoy, the more motivated, creative, and happy they will be.
In addition to creating a work environment that decreases our likelihood of experiencing burnout, we can also work on improving ourselves to become more resilient to those environments. This area can sometimes feel daunting to look at because there are so many different ways that we can improve ourselves to become more burnout resistant. Each of us will vary with what we need to work on and this is where getting a good coach can help.
Another big contributor as mentioned before is that dentists tend to isolate themselves. Is this due to our personalities or are we trained to be competitive in dental school and it carries over into our practices. When was the last time you reached out to a dentist that is in your town and was able to discuss some of the headaches you experience as a practitioner or business owner. When was the last time you reached out to offer help or to seek help with another dentist? I don’t know if we are worried about our “competitors” finding out our secret sauce or if we have too big of an ego to reach out for help but we tend to look at the other dentists in our community as competition instead of as a valuable resource with the ability to collaborate with them. I have found that through collaborating with fellow dentists, even those close in proximity to my office, has been a massive help. Afterall, I don’t need to look at them as competitors, we are
completely different individuals and people interested in being seen by that dentist, likely wouldn’t want to be seen in my practice. Not to mention, traditionally less than 50% of the population seek regular dental care. Sounds like there are plenty of patients to go around. Maybe if we didn’t isolate ourselves, we could collaborate with other dentists in our community and figure out how to get to those other 50% and have it be a win-win situation for us all. The reality is, those neighboring dentists are likely experiencing similar issues of burnout like you and may have been able to find ways to improve their practice that would be of benefit to you!
A personality trait that many dentists have leads to increased levels of burnout is their perfectionistic personalities. Over the years, dentistry has become very good. We have amazing products and techniques to provide great care to patients. However, all of this is happening in a biological system that we have very little control over besides encouraging good oral hygiene and dietary habits. Oftentimes when we have procedures “fail” or perform more poorly than we would expect, we take this on ourselves. There might be some truth to this when we are first learning but once we get our craft down, it more often is the
fault of the patient and different things they are doing (or not doing). Regardless of how well fitting a crown is or how perfectly a composite is placed, if the patient doesn’t care for them, they won’t last. We intuitively know this, but too often we take on the burden of responsibility. We have to be okay knowing that every patient isn’t going to care for their mouths as if they were a dental hygienist! We have to allow our patients to accept responsibility and be ok when things don’t go perfectly.
Bottom line… we belong to an amazing profession that is doing amazing things for others and can provide us with an amazing life. Can you imagine the excitement for life you would have if you felt this way? I am here to let you know that you can have this in your life! By working on these different aspects and choosing to change yourself and your practice, you can create a mindset and practice that you love and all of this will flow over to all other aspects of your life!
I would love to hear your thoughts and how this has affected you. Email me at jaren@theelevateddentist.com
Jaren Argyle, DDS
UDA Health & Wellness Committee Chair
MCNA Insurance Company is pleased to administer benefits for the Utah Medicaid Dental Program.
MCNA is a provider-centered organization committed to helping dentists serve Medicaid and CHIP enrollees. We provide dentists with leading-edge technology and superb customer service support to reduce missed appointments and encourage patients to seek timely dental care.
For more information, visit us online at: www.mcnaUT.net
SHOULD YOU FLOSS BEFORE OR AFTER YOU BRUSH?
In a report from Live Science, experts cited in the article detailed whether flossing prior to or following brushing may be preferable.
Brushing your teeth is important for keeping your mouth clean, preventing cavities and avoiding noxious breath. Flossing is equally important for many of the same reasons — but should you floss before or after brushing?
The official stance of the American Dental Association (ADA) is that it doesn’t matter. “Either way is acceptable as long as you do a thorough job,” the ADA says.
“Flossing will get deeper into your gums than a toothbrush will alone, and it will get any food particles that are where the toothbrush can’t reach, so really any order is effective,” Dr. Naomi Lane, a board-certified pediatric dentist in Greensboro, North Carolina, told Live Science.
Still, there’s an argument to be made for flossing first, before you brush, Dr. Chavala Harris, a dentist in Durham, North Carolina, told Live Science in an email.
“Flossing before brushing will allow removal of any food debris and plaque accumulation between the surfaces of teeth,” Harris said. “Brushing after flossing will then remove all remaining food debris and plaque accumulation on the front and back surfaces of teeth.”
However, this is more of an educated guess than scientifically founded advice, Lane noted.
“There haven’t been any studies that have looked at doing a different particular order, so we don’t have any science proving that” Lane said. “But if you think of it, [flossing before brushing] makes sense, so that you’re taking out the bigger food chunks first so that the toothpaste can reach and then the fluoride from your toothpaste can reach into those crevices a little bit easier.”
Flossing is also good for the gums; it can help remove plaque from below the gumline and reduce gum soreness and the risk of gingivitis, or gum inflammation.
Is it better to floss in the morning or at night?
The ADA recommends brushing twice a day and flossing once per day. But is it better to floss in the morning or at night?
“Another one where it doesn’t matter — it can be done at any time of day,” Lane said. This is another situation where there isn’t scientifically guided advice one way or the other. However, in general, dentists recommend paying the most attention to your nightly oral hygiene routine, because there’s a long length of time between that final brushing and waking up in the morning, she noted.
“At nighttime, our salivary glands decrease their output, so your mouth is in a drier oral environment,” Lane explained. “So, if there are any food particles left on during the nighttime, they can have … a higher risk of turning into some decalcifications or potential cavities.” “Decalcification” describes when minerals like calcium are lost, leaving white spots on teeth.
The most important thing is to build a routine you can stick with consistently, she said. “If it works better in one particular individual’s schedule to do it in the middle of the day at lunchtime … then that is by all means effective.”
And while it might feel like your mouth is clean enough after brushing, you shouldn’t skip the flossing. Doing so overlooks important areas that your toothbrush can’t reach; that can cause cavities, which can lead to problems far beyond the mouth.
Tooth decay can, of course, cause local issues in the mouth, such as pain, trouble chewing and infections. But “the overall goal of preventing cavities is to ensure that bacteria byproducts of cavities do not travel through the bloodstream, negatively affecting other areas of the body,” Harris said.
Flossing is thus important for the health of the gum tissues and “for the health of the entire body,” not only teeth and gums, Lane said
Ashley Hamer Life Science
The article presented here is intended to inform you about the broader media perspective on dentistry, regardless of its alignment with the ADA’s stance. It is important to note that publication of an article does not imply the ADA’s endorsement, agreement, or promotion of its content.
Photo: Image licensed by Ingram Image
THE NEW FACES OF ORGANIZED DENTISTRY Young dentists step up, take on leadership roles in tripartite
Both Alexandra Fitzgerald, D.D.S., and Adam Saltz, D.M.D., became involved with organized dentistry during dental school. After rising through the ranks, they now serve as leaders within the tripartite, bringing their unique perspectives as new dentists to the top levels of decision making.
“As new dentists, we have decades left in our careers, and the decisions made by the leaders of organizations will impact us and our patients over that period,” said Dr. Fitzgerald, president of the Maryland State Dental Association. “From a continuity standpoint, new dentists must be involved and share improvements to ensure our organizations evolve and stay relevant.”
Dr. Fitzgerald, who is also the treasurer of her local component, the Frederick County Dental Society, and a member of the ADA Council on Communications, said she has always been encouraged to share her perspective by her mentors, but there were times others underestimated her because of her age.
“Many times, I was — and still am — the youngest person in the room,” she said. “The biggest challenge I faced was people underestimating my knowledge and background. They incorrectly assumed that I could not actively contribute because I was not a practice owner with decades of experience. My fresh perspective is a positive attribute and an opportunity to see the organization through a new and different lens. Most organizations and their leadership are receptive; they want to bridge generational divides and create more inclusive and welcoming environments.”
Dr. Saltz, president-elect of the Maine Dental Association and member of the ADA New Dentist Committee, was the editorin-chief of the American Student Dental Association during dental school. He took a break from organized dentistry during his residency, but after returning to his home state, the Maine Dental Association executive director asked him to serve on a committee, which began his journey to the presidency. He, too, has felt he had to prove himself as a new dentist leader at times.
“The MDA could not be more receptive to the input and leadership of early career and new dentists. In fact, we have several on our board of directors,” he said. “Unfortunately, it isn’t always this easy. There have been situations where I had to prove my place because of my age and ‘inexperience.’ I work that much harder, provide meaningful feedback and forge an entirely new path for myself and other young leaders to follow.”
He said he believes every level of organized dentistry should offer mentorship programs that connect new dentists with new dental school graduates to help welcome them into their dental organizations.
“It’s easy to feel lost and disconnected early on, but this kind of supportive network could offer knowledge sharing, guidance and career advice among dentists in different practice workflows, demographics, geographic settings, etc.,” Dr. Saltz said.
Professional development programs consisting of continuing education, workshops and seminars addressing new technology, treatment planning and practice management can also help empower new dentists in the communities they serve, he said.
At the Maryland State Dental Association, Dr. Fitzgerald strives to make involvement easy for new dentists.
“Organized dentistry can sometimes place barriers that prevent involvement or make it seem unattainable,” she said. “Worklife balance is a priority for new dentists, and clearly defining expectations is fundamental, whether it be duties, advanced notice of meetings or utilizing technology.”
Most committee meetings are conducted via Zoom, making it easy for members to join from their home or workplace. Dr. Fitzgerald also engages with the students at her alma mater, the University of Maryland School of Dentistry, where she is on the alumni association’s board of directors. Her mentees serve on various Maryland State Dental Association committees and have taken part in the association’s Leadership Academy.
She said new dentists who want to be more active in organized dentistry shouldn’t hesitate to reach out to those already in leadership roles. Leaders may suggest where the dentists’ energy and efforts would have the most impact, based on their interests.
“There is enough room for everyone to contribute, and you can start small; it can be as simple as joining a committee,” Dr Fitzgerald said.
Dr. Saltz has simple advice for new dentists looking to get involved: Just show up.
“Attend a virtual town hall, component meeting or state lobby day,” he said. “It is important for new dentists to become active within organized dentistry because our local, state and national leadership should reflect the current dental landscape. Organized dentistry offers a platform for learning, networking and career growth. New dentists can not only stay abreast of industry and professional developments but also play a role in shaping its future.”
Mary Beth Versaci ADA New Dentist News
The first U.S. standard related to artificial intelligence in dentistry is available for review and comment from the American Dental Association.
The purpose of proposed ANSI/ADA Standard No. 1110-1 for Dentistry — Validation Dataset Guidance for Image Analysis Systems Using Artificial Intelligence, Part 1: Image Annotation and Data Collection is to provide standardized criteria for annotating and collecting data from 2D radiographs to classify the images and use them in clinical decision making.
The draft standard includes image analysis associated with machine learning and deep learning. It identifies the necessary annotations and data content for 2D radiographic images to be queried, exchanged and communicated among providers at all treatment locations for diagnosis, treatment, administrative tasks, research and development efforts. This standard does not prescribe or endorse any specific AI implementation methodology or guide.
To obtain a copy of the draft standard, visit ADA.org/aipreview. Interested parties have until Sept. 25 to comment.
The ADA is an American National Standards InstituteAccredited Standards Developer and has played a key role in the development of dental standards since 1928. These standards establish requirements for safe and effective dental products and technologies through a consensus-based process.
The ADA Standards Program working groups that develop the standards are made up of a diverse group of expert volunteers representing dental practitioners, industry, government and academia. Involvement is open to anyone who would like to contribute their expertise.
To learn more about the standards program, visit ADA.org/dentalstandards.
Mary Beth Versaci ADA News
THANK YOU TO OUR CONVENTION SPONSORS
THANK YOU TO OUR CO-SPONSOR
THANK YOU TO OUR GOLD LEVEL SPONSOR
THANK YOU TO OUR SPEAKER CO-SPONSOR
Pathology Puzzler (continued from page 11)
Gardner Syndrome is a rare inherited disorder characterized primarily by its multiple colorectal polyps and propensity to develop colorectal carcinoma. Multiple benign tumors are also associated with Gardner syndrome, as are several maxillofacial manifestations. Among them are multiple gnathic osteomas and multiple supernumerary teeth, often causing impactions.
The genetic driver of Gardner syndrome is mutation in the APC gene, located on chromosome 5. This gene is a tumor suppressor gene that regulates cell growth and prevents cell from dividing when normally functioning. Gardner syndrome is an autosomal dominant disease with 100% penetrance, and often patients have at least one parent who are also affected. However, one-third of cases seem to be related to novel mutations.
In the present case, multiple radiopacities representing osteomas are seen throughout the mandible and maxilla. These range in size dramatically, but lack any associated radiolucency. Multiple impacted teeth can be seen, and astute diagnosticians may spot supernumerary teeth. This combination of signs points towards Gardner Syndrome.
The implications of a diagnosis of Gardner syndrome significantly include the risk of developing colorectal carcinoma. By age 30, half of patients will develop colorectal carcinoma. The lifetime risk of developing colorectal carcinoma approaches 100% in these patients. Recognition of the maxillofacial findings can allow for prompt referral and preventative therapies.
Multifocal idiopathic osteosclerosis is a diagnosis of exclusion- particularly as idiopathic osteosclerosis is much more commonly unifocal. All other possible etiologies and causes should be ruled out before idiopathic osteosclerosis is diagnosed clinically. Idiopathic osteosclerosis should not be associated with multiple supernumerary teeth.
Florid cemento-osseous dysplasia is a disease process better characterized radiographically as a mixed radiopaque and radiolucent process. Advanced lesions can be completely calcified, but that does not make it a good fit for the radiograph in this case. As a benign fibro-osseous lesion, this entity is important to recognize and diagnose to avoid unnecessary bone manipulation which can possibly result in osteonecrosis. It is uncommon to see this entity affect the inferior border of the mandible as was seen in the present case.
Intramedullary osteosarcoma would present with a moth-eaten radiolucency showing cortical and medullary destruction, possibly with the classic periosteal reaction “Codman’s Triangle” and blastic lesion in a “sunburst” pattern. In the present case, no bone destruction is noted.
Bryan Trump, DDS, MS Carter Bruett, DDS, MS
Successfully connecting the dentist’s present with their future
• Associate Search
• Practice Transitions
• Valuations and Appraisals
• Dental Real Estate
• DSO & Private Equity
Seller Representation
THE TRUSTED TRANSITION PROCESS®
When the time is right, The Trusted Transition Process® provides a clear, consistent path to help you transition your practice, while maintaining the legacy you worked so hard to establish.
CONCEPTUAL TRANSITION EXPERIENCE
We help visualize your future, set achievable goals and devise strategies to start you in the direction of your post-transition dreams, well in advance of your intended transition timeframe to help you transition on your terms.
STRATEGIC PRACTICE OUTREACH TRUSTED VALUATION ANALYSIS
We identify the unique aspects of your practice and share them strategically and confidentially with our extensive network of pre-screened viable candidates. Our company invests heavily in Google digital marketing to promote our listings. We pair today’s technology with a human touch to determine potential matches.
Your practice will be analyzed by independent third-party Certified Valuation Analysts with dental industry expertise. Their findings are fair, reliable, and respected by banking institutions. This analysis leads the financial process for all parties. For your building, DDSmatch provides Broker Price Opinions utilizing Modum, a commercial valuation reporting service known for its quality.
DDSmatch will collaborate with Dental Intelligence to analyze your data to reveal your practice’s potential in a detailed report. The Clinical Opportunity BlueprintTM reveals opportunities, detailing production mix and intensity, new patient flow and more to give potential buyers confidence in their future success.
After potential matches are discerned, our advisors will lead an in-depth interview so you can determine the best match for you, your staff and your patients.
We work with Attorneys, Accountants, Practice Management Consultants and Financial Advisors to foster a smooth transition. We can connect you to local Commercial Real Estate Brokers or personally assist in lease negotiation of the building and land sale.
For the final stage of the process, our team will engage advisors from both sides to provide the necessary documents, including purchase agreements, post-transition employment agreements and building leases to successfully complete The Trusted Transition Process.® • Practice Sales
