November 2023 Texas Dental Journal by Texas Dental Association

TDA

Texas Dental Journal NOVEMBER 2023 536 DR RISE’ MARTIN AWARDED TDA GOLD MEDAL FOR DISTINGUISHED SERVICE 544 YOUNG DENTISTS’ AND STUDENTS’ VOICES: USING CULTURAL SENSITIVITY IN NUTRITION TO ENHANCE ORAL HEALTH AMONG SOUTH ASIAN IMMIGRANTS SHWETHA RAMANATHAN, DDS TAYLOR W. SMITHERMAN, BSN, RN KERIN L. BURDETTE, DDS, MPH JAYNE S. REUBEN, PHD “DOPESICK” IN DENTISTRY: APPLICATIONS OF SBIRT SUBSTANCE ABUSE SCREENING FOR PATIENT-CENTERED CARE SOPHIA NICOLOSI, BS JAYME WITEK, BS, MS BEN F. WARNER, MS, DDS, MD CLEVERICK (C.D.) JOHNSON, DDS, MS GEORGE T. BRADY, DMD GARY R. PILLERS, DDS, RPH

552 ETHICS CORNER: NEGATIVE ONLINE REVIEWS AND THEIR ETHICAL IMPLICATIONS GUENTER JONKE, DMD Reprinted with permission from the Journal of the American Dental Association.

www.tda.org | November 2023

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For more information, call

800-677-8644 526 Texas Dental Journal | Vol 140 | No. 9

Anesthesia Education & Safety Foundation Two ways to register: Call us at 214-384-0796 or e-mail us at sedationce@aol.com Visit us on the web: www.sedationce.com

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OUR GOAL: To teach safe and effective anesthesia techniques and management of medical emergencies in an understandable manner. WHO WE ARE: We are licensed and practicing dentists in Texas who understand your needs, having provided anesthesia continuing education courses for 34 years. The new anesthesia guidelines were recently approved by the Texas State Board of Dental Examiners. As practicing dental anesthesiologists and educators, we have established continuing education programs to meet these needs.

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Use and Abuse of Prescription Medications and Provider Prescription Program Fulfills rules 104.1 and 111.1

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WEBCASTING and ONLINE RENEWALS AVAILABLE! Live and archived webcasting to your computer in the comfort of your home. Here are the distinct advantages of the webcast (contact us at 214-384-0796 to see which courses are available for webcast): 1. You can receive continuing education credit for simultaneous live lecture CE hours. 2. There is no need to travel to the program location. You can stay at home or in your office to view and listen to the course. 3. There may be a post-test after the online course concludes, so you will receive immediate CE credit for attendance 4. With the webcast, you can enjoy real-time interaction with the course instructor, utilizing a question and answer format

OUR MISSION STATEMENT: To provide affordable, quality anesthesia education with knowledgeable and experienced instructors, both in a clinical and academic manner while being a valuable resource to the practitioner after the programs. Courses are designed to meet the needs of the dental profession at all levels. Our continuing education programs fulfill the TSBDE Rule 110 practitioner requirement in the process to obtain selected Sedation permits.

AGD Codes for all programs: 341 Anesthesia & Pain Control; 342 Conscious Sedation; 343 Oral Sedation This is only a partial listing of sedation courses. Please consult our www.sedationce.com for updates and new programs.

Two ways to Register: e-mail us at sedationce@aol.com or call us at 214-384-0796 www.tda.org | November 2023

527

Editorial Staff

contents FEATURES

HIGHLIGHTS

536 DR RISE’ MARTIN AWARDED TDA GOLD MEDAL FOR DISTINGUISHED SERVICE

532

544 YOUNG DENTISTS’ AND STUDENTS’ VOICES: Using Cultural Sensitivity in Nutrition to Enhance Oral Health Among South Asian Immigrants

534

Kerin L. Burdette, DDS, MPH Jayne S. Reuben, PhD

TDA Grant Availability

Juliana Robledo, DDS, Associate Editor Nicole Scott, Managing Editor Barbara Donovan, Art Director Lee Ann Johnson, CAE, Director of Member Services

Editorial Advisory Board Ronald C. Auvenshine, DDS, PhD Barry K. Bartee, DDS, MD Patricia L. Blanton, DDS, PhD William C. Bone, DDS Phillip M. Campbell, DDS, MSD

556

Oral and Maxillofacial Pathology: Case of the Month

Michaell A. Huber, DDS Arthur H. Jeske, DMD, PhD Larry D. Jones, DDS Paul A. Kennedy, Jr., DDS, MS Scott R. Makins, DDS, MS

558

562

Oral and Maxillofacial Pathology: Case of the Month Diagnosis and Management Value for Your Profession: What You Should Know About Dental Membership Plans

Shwetha Ramanathan, DDS Taylor W. Smitherman, BSN, RN

Official Call for Nominations

Jacqueline M. Plemons, DDS, MS, Editor

Daniel Perez, DDS William F. Wathen, DMD Robert C. White, DDS Leighton A. Wier, DDS Douglas B. Willingham, DDS

The Texas Dental Journal is a peer-reviewed publication. Established February 1883 • Vol 140 | No. 9 Texas Dental Association

564 570

Classifieds Index to Advertisers

“Dopesick” in Dentistry: Applications of SBIRT Substance-Abuse Screening for PatientCentered Care

1946 S IH-35 Ste 400, Austin, TX 78704-3698 Phone: 512-443-3675 • FAX: 512-443-3031 Email: tda@tda.org • Website: www.tda.org Texas Dental Journal (ISSN 0040-4284) is published monthly except January-February and August-September, which are combined issues, by the Texas Dental Association, 1946 S IH-35, Austin, TX, 78704-3698, 512-443-3675. PeriodicalsPostage Paid at Austin, Texas and at additional mailing offices. POSTMASTER: Send address changes to TEXAS DENTAL JOURNAL, 1946 S IH 35 Ste 400, Austin, TX 78704. Copyright 2023 Texas Dental Association. All rights reserved. Annual subscriptions: Texas Dental Association members $17. Instate ADA Affiliated $49.50 + tax, Out-of-state ADA Affiliated $49.50. In-state Non-ADA Affiliated $82.50 + tax, Out-of-state Non-ADA Affiliated $82.50. Single issue price: $6 ADA Affiliated, $17 Non-ADA

Sophia Nicolosi, BS

Affiliated. For in-state orders, add 8.25% sales tax.

Jayme Witek, BS, MS

membership of the society are solicited. Electronic submissions

Contributions: Manuscripts and news items of interest to the

Ben F. Warner, Ms, DDS, MD

are required. Manuscripts should be typewritten, double spaced,

Cleverick (C.D.) Johnson, DDS, MS

please refer to the Instructions for Contributors statement included

George T. Brady, DMD Gary R. Pillers, DDS, RPh

and the original copy should be submitted. For more information, in the online September Annual Membership Directory or on the TDA website: tda.org. All statements of opinion and of supposed facts are published on authority of the writer under whose name they appear and are not to be regarded as the views of the Texas Dental Association, unless such statements have been adopted by

552 ETHICS CORNER: Negative Online Reviews and Their Ethical Implications Guenter Jonke, DMD Reprinted with permission from the Journal of the American Dental Association.

528 Texas Dental Journal | Vol 140 | No. 9

the Association. Articles are accepted with the understanding that they have not been published previously. Authors must disclose any financial or other interests they may have in products or services described in their articles. Advertisements: Publication of advertisements in this journal does not constitute a guarantee or endorsement by the Association of the quality of value of such product or of the claims made.

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GD-4245809-110123

Board of Directors Texas Dental Association PRESIDENT Cody C. Graves, DDS 325-648-2251, drc@centex.net PRESIDENT-ELECT Georganne P. McCandless, DDS 281-516-2700, gmccandl@yahoo.com PAST PRESIDENT Duc “Duke” M. Ho, DDS 281-395-2112, ducmho@sbcglobal.net VICE PRESIDENT, SOUTHWEST Richard M. Potter, DDS 210-673-9051, rnpotter@att.net

JKJ Pathology Oral Pathology Laboratory

John E Kacher, DDS ¥ Available for consultation by phone or

VICE PRESIDENT, NORTHWEST Summer Ketron Roark, DDS 806-793-3556, summerketron@gmail.com VICE PRESIDENT, NORTHEAST Jodi D. Danna, DDS 972-377-7800, jodidds1@gmail.com VICE PRESIDENT, SOUTHEAST Shailee J. Gupta, DDS 512-879-6225, sgupta@stdavidsfoundation.org SENIOR DIRECTOR, SOUTHWEST Krystelle Anaya, DDS 915-855-1000, krystelle.barrera@gmail.com

email ¥ Color histology images on all reports ¥ Expedited specimen shipping with tracking numbers ¥ Reports available online through secure web interface

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Protecting your patients, limiting your liability

SENIOR DIRECTOR, NORTHWEST Stephen A. Sperry, DDS 806-794-8124, stephenasperry@gmail.com SENIOR DIRECTOR, NORTHEAST Mark A. Camp, DDS 903-757-8890, macamp1970@yahoo.com SENIOR DIRECTOR, SOUTHEAST Laji J. James, DDS 281-870-9270, lajijames@yahoo.com DIRECTOR, SOUTHWEST Melissa Uriegas, DDS 956-369-9235, meluriegas@gmail.com DIRECTOR, NORTHWEST Adam S. Awtrey, DDS 314-503-4457, awtrey.adam@gmail.com DIRECTOR, NORTHEAST Drew M. Vanderbrook, DDS 214-821-5200, vanderbrookdds@gmail.com DIRECTOR, SOUTHEAST Matthew J. Heck, DDS 210-393-6606, matthewjheckdds@gmail.com SECRETARY-TREASURER* Carmen P. Smith, DDS 214-503-6776, drprincele@gmail.com SPEAKER OF THE HOUSE* John W. Baucum III, DDS 361-855-3900, jbaucum3@gmail.com PARLIAMENTARIAN** Glen D. Hall, DDS 325-698-7560, abdent78@gmail.com EDITOR** Jacqueline M. Plemons, DDS, MS 214-369-8585, drplemons@yahoo.com LEGAL COUNSEL Carl R. Galant *Non-voting member **Non-voting

530 Texas Dental Journal | Vol 140 | No. 9

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OFFICIAL CALL FOR NOMINATIONS OFFICIAL CALL FOR CANDIDACY ANNOUNCEMENTS AND SUBSEQUENT NOMINATIONS: SPEAKER OF THE HOUSE, SECRETARY-TREASURER, AND EDITOR OFFICIAL CALL FOR SPEAKER OF THE HOUSE CANDIDACY ANNOUNCEMENTS AND SUBSEQUENT NOMINATIONS

To appoint members of reference committees in consultation with the president, president-elect, and the immediate past president by the Board of Directors’ first meeting of the calendar year.

To notify the divisional officers and the Committee on Credentials, Rules and Order, prior to the annual session,

Candidacy announcements for the statewide elective office

the number of delegates and alternates necessary to

of Texas Dental Association (TDA) Speaker of the House may

constitute a quorum.

be submitted to TDA Secretary-Treasurer Dr Carmen P Smith

To meet with the divisional officers prior to the meeting

for the upcoming 2024 House elections. Only an active, life,

of the divisional caucuses at the annual session to review

or retired member in good standing of this Association shall

the Rules for Caucus Procedures, Nominations, And

be eligible. A curriculum vitae (CV) must be submitted, and

Elections.

the candidate will also have to sign a conflict of interest statement. Nominations are in order at the first meeting of the House of Delegates and remain open until the close of

To appoint a parliamentarian pro tem, should it become necessary for the parliamentarian to be absent during a session of the House of Delegates.

the second meeting of the House of Delegates; however,

10. To serve as presiding officer of the TDA Candidates

announcements of candidacy should be made as early as

Forum, unless the Speaker is in a contested race, at

possible so that membership eligibility may be verified. To

which time the Speaker Pro-tem will preside.

become a nominee, a delegate must place the name of the candidate in nomination at the first meeting of the House

11. To be a certified parliamentarian or be in the process of certification

of Delegates. Please see the Manual on Caucus, Campaigns, Nominations and Elections at tda.org for full details.

Candidacy announcements are to be mailed to TDA Secretary-Treasurer Dr Carmen P Smith, Texas Dental

Duties of the Speaker of the House are enumerated in the

Association, 1946 S IH-35 Ste 400, Austin, Texas 78704; or,

Bylaws and include the following (excerpt):

emailed to TDA Executive Director Linda Brady: lbrady@

tda.org.

To serve as an ex-officio member of the Board of Directors without vote or the privilege of proposing

resolutions.

(See TDA Bylaws, Chapter IV, House of Delegates—Sections

To serve as an ex-officio member of the Executive

100 (Officers), 110A (Duties), 150C(3), 150D, Chapter V, Board

Committee without vote or the privilege of proposing

of Directors—Sections 10 (Composition); TDA House Manual;

resolutions.

Speaker Manual).

To preside at all meetings of the House of Delegates.

To determine the order of business for all meetings, subject to the approval of the House of Delegates, in accordance with Section 140B of this chapter.

To appoint tellers to assist him/her in determining the result of any action taken by vote.

532 Texas Dental Journal | Vol 140 | No. 9

OFFICIAL CALL FOR SECRETARY-TREASURER CANDIDACY ANNOUNCEMENTS AND SUBSEQUENT NOMINATIONS

Candidacy announcements are to be mailed to TDA

Candidacy announcements for the statewide elective office

70A-B (Notice and Publication-Official Call & Publication of

of Texas Dental Association (TDA) Secretary-Treasurer may be submitted to TDA Secretary-Treasurer Dr Carmen P Smith for the upcoming 2024 House elections. Only an active, life, or retired member in good standing of this Association shall be eligible. A curriculum vitae (CV) must be submitted, and the candidate will also have to sign a conflict of interest

Secretary-Treasurer Dr Carmen P Smith, Texas Dental Association, 1946 S IH-35 Ste 400, Austin, Texas 78704; or, emailed to TDA Executive Director Linda Brady: lbrady@ tda.org. (Ref. TDA Bylaws, Chapter IV, House of Delegates—Sections Actions, 110B (Duties); Chapter V, Board of Directors—Sections 10 (Composition), 80B (Officers-Secretary); Chapter VI, Elective Officers—Section 90G (Duties); Chapter VIII, Fifteenth Trustee District American Dental Association Delegates and Alternate Delegates—Section 80 (Delegation Secretary); Board Manual; Secretary-Treasurer Manual).

statement. Nominations are in order at the first meeting of the House of Delegates and remain open until the close of nominations at the end of the second meeting of the House of Delegates; however, announcements of candidacy should be made as early as possible so that membership eligibility can be verified. To become a nominee, a delegate must place the name of the candidate in nomination at the first meeting

OFFICIAL CALL FOR EDITOR CANDIDACY ANNOUNCEMENTS AND SUBSEQUENT NOMINATIONS

of the House of Delegates. Please see the Manual on Caucus, Campaigns, Nominations and Elections at tda.org for full

Candidacy announcements for the statewide elective office

details.

of Texas Dental Association (TDA) Editor may be submitted to TDA Secretary-Treasurer Dr Carmen P Smith for the

Duties of the TDA Secretary-Treasurer are enumerated in the

upcoming 2024 House elections. Only an active, life, or

Bylaws and include the following (excerpt):

retired member in good standing of this Association shall

To serve without vote as member of the Board of

be eligible. A curriculum vitae (CV) must be submitted, and

Directors and the House of Delegates.

the candidate will also have to sign a conflict of interest

To serve without vote as chair of the Budget Committee.

statement. Nominations are in order at the first meeting of

To examine the income and expenses of this Association

the House of Delegates and remain open until the close of

and report at each meeting of the Board of Directors.

nominations at the end of the second meeting of the House

To ensure that the minutes of the House of Delegates

of Delegates; however, announcements of candidacy should

and the Board of Directors be maintained.

be made as early as possible so that membership eligibility

To be responsible and perform such other duties as shall

can be verified. To become a nominee, a delegate must place

be specified by the Board of Directors and the Bylaws.

the name of the candidate in nomination at the first meeting

4. 5.

of the House of Delegates. Please see the Manual on Caucus, Other duties as Secretary include the following:

Campaigns, Nominations and Elections at tda.org for full

•

details.

Serve as recording officer and custodian of the records of the House of Delegates and the Board of Directors. Serve as secretary to the Executive Committee, without

Duties of the editor are enumerated in the Bylaws and include

the right to vote.

the following (excerpt):

•

Serve as secretary to the House of Delegates.

•

Serve as the secretary of the American Dental Association

the Association and exercise full editorial control over

Fifteenth Trustee District Delegation.

such publications, subject only to policies established by

•

To be editor-in-chief of all journals and publications of

the House of Delegates, Board of Directors, and these Bylaws and provided such content is not in conflict with

www.tda.org | November 2023

533

or contrary to the TDA’s established policies, legislative agenda, or advocacy efforts. 2.

To control the selection of scientific material published in the Journal. The

TEXAS DENTAL ASSOCIATION NOTICE OF GRANT AVAILABILITY 501(C)(3) NONPROFIT DENTAL ORGANIZATIONS

editor may appoint associate editors, with the concurrence of the Board

The Texas Dental Association (TDA) announces availability

of Directors, to gather and/or review

of financial assistance for qualifying 501(c)(3) non-profit

material for publication. Such associate

organizations affiliated with dentistry. The monies are derived

editors shall serve as long as the editor deems necessary; but never longer than the term of the editor. 3.

from TDA Relief Fund interest income earned over the 2023 fiscal year. Grantees will be determined by the TDA Board of Directors.

To attend all open meetings of the Board of Directors and the House of

Eligibility: Grantees must be 501(c)(3) non-profit organizations

Delegates of this association, and the

affiliated with dentistry.

annual session of the American Dental Association. 4.

To hold no other office in this association or the American Dental Association while serving as editor, except the editor may be elected as delegate or alternate delegate to the

Application: Letters of interest detailing the proposed project(s), including a budget, should be mailed to: TDA Board of Directors C/O Mr Terry Cornwell

ADA House of Delegates from his/her

1946 S. IH 35, Ste. 400

respective division.

Austin, TX 78704

To cooperate with his/her successor upon termination of the Editor’s term

Deadline: Letters of Interest must be postmarked or emailed

of office.

(tcornwell@tda.org) no later than January 31, 2024.

Candidacy announcements are to be mailed to TDA Secretary-Treasurer Dr Carmen P Smith, Texas Dental Association, 1946 S IH-35 Ste 400,

Approval: All letters of Interest will be reviewed by the TDA Relief Committee and considered by the TDA Board of Directors.

Austin, Texas 78704; or, emailed to TDA

Notification: All recipients will be notified in writing on or before

Executive Director Linda Brady: lbrady@

May 15, 2024.

tda.org.

Previous Recipients: In 2023, grants totaling $14,200 were (Ref. TDA Bylaws, Chapter VI, Elective Officers—Section 90I (Duties); Policy Manual).

awarded to the following organizations in Texas for charitable patient care: Capital Area Dental Foundation (Austin), The Family Place (Dallas), Greater Killeen Community Clinic (Killeen), Network of Community Ministries (Richardson), Rotary Club of Grand Prairie Saving Smiles Program (Grand Prairie), and San Jose Clinic (Houston). For more information, please contact Mr Terry Cornwell, TDA Governance Manager, 512-443-3675, Ext. 146, or email tcornwell@tda.org.

534 Texas Dental Journal | Vol 140 | No. 9

Terry Watson, D.D.S.

Jeremy Brown, J.D.

Frank Brown, J.D., LL.M.

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469-222-3200 www.tda.org | November 2023

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536 Texas Dental Journal | Vol 140 | No. 9

Dr Risé L Martin, 2023 recipient of the Gold Medal Award, is presented by 2022-23 TDA President Dr Duc “Duke” M. Ho.

Dr Rise’ Martin Awarded TDA Gold Medal for Distinguished Service The Texas Dental Association awarded Dr Rise’ Martin of Lakehills with the TDA Gold Medal for Distinguished Service at the TDA House of Delegates in San Antonio in May 2023. She says receiving the association’s highest honor was a surprise and her proudest moment as a dentist. “Receiving the Gold Medal is such an honor to be considered, let alone the recipient. I am humbled and honored to be presented with this award!” Dr Martin says she is delighted to be among the small group of dentists who have received the Gold Medal. As a dentist, she has had the opportunity to help others, and she has always tried to pay it forward, professionally and personally. She was born in Indianapolis, Indiana, in 1953. Her father was a life insurance representative, and her mother was a homemaker. They divorced when Dr Martin was 6 years old, and she lived with her mother and stepfather, who was an engineer.

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537

Pictured is Dr Martin’s family houseboat in 1960.

“He designed and developed weird stuff like the concept of a vacuum in the wall,” she says, explaining how he designed and built a 3-story houseboat in Madison, Indiana, on the Ohio River. “Once it was completed, we sailed to the Mississippi River and down to New Orleans. Several employees lived on board as well. I felt like Huckleberry Finn!” she recalls, fishing and swimming down the river. “Every day was such an adventure. Mom homeschooled me until we settled in Madisonville, Louisiana, where my stepfather, Jim, built a shop to perfect his creations and manage his manufacturing business.” When Dr Martin was 14, her mother took her to the dentist. “My maxillary canines were so crooked and flared buccally that my upper lip stuck above the teeth when I smiled,” Dr Martin says. “Thankfully, she decided it was time to correct this situation.” Tragically, her mother died in a car accident a week after that dentist visit. “My life changed drastically. I had to relocate to Indiana with my father and his new family,” she says. “Fortunately, I was able to complete my orthodontic treatment.” Dr Martin poured herself into school sports, speech/debate, Student Council, pep squad, and was named senior class treasurer. She graduated Magna Cum Laude in 1971. She was even recognized and placed on her high school’s Alumni Wall of Fame in 2007. When she was 16, Dr Martin’s love for dentistry began to flourish as she became an assistant for their family dentist. “It was a busy practice, and I picked up extra hours in the evenings assisting a part-time oral surgeon. My bosses were great mentors and

538 Texas Dental Journal | Vol 140 | No. 9

encouraged me to pursue the profession even though it was male dominant at that time.” She continued to dental school at the University of Texas Health Science Center in San Antonio, and she joined an organization called the American Association of Women Dentists, which was forming dental chapters around the US. “I joined with several other students and faculty to form the Texas Chapter of AAWD. We realized that with more women entering the dental profession, we wanted and needed women in leadership positions. We also needed an avenue to vocalize our input to dental manufacturers.” It was 1984, and HIV/Aids was a world-wide epidemic. Scientific studies were emerging that linked saliva to transmission.1 Dentistry was adapting to this new threat. “Gloves were mandated but needed to be offered in smaller sizes to properly fit. Imagine performing an endodontic procedure with a half inch of your glove extending beyond your fingers,” recalls Dr Martin. “Scrubs became the preferred attire. Ladies wanted to look professional yet compliant, so we asked for fitted options with style.” She says many instruments were manufactured for the stature of a 6-foot man with a complementing hand size. “We approached the dental representatives and offered suggestions,” she says. “They encouraged me to do research, interview others, and provide feedback to instill changes. Eventually, we had a seat at the table with the manufacturers.” Mentoring other young women became a new goal for Dr Martin, who has twin daughters, Jenny and Darcy, who are 46, and 2 stepdaughters, Denise and Darla, 62 and 57, respectively. “You are never too old to set another goal or to dream a new

“Gloves were mandated but needed to be offered in smaller sizes to properly fit. Imagine performing an endodontic procedure with a half inch of your glove extending beyond your fingers,” recalls Dr Martin.

dream. Most leaders at the TDA and ADA were men.”

Dr Martin joined her family in Destin, Florida, to celebrate her 70th birthday.

www.tda.org | November 2023

539

Being a female dentist in a male-

mission trips she has taken since the

profession. Two of her grandsons

dominated industry was challenging.

1980s, many of which she implemented

accompanied her last year on a

“I would be asked, ’Why do you

as part-time faculty at UTHSCSA Dental

charitable mission, and she says it was

feel the need to have an American

School.

one of the highlights of her professional experiences.

Association of Women Dentists?’ I would reply, ‘The TDA depicts the male

“The mission trips were coordinated by

dentist association.’ It was time for a

the Christian Medical Dental Association

She and Sam serve their church and

more inclusive representation of the

(CMDA) of which I have been a member

encourage members to pay it forward.

membership. Proudly today, the TDA

since inception in San Antonio. My

“I volunteer for Emmaus Walk spiritual

portrays the faces of all dentists, not

charitable dental license allows me

retreats to embolden others how to be

because of me, but perhaps because I

to continue to volunteer with Texas

the hands and feet of Jesus in their daily

was bold enough to talk about it years

Missions of Mercy, the Refuge Clinic,

lives. Among the things you can share

prior.”

Smiles for Hope, and other CMDA trips,”

and keep are your word, smile, and

she explains.

grateful heart.”

to roles at ADA, TDA, and San Antonio

Dr Martin currently maintains adjunct

With a grateful heart, she and Sam

Distrist Dental Society over the 35

faculty status at UT Health San Antonio

enjoy their relaxed life on Medina Lake.

years she practiced dentistry, retiring in

to mentor dental students and allow

“Small communities are more charming

2020. Perhaps most rewarding are the

them the opportunity to serve our

and personal than metropolis lifestyles.”

Dr Martin’s natural leadership led her

Dr Martin and her grandsons Jack and Cole volunteered together at a Texas Mission of Mercy.

540 Texas Dental Journal | Vol 140 | No. 9

Dr Martin is surrounded by her San Antonio District Dental Society family after winning the TDA Gold Medal for Distinguished Service in May 2023. They have 16 grandchildren and 13 great grandchildren with another on the

About the Gold Medal Presentation

way. Life is good for Dr Martin, the 27th

Owing to its stature, the TDA president

recipient of the esteemed Gold Medal

presents the award before the House of

for Distinguished Service.

Delegates. The name of the recipient is not revealed to anyone, including the recipient,

“When your own children mature into

until the actual presentation takes place.

successful professionals and leaders

The Awards Committee works behind the

in their business, you know you

scenes with the recipient’s family members

have succeeded. My daughters have

to make sure they are in attendance without

thanked me for being a great mentor

alerting the recipient. In 2006 the TDA

by setting high goals. Then when you

commissioned nationally-renowned Texas

instill confidence in your grandchildren

artist Ronadró to design a unique award

to accompany you on dental mission

piece to represent the Association. The

trips, it is exciting to see new leaders

result is a beautiful, bronze relief depicting

developing. Life is about what you can

a dentist caring for a patient. This sculpture was adopted for the Gold Medal award in

do to make the world better.”

2008. Inset into the shadowbox are custom designed medallions: the TDA seal and the gold medal.

References. 1.

Altman, Lawrence K. AIDS Studies Hint Saliva May Transmit Infection. New York Times, Section C, Page 1, October 9, 1984 [cited online November 13, 2023].

About the Past Recipients To date, there have been 26 previous recipients of the Gold Medal: Drs John D. Wilbanks, Michael D. Vaclav, O.V. Cartwright, H.M. “Mit” Sorrels, Jack H. Harris, James E. Bauerle,

Available from: URL: https://www.nytimes.

Robert V. Walker, Frank K. Eggleston, Robert M. Anderton, Rene M. Rosas, Richard M.

com/1984/10/09/science/aids-studies-hint-

Smith, Sam W. Rogers Jr, Stephen F. Schwartz, John S. Findley, S. Jerry Long, Patricia L.

saliva-may-transmit-infection.html

Blanton, Paul E. Stubbs, Richard C. Black, Michael L. Stuart, Hilton Israelson, Thomas Harrison, J. Preston Coleman, Larry W. Spradley, Rita M. Cammarata, John Purdy, and Jacqueline M. Plemons. By the judgment of their colleagues, they represent the best of the TDA; dentists who have dedicated their lives to the Association and profession, and have advanced both through their commitment, strength, and vision.

www.tda.org | November 2023

541

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• Evaluate what factors are affecting the value of your practice • Write a Letter of Instruction (LOI) • Apply for financing • Form merger/partnership agreements Henry chein Dental ractice ransitions valuation considers both tangible and intangible assets o of the practice and can provide the many key factors that influence the practice’s value.

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542 Texas Dental Journal | Vol 140 | No. 9

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www.tda.org | November 2023

543

Young Dentists’ and Students’ Voices

Using Cultural Sensitivity in Nutrition to Enhance Oral Health Among South Asian Immigrants Shwetha Ramanathan, DDS Taylor W. Smitherman, BSN RN Kerin L. Burdette, DDS, MPH Jayne S. Reuben, PhD Dental caries and periodontal disease are largely preventable oral health issues with the proper patient education, adherence, behavioral modification, and access to care. Understanding the nuances of different diets and cultural practices will allow practitioners to provide more accurate diagnoses and treatments for their patients. Like many members of the Indian community, my parents’ utilization of preventative oral healthcare was limited because of treatment cost as well as distrust in dentists. These factors may help explain why periodontal disease affects 90-95% of the population in India and dental caries affects 60-80% of the children.1,2 Roughly 5.4 million South Asians live in the United States today, so it is important for dentists to understand diverse cultural practices and for dentistry to remain accessible to those of different backgrounds.3 Diet and nutrition affect the health of the oral tissues as the consumption of sugars has been linked to an increased risk of dental caries.4 When sugary food or drink is consumed, oral bacteria produce acids that weaken the tooth enamel eventually forming a cavity.5 The acid that is formed by these bacteria can inhibit protective biofilm formation.5 As a result, plaque and calculus begin to form, causing gingival inflammation or potential periodontal disease.5 Educating patients about diet and nutrition in the

544 Texas Dental Journal | Vol 140 | No. 9

dental setting can help foster an

Lack of dietary diversity is a root cause

and other additives, appear to have

understanding of the larger connection

for many systemic health issues found

higher levels of nicotine, tar, and carbon

between oral and overall health.

in the South Asian population.9 South

monoxide than cigarettes that are

Asians consume refined carbohydrates,

mass-produced in the US.14 Yet, these

Children and young adults who

starchy vegetables and processed foods

cigarettes are distributed to consumers

immigrate to the United States tend

in excess amounts but lack sufficient

without any mention of their link with

to transition more readily into the

protein, fruits, and vegetables.10 Refined

increased risk of oral cancer.15,16

highly processed US diet even though

carbohydrates should be consumed in

traditional Indian dietary practices are

moderation for healthier alternatives

These culturally-specific behaviors

similar to the healthier Mediterranean

such as fruits, vegetables, and protein.

and diets may adversely impact oral

and DASH diets. These well-established

Most cultural diets can be easily

and even overall health outcomes.

diets have been proven to reduce to

adapted to follow the Mediterranean

This is significant because poor oral

the risk of cardiovascular disease,

and DASH diets by emphasizing

health has been correlated with

hypertension and improve cognitive

plant-based eating and limiting ultra-

increased risk of cardiovascular disease,

health by focusing on vegetables, fruits,

processed foods and meats.11 Table

endocarditis, diabetes, pneumonia and

whole grains and moderate intake of

1.1 displays examples of foods from

even pregnancy complications.17 This

fish, poultry, and beans.6,7

different nutritional groups that are

relationship is illustrated by evidence

found in the South Asian diet.

that suggests that people with poorly controlled diabetes are at higher

“Thali”, a cultural practice in the traditional South Asian diet, also

Other lesser-known dietary

risk of periodontitis.18 South-Asians

emphasizes combinations of grains,

components, like betel leaf and bidis,

appear to have the highest prevalence

lentils, vegetables, dairy, spices,

play an important role in Indian

of diabetes among all immigrant

prebiotics, and probiotics.8 Evidence

culture. Betel leaf, a smokeless tobacco

populations; therefore, it is notable that

suggests that this form of eating

commonly used in India, is wrapped

50% also suffer from periodontitis.19,20

contains the necessary food groups for

around a mixture of crushed areca nut

These chronic health conditions and

diverse, well-balanced, nutrient-dense

and spices before being placed in the

their management can pose risks to

meals that improve glycemic control

mouth between the gum and cheek.12

oral health. Many commonly used

and overall health. Practitioners could

The chronic habit of chewing of betel

medications for these conditions may

encourage and educate patients on the

leaf can result in progressive fibrosis in

also cause xerostomia which increases

importance of continuing their cultural

submucosal tissue, a condition that has

the likelihood of the patient developing

diets or to model their nutrition after

the potential for malignancy.13 Bidis,

gingivitis, periodontitis, and rampant

the Mediterranean and DASH diets.

hand-rolled cigarettes containing cloves

caries.

Table 1. Examples of Foods found in the South Asian Diet Carbohydrates

Refined: white rice, white flour, sugars Examples: Idli, paratha, halwa, gulab jamun Unrefined: whole wheat, brown rice, bajra, sorghum, barley Examples: Whole-wheat chapati, quinoa upma

Fats

Saturated: animal fat, coconut oil, palm oil, ghee Unsaturated: nuts, olive oil, skim-milk, vegetable oils

Proteins

Lentils, legumes, beans, cheeses, milk Examples: Daal, rajma, chana masala, paneer, dahi

Fiber

Lentils, whole grains, barley, nuts, moringa leaves, cucumber, banana

www.tda.org | November 2023

545

However, these issues are not unique to

and oral diagnosis appointments. The

the South Asian community; therefore,

incorporation of more medical primary

using an interprofessional approach

care and culturally sensitive approaches

to improve the cultural competency

in dentistry will allow patients to

of healthcare providers can have a

appreciate the bidirectional relationship

reciprocal effect on the oral and overall

between their oral and overall health.

health outcomes of patients. Collecting and routinely updating patient nutrition thorough health and social history is crucial for providing pertinent treatment Hence, it is important to train providers to be aware that foods included in specific cultural practices and diets may

possess unique oral health risks. There is not enough time in any curriculum to cover foods from every

culture. However, there is sufficient time to train future practitioners to ask the right questions to uncover distinct dietary practices that can impact patient health. Because it is recommended

to visit the dentist biannually in comparison to the annual physician visit, the dentist may have opportunities to educate patients on the importance

of oral health and its impact on overall health. When more patients trust that the provider is acknowledging their unique circumstances, these improved relationships can lead to better patient

self-efficacy, outcomes, and healthier communities. Tables 2 and 3 lists strategies that can be employed during dental visits to gain a complete overview

of the patient’s health. Recognizing our own unfamiliarity as healthcare providers and asking our patients targeted follow-up questions is an easy-to-implement first step for a more comprehensive health history. Furthermore, the perspectives of health professionals in and from these marginalized communities will allow us to design better questionnaires that can be deployed at screening

11.

References 1.

and diet information as part of a

recommendations to our patients.

10.

Batra, M., Gupta, S., & Erbas, B. (2019). Oral health Beliefs, attitudes, and practices of South Asian Migrants: A systematic review. International Journal of Environmental Research and Public Health, 16(11), 1952. https://doi.org/10.3390/ijerph16111952 Sharma, R. (2000). India launches oral health strategy. BMJ : British Medical Journal, 320, 1030. Demographic Information . SAALT. (n.d.). Retrieved October 14, 2021, from https://saalt.org/southasians-in-the-us/demographicinformation/#:~:text=Nearly%205.4%20 million%20South%20Asians%20live%20 in%20the%20United%20States. Moynihan, P. (2016, January 15). Sugars and dental caries: Evidence for setting a recommended threshold for intake. Advances in nutrition (Bethesda, Md.). Retrieved January 17, 2023, from https:// www.ncbi.nlm.nih.gov/pmc/articles/ PMC4717883/ Centers for Disease Control and Prevention. (2013, July 10). Periodontal disease. Centers for Disease Control and Prevention. Retrieved January 17, 2023, from https://www.cdc.gov/oralhealth/ conditions/periodontal-disease.html Davis, C., Bryan, J., Hodgson, J., & Murphy, K. (2015, November 5). Definition of the Mediterranean diet; a literature review. Nutrients. Retrieved August 23, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4663587/ Mayo Foundation for Medical Education and Research. (2021, June 25). How to make the Dash Diet Work For you. Mayo Clinic. Retrieved August 23, 2022, from https://www.mayoclinic.org/healthylifestyle/nutrition-and-healthy-eating/indepth/dash-diet/art-20048456 Salis S;Virmani A;Priyambada L;Mohan M;Hansda K;Beaufort C; (n.d.). ‘old is gold’: How traditional Indian dietary practices can support pediatric diabetes management. Nutrients. Retrieved August 23, 2022, from https://pubmed.ncbi.nlm. nih.gov/34959978/ Kapoor D;Iqbal R;Singh K;Jaacks LM;Shivashankar R;Sudha V;Anjana RM;Kadir M;Mohan V;Ali MK;Narayan KM;Tandon N;Prabhakaran D;Merchant AT; (n.d.). Association of dietary patterns and dietary diversity with cardiometabolic disease risk factors among adults in South Asia: The carrs study. Asia Pacific journal of clinical nutrition. Retrieved August 23, 2022, from https://pubmed.ncbi.nlm.nih. gov/30485933/

546 Texas Dental Journal | Vol 140 | No. 9

12.

13.

14.

15.

16.

17.

18.

19.

20.

Sharma, M., Kishore, A., Roy, D., & Joshi, K. (2020, May 29). A comparison of the Indian diet with the EAT-lancet reference diet. BMC public health. Retrieved August 23, 2022, from https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC7260780/ Martínez Steele E;Baraldi LG;Louzada ML;Moubarac JC;Mozaffarian D;Monteiro CA; (n.d.). Ultra-processed foods and added sugars in the US diet: Evidence from a nationally representative cross-sectional study. BMJ open. Retrieved August 23, 2022, from https://pubmed.ncbi.nlm.nih. gov/26962035/ NCI Dictionary of Cancer terms. National Cancer Institute. (n.d.). Retrieved December 23, 2021, from https://www. cancer.gov/publications/dictionaries/ cancer-terms/def/betel-quid-with-tobacco Niaz K;Maqbool F;Khan F;Bahadar H;Ismail Hassan F;Abdollahi M; (n.d.). Smokeless tobacco ( paan and gutkha) consumption, prevalence, and contribution to oral cancer. Epidemiology and health. Retrieved December 23, 2021, from https://pubmed. ncbi.nlm.nih.gov/28292008/ Centers for Disease Control and Prevention. (2018, January 17). Bidis and Kreteks. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/ data_statistics/fact_sheets/tobacco_ industry/bidis_kreteks/index.htm. Jirender, S., Sarika, G., Sharma, P., Mishra, P, (n.d.). Bidi smoking: An underestimated issue of Indian Society. Journal of experimental therapeutics & oncology. Retrieved December 23, 2021, from https:// pubmed.ncbi.nlm.nih.gov/28472568/ Rahman, Mahbubur & Sakamoto, Junichi & Fukui, Tsuguya. (2003). Bidi smoking and oral cancer: A meta-analysis. International journal of cancer Mayo Foundation for Medical Education and Research. (2021, October 28). Oral Health: A window to your overall health. Mayo Clinic. Retrieved January 7, 2022, from https://www.mayoclinic.org/healthylifestyle/adult-health/in-depth/dental/art20047475 Stanko, P., & Izakovicova Holla, L. (2014). Bidirectional association between diabetes mellitus and inflammatory periodontal disease. A review. Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia, 158(1), 35–38. https://doi.org/10.5507/bp.2014.005 Oza-Frank, R., & Narayan, K. M. (2010). Overweight and diabetes prevalence among US immigrants. American journal of public health, 100(4), 661–668. https://doi. org/10.2105/AJPH.2008.149492 Janakiram, C., Mehta, A., & Venkitachalam, R. (2020). Prevalence of periodontal disease among adults in India: A systematic review and meta-analysis. Journal of oral biology and craniofacial research, 10(4), 800–806. https://doi. org/10.1016/j.jobcr.2020.10.016

Table 2. Challenges and Strategies for Improving Oral Health Outcomes among the South Asian Population Strategies

Challenges Clinician Challenges Clinician’s inadequate knowledge of

Provide practitioners with additional training in diet and nutrition (self-learning

nutritional concepts

modules, class discussion, integration into biochemistry, physiology, and pathology).

Clinician understanding the impact

Develop an integrated “nutrition as medicine” curriculum to be embedded into

of patient’s diet on oral health

the dental curriculum.

Clinician collecting a

Have patients start a food journal so that the practitioner can identify foods in

comprehensive health history to

the patient’s diet that may offer protective and destructive properties.

achieve cultural proficiency

At the initial visit or prior to visit, provide a questionnaire that contains questions about patient’s diet as well as social and cultural practices. Continue updating patient’s dietary and nutritional patterns at follow-up visits. Changes to diet can be better observed via acculturation.

Patient Challenges Insufficient access to information

Incorporating more diverse and targeted representation in healthcare.

about preventative care for

Practitioners can utilize educational pamphlets to improve health literacy.

patients

Practitioners can advocate for pediatric participation in school-based programs. Enlisting and partnering with trusted members of the community to share updated oral health practices.

Obtaining information of patient’s

Practicing collaborative and coordinated healthcare by increasing the integration

current situation

of the medical-dental model.

Table 3. Culturally Sensitive Questionnaire 1

Do you subscribe to any cultural customs or beliefs surrounding oral hygiene?

Do cultural practices affect the way that you practice oral hygiene? If so, how?

Have you experienced any difficulties in maintaining proper oral hygiene while adhering to your cultural norms?

Are there any cultural myths in your community about oral health?

What role do dietary habits, traditional foods and cultural preferences have in affecting your oral health? How do you think these elements influence oral hygiene?

Are there any cultural customs that relate to tobacco use?

Do you have any suggestions for promoting culturally appropriate oral health practices in your community?

www.tda.org | November 2023

547

Young Dentists’ and Students’ Voices

“Dopesick” in Dentistry: Applications of SBIRT Substance-Abuse Screening for Patient-Centered Care Sophia Nicolosi, BS Dental Student Year Three, UTHealth Houston School of Dentistry, Houston, Texas

Jayme Witek, BS, MS Dental Student Year Three, UTHealth Houston School of Dentistry, Houston, Texas

Ben F. Warner, Ms, DDS, MD Professor, UTHealth Houston School of Dentistry, Houston, Texas

Cleverick (C.D.) Johnson, DDS, MS Professor, UTHealth Houston School of Dentistry, Houston, Texas

George T. Brady, DMD Assistant Professor, UTHealth Houston School of Dentistry, Houston, Texas

Gary R. Pillers, DDS, RPh Assistant Professor, UTHealth Houston School of Dentistry, Houston, Texas Disclosures: There are no financial, economic, or professional interest disclosures for this study.

548 Texas Dental Journal | Vol 140 | No. 9

Abstract

Introduction In 2019, 49,860 overdose deaths involved opioids. This comprised 70.6% of all drug

Opioid use has been

overdose deaths for that year.1 Dentists have been recognized as leading opioid

presented as a problem

prescribers. In 2009, dentists accounted for 12% of the opioid prescriptions in the

for patients across many

United States, while family physicians wrote 15% of opioid prescriptions. Dentists were

demographics in the

the highest prescriber of opioids to teenagers as a result of 3rd molar extractions that

management of pain. It

frequently occur during the teen years.2

has been documented that dentists are a

As of 2016, the ADA guidelines on Substance Use Disorders states dentists should refer

significant source of opioid

to nonsteroidal anti-inflammatory analgesics as the first-line therapy for acute pain

prescriptions in recent

management with consideration of multi-modal strategies in order to provide opioid-

years. In response, the

sparing options for acute postoperative pain. Additionally, the ADA has called for the

ADA has defined guidelines

use of Prescription Drug Monitoring Programs (PDMPs) in an effort to promote the

for pain management by

appropriate use of controlled substances and deter misuse. In 2018, the ADA also added

using NSAIDs as first-line

requirements for Continuing Education covering prescribing practices of opioids and

therapy. The TSBDE has

controlled substances with a focus on preventing drug overdoses, chemical dependency,

acknowledged the opioid

and diversion.8

epidemic and responded by requiring licensed dentists

In Texas, the TSBDE has supported these policies by having standards for prescribing

to refer to a Prescription

controlled substances and dangerous drugs. Dentists must check a patient’s PMP

Monitoring Program (PMP)

history before prescribing or dispensing opioids, benzodiazepines, barbiturates, or

when prescribing controlled

carisoprodol. The TSBDE also has specific CE requirements pertaining to opioids and

substances such as opioids

controlled substances. All Texas-licensed dentists whose practice includes direct patient

as well as taking Substance

care must complete a minimum of 4 CE hours for each license renewal in safe and

Use CE courses. In addition

effective pain management related to the prescription of opioids and other controlled

to these resources, we

substances—104.1(2)(B). Additionally, dentists permitted by the Drug Enforcement Agency

believe the utilization of

to prescribe controlled substances must complete a one-time 2-hour CE requirement

Screening, Brief Intervention,

related to approved procedures of prescribing and monitoring controlled substances—

and Referral to Treatment

111.1(b).4,5

(SBIRT) model to screen for substance use behavior

In addition to these measures and to better serve our community by delivering patient-

in patients, would be an

centered care, it’s important to screen patients for potential substance use behavior so

effective tool for delivering

that we do not initiate or promote a relapse of opioid misuse. The SBIRT model can be

patient-centered care. By

incorporated in the dental school clinic settings to determine a patient’s relationship with

identifying patients with a

prescription drug-use in a time-efficient way so that they can be directed to treatment

history of or current struggle

resources if needed.

with substance use, we can better refer patients to resources to help them manage by using the brief questionnaire SBIRT model.

KEYWORDS Dopesick, Substance Use, PMP, SBIRT, MASBIRT

Methods We conducted systematic electronic database searches to determine how the SBIRT model was applied in a clinical setting and its effects on patient management in the reduction of substance use and opioid-prescribing practices. We conducted a similar search for the effectiveness of PMP programs with regards to reduction of opioidprescribing practices as well. Electronic database searches included PubMed and the Cochrane Library, using the key terms: SBIRT screening, Prescription Monitoring Programs, opioid abuse, substance abuse screening, and prescription drug use in dentistry. We also referenced the CDC website, the TSBDE website as well as the ADA current policies on Substance Use Disorders.

www.tda.org | November 2023

549

Screening, Brief Intervention, Referral to Treatment (SBIRT) Screening (S) n

Identifies unhealthy use of drugs or alcohol.10

Brief Intervention (BI) n

Provides feedback, education, and increased patient awareness about the risks associated with unhealthy substance use.

The goal is to enhance motivation toward healthy behavior.10

Please see Massachusetts SBIRT tool kit for tips on brief intervention

Referral to Treatment (RT) n

Facilitates patient access to proper assessment and treatment facilities/resources

Only 5% of patients screened need referral to treatment.10

ADA recommends this hotline: 1-800-662-HELP (4357)3

ADA has this link to SAMSHA for finding a treatment center near you https://findtreatment.samhsa.gov/3

Total Time n

75-85% of patients will screen negative: 3-4 questions taking 1-2 minutes.10

15-25% of patients will screen positive: undergo full screen and brief intervention taking 5-20 minutes.10

Quick Screening Approach Derived from Massachusetts Screening, Brief Intervention, and Referral to Treatment Training and Technical Assistance (MASBIRT) Step 1: Inquire About Drug & Alcohol Use Alcohol: 1 drink = 12 oz of beer, 5 oz of wine, or 1.5 oz of spirits 1.

Do you drink wine, beer, or other alcoholic beverages sometimes?

How many instances have you had 5 or more drinks (4 or more for women and men 65 and older) in a day?

A positive is considered as 1 or more instances. If a patient is positive they are at risk for consequences

like trauma or accidents.

Proceed to answer questions 3 and 4 if the score is greater than zero.

How many days a week do you have an alcoholic beverage?

During a typical day of drinking how many drinks do you have?

Patients at risk for chronic health problems:

Men younger than 65 years who average 14 or more drinks per week

Healthy women or men older than 65 years of age who average 7 or more drinks per week

Drug Use 1.

In the past year, how many instances have you used an illegal drug or used a prescription drug recreationally?

one or more instances is considered a positive

Next Step? n

If positive, go to step 2 → patient is at least a risky alcohol and/or drug user

If Negative, reinforce their healthy decisions

Step 2: Assess for Severity of Drug & Alcohol Use 1.

Have you ever felt that you need to decrease your drug and/or alcohol use?

Have you been annoyed at others criticizing your drug and/or alcohol use?

Has your drug and/or alcohol use ever made you feel guilty or bad?

Have you ever used drugs or alcohol after waking up in the morning to get rid of a hangover or calm your nerves?

Each YES response = 1

Scoring n

≤ 1 in men and women = Risky Use

> 1 in men and women = Further diagnostic evaluation, brief intervention, and referral to treatment

550 Texas Dental Journal | Vol 140 | No. 9

Conclusions

American Dental Association. (n.d.).

10. Massachusetts Screening, Brief

Opioids. Mouth Healthy . Retrieved

Intervention, and Referral to

In summary, the SBIRT model could

January 10, 2022, from https://

Treatment Training and Technical

be applied in a dental school setting

www.mouthhealthy.org/en/az-

Assistance (MASBIRT). (2012). A

as a time-saving method for assessing

topics/o/opioids

Step-By-Step Guide for Screening

Texas Health and Safety Code

and Intervening for Unhealthy

§481.0764(a).

Alcohol and Other Drug Use.

22 Texas Administrative

Massachusetts Screening, Brief

Code §104.1(2)(B) & 22 Texas

Intervention, and Referral to

Administrative Code §111.1(b).

Treatment Training and Technical

Wang, T. T., Tong, J., Hersh, E. V.,

Assistance (MASBIRT).

a patient’s level of risk for prescription

drug use and would provide direction to treatment resources if needed. In a

six-state study of SBIRT used in medical settings, rates of drug use were 68 percent lower and heavy alcohol use

11. The ADA Principles of Ethics and

was 39 percent lower after 6 months

Chuang, S.-K., & Panchal, N. (2021,

from the beginning of treatment.

January 16). Does prescription drug

Code of Conduct: https://www.ada.

Patients who were referred for brief

monitoring program usage affect

org/about/principles/code-of-ethics

or specialized treatment self-reported

opioid analgesic prescriptions by

improvements in general health, mental

oral and maxillofacial surgeons

health, employment, housing status and

after third molar surgery? Oral

criminal behavior.9 As for results from

Surgery, Oral Medicine, Oral

using Prescription Monitoring Programs,

Pathology and Oral Radiology.

a retrospective observational cohort

Retrieved January 10, 2022,

study analyzing analgesic prescriptions

from https://www.sciencedirect.

after third molar surgeries from the

com/science/article/pii/

University of Pennsylvania from July

S2212440321000432.

2016 to December 2019 found that

Parish, C. L., Pereyra, M. R., Pollack,

mandatory PDMP usage was associated

H. A., Cardenas, G., Castellon, P. C.,

with decreased odds of a patient

Abel, S. N., Singer, R., & Metsch, L.

receiving an opioid analgesic as well

R. (2015). Screening for substance

as a decrease in mean opioid pills per

misuse in the dental care setting:

script.

findings from a nationally

representative survey of dentists. References

Addiction (Abingdon, England),

CDC. (2021, March 3). Drug

110(9), 1516–1523. https://doi.

overdose deaths. Centers for

org/10.1111/add.13004

Disease Control and Prevention.

ADA Current Policies on Substance

Retrieved January 10, 2022, from

Use Disorders: https://www.ada.

https://www.cdc.gov/drugoverdose/

org/about/governance/current-

deaths/index.html

policies#substanceusedisorders

Contreras, O. A., Stewart, D., &

Denisco, R. C., Kenna, G. A.,

Valachovic, R. W. (2018, March).

ONeal, M. G., Mehta, N. R., Hersh,

The Role of Dental Education in the

E. V., & Katz, N. P. (2011, July 1).

Prevention of Opioid Prescription

Prevention of prescription opioid

Drug Misuse. The role of Dental

abuse The role of the dentist. JADA.

Education in the prevention of

Retrieved January 20, 2022, from

opioid prescription drug misuse.

https://jada.ada.org/article/S0002-

Retrieved January 10, 2022, from

8177(14)62264-9/fulltext

https://www.adea.org/policy/ white-papers/preventing-opioidprescription-drug-misuse.aspx#6

www.tda.org | November 2023

551

ethics corner TDA Council on Ethics and Judicial Affairs

Negative online reviews and their

ethical implications Guenter Jonke, DMD

This article is reprinted from The Journal of the American Dental Association and may not be copied, distributed, or modified without written permission from the American Dental Association. The article was reprinted with permission from The Journal of the American Dental Association (JADA) and published in the The Journal of the American Dental Association (JADA), Vol 150, Issue 7, Guenter Jonke, DMD, Negative online reviews and their ethical implications, pp 632-633, Copyright American Dental Association (2019). The copyright line for this article should state: ©2019 American Dental Association (ADA). Reprinted with permission from the ADA. All rights reserved.

552 Texas Dental Journal | Vol 140 | No. 9

Mr Smith is an older patient who has challenges at every dental visit. He is consistently late for his appointments, does not pay his balance when

payment is due, and regularly reschedules his

It is important to remember the American Dental Association Principles of Ethics and Code of Professional Conduct (ADA Code) when dealing with patient reviews.1 Online review sites have changed dramatically the

way patients seek dental care.

appointments. Recently, like clockwork, Mr Smith

According to the Ceatus Media Group, as many as 63%

arrived late, apologized profusely, but did not

of consumers who are considering any type of esthetic

offer an excuse for being late. I accommodated

dentistry procedure find online reviews to be a vital part of their decision-making process.2 Positive reviews are critical

Mr Smith that day and completed the dental

for dental practices. Take the time to respond to a positive

treatment as scheduled. At the end of the

review by thanking the reviewer, mentioning your company

appointment, I calmly explained to him that if he cannot be on time and follow through with his commitments with the office, it may be necessary

name so that the review will show up on search engine results, and briefly describe the dental services that you provide. Remember, responses to positive reviews are out there for all to read. Be as polite as you can.

to terminate the dentist-patient relationship. The

The ethics of reviews and ratings can get complicated. Do

dental assistants were stunned that I would say

not offer patient discounts for positive reviews on future

such a thing to any patient, let alone Mr Smith.

treatment so that patients do not feel any pressure to provide a review or that a review will impact their treatment. This should not seem as if you are offering a

The next week, another long-time patient mentioned to the receptionist that he read a scathing review about me on Yelp and found the review written by Mr Smith. The review reads in part, “Besides doing substandard work, Dr Jones

rebate. ADA Code advisory opinion 4.E.1., Rebates and Split Fees, prohibits “dentist’s accepting or tendering rebates or split fees. [in] business dealings between dentists and any third party . .”1 Most, if not all, of us take negative reviews as a personal attack individually or on our practice. Take a deep breath

is rude, insensitive, and does not relate well to

and do not respond immediately. Be careful in your

patients. This dentist should be avoided!” At first,

response. Do not ignore it. It is out there for everyone to

I was angry and upset as any dental professional would be reading such a negative review. I value my reputation and was deeply offended by the injustice of this review. Critical reviews can cause lasting damage to any dental practice. This is a reality in the world we live in. The following day, I

read, including future patients. Negative reviews can be managed in such a way as to allow some credibility to your practice. Too many positive reviews may create a doubt of perfection to patients. Section 5 of the ADA Code discusses the principle Veracity (“truthfulness”). Under this principle, all dentists have “a duty to communicate truthfully.”2 Truth telling promotes respect for your patients. It “respect[s] the position of trust inherent in the dentist-patient relationship…”1 Publishing bad reviews shows that you have

decided it was time to terminate my relationship

nothing to hide, and it may even promote your positive

with Mr Smith. I reached out to my local dental

reviews.

society and took the necessary steps to terminate

The principle Veracity also “expresses the concept that

the relationship ethically. My question is, what are

professionals have a duty to be honest and trustworthy in

the ethical issues in responding to negative online

their dealings with people…communicating truthfully and

reviews?

without deception, and maintaining intellectual integrity.”1 With this in mind, dental offices need to develop or have

www.tda.org | November 2023

553

A Review Trackers survey found that 94%

in place procedures to handle negative online reviews. Any dentist, including new dentists and retiring dentists who

of consumers have

may be looking to sell their practices,

been convinced to

The response to the review will help

avoid a business after a

may be the subject of a negative review. future patients decide if this is the type of practice that suits their needs.

negative review.3 Responding to the complaint will show patients you care and take negative reviews seriously. It is also your way to make amends with the reviewing patient.

A Review Trackers survey found that 94% of consumers have been convinced to avoid a business after a negative

Dr Jonke practices general dentistry in Stony Brook, NY, and is a member of the American Dental Association Council on Ethics, Bylaws and Judicial Affairs. Address correspondence to the American Dental Association Council on Ethics, Bylaws and Judicial Affairs, 211 E. Chicago Ave., Chicago, IL 60611.

review.3 Responding to the complaint

Disclosure. Dr Jonke did not report any

will show patients you care and take

disclosures.

negative reviews seriously. It is also your way to make amends with the reviewing

Ethical Moment is prepared by individual

patient. Once again, your existing

members of the American Dental

patients and future patients are reading

Association Council on Ethics, Bylaws and

your response. Keep it short and sweet

Judicial Affairs (CEBJA) or guests of CEBJA,

and avoid any potentially identifiable

in cooperation with The Journal of the

information about the patient so as

American Dental Association. Its purpose

to respect the patient’s privacy. First,

is to promote awareness of the American

apologize for the negative experience

Dental Association Principles of Ethics and

that the patient has had and then try to

Code of Professional Conduct. Readers

move the conversation off-line by

are invited to submit questions to CEBJA

suggesting the patient contact the

at 211 E. Chicago Ave., Chicago, Ill. 60611,

office for assistance in addressing the

email ethics@ada.org.

complaint. Hopefully, by responding in this way, your reviewer will update the original review. Even if the reviewer does not, you have done as the Preamble of the ADA Code recommends by exhibiting “[q]ualities of honesty, compassion, kindness, integrity, fairness and charity…”1 Never let a negative review go unnoticed. Do your best to

The views expressed are those of the author and do not necessarily reflect the opinions of the American Dental Association Council on Ethics, Bylaws and Judicial Affairs or official policy of the ADA. References 1.

correct the situation. This can be a learning experience for you and your staff. Responding to reviews is important. Ethical implications may exist, so understand the ADA Code and each

of the principles, because they can guide you in responding in a thoughtful manner. Take the time and make the effort to monitor your online presence and respond accordingly. Your success depends on it.

554 Texas Dental Journal | Vol 140 | No. 9

American Dental Association. American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to November 2018. Available at: https://www.ada. org/w/media/ADA/Member %20Center/ Ethics/Code_Of_Ethics_Book_%20With%20 Advisory%20Opinions%20Revised%20 to%20November%202018.pdf?la¼en. Accessed March 30, 2019. Handzel Sarah. Survey shows dentists reviews “extremely important” when choosing providers. Available at: https:// www.dmdtoday.com/news/survey-showsdentists-reviewsextremely-importantwhen-choosing-providers. Accessed February 16, 2019. 2018 ReviewTrackers online reviews survey: statistics and trends. Available at: https:// www.reviewtrackers.com/online-reviewssurvey/. Accessed February 16, 2019.

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555

ORAL

and maxillofacial pathology case of the month

Clinical History An 81-year-old male was referred to an oral and maxillofacial surgeon (C.C.) with a chief complaint related by his sister, “He needs to get a lesion evaluated for cancer and some teeth extracted.” The patient presented with a 2 cm x 2 cm multilobular, ulcerated, soft tissue mass with grey-to-brown pigmentation on the left mandibular alveolar crest, surrounding teeth

AUTHORS Cheyenne Alexander, BA Fourth-year dental student, School of Dentistry, UT Health San Antonio, San Antonio, Texas

Juliana Robledo, DDS Assistant Professor/ Clinical, Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, Texas

Carlos Cruz, DDS Oral and Maxillofacial Surgeon, Private Practice, Oral & Craniofacial Center, Edinburg, Texas

#20 and #21 (Figure 1). The patient mentioned that the mass was painless and had been growing for the past 3 months. The clinical impression was a pyogenic granuloma, and the patient was scheduled for removal of the mass and the involved teeth. Extraoral examination was unremarkable with no lymphadenopathy detected upon palpation of the neck. Periapical

Figure 1. Clinical photograph demonstrating lobular mass on the left mandibular alveolar crest, surrounding teeth #20 and #21.

556 Texas Dental Journal | Vol 140 | No. 9

Anne Cale Jones, DDS Distinguished Teaching Professor, Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, Texas

Figure 2. Micrograph. 4x. Mass surfaced by epithelium, exhibiting a sheet-like proliferation of neoplastic cells within the connective tissue.

Figure 3. Micrograph. 40x. Large cells with pleomorphism and some atypical mitotic figures.

radiographs revealed no evidence of bone pathosis or other

Teeth removal and excision of the soft tissue mass were

abnormalities.

performed under intravenous sedation and the specimen was

The patient’s past medical history included cerebrovascular disease, hypertension, pneumonia, asthma, diabetes mellitus, end stage renal disease, anemia, dementia, and benign prostatic hyperplasia. The patient’s surgical, social, and family history were unremarkable. His medications and supplements included amlodipine, omadacycline, Lantus (insulin glargine), tamsulosin, Nephro-Vite (vitamin B and C complex), and bupropion.

submitted for histopathologic evaluation.

Pathologic findings Histopathologic examination revealed a dome shaped mass surfaced by parakeratinized stratified squamous epithelium, which appeared thin with flat rete ridges and areas of ulceration. Within the connective tissue was a sheet-like proliferation of large atypical neoplastic cells with vesicular nuclei and prominent nucleoli (Figure 2). These cells exhibited marked pleomorphism and numerous atypical mitoses (Figure 3). Brown pigment was seen within some of the larger cells at the interface with the surface epithelium (Figure 4). The neoplastic cells were positive for S-100 protein, HMB-45 and Mart-1 by immunohistochemistry.

What is the most likely diagnosis? See page 556 for the answer and discussion.

Figure 4. Micrograph. 20x. Some cells have heavy brown pigment.

www.tda.org | November 2023

557

ORAL

effective, non-invasive, clinical aid to evaluate oral pigmentation. This involves pressing a glass slide against the pigmented mucosa and assessing for tissue blanching. Blanching indicates

and maxillofacial pathology

compression of intravascular blood. The absence of blanching (negative diascopy) in KS is consistent with the

diagnosis and management—from page 558

histology of extravascular red blood

Diagnosis: Oral Mucosal Melanoma

Metastasis to the oral cavity is common

cells.5

and the most affected location is the mandible, followed by the gingiva.6,7

Discussion

Metastasis to the oral soft tissue typically presents as a submucosal mass

Based upon the patient’s clinical findings, the differential diagnosis included:

with or without ulceration. It most often

pyogenic granuloma, Kaposi sarcoma, and metastasis to soft tissue from a primary

affects middle-aged males. While there

prostatic neoplasm.

are numerous malignancies that can metastasize to the oral cavity, they often

Pyogenic granuloma presents as an asymptomatic, smooth, or lobulated mass which

originate from the lungs, kidney, and

may be ulcerated. It exhibits a rapid growth potential and appears red-to-pink in

skin.6,7 Even though this patient did not

color. Pyogenic granulomas develop in response to trauma or irritation, leading to the

have a history of a cancer elsewhere,

production of highly vascularized connective tissue (granulation tissue). Hemorrhage

given his age and general health history,

may occur if the lesion is manipulated. Intraorally, pyogenic granulomas present

a metastatic lesion from an unknown

most commonly on the maxillary facial gingiva in children and young adults. Pyogenic

source was discussed. Soft tissue

granulomas associated with pregnancy can manifest as early as the first trimester.1

metastatic lesions in the oral cavity may

Treatment involves removing the source of trauma or local irritant (e.g., scaling teeth

represent the first sign of an unknown

in the affected area to remove calculus) and possibly excising the mass.2

primary tumor, and the prognosis is

considered poor, with emphasis on Kaposi sarcoma (KS) is a malignant proliferation of endothelial cells infected with

palliative care rather than curative

HHV-8 (human herpes virus 8). KS displays a rapid growth potential. Between 2016

treatment.

and 2020 the incidence rate in the USA has been reported as 0.4 per every 100,000 population by SEER data3 including males and females. The incidence of KS has

The definitive diagnosis was oral

been declining since 1996 with the implementation of combination antiretroviral

mucosal melanoma (OMM). OMM is a

therapy (cART). The clinical presentation includes painless, violet-blue plaques,

malignant neoplasm of melanocytes

papules or nodules on the mucosa or skin. KS most commonly affects individuals

derived from neural crest cells. Primary

with human immunodeficiency virus (HIV), especially in those with a CD4 count of

OMM is a rare occurrence and accounts

<500/mm3 and a higher viral load.1 There are 4 distinct epidemiologic subtypes for

for 0.2% to 0.8% of all melanomas.9-12

Kaposi Sarcoma: classic, endemic, iatrogenic, and epidemic and a new emerging

Malignant melanoma commonly arises

subtype non-epidemic HIV negative patients with no other immunodeficiency.1,4 In

on the skin and in recent years, there

our case, the patient did not have any history of HIV, and his ethnicity was not of

has been an increase in the incidence

Mediterranean origin. When KS neoplasm progresses, it can involve lymph nodes, the

of skin melanoma in patients over

lungs, and the gastrointestinal tract, leading to a wide range of symptoms. Intraorally,

60 years and is a cause for 90% of

KS has a predilection for the hard palate, gingiva, and tongue. Histologically, KS

skin cancer related deaths.9,10 The

exhibits a proliferation of atypical spindle-shaped cells, slit-like vascular spaces,

first reported OMM was published by

and extravasated red blood cells. Diascopy can be used to establish a tentative

Weber in 1859.8 The etiology and risk

differential diagnosis for red to violet-blue lesions in the oral mucosa. It is a cost-

factors for OMM remain unknown. In

558 Texas Dental Journal | Vol 140 | No. 9

contrast, the risk factors for cutaneous

is an important and helpful tool in the

melanoma include intense intermittent

diagnosis of amelanotic melanomas

exposure to sunlight, skin that burns

and those tumors that appear poorly

in the sun and inherited characteristics

differentiated. Stains such as S-100

in melanoma-prone families.9-11 There

protein and Melan-A will highlight the

are four clinicopathologic forms of

neural-crest derived melanocytes.10-13

melanoma: superficial spreading,

BRAFv600 mutation testing has

nodular, lentigo maligna, and acral

also become an important tool for

lentiginous. The ABCDE criteria, used

the treatment decisions in patients

to describe cutaneous clinical features,

with metastatic lesions, high stage

may also be applicable to OMM’s: A—

melanoma patients and unresectable

asymmetry, B—border irregularity, C—

tumors.9-11

variation in color, D—diameter greater than 6 mm, E—evolution.9,10,12,13 Most

Our current case was somewhat

cases of primary OMM are diagnosed

unusual, since this patient was living

in males and in patients in the seventh

in a nursing home, and had multiple

decade.11,12 Intraorally OMM’s have a

systemic issues. His oral lesion was not

predilection for the maxillary mucosa,

detected until there was increased and

predominantly the hard palate

rapid growth. The large dimensions

and maxillary alveolar mucosa.

and exophytic presentation, coupled

Radiographically, the underlying bone

with the color variation and rapid

may exhibit an irregular, destructive

growth, were worrisome factors which

appearance with external resorption

demanded further evaluation.

11,14

Based upon the patient’s clinical findings, the differential diagnosis included: pyogenic granuloma, Kaposi sarcoma, and metastasis to soft tissue from a primary prostatic neoplasm.

affecting surrounding the roots of adjacent teeth. In our case, the clinical

Treatment options for OMM include

presentation was unusual, because the

wide margin excision, radiation therapy,

lesion was more a polypoid, nodular

immunotherapy, targeted therapy,

lesion with no evident radiographic

and chemotherapy.14,15 The prognosis

abnormalities.

for mucosal melanoma is poor and significantly worsens in the presence

Histopathologic examination reveals

of metastasis. The 5-year survival rate

2 distinct growth phases. In the radial

for OMM is 11-18%.11,12,14,15 Once the

growth phase (superficial spreading),

diagnosis of melanoma was obtained,

the atypical melanocytes are identified

our patient chose to consult a local

at the basal cell layer. In the vertical

oncologist who obtained CT scans and

growth phase (nodular), atypical

PET scans. No metastatic lesions were

melanocytes invade the basement

identified. The oncologist continues to

membrane and underlying connective

follow the patient periodically by PET

tissue. Lesions that appear flat clinically

scan. The patient remains free of tumor

could represent superficial spreading

to this day.

melanoma, while the deep, nodular melanomas present as a submucosal

References

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Neville B, Damm D, Allen C,

brown pigment within the cytoplasm

Chi A, Oral and Maxillofacial

which is melanin, and the lesion

Pathology.4th edition. 2016 Elsevier

clinically will have a dark brown

Inc. St. Louis, MS. (US).

appearance. Immunohistochemistry

www.tda.org | November 2023

559

ORAL

and maxillofacial pathology continued

11. Greene GW, Haynes JW, and Dozier M, et al (1953) Primary malignant melanoma of the oral mucosa Oral Surg Oral Med Oral Pathol 6(12) 1435–1443 https://doi. org/10.1016/0030-4220(53)90242-4

Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: a review. J Oral Sci. 2006 Dec;48(4):167-75. doi: 10.2334/josnusd.48.167. PMID: 17220613.

Lenzi C, Graziani F. Oral Mucosal

statistics-network/explorer/application.html?site=110&data_type=1&graph_

Melanoma. J Craniofac Surg. 2022

type=2&compareBy=sex&chk_sex_3=3&chk_sex_2=2&hdn_rate_

May 1;33(3):830-834. doi: 10.1097/

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SCS.0000000000008054. Epub

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2021 Jul 30. PMID: 34334749.

Morales AE, Benson G, Glavan S, Giuliano R, Dickson MA. The emerging fifth

13. Xavier-Junior JCC, Ocanha-Xavier

epidemiologic subtype of Kaposi sarcoma in HIV-negative men who have sex

JP, Asato MA, Bernabé DG. The

with men at a tertiary care center in NYC from 2000 to 2021. Journal of Clinical

‘AEIOU’ system to identify primary

Oncology 2022 40:16_suppl, 11579

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Pérez-López D, Pena-Cristóbal M, Otero-Rey EM, Tomás I, Blanco-Carrión A.

Jan;124:105670. doi: 10.1016/j.

Clinical value of diascopy and other non-invasive techniques on differential

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2021 Dec 13. PMID: 34915256.

2016 Oct 1;8(4):e448-e458. doi: 10.4317/jced.53005. PMID: 27703615; PMCID:

14. M.J. Hicks, C.M. Flaitz Oral mucosal

PMC5045694.

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Hirshberg A, Shnaiderman-Shapiro A, Kaplan I, Berger R. Metastatic tumours to

pathobiology. Oral Oncol.36 (2)

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(2000), pp. 152-169 15. Chatzistefanou I, Kolokythas A,

Ana Margarida Lopes, Filipe Freitas, Miguel Vilares, João Caramês. Metastasis

Vahtsevanos K, Antoniades K.

of malignant tumors to the oral cavity: Systematic review of case reports and

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case series. Journal of Stomatology, Oral and Maxillofacial Surgery, Volume 124,

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and future directions. Oral Surg

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PMID: 13120118

Bilal Ahmed and Muhammad Imran Qadir and Saba Ghafoor. Malignant Melanoma: Skin Cancer; Diagnosis, Prevention, and Treatment. Critical Reviews in Eukaryotic Gene Expression. Vol 30(4),2020. (291-297)

10. Claus Garbe, Teresa Amaral, Ketty Peris, Axel Hauschild, Petr Arenberger, Nicole Basset-Seguin, Lars Bastholt, Veronique Bataille, Veronique del Marmol, Brigitte Dréno, Maria C. Fargnoli, Ana-Maria Forsea, Jean-Jacques Grob, Christoph Höller, Roland Kaufmann, Nicole Kelleners-Smeets, Aimilios Lallas, Celeste Lebbé, Bohdan Lytvynenko, Josep Malvehy, David Moreno-Ramirez, Paul Nathan, Giovanni Pellacani, Philippe Saiag, Alexander J. Stratigos, Alexander C.J. Van Akkooi, Ricardo Vieira, Iris Zalaudek, Paul Lorigan. European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics: Update 2022. European Journal of Cancer. Vol 170, 2022, Pages 236-255, ISSN 0959-8049. https://doi.org/10.1016/j.ejca.2022.03.008.

560 Texas Dental Journal | Vol 140 | No. 9

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What You Should Know About Dental Membership Plans By Eric Dawe Head of Business Development, DentalHQ

562 Texas Dental Journal | Vol 140 | No. 9

Dental membership plans, a term that may have crossed your radar, have gained attention as an innovative approach to dental care. They’re fairly new to the industry, and if you’re not sure what exactly they do and how they can help your practice, it’s very worth your while to find out.

Dental membership plans provide

Here are a few misconceptions associated with them—along with some clarification.

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Aren’t They Savings Plans?

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It’s common to confuse dental membership plans with savings plans, but they’re fundamentally distinct from one another. Savings plans essentially function as coupons

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for dental care, offering limited value to patients. In contrast, dental membership plans are not driven by discounts. They can be tailored to meet your patients’ needs and are unique to your practice. When your patients feel like

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Won’t I Have to Discount My Fees? (And

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Decrease My Revenue?) No, you don’t have to discount your fees. But let’s talk about why it would be a good idea to do so.

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Classified-Ads-Terms. By official TDA resolution,

FFS patient base, approximately 2,200 active

ads may not quote specific incomes or

patients, all perio, implants, and ortho is being

revenues and must be stated in generic terms (ie “$315,000” should be “low-to-mid-6 figures”).

referred out. The owner is retiring and open to

Journal editors reserve the right to edit and/or

a transition period. HOUSTON-SOUTHWEST

deny copy.

(ID #625): Modern GD practice in a highvisibility retail location in a desirable suburb in

564 Texas Dental Journal | Vol 140 | No. 9

southwest Houston. Large, 2,800 sq ft office

FFS, legacy office located in a high traffic retail

that features 6 fully equipped operatories,

shopping center in a highly desirable suburb

computers in operatories, intra oral cameras,

north of Houston. 4 fully equipped ops with

a digital scanner, and CBCT. The practice is

digital sensors, intraoral cameras, computers

on track to collect over 7 figures in 2023 with

in ops, and paperless charts. This is a rare

strong historical year over year growth. The

opportunity to own an established, legacy

office serves a primarily FFS patient base with a

practice in a sought-out community that is

limited number of patients in-network, has over

sure to move quickly! NORTHEAST TEXAS (ID

1,450 active patients, and has added 25+ new

#584): 100% FFS general dentistry practice in a

patients per month over the last 12 months.

desirable town in northeast Texas with 7 figures

HOUSTON-SOUTHWEST (ID #627): Legacy

in revenue and strong net income. The turn-key

GD practice with majority FFS patient base in a

practice features 4 fully equipped operatories

growing southwest Houston suburb. Located

with digital radiography, intra oral cameras,

in a retail center on a busy intersection, this

paperless charts, CBCT, and a digital scanner.

1,200 sq ft office features 4 fully equipped ops

TEXAS HILL COUNTRY, ORTHO (ID #616):

plumbed for nitrous, computers throughout,

Rare opportunity to purchase an orthodontic

digital radiography, a digital scanner, intraoral

practice located in a serene, rapidly growing

cameras, and paperless charts. HOUSTON-

community in the Texas Hill Country (Austin,

NORTH (ID #615): Thriving, legacy, general

San Antonio, and the Texas wine country all

dentistry practice approximately 60 miles

available within a short drive). State-of-the-art

north of downtown Houston with a multi-

facility with extensive, modern upgrades and

generational, primarily FFS, patient base.

top-of-the-line digital technology. The buyer

The large, free-standing building contains 9

will have the option of purchasing or leasing

fully equipped operatories with digital x-rays,

the real estate. The current owner will be

a pano, Cerec w/milling unit, and intraoral

retiring but is available to provide a transition

cameras throughout. The real estate is also for

period to the incoming buyer. TO REQUEST

purchase. HOUSTON-NORTH (ID #618): 100%

MORE INFORMATION ON MCLERRAN &

www.tda.org | November 2023

565

classifieds ASSOCIATESí LISTINGS: Please register at

old. Practice has operated at this location for

www.dentaltransitions.com or contact us

over 38 years. Practice sees patients about 16

at 512-900-7989 or info@dentaltransitions.

days a month. Collection ratio of 100%. The

com.

practice is a fee-for-service practice. Building is owned by dentist and is available for sale.

AUSTIN: Fee-for-service private practice,

Contact Christopher Dunn at 800-930-8017

45 years same location with a 10-15 mile

or christopher@ddrdental.com. HOUSTON

panoramic view over downtown Austin

(SHARPSTOWN AREA): GENERAL (REFERENCE

skyline. Associate to buy with a preferred long

“SHARPSTOWN GENERAL”). Motivated seller.

transition for the senior doctor. Nine years

Well-established general dentist with high-

remaining current lease. Tremendous amount

6 figure gross production. Comprehensive

of residential growth immediately outside

general dentistry in the southwest Houston

our huge windows. Ideally a GP interested in

area focused on children (Medicaid). Very, very

learning full scale orthodontics. Please email for

high profitability. 1,300 sq ft, 4 operatories

information, info@austinskylinedental.com.

in single building. 95% collection ratio. Over 1,200 active patients. 20% Medicaid, 45%

BEAUMONT: GENERAL (REFERENCE

PPO, and 35% fee-for-service. 30% of patients

“BEAUMONT”). Small town practice near a

younger than 30. Office open 6 days a week and

main thoroughfare. 80 miles east of Houston.

accepts Medicaid. Contact Christopher Dunn

Collections in 7 figures. Country living, close

at 800-930-8017 or christopher@ddrdental.

enough to Houston for small commute.

com. HOUSTON (BAYTOWN AREA): GENERAL

Practice in a stand-alone building built in

(Reference “BAYTOWN GENERAL”). Motivated

1970. The office is 1,675 sq ft with 4 total

seller. Well-established general practice with

operatories, 2 operatories for hygiene and 2

mid-6 figure gross production. Comprehensive

operatories for dentistry. Contains reception

general dentistry in Baytown on the east side of

area, dentist office, sterilization area, lab

Houston. Great opportunity for growth! 1,400 sq

area. Majority of patients are 30 to 65 years

ft, 4 operatories in single story building. 100%

566 Texas Dental Journal | Vol 140 | No. 9

collection ratio. 100% fee-for-service. Practice

single-story, free-standing building, built in 1996

focuses on restorative, cosmetic and implant

and is ALSO available for purchase. Natural light

dental procedures. Office open 3.5 days a

from large windows within 2,300 sq ft with 4

week. Practice area is owned by dentist and is

operatories (2 hygiene and 2 dental). Includes

available for sale. Contact Christopher Dunn

a reception area, dentist office, a sterilization

at 800-930-8017 or christopher@ddrdental.

area, lab area, and break room. All operatories

com. WEST OF AUSTIN: ORTHODONTIC

fully equipped. Does not have a pano but

(REFERENCE “HILL COUNTRY ORTHO”). Located

does have digital X-ray. Production is 50% FFS

in a rapidly growing small town, this practice

and 50% PPO (no Medicaid), with collection

is in the heart of the Texas Hill Country. This

ratio above 95%. Providing general dental and

practice serves the youth of the area. There are 4 operatories in the practice. The practice is 100% fee-for-service. Orthodontic care is the only service provided at this office. 1,300 sq ft. Open 4 days per week. Digital X-rays and pano and Cloud9Ortho software. The practice has excellent visibility and is located near a hospital. Contact Christopher Dunn at 800-930-8017 or

McLerran & Associates is the largest dental practice brokerage firm in Texas. When it’s time to buy or sell a practice, we’ve got you covered.

christopher@ddrdental.com. DS O

P RAC T I C E S AL E S C S

P RAC T I C E AP P RA ISA LS

HOUSTON, COLLEGE STATION, AND LUFKIN (DDR DENTAL Listings). (See also AUSTIN

Austin

512-900-7989

DFW

214-960-4451

DDRDental.com for full details. LUFKIN:

Houston

281-362-1707

GENERAL practice on a high visibility outer

San Antonio 210-737-0100

for other DDR Dental listings and visit www.

loop highway near mall, hospital and mature neighborhoods. Located within a beautiful

South Texas 361-221-1990 E m ai l : t ex as@ den t al t r an si t i o n s.co m www.dentaltransitions.com

www.tda.org | November 2023

567

classifieds cosmetic procedures, producing mid-6 figure

800-930-8017 or christopher@ddrdental.com

gross collections. Contact Christopher Dunn

and reference “Pearland General or TX#538”.

at 800-930-8017 or Christopher@DDRDental.

HOUSTON: PEDIATRIC (NORTH HOUSTON).

com and reference “Lufkin General or TX#540”.

This practice is located in a highly sought-

HOUSTON: GENERAL (SHARPSTOWN). Well

after upscale neighborhood. It is on a major

established general dentist with high-6 figure

thoroughfare with high visibility in a strip

gross production. Comprehensive general

shopping center. The practice has 3 operatories

dentistry in the southwest Houston area

for hygiene and 2 for dentistry. Nitrous is

focused on children (Medicaid). Very, very

plumbed for all operatories. The practice has

high profitability. 1,300 sq. ft., 4 operatories

digital x-rays and is fully computerized. The

in single building. 95% collection ratio. Over

practice was completely renovated in 2018.

1,200 active patients. 20% Medicaid, 45%

The practice is only open 3.5 days per week.

PPO, and 35% fee-for-service. 30% of patients

Contact Christopher Dunn at 800-930-8017

younger than 30. Office open 6 days a week

or christopher@ddrdental.com and reference

and accepts Medicaid. Contact Chrissy Dunn at

“North Houston or TX#562”. WEST HOUSTON:

800-930-8017 or chrissy@ddrdental.com and

MOTIVATED SELLER. Medicaid practice with

reference “Sharpstown General or TX#548”.

production over 6 figures. Three operatories

HOUSTON: GENERAL (PEARLAND AREA).

in 1,200 sq ft in a strip shopping center.

GENERAL located in southeast Houston near

Equipment is within 10 years of age. Has

Beltway 8. It is in a freestanding building.

a pano and Digital X-ray. Great location. If

Dentist has ownership in the building and

interested contact chrissy@ddrdental.com.

would like to sell the ownership in the building

Reference “West Houston General or TX#559”.

with the practice. One office currently in use by seller. 60% of patients age 31 to 80 and

PORTLAND, TEXAS: Seeking full time associate

20% 80 and above. Four operatories in use,

in an established, fee-for-service, high

plumbed for 5 operatories. Digital pano and

quality dental practice. This is an exceptional

Digital X-ray. Contact Christopher Dunn at

opportunity to move into partnership after

568 Texas Dental Journal | Vol 140 | No. 9

a successful initial employment phase. Must be committed to providing optimal patient care with exceptional technical skills, strong people skills and a passion for excellence. This practice has a dynamic, experienced team and a strong emphasis on CE and professional growth. Please send CV and a letter outlining your future objectives and goals to pam@

INTERIM SERVICES HAVE MIRROR AND EXPLORER, WILL TRAVEL: Sick leave, maternity leave, vacation, or death, I will cover your general or pediatric practice. Call Robert Zoch, DDS, MAGD, at 512-517-2826 or drzoch@yahoo.com.

lifetransitions.com. WATSON BROWN PRACTICES FOR SALE: Practices for sale in Texas and surrounding states, For more information and current listings please visit our website at www. adstexas.com or call us at 469-222-3200 to speak with Frank or Jeremy.

FOR SALE FOR SALE! Complete Dentsply Friadent motor, handpiece, Ankylos surgical and prosthetic kits, manuals and instruction discs. The total package, rarely used, $3,000. Will text pics, docjenk1@gmail.com.

www.tda.org | November 2023

569

YOUR PATIENTS TRUST YOU.

WHO CAN YOU TRUST?

ADVERTISERS AFTCO.............................................................................542 Anesthesia Education & Safety Foundation, Inc.....527 Choice Transitions............................... Inside Back Cover E-VAC, Inc.......................................................................555

If you or a dental colleague are experiencing impairment

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due to substance use or mental illness, The Professional Recovery Network is here to provide support and an opportunity for confidential recovery.

Henry Schein Financial Services.................................542 Law Offices of Mark J. Hanna......................................561 McLerran & Associates.................................................567 MedPro...........................................................................531 Princess Dental Staffing..................................Back Cover Professional Recovery Network..................................570 TDA Perks............................................. Inside Front Cover Texas A&M School of Dentistry...................................555

PRN Helpline (800) 727-5152

Visit us online www.txprn.com

570 Texas Dental Journal | Vol 140 | No. 9

Texas Health Steps.......................................................543 Watson Brown...............................................................535

Since 1996, our team of experts have provided successful transition services exclusively to dentists. Choice prides itself on its reputation for integrity, service and results.

Considering selling to a DSO? Scan the QR code to watch a brief and informative video to help you decide.

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www.tda.org | November 2023

571

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