May 2022 Texas Dental Journal by Texas Dental Association

May 2022

TEXAS DENTAL

INSIDE: Let’s Welcome Our Colleagues from Different Practice Models Of Conquerors and Colleagues— The Clash of Experience and Ingenuity in the Boardroom and the Dental Office

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Contents May 2022 Established February 1883 n Vol 139, No. 5

FEATURES 231 | Of Conquerors and Colleagues—

The Clash of Experience and Ingenuity in the Boardroom and the Dental Office Stephanie R. Ganter, DDS, MS The challenge with a young leader like myself, is that it is natural to look at leadership as a space to conquer, not a space for colleagues. The opportunity for leaders of any age is to continue to grow through our experiences, mentorship, and education.

238 | Let’s Welcome Our Colleagues from Different Practice Models Vincent Lizzio, DDS Diversity impacts personal practice choice. Therefore, I believe it is crucial for our association to become relevant, welcoming, and inclusive to prospective members who practice in a broad range of care settings. Reprinted with permission from the Michigan Dental Association.

DEPARTMENTS 228 | President’s Message 234 | Oral and Maxillofacial

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

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Pathology Case of the Month

Texas Dental Journal | Vol 139 | No. 5

Editorial Staff Daniel L. Jones, DDS, PhD, 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 PRESIDENT Debrah J. Worsham, DDS 936-598-2626, worshamdds@sbcglobal.net PRESIDENT-ELECT Duc “Duke” M. Ho, DDS 281-395-2112, ducmho@sbcglobal.net PAST PRESIDENT Jacqueline M. Plemons, DDS, MS 214-369-8585, drplemons@yahoo.com VICE PRESIDENT, NORTHEAST Carmen P. Smith, DDS 214-503-6776, drprincele@gmail.com VICE PRESIDENT, SOUTHEAST Georganne P. McCandless, DDS 281-516-2700, gmccandl@yahoo.com VICE PRESIDENT, SOUTHWEST J. Ted Thompson, DDS 361-242-3151, tedito@aol.com 817-238-6450, pdalw@yahoo.com VICE PRESIDENT, NORTHWEST E. Dale Martin, DDS SENIOR DIRECTOR, NORTHEAST Elizabeth S. Goldman, DDS 214-585-0268, texasredbuddental@gmail.com SENIOR DIRECTOR, SOUTHEAST Glenda G. Owen, DDS 713-622-2248, dr.owen@owendds.com SENIOR DIRECTOR, SOUTHWEST Carlos Cruz, DDS 956-627-3556, ccruzdds@hotmail.com SENIOR DIRECTOR, NORTHWEST Teri B. Lovelace, DDS 325-695-1131, lovelace27@icloud.com DIRECTOR, NORTHEAST Jodi D. Danna, DDS 972-377-7800, jodidds1@gmail.com DIRECTOR, SOUTHEAST Shailee J. Gupta, DDS 512-879-6225, sgupta@stdavidsfoundation.org DIRECTOR, SOUTHWEST Richard M. Potter, DDS 210-673-9051, rnpotter@att.net DIRECTOR, NORTHWEST Summer Ketron Roark, DDS 806-793-3556, summerketron@gmail.com SECRETARY-TREASURER* Cody C. Graves, DDS 325-648-2251, drc@centex.net 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** Daniel L. Jones, DDS, PhD 214-828-8350, editor@tda.org LEGAL COUNSEL Carl R. Galant William H. Bingham, Advisor *Non-voting member **Non-voting attendee

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CELEBRATING 30 YEARS

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on this Chew I ’d like to express my gratitude to all who supported me on my journey as TDA President. 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! To my husband, Phil, my biggest cheerleader, thank you for putting up with me for almost 44 years and for “Driving Miss Daisy” to McAllen, Abilene, and Lubbock. To my three kids, their spouses, and my three grands, thank you for all your support. And to my staff, thanks for holding down the fort while I was away from the office serving the dentists of Texas. You’re the best! All of you are a very special and important part of my life! This year has definitely passed quickly! From the first stop in Amarillo last year on May 13th (the very next week following the TDA meeting), to the last visit in Corsicana on April 21st, 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. To my home district, the Third District, thank you for your unwavering support this last year. Dr David Nichols gets the “encourage Debrah to do

TDA President Debrah J. Worsham, DDS

Dr Debrah Worsham presents Dr Jacqueline Plemons the Gold Medal for Distinguished Service Award

something” award. He was 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! 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! We’ve accomplished a lot this past year! Your TDA Board of Directors discussed and made decisions revolving around member value, membership trends, and component needs. In the Membership outreach campaign which ran from October through December, 2021, there were 132 NEW members recruited. Thank you to everyone who participated and encouraged even one member to join or renew. The council on membership initiated several new outreach programs. They hosted and developed two town hall diversity webinars. Because of so much interest and positive feedback, they have another one planned for the Fall. TDA will soon embark on what I call the “TDA CE Roadshow”, where

Dr Worsham with husband Phil, daughter Olivia Hatfield, and grandson August Edward.

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TDA will partner with local components to produce CE in that area. There is already a lot of excitement from those districts who need and want it! One of our biggest accomplishments, 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. If you haven’t signed up for this app, you need to get moving! Plans are in the works for a new doctors-only conference in very nice and out of the ordinary resort-like areas, with high quality CE courses and speakers. CAMCEP is spending lots of time and effort planning this. These are just a few of the highlights from this past year. I encourage you to read my full speech in the June issue of the Texas Dental Journal for more on how the TDA has served you, the member. You can also read Dr Duc “Duke” Ho’s incoming Presidential speech. As he says, “It’s a killer speech!” We know it takes all of us engaging with our different talents and unique strengths working together in unity to be on point and laser-focused 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. Thank you again for allowing me to serve you as President of the TDA. It has been my honor. Dr Worsham seated with TDA Past Presidents at the Annual Past President’s Breakfast

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Member Recruitment

Winners

2021 Year

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Dr Danette McNew Member

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The TDA conducted a membership campaign from October to December 2021 that successfully recruited 132 new members. The “15 for 12” campaign challenged current members to recruit a new member for the chance to win 3 months of free TDA dues for 2022.

Dr Teri Lovelace TDA Board Member

Abilene, TX

Dr Duc “Duke” Ho TDA Board Member

Katy, TX

Three members were the top recruiters— Dr Duc “Duke” Ho of Katy, Dr Teri Lovelace of Abilene, and Dr Danette McNew of Dallas. Each reached out to potential members to describe what he or she loves best about TDA membership. Read their stories in TDA Today.

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Of Conquerors and Colleagues The clash of experience and ingenuity in the boardroom and the dental office Stephanie R. Ganter, DDS, MS Reprinted with permission from Dallas County Dental Society

i all. I’m Stephanie R. Ganter, a lifelong

learner and admitted tryhard. By my very nature I fall into the stereotypical “unproven, young leader” role—eager to please all who have come before me and hungry for attention to prove that I matter. Who can relate? I practice alongside an experienced, successful oral and maxillofacial surgeon. Our experiences together have given me the inspiration to write on the challenges and opportunities faced when the conquering young meets the wiser, experienced leader. In Arthur C. Brooks’ book titled, “Strength to Strength”, he discusses fluid intelligence and crystallized intelligence. Fluid intelligence peaks in our 20-30s and represents the height of creativity and ingenuity. Crystallized intelligence peaks later in life around 65 years old and represents an intelligence based on experience, what some would call “wisdom.” Brooks uses these concepts to discuss our inevitable decline in fluid intelligence and gives us hope in catching the next curve of life, or making the ‘jump’ to our next strength based on our developing crystallized intelligence.

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was at a bar called The Druid in Cambridge, Massachusetts, where I was discussing these very concepts in leadership with ADA New Dentist Committee Vice Chair Dr James Lee and my partner/TSBDE Board Member Dr Robert G. McNeill. James was asked by Bob to give me advice as a young leader. James said, “Enjoy the ride. Enjoy the positions you are in right now, because as you rise higher in leadership, more will be expected of you.” He continued, “You suddenly realize it’s not about advancing your name anymore, for the group to accomplish its goal you have

The challenge with a young

to shift into thinking how can I advance those around me”. At this point it clicked. Experience, or crystallized intelligence allows wiser leaders to see the field, to know what has worked and what has not in an organization. They become masters of synergy, bringing individuals together to form a productive team. So how can young leaders who may lack the years of experience be valuable on a committee or in a boardroom? The answer will be different for everyone. I can tell you for me, it means looking at ingenuity through the lens of the group’s advancement versus that of my own.

leader like

myself is that it is natural to look at leadership as a space to conquer, not a space for colleagues.

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The challenge with a young leader like myself is that it is natural to look at leadership as a space to conquer, not a space for colleagues. The opportunity for leaders of any age is to continue to grow through our experiences, mentorship, and education. I’d encourage those that wish to enhance their leadership perspective to read, and read often! For my fellow millennials out there, maybe that means having a goal to read more than the amount of time you are on social media. I recently read an article on retired U.S. Navy Admiral Jame Starvidis. Admiral Starvidis has commanded destroyers in combat and served as a four-star admiral and the Supreme Allied Commander at NATO. He also reads more than 100 books a year. Reading is part of his recommendations to young leaders. Admiral Starvidis encourages the following habits: Listen, read, study deeply, take emotion out of your decision making, be prepared to compromise, and reflect (especially after failure). Although there is much to unpack there, I want to leave you with the key takeaway for your time spent reading this article. Young leaders face the challenges of ego and have the gift of fluid intelligence to bring to their practices and additional leadership roles. More experienced leaders offer the gift of crystallized intelligence, based on experience and are challenged by change. Both young and experienced leaders can benefit greatly from small, incremental change. We will become what we practice. In the book, “Atomic Habits,” author James Clear talks about the power of small, daily changes. I couldn’t help

Experience, or crystallized

intelligence, allows wiser leaders to see the field, to know what has worked and what has not in an organization. They become masters of synergy, bringing individuals together to form a

productive team.

reflecting on the advice of Dr Robert Spears, now Associate Dean for Student and Academic Affairs at UT Houston School of Dentistry. Dr Spears would tell all of us taking the rigorous gross anatomy course, “a little bit every day goes a long way.” I hope you come away from this article more apt to appreciate the gifts that both conquerors and colleagues may offer to your next board meeting, office morning huddle, or group project. Stephanie R. Ganter, DDS, MS is a Board Certified Periodontal and Implant Surgeon and partner in practice at The Dental Specialists in Garland, Texas. Dr Ganter has completed a 2-year Integrative Medicine Fellowship out of the University of Arizona School of Medicine. She has also completed executive leadership training through Cornell University and is currently enrolled in a Surgical Leadership Program through Harvard Medical School.

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ORAL

and maxillofacial pathology

Clinical History

A 30-year-old Caucasian male presented to a Federally Qualified Health Center providing oral health care to patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The patient’s chief complaint was “painful teeth and gums.” Multiple asymptomatic raised white plaques involving the right soft palate and tonsillar pillar area were noted during oral examination. These white plaques exhibited nonhomogeneous verrucoid surfaces with thin erythematous streaks (Figure 1). These lesions were discovered as an incidental finding and the patient was unaware of these lesions prior to their discovery. The patient denied trauma, chemical or thermal burn to the affected area. The patient did not

case of the month AUTHORS Safia Durab, BDS, BSc, MSc Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas

Ashley Clark, DDS Department of Oral Health Science, Division of Oral Pathology, University of Kentucky College of Dentistry Lexington, Kentucky

Mark Nichols, DDS Dental Director, Avenue 360 Health and Wellness Houston, Texas

Nadarajah Vigneswaran, BDS, DMD, Dr Med Dent Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas

Figure 1. Clinical image of the multiple white plaques involving the oropharynx and tonsillar area.

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experience any difficulty in swallowing and denied pain or bleeding from his throat. The patient’s only medication was GENVOYA® (elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide). Patient’s CD4 counts at the time of presentation was 527/mm3, while his HIV-RNA viral load was <20 (undetectable). The remainder of the oral soft tissue examination findings were non-contributory. The patient underwent incisional biopsy of the white plaques under local anesthesia.

What is your clinical differential diagnosis?

Biopsy Findings This biopsy specimen was submitted to the UTSDHouston, Oral and Maxillofacial Pathology Laboratory for diagnosis. The biopsy specimen consisted of an irregular tan fragment of soft tissue measuring 8 x 5 x 2 mm. This specimen was serially sectioned and submitted for routine histopathologic examination. Microscopic examination of the hematoxylin and eosin (H&E)-stained sections revealed mucosal fragments surfaced by hyperparakeratinized and hyperplastic stratified squamous epithelium with elongated and irregular rete ridges and thinning of the suprapapillary epithelium. Prominent neutrophilic exocytosis was noted within the surface epithelium and parakeratin. The underlying lamina propria revealed intense chronic inflammation consisting mostly of a plasma cell infiltrate within the superficial lamina propria and around the blood vessels (perivascular) within the deeper tissue. Special stain (Warthin-Starry) demonstrated the presence of spirochetes within the surface epithelium (Figure 2C).

What is your most likely diagnosis? See page 250 for the answer and discussion.

A Figure 2. Microscopic examination of the biopsy revealed mucosal fragments surfaced by hyperparakeratinized and hyperplastic stratified squamous epithelium with elongated and irregular rete ridges and thinning of the suprapapillary epithelium (A; 40x) . Prominent neutrophilic exocytosis was noted within the surface epithelium and parakeratin (A; 40x). The underlying lamina propria revealed an intense chronic inflammatory cell infiltrate consisting mostly plasma cells within the superficial lamina propria and around the blood vessels (arrow) (B; 200x). Warthin-Starry stain (C) demonstrated the presence of spirochetes within the surface epithelium (arrows).

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Let’s Welcome Our Colleagues from

Different Practice Models By Vincent Lizzio, DDS Reprinted with permission from the Michigan Dental Association. Originally printed in October 2021.

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Diversity isn’t just about ethnicity or gender. It’s also about the growing variety of practice models in dentistry today. There isn’t just “one” way to practice dentistry, and our association needs the ideas and talents of dentists in all types of practice. And, these dentists need our association, too.

s a member of the Board of Trustees of the Michigan Dental Association, I am committed to the goals of the MDA’s strategic plan. That

plan includes understanding and improving diversity, equity, and inclusion at all levels of our organization. The recent addition of this goal complements our long-standing objective to welcome all members of the dental community.

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About

the

Author

he ADA Council on Membership has proposed an association policy on diversity and inclusion for consideration by the 2021 House of Delegates. (Editor’s Note: This article is a reprint from the Michigan Dental Association. The author is referencing the ADA House of Delegates, which met in October 2021). The ADA background statement points out that “for much of the ADA’s history, members have been predominantly white and male. Only in the past few decades have there been significant increases in women and racially/ ethnically diverse dentists. Today dental students are more than half female and almost 48% are racially/ ethnically diverse.” The ADA also recognizes that diversity can reflect personal practice choice.

Vincent Lizzio, DDS, is a general dentist and regional director/ clinical director at Great Expressions Dental Centers, in which he helps direct the development and growth of 50 offices in Michigan and Ohio, as well as mentoring dentists who come to work for the organization. He is currently serving as a member of the Michigan Dental Association Board of Trustees. A graduate of the University of Michigan School of Dentistry, he is also a member of the United Concordia Dental Advisory Board. Contact him at vincent.lizzio@ greatexpressions.com.

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Women, dentists from diverse backgrounds, and those in large group practices currently are lagging in terms of the ADA’s overall membership market share. The ADA Council then points out that “a lack of membership diversity will lead to continued reduction in overall market share, risking a drop below 50%, where the ADA will no longer represent the majority of dentists.” As a leader in our association, this concerns me because that would risk jeopardizing our voice to advocate on behalf of dentists and the public. And in my other role, as a managing dentist in a large dental service organization, I recognize that my practice setting attracts a large number of female colleagues as well as those from diverse backgrounds. Diversity impacts personal practice choice. Therefore, I believe it is crucial for our association to become relevant, welcoming, and inclusive to prospective members who practice in a broad range of care settings. Unfortunately, leaders and individual members often struggle, either intentionally or unintentionally, to be inclusive and welcoming of some colleagues, particularly those employed in large group settings.

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Women, dentists from diverse backgrounds, and those in large group practices currently are lagging in terms of the ADA’s overall membership market share.

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I can speak to this firsthand, being a practicing dentist for more than 30 years at a large DSO, Great Expressions Dental Centers. You might be surprised to find that my practice is not that different from traditional models. I’ve had the privilege of treating the same families and the children of patients who were young themselves when they first came to see me. I have complete control of my treatment plans and patient care decisions. And, I am the leader of my practice and need to manage my staff like other dentists in solo practice. I chose to be a DSO dentist for my entire career because it afforded me several opportunities to grow in my profession. I have been able to work with innovative leaders who encouraged me to develop stronger business and management skills. I’ve enjoyed varied opportunities for

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continuing education and professional development. Working in a DSO frees me from credentialing, billing, and monitoring compliance for new regulations. Perhaps the greatest joy I have had is the ability to coach and mentor many dentists entering our profession. They’ve motivated me to keep my skills current and stay up to date with new technologies. I’m not saying that being a DSO dentist is better; I am saying that it has been best for me.

NOT A WELCOMING EXPERIENCE Like many of you, my initial experience with organized dentistry was early in my dental career when I attended a component dental meeting. Everyone was entirely professional, yet I was left with a feeling that I was somehow different. When I told other doctors where I worked, the conversation came to an abrupt end. Perhaps this was because I didn’t have the same background as the majority of the doctors in traditional private

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practice. I was left with a feeling that I was some kind of a “dental outsider.” I had always been passionate about our profession, yet I didn’t feel embraced by my local society. During the remainder of that meeting, I kept quiet about where I practiced, and I certainly wasn’t inspired to attend future dental society events. Consequently, I chose not to be an active member in organized dentistry for many years. But as time went on, I realized that many issues in dentistry are shared across the profession, especially with the younger dentists I had came to mentor. It became evident that we all need organized dentistry for the sense of community and advocacy it provides. As time passed, I also sensed more openness and a greater acceptance of DSO practitioners by our association. So, I decided I needed to get involved. Curiosity inspired me to become a member of the MDA’s first Leadership Exploration And Development (LEAD)

Like many of you, my initial experience with organized dentistry was early in my dental career when I attended a component dental meeting. Everyone was entirely professional, yet I was left with a feeling that I was somehow different.

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class, which reignited my commitment to my profession. I took on roles with committees and involved myself in focus groups. Eventually, I ran for a seat on the MDA Board, and I was elected as a trustee. I am currently serving in my third year on the Board. Looking back, I have to say that my first encounter with organized dentistry was not something I ever really resented. I didn’t feel any malicious intent. Still, it bothered me. I suspect that women dentists and those from minority backgrounds have had similar experiences. It’s subtle, perhaps even unconscious, but you can feel it. I recognize that it’s human nature to be at ease with people who are most like us, but I hope my story raises awareness of how other dentists may feel when they are perceived as different. We need to break out of the comfort zone of our limited social

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circles and extend a hand to welcome them to our dental community. I’m concerned that my story of initial disillusionment with organized dentistry may be all too common. And I wonder if my subsequent return as an active leader may be a unique experience. No doubt too many others have been “turned off” to organized dentistry due to a negative first impression. It’s hard to overcome first impressions, after all. But our association can’t risk having any colleague feel like an outsider and walk away, never to return. And

conversely, it’s a shame when dentists miss out on the many professional opportunities and personal advantages that membership offers. Increasingly, we’re seeing many different practice models. Some dentists choose public health or academic practices. Some prefer traditional private practices. Others choose to associate with DSOs. Yet we’re all dentists struggling with the same issues. Frustrations with insurance reimbursement and government regulations are universal. No one path is suitable for everyone.

FIGURE 1: Michigan dentists affiliated with DSOs

11.5% of Michigan dentists were affiliated with dental service organizations (DSOs)

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in 2019.

According to an ADA Health Policy Institute (HPI) report, 11.5% of Michigan dentists are affiliated with a DSO (see Figure 1). A 2020 survey by the American Dental Education Association (ADEA) shows that 30% of dental students intend to work in DSOs following graduation.1 With more than 20% of current dentists age 21-34 practicing in a DSO (See Figure 2), the market share of this delivery model will grow. Practitioners in DSOs include between 6 and 12% of dental specialists and more than 13% of female dentists. It is important to note that female dentists were 48% more likely to join a DMSO group practice than male dentists. When contrasted with white dentists, Black (158%), Hispanic (43%), and Asian dentists (67%) are more likely to join a DMSO group practice.2

FIGURE 2: U.S. DSO Dentists by Gender

13.3% 8.7%

Female Dentists

Male Dentists

U.S. DSO Dentists by Age 20.4%

13.3%

If these demographics sound familiar, it’s because these are the very colleagues we must recruit into MDA/ADA membership if our association is to

5.4%

21-34

35-49

50-64

4.0%

65+

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DSO Dentists by Speciality Orthodontics Pediatric Dentistry General Practice All Specialities Oral Surgery Periodontics Endodontics Prosthodontics Public Health

ADA Market Share: Lagging Segments 75.0% New dentists 1-3 years (Discounted rates)

70.0% 65.0%

All members

60.0%

Women 55.0%

New dentists 4-6 years Diverse

50.0%

DSO (non owner) 45.0% 2016

2017

2018

2019

2020

Risk: Broader diversity is now reflected in the profession, including women, ethnically diverse, and group practice dentists. These growing market segments represent the demographics where ADA market share tends to lag. Ongoing diversity gaps will lead to continued reductions in overall market share, specifically with new dentists entering the profession. Source: ADA

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remain relevant. Organized dentistry must welcome this growing group of DSO members, or we will soon lose the ability to speak for our profession.

LET’S WORK TO TAKE ACTION What can we do? Well, each of us must take an active role to reverse this trend. I was inspired to be an active member and overcame that first impression thanks to oneon-one relationships and active recruitment from leaders who led me to invest my time and passion in organized dentistry. The bottom line is that we want young dentists to feel included from the very start of their careers, so that we don’t have to overcome a bad first impression like I had, or like many experience. We need to welcome those of all the varied backgrounds represented in our profession. This can only happen by actively making efforts to welcome diversity to our association.

We are all very aware of the meaning of discrimination and undoubtedly are mindful of its negative impact on our society. But it’s important to recognize that the absence of overt discrimination does not create an atmosphere of inclusion by itself. To me, inclusion is the act or practice of incorporating and accommodating people who have historically been excluded. We need to actively welcome dentists from diverse backgrounds. I hope all members can agree that an inclusive association serves our profession the best. Readers may now ask, “What can I do to make our dental community open and inviting to colleagues of varied backgrounds? How can I make someone from a different background feel welcomed and comfortable at our next meeting?” My answer is that it simply takes an effort to get out of our comfort zone. I applaud the MDA for making DEI (Editor’s note: Diversity/Equity/Inclusion)

a priority, and I look forward to seeing the continued growth of organized dentistry in representing all colleagues who share our great profession. References 1. Istrate EC, Slapar FJ, Mallarapu M, Stewart DCL, West KP. Dentists of tomorrow 2020: An analysis of the results of the 2020 ADEA Survey of U.S. Dental School Seniors. J Dent Educ. 2021 Mar;85(3):427440. doi: 10.1002/ jdd.12568. Epub 2021 Feb 26. PMID: 33638174.) 2. Nasseh K, Vujicic M. The relationship between education debt and career choices in professional programs: The case of dentistry. J Am Dent Assoc. 2017 Nov;148(11):825833. doi: 10.1016/j. adaj.2017.06.042. Epub 2017 Aug 23. PMID: 28843498.

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ORAL

and maxillofacial pathology diagnosis and management—from page 234

Diagnosis: Mucous Patch-secondary Syphilis Discussion Based on the clinical findings, location of the lesions and the patient’s medical history, a differential diagnosis should include mucous patch as a manifestation of secondary syphilis; chronic hyperplastic candidiasis, leukoplakia, and pseudomembranous pharyngitis are also considered. Syphilis: Syphilis, caused by the Spirochete Treponema pallidum, is one of the common sexually transmitted diseases noted in the United States.1,2 Mucous patch is the classic oral manifestation of secondary syphilis which develops 2-12 weeks after the initial infection and 8-weeks after the resolution of primary syphilis. Since reaching a historic low in 2000 and 2001, there has been a resurgence in syphilis incidence in the United States, especially among males who have sex

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with men (MSM).1,2 Multiple sexual partners, decreasing use of barrier protection (i.e., condom), illicit drug use, alcohol abuse, and HIV coinfection are the major risk factors for contracting syphilis.1,2 The transmission of T. pallidum usually occurs via sexual contact.3,4 These organisms penetrate the skin and mucosal barriers via oral or genital mucosal breeches during sexual activity. Once entered through the skin or mucosa, T. pallidum disseminates rapidly to the regional lymph nodes.2,4 If left untreated, it undergoes systemic dissemination via the bloodstream and progresses to secondary syphilis.2,4 Untreated syphilis can progress over years through a series of clinical stages and have serious potentially lifealtering and irreversible health consequences such as neurological complications, hearing loss, blindness, and an increased likelihood of contracting

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other sexually transmitted diseases.2 Pregnant females with syphilis infection can give birth to babies with congenital syphilis, as well as suffer from an increased risk of miscarriage, stillbirth, birth defects, and/ or infant death.2 Although deaths from syphilis in the adult population are rare, a 6.5% case-fatality rate has been reported for babies born with congenital syphilis. Primary Syphilis: Primary syphilis, which presents as a chancre, develops the site of the bacterial organism’s entry and presents as a painless, red, indurated ulcer. Primary syphilis usually appears on the genitalia, but may be present on other sites such as the anus or oral cavity. The chancre heals on its own in a few days to weeks, even without treatment. The lips are the most common site of primary syphilis of the oral cavity, followed by the tongue and tonsillar area.

Secondary Syphilis: Secondary syphilis demonstrates the most recognized clinical manifestations of syphilis, particularly among women or MSM, presumably because the painless anogenital chancre of primary syphilis is often overlooked. The classic presentation of secondary syphilis consists of nonspecific generalized symptoms (e.g., fever, malaise, lymphadenopathy) and variable mucocutaneous manifestations, including a maculopapular skin rash. When mucous membranes are involved, lesions can appear as highly infectious mucous patches and in moist areas might have an exuberant, verrucous appearance resembling warts (referred to as condylomata lata). These manifestations usually present 3 to 10 weeks after initial exposure. Primary syphilis and secondary syphilis are the sexually transmissible stages of infection. Latent Syphilis: The latent stage of syphilis is a period when there are no visible signs or symptoms of syphilis. It can occur between the primary

and secondary stages and can also occur after the resolution of secondarystage lesions, potentially lasting for years. Tertiary Syphilis: Tertiary syphilis is a rare form of syphilis that can appear 10–30 years after infection was first acquired and it can be fatal. It can affect multiple organ systems, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Tertiary syphilis is rarely encountered in developed countries owing to advancement of disease diagnosis and treatment. Congenital Syphilis: While the major increase in syphilis has been attributed to MSM, an increase in infection rates among females has also been reported. Pregnant females with syphilis infection are at risk of giving birth to babies with congenital syphilis due to vertical transmission. Contracting syphilis during pregnancy increases the risk of risk of miscarriage, stillbirth, premature labor, low birth weight, birth defects, and/ or infant death. Early intervention with penicillin therapy can successfully treat congenital syphilis

in newborns. While the timely diagnosis of the disease remains the most prominent prognostic marker for congenital syphilis, blanket antenatal screening may prove an effective tool in disease prevention.2 Diagnosis of syphilis: Treponema pallidum has a slender, coiled morphology and when examined by dark-field microscopy it moves with a drifting rotary motion (corkscrew). However, most clinical settings do not have the facility to directly detect T. pallidum with darkfield microscopy when lesions are present.6 Moreover, the darkfield microscopy cannot distinguish T-pallidum from other morphologically similar spirochetes of oral microbiome. Serologic tests consisting of both non-treponemal tests and treponemal-specific tests are used for screening and diagnostic confirmation of syphilis, respectively. Commonly used nontreponemal tests are rapid plasma reagin [RPR] and Venereal Disease Research Laboratory [VDRL]. The screening tests detect anticardiolipin antibodies present in syphilitic patients’ sera, www.tda.org | May 2022

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ORAL

and maxillofacial pathology, continued

using antigen substrate composed of cardiolipin, cholesterol and lecithin. These non-treponemal tests are inexpensive, rapid, and convenient for initial screening of patients suspected of having syphilis. These tests are also useful for monitoring the efficacy of treatment. However, these tests have less sensitivity for detecting syphilis during its early and late stages. Moreover, these tests tend to give false positivity among older patients, pregnant women, patients with autoimmune diseases such as systemic lupus erythematosus, malignancy, viral and mycoplasma infection. The treponemal tests (e.g., the T. pallidum particle-agglutination test or an automated enzyme or chemiluminescence immunoassay) are sensitive and specific for diagnostic confirmation of syphilis. If the nontreponemal test is non-reactive, further testing is necessary with a confirmatory treponemal test. The standard of care for treating syphilis is penicillin, and the patient’s response to treatment is assessed via serological

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test titers over a period of several months. Hyperplastic candidiasis HIV-positive patients are at high-risk for developing oropharyngeal candidiasis. Candidiasis is the most common opportunistic infection among HIV positive patients.5 Soft palate, tonsils, and oropharynx are the favored slides for candidiasis. Oropharyngeal candidiasis is considered a cardinal sign of immune suppression secondary to HIV infection.6 Although most of the oropharyngeal candidiasis among HIV patients is caused by Candida albicans, oral infections caused by nonalbicans Candida species are in the rise among HIV positive patients, especially among patients who are undergoing nucleosidebased HAART therapy.7 There are 3 clinical forms of oropharyngeal candidiasis: 1. Pseudomembranous candidiasis (also known as thrush) 2. Erythematous (atrophic) candidiasis 3. Hyperplastic candidiasis Among HIV patients with immunosuppression,

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pseudomembranous candidiasis is the most common form and presents as painless, creamy white plaques. These white plaques can be partially wiped away with a tongue blade leaving an erythematous and eroded mucosal surface. Hyperplastic candidiasis presenting as thick white plaque resembling leukoplakia is a chronic form of candidal infection seen among HIV positive patients. Occurrence of chronic and/or recalcitrant oropharyngeal candidiasis among HIV-positive patients is an indicator of immune suppression. Oropharyngeal candidiasis typically occurs among HIV positive patients with CD4 T-lymphocytes counts <200 cells/mm.3 With the advent of “Combination Antiretroviral Therapy (cART)” oral candidiasis among HIV patients has declined dramatically. The current patient was on cART and his CD4 count was 527/mm.3 Therefore, it is highly unlikely the white plaques noted in his oropharynx and tonsillar area represent hyperplastic candidiasis.

Multifocal leukoplakias: Oral leukoplakia is the most common type of oral potentially malignant disorder.8 It presents as a non-wipeable white patch/ plaque that cannot be characterized clinically or histopathologically to any specific disease.8 Leukoplakias most frequently occur at a single site and rarely present as multiple white patches/ plaques. The only exception for this rule is proliferative verrucous leukoplakia (PVL). PVL is a high-risk premalignancy presenting as multifocal and progressive leukoplakias. PVL is more common among elderly females and frequently involves the gingivae. PVL rarely begins in the oropharynx and only involves the oropharynx and its advanced stage. HIV patients have increased risk for developing both HPV-related and HPVunrelated oropharyngeal squamous cell carcinomas designated as nonAIDS defining cancers. However, multifocal white plaques are not the clinical presentations of these cancers involving the oropharynx and tonsil.

Pseudomembranous pharyngitis: Pseudomembranous pharyngitis is bacterial infection caused by toxin-producing strains of Corynebacterium diphtheriae.9 C. diphtheria is a non-encapsulated, nonmotile, gram positive bacillus causes upper respiratory tract and cutaneous infections.9 Pseudomembranous pharyngitis clinically presents with thick gray to white pseudomembrane overlying uvula, tonsils, and pharynx.9 It is preventable by vaccination, hence people most at risk of catching this infection on exposure to carrier or diseased individuals are those who are unvaccinated or have low antitoxin antibody levels. Pseudomembranous pharyngitis frequently occurs among children and is symptomatic, which effectively rules out this diagnosis in the current case.9

penicillin G benzathine, resulting in successful resolution of the infection.

Patient’s follow-up: This patient was tested for syphilis with reactive rapid plasma reagin (RPR) and RPR Reactive with 1:128. Subsequently, the patient was treated with three doses of 2.4 million

References 1.

2. 3.

Ghanem, K.G., S. Ram, and P.A. Rice, The Modern Epidemic of Syphilis. N Engl J Med, 2020. 382(9): p. 845854. Hook, E.W., 3rd, Syphilis. Lancet, 2017. 389(10078): p. 1550-1557. INFO.HIV.GOV, C., Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. 2022, Office of AIDS Research, National Institutes of Health: ROCKVILLE MD, U.S.A. Ramirez-Amador, V., et al., Clinical Spectrum of Oral Secondary Syphilis in HIVInfected Patients. J Sex Transm Dis, 2013. 2013: p. 892427. Migliorati, C.A., E.G. Birman, and A.E. Cury, Oropharyngeal candidiasis in HIV-infected patients under treatment with protease inhibitors. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2004. 98(3): p. 301-10. Diz Dios, P., et al., Frequency of oropharyngeal candidiasis in HIV-infected patients on protease inhibitor therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1999. 87(4): p. 437-41. Mushi, M.F., et al., High Oral Carriage of Non-albicans Candida spp. among HIVinfected individuals. Int J Infect Dis, 2016. 49: p. 1858. Vigneswaran, N. and M.D. Williams, Epidemiologic trends in head and neck cancer and aids in diagnosis. Oral Maxillofac Surg Clin North Am, 2014. 26(2): p. 123-41. Chaudhary, A. and S. Pandey, Corynebacterium Diphtheriae, in StatPearls. 2022: Treasure Island (FL).

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VALUE

for your

Provided by:

profession

THE MOST IMPORTANT PART OF YOUR EMERGENCY KIT: WHAT IT IS AND HOW TO USE IT

By Rose Dodson, MS, CEO; Sedation Resource, Inc.

edical emergencies can and do happen in a dental office. Successful management of an emergency requires preparation and practice. While having proper tools is essential, knowing how to use them is imperative for the best outcome in a crisis situation. Part of that preparation includes having an adequate emergency kit containing 8 essential drugs, according to Dr Mort Rosenberg in the special 2010 JADA publication about dental office emergencies. Most of those drugs will fit neatly into a well organized box, such as the one pictured to the right. However, the most critical drug in saving lives cannot be boxed and requires an adequate delivery system along with the knowledge of how to administer it.

OXYGEN Oxygen is the most important component of the medical emergency kit, and it must be present in dentist’s office. The chances of oxygen being used in an emergency are greater than 90%, according to Dr Stanley Malamed, Dr Jeffery Bennet; and Dr Morton Rosenberg, DMD, in their books Medical Emergencies in the Dental Office and Medical Emergencies in Dentistry.

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“Oxygen is of primary importance in any medical emergency.” —Dr Morton Rosenberg, DMD

OXYGEN ACCESS

Sourcing oxygen can be done with portable e-cylinder tanks or large stationary tanks plumbed into the facility. These sources can then be accessed in 3 ways.

OXYGEN CART WITH AN E-CYLINDER Accessing the oxygen in an e-cylinder requires a regulator. This can be a simple click style regulator with a barbed outlet. The flow rate should go as high as 15 liters per minute (LPM). Once the regulator is on the tank, the tank must be opened by turning the built-in toggle handle or an oxygen key. The flow of oxygen is then controlled by the dial on the regulator.

O2 WALL OUTLET An O2 wall outlet is generally plumbed into the larger stationary tanks. Accessing the oxygen through the wall outlet can be accomplished by using a quick connector specific to the style of outlet. Customized quick connect sets are available that include a click style regulator. Just like the one on the portable tank, it’s important that the regulator be able to deliver oxygen at a flow rate of up to 15 LPM in order to provide 100% positive pressure oxygen.

NITROUS OXIDE FLOWMETERS An often overlooked method of accessing oxygen is through a nitrous flowmeter. Most current model nitrous units have an auxillary oxygen outlet similar to the wall outlet. These outlets are situated in variable places on or near the flowmeter. In addition to the style of outlet, the location will determine the type of quick connect set that will work best. Older flowmeters (right) may not have an oxygen outlet; in which case, you can employ an appropriate nitrous cannula adapter.

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OXYGEN ADMINISTRATION Oxygen delivery to a spontaeneously breathing person can be accomplished with a nasal cannula, a standard mask, or a non-rebreather mask. However, a person experiencing impaired breathing or who is unconscious will require a more advanced device such as a bag valve mask resuscitator (BVM) or a demand valve. The flow rate should be adjusted according to the specific adjunct being used to deliver oxygen. Using an inadequate flow for the specified device can result in insufficient delivery of oxygen and adversely affect the outcome of the emergency.

NASAL CANNULA Long tubing with two nasal prongs on the patient side and a standard oxygen connector on the opposite end is a nasal cannula. The oxygen connector is pushed onto the barbed outlet on a regulator, then placed on the patient. The cannula should be oriented in such a way that the nasal prongs go inside the nostrils in a downward fashion. The tubing should not drape around the head. It is held behind the ears and tucked under the chin. The flow rate of oxygen via a nasal cannula should be 1-6 LPM. The oxygen concentration at these rates would be 2345%.

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STANDARD MASK The standard oxygen mask covers the mouth and nose and has long tubing with a standard oxygen connector at the end. Once connected to the barbed outlet on the regulator, the oxygen flow rate should be set for 5-10 LPM. This gives an oxygen concentration of 40-60%.

NON-REBREATHER MASK The non-rebreather mask is a variant of a standard mask that includes a reservoir bag below the mask. This is the more commonly used mask in emergencies. The flow rate should be at least 10–15 LPM. With this flow rate, 90-100% oxygen is delivered.

DEMAND VALVE RESUSCITATOR A demand valve is a manually triggered oxygen-powered device that is seemingly simple to use; however adequate skills are required to avoid unintended consequences to the patient, such as over inflation of the lungs. Therefore, it is not the preferred device to utilize in an emergency without proper training and practice. The demand valve is operated by placing the face mask over the nose and mouth and pressing a button to inflate the lungs of a non-breathing patient. The preset flow rate of 40 LPM delivers 100% positive pressure oxygen. Connecting this device to an oxygen source will require a regulator with a threaded DISS port or a quick connect appropriate to the oxygen source.

BAG-VALVE MASK (BVM) RESUSCITATOR The bag valve mask resuscitator is the most reliable and commonly used method of delivering oxygen to a non-breathing patient. Ventilating with a BVM is a life-saving skill that should be practiced on an ongoing basis. A standard bag valve mask consists of a cushioned face mask that covers the nose and mouth, a self inflating bag, an oxygen reservoir, and oxygen connection tubing.

The appropriate sized mask is held firmly in place while the bag is squeezed to inflate the lungs. In order to deliver 100% positive pressure oxygen, the oxygen flow rate should be set to at least 15 LPM. One valuable benefit of a bag valve mask resuscitator is that it can be utilized to save a life—even when used without an oxygen source, in which case 21% room air oxygen will be delivered. Attach the oxygen tubing to the regulator by pushing it onto the barbed outlet. In the case of a threaded port on the end of the oxygen tubing, push it firmly onto the barbed outlet ignoring the threads.

CONCLUSION Oxygen administration is essential in managing most emergencies. Usages of a mask and a cannula are common, but understanding how oxygen is delivered from the source to the patient is often not addressed. Knowledge of the sources of oxygen in a dental office and what

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Suzanne M. George, D.M.D. has acquired the practice of

Antoine V. Bach, D.M.D. Katy, Texas

We are please to have assisted in these transitions.

AUSTIN NEAR APPLE CAMPUS: Fantastic opportunity for a new start-up office. The 1,800 sq. ft. facility has 4 ops, each fully equipped with wall-mounted x-ray units, and computer stations. The office comes with Dentrix Management software, Dexis Imaging and a Gendex Pano. This is a location and equipment sale only; no patient records included with sale. Location is the opportunity, be the first to check this out. Phone number comes with office. Rent $3,800. Price $300K. Opportunity ID: TX-7305 PRESTIGIOUS UPPER KIRBY LOCATION: This is a great opportunity to acquire a quasi-startup in the West University area of Houston. This opportunity comes with staff and an office that is in operation about 2-3 days a week. Price $170K. Owner ready to retire. Don’t wait; call AFTCO today! Opportunity ID: TX-7207 PRIME AUSTIN OPPORTUNITY: This practice collected $600K pre-Covid on a 4 doctor and 4 hygiene day workweek. Located in a busy retail center, with 5 ops in 1,700 sq. ft. the office is in excellent condition and has digital x-ray and pan. With over 1,350 active FFS 20%, PPO 80%, patients and an average of 25 new patients per month; this practice is primed for growth. The seller refers most specialty procedures, lending more room for growth. Opportunity ID: TX-7183 HOUSTON SUBURB NEAR GALVESTON BAY: Exceptional 2000, 24-month count PPO/ FFS patient base about 30 minutes south of downtown Houston. This 4 op, 2000 sq. ft. facility is located in a free-standing building on a major thoroughfare. This is currently a bread and butter practice focusing on restorations, crown & bridge and hygiene services. Tremendous opportunity for growth for the doctor with implant skills, who enjoys oral surgery, endo and perio, in addition to producing fine restorative dentistry. Real estate is available for purchase in the future. Opportunity ID: TX-7153 Go to our website or call to request information on other available practice opportunities!

800.232.3826

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www.AFTCO.net

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.)

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.

us at 512-900-7989 or info@ dentaltransitions.com. AUSTIN (ID #T532): This turn-key, GD practice in West Austin is located in a 2,500 sq ft, modern facility featuring 6 operatories, digital radiography, paperless charts, a digital pano, and a Cerec Omnicam with milling unit. The practice serves a large FFS/PPO patient base with over 2,700 active patients. The office offers significant upside potential by way of keeping specialty procedures in-house, implementation of a marketing/advertising campaign, and the potential to expand office hours. AUSTIN (ID #T538): State-of-theart 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 approximately 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 #T539): Located in the beautiful Texas Hill Country, this practice features an established, 100% fee-for-service patient base, strong hygiene recall (approximately 30% of total production), and an increasing revenue trend over the past

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ADVERTISING BRIEFS 3 years. The practice is located in a free-standing building that features 3 fully equipped operatories, newly installed computers in each room, digital sensors, hand-held X-ray units, practice management software (Dentrix Ascend), and paperless charts. The real estate is also for sale. EAST TEXAS (ID #H486): Located in 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, digital pano, plumbed nitrous, and computers throughout. EAST TEXAS (ID #H489): This highly profitable, general dentistry practice and real estate is located in an east Texas town. The practice serves a large FFS/ PPO patient base and is on pace to exceed seven figures in revenue in 2021 while maintaining a 45%+ profit margin. The office has 3 fully equipped operatories with possible room for expansion, digital radiography, and computers throughout. HOUSTON (ID #H472): This established, boutique practice is located in a highly desirable area of central Houston. The practice provides general, implant, and cosmetic dentistry services to a 100% FFS patient base and has an excellent reputation in the local

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community. The beautiful facility features high-end finishes/décor, 3 fully equipped operatories, digital radiography, and a CBCT. HOUSTON, ORTHODONTICS (ID #H480): This productive, FFS orthodontic practice occupies an attractive free-standing building situated on a high traffic street in a desirable community in the heart of east Texas. The practice has realized annual revenue of seven figures with exceptional profitability. The office features a 4-chair ortho bay, 2 exam rooms, and digital Pan/ Ceph unit. The real estate is also available for purchase. HOUSTONEAST (ID #H483): 100% FFS GD practice + Real Estate. Situated in a 2,200 sq ft, free standing building with 5 fully equipped operatories. Hygiene production is very healthy and the practice has seen 1,700+ active patients in the last 24 months with a steady new patient flow. HOUSTONNORTHEAST (ID #H488): FFS/ PPO practice and real estate, growing suburb 45 minutes NE of Houston. 1,800 total patients, steady flow of new patients, solid hygiene recall, and consistent revenue of high-6 figures per year. The office contains 6 fully equipped operatories, plumbed nitrous, digital X-rays, CBCT, and computers throughout. HOUSTON-SOUTHEAST

ADVERTISING BRIEFS (ID #H491): 100% FFS practice in a growing suburb southeast of Houston. The 1,685 sq ft facility contains 3 fully equipped operatories with room for expansion, digital radiography, and computers throughout. With most specialty procedures being referred out and little to no marketing, this practice offers a tremendous level of upside potential. HOUSTON-NORTH (ID #H493): 100% fee-for-service practice located north of Houston in the high growth area of Spring/ The Woodlands. The office occupies a spacious, standalone office condo and features 5 fully equipped operatories, digital technology, computers throughout, and 2 plumbed operatories prepared for future expansion. This is an excellent opportunity to purchase a successful legacy practice poised for growth. HOUSTON, PERIODONTAL (ID #H494): Located in a growing suburb south of downtown Houston. There are 5 fully equipped operatories, digital radiography, computers throughout, and a 3D Cone Beam CT in the wellappointed 2,400 sq ft modern space. Annual revenues are around seven figures, and the owner is open to a phased transition in which they provide support to the incoming

buyer to ensure they are set up for long term success. SAN ANTONIOWEST (ID #T454): General dental practice plus real estate, located in a rural community approximately 75 miles west of San Antonio. Serves a PPO/FFS patient base, sees about 30+ new patients per month, and offers consistent annual revenue with substantial upside potential through expanding the procedures offered in-house. The turn-key office features 3 fully equipped operatories, digital sensors, intra-oral cameras, and a digital pano. SAN ANTONIO (ID #T531): GD practice in a high visibility retail center along a major interstate in northwest San Antonio. The office features 4 operatories, digital radiography, CBCT, digital scanner, and paperless charts. Uniquely placed near the intersection of two major interstates in a retail center with a major anchor tenant, this location offers tremendous growth opportunities for a buyer to capitalize on the surrounding foot traffic and visibility. To request more information on our listings, please register at www.dentaltransitions.com or contact us at 512-900-7989 or info@ dentaltransitions.com.

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ADVERTISING BRIEFS BAYTOWN: Dental practice for sale. Doctor retiring. Four ops, digital X-ray, computerized (Dexis/Adec), excellent gross (midrange) and collections on 3.5 days a week. Good location next to Methodist Hospital. Office building, loyal staff of 3 (full-time hygienist). Will consider associate with intention to buy. Contact docboehme@yahoo. 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 800930-8017 or Christopher@DDRDental. com. HOUSTON (SHARPSTOWN AREA): GENERAL (REFERENCE “SHARPSTOWN

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GENERAL”). MOTIVATED SELLER. Well established general dentist with high-6 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 800930-8017 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 3-1/2 days a week. Practice area is owned by dentist and is available for sale. Contact Christopher Dunn at 800-9308017 or Christopher@DDRDental.com.

ADVERTISING BRIEFS HOUSTON AREA: Several acquisition opportunities in the greater Houston area. General, ortho, pedo practices available for sale. Visit lonestarpracticesales.com or email houstondentist2019@gmail.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, free-standing 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 six 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 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). 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. 60% 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 ñ PEDIATRIC (NORTH HOUSTON) This practice is located in a highly soughtafter upscale neighborhood. It is on a major thoroughfare with high visibility www.tda.org | May 2022

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ADVERTISING BRIEFS in a strip shopping center. The practice has 3 operatories for hygiene and 2 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 3-1/2 days per week. Contact Christopher Dunn at 800-930-8017 or christopher@ddrdental.com and reference “North Houston or TX#562”. WEST HOUSTON: MOTIVATED SELLER. Medicaid practice with production of 6 figures. Three operatories in 1200 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”. KATY: Now is the time to join Grand Lakes Dental Group and Orthodontics. You will have opportunities to learn new skills from our team of experienced professionals. If you’re ready to take your career to the next level and gain valuable experience, apply today! You’ve invested the time to become a great dentist, now let us help you take your career further with more opportunity, excellent clinical leadership and one of the best practice models in modern dentistry.

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In working with our practice you will have the autonomy to provide your patients the care they deserve. In addition, you’ll enjoy the opportunity to earn excellent income and have great work-life balance without the worries of running a practice. You became a dentist to provide excellent patient care and have a career that will serve you for a lifetime. With us, you will have a balanced lifestyle, fantastic income opportunities, and you’ll work for an office that cares about their people, their patients and their community. Our practice is an office supported by Pacific Dental Services (PDS), which means you won’t have to spend your career navigating practice administration. Instead, you’ll focus on your patients and your well-being. Add on excellent benefits, including malpractice insurance, medical, dental and vision insurance, retirement plans and much more and you’ll feel well taken care of throughout your career. The average full-time PDS-supported associate dentist earns low-6 figures in their first year. The average income for a PDS-supported owner dentist, whose practice has been open at least 2 years, is mid-6 figures. As an associate dentist, you will receive ongoing training to keep you informed and utilizing the latest technologies

ADVERTISING BRIEFS and dentistry practices. If you are interested in a path to ownership, our proven model will provide you with the training needed to become an owner of your own office. PDSÆ is one of the fastest growing companies in the US which means we will need excellent dentists like you to continue to lead 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, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status. Apply here:http://www. Click2Apply.net/gwy6pkn22knbzwzx PI106822492.

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.

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.

SMILECON

WATSON BROWN PRACTICES FOR SALE: Practices for sale in Texas and surrounding states, For more

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.

Calendar of events

TMOM 2022 SCHEDULE Texarkana—June 17-18, 2022 Luling—September 9-10, 2022 Dallas—November 4-5, 2022

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.

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YOUR PATIENTS TRUST YOU.

WHO CAN YOU TRUST?

ADVERTISERS AFTCO........................................................... 258 Anesthesia Education & Safety Foundation... 226 Choice Transitions................... Inside Back Cover DentalPost..................................................... 258

If you or a dental colleague 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.

E-VAC, Inc..................................................... 237 JKJ Pathology................................................ 248 Law Offices of Hanna & Anderton..................... 236

MedPro Group.................................................. 229

Professional Recovery Network..................... 266 SmileCon 2022.............................................. 249 Southwest Sedation Education...................... 237 TDA Perks.............................. Inside Front Cover Texas Health Steps........................................ 223 UTHealth Houston Pathology......................... 236

PRN Helpline (800) 727-5152

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Visit us online www.txprn.com

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Watson Brown Practice Sales & Appraisals.... 227

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

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May 2022 Texas Dental Journal

Articles inside

Value for Your Profession: The Most

Oral and Maxillofacial Pathology Case of the Month Diagnosis and Management

Advertising Briefs

In Memoriam