ODA Journal November/December 2023 by Oklahoma Dental Association

November/December 2023 | Vol. 114, No. 6

A Gift to the Future How Tim and Pamela Fagan's Generosity Secured the Oklahoma Mission of Mercy Legacy page 12

Joe Strunk, Owner Joe@3000iG.com

Guy Strunk, Agent Guy@3000iG.com

Lydia Christine, Agent

Cooper Tate, Agent

Lydia@3000iG.com

Cooper@3000iG.com

405.521.1600 | WWW.3000IG.COM

ADVERTISERS Thank you to the following businesses who support the Oklahoma Dental Association by advertising in the Journal: 3000 IG DentaQuest Endodontic Practice Associates Liberty Dental Plan MCNA Dental ProSites Suction Solutions Endodontic Associates iCoreConnect Laurel Road Lewis Health Profession Services University of Oklahoma College of Dentistry Tobacco Settlement Endowment Trust 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. 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.

CONTENTS November/December 2023 | Vol. 114, No. 6

EDITORIAL 0 6 A Letter from ODA President Dr. Paul Wood

ASSOCIATION 04 Calendar of Events 08 ODA by the Numbers

Editorial: Celebrating 2023 Accomplishments

2 2 Thank You, 2023 Contributors 2 6 ADA's Newly Elected Officers & Award Winners 27 Outgoing ADA President Praises Unity 35 ODA Annual Awards Nomination Form

39 In Memoriam

Office Space:

4 6 Meet the Newest ODA Team Members

Dr. Kimberly Greenlee designed a facility with her patients' comfort and convenience in mind.

4 6 Local Dental Society Update

4 0 Membership Renewal Information

COVER STORY 1 2 A Gift to the Future How Tim and Pamela Fagan's Generosity Secured the Oklahoma Mission of Mercy Legacy

LEGISLATIVE LOOP 1 6 Advancing Dental Workforce Legislation 17 Oklahoma Advocacy Update

Cover Story: A Gift to the Future

28 Flouride Therapy: The Silver Bullet in Preventive Dentistry

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.

Oklahoma Dental Association

1 8 DENPAC Contributors 1 9 ADA Advocacy Activity

FEATURES 10 Office Space: Greenlee Dental

LEARN TO LEAD

Join the ODA Leadership Academy today to grow your skills as a leader and practitioner.

21 Hygiene Hot Spot: The Oklahoma Dental Asso Hygienists and Neuromodular Administration a six-month statewide prog organized dentistry and edu by Krista Jones, DDS

to it

28 Scientific Feature: Flouride Therapy, What’s in it for participan • A first-hand look at how the Asso The Silver Bullet in Preventive Dentistry of shaping its future by Divesh Sardana, MDS, MBA, MPH, PhD et. al.

• Valuable leadership skills that wil professional life • Relationships with your Leadershi month program • Each attendee will receive “Dare Irrefutable Laws of Leadership” b • An Award upon graduation from Delegates meeting at the Omni in commitment to the program

34 Case Study by Glen Houston, DDS, MSD 41 Keep it Local: Visit okda.org/leadersh Celebrating the Career of Dr. Jana Winfree

Keep it Local: Dr. Jana Winfree Retires

Is Your Information Correct?

42 Third Grade Oral Health Survey Results by Nicole Reynolds, DDS 4 3 ADA Toolkit: Referring Patients to QuitLines

CLASSIFIEDS 4 4 ODA Classifieds

Help the ODA keep you informed about legislative actions, educational opportunities, events, and other important member-only news. Contact Kylie Faherty, ODA Membership Director, at kfaherty@okda.org or 800.876.8890 to provide the ODA with all of your current contact information.

www.okda.org

ODA JOURNAL STAFF EDITOR Mary Hamburg, DDS, MS ASSOCIATE EDITOR

See more online at OKDA.ORG/CALENDAR

Roberta A. Wright, DMD, MDSc, FACP

November TMJ Awareness Month

EDITORIAL BOARD MEMBERS M. Edmund Braly, DDS, FACS, FAACS Daryn Lu, DDS Phoebe Vaughan, DDS Meredith Turbeville, DDS

November 1 National Brush Day

Divesh Sardana, BDS, MDS, MBA, MPH, PhD

ODA OFFICERS 2023-2024 PRESIDENT Paul Wood, DDS president@okda.org PRESIDENT-ELECT Daryn Lu, DDS presidentelect@okda.org VICE PRESIDENT Twana Duncan, DDS vicepresident@okda.org SECRETARY/TREASURER Nicole Nellis, DDS treasurer@okda.org SPEAKER OF THE HOUSE Mitch Kramer, DDS speaker@okda.org

November 25 National Floss Day November 2 Oklahoma County Dental Society General Assembly Meeting Renaissance Waterford 5:30 p.m. - 8:30 p.m. November 2 ODA Leadership Academy Kickoff ODA Building 6:00 p.m. November 3 Annual Meeting Planning Committee Zoom 8:00 a.m.

IMMEDIATE PAST PRESIDENT Robert Herman, DDS,MS pastpresident@okda.org

November 3 ODA Council on Governmental Affairs ODA Building & Zoom 9:00 a.m.

ADMINISTRATIVE STAFF EXECUTIVE DIRECTOR F. Lynn Means

November 3 ODA Board of Trustees Meeting ODA Building & Zoom 1:30 p.m.

DIRECTOR OF GOVERNANCE & FINANCE Shelly Frantz DIRECTOR OF MEMBERSHIP Kylie Faherty DIRECTOR OF COMMUNICATIONS & EDUCATION Jill Johnson SPECIAL PROJECTS & COMMUNICATIONS MANAGER Apryl Awbrey MEMBERSHIP ENGAGEMENT MANAGER Ansley Jinkins OFFICE MANAGER Carly Hatfield

Stay connected with the ODA!

CALENDAR OF EVENTS

journal | November/December 2023

November 3 Oklahoma County Dental Society Continuing Education Renaissance Waterford 8:30 a.m.

November 9 OkMOM Community Dinner Lawton, OK Email okmom@okda.org for details November 14 Hard Trends in Dentistry Online Presentation by Marko Vujicic, PhD Zoom 6:00 p.m. November 16 "Ask Me Anything" New Dentist Panel City + State Event Center Oklahoma City 5:30 p.m. - 7:30 p.m. November 17-18 OU College of Dentistry Alumni Continuing Education Course Intro to botulinum toxin type A and dermal fillers. dentistry.ouhsc.edu/CE November 24 - 25 ODA Offices Closed December Hand Washing Awareness Month

December 8 Tulsa County Dental Society Holiday Party American Solera 7:00 p.m. December 25 - 26 ODA Offices Closed January Blood Donor Month January 1 ODA Offices Closed January 5 OkMOM Leads Meeting and Walk-Through Great Plains Coliseum 3:00 p.m. January 12 Annual Meeting Planning Committee Zoom 8:00 a.m. January 12 ODA Council on Membership ODA Building & Zoom 11:00 a.m.

Sharps Injury Prevention Awareness Month

January 12 ODA Council on Dental Care ODA Building & Zoom 1:00 p.m.

December 1 Dental Relief and Disaster Grant Program Board of Trustees Meeting ODA Building & Zoom 11:00 a.m.

January 12 ODA Council on Dental Education and Public Information ODA Building & Zoom 2:30 p.m.

SAVE THE DATE February 9-10

April 12-13

Oklahoma Mission of Mercy

ODA Annual Meeting and Conference

Great Plains Coliseum Lawton, OK

Oklahoma City Convention Center Oklahoma City, OK

okmom.org

okda.org

Volunteer sign-up now open

Registration opens January 15

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www.okda.org

EDITORIAL Celebrating 2023 Accomplishments

November 1, 2023 Dear Oklahoma Dentistry, My year as president is half over, and we have made excellent progress. The ODA staff is amazing, and their long hours of tireless efforts show in all of our accomplishments. Perhaps the greatest thing we saw come to fruition in 2023 was the completion of the OkMOM Legacy Fund matching campaign.

Paul Wood, DDS ODA President

As you know, the Oklahoma Mission of Mercy (OkMOM) is one of our signature events that is greatly needed, anticipated, and appreciated in our local communities. The two-day free dental clinic is held annually at various locations throughout the state. We owe a debt of gratitude to Dr. and Mrs. Tim Fagan for their significant contribution to the OkMOM Legacy Fund, which was established to help bridge a gap in funding, and for challenging our members to match that gift with donations of their own. Their generosity will never be overlooked, and now OkMOM will be able to continue to provide services to those in need for years to come. Please consider contributing to the OkMOM Legacy Fund to ensure this event endures indefinitely. OkMOM 2024 is really coming together. I would like to express my gratitude to Dr. Shannon Griffin, Dr. Juan Lopez, and Dr. Todd Bridges for all the hard work they have done to ensure that OkMOM 2024 in Lawton is successful. They have been tireless in their efforts to recruit team leads, get donations, and arrange in-kind discounts.

journal | November/December 2023

I'd like to give a special thank you to Dr. Lauren Lunday and Dr. Ed Braly for volunteering to cover OMS at OkMOM on that Saturday. OkMOM 2024 will take place in Lawton at the Great Plains Coliseum on February 9 and 10, with setup occuring on February 8. Volunteer registration opened October 15th, so encourage people you know to sign up. I would also like to thank Dean Mullasseril for allowing OUCOD faculty, dental students, and dental hygiene students to participate in OkMOM. They provide a great service to the community with their participation. The ODA Annual Meeting Planning Committee has been very busy working to make your 2024 Annual Meeting a success. We are very lucky that Dr. Sara Spurlock and Dr. Jennifer Jenkins agreed to co-chair the ODA Annual Meeting for 2024. They are putting together a great meeting that will be enjoyed by all. The presentations will be both exciting and beneficial to dentists, hygienists and their staff. DENPAC is extra important this year as we pursue medical loss ratio (MLR) legislation in the Oklahoma State Legislature. The ODA lobbyists and Dr. Lindsay Smith, the chairman of our Council on Governmental Affairs, have developed success-based strategies to make sure we are triumphant. Here's to ending this year on a high note and preparing to make 2024 even better.

Endodontic Practice Associates Norman, Oklahoma

Dr. Spencer Hinckley and Dr. Percy Bolen

Serving the OKC Metro for 43 years - since 1977 Your patient’s experience is top priority 3D CBCT scanning for improved diagnosis Complex endodontic cases welcomed Complex and “heroic” teeth salvage Build-up and post & core placement available Cutting edge instrumentation and disinfection Zeiss microscopes used on every case Specializing in finding 4+ canals in molars Surgical and nonsurgical retreatment General anesthesia and oral sedation Open during pandemic shut-down

e pride ourselves in a trusted referral pattern that ensures your patient returns to you holding you in high regard - regardless of the reason for referral. We speak highly of you to your patient and reassure them they are in good hands in your care. We value communication between you and our office. Give us a call to talk about anything. We are even happy to help you navigate through a difficult case in your chair.

Phone: 405.329.7936 1.800.238.5215

Fax: 405.329.1722

www.endodonticpracticeassociates.com

ODA BY THE NUMBERS Member demographics

25%

Women

75%

Men

75%

Active

25%

Retired

Age Breakdown Member Location 17%

75+

19%

65 - 74

12%

55 - 64

16%

45 - 54

19%

35 - 44

17%

25 - 34

11% 7% 6%

Central Oklahoma Eastern Oklahoma Northern Oklahoma

Northwest Oklahoma

38%

Oklahoma County

10%

Southwest Oklahoma

23%

Tulsa County

All numbers reflect September 2023 data.

marketing stats

1,622 number of ODA Journal subscribers 98% of OU College of Dentistry students are members 9,800 average website visits per month 56% average ODA e-mail open rate 69% average monthly e-news open rate

Oklahoma Dental Association has more than 1,600 Dentist Members.

A Provider Friendly Program For over 30 years, MCNA has been a leading dental benefits administrator with a focus on providing exceptional service for Medicaid and CHIP members. Founded by dentists, MCNA serves over 5 million children and adults nationwide. We are the largest dental insurer of Medicaid and CHIP programs in the country via direct contracts with state agencies. MCNA’s eight state partners include: Texas, Louisiana, Florida, Iowa, Idaho, Nebraska, Arkansas, and Utah. Our approach emphasizes prevention and compassionate care through our robust provider networks. MCNA’s mission to care includes: • Preventive dental care in a dental home setting. • Positive engagement with members beginning at a very young age. • Innovative member outreach via our member advocate team. • Dedicated support for our network providers via our in-state provider relations team. • Clinical decisions made by licensed dentists and guided by leadership with extensive clinical and administrative experience serving Medicaid programs. MCNA is an active and effective partner to our network providers in the delivery of oral health care and services. We invite you to learn more about us and our mission to care by visiting us online at www.mcna.net.

OFFICE SPACE Greenlee Dental by Jill Johnson Photos by Apryl Awbrey

Greenlee Dental, situated in the heart of Oklahoma City, is redefining the dental care experience for its patients by placing an unwavering focus on comfort and convenience. Dr. Kimberly Greenlee, who designed the space herself, says she wanted to create a home-like atmosphere for every guest. "Natural light was very important to me when selecting a building for us to move into," said Greenlee. "I believe having lots of windows helps create a better mood and keeps the energy high in our office." Greenlee Dental was the first tenant in the newly constructed Nicholas building, which is now also home to a bank and architecture firm. 10 journal | November/December 2023

The Greenlee Dental office has been open a little over a year in its new location, and patients have been sharing great feedback. "They love the openness of the lobby and shared spaces combined with the privacy of individual treatment rooms," said one team member. The crisp white walls, the artwork, and even the dental equipment itself, were all chosen for reducing stress and showcasing the office's cleanliness. "We constantly get comments on how clean the office is, and that is intentional on our part. You can see exactly how and where we sterilize our equipment, and I think patients appreciate the transparency," said Greenlee.

Upon entering Greenlee Dental, patients are greeted by a bright space, fresh flowers, and soothing nature sounds and images coming from the lobby's TV. A thoughtful refreshment station offering coffee, water, sparkling water, and juice is open for everyone's use, and a children's bookshelf and toys are nestled in a corner created just for them. The nearby patient bathrooms are stocked with complimentary dental care kits featuring a toothbrush, toothpaste, floss, and mouthwash.

"We love having the opportunity to exceed patient expectations." - Kimberly Greenlee, DDS

Greenlee Dental offers a comprehensive range of dental services tailored to meet the unique needs of every individual. Dr. Greenlee offers not only cleanings and exams, but preventative and restorative procedures, cosmetic dentistry, and Invisalign, as well. Each room has a large TV mounted on the ceiling so the staff can easily discuss x-rays or photos with patients. Then when undergoing their treatments, they can connect provided Bluetooth headphones to the TV to watch cable or streaming services.

Greenlee's guests may also choose to take advantage of items on the Comfort Menu, which features several aromatherapy options, a warm blanket, a supportive neck pillow, or lip balm. They also offer nitrous oxide sedation, a warm lavenderinfused towelette, and acetaminophen or ibuprofen if needed. Younger patients may select a prize from the treasure chest after their appointment, and having two children herself, Dr. Greenlee says she wants to ensure kids have a positive experience every time they go to the dentist - perhaps even looking forward to it.

The clinic utilizes cutting-edge technology and modern techniques to ensure efficient and effective treatments. Dr. Greenlee is especially proud that she can provide same-day crowns due to their investment in technology. With additional patient rooms open at the end of the main hallway and a growing list of clients since moving into the new office, Greenlee Dental has room to expand in the near future. Greenlee Dental 6501 N. Classen Blvd, Suite 100C Oklahoma City, OK 73116

greenleedental.com www.okda.org

A Gift to the Future How Tim and Pamela Fagan's Generosity Secured the Oklahoma Mission of Mercy Legacy by Jill Johnson

Dr. Tim Fagan and his wife Pamela have exemplified the true spirit of generosity by supporting the Oklahoma Mission of Mercy through a heartfelt donation matching program last year. They hoped to meet the fundraising goal but had no idea how much they would inspire others to give, as well. (continued on next page)

12 journal | November/December 2023

Early last year, after learning that one of Oklahoma Dental Association's signature programs, the Oklahoma Mission of Mercy, needed additional funding to continue beyond 2025, the Fagans began discussing how they could contribute. OKMOM is a two-day free dental clinic organized by the Oklahoma Dental Association and its charitable arm, the Oklahoma Dental Foundation. The mission of the event is to provide free dental care and treatment to underserved and underprivileged individuals in Oklahoma who may not have access to regular dental care. Dr. Fagan has volunteered his professional services at the Mission of Mercy every year since it started in Oklahoma in 2010, and he chaired the event in 2014 when it came to his hometown of Enid.

COVER STORY "This annual event touches so many people. It really tugs at my heart every year," Dr. Fagan said. However, after the February 2024 event, a large portion of OKMOM sponsorship funds will expire. Knowing it was going to be challenging to produce the clinics without a large amount of financial support in the future, ODA's board of trustees launched a campaign to fundraise and aptly named it The Legacy Fund. Upon learning about the lack of future funding, Dr. Fagan says he and Pamela felt called to give back.

"We felt that offering the match to help get the Legacy Fund going was a way for us to give back for all God's blessings and to help those in need get dental care. " - Tim Fagan, DDS "I heard that the Mission of Mercy was going to lose a major funding source, so I thought this might be a good place to put my money," said Dr. Fagan. So in the summer of 2022, the Fagans offered to donate $448,000 to the Mission of Mercy event if Oklahoma Dental Association members and other supporters would match that amount dollar-fordollar in individual contributions. Oklahoma Dental Association staff and leaders got to work promoting the campaign and its new matching funds opportunity, and donations began to roll in. "Pamela and I have been immensely rewarded in dentistry. We felt that offering the match to help get the Legacy Fund going was a way for us to give back for all God’s blessings and to help those in need get dental care," said Dr. Fagan.

OKMOM serves around 1,500 patients each year and requires at least 1,600 volunteers to produce. The clinic costs an average of $150,000 per year to put on, and as the costs of supplies, rented equipment, and leasing large spaces continue to go up, the ODA and ODF are so grateful the campaign has been a success, and credit the Fagans with bringing attention to the cause with their generosity. "Sixty-seven of the 77 counties in Oklahoma are considered needy when it comes to dental providers," said John Wilguess, executive director of Oklahoma Dental Foundation, "so this event is extremely important for our local communities." At each OKMOM event, free dental treatments including exams, cleanings, fillings, extractions, surgery, crowns, and even dentures are provided to those who are underserved and who need these vital dental care services. Talking about why OKMOM is important to her personally, Pamela Fagan said, "Patients are given the opportunity to come in to get treatment, and it can change their lives." (continued on next page)

(top) Dr. Tim Fagan and his son, Dr. Chris Fagan, at Brush Pediatric & Family Dentistry where they both practice. (second) Dr. Tim Fagan and Dr. Chris Fagan with volunteers at the 2014 OKMOM in Enid, OK. (third) Dr. Tim Fagan and Pamela Fagan enjoying a baseball game. (bottom) The Fagans' four grandchildren. www.okda.org

COVER STORY (continued from previous page)

Although they initially requested to remain anonymous, The Fagans were advised that revealing their identity may actually increase the number of donations the campaign collected. "We did this not seeking notoriety, but following God’s request. As the Bible says: 'God has shown you his grace in many different ways. So be good servants and use whatever gift he has given you in a way that will best serve each other.'" Dr. Fagan has long been known for his unwavering dedication to serving the community and advancing the dental profession. He earned his DDS in 1981 and MS in Pediatric Dentistry in 1984, and he has served as President of the Oklahoma Dental Association, Chair of the Council on Advocacy for Access and Prevention for American Dental Association, a member of the ADA House of Delegates, Diplomate and board examiner for American Board of Pediatric Dentistry, President of the Southwestern Society of Pediatric Dentistry, and President of the Oklahoma Academy of Pediatric Dentistry. Dr. Fagan has been a Fellow with American College of Dentists, International College of Dentists, and the Pierre Fauchard Academy. He has won many awards for his service and achievements, including the 2023 Oklahoma Dental Association President's Leadership Award, which he shares with Pamela.

"The Fagans' dedication to this cause is a testament to their deeprooted commitment to Oklahomans' well-being and enhancing our state's overall livability," said Oklahoma Dental Association Executive Director, Lynn Means, as she prepared to tell ODA leaders that the matching funds goal had been met this past summer. ODA staff say underserved communities often face systemic inequalities and barriers that limit their access to basic resources. Giving back helps to address these disparities and promote social equity, ensuring that everyone has a fair chance to thrive. "When a community receives support and assistance like this, they feel valued and recognized. Giving back helps restore a sense of

LIMITED TREATMENT REFERRALS Did you know you can refer patients to the OU College of Dentistry for limited treatment? If your patient is in need of specialty care or a low-cost procedure, consider referring them to the OU College of Dentistry. Not only will your patient receive the care they need, but you are supporting the clinical education of our dental students and residents. Visit the website below for more information.

DENTISTRY.OUHSC.EDU/REFERRALS

14 journal | November/December 2023

COVER STORY dignity and worth to these underserved populations and we are so proud that our Oklahoma dentists, hygienists, assistants, and the general public understand what a difference they can make by volunteering," said Means. Thousands of OKMOM patients have expressed their gratitude over the years, explaining that they would not have had any other way to manage pain and to repair their teeth and those of their children if it weren't for the clinic each year. As of October 10, 2023, the Legacy Fund campaign has generated an astounding $954,566 including the Fagans' contribution, and the fund continues to grow daily with recurring gifts and one-time donations from members. "We are all just ordinary people who can do extraordinary things, and we feel this is going to help everybody continue to do those things. That's exactly what the Mission of Mercy is-extraordinary," said Pamela Fagan.

To donate to OkMOM, please visit okmom.org

Dr. Fagan testifies before Congress in 2018 in support of federal programs to expand access to oral health care.

Since its inception, through OkMOM, dental professionals have donated more than $15 million in treatments to patients. The 2024 event will take place February 9-10 in Lawton, OK at the Great Plains Coliseum. Volunteer registration is now open online at okmom.org.

LEGISLATIVE LOOP Take Action to Advance Dental Workforce Legislation ODA members are encouraged to contact their U.S. Senators to ask for support of the Bipartisan Primary Care and Health Workforce Act, a bill that would ensure important workforce programs designed to expand the dental workforce pipeline and increase access to care are able to continue by reauthorizing a number of crucial priorities: • Action for Dental Health workforce grants directed towards programs for dentists and other dental professionals. • Oral Health Training Programs, which support the dental faculty loan repayment program and residency training for general, pediatric, and public health dentists, as well as dental hygienists. • The Teaching Health Center Graduate Medical Education (THCGME) Program, which helps communities train dentists in community-based settings with a focus on rural and underserved populations and community health centers. • The National Health Service Corps’ (NHSC) scholarships and loan repayment programs for health care workers, including dentists and dental hygienists, who serve in federally designated shortage areas.

Dr. Rieger Wood (left) meeting with Representative Lonnie Sims in Tulsa

• Community Health Centers, which serve a critical role in providing quality preventive and primary oral health care in underserved communities and populations. Please contact Senators James Lankford and Markwayne Mullin today and ask them to support the Bipartisan Primary Care and Health Workforce Act. In doing so, they can ensure we are creating a robust provider network that will improve access to quality oral health care for patients in Oklahoma and nationwide. Senator James Lankford (202) 224-5754 james_lankford@lankford.senate.gov Senator Markwayne Mullin (202) 224-4721 markwayne_mullin@mullin.senate.gov

Dr. Lindsay Smith (left) and ODA executive director Lynn Means (right) meeting with U.S. Representative Kevin Hern in Tulsa

Dr. Lindsay Smith (left) meeting with Senator Dana Prieto in Tulsa

Help us advocate for dentistry To get more involved with ODA's political efforts, consider joining or contributing to DENPAC, our general purpose political action committee that works to safeguard against counterproductive legislation at our state capitol. When lawmakers address issues impacting the practice of dentistry in Oklahoma, ODA and DENPAC are hard at work making your voice heard. U.S. Senator James Lankford (middle) receiving an ADPAC check from Drs. Ryan Theobald, Dan Wilguess, Matt Cohlmia and John Archer 16 journal | November/December 2023

Visit okda.org/advocacy or email ODA executive director Lynn Means at lmeans@okda.org for more info.

LEGISLATIVE LOOP Oklahoma Update Courtesy of Cornerstone Government Affairs

SENATE DISTRICT 32 SPECIAL ELECTION

INTERIM STUDIES

As former State Senator John Michael Montgomery transitioned to CEO of the Lawton-Ft. Sill Chamber of Commerce late this summer, a special election was called for his replacement. The winner-take-all primary elections were held Tuesday, October 10th. Four Republicans and two Democrats vied for their party’s nomination to fill the vacated seat. The General Election will be held on December 12th, 2023. The winner of the general election will be sworn in to complete the three remaining years of the four-year term.

The Oklahoma Legislature has multiple interim studies taking place throughout the fall. These studies cover a variety of subjects and issues that are both challenges and opportunities for the state moving forward. Topics ranging from Artificial Intelligence, Energy Policy, Domestic Violence, Workforce Development, Water Issues, and many others are being explored as the legislature looks to craft policy for next year’s session.

OFFICIAL VOTE COUNT

UPCOMING LEGISLATIVE DEADLINES

Dusty Deevers (R): 1,416 votes

December 8, 2023 - Bill Request Deadline

Jean Hausheer (R): 1,177 votes JJ Francais (R): 725 votes

January 18, 2024 at 4:00 P.M. - Bill Introduction Deadline

Jennifer Ellis (R): 501 votes

February 5, 2024 at 12:00 P.M. - Session Begins

Larry Bush (D): 922 votes

*deadlines have not yet been announced for substantial bill language to be submitted for drafting prior to the bill introduction deadline

Johnny Jernigan (D): 335 votes

Patients Who Smoke Have a 30–40% Higher Risk of Type 2 Diabetes Than Nonsmokers Call 1-800-QUIT NOW. Text READY to 34191. Visit OKhelpline.com.

If you have a patient who smokes, tell them the truth. Tobacco and nicotine can lead to: • Increased cortisol levels • Decreased blood flow • Increased blood sugar

• Increased build-up of plaque in arteries • Increased heart rate

LEGISLATIVE LOOP Thank you, 2023 DENPAC Members

*Current DENPAC Board Member

Ex Ac

GRAND MEMBERS

Dr. Heath Evans

Dr. Jamie Talley

Dr. Myrna Domoney

Dr. Kenner Misner

Dr. Douglas Auld*

Dr. Christopher Fagan*

Dr. Jim Taylor

Dr. Kevin Duffy

Dr. Andrea Montgomery

Dr. Ed Braly

Dr. Barry Farmer

Dr. Stephen Taylor

Dr. K. Elassal

Dr. James Murtaugh

Dr. Matthew Cohlmia*

Dr. John Folks

Dr. Ryan Theobald

Dr. Timothy Fagan

Dr. Jana Oister

Dr. Twana Duncan

Dr. Richard Freeman

Dr. Kara Tims

Dr. Casey Fishburn

Dr. Garrett Phipps

Dr. Shannon Griffin*

Dr. Chad Garrison

Dr. Jonah Vandiver

Dr. Mark Goodman

Dr. Roger Richter

Dr. Richard Haught

Dr. Sandra Grace

Dr. Nathan Villines

Dr. James Gore

Dr. Casey Roberts

Dr. Robert Herman*

Dr. Michael Hansen

Dr. Carlie Wager

Dr. Matthew Gray

Dr. Daulton Roberts

Dr. Krista Jones*

Dr. Aaron Harman

Dr. Robert Webb

Dr. Stephen Gray

Dr. Thomas Rogers

Dr. Juan Lopez

Dr. Edward Harroz

Dr. Mark Weems

Dr. Evangeline Greer

Dr. Miranda Ruleford

Dr. Paul Mullasseril

Dr. Jeffrey Hermen

Dr. Robert Wells

Dr. Jerry Greer

Dr. Robert Schick

ACTIO

Dr. Steffan Sigler

Dr. Mathew Hookom

Dr. James Wendelken

Dr. Robert Gruenberg

Dr. Lance Schmidt

Dr. Lindsay Smith*

Dr. James Hooper

Dr. W. Scott White

Dr. Jacob Hager

Dr. Scott Searcey

Dr. Daniel Wilguess*

Dr. Brad Hoopes

Dr. Brian Wilson

Dr. H. Douglas Hall

Dr. Kyle Serfoss

Dr. Rieger Wood*

Dr. Karl Jobst

Dr. Ronald Winder

Dr. Kevin Haney

Dr. Carrie Sessom

Continu which p Health unders

Dr. Paul Wood*

Dr. Donald Johnson

Dr. Leslie Hardy

Dr. Jeff Shadid

Dr. Ross Allen

Dr. Jennifer Harreld

Dr. Paul Shadid

CAPITAL CLUB MEMBERS Dr. Michael Kirk

Dr. Addie Allen-Steed

Dr. Hannah Henry

Dr. John Sheets

Dr. Jeffrey Ahlert

Dr. Jandra Korb

Dr. Mark Argo

Dr. Richard Henry

Dr. Charles Sims

Dr. Clay Anderson

Dr. Marti Levinson

Dr. Jamie Ariana

Dr. Marilyn Hiebert

Dr. Lori Smith

Dr. Tabitha Arias

Dr. David Marks

Dr. Lauren Avery

Dr. David Hoffman

Dr. Brooke Snowden

Dr. Glenn Ashmore

Dr. Stephen Martin

Dr. Jeffrey Baggett

Dr. Mitchell Hoopes

Dr. James Sparks

Dr. Justin Beasley

Dr. Stephen Mayer*

Dr. Robert Baumann

Dr. Brian Howell

Dr. James Steyer

Dr. William Beasley

Dr. Tracy McIntire

Dr. Kari Bender

Dr. Scott Hubbard

Dr. Dan Storm

Dr. Tamara Berg*

Dr. Janna McIntosh

Dr. Michael Breland

Dr. Mohammad Karami

Dr. Patrick Stover

Dr. David Birdwell

Dr. Glenn Mead*

Dr. Craig Buntemeyer

Dr. Olivia Karim

Dr. Mary Temple-Goins

Dr. Bryan Blankenship

Dr. Mohsen Moosavi

Dr. Kristen Campbell

Dr. Jennifer Koonce

Dr. John Thomas

Dr. Elizabeth Bohanon

Dr. Nicole Nellis

Dr. Steven Carson

Dr. Mitchell Kramer

Dr. Paul Thomas

Dr. Blaire Bowers Ersteniuk

Dr. Samuel Owens

Dr. William Carter

Dr. Ashley Lanman

Dr. Steve Truong

Dr. Todd Bridges*

Dr. Ray Plant

Dr. Conrad Casler

Dr. Grady Lembke

Dr. William Weber

Dr. Matthew Bridges*

Dr. Dana Price

Dr. Cory Chambers

Dr. Shannon Lewis

Dr. Jay White

Dr. Trace Bridges

Dr. Christopher Ray

Dr. Jennifer Chambers

Dr. Brandon Loeser

Dr. Steven White

Dr. Nathan Brown

Dr. Karen Reed

Dr. Brian Chastain

Dr. Eric Loper

Dr. Theresa White

Dr. S. Kelly Brown

Dr. Ryan Roberts

Dr. Llon Clendenen

Dr. Eric Lopez

Dr. Vincent Willcox

Dr. Tricia Cannon

Dr. Brant Rouse

Dr. Logan Coffee

Dr. Jeff Lunday

Dr. Craig Wooten

Dr. Wuse Cara

Dr. Troy Schmitz

Dr. Christopher Corbin

Dr. Madeline Lynch

Dr. Savannah Wright

Dr. John Carletti

Dr. Brandon Schultz

Dr. Deborah Corwin

Dr. David Maddox

Dr. William Wynn

Dr. Bobby Carmen

Dr. Floyd Simon

Dr. James Corwin

Dr. Molly Marshall Hays

Dr. Trent Yadon

Dr. Tennille Cheek-Covey

Dr. Chad Spiva

Dr. Russell Danner

Dr. Mary Martin

Dr. Kendra Yandell

Dr. Raymond Cohlmia

Dr. Braden Stoltenberg

Dr. Darrell Daugherty

Dr. Alan Mauldin

Dr. Susan Davis

Dr. Julie Storm

Dr. Mark Davis

Dr. David Merrell

Dr. Ana Dotson

Dr. Carla Sullivan

Dr. Tara Denton

Dr. Clay Michels

Dr. Brian Drew

Dr. Marc Susman

Dr. Kali Domoney

Dr. Robert Miracle

Dr. Eugenia Johnson

18 journal | November/December 2023

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Explore ADA Advocacy Activity in 2023 Federal Advocacy

State Advocacy

BIPARTISAN WORKFORCE LEGISLATION

149 NEW DENTAL INSURANCE REFORM LAWS

Aided the introduction of the Bipartisan Primary Care and Health Workforce Act, which would improve access to and the quality of primary health care that would also expand the oral health care workforce.

Between 2018 and 2023 successfully advocated for 149 new dental insurance reform laws across the United States.

ACTION FOR DENTAL HEALTH (ADH) PROGRAM Continued to lobby for more funding toward the ADH program, which provides federal funding through the HRSA State Oral Health Workforce Grants to address the dental health needs of underserved populations.

DOC ACCESS REFORM Continued support advocating for the Dentist and Optometric Care Access Act or the DOC Access Act in Congress to foster insurance competition, benefit consumers, and bring balance to contract negotiations. DOC Access Act prohibits dental and vision plans from setting the fees network doctors may charge for services not covered by the insurers.

STUDENT LOAN REFORM Continued to lead on efforts with other dental and medical organizations to push for bipartisan legislation that would ease the burden of dental school debt, and also secured long-sought reforms to the Public Service Loan Forgiveness program.

21 States with New Network Leasing Laws Between 2018 and 2023 successfully protected dentists in 21 states from being pawned off to different insurance networks without knowledge or consent.

21 States with New Virtual Credit Card Laws Between 2018 and 2023 successfully gave dentists in 21 states a say in how they get reimbursed for care.

MEDICAID REFORM The ADA develops resources that state dental societies have used to reform their Medicaid programs, making it easier for dentists to participate and deliver patient care. Federal advocacy continues to ensure states provide comprehensive dental services to adult Medicaid beneficiaries.

THE DENTIST AND DENTAL HYGIENIST LICENSURE COMPACT Three states have passed legislation designed to allow dentists to practice in multiple states (WA, IA, and TN), three more have active legislation for 2023 (OH, PA, NJ), and nearly a dozen states are expected to file this legislation in 2024. Seven states total must pass the DDH Compact before it becomes effective.

TRICARE REFORM Urged Congress to increase resources for VA Dentistry to provide full access to dental care for veterans eligible for VA dental benefits and supported VET CARE Act to create a new pilot program for veterans with diabetes.

Scan to learn more

The LIBERTY Advantage Managed Dental Care Dental managed care is revolutionizing the industry by providing a framework to ensure that necessary dental services are accessible, affordable, and of highest quality for underserved populations. As a dental benefits administrator, LIBERTY Dental Plan (LIBERTY) invests in managed care systems to strengthen provider networks and promote better access and coordination of oral health care. Some of the significant benefits for LIBERTY network providers include bonus/ compensation for improved health outcomes, access to an extensive dental network with dedicated support, integrated care models, cost predictability, education and resources, and established mechanisms to improve access to care and quality assurance.

Patient Retention

Partnering with LIBERTY gives providers access to a broader patient base that enhances revenue streams and helps them enhance their practice. We encourage patient retention through soft assignments, establishing dental homes and advocating for preventive beneﬁt utilization. This includes launching call campaigns to assist in re-care and coaching patients to reduce late or missed appointments. We work with providers to remove treatment boundaries and promote a wholistic approach. In doing this, we help providers connect with their patients on how better oral health can improve overall health by using care management coordinators for more vulnerable patients as well as providing educational resources to engage their patients.

20 journal | November/December 2023

Quality Improvement Initiatives

As a LIBERTY contracted provider, dental ofﬁces can access a vast array of resources to enhance their clinical practices, adhere to evidence-based guidelines, and improve patient outcomes. Our highly trained Provider Services team and our 24/7 self-service portal also offer innovative ways to optimize care pathways. Our incentive-base program rewards providers for improved health outcomes and decreasing their patients’ incidences of dental disease. We recognize and reward our high-performing providers through our Platinum Practices program, which helps reduce administrative burden and retain patient base.

Conclusion

With over 22 years of experience, LIBERTY’s managed care programs have improved the oral health and whole-body wellness of members in communities across the nation. Oklahoma can expect to see better oral health for individuals, improvement in overall wellness, and a healthier population as the program expands. The beneﬁts to dental providers are undeniable. LIBERTY’s managed care programs will improve communities across Oklahoma, including rural areas and vulnerable populations. Our extensive managed care network will give access to our members, streamline administrative work and leave providers more time to focus on their patients. As the dental care landscape continues to evolve, partnering with a managed care industry leader like LIBERTY will be a crucial step for dental ofﬁces looking for professional growth and exceptional patient care.

HYGIENE HOT SPOT Hygienists and Neuromodular Administration by Krista Jones, DDS

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During this past legislative session, Oklahoma joined four other states in allowing dental hygienists to perform neuromodular administration after they are trained through a program approved by the Oklahoma Board of Dentistry (BOD). After being trained and approved, hygienists performing this advanced procedure must be under the direct supervision of a dentist, and it may only be on a patient of record. The process for hygienists to obtain this new ability include completing a pre-approved certification program (see Approved Courses) then submitting an official Dental Hygiene Neuromodulator Administration Application form to the Oklahoma Board of Dentistry. The form can be found online at ok.gov/ dentistry/Applications_&_Forms/. Applicants must be a hygienist with at least two years of licensed experience who already hold the Administration of Local Anesthesia advanced procedure certification. Applicants will be required to provide a statement with their application ensuring every neuromodulator injected by the applicant is approved for the use in dentistry by the U.S. Food and Drug Administration. Applicants must also secure, maintain, and show proof of malpractice insurance annually.

BENEFITS According to the Journal of Clinical & Diagnostic Research, the use of Botox® (Botulinum toxin-A) is showing promising results in the management of muscle-generated dental diseases like TMJ disorder, bruxism, clenching, and masseter hypertrophy. Hygienists may also use neuromodulators for temporomandibular joint disorder and myofascial pain syndrome as diagnosed by the treating dentist. Botox® is also being used to treat functional or esthetic dental and facial conditions like deep nasolabial fold, radial lip lines, high lip lines, and black triangles between teeth. Treatment outcomes usually last eight months or longer, after which the treatment will likely need to be repeated.

TRAINING COURSE REQUIREMENTS The training must be a minimum of 24 total hours in length, including a minimum of 4 hours of didactic and 4 hours of clinical training in each of the following three subjects: (i.) Use of neuromodulators that are derived from Clostridium botulinum or that are biosimilar to or the bioequivalent of such a neuromodulator in the treatment of temporomandibular joint disorder and myofascial pain syndrome; (ii.) Use of neuromodulators that are derived from Clostridium botulinum that are biosimilar to or the bioequivalent of such a neuromodulator for dental and facial esthetics; and (iii.) Use of dermal and soft tissue fillers for dental or facial esthetics.

APPROVED BOTOX COURSES FOR OKLAHOMA HYGIENISTS Classes must be reviewed by the Allied Dental Health Committee then submitted to the Oklahoma Board of Dentistry for final approval before becoming an officially approved course that leads to authorization. As of publication date, the three courses that have been reviewed by the committee and approved by the BOD include:

1) The Advanced Dental Institute (ADI) - 24 hours of CE: Comprehensive Botox/TMJ & Dermal Fillers Course.

advanceddentalce.org 2) DentaSpa Seminars (DSS) - two days of instruction totalling 24 hours of CE: Botulinum Toxin and Dermal Filler Dental Training.

dentaspa-seminars.com 3) American Academy of Facial Esthetics (AAFE) - three courses totalling 30 hours of CE: Level I Botulinum Toxin (10 hrs), Level I Dermal Fillers (10 hrs), and Frontline TMJ & Facial Pain Therapy Level I (10 hrs).

facialesthetics.org

Krista Jones, DDS graduated from the OU College of Dentistry in 1981, and had a private restorative dental general practice for 39 years before retiring in 2020. She has been active in organized dentistry and has been president of the Oklahoma Dental Association, Oklahoma County Dental Society, Oklahoma Association of Women Dentists, an ADA Delegate, and a founding member of the J. Dean Robertson Society, also serving on their Board of Directors. Dr. Jones was named Dentist of the year by the ODA and received its Jim Saddoris Lifetime Leadership Award. Dr. Jones is currently a District 5 member and Secretary/Treasurer of the Oklahoma Board of Dentistry and is an Examiner for licensure with the CDCA, WREB, CITA. She is a Fellow with the American College of Dentists, International College of Dentists, the Pierre Fauchard Academy, and the Academy of Dentistry International.

www.okda.org

THANK YOU Oklahoma Dental Foundation Contributors ODF contributions go directly to providing life-changing treatment and oral health education to Oklahomans in need. Dr. Jeffrey Ahlert

Dr. Christopher Corbin

Dr. Aaron Harman

Dr. Andrea Montgomery

Dr. Patrick Stover

Dr. Ross Allen

Dr. Deborah Corwin

Dr. Edward Harroz III

Dr. Nicole Nellis

Dr. Steven Strange

Dr. Clay Anderson

Dr. James Corwin

Dr. Robert Herman

Dr. Jerry Nick

Dr. Marc Susman

Dr. Jamie Ariana

Dr. G Frans Currier

Dr. Marilyn Hiebert

Dr. David Nittler

Dr. Jamie Talley

Dr. Bonnie Arnould

Dr. Russell Danner

Dr. Myron Hilton

Dr. Jana Oister

Dr. Jim Taylor

Dr. Forrest Arnould

Dr. Steven Deaton

Dr. Mathew Hookom

Dr. Anne Orr

Dr. Stephen Taylor

Dr. Lauren Avery

Dr. William Deprater

Dr. James Hooper

Dr. Chad Orr

Dr. Ryan Theobald

Dr. Victoria Ball

Dr. Calvin Doan

Dr. Brad Hoopes

Dr. Samuel Owens

Dr. John Thomas

Dr. Jeannie Bath

Dr. Bryce Dorrough

Dr. Scott Hubbard

Dr. Deborah Ozment

Dr. Kara Tims

Dr. Bryce Baumann

Dr. Ana Dotson

Dr. James Hulsey

Dr. Garrett Phipps

Dr. Jonah Vandiver

Dr. Justin Beasley

Dr. Brian Drew

Dr. Benjamin Humphrey

Dr. Ray Plant

Dr. Nathan Villines

Dr. William Beasley

Dr. Zane Dubberstein

Dr. Donald Johnson

Dr. Dana Price

Dr. Carlie Wager

Dr. Fred Benenati

Dr. Kevin Duffy

Dr. Eugenia Johnson

Dr. Christopher Ray

Dr. Michael Wallace

Dr. David Birdwell

Dr. Patrick Dukes

Dr. Mohammad Karami

Dr. Karen Reed

Dr. Gregory Watkins

Dr. Bryan Blankenship

Dr. George Dula

Dr. Michael Kirk

Dr. Chad Reid

Dr. Robert Webb III

Dr. Elizabeth Bohanon

Dr. Twana Duncan

Dr. Jandra Korb

Dr. Roger Richter III

Dr. Robert Wells Jr.

Dr. Jay Kruska

Dr. Ryan Roberts

Dr. James Wendelken

Dr. Blaire Bowers Ersteniuk Dr. K. Elassal Dr. Todd Bridges

Dr. Lee Eliot

Dr. Ashley Lanman

Dr. Tyler Rolland

Dr. Jay White

Dr. Matthew Bridges

Dr. Renalla Ellis

Dr. Grady Lembke

Dr. Mack Rudd

Dr. Steven White

Dr. Trace Bridges III

Dr. Heath Evans

Dr. Shannon Lewis

Dr. Miranda Ruleford

Dr. Theresa White

Dr. Nathan Brown

Dr. Christopher Fagan

Dr. Dustin Lively

Dr. Robert Schick

Dr. V. Ralph Willcox

Dr. S. Kelly Brown

Dr. Barry Farmer

Dr. Eric Loper

Dr. Scott Searcey

Dr. Vincent Willcox

Dr. Jamie Cameron

Dr. Joseph Feng

Dr. Pamela Low

Dr. Mickey Sehorn

Dr. Brian Wilson

Dr. Sarah Campbell

Dr. Keifer Fisher

Dr. David Marks

Dr. Jeff Shadid

Dr. Ronald Winder

Dr. Tricia Cannon

Dr. John Folks

Dr. Stephen Martin

Dr. Paul Shadid

Dr. Paul Wood

Dr. Wuse Cara

Dr. Richard Freeman

Dr. Alan Mauldin

Dr. Steffan Sigler

Dr. Craig Wooten

Dr. John Carletti

Dr. Emily Frye

Dr. Tracy McIntire

Dr. Johnny Siler

Dr. William Wynn IV

Dr. Bobby Carmen

Dr. Chad Garrison

Dr. Janna McIntosh

Dr. Floyd Simon Jr.

Dr. Trent Yadon

Dr. William Carter Jr.

Dr. LaMont Gee

Dr. Daniel McNair

Dr. Aaron Southerland

Dr. Conrad Casler Jr.

Dr. Mark Goodman

Dr. Glenn Mead

Dr. Chad Spiva

Dr. Cory Chambers

Dr. Sandra Grace

Dr. Joseph Meador

Dr. Clinton Stevens

Dr. Jennifer Chambers

Dr. Matthew Gray

Dr. Jamie Means

Dr. James Steyer Jr.

Dr. Brian Chastain

Dr. Barry Greenley

Dr. John Miller

Dr. Braden Stoltenberg

Dr. Logan Coffee

Dr. Jacob Hager

Dr. Robert Miracle

Dr. Dan Storm

Dr. Matthew Cohlmia

Dr. Leslie Hardy Jr.

Dr. Robert Mongrain

Dr. Julie Storm

22 journal | November/December 2023

Consider adding a donation to your membership renewal this year and visit okdf.org for more info

THANK YOU Relief & Disaster Grant Program Contributors The RDGP is a charitable entity that offers financial aid to dental professionals and their dependents faced with natural disasters, chemical dependence, physical disability, or other hindering conditions. This program relies solely on donations from members, so please consider adding a donation to your membership renewal this year. Dr. Jeffrey Ahlert

Dr. Logan Coffee

Dr. Leslie Hardy Jr.

Dr. Robert Miracle

Dr. Dan Storm

Dr. Ross Allen

Dr. Jeff Cohlmia

Dr. Aaron Harman

Dr. Andrea Montgomery

Dr. Julie Storm

Dr. Errol Allison

Dr. Matthew Cohlmia

Dr. Edward Harroz III

Dr. Mohsen Moosavi

Dr. Patrick Stover

Dr. Clay Anderson

Dr. Raymond Cohlmia

Dr. Robert Herman

Dr. Nicole Nellis

Mr. Guy Strunk

Dr. Jamie Ariana

Dr. Deborah Corwin

Dr. Marilyn Hiebert

Dr. David Nittler

Dr. Marc Susman

Dr. Bonnie Arnould

Dr. James Corwin

Dr. Myron Hilton

NW District Dental Society Dr. Jamie Talley

Dr. Forrest Arnould

Dr. Darrell Daugherty

Dr. James Hooper

Dr. Samuel Owens

Dr. Jim Taylor

Dr. Lauren Avery

Dr. David Deason

Dr. Brad Hoopes

Dr. Ray Plant

Dr. Stephen Taylor

Dr. Bryce Baumann

Dr. Bryce Dorrough

Dr. James Hulsey

Dr. Jillian Prather

Dr. Ryan Theobald

Dr. Justin Beasley

Dr. Ana Dotson

Dr. Benjamin Humphrey

Dr. Dana Price

Dr. John Thomas

Dr. William Beasley

Dr. Brian Drew

Dr. Donald Johnson

Dr. Christopher Ray

Dr. Kara Tims

Dr. David Birdwell

Dr. Neill Dubberstein

Dr. Eugenia Johnson

Dr. Karen Reed

Dr. Jonah Vandiver

Dr. Bryan Blankenship

Dr. Zane Dubberstein

Dr. Krista Jones

Dr. Chad Reid

Dr. Nathan Villines

Dr. Elizabeth Bohanon

Dr. Kevin Duffy

Dr. Mohammad Karami

Dr. Roger Richter III

Dr. Carlie Wager

Dr. Blaire Bowers Ersteniuk Dr. Patrick Dukes

Dr. Michael Kirk

Dr. Ryan Roberts

Dr. Robert Webb III

Dr. Todd Bridges

Dr. George Dula

Dr. Jandra Korb

Dr. Tyler Rolland

Dr. Robert Wells Jr.

Dr. George Bridges

Dr. Twana Duncan

Dr. Ashley Lanman

Dr. Mack Rudd

Dr. James Wendelken

Dr. Matthew Bridges

Dr. Renalla Ellis

Dr. Grady Lembke

Dr. Scott Searcey

Dr. Steven White

Dr. Trace Bridges III

Dr. Heath Evans

Dr. Shannon Lewis

Dr. Mickey Sehorn

Dr. Theresa White

Dr. Nathan Brown

Dr. Christopher Fagan

Dr. Dustin Lively

Dr. Jeff Shadid

Dr. Vincent Willcox

Dr. S. Kelly Brown

Dr. Barry Farmer

Dr. Eric Loper

Dr. Paul Shadid

Dr. Mary Willhoite

Dr. Kristen Campbell

Dr. John Folks

Dr. Eric Lopez

Dr. Gregory Shanbour

Dr. Brian Wilson

Dr. Tricia Cannon

Dr. Richard Freeman

Dr. Steve Lusk

Dr. Gregory Shanbour

Dr. Paul Wood

Dr. Wuse Cara

Dr. Chad Garrison

Dr. David Marks

Dr. Kyle Shannon

Dr. William Wynn IV

Dr. Scott Carel

Dr. LaMont Gee

Dr. Stephen Martin

Dr. Steffan Sigler

Dr. John Carletti

Dr. James Gilliam

Dr. Alan Mauldin

Dr. Floyd Simon Jr.

Dr. Bobby Carmen

Dr. Mark Goodman

Dr. Jonas McCall

Dr. Gregg Smith

Dr. Conrad Casler Jr.

Dr. Sandra Grace

Dr. Tracy McIntire

Dr. Lori Smith

Dr. Cory Chambers

Dr. Matthew Gray

Dr. Janna McIntosh

Dr. Chad Spiva

Dr. Jennifer Chambers

Dr. Evangeline Greer

Dr. Daniel McNair

Dr. Clinton Stevens

Dr. Brian Chastain

Dr. Robert Gruenberg

Dr. Glenn Mead

Dr. James Steyer Jr.

Dr. Carrie Chastain

Dr. Jacob Hager

Dr. Jamie Means

Dr. Braden Stoltenberg

To learn more about RDGP, including how to donate and how to apply for assistance, please visit okda.org

www.okda.org

THANK YOU Smile Member Contributors A Smile membership is a voluntary add-on to your regular ODA membership that helps us communicate the importance of dentistry as a career and promote advances in dentistry to the public. Your $25 Smile contribution enables the ODA to share positive oral health messages through marketing and public relations statewide. Funds collected through Smile also support our Find a Dentist program. Dr. Jeffrey Ahlert

Dr. Conrad Casler Jr.

Dr. Jerry Greer

Dr. Jana Oister

Dr. Carlie Wager

Dr. Ross Allen

Dr. Cory Chambers

Dr. Jacob Hager

Dr. Samuel Owens

Dr. Robert Webb III

Dr. Addie Allen-Steed

Dr. Jennifer Chambers

Dr. H. Douglas Hall

Dr. Ray Plant

Dr. William Weber

Dr. Clay Anderson

Dr. Logan Coffee

Dr. Leslie Hardy Jr.

Dr. Dana Price

Dr. Robert Wells Jr.

Dr. Jamie Ariana

Dr. Matthew Cohlmia

Dr. Aaron Harman

Dr. Christopher Ray

Dr. James Wendelken

Dr. Bonnie Arnould

Dr. Raymond Cohlmia

Dr. John Henry

Dr. Karen Reed

Dr. Steven White

Dr. Forrest Arnould

Dr. Deborah Corwin

Dr. Robert Herman

Dr. Roger Richter III

Dr. Theresa White

Dr. Glenn Ashmore

Dr. James Corwin

Dr. Marilyn Hiebert

Dr. Ryan Roberts

Dr. V. Ralph Willcox

Dr. Douglas Auld

Dr. G Frans Currier

Dr. James Hooper

Dr. Brant Rouse

Dr. Brian Wilson

Dr. Lauren Avery

Dr. David Deason

Dr. Eric Hopkins

Dr. Miranda Ruleford

Dr. Paul Wood

Dr. Jeffrey Baggett

Dr. Calvin Doan

Dr. James Hulsey

Dr. Mickey Sehorn

Dr. Victoria Ball

Dr. Bryce Dorrough

Dr. Donald Johnson

Dr. Jeff Shadid

Dr. Bryce Baumann

Dr. Ana Dotson

Dr. Eugenia Johnson

Dr. Paul Shadid

Dr. Robert Baumann

Dr. Brian Drew

Dr. Mohammad Karami

Dr. Steffan Sigler

Dr. Justin Beasley

Dr. Zane Dubberstein

Dr. Michael Kirk

Dr. Floyd Simon Jr.

Dr. William Beasley

Dr. Kevin Duffy

Dr. Jandra Korb

Dr. Gregg Smith

Dr. Tamara Berg

Dr. Patrick Dukes

Dr. Ashley Lanman

Dr. Lori Smith

Dr. David Birdwell

Dr. George Dula

Dr. Dustin Lively

Dr. Chad Spiva

Dr. Bryan Blankenship

Dr. Twana Duncan

Dr. Eric Loper

Dr. James Steyer Jr.

Dr. Elizabeth Bohanon

Dr. Renalla Ellis

Dr. Steve Lusk

Dr. Dan Storm

Dr. Todd Bridges

Dr. Heath Evans

Dr. Michael Manuel

Dr. Julie Storm

Dr. Matthew Bridges

Dr. Christopher Fagan

Dr. David Marks

Dr. Steven Strange

Dr. Trace Bridges III

Dr. Barry Farmer

Dr. Stephen Martin

Dr. Marc Susman

Dr. Nathan Brown

Dr. Keifer Fisher

Dr. Alan Mauldin

Dr. Jamie Talley

Dr. S. Kelly Brown

Dr. John Folks

Dr. Janna McIntosh

Dr. Jim Taylor

Dr. Kristen Campbell

Dr. Richard Freeman

Dr. Zachary McNickle

Dr. Stephen Taylor

Dr. Tricia Cannon

Dr. Chad Garrison

Dr. Glenn Mead

Dr. John Thomas

Dr. Wuse Cara

Dr. Mark Goodman

Dr. Andrea Montgomery

Dr. Kara Tims

Dr. John Carletti

Dr. James Gore

Dr. Mohsen Moosavi

Dr. Jonah Vandiver

Dr. Bobby Carmen

Dr. Sandra Grace

Dr. Nicole Nellis

Dr. Nathan Villines

Dr. William Carter Jr.

Dr. Matthew Gray

Dr. Jerry Nick

Dr. Diane Vincent

24 journal | November/December 2023

To learn more about additional membership contributions and how they are used to further ODA's mission, please visit okda.org

THANK YOU Pride Member Contributors A Pride membership is a voluntary add-on to your regular ODA membership that supports our lobbying efforts at the State Capitol. Our members continue to rank advocacy as one of the most important benefits of being an ODA and ADA member. Your $25 Pride membership helps us continue making your voice heard and presenting a united front for organized dentistry with our lawmakers. Dr. Jeffrey Ahlert

Dr. Bobby Carmen

Dr. Robert Gruenberg

Dr. Jonas McCall

Dr. Dan Storm

Dr. Ross Allen

Dr. Conrad Casler Jr.

Dr. Jacob Hager

Dr. Tracy McIntire

Dr. Julie Storm

Dr. Addie Allen-Steed

Dr. Logan Coffee

Dr. H. Douglas Hall

Dr. Janna McIntosh

Dr. Marc Susman

Dr. Errol Allison

Dr. Jeff Cohlmia

Dr. Leslie Hardy Jr.

Dr. Glenn Mead

Dr. Jamie Talley

Dr. Clay Anderson

Dr. Matthew Cohlmia

Dr. Aaron Harman

Dr. Jamie Means

Dr. Jim Taylor

Dr. Jamie Ariana

Dr. Raymond Cohlmia

Dr. John Henry

Dr. Robert Miracle

Dr. Stephen Taylor

Dr. Bonnie Arnould

Dr. Deborah Corwin

Dr. Robert Herman

Dr. Andrea Montgomery

Dr. John Thomas

Dr. Forrest Arnould

Dr. James Corwin

Dr. Jeffrey Hermen

Dr. Nicole Nellis

Dr. Kara Tims

Dr. Glenn Ashmore

Dr. G Frans Currier

Dr. Marilyn Hiebert

Dr. David Nittler

Dr. Steve Truong

Dr. Douglas Auld

Dr. Russell Danner

Dr. James Hooper

Dr. Jana Oister

Dr. Jonah Vandiver

Dr. Lauren Avery

Dr. Darrell Daugherty

Dr. Brad Hoopes

Dr. Anne Orr

Dr. Nathan Villines

Dr. Jeffrey Baggett

Dr. David Deason

Dr. James Hulsey

Dr. Chad Orr

Dr. Carlie Wager

Dr. Bryce Baumann

Dr. William Deprater

Dr. Donald Johnson

Dr. Samuel Owens

Dr. Robert Webb III

Dr. Robert Baumann

Dr. Ana Dotson

Dr. Eugenia Johnson

Dr. Ray Plant

Dr. William Weber

Dr. Justin Beasley

Dr. Brian Drew

Dr. Krista Jones

Dr. Dana Price

Dr. Robert Wells Jr.

Dr. William Beasley

Dr. Kevin Duffy

Dr. Janet Julian

Dr. Christopher Ray

Dr. James Wendelken

Dr. David Birdwell

Dr. George Dula

Dr. Mohammad Karami

Dr. Karen Reed

Dr. Steven White

Dr. Bryan Blankenship

Dr. Twana Duncan

Dr. Michael Kirk

Dr. Roger Richter III

Dr. Theresa White

Dr. Elizabeth Bohanon

Dr. Renalla Ellis

Dr. Jennifer Koonce

Dr. Ryan Roberts

Dr. Brian Wilson

Dr. Blaire Bowers Ersteniuk Dr. Heath Evans

Dr. Jandra Korb

Dr. Tyler Rolland

Dr. Paul Wood

Dr. Todd Bridges

Dr. Christopher Fagan

Dr. Jay Kruska

Dr. Brant Rouse

Dr. William Wynn IV

Dr. Matthew Bridges

Dr. Joseph Fallin Jr.

Dr. Ashley Lanman

Dr. Miranda Ruleford

Dr. Trace Bridges III

Dr. Barry Farmer

Dr. Grady Lembke

Dr. Mickey Sehorn

Dr. Nathan Brown

Dr. John Folks

Dr. Dustin Lively

Dr. Paul Shadid

Dr. S. Kelly Brown

Dr. Richard Freeman

Dr. Brandon Loeser

Dr. Kyle Shannon

Dr. William Burchard

Dr. Emily Frye

Dr. Eric Loper

Dr. Steffan Sigler

Dr. Jamie Cameron

Dr. Chad Garrison

Dr. Steve Lusk

Dr. Floyd Simon Jr.

Dr. Kristen Campbell

Dr. Martha Garzon

Dr. Kevin Mailot

Dr. Lori Smith

Dr. Tricia Cannon

Dr. Mark Goodman

Dr. David Marks

Dr. Brooke Snowden

Dr. Wuse Cara

Dr. James Gore

Dr. Molly Marshall Hays

Dr. Chad Spiva

Dr. Scott Carel

Dr. Sandra Grace

Dr. Stephen Martin

Dr. Tristanne Spottswood

Dr. John Carletti

Dr. Matthew Gray

Dr. Alan Mauldin

Dr. James Steyer Jr.

To learn more about ODA's legislative efforts, please visit okda.org

www.okda.org

NATIONAL ASSOCIATION NEWS ADA's Newly Elected Officers & Award Winners Brent H. Kessler, DDS ADA President-Elect Dr. Brett Kessler, a Denver, Colorado dentist and 14th District trustee was voted president-elect by the ADA House of Delegates Oct. 10.

Edwin A. del ValleSepulveda, DMD, JD ADA Second Vice President Edwin A. del Valle-Sepulveda, D.M.D., J.D., an oral and maxillofacial surgeon from San Juan, Puerto Rico, was named second vice president of the ADA Oct. 10.

Dr. Kessler is the former president of the Colorado Dental Association and the founding chair of the Colorado Dental Association Foundation. He received his dental degree from the University of Illinois at Chicago College of Dentistry.

de Cirujanos Dentistas de Puerto Rico and received his dental degree from the University of Puerto Rico School of Dental Medicine.

“The changemaker movement is on, and I’m so so grateful, and I’m looking so forward to these next two years,” Dr. Kessler told the House of Delegates.

“I am so excited,” Dr. del Valle-Sepulveda told the House of Delegates. “I hope to lead to your expectations. I thank you for trusting in me.”

Dr. del Valle-Sepulveda is the former president of the Colegio

Bill Milner, DDS

Allen Reavis, DDS

2023 ADA Humanitarian Award Winner

12th District Trustee

Dr. William Milner, D.D.S, has received ADA’s 2023 Humanitarian Award for founding his nonprofit, Access Dental Care, to provide elder dental care and treat patients with special needs.

Dr. Allen Reavis of Kansas will now represent District 12 on the ADA Board of Trustees. District 12 includes Arkansas, Kansas, Louisiana, and Oklahoma.

The award is bestowed by the Board of Trustees annually at SmileCon to dentists who have distinguished themselves by outstanding, unselfish leadership through the expenditure of extraordinary time and professional skills — all to improve the oral health of underserved populations. The award includes $10,000 given to the dental charity or project of the recipient’s choice. “On behalf of the Board of Trustees, I was proud to call and congratulate Dr. Milner on being the recipient of one of the ADA’s highest honors,” said ADA President George R. Shepley, D.D.S. “He has spent his 40-plus years in organized dentistry working toward oral health equity, providing care to those most in need. Patients with disabilities, those in nursing homes, and even patients with infectious diseases like HIV/AIDS are receiving care that might not always be available otherwise. Dr. Milner and his staff 's dedication is epitomized by the fact they are being proactive about meeting the needs of seniors and those with special health needs, while at the same time inspiring early-career dentists and dental students in North Carolina to follow his lead.” 26 journal | November/December 2023

Reavis is a 1984 graduate of UMKC School of Dentistry and has been active in the Kansas Dental Association for his entire career, serving as president in 2020. Reavis serves on the Council on Dental Legislation, Council on Finance and Budget, and serves on the Kansas Dental Charitable Foundation Board. Dr. Reavis also serves on several ADA councils and has been honored as a Fellow in the American College of Dentists, Fellow in the International College of Dentists, Fellow in the Pierre Fauchard Academy, and Mastership in AGD. Reavis retired from Atchison Dental Associates after 37 years of ownership and now works part time at the Atchison Community Health Clinic FQHC as the Dental Director and provides care to the underserved.

To read more ADA news and updates from SmileCon 2023 in Orlando, visit adanews.ada.org

NATIONAL ASSOCIATION NEWS Outgoing ADA President Praises Unity of Association There is no single way for the ADA to express its purpose, but it’s in unity where the Association’s strength lies, ADA President George R. Shepley, D.D.S., told the ADA House of Delegates on October 7. Dr. Shepley completed his presidential year at SmileCon 2023, recounting a number of successes during his term, including a ballot measure in Massachusetts that passed in 2022 allowing dental insurance carriers in the state to establish a medical loss ratio for dentistry. Beginning in 2024, the state's carriers will be required to spend at least 83% of premium dollars on patient care rather than on administrative costs, salaries and profits. Other states are following suit with their own legislation. He also discussed the workforce shortage in dentistry and how the ADA is working to help dentists alleviate it. “Strengthening the workforce pipeline requires comprehensive solutions, and states in our tripartite are taking action – like

streamlining in-office training for assistants, running recruitment campaigns for high school graduates and funding efforts for education programs that also incentivize service in underserved communities,” Dr. Shepley said. “At the federal level, the ADA supports the reauthorization of the Action for Dental Health Act and increased funding for the Oral Health Workforce Improvement Grant Program.” The ADA is also promoting workforce mobility through the Dentist and Dental Hygienist Compact—in collaboration with the Council of State Governments. The compact simplifies multistate practice by standardizing credentials across participating states. Washington, Iowa, and Tennessee have enacted the compact, with active bills in New Jersey, Ohio, Pennsylvania, and Wisconsin soon introducing it. Ten more states have stated their interest in introducing the compact next year. He asked the House and members to tap into their collective power as they look ahead.

by Kelly Ganski, ADA Staff

George R. Shepley, DDS addresses the House of Delegates at SmileCon in Orlando. “To be bold in designing a health care system that works. Even if it means disrupting the status quo, rejecting current options and creating a new thing. To be daring as we set the global standard for oral health. To be fearless in our calling to make people healthy,” Dr. Shepley said. “Who says we can’t? Who better to try than us? And how else to do it but together. Because in unity, where one thrives, we all thrive.”

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SCIENTIFIC FEATURE Fluoride: The Silver Bullet in Preventive Dentistry by Divesh Sardana, BDS, MDS, MBA, MPH, PhD Sallie Lau, DMD and Rebecca King, DDS

ABSTRACT Fluorides have long been recognized for their effectiveness in reducing the incidence and severity of dental caries, making them a cornerstone of modern preventive dentistry. However, clinicians and practitioners might face certain dilemmas around the use of fluorides, some of which are the effectiveness of systemic or topical fluoride, the use of monotherapy versus combination fluoride therapy, or whether to use fluoride supplements for their patients. Furthermore, there have been concerns about the oral and systemic toxicity and adverse effects of fluorides. The purpose of this paper is to delve into the world of fluoride treatment, with a specific emphasis on evidence-based recommendations, most of which are pivoted on high-quality systematic reviews or clinical trials. By centering our discussion on evidence-based practices, this paper seeks to assist dental professionals, policymakers, and the public in making informed decisions regarding some of the dilemmas faced during fluoride administration.

INTRODUCTION Fluoride therapy has remained a cornerstone of preventive dentistry, aimed at maintaining and enhancing oral health by strengthening tooth enamel and reducing the risk of dental decay. It inhibits demineralization by forming a fluoride reservoir on the tooth surface, which is not readily soluble and more resistant to acid dissolution. It also enhances the remineralization of the tooth enamel. As one of the most effective and cost-efficient methods in dentistry, fluoride treatment is crucial in promoting oral hygiene and preserving healthy smiles for individuals of all ages. This paper aims to delve into the world of fluoride treatment, with a specific emphasis on evidence-based recommendations, most of which are pivoted on high-quality systematic reviews or clinical trials. By centering our discussion on evidence-based practices, this paper seeks to assist dental professionals, policymakers, and the public in making informed decisions regarding some of the dilemmas faced during the administration of fluoride. Ultimately, the goal is to underscore the crucial role that fluoride plays in oral health while ensuring that its application aligns with the highest standards of scientific rigor and patient well-being.

ARE SYSTEMIC FLUORIDES REALLY EFFECTIVE IN PREVENTING DENTAL CARIES? The question of whether fluoride is truly effective in preventing dental caries has been a subject of considerable debate and investigation within the field of dentistry. Community water fluoridation is one of the oldest methods to administer systemic fluoride and is considered a cost-effective and accessible strategy to prevent dental caries. A systematic review pooling 155 studies

concluded that although the “initiation of water fluoridation” caused lower dmft (decayed, missing, or filled teeth) scores in deciduous dentition or DMFT in permanent dentition, the quality of evidence was low [1]. Similarly, the proportion of caries-free children with deciduous and permanent teeth increased with water fluoridation, but the evidence was low. Contrary to “initiation of water fluoridation”, there was no evidence to determine whether “cessation of water fluoridation” affected caries in deciduous dentition or the proportion of caries-free children in deciduous or permanent dentition. Also, nearly all the included studies were conducted prior to 1975 and were observational with a high risk of bias, raising concerns on the internal validity of the results. However, recent data from the National Health and Nutrition Examination Survey (NHANES) concluded that water fluoridation might result in 1.3 fewer dfs (decayed or filled surfaces) per child or 0.3 fewer DMFS (decayed, missing, or filled surfaces) per child, which might appear to be small or have negligible effect, but when translated clinically to the whole population of children in the US, will result in millions of less carious teeth surfaces [2]. However, the challenge to water fluoridation might be the lack of water fluoridation, rising use of bottled water, and public opposition to water fluoridation. [3]

A close-up photo of a layered slice of fluorite, the source of fluoride. Fluoridated milk has been another modality that has been tried to ward off dental caries; however, the data is limited. The Cochrane review published in 2015 only reported on one randomized clinical trial involving 166 participants. Although mean caries in the primary and permanent teeth were low in the milk fluoridation group, the certainty of evidence was too low to generate any robust conclusion [4]. Fluoride has been tried in other foods as well, like salt and sugar, with an intention to provide systemic effect and prevent dental caries; however, the evidence of the effectiveness of fluorides added in salt or sugar is scant due to no or very few studies [5,6]. Thus, this might be a future research area for those studying food fortification for better health outcomes. (continued on page 30)

28 journal | November/December 2023

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SCIENTIFIC FEATURE continued ARE TOPICAL FLUORIDES REALLY EFFECTIVE IN PREVENTING DENTAL CARIES? The mechanism of action of fluoride, as demonstrated through various laboratory studies, is primarily topical by enhancing the remineralization of early carious lesions and inhibiting the demineralization of intact tooth enamel. Furthermore, the concept has changed over the last 2 decades and the effect of fluorides has been predominantly considered post-eruptive rather than preeruptive; thus, topical forms of fluorides are universally popular [7]. As the term specifies, topical fluorides are intended for local application over tooth surfaces, providing an elevated concentration of fluoride for a short span of time. Depending upon the delivery system used, they have been categorized as self-applied or professionally-applied topical fluorides. Among the self-applied forms, fluoridated toothpastes have been so far the most widely used and its benefits have been established through a systematic review [8]. On the contrary, varnishes, gels, foams, and solutions are included as the professionally-applied forms of fluoride that have gained attention in the last two decades. A systematic review included 144 studies that compared the different forms of topical fluorides for the prevention of dental caries in primary and permanent dentition [9]. The review reported strong evidence of 26% caries-inhibiting effect of topical fluorides compared to a placebo/no intervention on permanent dentition through the meta-analysis of 133 included studies. However, only 5 studies reporting the effect of topical fluorides on deciduous dentition were included in the review and concluded a 33% reduction in the dmfs scores. On the other hand, when one topical fluoride was compared to another, 14% caries-inhibiting effect was found with no significant difference among them for the treatment effects. The comparison of one topical fluoride to another was attempted through a review and found a similar degree of effectiveness of fluoridated toothpastes to the mouth rinses in preventing caries in children. Moreover, inconclusive evidence was reported for the comparative effectiveness of varnishes and gels, varnishes and mouth rinses, as well as mouth rinses and gels.

IS FLUORIDE MONOTHERAPY BETTER THAN COMBINED FLUORIDE THERAPY IN PREVENTING DENTAL CARIES? The effectiveness of fluorides and their appropriate usage has been debated for decades. Moreover, the evidence justifying the use of professionally-applied topical fluoride along with the self-applied topical fluorides has been questioned. A systematic review compared the different forms of topical fluorides when used in combination or when they were used alone [12]. The review reported a modest reduction in dental caries, with a preventive fraction of 10% when a combination of topical fluorides and toothpaste were compared to the usage of fluoride toothpaste alone. Thus. This supports the use of additional topical fluoride therapy in addition to monotherapy toothpaste in high caries-risk children. However, the lack of randomized clinical trials assessing the different combinations of topical fluorides in children for caries prevention led to inconclusive evidence for the benefit of combination therapy over monotherapy.

ARE FLUORIDE SUPPLEMENTS EFFECTIVE IN PREVENTING DENTAL CARIES? Furthermore, the evidence of remineralization of early carious lesions, called white spot lesions, by professionally applied topical fluorides has been established by a review through a meta-analysis [10]. The review included 17 randomized clinical trials and found that 63.6% of initial carious lesions are remineralized and 65.9% of dentinal caries are arrested by professional fluoride treatment. The review reported 5% sodium fluoride varnish and 38% silver diamine fluoride solution as effective remineralizing and caries-arresting professional fluoride agents respectively. Another systematic review with network metaanalysis (NMA) conducted on professionally and self-applied topical fluorides in primary dentition provided both direct as well as indirect evidence for their caries-inhibiting effect [11]. The review reported the quarterly application of 0.9% Difluorosilane which ranked highest among the professionally-applied topical fluorides compared to a non-fluoride control in preventing Early Childhood Caries. Regarding the self-applied topical fluorides, inconclusive evidence was reported due to variations in the included studies. 30 journal | November/December 2023

Additional sources of fluoride are recommended when self-applied topical fluorides are not used or accessible to the child, or when the individual is at a higher risk for caries. Different forms of fluorides are available that have been used as supplements in children while considering their adverse effects. These supplements may be in the form of tablets, drops, chewing gum, or lozenges. However, all of these supplements have been considered a risk factor for fluorosis, and thus, have been under debate and limited to high caries-risk children only. A review found 24% reduction in DMFS in children with permanent dentition with the use of fluoride supplements when compared to those with no fluoride treatment. However, no difference was found when compared with other topical fluoride interventions. Similarly, inconclusive evidence was reported for using fluoride supplements in children with primary dentition, and with uncertainty on its benefit/risk ratio. Thus, the evidence on the appropriate and safe use of fluoride supplements was found to be weak and inconclusive [13].

SCIENTIFIC FEATURE continued ARE FLUORIDE SUPPLEMENTS IN PREGNANT WOMEN ASSOCIATED WITH A LOW CARIES RATE IN THEIR CHILDREN?

Bone fracture has been another concern with the use of fluorides systemically; however, a review by Jones et al. (1999) found that it was not significant, with a relative risk of 1.02 [95% CI: 0.96 to 1.09] [16]. Skeletal fluorosis is another potential adverse effect, albeit rare, associated with excessive fluoride intake over extended periods occurring at fluoride concentrations of 4.0 ppm. Additionally, concerns have been raised about potential Since all of the primary tooth enamel and some of the permanent neurodevelopmental effects in children exposed to high fluoride tooth enamel start to develop in utero, it might seem logical levels, although there are no quality studies to substantiate this to sound that fluorides given during pregnancy might have a claim. To harness the benefits of fluoride in preventive dentistry pre-eruptive effect, making the enamel strong and more caries while mitigating these adverse effects, dental professionals resistant. However, it is not known if fluoride can cross the and public health authorities must strike a balance through placenta and, if it does, what percentage of fluoride is able to be appropriate fluoride concentration levels in drinking water and biologically available to the fetus. One Cochrane review concluded dental products, as well as patient education and monitoring. that there is no evidence that fluoride taken during pregnancy results in decreased caries in primary dentition in children [14].

REFERENCES

WHAT ARE THE POTENTIAL ADVERSE EFFECTS OF THE USE OF FLUORIDES IN DENTISTRY? Adverse effects of fluorides in dentistry can manifest as dental fluorosis, a cosmetic concern characterized by discoloration or pitting of tooth enamel. A systematic review by McDonagh et al. (2000) found that dental fluorosis occurred in a dose-response manner with an increase in ppm of fluorides in drinking water [15]. Furthermore, even at 1.0 ppm fluoride in drinking water, nearly 12.5% of people might be affected by esthetically concerning levels of dental fluorosis. It is to be noted that the absolute increase in prevalence is slight compared to the relative prevalence as individuals might be affected with other hypoplastic defects of the teeth, and the fluorosis that might occur at 1.0 ppm is mild or questionable. While the risk of severe dental fluorosis is relatively low, it highlights the importance of carefully monitored fluoride exposure, especially in children during their tooth development years.

1. Iheozor-Ejiofor Z, Worthington HV, Walsh T, O'Malley L, Clarkson JE, Macey R, Alam R, Tugwell P, Welch V, Glenny AM. Water fluoridation for the prevention of dental caries. Cochrane Database Syst Rev. 2015;2015(6):CD010856. 2. Slade GD, Grider WB, Maas WR, Sanders AE. Water Fluoridation and Dental Caries in U.S. Children and Adolescents. J Dent Res. 2018;97(10):1122-1128. 3. Allukian M Jr, Carter-Pokras OD, Gooch BF, Horowitz AM, Iida H, Jacob M, Kleinman DV, Kumar J, Maas WR, Pollick H, Rozier RG. Science, Politics, and Communication: The Case of Community Water Fluoridation in the US. Ann Epidemiol. 2018;28(6):401-410 4. Yeung CA, Chong LY, Glenny AM. Fluoridated milk for preventing dental caries. Cochrane Database Syst Rev. 2015 Sep 3;2015(9):CD003876. 5. Espelid I. Caries preventive effect of fluoride in milk, salt and tablets: a literature review. Eur Arch Paediatr Dent. 2009;10(3):149-56. 6. Cagetti MG, Campus G, Milia E, Lingström P. A systematic review on fluoridated food in caries prevention. Acta Odontol Scand. 2013;71(3-4):381-7. 7. Fejerskov O. Changing paradigms in concepts on dental caries: consequences for oral health care. Caries Res. 2004;38(3):182-91. 8. Marinho VC, Higgins JP, Sheiham A, Logan S. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003;2003(1):CD002278. 9. Marinho VC, Higgins JP, Logan S, Sheiham A. Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003;2003(4):CD002782. 10. Gao SS, Zhang S, Mei ML, Lo EC, Chu CH. Caries remineralisation and arresting effect in children by professionally applied fluoride treatment - a systematic review. BMC Oral Health. 2016;16:12.

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SCIENTIFIC FEATURE continued 11. Manchanda S, Sardana D, Liu P, Lee GH, Li KY, Lo EC, Yiu CK. Topical fluoride to prevent early childhood caries: Systematic review with network meta-analysis. J Dent. 2022;116:103885. 12. Marinho VC, Higgins JP, Sheiham A, Logan S. Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2004;2004:CD002781. 13. Tubert-Jeannin S, Auclair C, Amsallem E, Tramini P, Gerbaud L, Ruffieux C, Schulte AG, Koch MJ, Rège-Walther M, Ismail A. Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children. Cochrane Database Syst Rev. 2011;2011(12):CD007592. 14. Takahashi R, Ota E, Hoshi K, Naito T, Toyoshima Y, Yuasa H, Mori R, Nango E. Fluoride supplementation (with tablets, drops, lozenges or chewing gum) in pregnant women for preventing dental caries in the primary teeth of their children. Cochrane Database Syst Rev. 2017;10(10):CD011850. 15. McDonagh MS, Whiting PF, Wilson PM, Sutton AJ, Chestnutt I, Cooper J, Misso K, Bradley M, Treasure E, Kleijnen J. Systematic review of water fluoridation. BMJ. 2000;321(7265):855-9. 16. Jones G, Riley M, Couper D, Dwyer T. Water fluoridation, bone mass and fracture: a quantitative overview of the literature. Aust N Z J Public Health. 1999;23(1):34-40.

Dr. Divesh Sardana received his BDS degree from Manipal Academy of Higher Education, India and MDS & residency training in Pediatric Dentistry from the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. He also received his MBA in Health Care Administration from the Faculty of Management Studies (FMS), University of Delhi. Subsequently, he completed his PhD in Pediatric Dentistry from the University of Hong Kong and an MPH in Quantitative Methods from Harvard University. He also holds Fellowships from the Higher Education Academy (FHEA) (UK Professional Standard Framework for Teaching and Learning Support in Higher Education), the International College of Dentists (FICD) and the Pierre Fauchard Academy (FPFA). He is an an Honorary Assistant Professor in the Division of Pediatric Dentistry and Orthodontics of the Faculty of Dentistry at the University of Hong Kong. He has previously worked as a Teaching Fellow at Harvard Medical School and a Research Assistant at Harvard School of Dental Medicine. Divesh has also worked as a Senior Resident in Pediatric Dentistry at the Center for Dental Education and Research (CDER), a WHO Collaborating Center for Oral Health Promotion at All India Institute of Medical Sciences (AIIMS), New Delhi, which is the most prominent Public Hospital in India. Divesh has published over 70 papers in international scientific journals and one book chapter with an H-index of 18 (as of September 2023). He is a member of the editorial board of the International Dental Journal (the official journal of the FDI World Dental Federation), BMC Oral Health, and the Journal of the Oklahoma Dental Association. Divesh is also a Member of the Faculty of Dental Surgery of the Royal College of Physicians and Surgeons of Glasgow (MFDS RCPSG). His areas of research interest are evidence-based dentistry, incipient carious lesions and children with special healthcare needs.

STATEMENT OF OWNERSHIP, MANAGEMENT, AND CIRCULATION 1. 2. 3. 4. 5. 6. 7.

8. 9.

10. 11. 12. 13. 14.

15. Publication Title: Oklahoma Dental Association Journal Publication Number: 284-980 Filing Date: October 10, 2023 Issue Frequency: Bimonthly Number of Issues Published Annually: 6 Annual Subscription Price: $56 Complete Mailing Address of Office of Publication: Oklahoma Dental Association 317 NE 13th St, Oklahoma City, OK 73104 Contact Name: Jill Johnson, (405) 848.8873 Editor Name: Mary Hamburg, DDS Managing Editor: F. Lynn Means Complete Mailing Address of Headquarters or General Business: Oklahoma Dental Association 317 NE 13th St, Oklahoma City, OK 73104 Full Names and Complete Mailing Addresses of Publisher, Editor and Managing Editor: Publisher: Oklahoma Dental Association, 317 NE 13th St, Oklahoma City, OK 73104 Editor Name: Mary Hamburg, DDS Managing Editor: F. Lynn Means Owner: Oklahoma Dental Association, 317 NE 13th St, Oklahoma City, OK 73104 Known Bondholders, Mortgagees, and Other Security Holders Owning or Holding I Percent or More of Total Amount of 16. Bonds, Mortgages, or Other Securities: None 17. Tax Status: Has Not Changed Publication Title: Oklahoma Dental Association Journal Issue Date for Circulation Data: September/October 2022 17.

32 journal | November/December 2023

Extent and Nature of Circulation a. Total Number of Copies (Net press run) b. Paid Circulation 1. Mail Outside-County Paid Subscriptions Stated on Form 3541 2. Mail In-County Paid Subscriptions Stated on Form 3541 3. Paid Distribution Outside the Mails Including Sales Through Dealers and Carriers, Street Vendors, Counter Sales, and Other Paid Distribution 4. Paid Distribution by Other Classes of Mail Through the USPS c. Total Paid Distribution [Sum of 15b] d. Free or Nominal Rate Distribution 1. Outside-County included on PS Form 3541 2. In-County included on PS Form 3541 3. Other Classes Through the USPS 4. Free Distribution Outside the Mail (Carriers or Other Means) e. Total Free Distribution (Sum of 15d) f. Total Distribution (Sum of 15c and 15e) g. Copies Not Distributed h. Total (Sum of 15f and g) i. Percent Paid (15c divided by 15f times 100) Electronic Copy Circulation Publication of Statement of Ownership required. Will be printed in the November/December 2023 issue of this publication Signature and Title of Editor, Publisher, Business Manager, or Owner F. Lynn Means, Managing Editor, October 9, 2023

Average No. Copies Each Issue During Proceeding 12 Months

No. Copies of Single Issue Published to Filing Date

1,749

1,934

1,643

1,622

1,643

1,622

81 287 81 1,724 25 1,749 95% 1,593

287 1,909 25 1,934 85% 1,610

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CASE STUDY Clinical Differential Diagnosis: Solitary Tongue Mass by Glen Houston, DDS, MSD

HISTORY A 67-year-old Caucasian man presents to his internist concerned about a “knot” involving his tongue. The patient notes the area of concern is “not painful” and has been present for “several days”. In review of his health history, the patient received a renal transplant approximately 10 years ago, has a lengthy history of uncontrolled hypertension, Type II non-insulin dependent diabetes mellitus (NIDDM) or adult onset diabetes, and a significant history of tobacco and alcohol abuse.

QUESTION #1 Terminology to describe this lesion clinically involving the ventral tongue would include which of the following: a. Circumscribed area of erythroplakia b. Asymptomatic ulcerated umbilicated mass c. Convoluted papillary lesion d. Asymptomatic pigmented macule e. None of the above

ANSWER #1 The correct answer is an asymptomatic ulcerated umbilicated mass (b). Because a circumscribed area of erythroplakia (a) represents a clinical term describing a red patch that cannot be clinically or pathologically diagnosed as any other condition, this answer is not a consideration in the clinical description. Additionally, a convoluted papillary lesion (c) and an asymptomatic pigmented macule (d) would not accurately describe this asymptomatic ulcerated umbilicated mass from a clinical standpoint. The last choice, none of the above (e), does not apply in this case.

QUESTION #2 An appropriate clinical differential diagnosis for this asymptomatic ulcerated umbilicated mass involving the ventral tongue would include: a. Traumatic ulcer b. Keratoacanthoma c. Squamous cell carcinoma d. Histoplasmosis e. Basal cell carcinoma

34 journal | November/December 2023

Patient reference photo

ANSWER #2 All of these lesions (a-e) may present clinically as an asymptomatic ulcerated umbilicated mass. However, the keratoacanthoma (b) and basal cell carcinoma (e) typically arise in actinically damaged skin. Both of these lesions have been reported intraorally, but further review and analysis indicate that the cases described as keratoacanthoma actually represent well differentiated squamous cell carcinoma. The cases of basal cell carcinoma were observed arising from the gingiva and actually represented the extra osseous or peripheral variant of the odontogenic neoplasm, ameloblastoma. Cases of traumatic ulcer (a) are usually unintentional and arise from a variety of causes. These lesions are usually observed involving the tongue, lips, and buccal mucosa injured by the dentition. Lesions of the gingiva, palate, and mucobuccal fold may occur from other sources of irritation. Thorough questioning of the patient will usually lead to the appropriate diagnosis. Once the irritating source of the injury has been identified and, if necessary, removed, rapid resolution is usually observed. The tongue is the most common location intraorally for squamous cell carcinoma (c) and accounts for approximately 50% of all oral cancer cases. The majority of these cases present as an asymptomatic ulcerated umbilicated mass involving the posterior lateral border, followed by the anterior lateral or ventral surfaces. A very small percent involves the dorsal surface. The most common systemic fungal infection in America is histoplasmosis (d) caused by the organism, Histoplasma capsulatum. It is primarily a respiratory disease but may manifest in the oral cavity (disseminated disease from the lungs) as an asymptomatic ulcerated umbilicated mass that is easily mistaken clinically for a chronic traumatic ulcer or squamous cell carcinoma. (continued on page 36)

2024 ODA AWARDS NOMINATION DEADLINE FOR NOMINATIONS IS DECEMBER 31, 2023

Nominee Information (Please print clearly or type) Name:

Address:

City:

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Phone:

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Award Nomination (please check one) Richard T. Haught Dentist of the Year - A member dentist who has made a great contribution in advancing dentistry.

Young Dentist Award - A member dentist who has been in practice ten years or less with active interest in organized dentistry and who has enhanced the image of the dental profession.

Public Service Award - A member dentist who has made significant contributions to community service and philanthropic works in the area of dentistry.

Robert K. Wynne Memorial Award for Public Education and Public Information - A member dentist who has worked to advance the knowledge of dentistry and dental health through public education and public relations efforts.

Dan E. Brannin Professionalism Award - A member dentist who has made significant contributions to the advancements of the principles and practice of ethics and professionalism in dentistry.

Richard T. Oliver Award for Legislative Leadership - A member dentist who has provided outstanding leadership in the Oklahoma legislative process on behalf of the Oklahoma Dental Association. NOMINATED BY (Nominations must be made by an ODA Member Dentist. Self nominations are accepted.) Name:

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A letter of nomination MUST accompany each nomination describing the nominee’s accomplishments and other contributions to the dental profession. Additional letters of recommendation, résumés and other documents are encouraged. Use a separate form for each award nomination. Copies of this original form will be accepted. Signature: Submit by mail: Oklahoma Dental Association Attention: ODA Annual Awards 317 NE 13th Street Oklahoma City, OK 73104

Date: By fax: 405.848.8873 By email: kfaherty@okda.org

Deadline for nominations is December 31, 2023. www.okda.org

CASE STUDY continued QUESTION #3 Considerations in the management of this patient should include: a. Incisional biopsy b. Reschedule patient for follow-up evaluation in 4-6 weeks c. Advise the patient this is a traumatically induced lesion and will resolve in 10-14 days d. Treat the patient with the “magic potion” for 30 days e. Place the patient on nystatin oral suspension for 7-10 days for the empirical treatment of candidiasis

The traumatic ulcer (d) demonstrates a defect in the surface epithelium with the associated formation of an ulcer bed composed of granulation tissue within the subjacent lamina propria. Lastly, the keratoacanthoma (e) exhibits some of the same histologic features as observed in squamous cell carcinoma as described above but without any cytologic atypia. The microscopic features for necrotizing sialometaplasia, histoplasmosis, traumatic ulcer, and keratoacanthoma are distinctive for these entities. These histologic features are not observed in the present case.

ANSWER #3

DISCUSSION

The correct answer is incisional biopsy (a) which is warranted in order to establish a diagnosis and develop a definitive treatment format. The remaining choices (b-e) are of no clinical benefit in the management of the patient and are not indicated for the treatment and management of an asymptomatic ulcerated umbilicated mass.

Oral cancer (squamous cell carcinoma) accounts for approximately 2-3% of all cancer cases in the U.S. Approximately 30,000 new cases of oral squamous cell carcinoma (OSCCa) are diagnosed annually and approximately 5500 individuals die of this disease each year.

QUESTION #4 An incisional biopsy was accomplished and the soft tissue specimen was submitted for pathologic evaluation. The microscopic features described in the pathology report were as follows: Sections revealed fragments of squamous mucosa composed of a superficial layer of ulcerated, dysplastic squamous epithelium. Arising from this epithelium, and invading into the underlying lamina propria, are islands of neoplastic squamous cells exhibiting cytologic atypia, atypical mitotic figures, and keratin pearl formation. Based upon this histologic description, the diagnosis would be: a. Necrotizing sialometaplasia b. Histoplasmosis c. Squamous cell carcinoma d. Traumatic ulcer e. Keratoacanthoma

ANSWER #4 The correct answer is squamous cell carcinoma (c). See “Discussion." The remaining choices (a), (b), (d), (e) are not considered in the present case. Necrotizing sialometaplasia (a) is a reactive/ inflammatory salivary gland lesion characterized by necrosis of salivary gland acini with an associated squamous metaplasia of the residual salivary gland ducts. Histoplasmosis (b) is a systemic fungal infection characterized histologically by the formation of necrotizing granulomatous inflammation which, as noted earlier, is caused by the microorganism, Histoplasma capsulatum. 36 journal | November/December 2023

The cause of OSCCa is multifactorial. No single agent has been definitively identified. Factors such as tobacco smoking, especially in combination with alcohol consumption, and immunosuppression are readily identified. Patients with HIV and those undergoing immunosuppressive therapy for the treatment of malignant neoplasia or solid organ transplantation are at increased risk for the development of OSCCa and other head and neck malignant neoplasms, especially when tobacco smoking and alcohol abuse are present. Persons developing OSCCa are most often older men. There is minimal pain in the early growth phases and a varied clinical presentation is observed. The earliest cases are probably examples of leukoplakic (white patch) and erythroplakic (red patch) lesions. Later development would include the endophytic asymptomatic ulcerated lesion as well as the exophytic fungating papillary mass. Induration is usually noted in these later stages of development. The most common site for OSCCa is the tongue. As noted earlier, the tongue accounts for approximately 50% of all the OSCCa cases in population studies conducted in the U.S. Two-thirds of these cases present on the posterior lateral border, 20% on the anterior lateral or ventral surfaces, and 4% on the dorsum. Other sites of involvement include the floor of the mouth, soft palate, gingiva, buccal/labial mucosa, and hard palate. Microscopic features include the presence of dysplastic surface epithelium. OSCCa arises from this epithelium and is characterized by invasive islands of malignant squamous cells that break through the basement membrane and destroy the underlying structures. Treatment usually consists of surgical excision, radiation therapy, or a combination of these modalities. A variety of chemotherapeutic agents are utilized as adjunctive therapy particularly in patients with larger primary lesions or those with clinically palpable lymph nodes in the neck. Patients that have developed one carcinoma of the oral cavity are at increased risk for additional concurrent (synchronous) or subsequent (metachronous) malignancies of the upper aerodigestive tract particularly those who continue to smoke and

CASE STUDY continued abuse alcohol after therapy. Despite advances in treatment and in the understanding of the underlying molecular pathogenesis of OSCCa, the survival rates over the past several decades have not improved significantly and have remained in the 50-60% overall 5-year survival rate. Therefore prevention, early detection, and diagnosis are essential for improving patient outcomes.

REFERENCES American Cancer Society. Cancer facts & figures 2013. American Cancer Society 2013; 1-64. Bsoul SA, Huber MA, Terezhalmy GT. Squamous cell carcinoma of the oral tissues: a comprehensive review for oral healthcare providers. J Comtemp Dent Pract 2005; 6:1-16. Glenny AM, Furness S, Worthington HV, et al. Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy. Cochrane Database Syst Rev 2010; (12):CD006387. Lubin JH, Purdue M, Kelsey K, et al. Total exposure and exposure rate effects for alcohol and smoking and risk of head and neck cancer: a pooled analysis of case-control studies. Am J Epidermiol 2009; 170:937-947.

Massano J, Regateiro FS, Januário G, et al. Oral squamous cell carcinoma: review of prognostic and predictive factors. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102:67-76. Morse DE, Psoter WJ, Cleveland D, et al. Smoking and drinking in relation to oral cancer and oral epithelial dysplasia. Cancer Causes Control 2007; 18:919-929. Specenier PM, Vermorken JB. Neoadjuvant chemotherapy in head and neck cancer: should it be revisited? Cancer Lett 2007; 256:166-177. Dr. Glen Houston earned his D.D.S. from Baylor College of Dentistry and his M.S.D. in Oral and Maxillofacial Pathology from Indiana University School of Dentistry. During 22 years of service with the U.S. Air Force, he also completed a Fellowship at the Armed Forces Institute of Pathology, Walter Reed Army Medical Center, Washington, D.C. He was department chair and laboratory director at the University of Oklahoma College of Dentistry for 16 years. His areas of interest are Sjögren syndrome; maxillary, nasal, paranasal sinus disease; fibro-osseous lesions; and lesions of the minor salivary glands. Special note from the Editorial Committee: This is the last of Dr. Houston's case studies for the ODA Journal, as he is stepping down from the committee at the end of this year. Many thanks to Dr. Houston for his vast and important scientific contributions to the Journal over the years.

STRONGER THAN EVER! OKLAHOMA DENTAL ASSOCIATION

ANNUAL MEETING APRIL 12 & 13, 2024 OKLAHOMA CITY, OK REGISTRATION OPENS JANUARY 23 ON OKDA.ORG To become a sponsor, please contact advertising@okda.org

IN MEMORIAM ODA extends our deepest sympathy to the families of our dear friends and colleagues who have passed this year. Dr. Jack Carl Luman

Dr. Thomas Allen David

Central District Dental Society

Oklahoma County Dental Society

November 14, 1934 - April 25, 2023

September 21, 1942 - August 31, 2023

Dr. Fred Benton Blythe

Dr. Phillip Earl Willey

Dr. Fred Raymond Lucas

Tulsa County Dental Society

Southwest District Dental Society

Northwest District Dental Society

March 5, 1942 - April 23, 2023

March 28, 1935 - January 5, 2023

March 16, 1940 - July 17, 2023

Dr. Michael Dwight Manuel

Dr. James B. Lowe

Southwest District Dental Society

Oklahoma County Dental Society

December 16, 1955 - June 22, 2023

December 2, 1936 - October 6, 2023

It's Time to Renew Your ODA and ADA Membership! The 2024 Oklahoma Dental Association membership renewal period begins this month. Make sure to renew by January 1 to maintain all of the great benefits your membership provides. Our strength in Washington, D.C., at our State Capitol, and in your community is reliant on our united front from an organized dentistry perpective, and we need your support to help us continue the fight.

Help keep the dental profession strong. Renew today! okda.org/renew Choose a Payment Plan Did you know you don’t have to pay your ODA/ADA/Component (Tripartite) dues all at once? ODA understands that it may work better for you to remit your membership dues over multiple payments instead of all at once. We are excited to provide you with the opportunity to pay your 2024 membership with one of the following convenient payment plans:* • • • •

2 monthly payments 4 monthly payments 6 monthly payments 12 monthly payments

*There is a $6.00 fee for each payment.

Sign up for Automatic Renewal This plan allows your membership to be renewed automatically and paid with your credit card or an ACH payment each year. You may choose a one-time payment or a 6-month or 12-month payment plan that the ODA will process at the beginning of each year until you cancel by contacting the ODA. You will be able to update your credit card information as needed. The ODA will process auto renew payments on the 15th of each month. One-time renewal payments will be processed on January 15.

Please note: Those on the auto renew plan will be charged the same amount they contributed the previous year, including any additional voluntary contributions. ODA also reserves the right to charge the credit card on file at any time for past due payments that did not go through on prior attempts. To cancel, change, or update automatic renewal preferences, please contact the ODA. Early renewal and automatic renewal help save ODA money on sending notices and invoices. Thank you!

To take advantage of our payment plan or automatic renewal options, contact Kylie Faherty, ODA Director of Membership at kfaherty@okda.org or 405.848.8873

KEEP IT LOCAL Celebrating the Career of Dr. Jana Winfree by Jill Johnson, ODA staff

Dr. Jana Winfree celebrated her last day of work as the Director of Dental Health Service at the Oklahoma State Department of Health on August 31 with a party her team put together — a nontraditional gathering that represented her fun and vibrant personality. The group visited Soundbar, a listening lounge with a view of downtown Oklahoma City that serves cocktails and spins vintage vinyl records, highlighting the nostalgia she felt leading up to her retirement. Although she plans to fill her days with sunshine, traveling, trivia games, and spending time with family, leaving full time work was still emotional. "I will definitely miss all my friends at the Health Department, ODA, and the College of Dentistry," Winfree said as she began to reflect on how her career evolved over the years. After graduating from Ada high school and earning a degree in Zoology from the University of Oklahoma, Dr. Winfree planned to go into optometry, but at the time, there were no doctoral-level programs for optometry in the state. She decided dentistry was the next best thing, albeit a bit messier of a job, and enrolled in the OU College of Dentistry. Dr. Winfree earned her Doctor of Dental Surgery from OU in 1985 and worked as an associate for several years. Early in her career, she also taught hygiene classes at Rose State College and worked for the Neighborhood Services Organization (NSO) Dental Clinic for nearly a decade. When the director role at the Department of Health opened up, she was recommended for the job and heartily accepted the new challenge. Winfree's duties included directing dental public health programs for the state and providing subject matter expertise on oral health issues. She dedicated 15 years to this position. Winfree says hiring a great staff that is willing to learn and grow, having an open mind, being willing to try new programs, following through on promises, and collaborating with other organizations were the keys to her success. "Working with other groups on various health initiatives like community water fluoridation, HPV vaccines, fluoride varnish application, and the Ryan White HIV Program got me a seat at the table and meant I was able to be an advocate for oral health in many important conversations." Dr. Winfree (second from left) with family in New York.

Dr. Winfree (left) with Dr. Stephen Glenn at the 2017 Oklahoma Mission of Mercy, where she had a leadership role for many years

Dr. Winfree (right) with Dr. Jeannie Bath

Oklahoma has consistently scored poorly on all 13 key oral health indicators, and the most recent Oral Health Report Card scored the state at a "D," but Dr. Winfree said that only made her more determined to bring the issues to light. She led the Third Grade Oral Health Needs Assessment and found that Oklahoma failed to meet national objectives every time. When asked why Oklahoma struggles more than nearly all other states when it comes to tooth decay and other untreated dental issues, she said poverty, inequality, low income, and low health literacy contribute to oral health problems more than people think. "Showing support for livable wages and public education are probably the best things we can do to start improving our state's health outcomes," Winfree said. "That, and staying away from sugary drinks." Dr. Winfree earned her Master of Public Health degree in 2016, and said it completely changed how she thought about disease prevention and the challenges different populations face. "Dental disease is very complex," said Winfree. "It's connected to so many other medical conditions, and poor oral health can really impact one's overall quality of life." "For individuals and entire populations to become healthier, we must involve and engage families and communities. We should have meaningful conversations with patients directly, and meet them where they are," said Winfree. Her advice to dental students and those considering entering the field is one of compassion. She said patients don't need lectures as much as they need understanding. For many people, it's a struggle just to make it to the dentist's office because they face financial barriers, lack of insurance, lack of transportation, or might be afraid or pain or bad news.

Dr. Winfree (second from right) with OSDH Dental Health staff

Winfree said there's a technique called motivational interviewing that is helpful for getting patients more interested in behavioral change. "You listen with empathy, ask open-ended questions without judgement, and gently motivate them to change health habits by giving them the confidence to do so." www.okda.org 41

ORAL HEALTH SURVEY RESULTS Two-Thirds of Oklahoma Third Graders Have Caries During the 2022-2023 school year, the University of Oklahoma Hudson College of Public Health, in collaboration with the Oklahoma State Department of Health (OSDH), conducted an oral health needs assessment among Oklahoma third grade children. Funding was made possible by a grant from Delta Dental of Oklahoma Foundation. A similar needs assessment has been conducted for nine of the last twenty years. The purpose of this needs assessment was to produce statewide estimates of dental health status indicators. These data are used to assess the burden of oral disease and inform public health policy decisions. The oral screening included an assessment of the prevalence of sealants, untreated caries, other caries experience, missing teeth, and need for dental treatment.

RESEARCH DESIGN This cross-sectional design included a random sample of third grade students and direct observation of dental caries and sealants by registered dental hygienists. The protocol for data collection and calibration training was guided by recommendations of the Association of State and Territorial Dental Directors (ASTDD) in their publication “Basic Screening Survey for Children Planning and Implementation Tool Kit (rev. 2022).”

SAMPLE Both public and private schools were included in the sampling frame. To derive statewide and regional estimates, Oklahoma was divided into six regions: northeast, northwest, southeast, southwest, Oklahoma county, and Tulsa county. Based on power analysis, approximately 600 students were needed, 100 in each region, to produce estimates with reasonable precision. To obtain this sample size, six schools from each region were selected to participate, for a total of 36 schools and 1,686 students.

DATA COLLECTION Dental hygienists completed the assessment for each participant, according to preset and calibrated criteria established by ASTDD and OSDH. • For decayed teeth, these criteria consisted of all cavitations, occlusal discolorations, and interproximal shadows. • For missing teeth, these criteria weighed the following variables simultaneously: age of the child, normal exfoliation ages for primary teeth, and normal eruption ages for permanent teeth. • For filled teeth, all amalgams, composites, and stainless steel crowns were classified as “filled.” • For sealants, any clear or tooth-colored resin on occlusal surfaces of permanent teeth was counted. For each student, the total number of decayed teeth, missing teeth, filled teeth, or teeth with sealants was recorded. 42 journal | November/December 2023

by Nicole Reynolds, DDS

OKLAHOMA DENTAL HEALTH STATUS INDICATORS COMPARED TO TARGETS FOR "HEALTHY PEOPLE 2030"

Total Caries

42.9%

Active Decay

10.2%

26.9% 21.5%

Sealants 0

66.7%

42.5%

Percentage of Third Graders

Oklahoma Current Data 2022/2023 2030 Healthy People Objective See additional survey results on next page.

TAKEAWAYS There is opportunity for improvement in all key indicators of oral health status. I encourage each of us to take a deep dive in to these results and look for one key thing we can do to affect change. That may be volunteering for community oral health education events, advocating for community water fluoridation in your town, or incorporating nutrition education into your exams with parents and children. The full Oklahoma Oral Health Needs Assessment, including region-specific data, example of the Result Form provided to parents, and trends in Dental Health Status Indicators across time, can be found on the OSDH Dental Health Service webpage at Oklahoma.gov/health. Nicole Reynolds, DDS is Director of Dental Health Service at the Oklahoma State Department of Health. In this position, she oversees public health program efforts designed to improve oral health for all Oklahomans. Prior to joining OSDH in 2022, she practiced clinically, primarily in long term care settings throughout the state. She is a 2009 graduate of the University of Oklahoma College of Dentistry and a 2005 graduate of Oklahoma State University.

SUMMARY OF RESULTS WEIGHTED DENTAL HEALTH STATUS INDICATOR ESTIMATE

95% CI

Percentage of third graders in Oklahoma with sealants on at least one permanent molar tooth

21.5%

16.4 - 26.6%

Percentage of third graders in Oklahoma with dental caries experience

66.7%

60.9 - 72.5%

Percentage of third graders in Oklahoma with untreated decay (active caries) in at least one permanent or primary tooth

26.9%

21.8 - 32.0%

Percentage of third graders in Oklahoma with untreated decay in at least one permanent tooth (active caries)

6.3%

4.0 - 8.5%

Percentage of third graders in Oklahoma with untreated decay in at least one primary tooth (active caries)

24.7%

20.0 - 29.5%

Percentage of third graders in Oklahoma with at least one missing permanent tooth

1.4%

0.6 - 2.2%

Percentage of third graders in Oklahoma with at least one missing primary tooth

13.0%

10.1 - 15.9%

Percentage of third graders in Oklahoma with at least one filled (treated/ restored) permanent tooth

10.2%

6.7 - 13.6%

Percentage of third graders in Oklahoma with at least one filled (treated/ restored) primary tooth

48.5%

43.0 - 54.1%

ADA TOOLKIT: Referring Patients to QuitLines A new toolkit released by the American Dental Assocation offers dentists guidance on how to refer patients to state QuitLines The toolkit, Implementing & Fostering QuitLine Referrals: A Guide for Oral Health Professionals, was developed by the ADA's Council on Advocacy for Access and Prevention (CAAP) in collaboration with the North American Quitline Consortium (NAQC). While smoking rates have fallen significantly over the past few decades, cigarette smoking remains the leading cause of preventable death in the U.S. In 2020, 12.5% of adults in the U.S. smoked cigarettes. Each year, smoking is responsible for 480,000 deaths in the U.S. Smoking and tobacco use, including vaping, has significant adverse effects on oral health. Cigarettes and other forms of tobacco can cause oral cancer and gum disease. Forty-three percent of adults 65 and over who smoke have lost all their teeth compared to 12% of nonsmoking adults. Tobacco addiction is a chronic, relapsing condition, and recovery is complex. Quitting can be difficult, and stress, stigma, and lack of support add to these challenges. State QuitLines are working to increase the reach of evidence-based cessation services, such as phone counseling and medications, to

support people seeking help for tobacco use. Oral health providers can help patients receive tobacco cessation services by linking them to their state's QuitLine. The ADA toolkit includes: background and rationale as to why oral health professionals should play a role in tobacco cessation, how and when to refer patients using a decision tree, how to include other office staff in the efforts, sample scripts, and answers to frequently asked questions. For more information on local resources available in Oklahoma, feel free to contact: Krystal George Lead Cessation Systems Coordinator Chronic Disease Prevention Services Oklahoma State Department of Health krystalg@health.ok.gov

To access the toolkit in its entirety visit the ADA website:

www.okda.org

CLASSIFIEDS PRACTICE FOR SALE Tulsa, OK

DENTAL OFFICE FOR LEASE

DENTAL OFFICE FOR SALE OR LEASE

Deer Creek/West Edmond, OK

Elk City, OK

High Traffic Intersection in Deer Creek/ West Edmond. Office is ready to move in. 3 operatories, waiting room and reception area. 1500 new homes under construction within 2 miles. Perfect location. Available now. Contact Sam Coury at (405) 850-0532 or ascoury@ gmail.com

$380,000 ($127psf, includes additional 85’ x 140’ Lot) or $3,500/month gross. 0.56 Acres and 3,000 ± square feet: 60% finished out dental 3 Op./waiting area, lab, CBCT, and office. 40% open for other (dental, general medical, office, storage). 3 restrooms. Dental equipment can be included with purchase or removed. Easily divisible for 2 tenant use. Adjacent to Great Plains Regional Medical Center in Elk City, OK. Contact Danny Storm at (580) 799-4770 or email daddydoc@sbcglobal.net.

JOB OPENING Dentist, Amarillo, TX The owners of Tumbleweed Dental, LLC and Sheman Dental Group LLP are seeking a dentist to join the practices who is ready to earn a path to partnership in the near future. Dentist is requested to have 2-5 years experience, available to join by early 2024, and has been exposed to-- and ready to grow in--modern dentistry services such as in-house CEREC restorative milling. These two dental practices are located in the heart of Amarillo, Texas, a hub of economic activity for the Panhandle. The practices are both located in modern buildings near Soncy Road, the city’s largest shopping center, the campus for the Texas Tech Pharmacy School, and A-rated public elementary schools. With 50 years of history, these practices offer a new dentist immediate, built-in demand from tenured patients of all ages who value the quality of care delivered. Owners Dr. Eddy Sauer and Dr. Nathanial Avirett are offering a guaranteed six-figure base pay for the first 3 years or 35% of collections, whichever is higher. Due to continued patient demand, the incoming dentist will have the opportunity to set his or her schedule in such a way to exceed base pay listed. The practices are fully staffed and managed. Learn more about Dr. Eddy Sauer and Dr. Nathanial Avirett at shermendental.com/about/. Email AmarilloDentistSearch@gmail.com to apply.

44 journal | November/December 2023

PRACTICE FOR SALE Grady County, OK General dental practice with 2 doc chairs and 1 hygiene room (with room for 4th chair), run as satellite office 1 day per week for 40 years. Mix of PPO and FFS. Loyal patient base and significant untapped potential in Minco/ Union City area to be open more than once per week. All equipment included, Carestream Softdent and Dexis software. Implant drill and diode laser. Staff not included. Low overhead. Equipment is old but fully functional. Asking $115k, open to negotiation. Contact Elizabeth Silver at (405) 831-0938 or elizabethksilver@ gmail.com. Email contact preferred.

PRACTICE FOR SALE Central Oklahoma Available for sale is a profitable general practice located in central Oklahoma. The practice generated over $800k in 2022 with the doctor seeing patients 4 days per week. The facility is equipped with 4 ops and occupies 1,600 sq. ft.. With an established reputation in the community, an excellent staff in place, and easy access to two major cities, this is a unique opportunity for anyone looking to acquire a successful and long-established practice with room for growth. Contact Matt Kosciewicz at (704) 424-5626 or matt.kosciewicz@ mcgillhillgroup.com

Beautiful five (5) op practice located in South Tulsa. Practice is collecting $900K per year with a strong patient base and nice mix of FFS and PPO. Practice is up to date with technology, including CEREC, Digital x-ray, and 3D. For more details, contact Henry Schein Transitions Sales Consultant Kriti Eisel by calling (405) 590-9694 or emailing kristi.eisel@ henryschein.com. #OK3362

JOB OPENING Oral and Maxillofacial Surgeon, Mustang, OK An excellent opportunity is available for a board eligible/certified OMS just 15 miles southwest from Oklahoma City, OK. Three-person Oklahoma City practice with excellent referral base is looking for an additional OMS to open our first expansion office in Mustang, OK. This is an exciting opportunity for a talented, personable, and technologically agile associate looking to grow a career with an expanding company. Full scope of practice will include implant, orthognathic, and dentoalveolar surgery. Oklahoma City practice scope includes soft-tissue procedures as well; however, we anticipate the needs of the Mustang practice to be solely OMS. Our practice was originally established in 1973 and over the past 10 years has grown substantially to include two OMS and one Periodontal Surgeon. We operate with state-ofthe-art technology, including an i-CAT cone bean CT scanner and Yomi robot by Neocis. Our highly trained and professional surgical assistants and administrative staff are second to none. Our practice also operates under a wellstructured business operating system. A competitive compensation package will be offered to the right candidate, commensurate with training and experience.Our new practice will be in a brand-new office in the city of Mustang, OK, which is a fast-growing community and an excellent place to live, work, and raise a family. Contact: Dianna Robicheau, Practice Administrator, via email at dianna@ oklahomacityoralsurgery.com or via phone at 405-755-4826.

CLASSIFIEDS See more classified ad listings online at okda.org

To place a classified ad or other advertisement in the

JOB OPENING

General Dentist, NW Oklahoma

Associate Dentist, Wichita, KS

NWOK Federally Qualified Health Center Hiring General Dentist. GSP Health is hiring a general dentist to work in Enid and Cherokee. Competitive pay, flexible schedule, benefits, PTO, loan repayment, CE and licensure stipend available. GSP Health is a non-profit health center that provides medical and dental services to the underserved population of NW Oklahoma. Contact Sydney Rogers at (580) 233-2900 or srogers@gsphealth.org.

We are excited to welcome a full-time General Dentist to our thriving private practice located in Wichita, KS. Our team is seeking an enthusiastic individual who is committed to providing high-quality dental care and exceptional patient experiences.

JOB OPENING Associate Dentist, Stigler, OK Private practice located in Stigler, OK seeking associate with possible buyout in future. Very well established office that has been in business for 45 years with a loyal patient base. Only private practice in Haskell County, located between Eufaula Lake and Kerr Lake. Office is in prime location right on the main highway across from Choctaw Travel Plaza. Building is 2000 sq ft, has 3 DR operatories, 1 hygiene operatory, break room has capabilities to be another operatory if needed. Equipment is older but fully functional. Office is open Tuesday - Thursday 8 to 5, and Friday 8 to 3 (only hygiene patients are seen on Fridays currently). Office has Dentrix software. Currently providers for 4 insurance companies including Medicaid and have FFS patients as well. Practice offers preventive, restorative, crown/bridge, denture/partials, some oral surgery, and some implants. Definite growth potential since the office currently refers for orthodontics, endodontics, periodontics, and some oral surgery and implants. Email lyndiejoan@gmail.com or call (918) 448-0181.

ODA Journal, email advertising@okda.org or visit okda.org/classifieds

As a dentist with us, you will have the opportunity to work in a supportive and friendly environment with long-term team members, utilizing your clinical expertise and treatment autonomy to meet the oral health needs of our growing patient base. Ideal Candidate: - Demonstrates the capability to practice independently, convey a positive, compassionate, and professional demeanor - Surpasses patient expectations in terms of service, comfort, and quality, thereby crafting an exceptional patient experience - Motivated and determined to succeed - Exhibits exceptional proficiency in dental procedures - Collaborates effectively within a team environment Benefits: - Brand new, state-of-the-art building with new equipment - Access to a CBCT, intraoral scanner, fully digital practice - Established PPO patient base that is rapidly growing--Medicaid not accepted - Equipped for molar endodontics, surgical extractions including third molars, implant surgeries, cosmetic procedures, and orthodontic aligner therapy - Competitive pay and retirement matching If these qualities resonate with you and you're seeking an exciting opportunity to contribute to a successful private dental practice, please contact Dr. Behnaz Raisdana at 316-304-1582 or drraisdana@auburn-familydental.com

www.okda.org

STATE ASSOCIATION NEWS Meet the Newest ODA Team Members Carly Hatfield

Jill Johnson

Office Manager

Director of Communications & Education

Carly joined the ODA staff on September 5 and provides administrative support to the ODA staff and its constituents by offering superior customer service, maintaining office inventory, and managing leases and maintenance agreements for our office and grounds. Carly is also responsible for mediation review management, exhibit hall communications for the Annual Meeting, and overseeing research projects and reports for the team. Carly graduated from the University of Central Oklahoma where she received a Bachelor of Science degree in Fashion Marketing, minoring in both Human Environmental Sciences and Photographic Arts. In her free time, she loves being outside, seeing live music, and playing with her dog Dexter and her kitten Mars.

Jill joined the ODA staff on August 8 and manages the Journal, speakers for Annual Meeting, public relations, advertising, and ODA's public education campaigns. She assists the Council on DEPI, the Editorial Committee, and the Annual Meeting Planning Committee. Jill graduated from Oklahoma State University where she received a Bachelor of Arts degree in Journalism with a minor in Advertising. She has worked in marketing and nonprofits in Oklahoma City for more than 22 years and has earned a Master of Science degree in Organizational Leadership from Colorado State University. Jill lives in Edmond with her husband, 12-year-old daughter, and their two dogs. Outside of work, she enjoys travelling and yoga.

Local Dental Society Updates Northern District Dental Society

Central District Dental Society

Northern District Dental Society held their meeting virtually on Monday, October 16 at 5:30pm to discuss opportunities for leadership, volunteering, brainstorming for the future, and more!

Central District Dental Society Reception was held Thursday, September 28 from 6:00 to 8:00pm at Red Rock Canyon Grill in Norman. Heavy hors d’oeuvres and wine were provided while attendees networked with fellow members.

Eastern District Dental Society

Oklahoma County Dental Society

Eastern District Dental Society Oklahoma County Dental Meeting was held Thursday, Society hosted their annual October 19 from 6:00 to 9:00pm party at Top Golf in Oklahoma City from 6:00 to 9:00pm on at Pete’s Place in Krebs. Thursday, August 10. Members Attendees enjoyed Italian and guests enjoyed food, drinks, cuisine while listening to CE presented by Dr. Glen Houston and friendly competition. speaking on Oral Pathology.

Northwest District Dental Society

Southwest District Dental Society

Tulsa County Dental Society

Northwest District Dental Society Meeting was held Friday, September 22, from 8:30am to 3:00pm at the Oakwood Country Club in Enid. Attendees enjoyed breakfast and lunch while listening to continuing education by Jeﬀ Puckett, Kim Graziano, and Dr. Rob Bryan.

Southwest District held their annual meeting on Friday, October 13 from 8:30am to 1:00pm at the University of Science and Arts of Oklahoma in Chickasha. Breakfast and lunch was provided, along with three hours of CE presented by Periodontist, Dr. Jaewon Kim & Oral Pathologist, Dr. Ronald Faram.

Tulsa County Dental Society hosted their annual New Dentist Party at the home of Drs. Ben and Eugenia Johnson on Friday, September 8 from 6:00 to 8:00pm. Guests enjoyed hors d’oeuvres and beverages while mingling with TCDS members and recent graduates.

Stay up-to-date with your local society events by visiting okda.org/events 46 journal | November/December 2023

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ODA Journal November/December 2023

Articles inside

Local Dental Society Updates

STATE ASSOCIATION NEWS Meet the Newest ODA Team Members

ADA TOOLKIT: Referring Patients to QuitLines

ORAL HEALTH SURVEY RESULTS Two-Thirds of Oklahoma Third Graders Have Caries

Celebrating the Career of Dr. Jana Winfree

It's Time to Renew Your ODA and ADA Membership!

2024 ODA AWARDS NOMINATION

CASE STUDY Clinical Differential Diagnosis: Solitary Tongue Mass

SCIENTIFIC FEATURE Fluoride: The Silver Bullet in Preventive Dentistry

Outgoing ADA President Praises Unity of Association

ADA's Newly Elected Officers & Award Winners

HYGIENE HOT SPOT Hygienists and Neuromodular Administration

Explore ADA Advocacy Activity in 2023

LEGISLATIVE LOOP Take Action to Advance Dental Workforce Legislation

A Gift to the Future

OFFICE SPACE Greenlee Dental

Celebrating 2023 Accomplishments