June 2023 Texas Dental Journal

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TMOM 2023 Events

TMOM, Abilene: July 14-15, 2023

TMOM, Edinburg: September 15-16, 2023

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

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. Established February 1883 • Vol 140 | No. 5

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 except January-February and August-September, which are combined issues, by the Texas Dental Association, 1946 S IH-35, Austin, TX, 78704-3698, 512-443-3675. PeriodicalsPostage Paid at Austin, Texas and at additional mailing offices. POSTMASTER: Send address changes to TEXAS DENTAL JOURNAL, 1946 S IH 35 Ste 400, Austin, TX 78704. Copyright 2023 Texas Dental Association. All rights reserved.

Annual subscriptions: Texas Dental Association members $17. Instate ADA Affiliated $49.50 + tax, Out-of-state ADA Affiliated $49.50. In-state Non-ADA Affiliated $82.50 + tax, Out-of-state Non-ADA Affiliated $82.50. Single issue price: $6 ADA Affiliated, $17 Non-ADA 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 included in the online September Annual Membership Directory or on the TDA website: tda.org. All statements of opinion and of supposed facts are published on authority of the writer under whose name they appear and are not to be regarded as the views of the Texas Dental Association, unless such statements have been adopted by the Association. Articles are accepted with the understanding that they have not been published previously. Authors must disclose any financial or other interests they may have in products or services described in their articles.

Advertisements: Publication of advertisements in this journal does not constitute a guarantee or endorsement by the Association of the quality of value of such product or of the claims made.

editor’s note

Below is the address Dr Plemons gave to the TDA House of Delegates on May 5, 2023, in San Antonio.

Mr Speaker, delegates, and distinguished guests, thank you for letting me share some “behind the scenes activities” involving the Texas Dental Journal over the past year. Serving as editor has really been an honor, but just as much, it’s been a whole lot of fun. Thank you for trusting me and our team with your publications.

As you most likely know, our Texas Dental Journal is steeped in history. Almost 12 years after its charter, the Texas Dental Association established the Texas Dental Journal as its official publication in 1883, and it’s been almost continuously published ever since. This is a picture of the only copy we have of the Journal’s first issue.

Jacqueline Plemons, DDS, MS

140 years later, we’re still plugging away. It’s undergone changes over the years. Images and design have improved as we’ve moved from the 19th, the 20th, and now the 21st Century.

Serving as editor has really been an honor, but just as much, it’s been a whole lot of fun. Thank you for trusting me and our team with your publications.

TDA’s only copy of the first edition of the Texas Dental Journal, published in February 1883.

Change is inevitable. Jimmy Dean said…yes, that Jimmy Dean…country singer and sausage entrepreneur (and evidently a man of many words), he said “I can’t change the direction of the wind, but I can adjust my sails to always reach my destination.”

And, that’s just what we’ve done over the past year—adjusted our sails. You’ve heard Dr Ho and others discuss the importance of finding new ways to reach our changing membership. Our Board of Directors recognized and acted on this, and in 2022 voted to appoint a task force to accomplish a full review of the publication, including but not limited to member-focused themes, appearance, design, subject matter, and profitability.

The task force was comprised of myself, the previous editor, our director of member services and managing editor (Lee Ann Johnson and Nicole Scott), and 3 young leaders, Drs Akshay Thusu of San Antonio, Stephanie Ganter of Dallas, and Katie Stuchlik of Houston. Over the course of several meetings, we reviewed the results of a member survey, which asked questions like:

• How would you rate your overall satisfaction with the Texas Dental Journal?

• What format works best for you when reading the Journal?

• How often would you like to receive the Journal?

The task force performed a cost benefit analysis and consulted TDA’s new advertising partner, MCI. Ultimately, we suggested to the Board to decrease the monthly publication to 10 months a year, which began in January. Additionally, we changed the entire look and feel of the Journal, and I hope you’ve noticed! Our new design includes a modern, clean look that uses more white space and the careful, precise placement of text and graphics. This creates an aesthetic visual hierarchy that leads readers between elements and improves readability and comprehension. Who knew that much attention is given to everything you see in the Journal?

Each month, we aim to publish information on fresh new topics for the bread-and-butter dentist, the new dentist, the aging dentist. We want to spotlight members, trends in dental technology, and tools for practice management.

Change is sometimes hard. But, we’re so proud of our new…old…Journal. And, who knew that the sausage king Jimmy Dean was so poignant, but as he said, “Today is your day to shine on!” And, shine on, we will. Just 10 times a year instead of 12.

Thank you.

TDA Editor Dr Jacqueline Plemons addresses the 2023 TDA House of Delegates in San Antonio.

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Board of Directors Texas Dental Association

PRESIDENT Cody C. Graves, DDS 325-648-2251, drc@centex.net

PRESIDENT-ELECT

Georganne P. McCandless, DDS 281-516-2700, gmccandl@yahoo.com

PAST PRESIDENT

Duc “Duke” M. Ho, DDS 281-395-2112, ducmho@sbcglobal.net

VICE PRESIDENT, SOUTHWEST Richard M. Potter, DDS 210-673-9051, rnpotter@att.net

VICE PRESIDENT, NORTHWEST

Summer Ketron Roark, DDS 806-793-3556, summerketron@gmail.com

VICE PRESIDENT, NORTHEAST Jodi D. Danna, DDS 972-377-7800, jodidds1@gmail.com

VICE PRESIDENT, SOUTHEAST Shailee J. Gupta, DDS 512-879-6225, sgupta@stdavidsfoundation.org

SENIOR DIRECTOR, SOUTHWEST Krystelle Anaya, DDS 915-855-1000, krystelle.barrera@gmail.com

SENIOR DIRECTOR, NORTHWEST

Stephen A. Sperry, DDS 806-794-8124, stephenasperry@gmail.com

SENIOR DIRECTOR, NORTHEAST

Mark A. Camp, DDS 903-757-8890, macamp1970@yahoo.com

SENIOR DIRECTOR, SOUTHEAST Laji J. James, DDS 281-870-9270, lajijames@yahoo.com

DIRECTOR, SOUTHWEST Melissa Uriegas, DDS 956-369-9235, meluriegas@gmail.com

DIRECTOR, NORTHWEST

Adam S. Awtrey, DDS 314-503-4457, awtrey.adam@gmail.com

DIRECTOR, NORTHEAST

Drew M. Vanderbrook, DDS 214-821-5200, vanderbrookdds@gmail.com

DIRECTOR, SOUTHEAST

Matthew J. Heck, DDS 210-393-6606, matthewjheckdds@gmail.com

SECRETARY-TREASURER*

Carmen P. Smith, DDS 214-503-6776, drprincele@gmail.com

SPEAKER OF THE HOUSE*

John W. Baucum III, DDS 361-855-3900, jbaucum3@gmail.com

PARLIAMENTARIAN**

Glen D. Hall, DDS 325-698-7560, abdent78@gmail.com

EDITOR**

Jacqueline M. Plemons, DDS, MS 214-369-8585, drplemons@yahoo.com

LEGAL COUNSEL

Carl R. Galant

*Non-voting member

**Non-voting

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2023 TDA Meeting Award Highlights

Photos by Laurie Rush Photography

TDA Awards Committee

Drs Shailee J. Gupta, Chair, Richard M. Potter, Summer Ketron Roark, Jodi D. Danna

Gold Medal for Distinguished Service: Dr Risé L Martin, 2023 recipient of the Gold Medal Award, presented by 2022 TDA President Dr Duc “Duke” M. Ho.

Rising

Star

of the Lone Star:

Dr Katie E. Stuchlik, 2023 Rising Star of the Lone Star recipient, presented by 2022 TDA President Dr Duc “Duke” M. Ho.

Outgoing Council Members, 2023:

Council on the Annual Meeting and Continuing Education Programs (CAMCEP) —Dr Robert C. Beatty

Council on Dental Licensing, Standards, and Education (CDLSE) — Dr Ernest B. Luce

Council on Legislative, Regulatory, and Governmental Affairs (CLRA) — Dr Lee P. Oneacre

Council on Membership, New Dentists, and Students (CMNS) — Drs Ensy A. Atarod, Tanya Sue Maestas, Sarah Percy Tovar

Council on Peer Review (CPR)—Dr Donna G. Miller

Outgoing Vice Presidents:

NE—Drs Elizabeth S. Goldman; SE—Glenda G. Owen; SW—Carlos Cruz NW—Teri B. Lovelace

Pictured are Awards Committee member Dr Summer Ketron (left) presenting to Dr Owen and Awards Committee member Dr Jodi Danna (right) presenting to Dr Goldman.

Incoming President Award:

Outgoing President Award:

Outgoing Past President Award:

Dr Cody C. Graves of Goldthwaite assumes the presidency of the TDA at the Saturday afternoon House of Delegates. Turning the office over to him is Outgoing President Duc “Duke” M. Ho of Katy.

TDA Service Recognition Award:

Dr Kent B. Macaulay in honor of his unwavering dedications and exceptional contributions to communities across Texas, on behalf of the Texas Dental Association. Presenting the award is TDA Award Committee member Dr Richard Potter.

Certificates of Merit: Several certificates of merit were presented at the House of Delegates, including: Brookwood Community in Houston, Center for Refugee Services in San Antonio, and Mercy Ministries in Laredo.

Outstanding Senior Dental Student Awards: Recipients of the TDA Outstanding Senior Dental Students Awards included Texas A&M—Roxana Ghaderi; UT Health Houston—Jackson B. Valencia; UT Health San Antonio—Alexis To 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 2023 Texas Dental Journal.

Dr Debrah J. Worsham of Center received the Outgoing Past President’s award from the Awards Committee at the Friday afternoon House of Delegates. Dr Worsham served as president-elect, president, and past president from 2020 to 2023. TDA Board member Dr Summer Ketron Roark present the award.

President’s Recognition Awards:

TDA Executive Director Linda Brady for exceptional stewardship and service as executive director of the Texas Dental Association and TDA Director of Public Affairs Jess Calvert for his many years of legislative leadership, loyalty, and dedicated service on behalf of the Texas Dental Association.

Alliance of the TDA Service Recognition: Ms Linda Radwanski in grateful appreciation for her service as president of the Alliance of the Texas Dental Association, 2022-2023. She is the wife of Dr Wayne C. Radwanski. She is pictured addressing the 2023 House of Delegates

Dr Duc “Duke” M. Ho of Katy receives the Outgoing President’s award from Incoming TDA President Dr Cody C. Graves of Goldthwaite at the Saturday afternoon House of Delegates.

Brady

Calvert

DR DUC “DUKE” M HO

TDA President’s Address to the 2023 Texas Dental Association House of Delegates

May 4, 2023

lot of responsibility, but my joy always came from relationships—meeting dentists, telling them all the great things that organized dentistry is doing, and explaining why we’re more relevant than ever.

That is what makes me happy; so, from the bottom of my heart, thank you for allowing me to do what I love.

Now the fact is, I am forever indebted to this Association. As I have shared countless times before, I grew up a poor immigrant son of a single mom, eating mayonnaise sandwiches, and sleeping on a pull-out sofa. It wasn’t until my involvement with organized dentistry did 2 huge mentors come into my life:

• Dr Gary Welch, who instilled the importance of treating all patients the same, regardless of model or insurance, mind you, 25 years before it was well accepted; and

• Dr Craig Armstrong, who showed me firsthand, how to be a meaningful mentor.

I’ve always loved asking questions, listening to stories, and challenging preconceived notions. And if you weren’t sure already, let me be the first to say: I am a handful. Nonetheless, these men showed amazing grace, as they taught me far more about life, than about dentistry.

So as my year comes to an end, I couldn’t help but reflect on the beginning. Specifically, my first year as a delegate, standing on the floor behind a mic, heart racing, and Dr Glen Hall, speaking before the entire House, warmly thanking me for my testimony. That simple act ensured that I felt welcomed to a bigger family, beyond just my local component and I will never forget that moment.

Since forever, my desire has always been to be the bridge between the past and the future, and I regret that I haven’t done more to share names and stories of great leaders—past, present, and future. Leaders who, through their own personal sacrifice, not only in words but in deeds, have given so much.

Names such as the late Dr Herb Wade, who passed just last year. Herb was a legend, and it saddens me that some within this House may have no idea who he was, witnessed his large stature, or experienced, firsthand, his gentle nature. Not only was Herb past president of the Texas Dental Association, but he also set up the first pediatric dental office in the city of Bryan, served as president of their school board, and established and implemented a local Head Start dental program.

Or people such as Dr David Duncan, who has held more roles inside and outside of organized dentistry than many will ever know. Beyond past president, he was also a professor at the Amarillo College Hygiene Program and most recently, a mentor, confidant, and friend to many, including myself. In fact, on my very first component visit to Amarillo, just 1 week into my presidency, we shared a long lunch at a dive grill that was dominated by me hammering him with questions. Questions such as the influence of student debt on young dentists, meeting the needs of our rural members, the proliferation of thirdparty payers and the overall future of our profession.

Perhaps more meaningful to me, however, was an early morning breakfast many, many years ago, during my very first ADA event—a golf tournament, nonetheless. David was the first person to say, “good morning” to me. Silly that I remember this? Perhaps. But he was the president of the TDA at the time and went out of his way to make me feel important. That is his legacy to me.

Of course, we know the names of:

• Dr Joey Cazares, who has been an influential voice in the Rio Grande Valley,

• Dr Jacque Plemons, who is simply the smartest dentist I know, and

• Legislative leaders—Drs Rick Black and Matt Roberts.

Quick side note: did you know that sometimes, during legislative sessions such as this year, Dr Roberts would cancel an entire day’s worth of patients at the last minute so he could drive to Austin to testify at the Texas Capitol. Literally, on a minute’s notice. How many of us could make that same sacrifice?

Back to names and stories. We know the familiar names, but when it comes to names beyond your local component, how many know of:

• Dr Rene Rosas, the first Hispanic dentist of the Texas Dental Association,

• Dr Pat Blanton, the first female President of the Texas Dental Association (not to mention a Vice President of the ADA), and

• Dr John Finley, the last Texas dentist to be president of the American Dental Association.

More so, how many recognize the name, Dr Terry Dickinson, who graduated dental school in Houston, practiced here for 30 years and went on to create the very first Mission of Mercy—a legacy that has been replicated throughout the country. Think about that. Creating a program that has provided free dental care to millions in need. We could only be so lucky to be half the leader Terry is.

So, how do we use the past to remind us of how good we’ve been, while also encouraging us toward a better future?

Well, we tell stories.

Presently, our Board and its actions reflect the blessings of our past, with an eye on the future. We have more women than men and represent more races, ages, ethnicities, practice models and locations—including urban and rural—than ever before, and likely more than another other state or organization.

We’ve advanced how continuing education is brought to you by focusing on:

• Quality—Pankey courses on our CE Concierge App,

• Convenience—regional meetings when travel to San Antonio may be difficult or costly, and

• Fellowship—a Dentist Only Symposium whose focus is on both education and community.

We’ve reached out to bring more benefits to all members with endorsed Perks vendors such as:

• Cloud Dentistry to help tackle workforce issues, and

• ERC Specialists, which now has more than $15 million in scheduled refunds to TDA members such as yourselves.

Furthermore, we’ve brought together a workgroup to tackle how we can bring more benefits to one of our fastest-growing segments: our employee dentists.

Perhaps most importantly, we’ve fought hard for an aggressive legislative agenda that includes patient protections with clear aligners, comprehensive insurance reform and increases in Medicaid reimbursements—priorities that benefit all members and their patients. And did I mention that the TDA offers personalized regulatory and compliance assistance with our Senior Policy Manager, Ms Diane Rhodes? Diane has forgotten more about regulatory issues than I will ever know. Literally. I know that’s not saying much about me, but you get the point. And yes, you can submit a question about a State Board rule, a DEA inquiry, or an insurance issue, and she will answer it—usually in less than 24 hours!

Just a glimpse of the most recent teledentistry statute in Texas illustrates how intertwined our past is with the present, as it mandates the same standard of care of an in-person exam—you know, once a year—standards influenced by leaders many years ago. You may not know it, but we are the envy of many other states.

The Greater Houston Dental Society presented Dr Ho with a gratitude gift for his presidential year of service.

Be proud of your association.

For instance, in 2011, this House passed a Diversity and Inclusion policy, long before it was cool. You may not have known about the policy, but both in principle and practice, this Association has intentionally sought out those who have a passion for service, a willingness to sacrifice, a love of the Association, and a desire to protect the profession. Don’t believe me, just look at our Board photo.

Now, what does the future hold? I’m not sure, but if it’s lead by people anywhere close to the those I’ve met in my journey, then the future is bright.

Dentists like:

• Drs Katie Stuchlik, Laura Schott, Austin Green, and Wendy Vu Steger—all of whom I’ve known since they were students in dental school – now serving on Boards of their respective local components,

• Dr Melissa Uerigas—past present of the Rio Grande Valley Dental Society, filling in for its president, coincidentally her husband, as he serves overseas, and

• Dr Jonathan James—a dentist who left Dallas after 7 years and decided to go to Harlingen, so that he could be the dentist in his community, rather than just another dentist in the community.

Texas leaders? We are blessed to have them in spades, such as:

• TAPD President Dr Roberto Loar,

• TAGD President Dr Shane Ricci, and

• International HDA President, Dr Christina Meiners

• And let’s not forget Dr Cody Graves, a third-generation dentist and banker who will soon supplant me as the youngest president of the Texas Dental Association.

The secret sauce to our success is simple: people. People have made this Association and this profession great. You have made this Association and this profession great.

Even better, if that’s possible, are the memories we’ve created on our journey together.

• Choking down drinks of scotch with Herb thinking to myself, “This is burning my throat”,

• Ubers with my rural twin, Dr Debrah Worsham, who I love and appreciate so much, laughing as we wonder why everyone we ride with feels the urge to weave in and out of traffic like they’re running from the law,

• Cocktails with Board members, explaining that I’m way too old to stay up past midnight and that I need to

Dr Ho is pictured with his mentor Dr Gary Welch, his dental practice partner of many years.

ADA President Dr George Shepley has a moment of fun with TDA President Dr Duc Ho at the House of Delegates.

work out in the morning, knowing full well that I have no intention of working out in the morning, and • Dinners with Craig, Rita, and Tommy, reminded at every opportunity that, “life is good”.

These are the moments that will last forever.

So, I finish with this thought. Recently, I watched an interview of our very own Dr Armstrong, and near the conclusion, he was asked, “What question would you like most answered?”. He replied, “When I’m gone, how will I be remembered?”. That profound answer is at the core of this very speech. How will you be remembered and who will tell your stories?

Selfishly, I hope to be remembered for my goofy enthusiasm, my genuine love for this association and my sincere desire to make each person feel as excited, appreciated, and warmly welcomed as Dr Hall and Dr Duncan

did for me many years ago. That is a legacy, and although I’m not naïve enough to believe that my personal journey alongside these great leaders is the rule, I also know with certainty that I am far from the exception.

So, I will continue doing my part and challenge each of us to be that person that leaves a legacy long after we’re gone. Take the time to look around this House and intentionally look for faces you don’t recognize. Get out of your comfort zone. I live this. And much like a church with new visitors (I stole that from Dr Duncan), go up to a stranger, introduce yourself, welcome them and encourage them to serve. Get to know them beyond just dentistry, but as people. Let us go back to our roots of fellowship, united by a common goal of protecting our profession and advancing our Association.

That will define our future. Thank you.

…in 2011, this House passed a Diversity and Inclusion policy, long before it was cool. You may not have known about the policy, but both in principle and practice, this Association has intentionally sought out those who have a passion for service, a willingness to sacrifice, a love of the Association, and a desire to protect the profession.

Don’t believe me, just look at our Board photo.

Dr Ho is pictured with the 2022-23 TDA Board of Directors during TDA Legislative Day in February in Austin.

DR CODY C. GRAVES

TDA Incoming President’s Address to the 2023 Texas Dental Association House of Delegates

San Antonio, Texas May 6, 2023

I’ll admit though, I’ve not looked forward to the amount of public speaking the role brings with it. But I’m confident that you will extend me the grace I need today to get through the next few minutes.

• Mr Speaker, I want to thank you for granting me the privilege of addressing this group.

• To the past presidents and other distinguished guests, I appreciate everything you have done for the association and the commitment/sacrifices you all have made.

• Delegates and alternate delegates, thank you for all the hard work and time away from your families and other endeavors to come here and help shape your profession.

One of the hardest things for me over these past few months has been to decide on the topic of this speech. Everyone has given me ideas…They told me to talk about…

1. My history.

2. What TDA means to me.

3. My vision.

So, that’s what I’m going to do. I’ll cover all of them, but I’m going to be leaving you all with some unanswered questions that I’m hoping we can find the answers to together. I like to throw ideas or questions out there and see what becomes of them.

Part One, the History:

I’m a third-generation dentist, seventh in the family. Speaking of family—I’d like for my family, in the audience, to stand while I introduce them. My Dad, Dr Tom Cody Graves, and my mom Carol. Thank you both for being here today and for supporting me all these years. My beautiful, supportive, and very patient wife, Tracy. My daughters, Avery and Linley of whom I’m incredibly proud.

Back to the history part of the speech - I live and work in a town of less than 2,000 people and a county of less than 4,500 people. I like to think that I’m helping to solve our access-to-care problem. And I have a father who retired over 2 years ago but is still an “active life” member thus paying full dues. If he stops paying his dues, then my small county could become a Dental Health Professional Shortage Area. One dentist in a less than 5,000-person county can create an access-to-care

problem. I’ll talk more about this later. (Remember rural dentistry)

I’ve had the benefit of working with my father for about 15 years. He’s the one who said, “load up, let’s go to our local TDA society meeting.” So that’s what we did for years. He would tell me stories about the many years he sat in this audience, just like you all, as a delegate to 21-B. I traveled with him to San Antonio for the TDA Meeting to take continuing education classes, and eventually, I become involved in my local society.

In the beginning, becoming TDA President was not a planned journey for me unlike some of my predecessors such as Dr Tommy Harrison. Dr Harrison went to one of his first TDA local component society meetings and prognosticated when he was going to be TDA President [that really happened, ask Dr Harrison].

My TDA experience started just about a decade ago with a lot more uncertainty.

I was at a local 21-B dental society meeting, and we had an open spot for the peer review chair. After a few seconds of silence, I raised my hand and said, “I’ll do it.” And my father who was sitting across the table from me looked at me and said, “You don’t want to do that”. As you can surmise, I was elected as peer review chair, but it was not a unanimous decision because my father was the only vote against me. This is how I started my TDA career.

I’ve definitely taken the road that was less traveled. I just went to my local component meeting because that is what my father told me to do. After serving a few terms on peer review both at the local and state level, I was asked to follow Dr Ron Collins as the TDA secretary/treasurer. That position allowed me to look at the TDA from a different perspective, and the honor to watch other presidents lead the association (8 for me so far, well 7 and Dr Ho). I also served on just about every task force imaginable over the past few years.

Part 2, the Meaning:

As you can imagine, most of my early years were just trying to survive or stay afloat. It was my first time serving on the TDA Board of Directors and learning the TDA financials. At the time, we had a new executive director, Mike Geeslin, who like me, was just trying to learn. It was like drinking from a firehose. Yet, the more comfortable I became as secretary/treasurer, the more I was able to look around and see what the TDA does and who we are.

As a result, my experiences with TDA, the meaning of being a TDA member changed for me. The meaning of the TDA for me now is “family.” It’s being a part of a group that can lean on one another. A group that grows together.

Those experiences also created more questions for me:

• Where are we going?

• We know where we’ve been, can we improve?

• What can we learn from our previous mistakes?

• Do we listen to other people who’ve gone through similar mistakes?

• Are we succeeding in representing ALL of our members?

The TDA is a diverse group of dentists. Take a moment to look around this room. According to a Health Policy Institute survey, Millennials (someone born in the 1980s or 1990s) make up a workforce share 1 to 2 times more than Baby Boomers (someone born from the mid-1940s to the mid-1960s). This seems an obvious progression as the older generation is retiring, and the younger generation is beginning. Though they might be selling their practices and beginning a quieter stage

In addition to practicing dentistry together in Goldthwaite, Dr Tom Graves and his son, TDA Incoming President Dr Cody Graves were inducted into the International College of Dentists together.

of life, it’s important to note that the older generations of dentists paved the way for their successors. They remain loyal to organized dentistry and continue to hold the highest market share in membership, according to a report from the ADA Strategic Forecasting Committee.

That same committee also reported that we struggle to turn Millennials into members. Why? What can we do to change that?

That question leads us to look closely at TDA membership trends and forecasts. The distribution of Texas dentists is concentrated in our state’s urban cities. However, the urban areas are where we struggle the most with membership retention and lower market share. Another question—what can we also do on a local level to engage the younger dentists?

A local society provides the fellowship and connectivity that is so important to all of us.

During my year as TDA president, I will promote the value of practicing dentistry in rural areas to help improve our access to care issues.

Living and practicing in rural communities has many advantages:

1. You are never too far away from home and work.

2. You can be as involved, social, or isolated as you want.

3. You can live with and among your patients (technically, that can also be a negative).

4. Rural practices allow time for other interests because you have short commutes.

5. You don’t have a lot of competition around you. (If you are anything like me, you don’t even have to advertise).

6. You can carve out any kind of niche you want.

7. You can choose to take insurance or not…it’s up to you.

Rural dentists enjoy many benefits to compete with those of our metropolitan brothers and sisters. Either way, in either place, you essentially create your own destiny.

Part 3, the Vision:

The vision for TDA is simple. Membership is the key to survival. You all have heard this for many years, and it’s true.

Dr Ho and I have now known each other for more than 8 years. Over those years, we have had numerous conversations about how we can grow membership. We keep

Dr Cody Graves is pictured calling a Friday night football game in the press box with his father Dr Tom Cody Graves (left) and Goldthwaite Mayor Mike McMahan.

coming back to “give me something sticky.”

What I mean by “sticky” is we need something that is of such value that paying dues each year isn’t debatable… a program, an app, a product, or a business that can improve the everyday life of a dental professional, not just a dentist.

We have some great products that our FSI board and staff have either partnered with or helped to create. To date, that “I must join the TDA” product is not YET in our list of offerings. You heard from Dr Akshay Thusu yesterday that the TDA Leadership Institute will allow members to create their “capstone” project around new ideas that fit within the TDA Strategic Plan. And we will continue to study possibilities and we’re open to hearing your ideas and suggestions.

Having the perfect, sticky product is not the only way to increase our membership.

The TDA board of directors, the TDA staff, the TDA’s executive director, and the presidents are tasked with retaining and gaining membership, but we are not the only ones with that charge.

Every one of you should feel the responsibility and should shoulder the weight of helping TDA increase our membership. There are numerous reasons to join TDA. For example, our Council on Legislative, Regulatory, and Governmental Affairs arguably had one of the best years at the Texas State Capitol. The presentation of our Texas Mission of Mercy events has shown what we can do to give back to our communities. You all have had the opportunity to listen and experience what TDA Perks can do for dental practices and enhance our offices.

The last question I have for you all today, is “DO YOU OWN IT?” Do you own being a TDA member like you own being a dentist? Do you walk the walk? When other dentists see you around town, or at continuing education events, do they know you are TDA members?

Are you asking them if they are TDA members? Are you telling them why TDA membership is important to the success of the profession?

We have all heard the phrase, “It takes a village.” Essentially, this means that many people must cooperate to achieve a goal. We all have contributions to make in developing our association.

You “live” in this village. Are you ready to help it grow and succeed? If you can say “YES”, then we will succeed. Go convince your colleagues to join in our village. Convince them to be a part of our family. To live in our village. We will make our profession better when “many members unite to achieve our goals!” That is how we can grow membership and strengthen our profession.

I’ll end this speech like my favorite podcast, Freakonomics: “Take care of yourself and if you can, someone else.”

We are all in this together. Thank you for your time and thank you for your support.

Dr Graves’ family were guests at the 2023 TDA House of Delegates.

DR CRAIG ARMSTRONG

ADA 15th District

Trustree

Address to the 2023 Texas Dental Association

House of Delegates

San Antonio, Texas

May 4, 2023

Before I begin, however, I’d like to share a quote that I came across a couple of months ago that seems apropos for where we are right now at the ADA. “Vision without action is merely a dream. Action without vision just passes the time. Vision with action can change the world”

I truly believe that right now at the ADA with your help, we have a Vision with Action that can and will change the world.

In December of last year, under the leadership of our current president Dr Shepley, we had one of the most successful Board retreats that I have been a part of in my 4 years on the Board. It was entitled, “Harnessing the Power of Strategic Focus” and was led by Dr Steven Shepard who facilitated several excellent sessions throughout the weekend.

During the meeting, we took turns going around the room answering questions such as, Why do we exist? What do we do? Why do we do what we do? Although all of us had answers for these questions, it was troublesome that there was not consensus within this group of leaders.

The inspirational speaker and author Simon Sinek refers to it as finding your Why. We began the journey to find our Why. What is our Why? Is it our mission or vision? No not exactly, but it is something that strengthens our mission and vision, giving true meaning to the reason why we exist.

After several sessions, we came up with our Why. It may take you a minute or 2 to wrap your head around this seemingly simple statement or to understand it and that’s ok. It took a lot of us some time to get comfortable with it. Simply stated, it’s what we do every day in our offices, every one of us, and sometimes we take it for granted: We Make People Healthy.

As many of you know I recently returned from a mission trip to Warsaw, Poland, where we treated displaced citizens from Ukraine, mainly women and children. There are 2.3 million Ukrainians in Poland, many with tremendous oral health challenges.

The trip was full of many highs and lows, and for me it was transformational, as it was during this trip that the impact of our new “Why” really hit home. It reaffirmed what I have thought and have always known —that we are part of the greatest profession in the world.

I can’t think of another profession where someone can come in with extreme pain, we assess the situation, develop a plan, take care of the issue and the patient leaves with a smile on their face. We really do Make People Healthy. It was a remarkable experience and one that I will never forget.

While I don’t want to steal too much of Dr Shepley’s thunder when he addresses the House tomorrow, I would like to give a preview of the work that he has initiated this year and I’m sure will continue under the leadership of Dr Edgar when she takes office in October.

Dr Shepley has appointed several task forces to effectively deal with issues that are near and dear to the hearts of dentistry and to

Dr Armstrong addresses the 2023 TDA House of Delegates.

dentists. Sugar and its effect on oral health, DSOs, and ERISA reform.

With his sugar task force, Dr Shepley has garnered a lot of excitement both here and abroad, having been recently invited to attend a forum on Hunger, Health, and Nutrition at the White House, as well as receiving interest from both the British Dental Association and the FDI. Dr Greg Chadwick, FDI president-elect, has taken such an interest that it they pursue it as one of FDI’s global initiatives.

The recent Massachusetts Medical Loss Ratio victory was monumental as it saw organized dentistry come together in a way rarely seen before, and I would like to personally thank the leadership on the TDA Board for being part of this unified national effort that was able to strike a blow to the insurance industry and set the stage for the creation of a task force to deal with the issue of ERISA reform. I am also proud to announce that our current TDA President Dr Ho was selected to serve on this group. Thank you, Dr Ho.

This group is focused on preparing a strategy to advocate for states to enact new laws to curb abusive practices by the insurance industry and to enhance enforcement of such existing laws. The task force also is considering whether to pursue further ERISA reforms at the federal level.

This is the kind of intentional thinking that is needed to help our members with the ever-troubling landscape of navigating dental insurance benefit plans. Something that we are all too familiar with here in Texas.

The establishment of a DSO task force is part of a pathway that is part of the ADA’s exploration of how to better engage and build member market share among dentists in group practice, while also building meaningful collaborations that unite the profession in advancing the public’s health.

At our April board meeting, we invited 6 leaders from the DSO industry to sit down with us and have a conversation. While we at the ADA board didn’t see eye to eye on everything this group believes in, we agreed to focus on the areas in which there is agreement and to continue the dialogue going forward.

Discussions centered around how the ADA and DSOs can collaborate to help employee dentists succeed and included each guest’s vision of the profession of dentistry in 5, 10, and 20 years.

We also discussed other topics that all practice models face, such as how to solve workforce issues, how to continue elevating the profession to ensure better overall clinical outcomes, and ways of educating the public that dentists are doctors who prevent and treat disease.

Current data supports the fact that dentistry is consolidating and that the pace of consolidation is likely to increase. There are unique benefits within each of the wide range of DSO business models that exist today. Collaboration through the sharing of information about the various models, as well as solo practice, could be helpful in helping all dentists make the best choice with respect to their own goals.

I can’t think of another profession where someone can come in with extreme pain, we assess the situation, develop a plan, take care of the issue and the patient leaves with a smile on their face. We really do Make People Healthy.

Our new Executive Director, Dr Cohlmia, has been extremely busy working alongside your Board of Trustees, preparing the ADA for a journey that will propel the organization in a direction that will help ensure a successful future. Dr Cohlmia is working with, not independently, of the board, to help the ADA undergo a transformational change that is desperately needed if we are to remain relevant in an everchanging dental landscape.

Last year the House of Delegates in Houston passed a Strategic Forecasting initiative and as a result, entrusted the ADA Board with the budget while still retaining control of the process for setting dues.

The process of Strategic Forecasting has begun, and your Board of Trustees remains committed to honoring the trust shown by the House by rolling out a process that will allow the ADA to be more responsive to the needs of its members in real time with the ability to evaluate the efficacy of programs without having to wait an entire year for the house to convene.

On a personal note, I would like to recognize Dr Cody Graves for his service on the SFC while juggling the office of TDA president-elect, bank officer, remodeler, football commentator, father, and husband. Thank you, Dr Graves.

Serving as chair of the Budget and Finance Committee, I am happy to report that your ADA finances are in good shape despite a rough first quarter which was rocked by some bank failures and a sluggish stock market. Our finance team at the ADA along with our financial advisors at Captrust have limited our exposure and continue to work to preserve the integrity of our portfolio.

Another exciting area for me to report on is the progress the ADA Foundation is making as we prepare to roll out our strategic plan in August. We are interviewing potential new board members to be voted on in a couple of weeks. As chair, I am tasked with the job of making sure that the new board is visionary and that the ADAF remains committed to working in a collaborative manner with our partners at the state and local levels to advance the great work that is already being done and to serve as a conduit when necessary to help our members during their time of need while at the same time operating in a financially responsible manner with complete transparency to our parent, the ADA.

One area that we continue to hear about from members is the lack of a social media presence by the ADA. At our April board meeting, the ADA Influencer Strategy was introduced which provides the ADA an opportunity to raise awareness about the ADA, demonstrate its value, and manage its reputation. The strategy will include social listening, the launch of an ADA ambassador program to educate all dentists about the value of the ADA through a network of authentic interactions in dentistry groups, including closed and dentist-only social media groups and through broader influencer campaigns focused on our priorities.

One area that we continue to hear about from members is the lack of a social media presence by the ADA. At our April board meeting the ADA Influencer Strategy was introduced which provides the ADA an opportunity to raise awareness about the ADA, demonstrate its value, and manage its reputation.

This weekend we are honored to have several ADA dignitaries in our midst, ADA President Dr George Shepley, our Executive Director Dr Cohlmia, 6th District Trustee Dr Mike Medovic and his wife Cathy, and Drs Kessler and Dorowshow, my opponents in the race for ADA president-elect. I know that each one of you will help me show them the famous Texas hospitality that we are known for!

Before I forget, I would like to take a couple of minutes to recognize some of the exceptional Texas leaders that represent you all in Chicago on councils or committees. I am so proud of each and every one of them.

I’m not sure if they are all present with us this morning; if they are not, when you see them, please thank them for their service:

• Dr Stephanie Ganter, CMIRP

• Dr Kathy Nichols, CEBJA

• Dr Laura Schott, Council on Communication, or as Ray likes to refer to them, the Council of Change, serving as its Vice Chair.

• Dr Susan Joliff, CDBP

• Dr Shane Ricci, CDP

• Dr Ensy Atarod, Council on Membership

• Dr Kerin Burdette, CAAP

• Dr Jon Vogel, New Dentist Committee; thank you, Jon, for continuing to shake things up on the NDC.

• Dr Matt Roberts, Council on Government Affairs

• Lastly, Dr Rita Cammaratta, ADPAC

I know that this House has a busy agenda and I wish you all the best for a great meeting as you continue to do the

work of the Texas Dental Association and the dentists of the state of Texas.

In closing, I would like to take a moment of personal privilege as my 4 years as your 15th district trustee come to an end. I would like to express my gratitude to all of you for your support during these last 4 years and for the support you continue to give me in my quest for a higher office. The ability to ask the hard questions and to make the hard decisions is made easier when you have such a supportive group at home that you know has your back. It has been a thrill of a lifetime to serve as your trustee and to represent such a dedicated group of professionals in this great state of Texas. You all have my eternal gratitude.

Thank you.

ADA 15th District Trustee Dr Craig Armstrong and TDA President Dr Duc “Duke” M. Ho.

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ORAL and

maxillofacial pathology case of the month

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 he/ she owns all copyrights in the work, that he/she has 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.

Disclosures: none

Clinical History:

A 24-year-old Asian American female presented for routine oral examination and prophylaxis. Her past medical history included papillary thyroid carcinoma (treated by partial left thyroidectomy 4 years prior), bilateral sensorineural and conductive hearing loss (since birth), enlarged vestibular aqueducts, childhood ear infections, scoliosis, acne, and attention-deficit/ hyperactivity disorder. The patient’s medications included azithromycin, spironolactone, and lisdexamfetamine. She reported an allergy to sulfa drugs. She had no history of tobacco or alcohol use. Her family history was negative for any heritable disorders or developmental conditions.

Upon clinical examination, you notice the unusual appearance of the corners of the patient’s mouth (Figure 1). No other significant oral anomalies are identified.

What is the diagnosis for this oral finding?

See page 264 for the answer and discussion.

AUTHORS

Michaela Nguyen, BSA Dental Student, Woody L. Hunt School of Dental Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas

Todd Parco, DDS, MSD Assistant Professor, 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

Corresponding Author: Angela C. Chi, DMD 5001 El Paso Dr., MSC 24001 El Paso, TX 79905

Phone: 915-215-5440

E-mail: angela.chi@ttuhsc.edu

Oral and Maxillofacial Radiology Interpretation Service

*Comprehensive, clinically oriented radiology reports

*Reassurance for exclusion of occult pathology

*Annotated images of relevant findings

*In-depth assessments aiding patient understanding

*Easy to use, HIPAA compliant image sharing portal

*2-4 day business day turn around time

Figure 1. Clinical photograph of the patient’s lips (A), with close-up views of the right commissure (B) and left commissure (C).

Those in the dental community who have recently passed

Dwayne E. Beeler

Fort Worth

November, 26, 1946–April 29, 2023

Good Fellow: 1998

Life: 2011 • Fifty Year: 2022

James A. Dewberry Jr Dallas

August 5, 1926–April 30, 2023

Good Fellow: 1972

Life: 1991 • Fifty Year: 1997

Geoffry O. Drake

San Benito

October 24, 1941–May 5, 2023

Life: 2006 • Fifty Year: 2018

David Mitchell Garrett

Nederland

January 11, 1941–April 28, 2023

Good Fellow: 1997

Life: 2006 • Fifty Year: 2021

Joseph A Harris Dallas

February 14, 1946–May 25, 2023

Good Fellow: 1999 • Life: 2011

Hilton Israelson

Dallas

November, 5, 1949–May 19, 2023

Good Fellow: 2004 • Life: 2014

Amos David May

Abilene

May 23, 1946–May 25, 2023

Good Fellow: 1996

Life: 2011 • Fifty Year: 2020

Conrad Errol McFee

Fair Oaks Ranch

May 12, 1931–December 29, 2021

Life: 1996 • Fifty Year: 2006

Luis Alejandro Perez-Melean

San Antonio

February 14, 1990–March 30, 2023

Tommy L. Russell

Dallas

August 1, 1932–May 13, 2023

Good Fellow: 1986

Life: 1997 • Fifty Year: 2011

LAW OFFICES OF MARK J. HANNA

EXPERIENCED LEGAL REPRESENTATION FOR TEXAS DENTISTS

General Counsel, Texas Dental Association

Mark J. Hanna JD Former

ORAL

and maxillofacial pathology diagnosis and management—from page 260

Diagnosis: Commissural Lip Pits

Discussion

Lip pits represent an uncommon developmental anomaly characterized by surface invaginations or sinuses involving the corners of the mouth (commissural lip pits), lower lip, or upper lip. Pits arising on the lower lip lateral to midline are termed paramedian lip pits. In addition, in rare cases a single pit may involve the midline of the lower or upper lip.1,2

Commissural lip pits are hypothesized to result from failure of fusion of the maxillary and mandibular processes during embryonic development and may be inherited as an autosomal dominant trait.3,4 Although commissural lip pits most often occur as an isolated developmental anomaly, some investigators have reported an association with congenital aural sinuses or preauricular pits.4-6 A few cases of patients with both commissural and lower lip pits have been reported as well.7,8 Furthermore, commissural lip pits have been reported in association with rare underlying syndromes, such as branchiootic syndrome 2 (BOS2) and curly hairankyloblepharon-nail dysplasia syndrome (CHANDS).9,10 In our case, the patient had no known underlying syndrome or familial disorder but did report a clinical history of conductive/sensorineural hearing loss and enlarged vestibular aqueducts. Similarly, congenital conductive or mixed hearing loss was described along with commissural lip pits, preauricular sinuses, and external ear anomalies in some members of the BOS2 pedigree reported by Marres and Cremers.11,12 Furthermore, branchiootic syndrome belongs to a spectrum of heritable conditions (termed branchiootorenal spectrum disorder) that also includes branchio-oto-renal (BOR) syndrome.13 Patients with BOR syndrome may exhibit EYA1 or SIX5 gene mutations; sensorineural, conductive, or mixed hearing loss; malformations of the outer, middle, or inner ear; preauricular pits or tags; branchial cleft cysts or fistulae; and renal abnormalities.14 Among reported ear malformations, enlarged vestibular aqueducts have been described in some cases.15

The reported prevalence of commissural lip pits varies widely, with studies of various cohorts in different geographic regions noting their presence in approximately 0.2% to 23% of individuals.4-6,16-21 Some non-population-based studies have found relatively high frequency among black individuals and Israeli Ashkenazi Jewish adults.5, 6,19 Most authors have reported either a male predilection or no significant gender predilection.17, 19, 21,22 Although lip pits generally are considered to be congenital, some

studies have found a greater frequency of commissural lip pits among adults compared to children; these findings suggest that the anomaly may develop later in life or may become accentuated with age.3,17,21,23 In the current case, the patient believed her commissural lip pits may have been congenital, although she did not become acutely aware of their presence until her teenage years upon realizing that most other individuals did not have such invaginations.

Commissural lip pits typically present either unilaterally or bilaterally as small invaginations or blind fistulas a few millimeters deep. Such lip pits should be distinguished from mere dimples at the commissures (termed “Michalowski foveola angularis”).6 Interestingly, some investigators have found unilateral commissural lip pits to exhibit a predilection for the left side, which correlates with a similar left-sided tendency among isolated unilateral orofacial clefts.23 Most patients with commissural lip pits are asymptomatic. Affected individuals may be unaware of the condition until it is noted incidentally during routine clinical examination. Sometimes viscous salivary secretions may be expressed from the invaginations, and secondary infection may develop rarely.24 Histopathologic features have been documented in only a few reported cases.4 Microscopic examination shows surface invagination lined by parakeratotic stratified squamous epithelium and containing mucin with isolated inflammatory cells; ductal structures lined by cuboidal epithelium may be found at the deepest portion of the pit.

Paramedian lip pits are believed to result from persistence of lateral sulci on the embryonic mandibular arch.3

Such pits typically present on the lower lip vermilion as bilaterally symmetric invaginations or depressions just lateral to midline. Occasional cases may be asymmetric or unilateral. Sometimes these pits are surrounded by a hump or mound. Paramedian lip pits may extend more deeply (up to depth of approximately 1.5 cm) than commissural lip pits.25

Paramedian lip pits may develop as an isolated finding or in association with an underlying syndrome, such as van der Woude syndrome or popliteal pterygium syndrome. Significantly, van der Woude syndrome represents one of the most common causes of syndromic orofacial clefting and occurs in approximately 1 in 40,000 to 100,000 births.3 This heritable condition exhibits an autosomal dominant inheritance pattern with mutations most often detected in the IRF6 gene.26 Characteristic clinical features include lower lip pits, cleft lip and/or cleft palate, and in some cases hypodontia. Popliteal pterygium syndrome is also an IRF6-related disorder; major features include popliteal pterygia (webs), syndactyly, intraoral adhesions (with resultant syngnathia in severe cases), ankyloblepharon, abnormal external genitalia, pyramidal skin on the hallux, and musculoskeletal anomalies.27

Overall, lip pits tend to be asymptomatic and often require no treatment. Unusual cases of secondary infection (e.g., induced by scratching of the area in young patients) may be managed by incision and drainage, antibiotic therapy, and/or surgical excision.24 In addition, surgical excision may be performed to address aesthetic concerns or persistent inflammation. For lower lip pits, the risk for postoperative mucocele formation or recurrence may be reduced by modified simple excision, inverted

T-lip reduction, or the Mutaf–Goldstein technique (split lip advancement excising the middle portion of the lower lip).28 It is also important to rule out underlying syndromes that may require clinical management specific to other associated abnormalities. Genetic counseling may be provided to patients with an underlying heritable syndrome.

REFERENCES:

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2. Richardson S, Khandeparker RV. Van der Woude syndrome presenting as a single median lower lip pit with associated dental, orofacial and limb deformities: a rare case report. J Korean Assoc Oral Maxillofac Surg 2017;43:267-71.

3. Neville BW, Damm DD, Allen CM, Chi AC. Chapter 1 Developmental defects of the oral and maxillofacial region. Oral and Maxillofacial Pathology. 4th ed. St. Louis: Elsevier; 2016. p. 1-48.

4. Everett FG, Wescott WB. Commissural lip pits. Oral Surg 1961;14:202-09.

5. Baker BR. Pits of the lip commissures in Caucasoid males. Oral Surg Oral Med Oral Pathol 1966;21(1):56-60.

6. Schaumann BF, Peagler FD, Gorlin RJ. Minor craniofacial anomalies among a Negro population. I. Prevalence of cleft uvula, commissural lip pits, preauricular pits, torus palatinus, and torus mandibularis. Oral Surg Oral Med Oral Pathol 1970;29(4):566-75.

7. Chewning LC, Sullivan CJ, Bavitz JB. Congenital commissural and lower lip pits in the same patient: report of a case. J Oral Maxillofac Surg 1988;46(6):499-501.

8. Murase Y, Kishimoto K, Yoshida S, et al. A case of congenital lower lip pits with commissural pits. Japanese J Oral Maxillofac Surg 2016;62:534-38.

9. Bocchini CA. CHAND Syndrome; CHANDS, MIM Number: 214350. In Online Mendelian Inheritance in Man, OMIM®. Johns Hopkins University, Baltimore, MD. October 12, 2018 (last updated).

10. McKusick VA. Branchiootic syndrome 2, MIM Number: 120502. In Online Mendelian Inheritance in Man, OMIM®. Johns Hopkins University, Baltimore, MD. October 12, 2018 (last edited).

11. Marres HA, Cremers CW. Congenital conductive or mixed deafness, preauricular sinus, external ear anomaly, and commissural lip pits: an autosomal dominant inherited syndrome. Ann Otol Rhinol Laryngol 1991;100(11):928-32.

12. Marres HA, Cremers CW, Huygen PL, Joosten FB. The deafness, pre-auricular sinus, external ear anomaly and commissural lip pits syndrome--otological, vestibular and radiological findings. J Laryngol Otol 1994;108(1):13-8.

13. Chen A, Song J, Acke FRE, et al. Otological manifestations in branchiootorenal spectrum disorder: A systematic review and meta-analysis. Clin Genet 2021;100(1):3-13.

14. Kniffin CL. Branchiootorenal syndrome 1; BOR1, MIM Number: 113650. In Online Mendelian Inheritance in Man, OMIM®. Johns Hopkins University, Baltimore, MD. March 26, 2012 (last edited).

15. Chen A, Francis M, Ni L, et al. Phenotypic manifestations of branchio-oto-renal syndrome. Am J Med Genet 1995;58(4):36570.

16. Witkop CJ, Jr., Barros L. Oral and genetic studies of Chileans, 1960. I. Oral anomalies. Am J Phys Anthropol 1963;21(1):15-24.

17. Sedano HO. Congenital oral anomalies in Argentinian children. Community Dent Oral Epidemiol 1975;3(2):61-3.

18. Sawyer DR, Taiwo EO, Mosadomi A. Oral anomalies in Nigerian children. Community Dent Oral Epidemiol 1984;12(4):269-73.

19. Gorsky M, Buchner A, Cohen C. Commissural lip pits in Israeli Jews of different ethnic origin. Community Dent Oral Epidemiol 1985;13(3):195-6.

20. Safadi RA, Shaweesh AI, Hamasha AA, et al. The significance of age group, gender and skin complexion in relation to the clinical distribution of developmental oral mucosal alterations in 5-13 year-old children. J Stomatol Oral Maxillofac Surg 2018;119(2):122-28.

21. Premakumar P, Thomas J, Mol PR, et al. Prevalence of commissural lip pits in patients visiting a dental college in a rural area of South Kerala: a pilot study. IOSR J Dent Med Sci 2013;10:59-61.

22. Tailor MN, Joshi MU. Prevalence of commissural lip pits in population of central Gujarat: A hospital-based study. J Oral Maxillofac Pathol 2018;22(1):144.

23. Freudenberger S, Santos Diaz MA, Bravo JM, Sedano HO. Intraoral findings and other developmental conditions in Mexican neonates. J Dent Child (Chic) 2008;75(3):280-6.

24. Ishimaru J, Toida M, Handa Y, Tatematsu N, Okuda T. An infected congenital commissural lip fistula. Report of a case. Int J Oral Maxillofac Surg 1990;19(3):160-1.

25. Gurpal-Chhabda V, Singh-Chhabda G. Congenital lower lip pits: Van der Woude syndrome. J Clin Exp Dent 2018;10(11):e1127-e29.

26. Alade AA, Buxo-Martinez CJ, Mossey PA, et al. Non-random distribution of deleterious mutations in the DNA and protein-binding domains of IRF6 are associated with Van Der Woude syndrome. Mol Genet Genomic Med 2020;8(8):e1355.

27. Schutte BC, Saal HM, Goudy S, Leslie EJ. IRF6-Related Disorders. In: Adam MP, Mirzaa GM, Pagon RA, Wallace SE, Bean LJH, Gripp KW, et al., editors. GeneReviews((R)). Seattle (WA); 2003 (updated 2021).

28. Peralta-Mamani M, Terrero-Perez A, Dalben G, et al. Treatment of lower lip pits in Van der Woude syndrome: a systematic review. Int J Oral Maxillofac Surg 2018;47(4):42127.

A Dental Receptionist’s Guide to Patient Acquisition:

10 Best Practices for Converting Phone Calls into Patients

Art

Commisso, Lasso MD

Here is an often overlooked but very real scenario when it comes to marketing your dental practice.

You just launched a beautiful new website. It went live in record time (because you understand how important your online presence is). You also threw $3,000/month at digital ad campaigns—an aggressive spend for a first-time effort, but you know you’re located in a competitive market for local dentists and that the more you spend on ads, the better the results.

You’re in a hurry to start seeing the results you hoped for, but…something isn’t adding up. Your incoming phone calls with inquiries are up 35% from previous months’ all-time highs, but your new patient numbers and total monthly production have plateaued. In fact, they’ve gone down. What gives?

For a practice owner or office manager, this should be setting off red flags.

Do Phone Calls Even Matter?

Aren’t They Old School?

Yes, phone calls matter a lot. While online scheduling and new patient forms are setting the trend at modern dental practices, the reality is, 60% of consumers prefer to call businesses over the phone when seeking more information. Dentistry is personal, and choosing a new dentist is a partly emotional process. Potential patients will have many concerns when choosing a practice, and your leads will have questions that can’t be answered by a one-size-fits-all page on your website.

Identifying Your Weakest Link

The first human point of contact a prospective patient interacts with is your receptionist. Let’s go back to the article’s opening scenario. If you’re using a call tracking or ROI tracking solution, you’ll see a list of incoming calls and where they are coming from—most likely, Google Ads.

There are several reasons why a patient might not convert after calling from a digital ad.

• Price: That’s okay, they’re not your ideal patient anyway.

• Location: Your ad targeting is out of whack. Don’t be greedy; narrow your scope.

• Insurance Coverage: It’s important to communicate insurance acceptance clearly.

• Underperforming Front Office Staff: We will cover this in the next section.

Fix Your Front Desk

If you think your front office staff is the likely culprit, before you turn into Gordon Ramsay from an episode of “Kitchen Nightmares,” you need to gather information to pinpoint the source of the breakdown.

Dentistry is personal, and choosing a new dentist is a partly emotional process.

value for your profession

The good news is you can do this without breathing down your receptionist’s neck. You can implement call/ROI tracking as part of your overall marketing and training strategies. From there, you can review call history with audio recordings and transcripts so you can take a personalized approach to coach and mentor your team.

10 Best Practices for Answering the Phone in a Dental Office

Make Yourself Available

Make sure someone is always available to answer the phone during business hours. Calls answered promptly and professionally can make a significant impact on patient acquisition, satisfaction, and retention. You can dedicate a specific staff member to the task. Consider using an answering service during busy times to avoid missed calls, but make sure to train the service’s staff on how to handle calls to your practice. You can use call forwarding to a mobile phone during after-hours.

Train Your Front Office Staff

Provide clear guidelines on how to answer calls, including on the use of appropriate language and etiquette. Setting clear expectations will ensure consistent and effective communication with patients.

Utilize Call Scripts

A standard script for answering calls can help ensure consistency and efficiency. Make sure staff are familiar with the script and feel comfortable deviating from it as needed to provide personalized and effective communication.

Consider role-playing exercises to help staff feel more confident and prepared. You may also want to incorporate word choices that fit your brand.

Be Prepared

Have a list of frequently asked questions and information readily available to help staff quickly and accurately answer patient inquiries. For example, invest in software that provides easy access to patient information and streamlines appointment scheduling and accommodating other frequent patient requests.

Listen Carefully

Encourage staff to actively listen to patients and avoid interrupting them. This shows respect and empathy and helps staff to obtain all information necessary to properly address patient concerns. Consider asking staff to use active listening techniques, such as repeating what the patient says, to demonstrate they’re paying attention.

Follow Up

After each call, follow up with patients to confirm appointments, address any concerns, and thank them for their business. This shows that your practice values their time and input and reinforces the importance of good communication. Use automated email or text message reminders to make the process more efficient.

Consider Call Volume

Monitor the volume of calls your practice receives and adjust staffing and other resources accordingly. You can also try staggering appointment times to reduce call volume during peak hours or add extra staff during busy periods.

Encourage Multi-Tasking

Encourage staff to handle multiple tasks, such as scheduling appointments or updating information, while on the phone with patients. This also makes the most of their phone time.

Provide Feedback

Monitor staff’s phone performance and provide feedback, including positive reinforcement and constructive criticism. This can help improve your staff’s skills and ensure they’re communicating with patients consistently and effectively.

Evaluate and Adjust

Regularly check in on your front desk staff. Consider conducting regular patient surveys to gather feedback on patient experiences. Identify areas for improvement and make adjustments as needed.

Conclusion

While digital marketing efforts are important for attracting new patients, remember that the role of the front desk staff—the first point of human contact for prospective patients—in converting phone inquiries to patients cannot be understated. Incorporate the ten best practices outlined in this article, and your front desk staff will have the tools and skills needed to answer calls professionally and effectively; which can make a significant impact on patient acquisition, satisfaction, and retention at your practice.

Lasso helps dentists create predictable new patient flow through innovative digital and video marketing strategies. The TDA Perks Program-endorsed company’s ROI software gives practice owners the ability to track where their marketing dollars are being spent and verify the effectiveness of the campaigns. Lasso offers exclusive pricing to TDA members. To learn more, visit tdaperks. com (Insurance, HR & Marketing) or call 858-449-0560.

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Opportunities Online at TDA.org and Printed in the Texas Dental Journal

CLASSIFIEDS 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.)

MONTHLY RATES

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

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.

SUBMISSION

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.

PRACTICE OPPORTUNITIES

ALL TEXAS LISTINGS FOR MCLERRAN & ASSOCIATES. AUSTIN (ID #601): Established, primarily fee-for-service general dentistry practice with revenue of 7 figures located in a rapidly growing suburb of Austin. This office has additional upside potential via three plumbed but not yet equipped operatories, expanding the office hours, or adding several specialty procedures currently being referred out. The current owner is planning to move out of the state later this year. AUSTINNORTH (ID #604): Legacy FFS practice with an impeccable reputation located in a budding community north of Austin. The office has relied solely on word of mouth referrals with very little marketing/advertising and refers out many specialty procedures leading to upside potential for an incoming buyer. The real estate is also available for purchase.

HOUSTON-SOUTHEAST (ID #592): Legacy practice in a growing suburb southeast of Houston, large, multi-generational, PPO/FFS patient base, and annual revenue of 7 figures. Located in a high visibility retail location that

contains 5 fully equipped operatories, digital radiography, and computers throughout. With many specialty procedures being referred out, little to no external marketing or advertising, and robust hygiene recall, this practice offers significant upside potential. The real estate is also available for purchase. HOUSTON-

NORTHEAST, PEDO (ID #596): Pediatric dentistry practice in NE Houston suburb. High visibility retail center, 2,500+ sq ft office featuring 6 ops, computers throughout, digital radiography, intra-oral cameras, and paperless charts. It has a growing active patient base, sees about 80 new patients per month, and has an excellent online reputation. HOUSTON-

NORTHWEST (ID #603): State-of-the-art, FFS/PPO general dentistry practice located in a booming suburb of northwest Houston in a high-visibility retail shopping center, 7 ops (4 fully equipped), digital radiography, computers in operatories, intraoral cameras, a digital scanner, and a digital Pano. Stellar online reputation and revenue in the high-6 figures. NORTHEAST TEXAS (ID #584): 100% FFS general dentistry practice in a desirable town in northeast Texas with 7 figures in

revenue and strong net income. The turn-key practice features 4 fully equipped operatories with digital radiography, intra oral cameras, paperless charts, CBCT, and a digital scanner.

SAN ANTONIO (ID #582): Well-established, PPO/FFS family practice in central San Antonio in a high visibility building. 4 fully-equipped ops, digital radiography, a digital pano, intraoral cameras, and computers in all ops. Large active patient base and a robust hygiene recall program with no website and minimal external marketing efforts and significant growth potential by way of expanding services to include endodontics, implant placement, ortho, and oral surgery. SOUTH TEXAS (ID #585): Majority PPO/FFS GD family practice in south Texas. 1,900 sq ft office, 3 fully equipped operatories, computers in all operatories, digital radiography, digital pano, intraoral cameras, digital scanner, and paperless charts. Strong active patient base, an average monthly new patient count of 45+ (over past 12 months) on limited external marketing efforts, healthy hygiene recall program (20% of annual production) and primed for continued success and future growth. TO REQUEST

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MORE INFORMATION ON MCLERRAN & ASSOCIATESí LISTINGS: Please register at www.dentaltransitions.com or contact us at 512-900-7989 or info@dentaltransitions. com.

BEAUMONT: GENERAL (REFERENCE

“BEAUMONT”). Small town practice near a main thoroughfare. 80 miles east of Houston. Collections in 7 figures. Country living, close enough to Houston for small commute.

Practice in a stand-alone building built in 1970. The office is 1,675 sq ft with 4 total operatories, 2 operatories for hygiene and 2 operatories for dentistry. Contains reception area, dentist office, sterilization area, lab area. Majority of patients are 30 to 65 years old. Practice has operated at this location for over 38 years. Practice sees patients about 16 days a month. Collection ratio of 100%. The practice is a fee-for-service practice. Building is owned by dentist and is available for sale. Contact Christopher Dunn at 800-930-8017 or christopher@ddrdental.com. HOUSTON

(SHARPSTOWN AREA): GENERAL (REFERENCE “SHARPSTOWN GENERAL”). MOTIVATED SELLER.

Well-established general dentist with high6 figure gross production. Comprehensive general dentistry in the southwest Houston area focused on children (Medicaid). Very, very high profitability. 1,300 sq ft, 4 operatories in single building. 95% collection ratio. Over 1,200 active patients. 20% Medicaid, 45% PPO, and 35% fee-for-service. 30% of patients younger than 30. Office open 6 days a week and accepts Medicaid. Contact Christopher Dunn at 800-930-8017 or christopher@ ddrdental.com. HOUSTON (BAYTOWN AREA): GENERAL (REFERENCE “BAYTOWN GENERAL”).

MOTIVATED SELLER. Well-established general practice with mid-6 figure gross production. Comprehensive general dentistry in Baytown on the east side of Houston. Great opportunity for growth! 1,400 sq ft., 4 operatories in single story building. 100% collection ratio. 100% fee-for-service. Practice focuses on restorative, cosmetic and implant dental procedures. Office open 3.5 days a week. Practice area is owned by dentist and is available for sale. Contact Christopher Dunn at 800-930-8017 or christopher@ddrdental.com. WEST OF AUSTIN:

ORTHODONTIC (REFERENCE “HILL COUNTRY

ORTHO”). Located in a rapidly growing small town, this practice is in the heart of the Texas hill country. This practice serves the youth of the area. There are 4 operatories in the practice. The practice is 100% fee-for-service. Orthodontic care is the only service provided at this office. 1,300 sq ft. Open 4 days per week. Digital X-rays and pano and Cloud9Ortho software. The practice has excellent visibility and is located near a hospital. Contact Christopher Dunn at 800-930-8017 or christopher@ddrdental.com.

HOUSTON, COLLEGE STATION, AND LUFKIN

(DDR DENTAL Listings). (See also AUSTIN for other DDR Dental listings and visit www. DDRDental.com for full details. LUFKIN: General practice on a high visibility outer loop highway near mall, hospital and mature neighborhoods. Located within a beautiful single-story, freestanding building, built in 1996 and is ALSO available for purchase. Natural light from large windows within 2,300 sq ft with 4 operatories (2 hygiene and 2 dental). Includes a reception area, dentist office, a sterilization area, lab area, and break room. All operatories fully

equipped. Does not have a pano but does have digital X-ray. Production is 50% FFS and 50% PPO (no Medicaid), with collection ratio above 95%. Providing general dental and cosmetic procedures, producing mid-6 figure gross collections. Contact Christopher Dunn at 800-930-8017 or Christopher@DDRDental. com and reference “Lufkin General or TX#540”. HOUSTON: GENERAL (SHARPSTOWN). Well established general dentist with high-6 figure

McLerran & Associates is the largest dental practice brokerage firm in Texas.

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gross production. Comprehensive general dentistry in the southwest Houston area focused on children (Medicaid). Very, very high profitability. 1,300 sq ft, 4 operatories in single building. 95% collection ratio. Over 1,200 active patients. 20% Medicaid, 45% PPO, and 35% fee-for-service. 30% of patients younger than 30. Office open 6 days a week and accepts Medicaid. Contact Chrissy Dunn at 800-930-8017 or chrissy@ddrdental.com and reference “Sharpstown General or TX#548”. HOUSTON: GENERAL (PEARLAND AREA).

GENERAL. Located in southeast Houston near Beltway 8. It is in a freestanding building. Dentist has ownership in the building and would like to sell the ownership in the building with the practice. One office currently in use by seller. A 60 percent of patients age 31 to 80 and 20% 80 and above. Four operatories in use, plumbed for 5 operatories. Digital pano and digital X-ray. Contact Christopher Dunn at 800-930-8017 or christopher@ddrdental.com and reference “Pearland General or TX#538”.

HOUSTON: PEDIATRIC (NORTH HOUSTON). This practice is located in a highly soughtafter upscale neighborhood. It is on a major

thoroughfare with high visibility in a strip shopping center. The practice has 3 operatories for hygiene and two for dentistry. Nitrous is plumbed for all operatories. The practice has digital X-rays and is fully computerized. The practice was completely renovated in 2018. The practice is only open three and a half days per week. Contact Christopher Dunn at 800930-8017 or christopher@ddrdental.com and reference “North Houston or TX#562”. WEST HOUSTON: MOTIVATED SELLER. Medicaid practice with production over 6 figures. Three operatories in 1,200 sq ft in a strip shopping center. Equipment is within 10 years of age. Has a pano and digital X-ray. Great location. If interested contact chrissy@ddrdental.com. Reference “West Houston General or TX#559”.

SOUTHEAST HOUSTON: Above mid-6 figures of adjusted net production and almost full collection (97%). Fee-for-service and PPO practice, highest-net income. The total collection over total production is about 90%. 4 days/week, free weekends. No Medicaid, No HMO/DMO, no in-network and no hassle. This practice has been in this area for over 40

years; the current practice location was built in 2006 in a new building with all new equipment. 4,000 sq ft, 5 fully equipped operatories, and 5 additional operatories plumbed. CBCT with pano and digital X-ray with a Phosphor-Plate scanner require little to no maintenance. We have a few digital sensors too. Microscopes and Fotona Lasers are available. Doctors over 70 years of age are ready to retire. Instead of using a broker, we are willing to provide a discount equal to the broker fee. Interested parties can contact us by calling or texting our personal cell number 346-754-9643. Email: smile.office@proton.me. Principals only. Sales agents and buyers bonded to the broker, please don’t contact this sales poster. Do NOT contact us with unsolicited services or offers.

OFFICE SPACE

SPRING: Space for lease; up to 4,875 sq ft. Build to suit located in master-planned Harmony Commons, 5 miles from Exxon campus. Great demographics, high median income, growing area. Brand new, modern construction. Available early 2024. Medical-only building with an orthodontist as a committed tenant. Contact 832-545-9376.

INTERIM SERVICES

HAVE MIRROR AND EXPLORER, WILL

WATSON BROWN PRACTICES FOR SALE:

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

TRAVEL: Sick leave, maternity leave, vacation, or death, I will cover your general or pediatric practice. Call Robert Zoch, DDS, MAGD, at 512517-2826 or drzoch@yahoo.com.

APP-SOLUTELY RE-IMAGINED!

Since 1996, our team of experts have provided successful transition services exclusively to dentists. Choice prides itself on its reputation for integrity, service and results for both traditional practice sales and commission-free sales to DSOs.