June 2022 Texas Dental Journal by Texas Dental Association

June 2022

TEXAS DENTAL

Outgoing President Dr Debrah Worsham Welcomes Incoming President Dr Duc “Duke” Ho at the TDA House of Delegates

INSIDE:

Speeches to the TDA House of Delegates, Bisphosphonate Therapy—An Important Pre-surgical Consideration www.tda.org | June 2022

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Contents June 2022 Established February 1883 n Vol 139, No. 6

FEATURE 274 | 2022

Annual Session Award Highlights Addresses to the 2022 Texas Dental Association House of Delegates 290 |

Dr Debrah Worsham, Outgoing TDA President Dr Duc “Duke” M. Ho was installed as the TDA Incoming President at the TDA House of Delegates on May 7, 2022.

302 |

Dr Duc “Duke” M. Ho, TDA Incoming President

310 |

Dr Craig Armstrong, ADA 15th District Trustee

TDA members, use your smartphone to scan this QR Code and access the online Texas Dental Journal.

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HIGHLIGHTS 278 | Oral and Maxillofacial Pathology Case of the Month 284 | Value for Your Profession: Bisphosphonate Therapy—An Important Pre-surgical Consideration

Texas Dental Journal | Vol 139 | No. 6

322 | Oral and Maxillofacial Pathology Case of the Month Diagnosis and Management 326 | Advertising Briefs 333 | Calendar of Events 334 | Index to Advertisers

Editorial Staff Jacqueline M. Plemons, DDS, MS, Editor Paras B. Patel, 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 Michaell A. Huber, DDS Arthur H. Jeske, DMD, PhD Larry D. Jones, DDS Paul A. Kennedy Jr, DDS, MS Scott R. Makins, DDS, MS 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. Texas Dental Association 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 (one issue will be a directory issue), by the Texas Dental Association, 1946 S IH-35, Austin, TX, 787043698, 512-443-3675. Periodicals Postage Paid at Austin, Texas and at additional mailing offices. POSTMASTER: Send address changes to TEXAS DENTAL JOURNAL, 1946 S IH 35, Austin, TX 78704. Copyright 2022 Texas Dental Association. All rights reserved. Annual subscriptions: Texas Dental Association members $17. In-state 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 Affiliated, September issue $17 ADA Affiliated, $65 NonADA Affiliated. For in-state orders, add 8.25% sales tax. Contributions: Manuscripts and news items of interest to the membership of the society are solicited. Electronic submissions are required. Manuscripts should be typewritten, double spaced, and the original copy should be submitted. For more information, please refer to the Instructions for Contributors statement printed in the 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 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 Association of the quality of value of Dental Editors and such product or of the claims made of Journalists. it by its manufacturer.

Board of Directors Texas Dental Association PRESIDENT Duc “Duke” M. Ho, DDS 281-395-2112, ducmho@sbcglobal.net PRESIDENT-ELECT Cody C. Graves, DDS 325-648-2251, drc@centex.net PAST PRESIDENT Debrah J. Worsham, DDS 936-598-2626, worshamdds@sbcglobal.net VICE PRESIDENT, SOUTHEAST Glenda G. Owen, DDS 713-622-2248, Dr.owen@owendds.com VICE PRESIDENT, SOUTHWEST Carlos Cruz, DDS 956-627-3556, ccruzdds@hotmail.com VICE PRESIDENT, NORTHWEST Teri B. Lovelace, DDS 325-695-1131, lovelace27@icloud.com VICE PRESIDENT, NORTHEAST Elizabeth S. Goldman, DDS 214-585-0268, texasredbuddental@gmail.com SENIOR DIRECTOR, SOUTHEAST Shailee J. Gupta, DDS 512-879-6225, sgupta@stdavidsfoundation.org SENIOR DIRECTOR, SOUTHWEST Richard M. Potter, DDS 210-673-9051, rnpotter@att.net SENIOR DIRECTOR, NORTHWEST Summer Ketron Roark, DDS 806-793-3556, summerketron@gmail.com SENIOR DIRECTOR, NORTHEAST Jodi D. Danna, DDS 972-377-7800, jodidds1@gmail.com DIRECTOR, SOUTHEAST Laji J. James, DDS 281-870-9270, lajijames@yahoo.com DIRECTOR, SOUTHWEST Krystelle Anaya, DDS 915-855-1000, krystelle.barrera@gmail.com DIRECTOR, NORTHWEST Stephen A. Sperry, DDS 806-794-8124, stephenasperry@gmail.com DIRECTOR, NORTHEAST Mark A. Camp, DDS 903-757-8890, macamp1970@yahoo.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

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2022 Annual Session Award Highlights Photos by Billy Callis, TDA Marketing Services Manager

TDA Awards Committee Drs Elizabeth S. Goldman, Chair, Carlos Cruz, Teri B. Lovelace, Glenda G. Owen Gold Medal for Distinguished Service: Dr Jacqueline Plemons, 2022 recipient of the Gold Medal Award, presented by 2021 TDA President Dr Debrah Worsham

Rising Star of the Lone Star: Dr Melissa Uriegas, 2022 Rising Star of the Lone Star, with 2021 TDA President Dr Debrah Worsham and Dr Joey Cazares

Outgoing Vice Presidents:

Outgoing Council Members, 2022: Council on the Annual Meeting and Continuing Education Programs—Dr Michael J. Goulding Council on Membership, New Dentists, and Students—Dr Brooke Z. Elmore, Dr Ryan D. Hyde Council on Peer Review—Dr Brian L. Britton, Dr Nadia Bahramnejad Council on Professions and Trends— Dr Matthew J. Heck

President’s Recognition Awards:

NE—Dr Carmen P. Smith, NW—Dr E. Dale Martin, SE—Dr Georgeanne P. McCandless, SW—Dr J. Ted Thompson. Each served on the TDA Board of Directors from 2019-2022.

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Mr Terry Cornwell in recognition of his outstanding performance, superior dedication, and exceptional work ethic throughout the years.

Incoming President Award:

Outgoing President Award:

Dr Duc “Duke” M. Ho of Katy assumes the presidency of the TDA at the Saturday afternoon House of Delegates. Turning the office over to him is Outgoing President Debrah J. Worsham of Center.

Dr Debrah J. Worsham of Center receives the Outgoing President’s award from Incoming TDA President Dr Duc “Duke” M. Ho of Katy at the Saturday afternoon House of Delegates.

TDA Service Recognition:

Outgoing Past President Award:

Dr Jacqueline Plemons receives the Outgoing Past President plaque from Outgoing President Dr Debrah Worsham. Dr Plemons served as president-elect, president, and past president from 2019 to 2022.

Certificates of Merit:

Several certificates of merit were present at the House of Delegates including: St. Francis Episcopal Church of San Antonio; Rev. Carrier Guerra, Living Water International, Houston

Outstanding Senior Dental Student Awards: Dr William H. Gerlach, Dr Charles M. Allen Jr, Dr Laura J. Schott, Dr Sarah P. Tovar, Dr R. Mark Peppard, Dr Robert A. Neal, Mr Donovan Osio in recognition for exemplary work developing the Dental Concierge app.

Dr David C. Woodburn in recognition for his exemplary work developing the Suction Trailer System on behalf of The Texas Dental Association Smiles Foundation.

10-Year, Good Fellow, Life, 50-Year, and 60-Year Membership Awards:

The recipients of the 10-year, Good Fellow, Life, 50-Year, and 60-Year Membership Awards will be featured in the July 2022 Texas Dental Journal.

Alliance of the TDA Service Recognition: Ms Karen Donelson received recognition for serving as president of the Alliance of the Texas Dental Association, 2021-2022.

Recipients of the TDA Outstanding Senior Dental Students Awards included Texas A&M—Erik Meckel; UT Health Houston—Dylan L. Drgac; UT Health San Antonio— Alyson Miller.

The Alliance of The Texas Dental Association with grateful appreciation for enhancing TDA’s advocacy efforts through selfless dedication and promotion of TDA’s Legislative Day events.

www.tda.org | June 2022

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ORAL

and maxillofacial pathology case of the month

Clinical History A 24-year-old white female presented to her general dentist complaining of jaw pain in the right lower quadrant from an impacted wisdom tooth. She was otherwise healthy, and her medical history was unremarkable. She was not taking any medications and reported no allergies. Her family history was negative for any developmental conditions or jaw tumors.

AUTHORS Dat T. Le, BS Dental Student, Woody L. Hunt School of Dental Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas

Angela C. Chi, DMD Professor, Woody L. Hunt School of Dental Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas

Upon clinical examination, no bony expansion was evident. All teeth in the right mandibular quadrant were vital. Radiographic examination showed a 2.5 cm radiolucency with focal radiopacities associated with the crown of an impacted right mandibular third molar (Figures 1A and 1B). The lesion was well circumscribed with partially corticated borders. In addition, there was a second radiolucency along the mesiolateral aspect of the root of the right mandibular second premolar (Figures 1A and 1C). This lesion exhibited well-defined, partially corticated borders and measured approximately 0.5 cm in maximum diameter.

lesion and lateral periodontal cyst for the second lesion.

The patient subsequently was referred to an oral and maxillofacial surgeon for extraction of the right mandibular third molar and biopsy of the 2 lesions. Based upon the clinical and radiographic findings, the surgeon’s impression was calcifying epithelial odontogenic tumor for the first

Surgical extraction of the right mandibular third molar and enucleation of both lesions were performed under local anesthesia with sedation. The third molar extraction bed was curetted thoroughly. All removed tissue was submitted for histopathologic examination.

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Corresponding Author: Angela C. Chi, DMD E-mail: angela.chi@ttuhsc.edu Disclosures: none Copyright statement: The authors warrant that the manuscript is the original work of the authors and has not been published previously, nor is it under consideration for publication elsewhere. The authors further warrant that they own all copyrights in the work, that they have not licensed any of the copyright in the work to any other person, and that the work does not infringe on any of the copyrights of any other person. In consideration of TDA’s taking action in reviewing and editing the submitted manuscript, the author hereby transfers, assigns and conveys to the TDA all of his/her copyrights in the work (including without limitation the right to publish, display, and distribute copies of the work electronically, individually, as part of a compilation or searchable database, or otherwise). In the event that the TDA declines to publish the work, the TDA will transfer, assign, and convey the copyrights in the work to the author, on the author’s written request.

Figure 1A.

Figure 1. Figure A—Panoramic radiograph and Figures B and C—periapical radiographs showing a mixed radiolucent/radiopaque lesion associated with the impacted right mandibular third molar and a radiolucent lesion associated with the mesiolateral aspect of the root of the right mandibular second premolar. Both lesions are well-defined with partially corticated borders.

Figure 1B.

Pathologic Findings Both lesions exhibited similar microscopic features. There was a proliferation of eosinophilic odontogenic epithelial

Figure 1C.

cells arranged in islands, nests, and cords (Figures 2A and 2B). Some of the epithelial islands exhibited a cribriform pattern formed by deposits of acellular, eosinophilic material;

deposits of this material also were evident within the surrounding fibrous stroma (Figures 2A and 2B). A Congo red stain showed this material to be positive with apple

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ORAL

and maxillofacial pathology, continued

green birefringence under polarized light (Figure 2C). Occasional basophilic calcifications with a concentric ring pattern (“Liesegang ring calcifications”) were noted as well (Figure 2B).

Follow-up

What is the diagnosis?

The biopsy and extraction sites healed uneventfully. There was no evidence of recurrence at a followup visit 19 months after surgery.

See page 322 for the answer and discussion.

Figure 2. Figure A—Medium power photomicrograph demonstrating islands of eosinophilic epithelial cells with associated deposits of acellular, amyloid protein (hematoxlyin and eosin stain, original magnfication 200x). Figure B—High power photomicrograph showing cords and nests of epithelial cells with scattered Liesegang ring calcifications. Amorphous amyloid material also is seen within the background. (hematoxlyin and eosin stain, original magnfication 400x). Figure C—Congo red stain of the amyloid material exhibiting apple-green birefringence under polarized light. (Congo red stain, original magnification 200x).

Figure 2A.

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Figure 2B.

Figure 2C.

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BISPHOSPHONATE THERAPY— An Important Pre-surgical Consideration 284

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BACKGROUND FACTS A 54-year-old post-menopausal accountant (Ms P) presented to an oral and maxillofacial surgeon (Dr T) on referral from her general dentist, for the removal of a vertically fractured and non-restorable lower left second molar. But for her longstanding fears about dental treatment, and her resultant desire to be “asleep” for the extraction, the general dentist would have performed the extraction himself, as it did not appear, radiographically or clinically, to be an overly difficult procedure, partly due to mild tooth mobility. Based upon the responses the patient provided on the oral surgeon’s history intake form, her only medical issues were related to laboratory outcomes, which demonstrated a moderately elevated serum calcium level, and a bone density study some 5 years prior to the current visit which revealed widespread osteopenia with focal areas of osteoporosis. As a result, she had been on a regular oral regimen of a bisphosphonate, prescribed by her primary care physician, since shortly after the diagnoses of osteopenia and osteoporosis were made.

On the day of surgery, Ms P was handed a consent form by a dental assistant, and asked to read it, after which she was to sign it. The patient had some questions regarding risks, and the assistant assured her that this form was “just for the lawyers”, so she shouldn’t be concerned.

After briefly discussing the patient’s medical history with her, the oral surgeon stated that he was not concerned with her bone condition or the medical treatment for it, especially because the monthly oral dose had been taken 20 days earlier, and because she had suffered no associated problems during her 4½ years taking the medication. A surgical appointment was scheduled for 3 days later, when the patient would be able to bring a friend to drive her home after the extraction under IV sedation. On the day of surgery, Ms P was handed a consent form by a dental assistant, and asked to read it, after which she was to sign it. The patient had some questions regarding risks, and the assistant assured her that this form was “just for the lawyers”, so she shouldn’t be concerned. The assistant added that Dr T is an excellent surgeon, so all of his patients do well and there was nothing to worry about. The patient signed the form before the doctor came into the room, and nothing was said about it or its contents www.tda.org | June 2022

285

after he arrived. A nitrous oxide/oxygen mixture was given through a nasal mask, sedatives were injected intravenously followed by local anesthesia, and the tooth was routinely delivered by forceps, after which the site was irrigated and sutured. Ms P was discharged home in the care of her friend and told to return in a week for suture removal. At that post-op visit, the patient complained of continuous, low-grade discomfort and tenderness. Dr T examined the area when he removed the suture, and noticed a sharp ledge of alveolar bone, which he reduced with a Rongeur and a bone file. Ms P was discharged and advised to return if she developed any problems or had any concerns. Two weeks later, she returned with continuing symptoms, so the site was irrigated and packed with dry-socket dressing, with a prescription given for Amoxicillin. This was followed by weekly visits, each time with increasing pain, which was repeatedly treated with the same process of irrigating and placing the sedative dressing. Approximately 3 months after the extraction, Dr T took a radiograph for the first time post-operatively, a panoramic film, and noted areas of what looked to be bony sequestra and poorly defined radiolucencies. A specimen of bone was taken and sent for pathology, with a diagnosis of “osteomyelitis vs. osteonecrosis” returned. Given the patient’s bisphosphonate history, Dr T suspected that Ms P had developed bisphosphonate-related osteonecrosis of the jaw (BRONJ), and referred to a hospital-based oral and maxillofacial surgeon, who concurred with

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the diagnosis. That surgeon performed a procedure in the hospital, uncovering the area and finding a non-displaced greenstick mandibular fracture—which had not yet worked its way to the inferior border—and necrotic bone. He aggressively excised the necrotic bone, which extended to and around the inferior alveolar nerve, and placed the patient in intermaxillary fixation for 8 weeks. Working with the patient’s primary care doctor, a regimen of antibiotics with frequent debridement intraorally was established, ultimately leading to a healed site, although she remained paresthetic permanently.

LEGAL ACTION After Ms P’s retained attorney obtained the dental and hospital records, and had an expert review them, a lawsuit was instituted against Dr T, alleging negligence and lack of informed consent. The major claims of negligence were the failure to consider and protect against the well-known effects of bisphosphonates, the failure to coordinate care with the patient’s primary care physician, and the failure to timely diagnose and act on the bony destructive process post-operatively, thereby leading to spread to the inferior alveolar nerve and paresthesia. Of particular concern was Ms P’s articulate deposition testimony regarding the issue of informed consent. The night before the extraction, she read on the internet about some potentially severe side effects after dental surgery in patients taking bisphosphonate drugs, and she had planned to discuss that concern with Dr T, but the dental assistant made the whole

process seem so routine that she felt lulled into signing the form and proceeding without further discussion. When that assistant was deposed, she acknowledged that she had no true understanding of any of the risks set forth on the form and no ability to substantively respond to any of the patient’s questions about the form contents, but she trusted Dr T and his abilities so deeply, and had heard his discussions with patients so many times, that she believed that she had acted appropriately. The assistant added two important points: that Dr T had given her permission to handle the informed consent process with patients, and, as was evident on the form itself, there was no written risk which spoke to what happened to Ms P.

CASE DEFENSE STEPS Defense counsel obtained an expert who was a board-certified oral surgeon. The expert was in full agreement with the surgical approach taken by Dr T, including that his assessment of the longstanding use of the bisphosphonate without problems was sound; that Dr T was knowledgeable enough about bisphosphonates that no consultation with the physician was initially needed, and even if obtained, nothing differently would have been done; and that repeated post-operative follow-up visits, adding the antibiotic Amoxicillin, taking a radiograph and biopsy specimen when the situation did not resolve, and referring as he did were all proper in every regard. However, the expert did not agree with the propriety of the informed consent process. www.tda.org | June 2022

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Dr T’s attorneys submitted an expert affidavit to the Court with the aforementioned opinions, in an attempt to have the negligence claim dismissed. The plaintiff’s attorney’s expert did not adequately refute the defense approach, so the negligence claim was dismissed, but the claim for lack of informed consent was allowed to stand and proceed to a jury. In the lead-up to trial, plaintiff’s counsel expressed that he did not wish to base his entire trial on the consent claim, thinking that the jury would not take it seriously enough, so he sought only to have his client reimbursed for her outof-pocket medical costs in exchange for discontinuing the lawsuit. Only upon Dr T’s agreement to do so were those settlement terms accepted, thereby ending the case.

TAKEAWAYS When obtaining a patient’s informed consent, oral surgeons and all dentists should understand that informed consent is not simply a signed piece of paper, regardless of how much detail that form contains. Consent is a give-and-take process between doctor and patient, in language and terms understood by the patient, in which the patient is advised of the benefits of, alternatives to, and the foreseeable risks associated with the planned procedure. The process must be specific to the procedure and to the individual patient, taking into account that patient’s medical, surgical, and social history; when doctors discuss risks not included on pre-printed forms, those should be documented in the chart. Obtaining informed consent is generally not delegable to a person other than

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the practitioner about to perform the procedure, although in some limited situations, a similarly trained practitioner who knows the case-specific facts may stand in for that purpose, but a dental assistant or other non-professional staff member is incapable of playing that role, as this case clearly demonstrates. In a similar vein, it is all too common for non-professional office staff to render opinions, give advice, or otherwise comment upon treatment-related issues. Practitioners must realize that they are liable for any and all consequences which may arise from the actions of their staff members, so staff training is necessary to make the members aware that they must not provide any such information or recommendations to patients, other than for entirely administrative purposes. This concept holds, as well, for telephone interactions between the patient and office members, when the practitioner is rarely present and when patients frequently ask questions about their care or condition; such inquiries must be directed to the practitioner. The concept of obtaining medical clearance from a patient’s physician is a judgment determination, but it ought to at least be considered when a patient presents with medical conditions, medication regimens, and social habits which the practitioner is either concerned about or unfamiliar with. If a dentist/oral surgeon does consult with a physician, best practices dictate that the substance of the interaction be documented, preferably with a writing directly from the physician consultant, but minimally with a detailed, contemporaneous chart entry; in

the event of subsequent litigation based upon a medical issue, such documentation will provide defense counsel with strong evidence of the dentist/oral surgeon having taken appropriate steps.

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It is not the purpose of this case study to advise as to what treatments For more information regarding MedPro are appropriate, as that is left to the Group, please call 800-677-8644 or practitioner’s judgment, but certain visit tdamemberinsure.com (Go to: For concepts—such as developing differential Dentists, Business, Professional Liability). diagnoses when problems arise, ongoing This document does not constitute determinations as to when to use legal or medical advice and should not radiographs, and be construed …it is all too common for non-professional office when to make as rules or staff to render opinions, give advice, or otherwise establishing a referrals —are best considered standard of care. comment upon treatment-related issues. with all patient Because the Practitioners must realize that they are liable for interactions. facts applicable any and all consequences which may arise from to your situation Finally, it is may vary, or the the actions of their staff members impossible to laws applicable in know what will your jurisdiction ultimately lead to case resolutions, but may differ, please contact your attorney or when insurance carriers retain defense other professional advisors if you have any counsel who are experienced and aware questions related to your legal or medical of all available approaches, oral surgeons obligations or rights, state or federal laws, and other professionals are best protected. contract interpretation, or other legal And when practitioners’ liability policies questions. allow them to decide whether or not to MedPro Group is the marketing name used settle, they control their own destinies. To help you practice more safely, MedPro Group has put together a variety of consent forms—you can review and download them at medprodental.com/ practice-more-safely. As the nation’s leading dental malpractice insurance carrier, MedPro Group has unparalleled success in defending malpractice claims and providing patient safety & risk solutions. MedPro is the

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DR DEBRAH WORSHAM TDA President’s Address to the 2022 Texas Dental Association House of Delegates May 5, 2022

Thank You, Mr Speaker. Delegates, alternate delegates, friends, family, and esteemed guests, I’m glad you made your way over the river and through the woods. That two mile drive in from the main highway could give you grief if you suffer from motion sickness, plus those blind, hilly curves could be a little scary to those not familiar with driving in the country, but God has not given us the spirit of fear, but of power, and of love, and of a sound mind.

Welcome to Buc-ee’s Backyard Playground! To those who don’t travel Highway 21 on a regular basis like Dr Roberts and I do, Buc-ee’s is just 10 miles up the road in Bastrop. For our out-of-state guests, Buc-ee’s is where Your Throne Awaits, and trust me-there’s a throne for everyone! If Texas ever decides to select a mascot, Bucky, the beaver, will probably be it.

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Let me first express my gratitude to all who supported me on this journey. Thank you for your leading questions and positive comments many years ago, and then your point blank prodding to get me to dip my toe into the water just a couple years back. Thank you for the support and encouragement received throughout this year. From the thumbs up I’ve gotten, the uplifting notes I’ve received, and the positive nods and sometimes timid, and other times robust laughter from those “I can’t believe you actually went there” moments, these all provided me with more confidence to lean into the task at hand. I couldn’t have done it without your support!

my trek across Texas has been informative and refreshing. Meeting new and different faces, seeing old faces again, learning how components are SO different and how each meet at different times on different days, some having socials, some having business meetings only, some with sit down formal dinners at country clubs with business meeting, presidential address and CE, some standing only events under a big tent in a parking lot with catered food and drink, it’s all been a most rewarding experience.

About the Third District, my district, I’ve always said we were the best little district in the state. (We’re actually a Big small district). Then over the years I gradually upgraded that description to we are the best district And since I was so nervous last year I in the state, regardless of size. (Whether almost forgot to thank my family, let me do that’s actually true or that first. … my trek across Texas has not, I don’t know, but To my husband, been informative and refreshing. shouldn’t we all think Phil, my biggest Meeting new and different faces, our district at least has the potential for cheerleader, thank seeing old faces again, learning becoming the best you for putting how components are SO different. district in the state)? up with me for For that reason alone, almost 44 years you should make sure a few dentists plus the and for “Driving Miss Daisy” to McAllen, ED from your district are registered for the Abilene, and Lubbock. To my three kids, rescheduled leadership conference on June their spouses, and my 3 grands, thank you 18th in Austin. It’s not everything you need for all your support. My youngest, Olivia, to know but there will be tons of information and the newest 10-month-old grand, on how to make your component thrive! Best August Edward, aka Auggie, are here in thing is, TDA is paying for it! the audience with Phil. And to my staff who aren’t here, thanks for holding down the But to the East Texas Dental Society, thank fort while I’ve been away. You’re the best! you for your unwavering support. When All of you are a very special and important you look at third district’s delegates today, part of my life! you quickly realize some were probably This year has definitely passed quickly! not even born, or they were infants or in From the first stop in Amarillo last year on elementary school when I was a newly May 13th (the very next week following graduated dentist and just getting started. the TDA meeting), to the last visit in Not to repeat last year’s speech, but there Corsicana on April 21st, just 2 weeks ago, ARE some new representatives in the House,

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Dr Worsham is pictured with her grandson August “Auggie” Edward, daughter Olivia Hatfield, and husband Phil at the TDA House of Delegates in Bastrop in May 2022.

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Pictured at the President’s Reception during the May 2022 House of Delegates in Bastrop are (L-R): Drs Jonathan James, Melissa Uriegas, Debrah Worsham, Jose Cazares, Michael Sullivan, and Carlos Cruz.

2021-22 TDA President Dr Debrah Worsham (center) is surrounded by previous TDA presidents at the Presidential Breakfast in Bastrop in May 2022: Front (L-R): Drs Bill Gerlach, Paul Stubbs, Jacqueline Plemons, Debrah Worsham, Joey Cazares, Craig Armstrong, Rita Cammarata; Back (L-R): Larry Spradley, Richard Smith, Don Lutes, Tommy Harrison, Richard Black, Matt Roberts, Charles Miller.

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plus more than a few of you left before my speech on Saturday afternoon and you didn’t hear it anyway! But Dr David Nichols gets the “encourage Debrah to do something” award. He is the first one to approach me and tell me I needed to be the DenPac rep and I would have to attend a few meetings in Austin, but it would be a good thing and they needed me to do it! And of course, I did exactly what he told me to do! Many of you have heard that story so many times you can tell it better than me by now, so Thank You, Dr Nichols, for bringing me into the fold my first year out of dental school! And that reminds me of good old Baylor College of Dentistry. I’ll never forget the first or second day of school when Dean Henry was “encouraging” the class. He gave statistics on the next 4 years—how many would drop out, how many wouldn’t graduate on time, but with the class behind us, how many were in our class from the class ahead of us, and how many married students would soon be divorced! I experienced my first ever panic attack that day. Our class of 140 had 40 females, a lot for back then. We were in groups of 4. I was in the very back row, in the last quad. We could have been the Fantastic Four I suppose, but it was more akin to “We’re Off To See The Wizard!” My group consisted of a girl from Heidelberg, Germany, a guy from Utah, a Brainiac Jeopardy super champion type know it all (but he really did), and me. They asked me what was that word I said and I had no idea what they were talking about until they attempted to pronounce it. They sounded like those actors trying to portray country Texas accents like mine, but sounding nothing like me! The word was “o-i-l.” I’m sure it sounded like a-w-l to them. That was our beginning….

But over the next couple years we managed to become somewhat cohesive and actually a little protective of each other. We either had to learn to respect and put up with each other or it was going to be a very long and traumatic episode in each of our lives. And so we did! On the other hand, there was another most unlikely group in the Class of 1985 that came together because we had something in common. Perfectionism on display, at its best, or worst, as this case may be. Or maybe we were just really unfocused and distracted. Nevertheless, Joey Cazares, Donna Miller, and I were in the lab all hours of the night. One from the front of the class, one from the middle, and one from the very back. We called ourselves The Lab Rats. We connected! In Crown and Bridge clinic, very early one semester, a much older doctor who had quite the reputation for being the one to avoid, said something to the effect, “So you grew up on a farm, did you?” I told him I grew up in the country, we had some land, we cut and baled hay, raised cows, showed steers in 4-H, rode horses, had gardens big enough to feed the whole county, but it wasn’t a cotton farm, nor was it a dairy, even though my dad had owned one for a few years after he married my mother, and I milked the evening shift at the SFA dairy one semester. He then proceeded to inquire about farm implements, including this question, “Do you know what a Georgia Stock is?” to which I retorted, “Well, I can’t draw one, but it’s a plow!” (You can’t make this stuff up, for real!) Why do I tell you this story about a student, a teacher, and a plow? www.tda.org | June 2022

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Even though he was caught off guard that I knew the answer, from that day forward we were colleagues and not adversaries. We made a connection! The lifeblood of any group or organization is all about relationships and connections, but that takes time to establish and develop. We have to engage long enough for it to happen. Almost exactly one year ago, Dr Folger Vallette came up to this podium and asked me if I was coming to Amarillo next week. I told him I had a plane ticket and I planned to be there. I apologized for them being my first visit and he said, “We’re always first! That’s how we like it!” I will have to say Amarillo was/is the best first district for any new and very nervous TDA president to go to. There are so many former TDA presidents from there, not to mention council members, Smiles volunteers, and their exceptional hospitality. Except for that one thing—the airport which is miles from the center of town and it has NO taxis. I know that’s not a big deal for most of you because you use Uber or Lyft, but Debrah doesn’t do that! I’m always with someone else who orders the vehicle. It was 4:30 PM and the meeting was at 6:30 I think. I‘ve landed, there are no taxis, so I began to call taxi services—they either never answered, you were to leave a message, or when one answered they told you they could be there at 7:30. Well I had no choice but to download one of those apps and I picked Lyft because it had just popped up on my phone. That was traumatic! You talk about Faith over Fear! That’s really taking your life into your hands—connecting with a total stranger. Obviously they know you are all alone or you wouldn’t be reaching out to them, and then

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you have to depend on someone you don’t know to be responsible enough to follow through with your meager request. Well I did it! And I did it again the next morning so I could get back to the airport. Folger, Folger, where were you? Plus, you weren’t even at the meeting. I remember that stuff! But I’m just telling you now, don’t even worry about Dr Ho next week though, because Dr Ho, he’s a pro at ordering ubers and lyfts! But when I finally got to their meeting, the hospitality was off the chart! Names I know…Drs David Duncan, Dick Smith, David Woodburn, Ken Crossland, and so many specialists at that meeting. Plus their spouses were there. Everyone was dressed to the nines! Food, Fellowship, and Fun! Thank you Amarillo for setting the tone for the rest of the year. But no more flying! That ended that! And then there’s Lubbock with many more leaders and a funny story. I was reciting membership statistics and after the meeting this married couple, both dentists (and I knew him from years back), had checked their membership status while I was giving my presentation and they were shocked to see that they had failed to renew their membership. But before that meeting was over, they both had re-upped their membership on their phones at their dental society meeting in a restaurant while I was talking. Afterwards, while discussing membership trends, two young dentists who were very happily employed by a DSO, reported their employer paid their TDA dues. One other item of interest is Dr Mary Glasheen’s husband, David Glasheen, is in a runoff for HD 84 on May 24th. If we

don’t have a dentist in the legislature, having a dentist’s spouse is the next best thing. Because of redistricting partially and “regular” retirements, 27 legislators chose to not seek re-election and 6 senators retired. Those are huge numbers and an opportunity for us to get to know these new folks representing us. There are more contested races than you might think in the runoff election— • 3 statewide offices: Attorney General, Land Commissioner, and Railroad Commissioner, plus • 7 Congressional seats, • 1 Senate seat, • 16 state representative seats, and a • State board of education race. Go vote on May 24th or early vote. Your DenPac dollars are at work in several of these legislative races. Houston currently has their meeting at the dental school with lots of students in attendance. What a huge opportunity for the Greater Houston Dental Society! When I traveled to San Antonio, Dean Loomer gave me a personal tour of the school. Before I could ask if he was a runner (because he’s so fit and trim), we scurried off as fast as I could walk without doing that weird race walking motion. Thank goodness I’m in pretty good shape and I wore comfortable walking shoes! We toured every state-of-the-art area, including seeing Dr Masters manning the perio department, then we ended up in a huge room with a luncheon for an entire class of students provided by the San Antonio Dental Society with Dr Richard Potter and their ED hosting the event. Thank you, Dr Loomer, for supporting organized dentistry within your school.

The life blood of any group or organization is all about relationships and connections, but that takes time to establish and develop. We have to engage long enough for it to happen. And thank you to all the educators who take the time to mentor young and expectant dental students. To those who have been educators for years, you have my deepest respect. I did not get your gift of teaching. And to those doctors who have gradually worked their way over to the dental schools for a few hours a week, Bless you! And for the dentists who have retired and sold their practices and now teach full or part time, you are especially to be commended for continuing to be involved. You could be coasting merrily along and yet because of your love of the profession and your gift of guiding others, you continue to give back whenever there’s an opportunity. You all are doing hero’s work. Think about those fertile minds waiting to be mentored, hanging onto every word of advice you offer, attending Lobby Day in DC or Legislative Day in Austin. The dividends are probably immeasurable at the present time by all accounts, but realize this - You are supporting, training, and encouraging the next group of TDA leaders as you give of yourself and as you make those connections! What we say and the attitude with which we say it matters. In back to back meetings, New Braunfels one night, then Fredericksburg the next, I met Drs Robert and David Heinrich, brothers of Dr Lisa Heinrich-Null in Victoria. Their dad was a dentist also. There’s another story for a member-focused issue of the Journal. www.tda.org | June 2022

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This past year your TDA Board of Directors discussed and made decisions revolving around member value, membership trends, and component needs. Questions like: • How is membership affected by this decision? • Is this something of value for members? • Will members receive this positively? Please remember that change is sometimes met with resistance and hesitancy, but change is inevitable if we want to continue to be relevant. As TDA embarks on what I call the TDA CE Roadshow, where TDA partners with local components to produce CE in that area, there are bound to be glitches and hiccups along the way; however, there is a lot of excitement from those districts who need and want it! District 1’s president is absolutely giddy! The Dental Concierge CE compliance app was rolled out just a few weeks ago. More docs are signing on and ordering courses, and other entities are excited about the possibility of using this platform for themselves. Stay tuned, you will hear more about this later! Plans are in the works for a new doctors only conference in a very nice and out of the ordinary resort-like area, with high quality CE courses and speakers. CAMCEP is currently spending lots of time and effort developing and planning this. In the Membership outreach campaign which ran from October through December 2021, the top 3 recruiters were Dr Duc Ho, Dr Teri Lovelace, and Dr Danette McNew. They received free TDA dues for this year. There were 132 members recruited. Thank you to everyone who participated and encouraged even one member to join.

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The council on membership initiated several new outreach programs. They hosted and developed 2 town hall diversity webinars, the first one had 38 attendees, the second one had 45 in attendance. Because of so much interest and positive feedback, another one is planned for the fall. Speaking of diversity, did you happen to notice that really cool and historic photograph in the March issue of TDA Today? That picture of all the Texas ladies in leadership? That would be the same one depicting for the first time ever there are more women than men on the TDA Board of Directors! Sorry, guys! So be it. That’s all you will ever hear me say about that. As you remember from my speech last year, (those who stayed and heard it on Saturday afternoon), I was always encouraged and really pushed to the forefront at my local component level. I suppose some of that stems from my upbringing. In my first through eighth grade country school (Excelsior School, still operating today), boys and girls played every sport together, and some of us girls were better athletes because we played with the guys. We didn’t compete against them, but we participated with them. Having four younger brothers (and one younger and mean sister whom I love dearly now), plus a daddy that said I could do whatever I wanted to do, I think that set a tone in my psyche, much like tuning an instrument. You just don’t expect things to be otherwise and so they weren’t. I’m sure you can think of those who guided you throughout your life as well, whether it was parents, grandparents, other relatives or teachers. We owe them a debt of gratitude for investing in us and offering advice along life’s way.

Female Dentists Make TDA History

For the first time in TDA history, female members of the TDA Board outnumber their male counterparts. Pictured at the February 2022 TDA Board meeting are (L-R) Dr Georganne McCandless, Dr Carmen Smith, Dr Glenda Owen, Dr Shailee Gupta, Immediate Past President Dr Jacqueline Plemons, President Dr Debrah Worsham, Executive Director Linda Brady, Dr Jodi Danna, Dr Summer Roark, Dr Teri Lovelace and Dr Elizabeth Goldman.

Pictured are the “Lab Rats,” (L-R) Drs Joey Cazares, Debrah Worsham, and Donna Miller.

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Since Mother’s Day is Sunday, I’m reminded of what a foreign-trained dentist from Egypt told me at a recent component visit in April. His mother gave him some serious advice when he told her his desire was to come to the United States to study and eventually practice. She told him to NOT get married as that would make travel difficult and it would be too hard to reach his goals. He followed her advice and after two plus years of training by way of Minnesota (that was a story in itself, the competitiveness of getting into that program), he is now a proud member of the Texas Dental Association. He loves Texas, he loves being a part of the TDA, and he loves his local Ninth District dental society! His genuinely positive personality reminds me of you, Dr Cruz! He’s looking forward to showing his parents Texas soon, as they finally get to travel abroad. And his question to me was: “How do I get involved? I’ve got to be a part of this!” In that same district, the president-elect was a dean at a dental school in another state before moving here with her husband’s job at UTMB-Galveston. I asked her why we’ve never met and it’s because they haven’t been here that long, maybe 5 years or so, but she will be president of her component in a few days. Please do not feel left out or slighted if I didn’t mention you. There are too many stories and these are just a few of the many interesting folks I’ve met. Time does not permit me to share everything and everyone I’ve encountered. However, our districts are full of people like those of us here this morning. Our components are made up of talented and eager members who are leading locally, or they are anxiously waiting to become

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involved. Do not think we are the lone rangers and do not fall into that depressive mindset of Elijah, the prophet, who told the LORD, “I am the only one left (and now they’re trying to kill me too)!” No, we’re not the only ones left. WE may be the only ones YOU know, but trust me! There ARE more! I’ve seen them, I’ve met them, I’ve experienced their zeal and excitement! They exist and they are real! This organization, the Texas Dental Association, is teeming with an abundance of dentists ready to step up and lead out—they only need to be asked! So, to the hidden gems of the Texas Dental Association, you have been discovered! Get ready to get off the bench and get in the game! We know it takes all of us engaging with our different talents and unique strengths working together in unity to be on point and laserfocused for the inevitable challenges and unavoidable changes in the future. But victory over the unexpected, whatever it is, is worth the effort we expend doing our best for our families, our patients, and our profession. Your TDA’s infrastructure is becoming stronger than ever. By leveraging the strengths of our amazing Team of Worker Bees at the central office, and by exploring ways of getting work done through a combination of new positions and strategic outsourcing, TDA continues to identify and meet the expanding needs of our members. You should be very grateful for the forward-thinking approach of our Executive Director, Mrs. Linda Brady, and you can be confident your TDA is moving in the right direction. Thank you, Mrs. Brady, and thank you to all the TDA staff. Will those of you in the audience please stand? Do you realize last year at this meeting was the first time this current TDA Board of Directors had met and “seen itself” in person? Your Board of Directors experienced the same

life events and changes as many of you this past year: • Dr Cruz lost his dad, a very famous heart surgeon in Guatemala. (Listen to his story!) • Dr McCandless lost her mom at a much too young age. • Dr Thompson became a first time grandpa with the birth of Bennie Harper. • And, Dr Martin sold his practice but he is still working, kind of. That’s so he can begin to write his book of quips and short stories, and that’s so he can conjure up ways to confound TDA presidents and others with foreign language phrases and quotes pulled from books, movies, and historical events. I hear he may be going on the circuit teaching freelance courses on IT updates, data breaches and malware, and OSHA and HIPPA training. One thing you can rest your hat on for sure—“He rides for the brand!” And that brand is TDA! Change has a way of weaving it’s way into all our lives, doesn’t it? No matter what stage of life you’re in, whether just starting out, newly retired, or somewhere in between, now is not the time to coast. It’s time to gear up and be intentional. There are “apprentices” watching your every move. It might be your children, grandchildren, colleagues, dental teams, your neighbors, or students. You are influencing others. You are making an impact on someone’s life. You are responsible for someone’s transformation. Do you have a positive influence or do you have a negative influence on others? That is the question for today. In my office I have several signs with quotes: “Get over it!” “No Whining!”

“Lack of planning on your part does not constitute an emergency on my part!” And probably my favorite: “Everyone brings joy to the office… Some when they enter, some when they leave!” Which one are you as you interact with those around you? I recently read a book entitled Gunlap, by Robert Wolgemuth. The title is taken from a long distance race where the starter fires the pistol the second time as the lead runner begins his last lap. This lap is called the gunlap. It’s a chance to leave it all on the track! Interesting concept, because we never know when that last lap might be for any of us! A quote from that book says, “We need to consider how to turn our accumulated skills and battle scars into something of real worth for the runners circling behind us.” I know those items are standard equipment for many of us! So… My prayer for you on this National Day of Prayer is to surrender a small piece of yourself to be used to equip, encourage, and challenge others on the race ahead of us. In closing, I want you to remember this famous quote about lightning bugs from the book Chasing Fireflies, A Novel of Discovery, by Charles Martin. “If God can make a firefly’s butt light up like a star, then anything is possible. Anything!” Just think what he can do with us! Thank you. It’s been an honor and a pleasure to serve this past year as your TDA president! www.tda.org | June 2022

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DR DUC “DUKE” M. HO TDA Incoming President’s Address to the 2022 Texas Dental Association House of Delegates Hyatt Regency Lost Pines Resort and Spa, Bastrop, Texas May 5, 2022

Thank you very much. I am deeply humbled and honored by this opportunity to serve you and the Association. It should come as no surprise that in dental school, I would occasionally joke about becoming president of my local component, simply to instill worry among my instructors. Ironically, that “joke” became reality in 2015, but my aspirations in organized dentistry never extended much further. Like my classmates, my singular focus at the time was to finish dental school, not to mention I just didn’t know enough about the Texas Dental Association. It wasn’t until the height of the pandemic, while helping to craft the “Returnto-Work” toolkits, that I gained an appreciation for the disconnect between our members and the critical work of this Association. At that moment, I knew it was my responsibility to run.

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Outgoing TDA President Dr Debrah Worsham receives the past president award from Incoming TDA President Dr Duc “Duke” Ho.

Drs Duc “Duke” M. Ho, Teri Lovelace, and Jacqueline Plemons share a laugh at the President’s Reception in May 2022.

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Now before I get too far ahead of myself, it’s important that I express how grateful I am for the opportunity to have worked alongside a great Board of Directors, an amazing staff and to follow 2 great Presidents: Dr Jacque Plemons and Dr Debrah Worsham. They are thoughtful, kind, extremely smart, and have a genuine passion for service and membership. Perhaps most impressively, they have managed to “tame this shrew”, which, in my humble opinion, can be no easy task. Without a doubt, I have always been a handful, but that wasn’t always the case. I grew up in Houston as a poor immigrant of a single mom. I ate mayonnaise sandwiches and slept on a pullout sofa in the living room of a 1-bedroom apartment until high school. I was somewhat of an introvert, but always cognizant of hardship, hard work and empathy. As I got older, I can say with confidence that the individual who had the most significant influence in my life was Dr Gary Welch. I started as an associate for Gary

after finishing a general practice residency and various minor employment stints. Back then, Gary had a midsize practice that treated all patients with all types of insurance—a practice model that wasn’t well received in organized dentistry or in this House. It was Gary who reinforced the simplicity of ethics in dentistry—provide quality, patient centered care, treat all patients the same (regardless of their insurance or your practice model), and trust that if you do, everything will take care of itself. As our practice has grown and the profession has changed, he was and continues to be right. Now my journey in organized dentistry resembles that of my personal life—great friends and mentors from throughout the state who have given me direction, support, and opportunities. I’m sure you know many of them, as they are likely sitting next to you. However, I would be remiss if I didn’t highlight the most important influence in my organized dentistry career: Dr Craig Armstrong. I know most of you are acutely aware of my feelings for Craig but may not understand the origins of my appreciation or why I feel this way. •

Craig was the first to ask if I would serve on the Board of Directors for the Greater Houston Dental Society—a huge leap of faith in me at that time,

Craig was the first to ask if I would serve on the Board of Directors for the Greater Houston Dental Society—a huge leap of faith in me at that time, and the first of many L-R: Dr Duc Ho, Dr Katie Stuchlik, Dr Craig Armstrong

opportunities to prove my devotion to organized dentistry. www.tda.org | June 2022

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•

and the first of many opportunities to prove my devotion to organized dentistry, He’s always provided a friendly ear and sage advice on any topic at any time, which happens to be often, And most importantly, he has taught me how to be a meaningful mentor to others, not through words, but through action.

These are traits I take seriously and practice daily. Admittedly, I am blessed because I’ve had some amazingly smart and caring people throughout my journey—from David Duncan to Tommy Harrison and Glen Hall, just to name a few—welcoming and teaching me valuable lessons which influence how I think and practice. Lessons and ideals I suspect many of you share, such as: • dentist autonomy, in all aspects of the profession, is essential • that we should not be weary of the changing dynamics of the profession but rather, embrace the potential of our future, while not erasing the successes of our past • and that we have a responsibility to the next generation of young dentists, to help them preserve the profession we love. Unfortunately, the current reality of our Association and our profession, is clear. • Texas showed the second largest growth in dentists per 100,000 population between 2010 and 2020, but our membership and our market share continues to decrease at an alarming rate

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•

During this same time, the percentage of female dentists in the workforce increased from 24 to 35 percent—a very good thing—but dental practice ownership has steadily declined over the last 15 years.

We can speculate about the causes of such, but that is a much larger and longer discussion for another day. Are these trends disheartening? Of course. And we have even more issues to tackle, including: • workforce shortages, • decreasing reimbursements, • increasing student debt, • meeting the needs of younger dentists, • and providing care for rural Texans and opportunities for rural dentists. These are difficult issues. However, we should welcome these trials and face them head on. So, how do we do this you ask? First, we need to embrace our diversity: in people and of ideas. Whether you’re rural or urban, fee for service or insurance driven, single owner or group practice, male or female, white or Asian, etc., if the betterment of the member dentist and the people they serve is our common goal, then all ideas must be welcomed. That requires active, open, and honest dialogue. However, active is the key word. We should actively seek out ideas that prioritize member value and think outside the box, unafraid to have difficult conversations, with our shared goal that more resources make it to those in need.

Dr Debrah Worsham receives the past president award from Dr Duc Ho.

Incoming TDA President Dr Duc Ho addresses the TDA House of Delegates during resolution debate.

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Fortunately, there are many more Katie’s and Laura’s inside this room and outside this hall. I know this because our own State Board of Dental Examiners approved over 1,000 dental licenses just last year! It is our responsibility to enthusiastically seek them out, nurture them and guide them through their own journeys— regardless of how or where they practice. If you are sincere about preserving and protecting the profession, then you must actively pursue those relationships and do what our mentors did for us—mindful that the key to creating early, valued mentorship is engagement, fellowship and genuine care for our younger colleagues, especially as they transition to seasoned The successes of this Association dentist. We reap what we do not happen without the sow, and if relationships of our amazing protecting the profession and legislative team at the Capitol, our patients is as well as your relationships with the fruit of our legislators at home. Don’t take our labor, then we must sow! victories for granted…

Second, we must continue to support and advance our legislative priorities through our Council on Legislative, Regulatory and Governmental Affairs. Yes, we’ve had successes! • Some big—like huge insurance reform in 2019 or being the first state to return to work in 2020 • Some still in the works—like a bill last year for additional insurance reform that made it out of committee but got hung up in Calendars • And some you will never hear of— like defeating a bill that would have mandated dentists to purchase and monitor their office AEDs through a physician We are blessed. The successes of this Association do not happen without the relationships of our amazing legislative team at the Capitol, as well as your relationships with legislators at home. Don’t take our victories for granted and remember, this did not happen overnight. It can end— literally—in time or money, is vital to that success. Third, we must continue to teach and mentor the next generation of young dentists. I am often in awe when I’m around Dr Katie Stuchlik and Dr Laura Schott. As mentees, they have embraced both organized dentistry and those who have paved the way for them to succeed. They understand the very important accomplishments of the past but are also eager to carry the Association forward.

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Lastly, we must continue to encourage participation. Service beyond the four walls of your practice matters, whether here or in: • the Academy of General Dentistry, • the Hispanic Dental Association, • the National Dental Association, • the American Association of Women Dentists, • and the TDA Smile’s Foundation, just to name a few. While we’re at it, get your spouse to serve on the Alliance for the Texas Dental Association, as they have done so many great things to support us!

Serve! More importantly, ask others to serve, as there are many just waiting for the opportunity to give of themselves! And contrary to what you may have been told before, this is not a dichotomy. We are not competing against one another. We have so much more in common than our differences, so don’t let anyone tell you otherwise! Now, specific to where we are today: this is your House, your voice matters, and change starts with you. We heard members share concerns that CE requirements for licensure were very confusing, so we developed an App which will track CE personalized to your needs, has classes to fulfill your specific requirements, and help you stay in compliance to protect your license. In addition, and as shared by our Executive Director earlier: • we are re-envisioning how meetings are held, while also reexamining how education and networking is provided for our members • we are working on providing you with a competitively priced PPO Health Insurance Plan that is available only to member dentists and their staffs, regardless of size • legislatively, we will continue to tackle issues like insurance reform, reducing administrative burdens, seeking higher reimbursements and much more • and immediately at the close of this House, your Board will meet to discuss additional options available to address the daily difficulties many of you experience as a result of staffing shortages in your practice This is just the start, but we need to hear more from you. Participate and be vocal. To that end, I want to make myself available to you. Feel free to call, text, or email

me to share your ideas, thoughts, and concerns. Don’t be that silent bystander who waits for people to come to them or who uses “keyboard courage”, but rather, be a supportive participant, active and engaged—working alongside one another, while we continue to bring more value to each member together. We may not always agree, but we will always be better for it. I finish with this thought. I appreciate the importance of being the youngest and first Asian President of the Texas Dental Association, and the significance of such is not lost on me. However, this organization exists to serve you, not me. “Member value” is not just a phrase, it is a belief and a conviction that I live every day. I know the elevator speech. I have enough enthusiasm and confidence for all of us, but also enough humility to know that I am very flawed and do not have all the answers. So, I will lean on each of you. I want to be the bridge between an amazing past filled with incredible leaders, to an awesome future overflowing with young trailblazers who will protect what was built, while eagerly moving us onward. We have a choice: to simply reflect on our past or define our future. So, I recognize it’s my duty to pay it forward. I want young dentists to be exposed to as many great leaders as possible, learn as much as possible, and have as many opportunities, new friendships, and lasting memories as possible! I want them to succeed so that they can protect the profession which has blessed each of us. And we will succeed if each of us embraces our role and responsibility. Yes, each of us has a role and responsibility. So, engage, participate and be vocal! I promise you; we will accomplish these goals if we work alongside one another. Thank you. www.tda.org | June 2022

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DR CRAIG ARMSTRONG ADA 15th District Trustree Address to the 2022 Texas Dental Association House of Delegates Hyatt Regency Lost Pines Resort and Spa, Bastrop, Texas May 5, 2022

Thank you, Mr Speaker, delegates, alternates, and distinguished guests. It’s great to see everyone here today and to be able to speak to you all in person. Last year in San Antonio we all heard an emotional speech by our then ADA President elect Dr Cesar Sabates. Cesar is the first to admit that it doesn’t take too much for him to shed a tear. He’s an emotional guy. I think that’s because he cares so much about our profession and everyone that he comes into contact with he considers them part of his “family”. It’s the way he lives each day and it’s just who he is.

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ADA 15th District Trustee Dr Craig Armstrong addresses the TDA House of Delegates in May 2022.

Dr Craig Armstrong with 2022 Rising Star of the Lone Star Dr Melissa Uriegas.

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From the day he took office he has attempted to instill a sense of family on the Board of Trustees along with a culture of respect. It was only logical that the choice for our Board retreat would be Disney World in Orlando where he encouraged the trustees to bring their families with them. You see, Disney is Cesar’s “happy place”, a place where family matters most and he wanted us to experience that. Because of the family atmosphere our Board has been a better place in which to conduct the business of the Association. While we don’t always agree with one another, the difference now is we are treating each other with respect, we are truly behaving like a functional family. My friends, 2 weeks ago, someone attacked our family. Our family experienced a cybersecurity incident that until now had been unimaginable. To say that communication regarding this event has been challenging is an understatement. Trying to get information out in a timely manner, balancing the need to inform you and me, part of the family, while maintaining the vigilant protocols recommended by our external cybersecurity specialists has been almost impossible and has left many of us with more questions than answers. But rest assured that the incident is under an ongoing investigation and our ADA IT staff and third-party cybersecurity personnel are literally working around the clock to resolve the situation and are making progress and we thank you for your patience and understanding as we work through this event.

The ADA family is a resilient one, we have come through a pandemic together, and I am confident that we will make it through the current situation and our family will be stronger than ever. In my opinion, one of the things that has made us stronger has been the addition of our new executive director, Dr Raymond Cohlmia. He has been on the job just under 6 months. I like to say that the ADA has been infected by a fever, “Cohlmia fever.” Many of us have known Raymond Cohlmia for many years. We knew him when he was a private practicing dentist and more recently as Dean of University of Oklahoma College of Dentistry. We knew his dad, Papa Ray, a great leader in organized dentistry and many know his brother Matt who serves on CGA with Dr Roberts, and his many cousins that are dentists in Oklahoma and Texas. He is one of us! He eats, sleeps, and breathes dentistry, and he is committed to helping us turn our organization around. Membership has long been a subject near and dear to his heart, serving as chair of the Council on Membership in 2006 to 2007. Currently our membership market share is hovering around the 59% mark nationally, with lagging segments that include women, racially and ethnically diverse dentists, dentists practicing within DSOs, and new dentists. For the last 12 years we have watched as membership market share has dropped year after year. At this rate in 10 years, we will be below the 50% mark and will no longer be able to tell www.tda.org | June 2022

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lawmakers that we represent the majority of dentists in this country.

delivering customizable messaging based on individual needs, and ensuring that members aren’t inundated weekly with emails that are of no interest to that particular member and communicating with them via their preferred method of communication.

While I one hundred percent agree we must address these lagging segments to ensure our future success, I also maintain that we must also not forget about those members that have been our loyal dues paying members Other items for 15, 20, or even he mentioned Currently our membership market 25 years. I fear included a loyalty share is hovering around the 59% that while the lion reward program mark nationally, with lagging share of our efforts for members segments that include women, are directed at this along with the millennial cohort, development racially and ethnically diverse we are at risk for of an ADA app dentists, dentists practicing within losing many of our that would put DSOs, and new dentists. longtime members everything the ADA that have carried has to offer at your the water for this organization for years. fingertips. And lastly, he spoke about the We must do a better job of addressing the need for the ADA to become a nimbler needs of all our members. organization and adoption of an agile form of governance in order to be more When the board of trustees interviewed responsive in a timelier manner. Raymond, he made a statement that still resonates with me today. Honestly, in my wildest dreams, I never imagined the words agile or nimble and He said, If you all want to have a market the ADA would ever be mentioned in the share below 50%, keep doing the things same sentence. you have been doing for the last 12 years, you are right on track. While Raymond by all accounts is a strong personality, and for some that was a But if you want to turn membership concern, but from our first interview with around and shift our focus directly to the him he acknowledged something that member, he said, I can help you get there. was a 180-degree change from what we I have a plan and with your support and have had in the past. He said, “I work for approval, we can turn the tide at the ADA. you, it’s not the other way around.” How refreshing to hear that from him and what He talked about mission-based a novel concept? accountability, ensuring that the customer/ member is our focus. He also spoke of direct-to-the-member engagement,

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I would like to share with you a quote by John Maxwell that I feel is very apropos for us right now.

The pessimist complains about the wind. The optimist expects it to change. The leader adjusts the sails. In order to accomplish some of the things that I just mentioned, we are going to have to adjust the sails. A quick word about the financial health of the ADA. We are in a good place; our reserves are healthy and our financial portfolio while down due to current market fluctuations, have been well positioned by our financial consultants to account for the period of anticipated volatility we are experiencing and are actually faring very well. I would like to take a moment to acknowledge the leadership of Dr Linda Edgar as chair of the Budget and Finance Committee. Working in conjunction with our internal and external finance teams, she has done an exemplary job of managing the assets of this association. It has been a pleasure to serve on the Budget and Finance Committee with her these last 3 years. I will have big shoes to fill next year when I take over as the chair. Thank you so much, Linda. I have previously reported that the ADA is in the midst of a digital transformation that has been in progress for a couple of years now and this new direction dovetails well into this process that is already in place.

I am happy to report that during the April Board meeting, the board approved a package to replace the current account management system (AMS) Aptify, along with all of our customer management systems. The new system provides, not only better performance, but a much stronger level of security to prevent the kind of activity like you all have seen in the last 2 weeks from occurring. We are going to have to spend some money to replace our systems, and it will come with a hefty price tag but while envisioning a brighter future, we will be able to deliver laser focused messaging to our members with a level of customizable messaging and services that has never been possible before. Our April 2022 Board of Trustees meeting started out with a joint session with the New Dentist Committee. Led by an outside facilitator, the group engaged in a shared vision activity to determine what the inclusion of new dentists in the ADA leadership structure could look like 3 to 5 years down the road. We broke into small groups to identify barriers and opportunities and potential solutions were discussed. We came up with a list of next steps for consideration to move this vision forward into reality. Dr Seth Wallbridge, the chair of the New Dentist Committee, who now sits on the Board of Trustees as a voting member, shared his enthusiasm for the exercise on behalf of his committee.

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ADA 15th District Trustee Dr Craig Armstrong is pictured with 2021-22 TDA Past President Dr Jacqueline Plemons.

Dr Craig Armstrong yields the microphone during the a candidate’s forum at the May 2022 House of Delegates.

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Health Equity has become and is an important issue for the ADA. The Council on Advocacy for Access and Prevention, lead by its chair, Dr Shailee Gupta put together a presentation to the Board of Trustees.

I would like to present you with a legislative update starting with information about Lobby Day.

Dr Shailee Gupta

Lobby Day was held in Washington DC on March 20-22. We had over 400 attendees attend our first in-person Lobby Day since 2019. Student participation was incredible, we had over 25 students from Texas. A special thank you to the deans at Houston and El Paso for allowing these students to participate.

Those of you in the House last year may recall that it passed a resolution further defining oral health equity from our previous policy definition.

ELSA, Student Debt Reform, and the DOC Access Act were all lobbied again this year with ELSA passing in the House the following day with a vote of 310-110.

One of the questions that Dr Gupta asked during her presentation was “What does health equity look like in the dental world?”

In somewhat of a departure from years past, an open forum was held with the members of the New Dentist Committee and ASDA and it provided some great insight, so much so that more collaborations are in the works.

She presented 3 scenarios that answered that question and example of how we can help include: • Lowering barriers to care through Medicaid reform and health literacy programs. • Promoting Dental Careers for Underrepresented Populations by reaching out to the NDA/HAD and SAID and reaching middle school students through their “Lessons in A Lunchbox” program. • And by providing dental homes through the use of the CDHC program and increasing our Medical-Dental collaborative relationships.

One of the issues that our congressional lobby team has been working on is adult Medicaid. They are working with Senator Ben Cardin D-MD and other supporters to advance the Medicaid Dental Benefit Act through Congress. The ADA is also supporting a similar bill in the House. Additionally, our congressional lobby team is working with proponents in both the House and Senate to advocate for added changes to help ensure that the Medicaid program is implemented in a way that is advantageous for the dental profession and patients.

Thank you, Dr Gupta, for your presentation!

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An issue that has great implications to a lot of our new dentists is student debt reform. Senators Jacky Rosen D-NV and John Boozman R-AR, introduced the REDI Act in February, as you recall our very own Dr Brian Babin has been the lead on this bill in the House but this is the first time that this bill has been introduced in the Senate. We are supportive of this bill and are working collaboratively with other groups. And lastly, some information about one of one of my favorite topics. Dental Insurance Reform. Working with State Public Affair Dollars dedicated to fighting third party payors, we are making tremendous progress nationally. I am happy to report that 18 states enacted 28 Dental insurance reform laws in 2021 and the 2022 legislative session is in full swing and already 50 dental insurance reform laws have been filed. This is a perfect example of what the ADA is doing that benefits us all at the local level. This year Texas has the privilege of hosting SmileCon 2022. It is being held in Houston October 13-15, with the House of Delegates meeting Saturday, October 15th and concluding Tuesday, October 18th. Please mark it on your calendar, we want to make sure we have a great showing for our out-of-town visitors.

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You will hear more about this from Bob Skinner, chair of the meeting but I wanted to let you know that registration opens June 1st. I would like to thank the Chair of Local Arrangements Dr Goulding and his team for all the hard work they are putting in to ensure the rest of the country experiences the best in Texas hospitality. Lastly, I would like to thank all of you for your commitment to dentistry in the state of Texas and to say that I am so very proud of all our council and committee members that are serving at the ADA. It is an honor to serve with such a talented group of Texas Leaders. Thank you so much for the honor of serving as your ADA Trustee.

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and maxillofacial pathology diagnosis and management—from page 280

Calcifying Epithelial Odontogenic Tumor, Multifocal Discussion The calcifying epithelial odontogenic tumor (CEOT) (or “Pindborg tumor”) represents a rare, benign odontogenic neoplasm. Its exact histogenesis is uncertain, although an origin from the stratum intermedium or dental lamina has been proposed.1 The tumor exhibits a predilection for the posterior mandible, with a peak age at diagnosis in the 4th decade and no significant gender predilection.2,3 Most patients exhibit a painless, slowly enlarging swelling. The majority of cases are intraosseous, although peripheral (i.e., gingival soft tissue) lesions also are possible. Radiographic examination shows a unilocular to occasionally multilocular radiolucency, often with associated opacification. Other possible findings include cortical bone resorption or perforation

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and tooth displacement.2 Many examples develop in association with an impacted tooth, especially a mandibular molar.1 The differential diagnosis for a mixed radiopaqueradiolucent lesion associated with the crown of impacted tooth may include other odontogenic tumors that produce calcification, including calcifying odontogenic cyst, ameloblastic fibro-odontoma, and adenomatoid odontogenic tumor. Ameloblastic fibroodontoma and adenomatoid odontogenic tumor tend to occur in somewhat younger patients compared to CEOT. Both CEOT and ameloblastic fibro-odontoma exhibit a predilection for the posterior mandible. In contrast, adenomatoid odontogenic tumor most often occurs in the anterior maxilla, and the calcifying odontogenic cyst exhibits an approximately even distribution between the maxilla and mandible. In

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addition, depending on the amount of calcification, some CEOTs may appear entirely radiolucent. In the present case, the lesion in the mesiolateral root area of the mandibular second premolar appeared entirely radiolucent, and the radiographic differential diagnosis included primarily a lateral periodontal cyst or odontogenic keratocyst. As exemplified by the current case, typical microscopic findings of CEOT include a proliferation of eosinophilic epithelial cells with associated pools of an amyloid protein. This material exhibits applegreen birefringence with Congo red staining and may form basophilic, lamellar calcifications (Liesegang ring calcifications). Investigators have identified odontogenic ameloblast-associated protein (ODAM) within the amyloid deposits of CEOT; this protein has been implicated in

ameloblast differentiation and tooth development.4,5 Pleomorphism at times may be observed among the tumor cells in CEOT but should not lead to misdiagnosis as malignancy. Unusual histomorphologic variants include clear cell, microcystic/cystic, and noncalcifying Langerhans cell-rich types.6-9 The latter also may be classified as the amyloid-rich variant of central odontogenic fibroma. Treatment of CEOT may range from enucleation or curettage for smaller lesions to resection for larger, more aggressive lesions. Although CEOT is a benign neoplasm, there is the potential for locally aggressive behavior. Malignant transformation is extremely rare.10 In their review of more than 300 previously reported cases, Chrcanovic and Gomez noted an overall recurrence rate of 12%, with recurrence varying by treatment rendered (24% for lesions treated by excision or curettage, 15% for lesions treated by enucleation, 0% for lesions treated by marginal resection, and 8% for lesions treated by

segmental resection).2 Given the possibility of recurrence, periodic clinical and radiographic follow-up is advisable. Multifocal CEOT is a rare phenomenon. A review of the English language literature reveals only 9 prior cases, with the number of lesions per patient ranging from 2 to 13.11-19 All cases represented synchronous lesions except for that described by Sedghizadeh et al.12 Affected patients exhibited intraosseous and/or extraosseous lesions. The clinical and radiographic features of the individual lesions seen in these multifocal cases were similar to those of isolated lesions. One patient also exhibited a concurrent squamous odontogenic tumor.19 No syndromic associations have been noted. One might speculate whether underlying genetic mutations could account for the development of multifocal CEOT, although currently little is known about the molecular etiopathogenesis of CEOT. Interestingly, somatic mutations in PTCH1—a

tumor suppressor gene that maps to chromosome 9q— have been demonstrated in two cases of localized CEOT.20 This gene participates in the Sonic hedgehog pathway, which has functions in tissue patterning and odontogenesis. PTCH1 mutations also have been detected in other pathologic conditions, such as the nevoid basal cell carcinoma syndrome (a heritable condition characterized by multiple odontogenic keratocysts of the jaws, cutaneous basal cell carcinomas, palmar/ plantar pits, skeletal abnormalities, and, rarely, medulloblastoma) as well as sporadic cases of odontogenic keratocyst, basal cell carcinoma, and medulloblastoma.20,21 In addition, in a small number of CEOT cases, investigators have detected mutations in various other genes, including AMBN, PTEN, CDKN2A, MET, and JAK3.22,23 However, the significance, if any, of mutations identified thus far is uncertain, and further studies are needed.

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and maxillofacial pathology, continued

REFERENCES: 1.

Neville BW, Damm DD, Allen CM, Chi AC. Calcifying epithelial odontogenic tumor (Pindborg tumor). Oral and Maxillofacial Pathology. St. Louis: Elsevier; 2016. p. 666-68. Chrcanovic BR, Gomez RS. Calcifying epithelial odontogenic tumor: an updated analysis of 339 cases reported in the literature. J Craniomaxillofac Surg 2017;45(8):1117-23. Ruddocks LA, Fitzpatrick SG, Bhattacharyya I, Cohen DM, Islam MN. Calcifying epithelial odontogenic tumor: a case series spanning 25 years and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2021;131(6):684-93. Kestler DP, Foster JS, Macy SD, et al. Expression of odontogenic ameloblast-associated protein (ODAM) in dental and other epithelial neoplasms. Mol Med 2008;14(5-6):318-26. Lee HK, Park JT, Cho YS, et al. Odontogenic ameloblastsassociated protein (ODAM), via phosphorylation by bone morphogenetic protein receptor type IB (BMPR-IB), is implicated in ameloblast differentiation. J Cell Biochem 2012;113(5):175465. Tseng CH, Lu PH, Wang YP, et al. Non-calcifying Langerhans cell rich variant of calcifying epithelial ddontogenic tumor and amyloid rich variant of central odontogenic fibroma: a unique entity or a spectrum? Front Oral Health 2021;2:767201. Sanchez-Romero C, Carlos R, de Almeida OP, Romanach MJ. Microcystic calcifying epithelial odontogenic tumor. Head Neck Pathol 2018;12(4):598-603. Chi AC, Neville BW. Odontogenic cysts and tumors. Surg Pathol Clin 2011;4(4):1027-91.

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14.

15.

Siriwardena B, Speight PM, Franklin CD, et al. CEOT variants or entities: time for a rethink? A case series with review of the literature. Head Neck Pathol 2021;15(1):186-201. Demian N, Harris RJ, Abramovitch K, Wilson JW, Vigneswaran N. Malignant transformation of calcifying epithelial odontogenic tumor is associated with the loss of p53 transcriptional activity: a case report with review of the literature. J Oral Maxillofac Surg 2010;68(8):1964-73. Chomette G, Auriol M, Guilbert F. Histoenzymological and ultrastructural study of a bifocal calcifying epithelial odontogenic tumor. Characteristics of epithelial cells and histogenesis of amyloid-like material. Virchows Arch A Pathol Anat Histopathol 1984;403(1):67-76. Sedghizadeh PP, Wong D, Shuler CF, et al. Multifocal calcifying epithelial odontogenic tumor. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104(2):e304. Abrahao AC, Camisasca DR, Bonelli BR, et al. Recurrent bilateral gingival peripheral calcifying epithelial odontogenic tumor (Pindborg tumor): a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108(3):e66-71. de Oliveira MG, Chaves AC, Visioli F, et al. Peripheral clear cell variant of calcifying epithelial odontogenic tumor affecting 2 sites: report of a case. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107(3):407-11. Tarsitano A, Agosti R, Marchetti C. The diagnostic and surgical management of a multifocal calcifiyng epithelial odontogenictumor in the mandible and maxilla associated with a squamous odontogenictumor: first reported case in the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2012;113(4):e6-e11.

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16. Ibituruna ACH, Costa ARGF, Paulo LFB, et al. Multiple calcifying epithelial odontogenic tumor: case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2019;128(3):268-72. 17. McCloy R, Bacaj P, Bouquot JE, Qari H. Thirteen synchronous multifocal calcifying epithelial odontogenic tumors (CEOT): case report and review of the literature. J Oral Maxillofac Surg 2021;79(10):2078-85. 18. So BB, Carrard VC, Hildebrand LC, Martins MAT, Martins MD. Synchronous calcifying epithelial odontogenic tumor: case report and analysis of the 5 cases in the literature. Head Neck Pathol 2020;14(2):435-41. 19. Tarsitano A, Agosti R, Marchetti C. The diagnostic and surgical management of a multifocal calcifiyng epithelial odontogenic tumor in the mandible and maxilla associated with a squamous odontogenic tumor: first reported case in the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113(4):e6-11. 20. Peacock ZS, Cox D, Schmidt BL. Involvement of PTCH1 mutations in the calcifying epithelial odontogenic tumor. Oral Oncol 2010;46:387-92. 21. Barreto DC, Gomez RS, Bale AE, Boson WL, De Marco L. PTCH gene mutations in odontogenic keratocysts. J Dent Res 2000;79(6):1418-22. 22. de Sousa SF, Diniz MG, França JA, et al. Cancer genes mutation profiling in calcifying epithelial odontogenic tumour. J Clin Pathol 2018;71(3):279-83. 23. Perdigao PF, Carvalho VM, L DEM, Gomez RS. Mutation of ameloblastin gene in calcifying epithelial odontogenic tumor. Anticancer Res 2009;29(8):30657.

CELEBRATING 30 YEARS

Experience Matters Since 1992, our firm has worked with hundreds of dentists to facilitate their practice sales and appraisals. We look forward to many more years of representing clients and providing smooth transitions for dental practices all over Texas.

www.tda.org 469-222-3200 | watsonbrowninc.com

| June 2022

325

ADVERTISING BRIEFS PRACTICE OPPORTUNITIES ALL TEXAS LISTINGS FOR MCLERRAN & ASSOCIATES: To request more information on our listings, please register at www. dentaltransitions.com or contact

Opportunities Online at TDA.org and Printed in the

Texas Dental Journal ADVERTISING BRIEF INFORMATION DEADLINE Copy text is due the 20th of the month, 2 months prior to publication (ie, January issue has a due date of November 20.)

us at 512-900-7989 or info@ dentaltransitions.com. AUSTIN (ID #538): State-of-the-art GD practice located in one of the most popular areas of Austin with great visibility in a busy retail center that draws over 30 new patients per month. The 2,700 sq ft office features 6 total operatories (3 fully equipped) with modern finish out, digital radiography, paperless charts, a digital pano, and iTero scanner. AUSTIN-WEST (ID #539): 100% fee-for-service practice in the Texas hill country with strong hygiene recall (approximately 30% of total production) and an increasing revenue trend over the past 3 years.

MONTHLY RATES

The practice is located in a free-

PRINT: First 30 words—$60 for ADA/TDA members & $100 for non-members. $0.10 each additional word.

fully equipped operatories, newly

ONLINE: $40 per month (no word limit). Online ads are circulated on the 1st business day of each month, however an ad can be placed within 24 business hours for an additional fee of $60.

standing building that features 3 installed computers in each room, digital sensors, hand-held x-ray units, practice management software (Dentrix Ascend), and paperless

SUBMISSION

charts. The real estate is also for sale.

Ads must be submitted, and are only accepted, via www.tda.org/Member-Resources/TDAClassified-Ads-Terms. By official TDA resolution, ads may not quote specific incomes or revenues and must be stated in generic terms (ie “$315,000” should be “low-to-mid-6 figures”). Journal editors reserve the right to edit and/or deny copy.

EAST TEXAS (ID #486): Located in

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Texas Dental Journal | Vol 139 | No. 6

a growing east Texas community, this general practice caters to a dedicated multi-generational active patient base. The well-appointed 2,500 sq ft space

contains 5 fully equipped operatories,

building situated on a high traffic

digital pano, plumbed nitrous, and

street in a desirable community in

computers throughout. EAST TEXAS

the heart of east Texas. The practice

(ID #489): This highly profitable,

has realized annual revenue of 7

general dentistry practice & real estate

figures with exceptional profitability.

is located in an east Texas town.

The office features a 4-chair ortho

The practice serves a large FFS/PPO

bay, 2 exam rooms, and digital Pan/

patient base and is on pace to exceed

Ceph unit. The real estate is also

7 figures in revenue in 2021 while

available for purchase. HOUSTON-

maintaining a 45%+ profit margin. The

EAST (ID #483): 100% FFS GD

office has 3 fully equipped operatories

practice and real estate. Situated in

with possible room for expansion,

a 2,200 sq ft, free standing building

digital radiography, and computers

with 5 fully equipped operatories.

throughout. EAST TEXAS (ID #542):

Hygiene production is very healthy and

Large practice and real estate in

the practice has seen 1,700+ active

east Texas with over 7 figures in

patients in the last 24 months with a

revenue. The recently updated 2,400

steady new patient flow. HOUSTON-

sq ft facility features 5 fully equipped

NORTHEAST (ID #488): FFS/PPO

operatories with digital radiography,

practice and real estate, growing

paperless charts, CBCT, digital pano,

suburb 45 minutes northeast of

and an iTero digital scanner. The

Houston. 1,800 total patients, steady

practice serves a large FFS/PPO, multi-

flow of new patients, solid hygiene

generational patient base with over

recall, and consistent revenue of

3,000 active patients and a stellar

high-6 figures per year. The office

online reputation. The seller is open

contains 6 fully equipped operatories,

to providing a long-term transition

plumbed nitrous, digital X-rays,

period to the buyer. HOUSTON,

CBCT, and computers throughout.

ORTHODONTICS (ID #480): This

HOUSTON-NORTH (ID #493):

productive, FFS orthodontic practice

100% fee-for-service practice located

occupies an attractive free-standing

north of Houston in the high growth

www.tda.org | June 2022

327

ADVERTISING BRIEFS area of Spring/The Woodlands.

a primarily FFS orthodontic practice in

The office occupies a spacious,

north central San Antonio. The facility

standalone office condo and features

has a modern feel and is equipped

5 fully equipped operatories, digital

with a 3-chair open bay, 2 additional

technology, computers throughout,

private treatment rooms, and digital

and 2 plumbed operatories prepared

radiography. In 2021, revenue was

for future expansion. This is an

high-6 figures with strong net cash

excellent opportunity to purchase a

flow. The practice has been a staple

successful legacy practice poised for

in the community with over 40

growth. HOUSTON, PERIODONTAL

years at its present location and is

(ID #494): Located in a growing

located near several highly desirable

suburb South of downtown Houston.

neighborhoods. To request more

There are 5 fully equipped operatories,

information on our listings, please

digital radiography, computers

throughout, and a 3D Cone Beam

com or contact us at 512-900-7989 or

CT in the well-appointed 2,400 sq ft

info@dentaltransitions.com.

modern space. Annual revenues are around 7 figures, and the owner is

HOUSTON, PERIODONTAL (ID

open to a phased transition in which

#H494): Located in a growing suburb

they provide support to the incoming

south of downtown Houston. There are

buyer to ensure they are set up for

5 fully equipped operatories, digital

long term success. HOUSTON (ID

radiography, computers throughout,

#541): Growing FFS/PPO practice

and a 3D Cone Beam CT in the well-

in central Houston located in a

appointed 2,400 sq ft modern space.

professional building. Revenue is over

Annual revenues are around seven

mid-6 figures, new patient flow is

figures, and the owner is open to

healthy at over 20 per month and all

a phased transition in which they

endo, perio, and implant placement

provide support to the incoming

is being referred to specialists. SAN

buyer to ensure they are set up for

ANTONIO, ORTHODONTIC (ID

long term success. SAN ANTONIO-

#547): Rare opportunity to purchase

WEST (ID #T454): General dental

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Texas Dental Journal | Vol 139 | No. 6

ADVERTISING BRIEFS practice plus real estate, located in

BAYTOWN: Dental practice for sale.

a rural community approximately 75

Doctor retiring. Four ops, digital X-ray,

miles west of San Antonio. Serves

computerized (Dexis/Adec), excellent

a PPO/FFS patient base, sees about

gross (midrange) and collections on

30+ new patients per month, and

3.5 days a week. Good location next

offers consistent annual revenue

to Methodist Hospital. Office building,

with substantial upside potential

loyal staff of 3 (full-time hygienist).

through expanding the procedures

Will consider associate with intention

offered in-house. The turn-key office

to buy. Contact docboehme@yahoo.

features 3 fully equipped operatories,

com.

digital sensors, intra-oral cameras, and a digital pano. SAN ANTONIO

BEAUMONT: GENERAL (REFERENCE

(ID #T531): GD practice in a high

“BEAUMONT”). Small town practice

visibility retail center along a major

near a main thoroughfare. 80 miles

interstate in northwest San Antonio.

east of Houston. Collections in 7

The office features 4 operatories,

figures. Country living, close enough to

digital radiography, CBCT, digital

Houston for small commute. Practice

scanner, and paperless charts.

in a stand-alone building built in

Uniquely placed near the intersection

1970. The office is 1,675 sq ft with

of two major interstates in a retail

4 total operatories, 2 operatories

center with a major anchor tenant,

for hygiene and 2 operatories for

this location offers tremendous growth

dentistry. Contains, reception area,

opportunities for a buyer to capitalize

dentist office, sterilization area, lab

on the surrounding foot traffic and

area. Majority of patients are 30 to

visibility. To request more information

65 years old. Practice has operated at

on our listings, please register

this location for over 38 years. Practice

at www.dentaltransitions.com or

sees patients about 16 days a month.

Collection ratio of 100%. The practice

dentaltransitions.com.

is a fee-for-service practice. Building is owned by dentist and is available for sale. Contact Christopher Dunn at 800www.tda.org | June 2022

329

ADVERTISING BRIEFS 930-8017 or Christopher@DDRDental.

dental procedures. Office open 3-1/2

com. HOUSTON (SHARPSTOWN AREA):

days a week. Practice area is owned

GENERAL (REFERENCE “SHARPSTOWN

by dentist and is available for sale.

GENERAL”). MOTIVATED SELLER.

Contact Christopher Dunn at 800-930-

Well established general dentist

8017 or Christopher@DDRDental.com.

with high-6 figure gross production. Comprehensive general dentistry in

HOUSTON AREA: Several acquisition

the southwest Houston area focused

opportunities in the greater

on children (Medicaid). Very, very

Houston area. General, ortho, pedo

high profitability. 1,300 sq ft, 4

practices available for sale. Visit

operatories in single building. 95%

lonestarpracticesales.com or email

collection ratio. Over 1,200 active

houstondentist2019@gmail.com.

patients. 20% Medicaid, 45% PPO, and 35% fee-for-service. 30% of

HOUSTON, COLLEGE STATION, AND

patients younger than 30. Office open

LUFKIN (DDR DENTAL Listings).

6 days a week and accepts Medicaid.

(See also AUSTIN for other DDR Dental

Contact Christopher Dunn at 800-

listings and visit www.DDRDental.

930-8017 or Christopher@DDRDental.

com for full details. LUFKIN: GENERAL

com. HOUSTON (BAYTOWN AREA):

practice on a high visibility outer

GENERAL (REFERENCE “BAYTOWN

loop highway near mall, hospital and

GENERAL”). MOTIVATED SELLER.

mature neighborhoods. Located within

Well established general practice

a beautiful single-story, free-standing

with mid-6 figure gross production.

building, built in 1996 and is ALSO

Comprehensive general dentistry in

available for purchase. Natural light

Baytown on the east side of Houston.

from large windows within 2,300 sq

Great opportunity for growth! 1,400

ft with 4 operatories (2 hygiene and

sq ft, 4 operatories in single story

2 dental). Includes a reception area,

building. 100% collection ratio. 100%

dentist office, a sterilization area, lab

fee-for-service. Practice focuses on

area, and break room. All operatories

restorative, cosmetic and implant

fully equipped. Does not have a

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Texas Dental Journal | Vol 139 | No. 6

ADVERTISING BRIEFS pano but does have digital x-ray.

the ownership in the building with

Production is 50% FFS and 50% PPO

the practice. One office currently in

(no Medicaid), with collection ratio

use by seller. 60% of patients age 31

above 95%. Providing general dental

to 80 and 20% 80 and above. Four

and cosmetic procedures, producing

operatories in use, plumbed for 5

mid-6 figure gross collections. Contact

operatories. Digital pano and digital

Christopher Dunn at 800-930-8017

X-ray. Contact Christopher Dunn

or Christopher@DDRDental.com and

at 800-930-8017 or christopher@

reference “Lufkin General or TX#540”.

ddrdental.com and reference “Pearland

HOUSTON: GENERAL (SHARPSTOWN).

General or TX#538”. HOUSTON:

Well established general dentist

PEDIATRIC (NORTH HOUSTON). This

with high-6 figure gross production.

practice is located in a highly sought-

Comprehensive general dentistry in

after upscale neighborhood. It is on a

the southwest Houston area focused

major thoroughfare with high visibility

on children (Medicaid). Very, very

in a strip shopping center. The practice

high profitability. 1,300 sq ft, 4

has 3 operatories for hygiene and 2

operatories in single building. 95%

for dentistry. Nitrous is plumbed for all

collection ratio. Over 1,200 active

operatories. The practice has digital

patients. 20% Medicaid, 45% PPO, and

X-rays and is fully computerized. The

35% fee for service. 30% of patients

practice was completely renovated

younger than 30. Office open 6 days

in 2018. The practice is only open

a week and accepts Medicaid. Contact

3-1/2 days per week. Contact

Chrissy Dunn at 800-930-8017 or

Christopher Dunn at 800-930-8017

chrissy@ddrdental.com and reference

or christopher@ddrdental.com and

“Sharpstown General or TX#548”.

reference “North Houston or TX#562”.

HOUSTON: GENERAL (PEARLAND

WEST HOUSTON: MOTIVATED SELLER.

AREA). Located in southeast Houston

Medicaid practice with production of 6

near Beltway 8. It is in a freestanding

figures. Three operatories in 1200 sq ft

building. Dentist has ownership in

in a strip shopping center. Equipment

the building and would like to sell

is within 10 years of age. Has a pano

www.tda.org | June 2022

331

ADVERTISING BRIEFS and digital X-ray. Great location. If

work for an office that cares about

interested contact chrissy@ddrdental.

their people, their patients and their

com. Reference “West Houston General

community. Our practice is an office

or TX#559”.

supported by Pacific Dental Services (PDS), which means you won’t have to

KATY: Now is the time to join Grand

spend your career navigating practice

Lakes Dental Group and Orthodontics.

administration. Instead, you’ll focus

You will have opportunities to

on your patients and your well-being.

learn new skills from our team of

Add on excellent benefits, including

experienced professionals. If you’re

malpractice insurance, medical, dental

ready to take your career to the next

and vision insurance, retirement plans

level and gain valuable experience,

and much more and you’ll feel well

apply today! You’ve invested the time

taken care of throughout your career.

to become a great dentist, now let

The average full-time PDS-supported

us help you take your career further

associate dentist earns low-6 figures

with more opportunity, excellent

in their first year. The average income

clinical leadership and one of the best

for a PDS-supported owner dentist,

practice models in modern dentistry.

whose practice has been open at

In working with our practice you will

least 2 years, is mid-6 figures. As

have the autonomy to provide your

an associate dentist, you will receive

patients the care they deserve. In

ongoing training to keep you informed

addition, you’ll enjoy the opportunity

and utilizing the latest technologies

to earn excellent income and have

and dentistry practices. If you are

great work-life balance without the

interested in a path to ownership, our

worries of running a practice. You

proven model will provide you with the

became a dentist to provide excellent

training needed to become an owner

patient care and have a career that will

of your own office. PDS is one of the

serve you for a lifetime. With us, you

fastest growing companies in the US

will have a balanced lifestyle, fantastic

which means we will need excellent

income opportunities, and you’ll

dentists like you to continue to lead

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Texas Dental Journal | Vol 139 | No. 6

ADVERTISING BRIEFS our growth in the future. Apply now or contact a recruiter anytime. We’d love to chat, get to know you and share more about us. Pacific Dental Services is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry,

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 512-5172826 or drzoch@yahoo.com.

citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here:http://www. Click2Apply.net/gwy6pkn22knbzwzx PI106822492. KERRVILLE: Associate to buy-in needed in long-standing dental practice in prime location in Kerrville, TX. 3-4 days per week. Must do extractions. Call 830-285-0674 and send resume to gaeldahse@gmail.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

Calendar of events

TMOM 2022 SCHEDULE Luling—September 9-10, 2022 Dallas—November 4-5, 2022

SMILECON Houston—October 13-15, 2022 House of Delegates, October 15-18 Due to COVID-19, please check each meeting’s website for up-to-date information related to cancellations or rescheduling. THE TEXAS DENTAL JOURNAL’S CALENDAR will include only meetings, symposia, etc., of statewide, national, and international interest to Texas dentists. Because of space limitations, individual continuing education courses will not be listed. Readers are directed to the monthly advertisements of courses that appear elsewhere in the Journal.

with Frank or Jeremy.

www.tda.org | June 2022

333

YOUR PATIENTS TRUST YOU.

WHO CAN YOU TRUST?

ADVERTISERS Anesthesia Education & Safety Foundation... 271 Choice Transitions................... Inside Back Cover Henry Schein Financial Services.................... 277 JKJ Pathology................................................ 321

If you or a dental colleague

Keyway......................................................... 277

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

Law Offices of Hanna & Anderton..................... 320

MedPro Group.................................................. 276

Professional Recovery Network..................... 342 SmileCon 2022.............................................. 319 Southwest Sedation Education...................... 283 TDA Perks.............................. Inside Front Cover Texas Health Steps........................................ 282 UTHealth Houston Pathology......................... 283 UTHSC-SA/South Texas Pathology Lab.......... 320

PRN Helpline (800) 727-5152

334

Visit us online www.txprn.com

Texas Dental Journal | Vol 139 | No. 6

Watson Brown Practice Sales & Appraisals.... 325

Put the pliers down, let the pros do their job. Some brokers just send you the candidate and leave all the heavy work to you Would your patient pull their own teeth? Trust your practice sale to an experienced full service broker who has had hundreds of practice sales.

(877) 365-6786 choicetransitions.com

Considering selling to a DSO? Don’t, until you read this. Choice walked me through the process, presented the best offers, and made the experience much less stressful by handling all the negotiations. In the end, I received more for my practice than I ever expected. The best part is that Choice provided all the consultation and services to me without charging any fees! If you are considering selling to a DSO, I highly recommend you contact Choice instead of directly contacting the DSOs.

Commission free. DSO Choice.

(877) 365-6786 • choicetransitions.com

www.tda.org | June 2022

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June 2022 Texas Dental Journal

Articles inside

Oral and Maxillofacial Pathology Case of the Month Diagnosis and Management

Advertising Briefs