ODA Journal: May/June 2020

May/June 2020 | Vol. 111, No. 3

Dr. Paul Mullasseril 2020-2021 President www.okda.org

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Contents

ADVERTISERS Thank you to these businesses who advertise in the ODA Journal

May/June 2020 | Vol. 111, No.3

Inside Front Cover Valliance Bank

ASSOCIATION 04 Calendar of Events

Back Cover Delta Dental of Oklahoma 3000IG Authentic Dental Labortorie, Inc. Black Talon CARR Healthcare Edmonds Dental Prosthetics,Inc. Endodontic Associates First Liberty Bank Fotona Lewis Health Profession Services MedPro Group ODASupplySource Simmons Bank Solmetex

0 5 ODA Happy Hour Events 0 6 ODA Editorial 07 Welcome New ODA Members 08 Letter from ODA President, Dr. Paul Mullasseril 09 2020-2021 ODA Executive Committee and

Board of Trustees

14

COVID-19 Resources

Periodical postage paid at Oklahoma City, OK and additional mailing offices.

Subscriptions: Rates for non-members are $56. Single copy rate is $18, payable in advance.

Reprints: of the Journal are available by contacting the ODA at (405) 848-8873, (800) 876-8890, editor@okda.org.

Opinions and statements expressed in the OKLAHOMA DENTAL ASSOCIATION JOURNAL are those of the author and are not necessarily those of the Oklahoma Dental Association. Neither the Editors nor the Oklahoma Dental Association are in any way responsible for the articles or views published in the OKLAHOMA DENTAL ASSOCIATION JOURNAL. Copyright © 2020 Oklahoma Dental Association.

10 Taking it Virtual: ODA Virtual Meetings 11 Veterans Dental Day 1 2 ODA Rewards Partners 1 3 ODA Rewards Partners Column

26 Dr. James Baker

THE OKLAHOMA DENTAL ASSOCIATION JOURNAL (ISSN 0164-9442) is the official publication of the Oklahoma Dental Association and is published bimonthly by the Oklahoma Dental Association, 317 NE 13th Street, Oklahoma City, OK 73104, Phone: (405) 848-8873; (800) 876-8890.

Fax: (405) 848-8875. Email: information@ okda.org. Annual subscription rate of $39 for ODA members is included in their annual membership dues.

POSTMASTER: Send address changes to OKLAHOMA DENTAL ASSOCIATION JOURNAL, 317 NE 13th Street, Oklahoma City, OK 73104.

Oklahoma Dental Association

1 4 COVID-19 Resources 1 6 ODA Member Benefit Corner 17 ODA Marketing Coach 2 0 Answering the Call for PPE 50 Final Thoughts: Words of Wisdom

LEGISLATIVE LOOP 2 2 ODA Legislative Update 2 3 2020 OKCapitol Club & DENPAC Grand Level Members

SPOTLIGHT 2 6 James Baker, DDS 2 9 OkMOM Spotlight: McConaghie Dental Lab

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Answering the Call for PPE Cover Photo: ODA President Dr. Paul Mullasseril with his family.

Photo by: Josh Fisher Portraits

FEATURES 30 Clinical Differential Diagnosis: Palatal Ulcer 32 Collect What You Produce: Maximizing a Patient Financing Program 36 Timing Your Next Real Estate Transaction 38 Hygiene HotSpot 39 New Dentist Corner 4 0 What the Coronavirus Has Taught Me 4 1 OUCOD Responds to Coronavirus 4 2 EPA Regulation: Management of Dental Amalgam Waste 4 4 What Can Dentists do About Youth Vaping?

4 6 A Real Game Changer: Ransomware

Is Your Information Correct?

Help the ODA keep you informed about legislative actions, CE opportunities, events and other important member-only news.

Contact Kylie Ethridge, ODA Membership Director, at kethridge@okda.org or 800.876.8890 to provide the ODA with all of your current contact information.

CLASSIFIEDS 4 8 ODA Classified Listings

www.okda.org

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ODA JOURNAL STAFF EDITOR Mary Hamburg, DDS, MS ASSOCIATE EDITOR Frank J. Miranda, DDS

CALENDAR OF EVENTS Visit the ODA’s online calendar at OKDA.ORG/CALENDAR for all upcoming meetings and events.

EDITORIAL BOARD MEMBERS M. Edmund Braly, DDS Daryn Lu, DDS Phoebe Vaughan, DDS

May 25 ODA Closed Memorial Day

EXECUTIVE DIRECTOR F. Lynn Means

May 28 ODA Member Happy Hour The Collective OKC 5:30 -7:30 p.m.

DIRECTOR OF COMMUNICATIONS & EDUCATION Stacy Yates OFFICERS 2020-2021 PRESIDENT Paul Mullasseril, DDS president@okda.org PRESIDENT-ELECT Chris Fagan, DDS presidentelect@okda.org VICE PRESIDENT Robert Herman, DDS vicepresident@okda.org SECRETARY/TREASURER Mike Gliddon, DDS treasurer@okda.org SPEAKER OF THE HOUSE Doug Auld, DDS speaker@okda.org IMMEDIATE PAST PRESIDENT Dan Wilguess, DDS pastpresident@okda.org ADMINISTRATIVE STAFF EXECUTIVE DIRECTOR F. Lynn Means DIRECTOR OF GOVERNANCE & FINANCE Shelly Frantz DIRECTOR OF COMMUNICATIONS & EDUCATION Stacy Yates DIRECTOR OF MEMBERSHIP Kylie Faherty PROGRAMS & OPERATIONS MANAGER Makenzie Dean SPECIAL PROJECTS MANAGER Abby Sholar MEMBERSHIP SERVICES MANAGER Madison Bolton

Stay connected with the ODA!

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journal | May/June 2020

June 2 Journal Editorial Board Meeting Zoom 5:30 p.m.

June 4 ODA Member Happy Hour Fassler Hall Tulsa 5:30-7:30 p.m.

June 12 Rewards Partners Committee Meeting Zoom 9:00 a.m.

DE/PI Meeting Zoom 10:00 a.m.

Membership Council Zoom 12:00 p.m.

June 19 RDGP Meeting Zoom 11:00 a.m.

July 2-3 ODA Closed

July 31 Governmental Affairs ODA Building 9:00 a.m.

ODA Board of Trustees Meeting ODA Building 1:30 p.m.

August 1 ODA Zoo Day OKC Zoo 9:30 a.m.

We are here for yoU We understand the last few months have been a roller coaster of emotions and there is still some uncertainty that lies ahead. As we work together to navigate these uncharted waters, you can count on the ODA, ADA and your local dental society to continue to advocate for you, your profession, your business and our collective path forward. We’re stronger together!

Please do not hesitate to contact our office.

405.848.8873 | information@okda.org | www.okda.org

www.okda.org

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ODA EDITORIAL By: Dr. Mary A. Hamburg, ODA Journal Editor The English language is an ever-evolving phenomenon. It can vary from place to place and from generation to generation with different pronunciations and meanings for the same words. Old words become new and new words become old.

I have witnessed this with my two boys.

Things they consider new and novel are in fact merely remakes from previous generations. Words like “burned” morph into the newer “roasted” with similar meaning while they scream at each other with the same amount of laughter and absurdity that it caused during my generation.

Like the language we speak, our world changes constantly. Sometimes slow and over time. Sometimes quick and painful (as is so evident with our current situation). As we deal with change, it helps to rely on what we know, what we feel comfortable with, what we trust and with whom we share similar goals and ideals. Our community reminds us that we are not alone in the world. We have others to help, to work with and to troubleshoot with in order to reach a common goal. Our concept of what makes up a community has changed.

For example, the traditional definition of community is a group of people living in the same place, but with our everexpanding Internet capabilities and social networking options, community may also include favorite podcasts or Facebook groups. We are able to remain close to each other without physically being in the same place.

groups, online CE courses and webinars that present dental professionals and small businesses with multiple options and avenues of information to fortify their teams and patients for the mandated physical distancing needed to combat the spread of this novel coronavirus pandemic.

Communities grow and change as our needs and interests evolve. My community became bigger out of necessity. My needs expanded those communities I rely on to include groups with projects for my children while they are quarantined at home. Communities that I may not have explored without the present situation. Also, my concern for my fellow healthcare professionals and their ability to protect themselves pushed me to join groups that support frontline healthcare teams by collecting and donating PPE, hand sanitizer, and other supplies.

A community is a group of people that cares about each other and feels they belong together. At the end of the day we are all dental professionals toiling to master our skills and gain resources in order to provide for our patients and our families. We are a group of people in a community that is locally connected in our towns, cities and states as well as on the national level. That feeling of

belonging is there but to really encompass a community we have to care about each other. When we care about each other we build trust. Trust in each other allows for coordination, sharing, hope, support and safety. It is my belief that trust is the most basic concept in any community.

We must trust each other to work towards a common goal and purpose. When we trust in each other it allows our profession to thrive no matter how the world may change around us.

Meet the ODA Journal’s new Editor: Dr. Mary Hamburg has served the Oklahoma City metro area as a board certified periodontist for the last nine years.

She has volunteered on the executive board of the Oklahoma Association of Women Dentists for nine years and as a member of the Oklahoma Dental Association along with the American Association of Women Dentists. Dr. Hamburg has practices in Midwest City and Yukon at Dental Implants and Endodontics of Oklahoma.

She is also a Clinical Assistant Professor at OUCOD in the AEGD residency. Dr. Hamburg and her husband Dustin live in Norman, OK with their two boys: Daxton (8) and Caden (5).

Over the past few weeks, I’ve witnessed my traditional community completely shut down due to the COVID-19 pandemic. My office and my staff are no longer a huge part of my daily routine.

Instead, my local community now consists of my immediate family and those I connect with on social media platforms.

Lately, the expanded communities I’ve connected with the most consist of several dental groups including my fellow ODA/ ADA members who are lobbying for our profession with mass emails and legislative alerts. Also, the many Facebook 6

journal | May/June 2020

The Hamburg family [l-r]: Mary, Caden, Daxton and Dustin with Baxter, the family dog.

www.okda.org

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FROM THE ODA PRESIDENT DR.PAUL MULLASSERIL As I write this, it is day 16 into the mandate

by Governor Kevin Stitt to suspend all but emergency dental treatment in Oklahoma.

In these unprecedented times, with a lot of uncertainty about the future, it is difficult to articulate a vision for the coming year. The words of Eleanor Roosevelt come to mind: “You gain strength, courage and confidence by every experience in which you really stop and look fear in the face. You are able to say to yourself ‘I have lived through this horror.

I can take the next thing that comes along’.”

The ODA will continue to follow the lead of the ADA and provide the best possible advice and be a source of information to our members during these trying and tumultuous times. The ODA Board of Trustees met multiple times via telephone to provide guidance to our members with the well-being of the people of Oklahoma being the overriding concern. Mark Twain once said, “Always do right. This will gratify some people and astonish the rest.”

In preparing this message several questions come to my mind. When are we going to get back to normal? Will there be a new normal? Will patients flock back to practices after the dust settles or will other financial priorities take precedence? Will this cause some dentists to postpone their retirement plans to make up for the loss of income over the next year? Will we see a fall in association membership? And am I the person to lead the organization during these trying times? Dentistry has faced similar issues in the past with HIV and hepatitis C patients, and today we treat them in our practices routinely. So, while no one knows the answers to these questions, one thing is certain: The spirit of Oklahomans and indeed of all people throughout this great country will overcome and prevail.

We are working on a new initiative this year to organize Veterans Day at the OU College of Dentistry. On November 7, 2020 we intend to provide much needed dental care for the veterans of Oklahoma. We have partnered with the Dale Graham Center Veterans Foundation in Norman to screen around 120 veterans that need urgent care.

The Dale Graham Center has served 19,000 veterans from all 77 Oklahoma counties and from 45 states. Veterans will be transported to the College to be treated free of charge primarily by fourth-year dental students 8

journal | May/June 2020

under the supervision of OUCOD faculty and ODA members.

OkMOM remains a shining star in the charitable endeavors of our organization.

We are in the second decade of this worthwhile cause. Our numerous sponsors and volunteers, and the sharp focus and superb efficiency of Executive Director Lynn Means and her staff, have continued to make this annual event a grand success.

The 2021 event will be held February 12-13 (second weekend of February) in Shawnee for the very first time. We are excited to be working with the Shawnee-based Avedis Foundation for this event.

Continuing the close bond between the dental community and the College of Dentistry will be a top priority during my term as your president. When the dental school was threatened with closure in the 1980s, the dental community came to the support of the school. During their tenures former Deans Russell Stratton and Stephen Young fostered a close relationship between the school and the practicing community.

Dean Raymond Cohlmia is a past president of the ODA and just finished his term as trustee of the ADA’s 12th District. His support is crucial in this relationship.

Every OUCOD faculty member is an ODA member and continues to support its initiatives, especially OkMOM. The dental school is the lifeblood of the dental community and having a clinically superior program bodes well both for the dental community and for the population of Oklahoma.

As with seemingly everything in the world, the Oklahoma legislative session was put in a state of disruption with the response to the coronavirus receiving priority. Next year’s session will bring to the forefront some of the challenges we expected to face this year. While we have had many successes in the past few years, the challenge of making sure that Soonercare remains in the hands of Oklahomans is a priority. We will fight to make sure that the failures of managed care in other states do not follow us here in Oklahoma. Scott Adkins, our ODA lobbyist, and Lynn Means will continue to keep a close eye on relevant bills as they make their way through the legislative process, and keep the ODA leadership and

2019-2020 ODA President, Dr. Dan Wilguess, passing on the ODA president's pin to Dr. Paul Mullasseril during the ODA's virtual House of Delegates meeting.

the general membership aware of their implications.

The ODA’s annual meeting will be held in Tulsa on April 9-10, 2021. I am excited to be working with ODA Director of Communication Stacy Yates to line up an all-star roster of speakers. We already have commitments from several speakers and sponsors. Let us make this a grand event and celebrate our profession and our organization. I challenge you to bring one member who has not been to the meeting recently to register for the Tulsa meeting. I hope to see you there!

My dear colleagues, in these difficult times I want to remind you that we are fortunate to be in a profession routinely ranked by Forbes Magazine as among the top five professions in the country. We enjoy the interactions we have with our patients as we alleviate their pain and instill confidence in them; in turn, our patients trust us and give us the opportunity to provide excellent livelihoods for our families. As a dental community we must celebrate this. Let us encourage each other and the broader dental community with the words of Irish poet John O’Donohue: “One of the most beautiful gifts in the world is the gift of encouragement. When someone encourages you, that person helps you over a threshold you might otherwise never have crossed on your own.”

2020-2021 ODA EXECUTIVE COMMITTEE

President Dr. Paul Mullasseril

President-elect Dr. Chris Fagan

Vice President Dr. Robie Herman

Secretary/Treasurer Dr. Mike Gliddon

Immediate Past President Dr. Dan Wilguess

Speaker of the House Dr. Doug Auld

2020-2021 ODA BOARD OF TRUSTEES Dr. Paul Mullasseril, President and ADA Delegate

Dr. M. Edmund Braly, Central Component Trustee

Dr. Chris Fagan, President-elect

Dr. Sid Nicholson, Eastern Component Trustee

Dr. Robie Herman, Vice President

Dr. Jandra Korb, Northern Component Trustee

Dr. Mike Gliddon, Secretary/Treasurer

Dr. Susan Davis, Northwest Component Trustee

Dr. Doug Auld, Speaker of the House and ADA Delegate

Dr. Edward Harroz III, OK County Component Trustee

Dr. Dan Wilguess, Immediate Past President

Dr. Paul Wood, Southwest Component Trustee

Dr. Rieger Wood, ADA Delegate

Dr. Lindsay Smith, Tulsa County Component Trustee

Dr. Tamara Berg, ADA Delegate

Dr. Tabitha Arias, New Dentist Trustee

Dr. Stephen Young, ADA Delegate

For the full list of ODA Council and Committee members, visit www.okda.org/about-the-oda/leadership.

www.okda.org

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Taking it Virtual During the past two months the Oklahoma Dental Association, just like you, has had to find new ways to continue business and make sure your association continues to move forward. This year's House of Delegates meeting was hosted virtually via Zoom.

More than 95 delegates came together to address bylaw issues, vote on new positions, hear from our ADA 12th district trustee, and watch our new president, Dr. Paul Mullasseril, be sworn into office.

We would like to thank all of our members who participated and who helped make this meeting a success! We are better together!

The ODA Executive Committee being sworn into office by Dr. Richard Haught. [l-r]: Drs. Paul Mullasseril, Doug Auld, Robert Herman, Dan Wilguess, Mike Gliddon, Richard Haught, Chris Fagan.

Immediate Past President Dr. Dan Wilguess pinning and giving an elbow bump to incoming President Dr. Paul Mullasseril after he was sworn into office.

With the cancellation of the 2020 Annual Meeting, the ODA still wanted to bring impactful CE to the dental community.

Over the span of two weeks we hosted five free webinars: Employment Law and Coronavirus Crisis, Opioids & Dentistry, Upper Anterior Segment- Perception vs Reality, Informing Informed Consent - An Ethical Imperative, Tips from an OSHA Infection Control Consultant, and Leading Your Teams Through Difficult Times. These webinars were for members, nonmembers, and the entire dental team! We would like to thank those who presented and helped bring this timely information to dental professionals across the state. We had approximately 1,559 participants in the entire webinar series!

A recording of each of these webinars can be found on the ODA website at okda.org/members-only/education/.

The ODA Board of Trustees met numerous times, including this meeting with the Oklahoma Board of Dentistry, over the past two months to discuss important issues affecting our members.

10 journal | May/June 2020

The Council on Bylaws, Policy and Ethics met on April 22. The Council was hard at work developing and updating policy to serve the membership.

With storm season approaching, Oklahomans face the risk of devastating disasters.

DON’T GET CAUGHT IN THE RAIN

Make a tax-deductible contribution to the RDGP The Oklahoma Dental Relief and Disaster Grant Program (RDGP) is a charitable trust established to provide aid to dental professionals affected by natural disasters,physical disability, chemical dependence, or other hindering conditions.

The RDGP is reliant solely on contributions from individuals like you. Help Prepare & Provide for those in need. You never know when it could be you.

Contact the ODA at 800.876.8890

www.okda.org

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OKLAHOMA DENTAL ASSOCIATION REWARDS PARTNERS RESEARCHED. PROVEN. ENDORSED. Insurance Products For You & Your Practice The insurance coverage you need for your business, personal life & employee benefits.

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Patient Payment Plans Help patients get what they need, without delay!

Interpretation Services Save nearly 70% off of interpretation services compared to those who aren’t ODA members.

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Computers & Technology Members are eligible to save up to 30% off the everyday public web price of Lenovo’s entire product line.

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Luxury Vehicles Exciting member discounts on Mercedes-Benz vehicles.

Dental & Office Supplies Save on more than 65,000 products.

Secure Communications Solutions Receive preferred pricing & waived set-up fees.

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Scrubs, Lab Coats & More Members receive a 15% discount of all purchases in-store and online.

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Special Services & Shipping Discounts Members have access to new & improved flat discount pricing.

Answers On Employer Dental Plans The solution for dental practices & you receive a $300 discount.

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Staff Logo Apparel Save up to 10% on products and logo embroidery.

On-Hold Messaging, Digital Video & Overhead Music Connect with your patients while they wait.

These are endorsed companies of the ODA that save members money while keeping dues lower by providing royalties to the Association.

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C O V I D - 1 9 C O R O N AV I R U S

RESOURCES

The Oklahoma Dental Association has made it a priority to communicate with and advocate for dentists across the state during the COVID-19 pandemic. We strive to offer relevant, helpful and life-saving information to our members every day across email, social media and our website (okda.org). By prioritizing our member dentists, we are also prioritizing their ability to care for their patients safely, and take care of their employees responsibly.

The following resources will be essential for dentists and dental team members to return to their practices safely, while optimizing their ability to stabilize their practices and regain financial security.

OKL AHOMA DENTAL ASSO CIATION RESOURCES Oklahoma Dental Association Website (okda.org/covid-19) Through okda.org, the ODA provides up-to-date information from our leadership, the governor’s office, the American Dental Association, the Center for Disease Control, the Oklahoma Board of Dentistry and more.

Webinars The ODA provides free webinars on Opioids, Ethics, Scientific Updates, Leadership, Infection Control and Employment. These webinars were viewed live by hundreds of members, and recorded to be posted on the ODA website.

Members and their teams were able to earn CE and develop their knowledge while practices were closed.

AMERICAN DENTAL ASSO CIATION RESOURCES American Dental Association Website (ada.org) The ADA website has resources on every topic concerning COVID-19. On the site, dentists can find information regarding SBA loans, webinars, practice resources, clinical safety, mental health, scientific updates and more.

Toolkit The ADA developed a “Back to Work Toolkit” to prepare dentists for successfully and safely returning to their practices. Because knowledge about COVID-19 continues to evolve, the toolkit and its offerings will be continually reviewed and updated as new information becomes available.

CENTERS FOR DISEASE C ONTROL RESOURCES Centers for Disease Control Website (cdc.gov/coronavirus) The CDC website has all of the scientific information for health care professionals looking for guidance and facts regarding COVID-19.

Dental Settings The CDC is constantly updating their resources regarding COVID-19 and their recommendations for dental offices. The CDC is also providing information regarding infection control, PPE, healthcare facility precautions and more.

ADDITIONAL LINKS :

Occupational Safety and Health Administration osha.gov/SLTC/covid-19/

OK State Department of Health coronavirus.health.ok.gov/

Oklahoma journal | May/JuneDental 2020 Association is consistently updating our website to keep dentists and dental teams informed 14 The and safe during the COVID-19 pandemic. Please routinely check our website (okda.org) for the latest information.

Call for

NOMINATIONS How to Enter: For complete category information and

to submit your nomination online, go to championsofhealth.org

Entry Deadline: All nominations must be submitted by Friday, May 29. There is no cost to enter.

The Oklahoma Caring Foundation, Inc. is a nonprofit organization administered as an in kind gift by Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company. These companies are independent licensees of the Blue Cross and Blue Shield Association.

610380.0420 www.okda.org

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ODA MEMBER BENEFIT CORNER Why is a membership with the ODA/ADA so valuable?

The ODA/ADA supports all members at the national, state and local levels. From helping you manage your practice more efficiently and advocating on your behalf to offering you tools and resources that help you find the answers for which you’re looking, we’re there every step of the way.

Third Party Payer Concierge By: Madison Bolton, ODA Membership Manager Running a practice and practicing full time can have it’s overwhelming moments.

Luckily, being a member of the Oklahoma Dental Association gives you access to resources that can help you achieve success.

One of those resources is having access to the American Dental Association’s Third Party Payer Concierge.

The Third Party Payer Concierge gives members one-on-one support if they are dealing with any dental benefit issues. These issues include third-party payers, provider contracts, coding and dental plan issues.

According to the ADA, provider issues remain among the top concerns for dentists.

Members have expressed frustration and

confusion when it comes to denied claims, low reimbursements and dealing with thirdparty payer portals and processing policies.

Luckily with the ADA’s Third Party Payer Concierge, expert advice is just a phone call and/or email away.

The ADA staff helps members with thirdparty payer issues in: • Providing guidance in the appeals process when a claim has been denied.

• Contacting dental plans to revise explanation of benefits language that impugned the dentist-patient relationship.

Choose patients over paperwork.

“The ADA credentialing service is an efficient and simple way to periodically re-credential with numerous insurance carriers. In fact, six of the insurance companies we participate in, or have interactions with, use the service.”

— Dr. Ron Ganik

• Connecting individual dentists with a dental plan's consulting dentist.

• Clarifying requirements on electronic fund transfer payments.

Call the ADA's Third Party Payer Concierge at 1-800-621-8099 or email dentalbenefits@ ada.org. Additional dental benefit resources can be found at ADA.org/dentalbenefits.

Members can also complete an online thirdparty complaint form at Success.ADA.org/ en/dental-benefits/online-third-party-form.

Tired of endless paperwork for credentialing with multiple plans?

The ADA® credentialing service, powered by CAQH ProView®, is a digital solution to help streamline the process so you and your team can spend more time on patients and less time on paperwork.

Learn more at ADA.org/credstate

16 journal | May/June 2020

ODA MARKETING COACH

Communicating & Marketing After a Pandemic

By: Stacy Yates, ODA Director of Communications and Education A welcome handshake, chatting with your patient about life, and smiles around the office seem like a distant memory.

That personal interaction with patients is something that is going to look a little different as we move forward in this postCOVID-19 world. While this pandemic has certainly created anxiety on some level, it has also challenged reflection in many areas of life including health, finances, technology, and how to operate a business.

But what about communication and marketing?

Crisis often exposes weakness, and for many businesses around the country how they navigate and implement changes postCOVID-19 will determine their long-term success. How you communicate with your patients and market your practice will be more important than ever before in this

post-COVID-19 world.

While the pandemic quickly elevated the need for timely and accurate communication with your patients it also presented an opportunity for your patients to interact with your office outside their normal six-month visit timeline and to look to you for important information.

Challenges exist for many that have not built out their platforms for patients to quickly access the information that needs to be communicated. How did you communicate with your patients during the crisis? Did your practice have active and updated social media accounts, a website with links to the latest updates, email blasts, or perhaps even utilizing ZOOM or similar platforms to virtually meet with patients for updates? Like most, you probably find yourself feeling unprepared in this

area especially with some of the newer technologies that exist. Often, marketing and communication are low priorities during normal times, but a crisis exposes just how important both are for your business.

Take a deep breath and realize that every business in our country has been and is currently faced with the same reality.

We all must become more efficient and savvier in this world of connectivity, but more than ever, it’s time to take action on communication and marketing. How you communicate with patients and market your practice moving forward will set you apart from others that choose to remain in pre-pandemic mode. Challenge has created opportunity! Let’s work to create stronger practices that will stand the test of this crisis and time!

Why Invest Time in Communication & Marketing?

Social Media

Email Marketing

Website

Global email users: amounted to 3.9 billion

94% of first impressions relate to your site’s web design

For every $1 you spend on email marketing, you can expect an average return of $42

66% of people prefer to look at a beautifully designed website if given 15 minutes to consume content

Personalized subject lines generate 50% higher open rates

74% of users are more likely to return to mobile-friendly websites

Adding videos to your email can increase click rates by 300%

Slow-loading websites lead to a $2.6 billion revenue loss each year

49% of consumers claim that they depend on influencer recommendations

49% of consumers said that they would like to receive promotional emails from their favorite brands/businesses on a weekly basis

83% of people expect a website to load in 3 seconds or less

Reference: oberlo.com/blog/socialmedia-marketing-statistics

Reference: oberlo.com/blog/emailmarketing-statistics

Reference: webfx.com/blog/webdesign/website-statistics-2020/ www.okda.org

3.5 Billion Active Social Media Users 68% Facebook Users Social Media Users By Generation 90.4 % Millenials 77.5% Gen X 48.2 %Baby Boomers 3 Hours: average time people spend on social media per day 54% of social browsers use social media to research products

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Answering the Call for PPE The COVID-19 pandemic brought about a very critical and immediate call to action for our profession. We were encouraged to practice only emergency dental care, which greatly reduced our demand for personal protective equipment (PPE) compared to years past. While our core mission to serve our community remains as strong as ever, how we serve that community demands change in light of the contagious nature of the coronavirus. It was vital that during this time we look for new ways to be of service. Sharing our PPE with those on the front lines treating the pandemic in our local hospitals was one of the ways we continued to fulfill our calling of service to our community.

We encouraged all members of our profession to assess what they could do to be of service. Members across the state inventoried their PPE and donated what they could, and continued to see emergency patients as needed to prevent an influx of dentalrelated issues flooding crowded emergency rooms and urgent care clinics.

Drs. Jennifer Jenkins and Sara Spurlock own Dental Design Studio in Norman, a comprehensive family dental practice. They donated their PPE to Norman Regional Hospital.

Dr. Jamie Guthrie's practice is in Ardmore, OK. She donated her PPE to the ICU at Mercy Hospital Ardmore!

20 journal | May/June 2020

Dr. Jamie Williams of Smiles Family Dental Care donated PPE to Integris Baptist Regional Hospital in Miami, OK.

Get the latest news on COVID-19

as well as answers to your questions concerning your practice, your staff and your patients.

ADA.ORG/VIRUS www.okda.org

21

LEGISLATIVE LOOP Legislative Overview & Political Update

Coronavirus Shuts Down Legislature State Faces Revenue Failure

By: Scott Adkins, ODA Lobbyist

For the first time since March 17, the Legislature met for two days starting April 6th to address a revenue failure in the current fiscal year and to open a thirty-day special session that provides the Governor with expanded emergency powers during the coronavirus outbreak.

The House of Representatives and the Senate passed three bills during the extraordinary legislative session to avoid cuts in services during the current fiscal year, which ends on June 30. The FY2020 budget, passed last session and effective as of July 1, 2019, is based on projected revenue to the state. However, the recent collapse in energy prices and the COVID-19 pandemic have devastated revenue collections over the last five months and created an estimated $416 million shortfall in the current fiscal year.

The Legislature voted to withdraw nearly $504 million from the Constitutional Reserve (“Rainy Day”) Fund to prevent any current fiscal year cuts to agencies.

Senate Bill 1053 transferred $201.6 million from the Rainy Day Fund into the Revenue Stabilization Fund. Senate Bill 199 transferred $302.3 million from the Rainy Day Fund into the General Revenue

Fund. And Senate Bill 617 authorized the Office of Management and Enterprise Services (OMES) to withdraw up to half of the balance of the Revenue Stabilization Fund to avoid cuts to agencies and the 1017 education fund.

The Board of Equalization formally declared a revenue failure for the current fiscal year, clearing the way for money to be transferred from the state’s Rainy Day Fund to plug holes in state agency budgets through June 30.

In addition, the Board projected that the official revenue estimate it certified in February for the upcoming fiscal year would be short by more than $1.3 billion due to the current economic recession caused by COVID-19 and the collapse of the energy market. The Board certified $8.2 billion in estimated revenues for the Legislature to use to build the FY-2021 budget, which it is currently working on. At the meeting, however, the Board predicted the State would likely only collect approximately $6.8 billion during the 12-month period from July 1, 2020 to June 30, 2021.

The Legislature also convened in special session and approved House

Join your colleagues in the Sunshine State for the ADA FDC Annual Meeting October 15-18, 2020 in Orlando, as two great meetings join together as one. This joint meeting of the American Dental Association and Florida Dental Association will bring you unparalleled continuing education, unlimited networking opportunities, and curated experiences that help you achieve your goals.

REGISTRATION OPENS SOON.

22 journal | May/June 2020

Concurrent Resolution 1001X, which affirmed Governor Stitt’s declaration of a catastrophic health emergency (CHE) as allowed under statute. The resolution also allows the Governor to tap up to $50 million for emergencies without legislative approval for 30 days.

The Oklahoma legislature has not announced formal plans to reconvene, but the May 29 constitutional deadline to pass a balanced budget and adjourn remains.

Your Oklahoma Dental Association will be there as we work our way through these challenging times.

ARE YOU GETTING OUR LEGISLATIVE ALERTS? We send out important alerts via email and text throughout the legislative session. Contact our membership services team at information@okda.org to update your contact information.

K

WE DON’T FUNDRAISE. WE FRIENDRAISE! THANK YOU TO THESE 2020 DENPAC CAPITOL CLUB MEMBERS!

CAPITOL CLUB Dr. Jim Ambrose Dr. Brandon Beaver Dr. Tamara Berg Dr. Raymond Cohlmia Dr. Brian Drew Dr. Leslie Hardy Dr. Richard Haught Dr. Robert Herman Dr. Katherine Johnson Dr. Samuel Owens Dr. Karen Reed Dr. Lindsay Smith Dr. Christopher Ward Dr. Jeffrey Ahlert Dr. Errol Allison

Dr. Douglas Auld Dr. Michael Auld Dr. David Birdwell Dr. Elizabeth Bohanon Dr. C. Todd Bridges Dr. Matthew Bridges Dr. Jamie Cameron Dr. Patricia Cannon Dr. Wuse Cara Dr. Bobby Carmen Dr. Matthew Cohlmia Dr. Debbie Corwin Dr. James Corwin Dr. Susan Davis Dr. Steven Deaton

Dr. Ana Dotson Dr. Heath Evans Dr. Christopher Fagan Dr. Barry Farmer Dr. Stephen Gray Dr. Clark Grilliot Dr. Michael Hansen Dr. Aaron Harman Dr. Jeffrey Hermen Dr. Robert Herman Dr. Richard Haught Dr. James Hooper Dr. Brad Hoopes Dr. Donald Johnson Dr. Eugenia Johnson

Dr. Krista Jones Dr. Mitchell Kramer Dr. Juan Lopez Dr. Alan Mauldin Dr. Stephen Mayer Dr. Glenn Mead Dr. Robert Miracle Dr. Mohsen Moosavi Dr. Anaita Mullasseril Dr. Paul Mullasseril Dr. Erin Roberts-Svob Dr. Brant Rouse Dr. Miranda Ruleford Dr. Floyd Simon Dr. Brooke Snowden

Dr. Lindsay Smith Dr. Braden Stoltenberg Dr. James Strand Dr. Jim Taylor Dr. Paul Thomas Dr. James Torchia Dr. Charles Tucker Dr. Jonah Vandiver Dr. Robert Webb Dr. Mori White Dr. Daniel Wilguess Dr. Ronald Winder Dr. Kendra Yandell

OKCapitol Club is for that “ABC” group of DENPAC members; or those who want to be “ABOVE AND BEYOND CONTRIBUTORS.” OKCapitol Club members truly understand the importance of the ODA’s participation in the political process and want to support candidates who are committed to the state’s oral health and the issues that affect your practice. OKCapitol Club members support those efforts even more by contributing an additional $300 to DENPAC ($470 total) per year. For more information about Capitol Club, contact Lynn Means at 800-876-8890 or lmeans@okda.org.

DENPAC Grand Level DENPAC funds our voice. Without our input, legislators are merely making decisions based on what sounds good, what makes the fewest people angry, or what is easiest for them.

Whether you like it or not, the campaign contributions we make to dentistry-friendly candidates are what open those lines of communication. It’s what reminds legislators once they’re in office to go directly to the ODA for information, and not somewhere else.

For more information about DENPAC, contact Lynn Means at 800-876-8890 or lmeans@okda.org.

THANK YOU TO THESE 2020 DENPAC GRAND ($1,000) LEVEL MEMBERS! Dr. Douglas Auld

Dr. Robert Herman

Dr. Anaita Mullasseril

Dr. Matthew Cohlmia

Dr. Krista Jones

Dr. Paul Mullasseril

Dr. Richard Haught

Dr. Juan Lopez

Dr. Lindsay Smith www.okda.org

23

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To learn more about NightLase® and what the LightWalker™ can do for your practice, contact Fotona Rep Scott McCracken at (817) 456-3987 or smccracken@fotona.org. www.okda.org

25

ODA MEMBER SPOTLIGHT

JAMES BAKER, DDS Oklahoma City, OK

By Abby Sholar, ODA Special Projects Manager If there is one overarching theme in Dr. James Baker’s life, it is endurance. Baker has not only succeeded over decades as an oral surgeon, he has mirrored that success and determination in ultra marathons.

Inspiration to pursue dentistry as a career came from an older fraternity brother. Baker was enticed by the idea that he would work for himself while helping people. After undergraduate studies at Oklahoma State University and dental school at Baylor College of Dentistry, Baker completed his oral & maxillofacial surgery residency at the OU College of Dentistry. He has been in private practice in Oklahoma City since 1979. He is currently practicing at OKC-OMS (Oklahoma City Oral & Maxillofacial Surgeons), which he founded in 2004. Dentistry is a family business for Baker. His wife, Dr. Melissa Farrow, is an orthodontist at Farrow & Dewbre Orthodontics. The Bakers have two daughters and four grandchildren, who refer to Baker as “Poppy.”

Baker has had the opportunity to give back in a way that is rewarding to his profession, but also satisfying to himself as a health care provider. The most rewarding philanthropic activity of his career is his working with the residents in the Oral & Maxillofacial Surgery program on a volunteer basis, including one year

as interim program chairman. “Building and maintaining relationships with these young surgeons has been very fulfilling,” Baker said. “I have been able to serve as a mentor to many successful surgeons.”

Not only has Baker served his community by passing on knowledge to future Dr. James Baker with family after running the Boston 30. generations of oral “Marathons were fun in the beginning, but surgeons, he also I needed more challenge so I became more extends that same above-and-beyond care interested in ultra-marathons and more to his patients. “I’ve been fortunate in my long distance runs. Beginning in 1995, I practice to treat multiple young people started my long distance ventures. Since with significant facial deformities that we 1995 I’ve run many 50 milers and 100 were able to correct. This has been the milers.” most satisfying part of my career.”

To be a great mentor, one must have had great mentors of their own to look to for inspiration. Baker credited Dr. Dan Brannin, an oral surgeon from Tulsa, as one of his most influential mentors. Not only was Brannin a successful surgeon who gave back to his profession and community, he was also (like Baker) an accomplished marathoner. Baker has also been shaped and encouraged by Drs. Mike Duffy and Tom Dudley, his original partners.

In addition to the rigors of dental school, oral surgery residency and decades of successful practice, Baker has also exemplified physical endurance through long-distance running and ultra marathons. He began running in dental school to stay in shape, and his hobby took off from there. He ran his first marathon while in his OMS residency in 1978. From that race, he qualified for the Boston Marathon and hasn’t stopped running since. He ran the Boston Marathon for 40 consecutive years. In Dr. James Baker with his daughter, Lori Baker-Prinz. total, he has run 55-60 full marathons.

26 journal | May/June 2020

As a self-proclaimed “Outdoor Enthusiast,” Baker has run distances most people couldn’t imagine attempting. His longest run ever was 103 miles. His most difficult run was a 100-mile race that started and ended in Silverton, CO, leading through Telluride and Ouray. This race included 12 major climbs (33,800 total feet of climbing and descent) and a 14,000-foot peak at the 60th mile. He has run this particular race four times; his best finishing time was 38 hours, finishing 26th out of 140 participants. On average, Baker dedicates 5-10 hours running and two Pilates workouts with a trainer every week.

A passion for long-distance running and a career in oral surgery have many parallels in Baker’s life. “Many of our complex operating room cases can take several hours. A tough day in the office can be several hours. Both require discipline and complete focus on what is happening. It is the same with marathons and more so with ultras. If your mind wanders, something bad may happen. It is all about the Now.”

Baker is grateful to have gotten to a point of contentment in his career. He knows that slowing down professionally is a learned behavior and he is working on being content with working less and enjoying his hobbies and family more.

The younger partners at OKC-OMS have helped Baker create a schedule where he can practice part time and focus on the things he loves to do. “With my long history of running I’m most grateful that I can still get out and go for a run. In my opinion, running has been my secret to a long, healthy career with both mental and physical benefits.”

Although Baker has gone through some healthcare issues, he is stronger today thanks to good outcomes and in realizing that he is not invincible. Today, Baker has the time to enjoy himself but by no means is he slowing down (unless you consider running 50 miles a week for fun “slowing down”). If he were able to plan his perfect day, he would spend it on a trail in the San Juan Mountains of southwest Colorado with friends, taking in the scenery and nature while racking up the miles. For a perfect vacation, Baker and his wife would go somewhere with a beach and mountains- although he admits it would

take him a few days to “check out” and relax.

Dr. James Baker has been a role model his entire career for how to prioritize your patients, give back to your profession, and push yourself to achieve new physical goals. He is a perfect example of endurance through strength and determination.

Boston Marathon 2008 Boston Marathon 1982

Boston Marathon 1985

FUN FAC TS: • If you could have dinner with anyone from history, who would it be and why? : Leonardo DaVinci (and hope he could speak English!) He was amazing, inventing so many things in so many different fields.

• What book are you currently reading?: Fewer, Richer, Greener: Prospects for Humanity (Laurence Siegel) • If you could have any other profession what would you choose to do?: philosophy; just could never see how to make a living at it!

• What is your favorite song that always puts you in a good mood?: Janice Joplin’s version of “Me & Bobby McGee” • What is one quality you admire most in others?: Living life with strong ethics

www.okda.org

27

Oklahoma Mission of Mercy OkMOM donated 20,000 masks to local Oklahoma City Hospitals to help with shortages during the covid-19 pandemic.

Dr. Paul Mullasseril with 20,000 Face Masks.

Visit okmom.org for more information on Okmom 2021: shawnee!

FEBRUARY 12 & 13, 2021 HEART OF OKLAHOMA EXPO CENTER VOLUNTEER REGISTRATION OPENS OCT. 15 AT OKMOM.ORG 28 journal | May/June 2020

OKMOM SPOTLIGHT: MCCONAGHIE DENTAL LAB In many humanitarian and philanthropic

endeavors, several behind-the-scenes heroes often go unheralded. During the 11th anniversary of OkMOM, we’d like to spotlight one of them: McConaghie Dental Lab of Oklahoma City. For the past six years, several members of the lab have worked tirelessly (literally onsite behind a curtain) to help us deliver smiles to over 536 patients by fabricating treatment partials for many OkMOM patients following the extraction of anterior teeth.

Invariably, both patients and volunteers shed tears when these cosmetic transformations are completed. Patients are able to smile again with confidence, look for jobs, present themselves professionally at interviews, and improve their self-esteem.

Reflecting on McConaghie Lab’s participation in OkMOM, Mike Finucane, McConaghie’s lab manager, said, “OkMOM is an opportunity to give back to the dental community, and our team here at McConaghie Lab looks forward to the event every year! Our lab has been in business since 1939 and is always eager to give back to the dental community; OkMOM allows us to do this in a very unique way. The event turns the dental community into a dental family that we are excited to be a part of! Among the many reasons we love attending OkMOM, one of the most satisfying is seeing the impact new smiles can have on patients for whom smiles have been rare because of the poor condition of their teeth. This is a part of our work that we don't get to see on a regular basis, so it’s awesome to be on the front line with the dentists and witness these transformations first hand -- only one of the many reasons OkMOM is so important to us every year!”

www.okda.org

29

ODA FEATURE

CLINICAL DIFFERENTIAL DIAGNOSIS: PALATAL ULCER By: Glen D. Houston, DDS, MSD Diplomate, American Board of Oral and Maxillofacial Pathology CASE HISTORY A 62-year-old male developed a large, ulcerated area (Fig. 1) involving the palatal mucosa. The area was asymptomatic except when irritated and prevented him from wearing his maxillary denture.

Radiographic findings were unremarkable.

The patient was diagnosed and treated for syphilis 20 years ago. Additionally, he admits to alcohol and tobacco abuse.

QUESTION #1 Based on the information given, the differential diagnosis for this lesion includes: a. Midline malignant reticulosis b. Histoplasmosis c. Squamous cell carcinoma d. Gumma e. Necrotizing sialometaplasia f. Trauma ANSWER #1 Your differential diagnosis should include all of the entities listed in Question #1.

Midline malignant reticulosis (a) is an aggressive process that produces destruction of the palate and nasal region and typically represents a malignant lymphoma. This lesion is usually observed in adults, may be painful, and presents clinically as a necrotic ulceration.

Histoplasmosis (b) is the most common systemic fungal disease in America. It is caused by the organism Histoplasma capsulatum and usually manifests as a pulmonary infection. Oral lesions can be observed and usually consist of a solitary, painful ulceration that occurs on the palate, tongue, or buccal mucosa.

Squamous cell carcinoma (c) typically presents in adult males with the tongue 30 journal | May/June 2020

being the most common intraoral site, followed by the floor of the mouth, soft palate, gingiva, and hard palate. Oral squamous cell carcinoma has a variety of clinical presentations, which include a mass, areas of erythroplakia and/or leukoplakia, and an area of ulceration.

the area is indicated.

The gumma (d) of tertiary syphilis is usually seen in adult males. It is a zone of granulomatous inflammation, which may present as an indurated, nodular, ulcerated lesion. Intraoral involvement typically affects the palate or the tongue.

Staining with the vital stain, toluidine blue (d), may be helpful in the evaluation of an area of erythroplakia, but is not indicated for an area of ulceration.

Necrotizing sialometaplasia (e) is an uncommon, locally destructive inflammatory condition of the salivary glands. It is most frequently associated with the minor salivary glands of the palate, is usually observed in adult males, and presents as an asymptomatic, necrotic, ulcerated area involving the palatal mucosa.

Traumatic lesions (f) of the oral cavity may present with a variety of clinical manifestations, one of the most common being an area of ulceration. Clinical history is usually helpful in determining the source of the injury.

QUESTION #2 The diagnostic procedure of choice is: a. Follow the patient for 3-4 weeks to evaluate for resolution of the lesion b. Biopsy c. Perform an oral cytologic smear of the area d. Stain the lesion with toluidine blue vital dye ANSWER #2 Because of the worrisome clinical presentation of the present case, a biopsy (b) of

Following the patient for 3-4 weeks to evaluate for resolution of the lesion (a) and performing an oral cytologic smear of the area (c) are not indicated in the management of a large, ulcerated area.

QUESTION #3 Microscopic examination of the lesion revealed multiple fragments of mucosa exhibiting a prominent ulcer, necrotic debris, lobules of salivary gland demonstrating necrosis with loss of functional acini, and associated squamous metaplasia of the residual ducts. The correct diagnosis would be: a. Squamous cell carcinoma b. Mucoepidermoid carcinoma c. Necrotizing sialometaplasia d. Gumma (syphilis)

ANSWER #3 The correct diagnosis is necrotizing sialometaplasia (c). See "Discussion" section.

The other conditions are not considered here for the following reasons: Squamous cell carcinoma (a) arises from dysplastic surface stratified squamous epithelium and exhibits invasive islands of malignant epithelial cells within the submucosa.

Mucoepidermoid carcinoma (b) is a malignant salivary gland neoplasm (adenocarcinoma) that is composed of a mixture of mucous cells and epidermoid or squamous cells. An associated lymphoid infiltrate may also be observed histologically.

Clinically, this entity may be confused with squamous cell carcinoma, adenocarcinoma, malignant lymphoma, granulomatous ulcer, or traumatic ulcer. The lack of pain, induration, and rolled margins clinically should divert suspicion of malignancy. A biopsy is required to obtain a definitive diagnosis.

Microscopically, the ulcer is composed of necrotic debris and fibrinous material. The underlying salivary gland is necrotic with loss of normal acinar morphology, extensive squamous metaplasia of the ducts, and a granulomatous response.

Once a definitive diagnosis is rendered, no treatment is required. The lesion will spontaneously regress in 6-8 weeks.

Palliation is not necessary since the lesion is generally asymptomatic.

About the Author: Dr. Houston works at Heartland Pathology Consultants, PC in Edmond, OK. He can be contacted with questions at gdhdds@ heartlandpath.com REFERENCES Imbery TA and Edwards PA: Necrotizing sialometaplasia: literature review and case reports. J Am Dent Assoc 127:1087-92, 1996.

Sneige N and Batsakis JG: Necrotizing sialometaplasia.

Ann Otol Rhino Laryngol 101:282-84, 1992.

Brannon RB, Fowler CB, and Hartman, KS: Necrotizing sialometaplasia: a clinicopathological study of sixty-nine cases and review of the literature. Oral Surg Oral Med Oral Pathol 72:317-25, 1991.

Abrams AM, Melrose RJ, and Howell FV: Necrotizing sialometaplasia: a disease simulating malignancy.

Cancer 32:130-35, 1973.

The gumma (d) of tertiary syphilis typically exhibits surface ulceration with focal areas of granulomatous inflammation within the submucosa. Special tissue stains will usually demonstrate the causative organism Treponema pallidum.

DISCUSSION: Abrams et al. first reported this condition as a distinct clinicopathologic entity in 1973, although this phenomenon had been recognized for a number of years previously.

Necrotizing sialometaplasia is a benign, non-neoplastic, self-limiting, ulcerative disease of the minor salivary glands, primarily involving the palate. The various entities listed in the differential diagnosis in Question #1 of the case history require consideration because the clinical spectrum of necrotizing sialometaplasia can mimic other diseases. Unfortunately, this condition is often mistaken clinically as well as microscopically for malignancy (squamous cell and/or mucoepidermoid carcinoma).

The etiology of this process is still unknown, although vascular occlusion of the arterioles supplying the salivary gland tissue has been suggested.

Most of the reports in the literature have dealt with the lesion in its most common presentation as an ulcer of the hard palate and adjacent tissues. Other sites of involvement include the maxillary sinus, nasal cavity, parotid and sublingual regions, soft palate, retromolar trigone, lower lip, tongue, larynx, and lung. Necrotizing sialometaplasia occurs predominantly in men with an observed age range of 23-66 years.

ODA SPEAKER’S BUREAU

Are you an expert in a topic related to dentistry?

Would you like to share that knowledge with Oklahoma dentists or other dental professionals?

The ODA is building a Speakers Bureau of member dentists who are qualified and who desire to speak at various events.

Learn more at okda.org/members-only www.okda.org

31

Collect What You Produce: MAXIMIZING A PATIENT FINANCING PROGRAM By: Cathy Jameson, PhD | Part 4 of a ten-part series “Stopping marketing to save money is like stopping your watch to save time.”- Henry Ford Would a 10% increase in production and collection make a difference for you? What about a 30% increase? This can (and does) happen when a practice becomes involved with and promotes a patient financing program.

For most practices, there is dentistry sitting in the charts waiting to be done. That doesn’t mean you’ve done anything wrong.

It means that something has prevented people from moving ahead. People wouldn’t come to your practice if they didn’t want or need something. If they walk out the door without scheduling an appointment, some barrier or objection prevented them from going ahead.

People who perceive the value of treatment, recognize the need, understand the urgency, and trust the doctor and team will go ahead, if they can afford it. That’s where your financial system comes into play.

An ADA survey asked people in every state if they could make a one-time dental purchase of $500. Seventy-seven percent of the people said “no,” unless they had a way to spread out the payments.

One person per week proceeding with $500 worth of treatment would result in $2,000/ month or $24,000/year of income. If one person per day proceeded with $500 worth of treatment because they had a convenient way to pay, you would realize $100,000/year of additional revenue (based on an average of 200 days/year that a practice is open). In this example, about 20% of the increased production would go to increased overhead expenses (additional supplies, lab costs, etc.). However, that still results in 80% of bottom-line profit.

The most gratifying result would be that people who want or need care would receive it instead of walking out the door saying, “I’d like to go ahead with this, but I can’t afford it right now.” Patients recognizing the value, need and urgency of treatment and having a high level of trust in your team, 32 journal | May/June 2020

added to your practice helping them find a financial solution is a win-win proposition.

Let people know that you offer convenient, long-term financing right in your office.

PROMOTING PATIENT FINANCING 1. INTRODUCE THE PROGRAM TO YOUR ENTIRE PATIENT FAMILY In a special mailing, or in your regularly published or digital newsletter, inform your existing patient family about your financing program and stress its benefits. Direct people to your website and guide them on how to apply online. (Check with your patient financing program for this option.)

Some patients in your practice will not need the program. However, fear of cost is the number one reason people don’t go to the dentist. Establishing a line of credit may dissolve that barrier.

2. NEWSLETTERS Good marketing recommends that you stay in contact with your patient family on a regular basis. Repetition is a key to learning so continuing to address opportunities, including financial ones, is essential. People’s need for dentistry and for financing can change from time to time.

Digital newsletters are easy, convenient, and excellent. Just because you have introduced patient financing once doesn’t mean reinforcement is unimportant.

In October of every year send a letter to patients who have unaddressed treatment needs and remind them to maximize their yearly benefits. Then, in January remind patients that a new year has begun and, thus, a new maximum for their insurance.

Encourage them to use patient financing to handle the balance after the insurance pays.

Or if they don’t have dental insurance, offer a comfortable, convenient way to financing.

3. BROCHURE A practice brochure is a marketing piece that lets people know who you are, where you are, what you do, and what makes you special. It must be attractive, informational, and inviting. Include information about patient financing in your brochure. Hold a team meeting and determine where, when,

and how you can use your brochure to retain patients, generate new patients, and encourage referrals. Be creative.

4. WELCOME PACKET Include information on patient financing in your welcome packet. You can also include an application and a brochure about your patient financing program.

5. ACCOUNTS RECEIVABLE TRANSFER Every day that an account sits on your books doing nothing, you lose money due to the cost of running a banking business within your practice, the chances of never collecting the account, and the dollars loss of an idle account.

If you have existing accounts receivable, consider making an active effort to transfer as many of them as possible to cash, to a bank card or to a financing program -- if the accounts are good. Don’t transfer bad accounts. Turn them over to collection.

6. CHART AUDITING Review your treatment plans to see which ones have dentistry diagnosed but incomplete. Try to reactivate these patients or encourage them to proceed with treatment as you introduce your patient financing program.

During your morning meetings, identify dentistry that has been diagnosed but not completed. About 50%-75% of each day’s patients need something beyond the day’s treatment. Make note of what each patient needs next. Then, when the patient is in the treatment area, have a conversation with them about the next phase of necessary dentistry. Use the intraoral or digital camera to show the patient the next areas of concern. Stress the benefits of proceeding with treatment and discuss any problems that may arise if the person doesn’t go ahead.

You do the patient a great service by continuing to encourage them to say “yes”.

This is a good time to introduce your patient financing program.

7. INSURANCE Available insurance benefits are often left unused because people cannot handle the estimated patient portion. Let people know that if they want to spread out the balance that insurance doesn’t cover, you have a new, convenient way for them to do just that. Tell them about your financing program.

8. CONTINUOUS CARE/HYGIENE At Jameson Management, we consider the hygiene department the lifeblood of the practice. This is where you get people healthy and keep them healthy. This is also where you can do the following: 1. Reinforce the value of dentistry diagnosed but incomplete; 2. Identify new areas of concern since the last appointment; 3. Identify periodontal concerns and make recommendations for appropriate treatment; 4. Introduce options for advanced restorative treatment; and 5. Introduce aesthetic alternatives.

Using an intraoral camera is your best teaching tool since approximately 83% of learning takes place visually. People need to see what is going on in their own mouths.

Plus, you can show them the features of what you are recommending, the benefits of treatment, and proof that you can produce the desired results. (Remember that written permission is required to use photographs if the face is shown.)

Hygiene retention will improve with the combined use of photographs and patient financing. Plus, you will gain higher acceptance of non-surgical periodontal therapy or sealant therapy. If people can fit payments into their budget many will proceed.

9. CASE PRESENTATION The human mind can only think of one thing at a time. Therefore, if a patient is calculating what they think the treatment will cost, they may not hear a word you’re saying during a consultation. Don’t hesitate to introduce your financing program during (or before) your presentation of your clinical recommendations. The key point here is that addressing a potential negative before the fact gives you a chance to turn that potential negative into a positive.

10. SOCIAL MEDIA Social media allows a practice to communicate on a regular basis with patients in a cost-effective manner. In addition, while there is still time and expertise required for effective social media (just as with any marketing strategy) the time involved is less intensive.

Marketing specialist Carrie Webber teaches what marketing experts have touted for years -- the rule of seven. Patients may require 5-7 contacts or “touches” with a practice before they actually pick up the phone and call to make an appointment.

While personal referral remains the number one method of accessing new patients, other sources include social media. A person may have heard about a practice through a personal referral. They may have received a brochure, or come across an online ad or a promotion in the community. But the next step is often to go directly to the practice’s website. Make sure that yours is good -created and maintained by a professional marketing organization with the capability to ensure that your practice pops up on the first page of a search when someone seeks information about you.

Your website needs to be easy to navigate, attractive, current and patient-friendly.

Update your information often. Provide new material regularly so that people -- including your existing patients -- will return repeatedly.

Establish a regular presence on social media outlets (Facebook, Instagram, Twitter, YouTube, etc.). Consistently ask for online reviews. Establish a “marketing champion” in your practice who will post regularly and retrieve responses so that questions or comments can be handled. Short, engaging videos of you, your team members, and patients (with written permission) grab the attention of people on social media. People/ patients love to see what you are doing in the community, with charities, schools, and in your practice. While you promote your dental services, remember that social media is just that -- social.

In your social media, promote patient financing. Get the message across that people don’t need to fear the cost of dental care in your practice. Your patient communication programs can help you with your social media messaging, as can your professional marketing advisors.

IN SUMMARY As a team, develop a strategic plan for maximizing/marketing your patient financing program. Make the financing comfortable for your patients. Defuse the fear of cost. Make it possible for people to receive quality, optimum, complete dentistry.

About the Author: Cathy Jameson, PhD, is

the founder of Jameson Management, Inc., an international management, hygiene, and marketing firm which offers proven management and marketing systems for helping organizations improve in a positive, forwardthinking culture.

Jameson holds a doctorate in management from Walden University where she focused her research on transformational leadership. She has been inducted into the College of Education Hall of Fame and is a Distinguished Alumna of Oklahoma State University. She serves on the Board of Governors there.

Jameson has been named one of the top 25 Women in Dentistry and has received Lifetime Achievement Awards from the Excellence in Dentistry Organization and from the Academy of Dental Office Managers. She was a finalist for the Stevie Award for outstanding entrepreneurial women. She is a member of the American Association of Female Executives, National Speaker’s Association, Academy of Dental Management Consultants, National Society of Leaders and Success and Chi Omega Women’s Fraternity.

Jameson has lectured in all US states and in 31 countries. She has had over 1,500 articles published throughout the US and the world.

She is the author of eight books, including the 3rd Edition of her bestseller, Collect What You Produce and Creating a Healthy Work Environment. These can be purchased from Amazon.

For more information on Dr. Jameson’s lecture or personal consulting services, contact her at Cathy@jamesonmanagement. com. For more information on the consulting services of The Jameson Management Group, contact www.info@jamesonmanagement.com or www.jamesonmanagement.com

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33

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35

TIMING YOUR NEXT REAL ESTATE TRANSACTION By: CARR Healthcare Every commercial real estate transaction has an ideal time-frame to begin the process. Most healthcare professionals understand that starting a new office or relocating an office doesn’t happen overnight, but the majority of professionals are not aware of the ideal time-frames for each type of transaction.

Different types of problems arise when starting a transaction too early or too late, and both need to be avoided.

TOO EARLY If you start the process too early, it creates a scenario where you spend your valuable time looking at properties and evaluating options, working with lenders and other members of your team, only to find out the landlords or sellers won’t negotiate with you yet. Many landlords and sellers won’t take their spaces off the market for extended periods of time while waiting for the tenant or buyer to be ready to transact, because there is too much time before the transaction will actually take place. Or if they do negotiate, they won’t be willing to offer you even close to their best terms since they are going to lose income on holding a space vacant for an extended period of time. On the other hand, if they will put forth reasonable terms, it is predicated upon you moving forward immediately, which can leave you stuck paying for a space you can’t occupy for a period of time or paying unnecessary rent on your former space if you leave early.

TOO LATE When starting a transaction too late, an entirely new set of problems arise. To start, most people underestimate how long a commercial lease or purchase transaction takes. They imagine it is similar to buying a home or leasing an apartment, which unfortunately is not the same as a commercial transaction timeline.

Simply identifying the top options and then negotiating a mutually agreeable deal can take several months. The legal process of reviewing contracts and finalizing details with lenders, architects, contractors, and equipment and technology providers comes next; this portion can also take months.

36 journal | May/June 2020

This is followed by the build out process if renovations are required. While you can build out a new space in 6 to 10 weeks depending on the size and scope of the project, you first have to design the space, then get construction documents and engineered plans created, then submit for and receive permits to start the build out. After construction, you need to leave time for installing furniture, fixtures, equipment and technology, final permitting and approvals, while also leaving room for uncontrollable delays, and change orders.

If you are relocating from a previous office and you don’t vacate your former space prior to the lease expiring, you’ll likely pay between 125% and 200% of your last month’s rent based on a provision found in most leases called “Holdover.” This allows the landlord to charge you a higher month-to-month lease rate as a penalty for not vacating or signing a new lease.

JUST RIGHT If you only had two choices, starting too early is definitely better than starting too late but it is by no means your top option.

Fortunately, there is an ideal time-frame to start each type of transaction and you don’t have to choose between the lesser of two mistakes. You can set yourself up for success by understanding the requirements of each type of transaction and how long each process takes.

Although there are many additional details needed to ensure each type of transaction is handled properly, let’s start with the correct timing for the primary types of transactions that Healthcare Professionals will engage in: • Start-up or new office: 10 – 12 months in advance • Relocation: 10 – 12 months in advance • Purchasing an existing building or condo: 10 – 12 months in advance • Buying land to develop a new building: 18 – 24 months in advance • Buying a practice and getting a new lease or purchasing the building: 60 – 90 days in advance

Every type of transaction starts with a specific approach and detailed game plan that is aimed at maximizing the opportunity. Getting the best possible deal and terms is extremely important, but so is making sure you don’t waste valuable time that could have been spent in your practice. If you lose the equivalent of twenty to thirty hours of your time— which is what an average commercial real estate transaction requires to be handled properly—how much money would that cost you in lost production?

Equally as important as saving time and money is avoiding costly mistakes that people make all too often when they don’t understand the nuances of healthcare real estate. The old adage, “if I knew then what I know now…” can easily be avoided by hiring licensed professionals that specialize in real estate for healthcare practices. The reason patients come to see you is because you are trained in a specific skillset that offers skill and expertise that they require and that few people have. The same is true for real estate professionals that can help you identify your top options, negotiate the most favorable terms, save you a substantial amount of time, and avoid common pitfalls.

The first step to maximizing any commercial real estate transaction: Start the process at the right time.

CARR is the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. Every year, thousands of healthcare practices trust CARR to help them achieve the most favorable terms on their lease and purchase negotiations. CARR’s team of experts assist with start-ups, lease renewals, relocations, expansions, additional offices, purchases and practice transitions. Healthcare providers choose CARR to help them save a substantial amount of time and money, while avoiding costly pitfalls and ensuring their interests are always first.

Increase your profitability by renegotiating your lease.

Contact an expert broker today to see how much you could save during your next lease negotiation.

CARR Healthcare is the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. Our team of experts assist with start-ups, lease renewals, expansions, relocations, additional offices, purchases and practice transitions.

EASTERN OKLAHOMA Curtis Hesser 918.977.0837 curtis.hesser@carr.us CENTRAL/WESTERN OKLAHOMA Jack Geurkink 405.590.5037 jack.geurkink@carr.us CARR.US

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HYGIENE HOTSPOT

THE WAITING GAME: SHOULD YOUR HYGIENIST CLOCK OUT FOR NO SHOWS? By: Rachel Stroble, B.A., RDH When a patient no shows a dental hygiene appointment, is it in your best interest to ask your hygienist to clock out? This has been a point of contention for many dentists and hygienists. Some practices utilize a clock-out strategy as an unofficial policy, while others include it in the written terms of employment for their hourly team members.

Let’s explore the legality of the issue.

According to the U.S. Department of Labor, off duty waiting (or layover) time is a period during which an employee is waiting to be engaged. Since it is not working time it does not require payment. However, to legally qualify as off duty time the employee must [1] be completely relieved from duty, [2] have enough time available for it to be used effectively for personal purposes, [3] be given permission in advance to leave the job, and [4] be advised of when a return to work is required.1 According to these criteria, a no show does not qualify as off duty time since the hygienist is not given advance permission to leave the job, nor is the time period typically long enough to be used to complete any personal task. In addition, the hygienist would most likely not be completely relieved of duty, but may be asked to assist another team member, catch up with sterilization, anesthetize a patient, etc.

On the other hand, on duty waiting time is defined as time when the employee is waiting for work to do, repairs to be made, etc. while on duty; the employee is engaged to wait and the time is considered hours worked.2 Payment is required.

Some examples of on duty time include a receptionist reading a book while waiting for customers or phone calls, and a factory worker talking to fellow employees while waiting for machinery to be repaired.2 In the case of the hygienist, waiting for another patient to arrive or for another team member to need support is clearly on duty waiting time (and constitutes obviously higher standards than reading a book!).

38 journal | May/June 2020

When asking your hygienist to clock out your intention may be to save money, but you should consider that the time could be better used to invest value into the practice.

A good example is instrument sharpening, an often overlooked duty that can be a significant investment in the practice. By sharpening instruments, hygienists are able to work more efficiently, spare their bodies undue wear and tear, and reduce the risk of musculoskeletal disorders. Over the years this will result in less pain and longer careers. Sharper instruments can also provide gentler yet quicker and higher quality care to patients, a priority in any exceptional dental practice. Scaling with dull and ineffective instruments, sending instruments out to a sharpening service, or replacing instruments more frequently are all less cost-effective alternatives to in-house sharpening.

Other tasks that would be beneficial to the practice include making post-op calls to patients who have recently undergone scaling and root planing, maintaining and logging the emergency drug kit, and keeping the office clean and well stocked (an important factor in patient perception and retention). By asking your hygienist to serve in these capacities instead of clocking out, you not only make sure essential duties are carried out, but you also let your hygienist know you value their time and skills and what they bring to your practice.

When you adopt the mindset that an investment of time has value for the practice, not only will you be compliant with U.S. labor laws, but you will also be seizing the opportunity to better care for your patients, your practice, and your other team members. The next time you are tempted to ask your hygienist to clock out when a patient no shows, ask yourself: “Do I want to save a few dollars, or do I want to invest in my practice?”

ABOUT THE AUTHOR: Rachel Stroble, B.A., RDH has practiced clinical dental hygiene with Edmond Dental Center since 2013. She also contributes to the dental hygiene and dental assisting programs at Rose State College as an adjunct clinical instructor. In addition to her dental hygiene credentials, Rachel also has a degree in journalism and writes for various dental hygiene publications. When not busy wielding a scaler, teaching or advocating, she enjoys the outdoors and loves traveling the world with her husband. For more information, email her at rachelstroblerdh@gmail.com.

References: 1.“Off Duty Waiting Time” Elaws - FLSA Hours Worked Advisor, United States Department of Labor, https://webapps.dol.gov/elaws/whd/flsa/hoursworked/ screenER79.asp.

2.“On Duty Waiting Time” Elaws - FLSA Hours Worked Advisor, United States Department of Labor, https://webapps.dol.gov/elaws/whd/flsa/hoursworked/ screenER78.asp.

NEW DENTIST CORNER

FIGHTING COMMERCE, CANCER, AND COVID-19: FAITH, FAMILY AND FRIENDS By: Diane Vincent, DDS Life after dental school hasn’t been easy.

Finding where I belong in this profession proved to be difficult as I worked in both private and corporate practice settings.

After three years of practice, the promise of graduation was a distant memory as my spirits dwindled. Dentistry just wasn’t as fun as I remembered. Determined to find my fit, I stumbled upon a classified listing on the ODA website for an associateship position at a private practice in Stillwater, Oklahoma.

A push of faith led me to respond. After meeting Dr. Zach McNickle, the owner of the practice, I discovered that my career goals and personality aligned perfectly with this opportunity, and I knew I had found my dental home. Those first few years after school, although challenging, gave me the invaluable knowledge and experience to know where I belonged and strengthened me as a provider.

However, just as life started feeling right again, during my transition to Stillwater my husband, Tyler, was diagnosed with stage IV Ewing’s sarcoma, a rare and very aggressive form of bone cancer. I was blessed to work for a caring and understanding practice owner as he allowed me the needed flexibility in my work schedule so I could provide care for Tyler through a year of intense chemotherapy and radiation. I am thrilled to report that just three weeks ago, Tyler celebrated one year of remission.

Our shared experience truly showed me the important things in life and once again grew my strength. Little did I know that this renewed strength was about to get seriously tested by something that would impact our profession in a way no one could have foreseen.

Shortly after returning home from Tyler’s checkup, COVID-19 started rattling the dental profession. Canceling routine dental care and seeing only emergencies has now become the new norm, and for small practice owners, the threat of great financial hardship looms large. I see the stress and the physical and mental toll that Dr. McNickle has been undergoing.

The feeling of helplessness that I initially

experienced with Tyler’s diagnosis was all too familiar. Filing for unemployment in the first week of April seems surreal, and the process itself, exhausting. However, I am thankful I have a mentor in place to help tread these uncharted waters. Also, through daily emails and seminars, I see how hard the ADA and ODA have been advocating for dentists, which helps calm my fears and reassures me that we are all in this together.

Instead of fearing the uncertainty, I choose to rely on the strength I’ve built up in order to lend a helping hand, safely and carefully, to those I can. I decided to turn off news sources that were causing me anxiety, I made a budget to cut out unnecessary expenses, and I requested forbearance for loans. Our practice has donated surgical masks to a local hospital and our staff has rallied around each other for support. Dr. McNickle has involved me in the decisionmaking process and kept me up to date on the EDL and PPP loans. Together, we’ve developed a plan of action for the day to come when we can resume business as usual.

I encourage my fellow associates to lift up their practice owners who are tirelessly fighting to preserve our jobs and our patient’s needs, and to be leaders in their practices. Yes, life after dental school hasn’t been easy, but I am proud to be in this profession and excited to see the growth in our practice and in myself after this storm passes. When asked how I managed through my first few years as a dentist, my husband’s treatment, and now the COVID-19 crisis, my answer remains the same: faith in God and the support of my family

and friends -- not to mention having a true rock star of a boss! Dr. McNickle, you are truly inspiring!

ABOUT THE AUTHOR: Dr. Vincent grew up on a farm in Red Rock, Oklahoma, a small town in northern Noble County. She earned her undergraduate degree from Oklahoma State University, and then attended the OU College of Dentistry, graduating in 2015. She and her husband, Tyler, reside in Stillwater, Oklahoma where she currently practices general dentistry at Stillwater Dental Associates. In her free time, she enjoys cooking, music, and playing fantasy football.

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WHAT THE CORONAVIRUS HAS TAUGHT ME By: Tabitha L. Arias, DDS

The word “pandemic” has not held much meaning or weight in my life until now. Seemingly overnight, it seems as if life as we knew it has come to a virtual halt. Any semblance of a schedule has fallen apart as personal appointments, school activities and religious gatherings were cancelled indefinitely.

Not to mention the quick escalation of my concern about how this pandemic would affect my patients, my dental team and the future of my practice.

On October 1, 2020, I will be celebrating my two-year anniversary as a new practice owner. So much time and attention was given in researching and advancing my education as a new business owner in an effort to ensure the future health of my practice moving forward. I can tell you that no piece of research or any education platform gave me information on how to plan, prepare for and recover from a pandemic. I can also tell you that what I’ve learned over these last few weeks has proven critical to my ability to lead my patients, my team and my practice. Some thoughts: GET AHEAD OF THE NOISE As news began to unfold about the COVID-19 pandemic my patients and my dental team began to look to me for guidance. As dentists we are not only leaders in our community but for our patients and our teams as well. In this time of so much uncertainty it is important that we provide leadership along with effective and timely communication. I made it clear to my patients and my team that they were and are my number one priority. I placed value on their safety as well as their concerns surrounding their job security and financial obligations. Even now that we are in long-term temporary closure, I continue to check in with my team, keep them informed on any new changes, and communicate with complete transparency. Most importantly I am checking on them and their families. Let your team members know you care and show them their value.

KNOW YOUR TEAM From the start of forming my dental team, I knew the importance of building valuable long-term local relationships over just finding someone who can do something for the least money. I didn’t fully appreciate the weight of how important these relationships would be until we were faced with this pandemic. The members on my team have dedicated themselves to be informed and up to date on issues that help small business owners like myself make the best decisions moving forward. Being able to call on team members such as my CPA and my financial personnel as we have moved through consistent legislative changes has been critical, especially when so much misinformation is present.

As a new business owner it is easy to think only about the bottom line and cutting costs, but I can tell you that it is 40 journal | May/June 2020

these relationships that have brought me so much peace in navigating through this time.

YOU ARE NOT ALONE From paying payroll from my reserves for a few weeks to moving towards furlough of my entire team, it is easy to feel alone. I’ve honestly lost sleep worrying about how I could support my team and my practice if closures were extended long term. I was so focused on what I couldn’t control that I lost sight of what I could. I have control over how I respond and how I lead those around me forward to the promise of tomorrow. I also have control over how I use the gift of time that this pandemic has provided. What can we do with this time to better our lives and our practices? We all come from different situations in our businesses and personal lives but we are in this together. I am more proud than ever to be a part of this profession; from the support of state and national organizations such as the ODA and ADA to the support of my local study club, I know I am not alone. Our perseverance is being tested but if we continue to support each other we will come out of this stronger.

ABOUT THE AUTHOR: Dr. Tabitha Arias is a 2017 graduate of the University of Oklahoma College of Dentistry.

While at OUCOD she served as president of the College’s chapter of the American Student Dental Association (OUASDA) and chair of the National ASDA’s Council on Communications.

Arias is currently serving as vice president of the Oklahoma County Dental Society and as the Oklahoma Dental Association’s New Dentist Trustee. She is a member of the Oklahoma Dental Association, the American Dental Association, the American Dental Education Association, the Academy of General Dentistry, and the American Dental Political Action Committee. She owns her own general dentistry practice in Oklahoma City, Oklahoma.

Arias enjoys spending her leisure time with her husband Josh, their “bonus kid” Jassmine, and the family’s five dogs (Elle, Khloe, Juno, Wrigley and Lucy). She and Josh are avid sports fans and attend all Oklahoma football games and Thunder basketball games.

OUCOD RESPONDS TO CORONAVIRUS Each year, I visit with our students about the annual Oklahoma Mission of Mercy and its importance in providing free dental care for those in need. I tell them that volunteering for OkMOM is the mark of a true professional. We give of ourselves to the service of others, and with that comes some advance preparation, which can interrupt our personal lives a bit. Because of the value gained from volunteerism and the assistance they can offer to the less fortunate, our students don’t mind the minor interruption in their schedules and they look forward to these annual OkMOM events. Fortunately, this year they were able to participate in this life changing experience before a much more serious and long-lasting interruption reared its head – the novel coronavirus pandemic.

COVID-19 is mounting a severe challenge to our profession, both in terms of how we serve and in how we educate. Since March 23rd, the OU College of Dentistry has reduced its personnel to minimum levels of operation.

Individuals able to telecommute are doing so, while others are staying at home per the orders of both our governor and mayor.

Our OMS faculty and GPR residents are addressing emergency cases in our Oral and Maxillofacial Surgery (OMS) Clinic. Activities in all other student and resident clinics and Faculty Practice have been suspended through the end of April. We are also limiting visitors accompanying patients to their appointments to one per patient.

Further, we are limiting access to our building. Hours have been restricted to 7:30am to 1:00pm Monday through Friday (subject to change). All students, faculty, staff and patients are required to enter through the front doors where they go through a screening process, which includes a questionnaire for new visitors and a temperature check for everyone. We are taking this pandemic seriously and will continue to monitor and make adjustments to our operations as needed. The health of our patients, students, faculty and staff is not only of utmost importance; it is our responsibility.

We were fortunate that our students were on Spring Break during the onset of the pandemic. This afforded us the time to revise our clinical operations and move lecture-based courses online. For the remainder of the spring semester, all didactic courses for both the dental and dental hygiene programs have been moved online and will continue throughout the entire summer semester.

In addition, all hands-on preclinical courses have been suspended through the end of April. We hope that these courses can resume after that date, although we intend to keep social distancing measures in place. We are working on scheduling additional makeup time to ensure program continuity. As of now, we will be working through the May intercession break straight through to the end of the summer semester on July 31st. After that, we will assess our progress and any changes needed for the fall semester and beyond.

The pandemic has had a very real impact on our instructional activities, but with our advanced clinical educational program we are in a much better position than many other schools across the nation. Most of our fourth-year students have already completed the majority of their requirements, with second-year hygiene students in much the same position. This will allow graduation times for both groups to occur as planned. (Per university regulations we have had to cancel our official May 9th graduation ceremony. We are working to identify a makeup date.)

Through the years, Oklahomans have proven themselves to be resilient and have shown incredible strength during difficult times. The College has weathered difficult years in the past and will continue to do so. Despite the current setbacks, our future remains bright and stable.

As always, if you have questions or concerns, I continue to be available to you. Please do not hesitate to reach out.

Best regards,

Raymond A. Cohlmia, D.D.S. Dean, OU College of Dentistry

www.okda.org

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EPA REGULATION:

MANAGEMENT OF DENTAL AMALGAM WASTE By: Makenzie Dean, ODA Operations Manager The Clean Water Act (CWA), a 1972 amendment of the original 1948 Federal Water Pollution Control Act, established regulations governing pollutant discharges into U.S. waters. Since 1972 a number of amendments have modified various CWA provisions over the years. One of the most recent amendments (instated July 14, 2017 with a phase-in period through July 14, 2020) created standards to reduce the discharge of mercury and other metals from dental offices into municipal sewage treatment plants such as publicly owned treatment works (POTWs). Dental offices are the main source of mercury (from dental amalgam fillings) and other metals discharged into sewers that drain to POTWs and ultimately released into the environment. The new federal regulation requires that dental offices comply with its provisions by using amalgam separators to capture these various metals for recycling. This is a means of managing mercury that would have otherwise been released into the air, land and water.

WHAT MUST YOU DO? Dental dischargers that were discharging into a POTW prior to July 14, 2017 must be in compliance with the standards by July 14, 2020, and must submit a one-time compliance report certifying such by October 12, 2020.

Dental dischargers whose first discharge into a POTW occurred after July 14, 2017 must be in compliance with the standards immediately, and must submit a one-time compliance report certifying such within 90 days after the first discharge.

WHO MUST COMPLY? The large majority of dental offices and other facilities (dental schools, clinics, etc.) that discharge wastewater into publicly owned treatment works are subject to this rule. Dental dischargers that exclusively practice one or more of the specialties listed below are not subject to the rule’s requirements, including the one-time compliance report to their Control Authority (usually a local wastewater utility, a state environmental agency, or a U.S. EPA regional office). If you are unsure who your Control Authority is, contact Roshini Schroeder, Water Quality Division, Oklahoma Department of Environmental Quality, at roshini.schroeder@deq. ok.gov or 405-702-8132.

The following are not subject to the rule’s requirements: • Oral and Maxillofacial Radiology • Oral and Maxillofacial Surgery • Oral Pathology • Orthodontics • Periodontics • Prosthodontics

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In addition, mobile units, dental offices and other facilities that do not discharge their wastewater into a POTW are exempt from the rule’s requirements.

WHO CAN ANSWER MY QUESTIONS? If you have any questions regarding this new regulation, contact Roshini Schroeder as indicated above. You can also visit epa.gov/ eg/dental-effluent-guidelines on the US Environmental Protection Agency’s website for more information.

The deadline for dental offices to install amalgam separators remains intact but the Environmental Protection Agency announced March 26 that it will be initiating “a new temporary enforcement discretion policy” during the COVID-19 pandemic. Under a federal rule adopted by the EPA in 2017, many dental practices will need to install an amalgam separator

by July 14.

Read the article from the ADA https://bit.ly/2XW9rGy

42 journal | May/June 2020

E N D O R S E D PA RT N E R

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WHAT CAN DENTISTS DO ABOUT YOUTH VAPING? By: Jana S. Winfree, DDS, MPH Dentists care about the general health and well-being of their adolescent patients. Today’s teenagers are prone to experimentation and many are curious about vaping. In fact, the most popular tobacco products among teens are electronic cigarettes (e-cigs). These battery-operated devices are used to inhale liquid solutions, usually of nicotine and flavors. Young users cited enticing flavors (mango, crème brûlée, cool mint, etc.) as the main reason they tried vaping. The flavors were appealing and masked the sting of inhaling tobacco.

In February 2020, the Food and Drug Administration (FDA) banned many flavors for cartridge or pre-filled pods because of their attraction to teens. However, flavors are allowed for some devices and savvy users can find desirable pod/cartridge flavors through online and third-party marketers.

Against manufacturer’s recommendations, some creative users believe they can up the kick by adding marijuana, alcohol, essential oils, coffee or other substances to the e-cig solution. Such actions increase the risk of harm. The severe lung damage and increased deaths in 2019 were related to adding vitamin E acetate to THC e-cigs.

Most of the almost 3,000 victims were male teenagers or young adults under age 24. An attractive alternative method for inhaling tobacco is the Juul, a USB-shaped e-cig

that is easy to use and simple to recharge in any USB port. The Juul pods contain 5% nicotine by volume – twice the nicotine of most other e-cig devices – putting Juul users at a higher risk for addiction and nicotine poisoning. Other types of vaping devices are e-hookahs, pods, mods, pens and bidi sticks.

In Oklahoma, 22% of high school boys and 17% of high school girls report current e-cig use. Both percentages are higher than the national average. In fact, a national poll using CDC data rated Oklahoma as the state with the highest rate of vapers. The Tobacco 21 federal law was passed in December 2019 and a mirror Oklahoma bill may follow soon. The impetus of T-21 legislation is to curb teen vaping by making it unlawful for any retailer to sell a tobacco product to a person younger than age 21. Having a discussion with a healthcare professional makes a difference in personal choices.

Dentists have a trusting and personal relationship with their patients. Clearly, Oklahoma teens need to hear about vaping from their dentist.

Have a conversation with your teen patients – not a lecture. Ask open-ended questions and advise them to take care of themselves and their friends. Share with them the ADA brochure Tobacco and Oral Health, which informs about the dangers of vaping. Make them aware of the following facts:

• About 50% of calls to poison lines are due to ingestion of nicotine related to e-cigs.

• E-cigs can harm brain development, which continues to at least age 25.

• E-cigs can injure your lungs -- for life.

• The nicotine in e-cigs is highly addictive.

• Some e-cigs batteries have exploded during use.

About the Author: Dr. Jana Winfree has been the State Dental Director at the Oklahoma State Department of Health since 2008. As the State Dental Director, her duties include dental public health efforts for the state: community water fluoridation, oral health surveillance, dental education, acting as subject matter expert and administering the state Dental Loan Repayment Program. Dr. Winfree graduated from the University of Oklahoma College of Dentistry in 1985 and earned her Master of Public Health from the OU College of Public Health in 2015.

HELPFUL RE SOURC E S F OR YOU AND YOUR PATIE NTS: 1-800-QUITE NOW (anyone at least 13 years old)

ASPIRE (Middle and High School)

N-O-T: Not on Tobacco (14-19 years old)

CATCHMyBreath Youth E-Cigarette Program

Smokefree Teen/smokefree.gov (anyone at least 13 years old) Truth Initiative: text "DITCHJUUL" to 88709

(Middle and High School)

Center for Disease Control & Prevention

(Teens, Young Adults, and Parents)

Oklahoma State Department of Health

Tobacco Prevention Tool Kit (Elementary, Middle, and High School

Oklahoma Tobacco Settlement Endowment Trust

44 journal | May/June 2020

DO YOU KNOW ABOUT VAPING? Your kids probably do.

E-cigarettes and vapor products are increasingly popular and accessible in Oklahoma – especially among youth – but do they know the dangers?

This is a JUUL️, the most popular brand of e-cigarette. Kids often refer to vaping as “JUUL️ing.”

WHAT IS VAPING?

WHY IS IT DANGEROUS?

“E-cigs” or “vapes” are battery-powered devices that heat nicotine juice to create an aerosol, which is inhaled by the user. The juice is often stored in replaceable pods. These devices have deceptively sleek designs that look like everyday items and can be easily hidden. E-cigarettes have become the most commonly used tobacco product among U.S. middle and high school students.

Vape juices often have dangerously high levels of nicotine.

In fact, just one JUUL️ pod contains as much nicotine as 20 cigarettes.

- Nicotine can impair youth brain development, which continues until at least age 25.

- Young people who use e-cigarettes are up to seven times as likely to use other forms of tobacco.

- Aerosols from vaping contain cancer-causing chemicals and heavy metals.

- Vaping can cause throat irritation and worsen respiratory conditions like asthma and bronchitis.

WHAT CAN YOU DO? - Ask kids about e-cigarettes and warn of their dangers.

- Learn about the shapes and types of e-cigarettes and how to spot them.

- Keep the conversation going; it’s important to talk often about the dangers of vaping.

Talk to your doctor today to learn more about protecting youth from a lifetime of addiction.

Need more resources to help protect our youth from e-cigarettes?

Discover signs of vape use, terms to know, tips for talking about vaping and more at

www.okda.org

45

A Real Game Changer By: Gary Salman, Chief Executive Officer of Black Talon Security During the last few months, there has been a significant paradigm shift in the cybersecurity world. Threat actors from Russia, in particular, have enhanced their capabilities to target individual businesses and Managed Service Providers (MSPs) or IT companies. In December 2019, hacking groups known as Sodinokibi (aka “The Evil Corp”) and Ryuk impacted thousands of dental practices across the United States in a multitude of ways.

Approximately 16 months ago, the FBI and the Department of Homeland Security warned MSPs that certain threat actors were planning large-scale attacks against them. In August 2019, we saw the largest distributed ransomware attack encrypt and hold hostage the data of approximately 450 dental practices and impact thousands of computers and servers. During Thanksgiving week, they hit an additional 100 dental offices. Then on December 24th, approximately 1,300 healthcare providers and financial institutions were victimized.

The ransomware encrypted almost every computer, server, external backup, cloud backup, etc., resulting in the inability to access any records, notes, appointments, x-rays or 3D images. Think about this for a minute. The second largest attack in our Nation’s history was not against banks, large corporations or hospitals; it was against our community --the average dental practice.

How does something like this happen?

It’s simple. The threat actors gain access to the IT company’s remote management tools used to access a practice’s computers and servers; they then load their malicious code into the tool and instruct the tool to download and install the ransomware into every computer. Within minutes, they can strike tens of thousands of computers.

These attacks typically occur during the early morning hours, so the first indicator of the attack is the inability of employees to log in and access any information on the computers. The result: literally every single file and database is encrypted with ransomware.

Based on some of the most recent attacks, most practices experienced a two- to fourweek outage. In every case that we were involved with, the practice experienced 100% encryption on every device and backup. Due to the pervasiveness of the 46 journal | May/June 2020

ransomware attacks, there was no recovery option except to pay the threat actors the ransom payment. Most practices had to pay, on average, $45,000 to the threat actors for a decryption tool. Add on top of that, the business interruption, the inability to collect A/R, take x-rays, file insurance claims or schedule patients, and the need to completely rebuild or repurchase every computer and server. The price tag for these types of attacks can easily exceed $100,000 for a small practice and is significantly higher for multi-office, multi-provider practices. Being unable to access systems and see patients was a nightmare. As one doctor described it, “It was like driving into my office parking lot only to find the foundation of my office was the only thing left. Everything else was gone.” Not one of these offices thought that it would ever happen to them because they were all engaged with reputable and capable IT partners. They were completely caught off guard. When these types of attacks occur, IT partners also become victims and have to work/struggle to get their own businesses operational before they can even think of responding to their clients’ needs. Most IT companies have a long list of clients and they will have to prioritize to whom they respond first. It can take several days to get a single office operational after being a victim of these attacks. Where will your practice fall in your IT company’s priority list? Many MSPs advertise that they carry insurance that will cover their clients in the event of an attack, but is it enough? How many clients do they have? If they work with 100+ dental offices, are they carrying enough insurance to cover three weeks of downtime for each client? In every case that we’ve been involved with, the answer has been “No.” Unfortunately, hackers are getting more malicious in their ransomware attacks.

In December 2019, the threat groups Sodinokibi, Ryuk and Maze all announced that they were getting into the data theft and extortion business. In order to ensure a ransom payment from the victim, these groups modified their malicious code to first steal (exfiltrate) all the data, then encrypt it. If their victim refuses to pay the ransom, the threat actors may release the data to a public website. This is exactly

what happened in Pensacola, Florida last December. The city refused to pay the ransom and the threat actors published two terabytes of data. Even if your practice has valid backups and can recover from the attack, the data may still be released if you fail to pay the ransom demand. Imagine all your patient records, health history forms, lab reports, medications, etc. showing up on the Internet. This would be a total PR nightmare for your practice and result in its reputation suffering greatly, not to mention the loss of trust from your patients and referrals.

What can you do to protect yourself, your practice and your patients? First, ask your MSP to provide you with documentation that their network is being independently audited and evaluated by a cybersecurity company to help prevent these types of attacks. Second, and now more than ever, you need to take a proactive approach to security. Keep in mind that nearly all your colleagues who were impacted by these attacks had an MSP, firewall, antivirus software and the “promise” that they were being protected. They all lacked the expertise and advice of a dedicated cybersecurity company. The risk is just too great not to enhance the security posture of your practice NOW, before you are the next victim. Remember, this is your business, patient data and livelihood. Make sure to engage with a cybersecurity company who has the advanced skills, first-hand working knowledge and credentials required to stay on the cutting edge of this ever-changing world we live in. It’s not IF it’s going to happen to you . . . but WHEN. About the Author: Gary Salman is Chief Executive Officer of Black Talon Security. He has over 30 years of experience in software development and computer IT in the dental industry. As a leader in cybersecurity, the company offers a complete suite of compliance and cybersecurity solutions that are custom engineered for your practice. To learn more about Black Talon Security and the company's services, visit their website at www. blacktalonsecurity.com. Gary can be reached at (800) 683-3797 or via email at gary@ blacktalonsecurity.com.

8 Million and Counting 17% of people who visit ADA Find-a-Dentist® take the next step to contact an ADA member. That’s more than 5x the industry average, so don’t miss out!

ADA.org/completemyprofile

It’s Time To Think Differently The number one mistake dental prac ces make...relying on their “IT Guy” for cybersecurity.

Cybersecurity is a specialized industry that employs highly trained and cer fied individuals who work in conjunc on with your “IT Guy” to secure your network. Your prac ce and pa ent data is vulnerable to a ack, unless preventa ve measures are put in place to mi gate risk. Let us take over where your IT company stops. Ransomware is decima ng the dental community, we can help prevent it.

Cybersecurity | HIPAA Compliance | PCI Scanning | Forensics | Breach Response blacktalonsecurity.com | 800-683-3797

www.okda.org

47

CLASSIFIEDS Looking to fill an open position in your office, need to sell dental equipment or a practice? Check out the latest listings below and visit okda.org/classifieds for additional listings.

JOB OPENING Associate Dentist Opportunity - Private Practice in Owasso, OK We have an exciting opportunity for an Associate Dentist in a Private Practice in Owasso, OK where we focus on the patient and complete care. Our practice is 19 years old, and we provide care at a higher level than corporate systems allow. We are a Delta Dental Provider, but no other discount PPO's. We are looking for someone interested in learning IV Sedation, Implants, Dentures, and other General Dentistry. Our Senior Dentist is willing to mentor and help as needed. The dental team supporting you is amazing, with a lot of excitement and anticipation for expanding opportunities. Base salary with bonus opportunities based on percentage of collections. Looking for motivated, caring dentist that communicates well and fits our team's mission to treat our patients at the highest level of care. Call for more information (918)269-0023. Leave message on cell phone and we will return your call. Thank you!

Busy Practice in Muskogee Looking for a FT Associate/Partner Dentist The Dental Care of Muskogee has a very large loyal patient base with a significant number of new patients every month. We are very busy and are having a very hard time seeing all of our new and exisiting patients as quickly as they like because being popular is a good problem to have, but it still a problem. We pride ourselves on offerring the very best restorative and preventative care for our patients. We offer the best that modern dentistry has to offer, including CBCT and a 3d Scanner. We are a looking for an excellent dentist that motivated, skilled, caring, and considerate to join our practice. We are looking for someone during the short term or the long term since there are great advancement opportunities available, including buy-in or partnership options down the road. We offer all employment benefits and a very competitive compensation package with a sign on bonus. New grads are welcome to apply and would receive guidance and mentorship. For more infomation, please contact either Janie Sherrell at 918-360-4187 jsherrell.dcom@gmail.com; or Moiz Horani, DDS at 918-280-8309 moizhorani@gmail.com Thank you!

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Place a Classified Ad Placing an ad with the ODA allows you to target your ad to a specific audience. Unlike other classified ad sources (local newspaper, other online classified sites, etc.), a listing with the ODA gives you exposure to the people who would be most interested in your ad. The online version of the ODA Journal contains active hyperlinks within the advertisement, ensuring you get maximum exposure for your ad.

SUBMIT A LISTING Submitting a classified ad is easy with our online form.

Find the form and more information at www.okda.org/classifieds.

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ODA Members Online - Free ODA Journal - $40 for first 50 words (additional words $0.15 each)

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QUESTIONS? Visit: www.okda.org/classifieds 48 journal | May/June 2020

Email: advertising@okda.org

Call: 800.876.8890

More than 7,000 dentists got answers to coding questions and dental benefit issues last year.

We’re here to help you overcome dental benefit issues with members-only resources.

• The ADA Third Party Payer Concierge™ will help answer your dental benefit and coding questions with one-on-one expert support by phone or email.

• ADA Contract Analysis Service helps you better understand dental benefit contracts before you sign to avoid unpleasant surprises.

• We advocate for legislation that benefits you and your patients on issues like the assignment of benefits, non-covered services, PPO leasing and more.

Take advantage of your member benefits today.

ADA.org/dentalbenefits

www.okda.org

49

FINAL THOUGHTS

WORDS OF WISDOM FROM DR. STEFFAN SIGLER, EDMOND 1. What motto do you live by? Don’t take this life for granted.

Look for things to appreciate, smile at, and give back to the people around you.

2. What is the best advice you've ever been given?

Never stop asking questions. Never stop growing and learning. It’s when we become complacent that we stop becoming the absolute best versions of ourselves. If you want to change the world, start with yourself. Then give back that knowledge and passion to others. It’s infectious.

-Dr. Randy White 3. What “words of wisdom” would you share with a Dentist one year out of school?

Whatever gave you that fire and passion in the beginning, hold onto it! There will be days when you’ll need it to stay positive and remember why it is you do what you do. “He who has a why to live for can bear almost any how.” Always remember we treat the person behind the teeth. Somedays the dentistry will be the easiest thing you do. Don’t forget, like Dean Cohlmia reminded us, sometimes we treat loneliness, heartache, and depression. But when we smile and genuinely care for the well being of our patients, that’s when we truly make a difference.

4. Where do you go for answers? (Professional and/or Personal) When I have questions or need to talk to someone, I always go to my best friend - my wife. She listens to me, tempers me, challenges me, and always gives me the best advice I need at that moment. Sometimes it’s not what I want to hear, but what I need to hear. She is the most understanding, loving, and wise person in my life and I am so humbled to have her. I love her immensely.

5. When was the last time you learned something new? During quarantine, I tried to fix my underground plumbing and a broken garage door. After two days trying, I had to hire the pros. While it’s great to be a jack of all trades and save some money, sometimes you need a master.

50 journal | May/June 2020

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www.okda.org

51

DDOK Response to COVID-19 Delta Dental of Oklahoma is working diligently to maintain high-quality customer service to our valued provider network during the COVID-19 (coronavirus) pandemic. Included in our efforts is a program to provide financial support to Oklahoma dental practices during this unprecedented time. Our updated response to circumstances surrounding the pandemic is available to participating providers in their PEARL accounts, at DeltaDentalOK.org/PEARL.

Patient Returns

Check out

Health through Oral Wellness® (HOW®) is a preventive benefits program designed to boost our members’ current Delta Dental plan.

With HOW, our members at a higher risk for developing caries and/or periodontal disease could qualify to receive enhanced preventive benefits.

DDOK began the rollout of HOW earlier this year, and on July 1 the majority of our fully-insured groups will have access to HOW enhanced benefits.

Register your practice location* today at DeltaDentalOK.org/HOWReg *Note: a separate registration is required for each practice location.

52 journal | May/June 2020