September 2022 Texas Dental Journal

Many Dentists are becoming disenchanted from working chairside, others are near the end of their career, and some are merely looking for supplemental income. For Doctors who identify with these life situations, and still want to be a part of the Dental Community, Dental Expert Witness Work could be for you. There have been no lectures and no instruction available on what it is, what it takes, and how to market yourself as an Expert Witness UNTIL NOW!

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542FEATURES

IMPLEMENTATION OF A YOUTH & YOUNG ADULT E-CIGARETTE CESSATION PROGRAM WITHIN A DENTAL CLINIC SETTING: A STOHN FEASIBILITY STUDY

Rahma Mungia, BDS, MS, DDPHRCS

Marissa J. Mexquitic, MS

Kathleen Case, DrPH, MPH

Betsy Jones, MPA, ACPS

Maria-Isabel Atique, DDS

Daniel Chen-PinMacCarthyWang,PhD

560 HOW TO RESPOND TO A NEGATIVE ONLINE REVIEW

Joshua Austin, DDS, MAGD

This article was originally published in Dental Economics (dentaleconomics.com). Reprinted with permission.

566 SEASON OF CHANGE: TIME FOR PREVENTION

Shailee Gupta, DDS, Austin, Texas

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 Staff 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 139 | No. 8

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, 78704-3698, 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

Annualreserved.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, September issue $17 ADA Affiliated, $65 Non-ADA Affili ated. 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 the quality of value of such product or of the claims made of it by its manufacturer.

Board of Directors TexasAssociationDental

PRESIDENT Duc “Duke” M. Ho, DDS 281-395-2112, 512-879-6225,214-585-0268,936-598-2626,325-648-2251,CodyPRESIDENT-ELECTducmho@sbcglobal.netC.Graves,DDSdrc@centex.netPASTPRESIDENTDebrahJ.Worsham,DDSworshamdds@sbcglobal.netVICEPRESIDENT,SOUTHEASTGlendaG.Owen,DDS713-622-2248,Dr.owen@owendds.comVICEPRESIDENT,SOUTHWESTCarlosCruz,DDS956-627-3556,ccruzdds@hotmail.comVICEPRESIDENT,NORTHWESTTeriB.Lovelace,DDS325-695-1131,lovelace27@icloud.comVICEPRESIDENT,NORTHEASTElizabethS.Goldman,DDStexasredbuddental@gmail.comSENIORDIRECTOR,SOUTHEASTShaileeJ.Gupta,DDSsgupta@stdavidsfoundation.orgSENIORDIRECTOR,SOUTHWESTRichardM.Potter,DDS210-673-9051,rnpotter@att.netSENIORDIRECTOR,NORTHWESTSummerKetronRoark,DDS806-793-3556,summerketron@gmail.comSENIORDIRECTOR,NORTHEASTJodiD.Danna,DDS972-377-7800,jodidds1@gmail.comDIRECTOR,SOUTHEASTLajiJ.James,DDS281-870-9270,lajijames@yahoo.comDIRECTOR,SOUTHWESTKrystelleAnaya,DDS915-855-1000,krystelle.barrera@gmail.comDIRECTOR,NORTHWESTStephenA.Sperry,DDS806-794-8124,stephenasperry@gmail.comDIRECTOR,NORTHEASTMarkA.Camp,DDS903-757-8890,macamp1970@yahoo.comSECRETARY-TREASURER*CarmenP.Smith,DDS214-503-6776,drprincele@gmail.comSPEAKEROFTHEHOUSE*JohnW.BaucumIII,DDS361-855-3900,jbaucum3@gmail.comPARLIAMENTARIAN**GlenD.Hall,DDS325-698-7560,abdent78@gmail.comEDITOR**JacquelineM.Plemons,DDS,MS214-369-8585,drplemons@yahoo.comLEGALCOUNSELCarlR.Galant*Non-votingmember**Non-voting

Editor’s Letter

Have you ever wondered what evidence exists to prove the value of a specific procedure you’re performing in your office? In the days of evidence-based dentistry, that information is often at our fingertips. Or is it

Systematicreally?

reviews rely on high quality scientific investigations with results that have been adequately scrutinized and are reproducible. To access these articles, most of us turn to scientific “search engines” such as Pubmed which currently provides access to over 34 million citations indexed in Medline including articles from 139 dental journals.

In the past few years, the process and criteria for a specific journal to be included in Medline and its articles accessible through Pubmed has become much more rigorous as only the highest level of scientific articles are accepted.

The TDJ was indexed in Medline/PubMed for at least 30 years prior to a change in 2017. All publications that were indexed prior to 1986 were required to go through a process to apply for review. Currently, only 14% of journals that are reviewed are accepted to be indexed. Several state and other dental journals including the TDJ were not in that 14%. Recognizing that authors from academic and research institutions will likely submit their papers to journals that are searchable in Pubmed and have the highest impact factors, the Journal will consider articles that represent “softer” science— often clinical in nature, featuring the latest products and technology, sprinkled now and again with a little evidencebased dentistry.

What else does this mean for your Journal? Well, it means we have an opportunity to make the Journal what our members want it to be! The TDA proudly welcomes dentists from every group we can imagine—new to experienced dentists; solo to small and large group practices; those serving as faculty, in public health and the military; men and women; and dentists from all racial and ethnic groups. We recently surveyed our members and received great feedback on changes we can make to the Journal to add value to your membership! In a few short months, you will see a focused effort on relevant content that will better meet your needs. We are listening!

Errata

The editorial staff at the Texas Dental Journal regrets the publication of incorrect information in the July 2022 special membership recognition issue. Dr William Clyde (60-year award member) was listed as living in Wynwood. Dr Clyde lives in Tyler. We sincerely apologize for this oversight.

Jacqueline Plemons, DDS, MS

Free Practice Valuation

Dentist to Dentist

RELATIONSHIP. MENTORSHIP. COMMUNICATION.

I admit I worry sometimes when writing these updates that people would wonder, “What’s up with all these bullet points?” My goal was always to communicate the work of the Association in a quick and easy-todigest format. Hopefully each of you has found that to be the case; if not, please don’t tell me because that will make me worry more, and worrying will get me

Now,nowhere!September

is a busy month for your Association, and we continue to work hard behind the scenes to bring value to each member.

TDA Perks

• TDA Perks’ endorsed vendor ERC

Specialists continues to bring money to member dentists, with now over 140 practices and $7 million of this fully forgiven tax credit. Please check your eligibility and apply at haven’tcompany-erc-tax-credittdaperks.com/specialty-payroll-https://ifyouyet.

Many members you know have either received or are scheduled to receive money, so please check and apply soon!

locally through continuing education programs, social programs, and outreach.

• In addition, the council is hosting a Practice Model Diversity Webinar geared for young dentists and students who may be interested in different career paths.

Council on Professions and Trends

• The Council on Professions and Trends is developing a toolkit to help address and provide resources for members whose mental health and well-being may be suffering, as well as guidance for practices where a dentist may have suffered a disability or died.

Texas Dental Association Board of Directors

• Your Board is meeting to examine all the activities of the Association and to review the proposed legislative agenda for the upcoming 88th Texas Legislative Session. Some issues such as insurance reform, increases in Medicaid reimbursement (the last being in 2007), and dental education loan repayment programs are likely to make the agenda.

Of course and as always, if there are any thoughts or ideas you want to share, please reach out! This is your Association, and our responsibility is to you.

Council on Membership, New Dentists, and Students

• The council is hosting a Local ForumLeaders membertoideasleaderscomponentsupporttolocalshareonhowimprovetheexperience

“I learned a long time ago that worrying is like a rocking chair. It gives you something to do but it doesn’t get you anywhere.”

Van Wilder (Ryan Reynolds), National Lampoon’s Van Wilder

Duc “Duke” M. Ho, DDS, FAGD TDA President

Dr Sarah Tovar, Chair, Council on Membership, New Dentists, and Students

1. live lecture

2. There is no need to the You can stay at home or in your office to view and listen to the cou rse.

3. There may be a post-test after the online course concludes, so you will receive immediate CE credit for attendance

4. With the webcast, you can enjoy real-time interaction with the course instructor, utilizing a question and answer format

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

AGD Codes for all programs: 341 Anesthesia & Pain Control; 342 Conscious Sedation; 343 Oral Sedation

This is only a partial listing of sedation courses. Please consult our www.sedationce.com for updates and new programs. Two ways to Register: e-mail us at sedationce@aol.com or call us at 214-384-0796

Since 1968

Sateesh K. Ummareddy, D.D.S. Niosha Edalat, D.M.D. has acquired the practice of has acquired the practice of Kilgore, all Jeremiah R. Taylor, D.D.S. Donald D. Landry, D.D.S.

Practices For Sale

$778K EAST TEXAS - NEAR LOUISIANA BORDER: 4,400+ sq. ft. facility with 6 fully equipped ops and 2 additional plumbed. All digital with digital Pan (Sirona Galileos CBCT) and paperless with Eaglesoft. The practice has 1,250 active 100% FFS patients with an average of 50 new patients per month. The collections are over $778K on a 4-day work week. The seller would also like to sell the real estate, but is open to leasing to start. Opportunity ID: TX-7432

$850K 15 MINUTES SOUTH OF HOUSTON: 65% Medicaid and 35% PPO with a healthy hygiene program. Operates on 4 doctor days and 9 hygiene days collecting over $850K per year. The facility is 1,950 sq. ft. and has 5 equipped ops with another op plumbed that could be an expanded operatory. If you want a practice where you work with kids and enjoy the diversity of providing more complex dentistry for adults, this practice is the right practice for you! Opportunity ID: TX-7373

$600K 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. Opportunity ID: TX-7183

$890K NEAR GALVESTON BAY: Exceptional 2000, 24-month count PPO/FFS patient base, 30 minutes south of downtown Houston. This 4 op, 2000 sq. ft. facility is located in a free-standing building on a major thoroughfare. It 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. Opportunity ID: TX-7153

Go to our website or call to request information on other available practice opportunities!

the emergence of an

Implementation of a youth and young adult e-cigarette cessation program within a dental clinic setting:

A SToHN feasibility study

Rahma Mungia, BDS, MS, DDPHRCS

South Texas Oral Health Network, Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas

Marissa J. Mexquitic, MS

South Texas Oral Health Network, San Antonio, Texas; Institute for Integration of Medicine & Science, University of Texas Health Science Center at San Antonio, San Antonio, Texas

Kathleen Case, DrPH, MPH

Center for Research to Advance Community Health, University of Texas Health Science Center at San Antonio, San Antonio, Texas

Betsy Jones, MPA, ACPS

San Antonio Council on Alcohol and Drug Awareness, San Antonio, Texas

Maria-Isabel Atique, DDS

Atique Orthodontics, San Antonio, Texas

Daniel MacCarthy

University of Texas Health Science Center at San Antonio, San Antonio, Texas

Chen-Pin Wang, PhD

University of Texas Health Science Center at San Antonio, San Antonio, Texas

Corresponding Author:Rahma Mungia, BDS, MS, DDPHRCS

UT Health San Antonio, 8403 Floyd Curl Dr., MSC 7728, San Antonio, Texas 78229-3900

Phone: (210) 562-5685 • mungia@uthscsa.edu

Abstract

While significant progress has been made to decrease tobacco smoking among youth and young adults, e-cigarettes threaten to reverse the progress. The purpose of this study was to test the feasibility of the ReACH Assessment of Knowledge for E-Cigarettes (RAKE) cessation program targeting youth and young adults in Texas.

Methods:

Seven dental practitioners and 12 patients participated in this pilot study. Patients aged 15 to 29 who reported current e-cigarette use were recruited by their dental practitioner. All participants completed pre-and post-assessments—practitioners receiving the RAKE training and patients the RAKE cessation intervention. Descriptive statistics were calculated.

Results:

After RAKE training, all practitioners reported the RAKE cessation program as useful and an important part of patient care. In addition, after completing the program (5A’s), 67% (n=9) patients reported that the program was helpful, and 100% (n=12) would recommend the program to other e-cigarette users.

Conclusions:

Practitioners and patients enhanced their knowledge of e-cigarettes and their harm to health. In addition, practitioners demonstrated their ability to implement the RAKE cessation program within the practice, and patients approved of the use of the program. This study illustrated the feasibility and acceptability of conducting an e-cigarette cessation study in dental practices and a critical need to develop and disseminate the program to young patients.

Keywords

e-cigarettes, cessation, implementation, feasibility, youth, vaping

Acknowledgments

This study was conducted by the South Texas Oral Health Network (STOHN), supported by the National Center for Advancing Translation Sciences, National Institutes of Health, through the Grant UL1TR002645. This study was reviewed and approved by the University of Texas Health San Antonio Institutional Review Board as an Exempt Study. All participants gave written or verbal consent to participate. The content is solely the authors’ responsibility and does not necessarily represent the official views of the NIH.

All authors affirm that they have no financial affiliation (employment, direct payment, stock holdings, retainers, consultantships, patent-licensing arrangements, or honoraria) or involvement with any commercial organization with a direct financial interest in the subject or materials discussed in this manuscript, nor have any such arrangements existed in the past 3 years. The authors deny any conflicts of interest related to this study.

Funding Statement

The study described was supported by the Institute for Integration of Medicine & Science Community Engagement Small Projects Grant, UT Health San Antonio.

Conflicting and Competing Interest

The authors declare no conflict of interest.

Introduction

Significant progress has been made in reducing the use of conventional cigarettes among young people. Specifically, conventional cigarette smoking among high school youth in the United States declined from 28% in 1996 to 8% in 2018.1 Unfortunately, electronic cigarettes (e-cigarettes) continue to threaten the progress in reducing tobacco use. Today, e-cigarettes are the most popular tobacco product among youth and young adults, surpassing cigarettes.1 One of the chief concerns regarding e-cigarette use is the potential for transition to conventional cigarette smoking. A recent meta-analysis found that youth who use e-cigarettes are 3.5

times more likely to initiate cigarette smoking as non-users.3

Use of tobacco products in youth and young adults poses many concerns. Not only are there notable systemic health effects of nicotine on young people, including its impact on mood and brain development, nicotine dependence also underlies the association between e-cigarette use and future initiation of cigarette smoking among youth and young adults.3 Other concerns associated with e-cigarette use is the mechanisms themselves when used. For example, the emergence of an e-cigarette or vaping useassociated lung injury (EVALI) has renewed concerns over the safety of vaping devices. Notably, vaping

tetrahydrocannabinol (THC) and vitamin E acetate seem to be implicated in the EVALI epidemic.5

The FDA recognizes the need for e-cigarette cessation interventions for young people and to date, no approved cessation program to target this product exists.6 One tobacco cessation program that has shown to be effective is the 5A’s (Ask, Advise, Assess, Assist, and Arrange)—a brief, practitionerdirected intervention.7,8 A recent study showed that patients satisfied with the 5A’s counseling services were 5 times more likely to intend to quit using tobacco and 4 times as likely to recommend counseling to other tobacco users 9 The feasibility of e-cigarette cessation within clinical practice as

South Texas Oral Health Network (STOHN) is a practicebased research network (PBRN) dedicated to developing a research infrastructure for generating practical and timely information to enhance the quality and efficacy of oral health care. STOHN members are practicing dentists and dental hygienists in south Texas who help to develop and implement dental research where it really matters— in their practices. The Network’s mission is to improve quality care by conducting oral health studies on topics of interest and important to practitioners and their practice. The research coordinator for the Network is Marissa Mexquitic. You can contribute to research projects by joining the network in one of 3 levels:

• Informational: receive newsletters and communication

• Limited: receive newsletters, communication, and participate in surveys

• Full: receive newsletters, communication, participate in surveys, and participate in clinical studies.

For more information, visit https://iims.uthscsa.edu/ STOHN/home or contact Marissa at mexquitic@uthscsa. edu.

QUICK FACTS:

The 5 A’s—Major Steps in Intervention

part of regular patient care is crucial for patient success. In a 2016 study examining the feasibility of vascular surgeons providing smoking cessation to their patients, surgeons stated having a “standardized protocol with brief interventions as easy and doable within their clinical practice”.11 Implementing a brief counseling intervention, such as the 5A’s, allows practitioners to integrate the counseling efficiently into their routine visits with their patients.

Formative research with dental practitioners and community members demonstrated the need for a dental practitioner-based e-cigarette cessation intervention.10 Dental practitioners indicated they were interested in an e-cigarette cessation tool but lacked the skills to effectively counsel patients on how best to quit. Community members stated they were interested in learning about the harms of e-cigarette use from their dental practitioners yet had never received such information.10

Given the lack of e-cigarette–specific cessation programs directed at young people who use e-cigarettes (vape) and the results of this formative research, the study team developed the ReACH Assessment of Knowledge for E-cigarettes (RAKE) cessation program, which consists of 1) training for dental practitioners on e-cigarette cessation utilizing the 5A’s and 2) screening youth and young adult (15- to 29–year-olds) dental patients for e-cigarette use to administer the cessation program. The purpose of this pilot study was to test the feasibility of the RAKE dental practice-based e-cigarette cessation program targeting youth and young adults (15- to 29–year-olds) in Texas.

Methods

Practitioner Recruitment

The study (HSC20200543H) was reviewed and approved for Expedited Review by the Institutional Review Board (IRB) at the University of Texas Health San Antonio (UTHSA). The study team consulted with: the South Texas Oral Health Network (STOHN)—a practice-based research network (PBRN), a Coalition Coordinator from the San Antonio Council on Alcohol & Drug Awareness (SACADA), a private practitioner who specializes in orthodontics, and an assistant professor from the Center for Research to Advance Community Health (ReACH). Dental practitioner participants were recruited via emails and telephone calls through the STOHN PBRN between October 2020 and January 2021. Practitioners were given an information sheet and provided verbal informed consent. Patients reviewed and gave written informed consent to participate in the study.

A total of 7 dental practitioners (n=6 dentists and n=1 dental hygienists) were recruited into the pilot study. Practitioners were sent a link via REDCap to access the pre- and postassessments as well as the RAKE training. The pre-assessment consisted of 28-items and captured their demographics, practice and patient characteristics, knowledge, attitudes, and perceptions of e-cigarettes as well as their perception of an e-cigarette cessation program. Practitioners then navigated to the training that could be downloaded onto their individual computers for access throughout the study. The training, if completed in one sitting, took approximately 30-40 minutes.

Intervention Description

The RAKE training component consisted of information on the prevalence, trends, and patterns of e-cigarette use; history and safety regulations; increases in the legal age to buy tobacco; components and mechanisms of action in the devices; chemical composition of the nicotine inhalant (“e-juice”); up-to-date best practices and screening guidance for assessing patient use of e-cigarettes; evidencebased information on oral health and systemic effects of e-cigarettes; evidence-based tobacco cessation strategies, including the 5A’s cessation counseling card; and information on evidence-based e-cigarette cessation products as they became available. Finally, practitioners took the 18-item post-training assessment to assess the acceptance, satisfaction, and usability of RAKE and items parallel to items of the pre-assessment addressing knowledge, attitudes, and behaviors (intention to utilize RAKE), e-cigarette education, and cessation training. Practitioners were encouraged to complete this post-assessment right after the training but could save and return with an individualized code if needed. Each assessment was estimated to take 1015 minutes to complete.

Implementation in Dental Practices

Practitioners completed an initial 30-minute phone call or Zoom meeting with the study coordinator to discuss timeline, their role in the study, how to complete the human subject protection training, remuneration for their efforts as well as patient remuneration, the different surveys the patients would need to complete, and review any questions they had about the implementation of the RAKE cessation program into their clinics. Communication with practitioners occurred at least twice a month. Regular check-in emails consisted of a fact about e-cigarettes that practitioners could discuss with patients and any study updates on patient screening and enrollment. Each check-in lasted 10-15 minutes, reviewed recruitment strategies, and troubleshot the RAKE cessation program. Narratives from the check-in sessions regarding screening and recruitment techniques and optimal timings to provide the RAKE cessation program during the dental visit. Discussions centered around actionable changes for recruitment (i.e., increasing study signage around the clinic, reviewing patient charts to determine expected age range for the day, bringing up the study during

cleanings and before dentist evaluation of patients) and any comments that patients made about the study/ cessation program.

Once assessments and training were completed, practitioners recruited patients at their respective clinics using flyers posted in the clinic waiting rooms and utilized staff and fellow practitioners within the same clinic to advertise the study. A total of 12 patients (between 17 and 29 years of age) who reported current e-cigarette use were recruited through these efforts between February 2021 and July

Patient2021.

participants were asked to complete a 39-item pre-assessment and a 12-item post-assessment, collecting demographics and assessing e-cigarette knowledge, perceptions of harm, use, and addictiveness, dependency/ addictiveness, and evaluation of the RAKE cessation program—acceptance, satisfaction, and usability. The preassessment took approximately 10 minutes to complete while the

post-assessment took 5 minutes. Responses conveyed by the patients to the practitioners and any comments practitioners had about the cessation program were documented, and later grouped by commonality. After the pre-assessment, patients completed a 5-7 minute 5A’s RAKE cessation session with the practitioner. Patients then completed the short post-assessment as previously mentioned. Patients were remunerated $25 for completing both surveys, and practitioners were remunerated $50 per patient who completed the study.

Data Analysis

Study data were collected and managed using REDCap electronic data capture tools hosted at UTHSA (Harris et al., 2009; 2019). Descriptive statistics were calculated through the statistical SAS® software. Categorical variables were summarized by frequency and continuous variables by means and standard deviations.

Results Practitioners

Practitioner participants were primarily female (71%, n=5), between the ages of 32 and 56 (M= 41 years, SD = 9.84), general dentists (86%, n=6), had between 11-20 years of professional experience (n=3, 43%), and worked in a single private practice setting (86%, n=6). All practitioners reported awareness of e-cigarettes but felt they had little knowledge about them (71%, n=5). One hundred percent (n=7) stated they were very willing to learn more about e-cigarettes; however, 29% (n=2) reported they were not very comfortable discussing e-cigarettes with adolescent Practitioners’patients.

current knowledge of e-cigarettes is shown in Figure 1. When asked if the RAKE program was useful and an important part of patient care, 28.6% (n=2) strongly agree, 57.1% (n=4) agree, and 14.3% (n=1) neither agree nor disagree with the statement. When asked whether they planned to utilize

Figure 1. Practitioner Knowledge, Attitudes, and Beliefs Pre-RAKE Training

If asked by adolescents or their parents, I would say that e-cigarettes are less harmful than regular cigarettes.

Discussing e-cigarettes with patients may encourage them to use e-cigarettes.*

E-cigarettes should be recommended for smoking cessation.

E-cigarettes are less addictive than conventional cigarettes.

You can become addicted to e-cigarettes.

E-cigarettes could be a “gateway” to conventional cigarette use in the future.

E-cigarettes use increases the risk of xerostomia.

E-cigarette use increases the risk of dental cares.

E-cigarette use increases the risk of susceptibility to periodontal disease.

E-cigarette use increases the risk of chronic lung diseases, including COPD.*

E-cigarette use increases the risk of cardiovascular diseases, including myocardial infarction and stroke.

E-cigarettes are less harmful than conventional cigarettes.

E-cigarette aerosol is harmful for people in the vicinity of the users.

E-cigarette use is harmful for health of the user.

Figure 2. Practitioner Knowledge, Attitudes, and Beliefs Post-RAKE Training

If asked by adolescents or their parents, I would say that e-cigarettes are less harmful than regular cigarettes.

Discussing e-cigarettes with patients may encourage them to use e-cigarettes.*

E-cigarettes should be recommended for smoking cessation.

E-cigarettes are less addictive than conventional cigarettes.

You can become addicted to e-cigarettes.

E-cigarettes could be a “gateway” to conventional cigarette use in the future.

E-cigarettes use increases the risk of xerostomia.

E-cigarette use increases the risk of dental cares.

E-cigarette use increases the risk of susceptibility to periodontal disease.

E-cigarette use increases the risk of chronic lung diseases, including COPD.*

E-cigarette use increases the risk of cardiovascular diseases, including myocardial infarction and stroke.

E-cigarettes are less harmful than conventional cigarettes.

E-cigarette aerosol is harmful for people in the vicinity of the users.

E-cigarette use is harmful for health of the user.

Table 1. Patient E-Cigarette Dependency, % (n)

Yes No

Have you ever felt you were addicted to e-cigarettes? 66.7% (8) 33.3% (4) Do you ever have strong cravings to use e-cigarettes? 66.7% (8) 33.3% (4)

Have you ever felt like you really needed an e-cigarette? 91.7% (11) 8.3% (1)

Is it hard to keep from using an e-cigarette in places you are not 41.7% (5) 58.3% (7) supposed to, like school or work?

When you tried to stop using e-cigarettes... or if you haven’t used e-cigarettes in awhile...

Did you find it hard to concentrate? 66.7% (8) 33.3% (4) Did you feel more irritable? 45.5% (5) 54.5% (6)

Did you feel a strong urge to use an e-cigarette? 66.7% (8) 33.3% (4) Did you feel nervous, restless, or anxious because you couldn’t use an e-cigarette? 50.0% (6) 50.0% (6)

aOne participant did not answer “Do you feel more irritable” question.

Table 2. Patient Pre- and Post-Survey on Perception of E-cigarettes, % (n)

True False Don’t Know

Pre- Post- Pre- Post- Pre- PostSurvey Survey Survey Survey Survey Survey

E-cigarettes usually contain nicotine, an addictive chemical. 100% (12) 100% (12) 0 0 0 0

E-cigarettes use liquid/salts that contain harmful chemicals. 58.3% (7) 91.7% (11) 8.3% (1) 0 33.3% (4) 8.3% (1)

E-cigarettes may harm teen brain development. 75% (9) 83.3% (10) 0 0 25% (3) 16.7% (2)

E-cigarettes have unknown long-term health effects. 66.7% (8) 91.7% (11) 8.3% (1) 8.3% (1) 25% (4) 0

E-cigarettes are not risk-free. 75% (9) 83.3% (10) 16.7% (2) 16.7% (2) 8.3% (1) 0

E-cigarettes use liquid/salts that is made from tobacco. 58.3% (7) 66.7% (8) 0 8.3% (1) 41.7% (5) 25% (3)

the information presented to them in the RAKE training component to counseling their patients on e-cigarettes or not, 85.7% (n=6) said they strongly agreed to do so. After completing the training, 100% (n=7) strongly agreed that the training is a useful and important part of patient care and would counsel

Overall,patients.practitioners

improved their knowledge, harm perceptions, beliefs, perceived addictiveness, and attitudes regarding e-cigarettes (see Figure 2).

Before the RAKE training, practitioners reported they agreed (28.6%, n=2) or neither agreed nor disagreed (71.4%, n=5) that they had the knowledge and skills to conduct e-cigarette cessation counseling with their patients (M= 3.28, SD = 0.49). After receiving the training, most practitioners strongly agreed (85.7%, n=6; M= 4.85, SD = 0.37) that they had the knowledge and skills to conduct cessation counseling. One hundred percent (n=7) of practitioners stated that they were very comfortable discussing e-cigarettes with their adolescent patients since they completed the training.

Patients

Among the twelve patient participants in the study, the mean age was 23 years (ranging between 17 and 26 years of age), 7 were female (58.3%), 11 were Caucasian (91.7%), and 5 had some college education (41.7%). Four patients (33.3%) also had private dental insurance. Nearly half (45.5%, n=5) of participants did not wish to disclose their annual household income, while income responses ranged from $25,001 to over $100,000. When asked about how common e-cigarette use is among their age group, patients reported it was very common (75%, n=9) and that mainly between a few and some of their close

friends (66.7%, n=8) used e-cigarettes (M= 2.75, SD = 0.97). Interestingly, half of the patients reported they thought it was probably not okay (50%, n=6) for people their age to use e-cigarettes, followed by definitely not (25%, n=3) and probably yes (25%, n=3).

All patients reported use within the last 30 days, where the highest frequency of use was more than 20 times per day (50%, n=6), and that the e-cigarette they used contained nicotine (100%, n=12). Half of the patients (50%, n=6) used e-cigarettes to help stop smoking conventional cigarettes and have tried to quit using e-cigarettes but couldn’t and found it really hard to quit. Eight patients (66.7%) felt they were addicted to e-cigarettes and reported ever having a strong craving to use e-cigarettes, and 91.7% (n=11) had ever felt like they really needed an e-cigarette (for other responses related to dependency on e-cigarettes, see Table 2). When assessing patients’ perceptions of e-cigarettes, 58.3% (n=7) said that they are very addictive, 41.7% (n=5) that they are somewhat addictive, and 41.7% (n=5) that they were somewhat harmful to health. Table 1 shows how patients perceive the risks of e-cigarettes and their use in both the pre-and postsurveys.

Patient Acceptability

Before counseling, just over half of all patients (58.3%, n=7) reported that an e-cigarette quitting program would not be helpful to them. After receiving the 5A’s from their dental provider during their appointment, most respondents (83.3%, n=10) stated that e-cigarette use was definitely not or probably not okay within their age group. Most notably, 75% (n=9) of patients reported that they learned new information about e-cigarettes from their dental provider,

beliefs,knowledge,improvedpractitionersOverall,theirharmperceptions,perceivedaddictiveness,andattitudesregardinge-cigarettes

100% (n=12) would recommend the RAKE cessation program to other people who use e-cigarettes, and 90% (n=10) of responders (2 missing responses) answered that the RAKE cessation program was helpful to them.

Discussion

As one of the standard counseling protocols for tobacco cessation, the 5A’s adapted for e-cigarettes in this study showed to be feasible within clinical practice. As shown in Appendix A, the 5A’s utilized for this study provided questions, topics, and check boxes to assist practitioners in reviewing quickly during their sessions. The American Dental Association recommends the 5A’s for cessation counseling to best consider tobacco use and oral health implications.12Overall,bothpractitioners and

patients in this study showed changes in knowledge, attitudes, and perceptions related to e-cigarette use after completing the RAKE cessation program. As previously mentioned, dental practitioners discussed their progress in recruitment and completion of study procedures. These discussions with the study coordinator indicated the implementation of the study within the practice: when patients were being screened, when the RAKE cessation program was being completed, and the overall receptiveness of the program. The study team relied on their experience to adapt and implement the cessation intervention that made sense for their patients and the clinic. This kind of implementation review allows the study team to make realtime adjustments to the cessation program’s timing as needed to best suit clinic practices. Providing upto-date, evidence-based training for

dental practitioners with online access at their convenience showed that the program can be utilized quickly and efficiently. Practitioners who gained new knowledge about e-cigarettes and the resources available showed increased confidence to implement the cessation program within their clinics.

Patients also provided feedback to their providers to help the study team increase the RAKE cessation program’s acceptability. Some suggestions from patients included: adding videos from former e-cigarette users discussing the benefits of quitting and why they should have quit earlier, a discussion between patients and providers about the financial cost of both long-term use and savings if ceasing use, adding graphics to show the dangers and injuries that have been reported in the news if devices malfunction and live presentations at schools to encourage student engagement through a Q&A. These suggestions could be utilized as the RAKE program continues to develop and be implemented in and out of dental settings. Cessation programs, including those made specifically for e-cigarettes, may become readily accepted among youth and young adults who also see that their use could pose issues for them.

Limitations

Study limitations included screening, recruitment, and training during the SARS-CoV2 pandemic. At the time of funding, the pandemic began to spread throughout Texas. This led the study team to revamp study protocols and make the procedures as easy as possible for practitioners to implement into their practice. However, challenges arose as practices limited patients coming in and modified their clinic flow to get patients in and out efficiently, thus minimizing the ability to add external procedures for the study. In addition, despite getting patients to return for their appointments, many were outside of the target age group for this study. Several dental practices had also shut down (permanently or temporarily) during the peak of the pandemic, leading to limited practitioners available to participate in the

Anotherstudy.limitation

was recruiting minors into the study. Though the study team received a Certificate of Confidentiality from NIH to ensure participants under the age of 21 who reported use of e-cigarettes were assured of their participation as confidential (as it is illegal to purchase an e-cigarette due to the Federal Tobacco 21 Law), patients hesitated to participate in the study. In addition, practitioners reported that patients they knew used e-cigarettes within the age group were unwilling to admit use, especially if their parent brought them to the appointment. Future studies should examine the relationship between patients and practitioners in establishing rapport and encouraging discussion on sensitive topics, such as e-cigarette use.

While statistical findings were descriptive, the sample size was not

Appendix A

E-Cigarette In-Office Counseling Session Completed

5A’s

1-Ask Obtain patient’s e-cigarette usage behavior

1. Does the e-cigarette have nicotine? ____Y / N____

2. How much or how often do you use e-cigarette? ___/day ___/month

Ask open-ended questions such as:

1. What do you and your friends think about e-cigarettes?

2. What have you learned about e-cigarettes online?

3. How do you and your friends learn about the health effects of vaping?

4. What does your school teach students about vaping?

2-Advise Counsel patient to quit in a clear, strong, and personalized manner.

Encourage them not to switch from e-cigarettes to conventional cigarettes.

Below are some topics for discussion:

1. Effects of nicotine on the developing brain and oral health

2. Risk of e-cigarettes and general health (EVALI, black market)

3. Risk of e-cigarette and oral health (soft and hard tissues)

4. Risk of COVID-19 and e-cigarettes

3-Assess Evaluate the patient’s willingness to quit.

1. Are you interested in quitting?

2. Are you interested in cutting down?

4-Assist Suggest resources such as:

1. BecomeAnEx—Access to develop a plan to quit

2. CATCH My Breath—Access lessons to equip youth with the knowledge and skills to make informed decisions about using e-cigarettes.

3. The Real Cost—FDA’s campaign to raise awareness about the dangers of vaping

5-Arrange For support, set a quit date.

Congratulate patients who are following their quit plans and address any anticipated challenges in the near future.

For patients who are not successful, identify and discuss barriers.

large enough to produce statistically significant or complex analyses. Nevertheless, findings were suitable for the conditions of the pilot study. Given the recruitment shortcomings, the next steps are to test further implementation of the RAKE cessation program among a larger sample of dental clinics and add resources for patients who want to quit e-cigarette use that may go beyond the 5A’s, including more frequent contact of cessation

1.Referencessupport.GentzkeAS,Creamer M, Cullen KA, et al. Vital Signs: Tobacco Product Use Among Middle and High School Students - United States, 2011-2018. MMWR Morb Mortal Wkly Rep. 2019;68(6):157164. Published 2019 Feb doi:10.15585/mmwr.mm6806e115.

2. Texas Department of State Health Services. Electronic nicotine delivery systems (e-cigarette) report., 2019. Tobacco Prevention and Control Branch, Texas Health and Human Services. ENDS-Report-2021.pdfdshs.state.tx.us/tobacco/pdf/https://www.

3. Soneji S, Barrington-Trimis JL, Wills TA, et al. Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis [published correction appears in JAMA Pediatr. 2018 Jan 1;172(1):92-93] [published correction appears in JAMA Pediatr. 2018 Jan 1;172(1):98] [published correction appears in JAMA Pediatr. 2020 May 1;174(5):509]. JAMA Pediatr. 2017;171(8):788-797. jamapediatrics.2017.1488doi:10.1001/

4. Barrington-Trimis JL, Urman R, Berhane K, et al. E-Cigarettes

and Future Cigarette Use. Pediatrics. doi:10.1542/peds.2016-03792016;138(1):e20160379.

5. Winnicka L, Shenoy MA. EVALI and the Pulmonary Toxicity of Electronic Cigarettes: A Review. J Gen Intern Med. 2020;35(7):21302135. 05813-2doi:10.1007/s11606-020-

6. Center for Tobacco Products. E-cigarettes, vapes, and other Electronic Nicotine Delivery Systems (ENDS) [Internet]. U.S. Food and Drug Administration. FDA; 2022 [cited 2022Aug12]. Available from: tobacco%20products.adults%20who%20use%20date%2C%20no%20e%2Dcigarette,systems-ends#:~:text=To%20other-electronic-nicotine-delivery-e-cigarettes-vapes-and-products-ingredients-components/fda.gov/tobacco-products/https://www.

7. American Dental Association. American Dental Association Announces Interim Policy on Vaping. December 16, 2019. Accessed September 21, 2021. vapingannounces-interim-policy-on-american-dental-association-releases/2019-archives/december/org/en/press-room/news-https://www.ada.

8. Chaffee BW. Electronic Cigarettes: Trends, Health Effects and Advising Patients Amid Uncertainty. J Calif Dent Assoc. 2019;47(2):85-92.

9. Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Services, June 2000.

10. Mungia R, Case K, Valerio MA, et al. Development of an E-Cigarettes Education and Cessation

Program: A South Texas Oral Health Network Study. Health Promot Pract. doi:10.1177/15248399209148702021;22(1):18-20.

11. Newhall K, Burnette M, Brooke BS, et al. Smoking cessation counseling in vascular surgical practice using the results of interviews and focus groups in the Vascular Surgeon offer and report smoking cessation pilot trial. J Vasc Surg. doi:10.1016/j.jvs.2015.10.0862016;63(4):1011-7.e2.

12. American Dental Association. Tobacco use and cessation [Internet]. American Dental Association. Department of Scientific Information, Evidence Synthesis & Translation Research, ADA Science & Research Institute, LLC.; 2022 [cited 2022Aug12].

Available from: topics/tobacco-use-and-cessationand-research-institute/oral-health-org/resources/research/science-https://www.ada.

•

•

•

• FOR TEXAS

M. Keith Cox Dallas

October 4, 1938–April 3, 2022

Good Fellow: 1990 • Life: 2003 • Fifty Year: 2015

Michael L. Boland Cibolo

February 21, 1948–April 29, 2022

Good Fellow: 1999 • Life: 2013

Ronald O. Teofan

Rossville, TN

October 3, 1932–May 17, 2022

Good Fellow: 1997 • Life: 1997 • Fifty Year: 2012

Robert William Hampton Sweetwater

March 1, 1935–May 19, 2022

Good Fellow: 1987 • Life: 2000 • Fifty Year: 2012

Jack L Pierce Fort Worth

September 16, 1930–May 27, 2022

Good Fellow: 1981 • Life: 1995 • Fifty Year: 2005

Leslie Arnim Wheeler III Sugar Land

November 25, 1941–May 24, 2022

Good Fellow: 1991 • Life: 2006 • Fifty Year: 2016

Jack Bruce Buck Kerrville

February 28, 1927–May 1, 2021 Life: 2000

Carlos Jaime Villarreal Pharr

October 20, 1963–April 3, 2022

William W. Dodge San Antonio

June 4, 1945–May 27, 2022

Good Fellow: 2010 • Life: 2015

Richard Arthur McFarland Frisco

August 18, 1947–May 21, 2022

Good Fellow: 1999 • Life: 2012

Guadalupe Montemayor

San Antonio

October 12, 1925–May 23, 2022

Good Fellow: 1979 • Life: 1990 • Fifty Year: 2004

Bill K. Forbus

Alvarado

October 21, 1931–January 5, 2022

Good Fellow: 1982 • Life: 1996 • Fifty Year: 2008

Robert Carroll English Buda

January 8, 1942–June 4, 2022

Good Fellow: 1992 • Life: 2007 • Fifty Year: 2017

Arne J. Koch Austin

June 1, 1943–December 23, 2021

Life: 2008

Robert Burton Reese Fairview

October 5, 1938–May 28, 2022

Good Fellow: 1989 • Life: 2000 • Fifty Year: 2014

Robert G. Williams

Mesquite

December 19, 1951–July 1, 2022 Life: 2016

Randolph Monroe Terry III Bullard

August 6, 1939–July 21, 2022

Good Fellow: 1996 • Life: 2004 • Fifty Year: 2016

James V. Burnett Fort Worth

June 16, 1926–July 24, 2022

Good Fellow: 1973 • Life: 1991 • Fifty Year: 1998

John F. Nelson Dallas

September 27, 1934–July 12, 2022

Good Fellow: 2009 • Life: 2000 • Fifty Year: 2009

Thomas A. Blaylock

Saline, MI

June 12, 1934–April 13, 2022

Good Fellow: 1988 • Life: 2000 • Fifty Year: 2013

David B. Neal

Evant

February 21, 1949–May 25, 2022

Good Fellow: 2012 • Life: 2017

Robert E. Sanders Dallas September 16, 1929–July 4, 2022

Good Fellow: 1982 • Life: 1994 • Fifty Year: 2006

Calendar of

How to respond to negative online review

Joshua Austin, DDS, MAGD

This article was originally published in Dental Economics (dentaleconomics.com). Reprinted with permission. a-negative-online-reviewhttps://www.dentaleconomics.com/practice/marketing/article/14167876/how-to-respond-to-

here are plenty of things that can turn my ordinary day into a really bad day. Waking up to a text from a hygienist telling me she is sick and won’t make it in today…bad day. Spilling my morning coffee on my white shirt right after I leave the house…bad day. Having a kid on nitrous yack all over my new Nike Epic Reacts…bad day. But for some reason, getting a bad review on Google or Yelp… terrible day!

There is something about getting a bad online review that cuts right down to the deepest portion of our souls. It shatters our confidence and unleashes our tempers. It makes us feel violated, misunderstood, and unappreciated. A bad online review can leave a mark on us that we never forget. Almost every dentist has a riveting story about a bad online review they have received. We never remember the five-star reviews—only the ranting one-star ones.

The review of my practice that I remember most came from a patient who called herself “KP.” I remember getting the notification on my Yelp for Business Owners app on my iPhone. It was around 9:00 p.m., and I was watching SportsCenter after a long day. When I got the alert, I looked at my phone and clicked to open the review. After a few seconds of reading, my Apple Watch asked me if I was exercising. It noticed my heart rate had risen to 108 beats per minute. As I read further and further, my heart rate continued to rise. I couldn’t take anymore. “So sorry to everyone who thinks this place is so great. Maybe if all these mishaps hadn’t piled up, I’d be a lot happier with this practice. But I can guarantee right now, I won’t be going back.” When I read that line, I couldn’t control myself anymore. I flung my iPhone…my precious iPhone…right into my bedroom wall.

There is something about getting a bad online review that cuts right down to the deepest portion of our souls.

The iPhone put a hole into the wall. The review put a pit in my stomach. It was scathing. I was raging. Without thinking, I started up my laptop and logged into my Yelp account. I started typing my public response to KP. It was fire, as the kids say. Snarky, insulting, demeaning, and scornful. It was worthy of John Oliver. My thumb hovered over the “Submit” button. Fortunately, my frontal cortex got a word in. I hesitated. It was then that I realized I needed a system

less of a factor. It lets the thinking part of your brain take over. If you respond angrily, there’s a chance your response will anger the patient even more—and that’s the best-case scenario! The worstcase scenario is that your response goes viral and way more eyes end up on the original bad review than ever would have before. Give yourself one to two days to cool down. Gather your thoughts and research the situation.

During the one- to two-day “bad review Sabbath,” I do my research. My research always starts with talking to my team members to gather background. Did this really happen? Did it happen like the patient said it happened? Was the patient’s issue with one of our systems that doesn’t work correctly? I have gotten a couple of bad reviews that opened my eyes to a system in my practice that wasn’t working well. Don’t let anger cloud your ability to improve your practice’s systems. We should always take criticisms that can lead us to having a better practice.

for this—what to do with a bad review. I knew that I had just executed what would become the first step in dealing with a bad review: wait and relax. Had I responded to KP publicly when I was angry—so angry that I threw my cell phone—would I have regretted what I said the next day? Absolutely.

So, the first step is this: wait 24 to 48 hours after getting the bad review before doing anything else. Rest on it. Get some sleep. Have a glass of wine. Don’t address it with anyone (i.e., the patient or your team) for at least a day. Time affords some clarity in these situations. It allows your emotions to be

Another thing I research during this time is the content guidelines of where the review appeared (i.e., Google or Yelp). The content guidelines are the rules of engagement that the patient has to follow when leaving a review. If you’ve never read the Google or Yelp content guidelines for reviews, search for them and read them. There is too much to list everything here, but if the patient violated any of the content guidelines, Google or Yelp will delete the review. You just need to flag it in your business owner’s portal. That process takes all of 30 seconds. If the reviewer violated the content guidelines and you flag it, the review goes away forever, and you never have to deal with it again. Assuming no content guidelines were violated, you will have to deal with the bad review with traditional means.

“But I guaranteecan right now, I won’t be going back.”

Chances are you know the patient who left you the bad review. Google places people’s first and last names on their reviews. Yelp usually puts someone’s first name and last initial or just their initials. Even if it’s just the initials displayed on the review, you will usually know who it is. I know exactly who “KP” is. If you know who the patients are who left you bad reviews, call them. Text them. Email them. Contact them via whatever method is best for them. Reach out. Show them you care. When I talk to a patients in this situation, I am always respectful, polite, and thankful for their feedback. Am I grinding my teeth sometimes while expressing my “gratitude” to them? Sure, but they don’t need to know that. I always ask patients to tell me about what happened, and I just let them talk. After they are finished with their rant, I thank them for their feedback again. I usually apologize to them about “not having the experience I wanted them to have.” The vast majority of the time, patients are surprised that I listened and cared. Oftentimes, they apologize to me for leaving the bad review and tell me pretty quickly that they will delete it. I never have asked a patient to delete a bad review. I want them to make that choice on their own. Sometimes you will have a patient who won’t want to talk to you or won’t respond. You can’t do much about that. You did your best and you tried. Time to move on.

The next step is to respond publicly on the review site. This response is, frankly, not for the patient who left the review. It’s for everyone else who reads it. It shows all those prospective new patients that you care and you want people to have the best experience possible. The truth is, at this point that you’ve probably lost the patient who left you the review. Don’t lose other patients over it. That’s why a response from

you is good for your practice. When you respond, you must be careful. You cannot violate the patient’s privacy in your response. Every month, I read about HHS fines for medical and dental practices who have violated a patients’ privacy on social media. Even if a patient discusses personal health information in his or her review, you cannot confirm or discuss this on a public site. Keep your responses generic and positive. Something such as, “Here at Joshua Austin, DDS, we value your feedback. We are sorry that your experience with us wasn’t what you were looking for. We wish you luck in finding your next dental home. Please let us know if we can assist you in any way in the future.

ThereCheers!”are situations when I will not respond to a bad review. If the review is a long, poorly written rant that makes the patient sound crazy, I will generally let those be. In these situations, it can be best to just let crazy be crazy, and you don’t want to engage with that. Just ignore it. Prospective patients are savvy enough to realize when someone is either too demanding or slightly unhinged. They won’t hold you responsible for that.

The final and most important step for dealing with a bad review is pretty simple. Drown it out with positives. Make it your team goal to get five more good reviews in the next week after that bad one. The default setting when prospective patients look at your business is to sort views chronologically. The more good reviews you get after that bad one, the further the bad one gets pushed down the page. Push it to page two, then page three, then bury it on page four, never to be seen again. If it’s your first bad review, no matter how far you bury it, your score will never be 5.0 again. That’s OK! I call it the Reese’s Peanut Butter Cup Phenomenon.

Sometimes a little salty mixed with the sweet can be a very good thing. Consumers seem to respond better to businesses that have a 4.6, 4.7, 4.8, or 4.9 ratings than they do to a business with a 5.0 rating. If you found a restaurant in your city with 5,000 5-star reviews and nothing else, what would you think? You’d probably think something was faked. Let’s not fret about not being a perfect 5.0. There are better things to waste brainpower on.

Dentists have been dealing with unhappy patients for as long as dentistry has been practiced. People have gotten upset. They’ve called the office and demanded to speak to the doctor. They’ve cornered us awkwardly in the hallway of the office to tell us that the receptionist was rude. Yes, patients have complained as long as patients have existed. The difference now is that patients have a platform to tell a much wider audience about why they are upset. We can’t put this genie back in the bottle and we can’t control it. We can simply do the best we can for our patients. In the event that a patient is upset and leaves us a bad review, we have to keep our cool and manage the situation. Develop a system for your practice for these situations and follow your system. The effect that good reviews can have on attracting new patients to your office far outweighs the downside of a rare bad review. You got this!

JOSHUA AUSTIN, DDS, MAGD, writes the Pearls for Your Practice column in Dental Economics. After graduating from the University of Texas Health Science Center Dental School, Dr Austin associated for several years. In October 2009, he opened a solo general practice in a suburban area of San Antonio, Texas. Dr. Austin is involved in all levels of organized dentistry and can be reached at jaustindds@icloud.com.

VALUE forprofessionyour

AN UPDATE ON TDA DENTAL CONCIERGE

THE INDISPENSABLE FREE APP THAT SIMPLIFIES MEETING TSBDE CE

REQUIREMENTS, AUDIT SUBMISSIONS

Before the release of the free TDA Dental Concierge app in February, staying on top of Texas State Board of Dental Examiners (TSBDE) CE requirements was a messy (and probably a stressful) task.

The app, commissioned by Texas Dental Association and TDA Perks Program, provides an easy way to keep track of completed CE courses and any requirements that remain, making submitting CE documentation to the TSBDE much easier in the event of an audit. In just a few months, the app has garnered more than 1,400 registered users who have completed more than 600 live and on-demand courses available through the app’s accompanying learning management system (LMS).

WHAT THE APP DOES FOR TDA MEMBERS

1. Tracks Completed CE, Shows What’s Needed, and Sends Reminders.

TDA Dental Concierge neatly organizes all CE completion documentation for courses offered through the app, sorting them into appropriate requirement categories and storing them in a digital vault until needed.

• Information for courses completed outside the app are manually entered. Users simply upload a photo of the completion certificate, check the box for the requirement it applies toward, and enter the completion date.

• Progress toward meeting requirements is demonstrated through a color-coded dashboard where app users can see which courses and categories need to be completed and have been fulfilled.

• As deadlines approach, reminders are sent via app alerts or emails at a frequency customized by the user.

• Other compliance-related custom reminders can also be set, for example, for meeting OSHA requirements or testing x-ray equipment.

2. Offers High Quality CE Courses at Low Cost.

A comprehensive library of courses— live and pre-recorded self-study— are available at a lower cost to TDA members. TDA is an ADA CERP Recognized Provider.1

For example, through February 2023, TDA Dental Concierge is offering a popular 4-hour live controlled substance course that enables dentists to meet all controlled substance CE requirements (“Safe and Effective Pain Management When Ethically Prescribing Opioids and Other Controlled Substances to Dental Patients”).

3. Helps Submission of CE Documentation to the TSBDE.

If a CE audit notice is received, app users can easily identify and compile required information for the TSBDE— documentation will be a snap.

Provided by:

Simplify CE for the whole team.

Dentists, hygienists, and RDAs can track and submit CE hours with the TDA Dental Concierge app.

And you can start right now.

Scan here:

tdadentalconcierge com

TEAM MEMBERS CAN USE THIS TOOL AS WELL!

TDA Dental Concierge debuted its RDH and RDA modules in late May, enabling team members to access the same features as dentists: easily track completed CE and see what they lack, access quality CE, and simplify the license-renewal process.

TDA members can sign up their staff and gift it to them, or simply share the information with them. Staff pricing is $4.99 /month; and instructions for

signing up team members are the same as they are for dentists.

TDA Dental Concierge is available for download through Google Play and the Apple App Store free of charge for TDA members. The app is available to nonTDA members for a monthly fee of $10.

Learn more and browse through our courses at tdadentalconcierge.com.

1.ReferenceADACERP

is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

Season of Change: Time for Prevention

Shailee Gupta, DDS, MPH

On behalf of the Prevention Subcommittee of the ADA Council on Advocacy for Access and Prevention

Back to school is a time for getting an annual physical, new beginnings, and the opportunity to establish good dental habits. In dentistry, we need to capitalize on this time with parents to reinforce the importance of disease, injury prevention and exceptional hygiene habits.

Now more than ever, as healthcare providers, we must embrace and challenge ourselves to prioritize prevention. For example, oral health for children includes ensuring that most school-aged patients have optimal opportunities to achieve academically without dental pain through oral health prevention, including regular visits with a dental provider, dental sealants, fluoride varnish, and mouthguards.

However, prevention goes beyond clinical care delivery and should also be supplemented with oral health education. Engagement with parents and children must be communicated in an inclusive manner that accounts for each individual’s conditions and the environments where they live, work, and play that affect their range of health, functionality, and quality of life outcomes and risks. Social determinants of health are a great way to incorporate health equity into your efforts.

Vaping and tobacco use ultimately lead to adverse oral health outcomes. Communicating the risks to especially vulnerable adolescents needs to be at the forefront of oral health examinations. Informing young people about this issue and the importance of HPV vaccinations needs to be a priority.

Here are 3 additional suggestions to expand your efforts to further engage with your community, promote health equity, and advocate for oral health prevention:

1. Partner with your local school or district in a back-to-school event

A back-to-school event is an excellent opportunity to engage parents, teachers, administrators, and community members to discuss the importance of oral health, community water fluoridation, dental sealants, fluoride varnish, and mouth guards. It is also an excellent time to promote the need for community members to have a dental home. In addition, this boosts the opportunity for future engagement. Furthermore, remember that school nurses continue to be excellent oral health advocates!

2. Meet with your medical colleagues to promote medical-dental collaboration and effective patient referrals

Consider establishing a close relationship with local members of the American Academy of Pediatrics (AAP) or the American Academy of Family Physicians (AAFP). Work in collaboration to advocate for oral health, promote oral health prevention, establish a dental home by age 1, and identify challenges and solutions to improve the community’s health.

3. Review prevention and oral health resources

Education and the opportunity to learn never ends! Reading a report, attending a live or pre-recorded webinar, or hosting a “lunch and learn” with your colleagues is an opportunity to promote diversity by remaining open-minded. One example includes the Oral Health Resource Center’s Advancing Oral Health Equity: A Resource Guide.

These direct and indirect efforts to promote oral health, emphasizing the importance of prevention, and engaging with your community must be inclusive, from a health equitable lens, and represent the values of all individuals involved.

Pay it forward and utilize this back-to-school season as an opportunity to promote oral health prevention!

ADVERTISING BRIEFS www.dentaltransitions.com at 512-900-7989

dentaltransitions.com. AUSTIN (ID #556): 100% fee-for-service GD practice in north Austin. The approx. 2,300 sq ft, fully equipped, 6 operatory office features computers in operatories, digital radiography, X-ray sensors, intra oral cameras, and paperless charts. The practice serves a large patient base with a robust hygiene recall program. AUSTIN-WEST (ID #539): 100% feefor-service practice in the Texas hill country with strong hygiene recall (approximately 30% of total production) and an increasing revenue trend over the past 3 years. 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. DALLAS/FORT WORTH (ID #551): Premier cosmetic dentistry practice located in the heart of the Dallas-Fort Worth metro area. The practice realized annual revenue of $2M+ and strong net cash flow of under 7 figures in 2021 and is on pace to grow significantly in 2022. The office is located in an attractive, free-standing building featuring 5 operatories and the real estate is available for purchase. EAST TEXAS (ID #486): 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 #489): 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 7 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. EAST TEXAS (ID #542): Large practice and real estate in east Texas with over 7 figures in revenue. The recently updated 2,400 sq ft facility features 5 fully equipped operatories with digital radiography, paperless charts, CBCT, digital pano, and an iTero digital scanner. The practice serves a large FFS/PPO, multi-generational patient base with over 3,000 active patients and a stellar online reputation. The seller is open to providing a long-term transition period to the buyer.

NORTHEAST TEXAS (ID #554): 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. HOUSTON-NORTHEAST (ID #488): 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-CENTRAL (ID #552): Established, boutique practice located in the highly desirable museum/River Oaks district 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 community. The beautiful facility features high-end finishes/

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

PRACTICE SALES

DSO C S

Austin 512-900-7989 DFW 214-960-4451 Houston 281-362-1707 San Antonio 210-737-0100 South Texas 361-221-1990

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decor, 3 fully equipped operatories, digital radiography, and a CBCT. HOUSTON-NORTH (ID #553): Large, extremely profitable practice and real estate in north Houston (Spring/ The Woodlands). The 5,600 sq ft standalone building contains 10 fully equipped operatories, computers throughout, digital technology, and room for future expansion. The massive active patient base is comprised of Capitation (40%), PPO (35%), Medicaid (15%), and FFS (10%) with 175+ new patients visiting the office per month. The owner is open to exploring a sale to a DSO, multi-location owner, or a well-qualified private practitioner. The 10,000+ sq ft property is also available for sale which offers additional rental income and the possibility for future development. SAN ANTONIO, ORTHODONTIC (ID #547): Rare opportunity to purchase a primarily FFS orthodontic practice in north central San Antonio. The facility has a modern feel and is equipped with a 3-chair open bay, 2 additional private treatment rooms, and digital radiography. In 2021, revenue was high-6 figures with strong net cash flow. The practice has been a staple in the community with over 40 years at its present location and is located near several highly desirable neighborhoods. SAN ANTONIO (ID #550): Established general dentistry practice and real estate in northeast San Antonio. The approximately 3,600 sq ft office is located in a free-standing building

and is equipped with 7 operatories, digital radiography, intra oral cameras, and computers in operatories. The practice has a strong hygiene recall program, over 2,700 active patients, and provides tremendous upside potential. SAN ANTONIO (ID #550): Majority fee-for-service general dentistry practice in northwest San Antonio. The practice is situated in a high visibility retail center near a bustling intersection and features 4 fully equipped operatories with computers in all ops, a digital scanner, digital radiography, a digital pano, and intraoral cameras. The office has a solid active patient count, a fantastic online reputation, and annual revenue of mid-6 figures year over year. TO REQUEST MORE INFORMATION ON MCLERRAN & ASSOCIATES’ LISTINGS: Please register at www.dentaltransitions. com or contact us at 512-900-7989 or info@ dentaltransitions.com.

AUSTIN: 32-year-old female-led private practice in a 7-year-old facility in central Austin. Collections in 7 figures over the last 3 years. 85% fee for service and 15% PPO production. Primarily a restorative practice. Strong Invisalign program with all implants, ortho, endo, and oral surgery referred out. Great opportunity to buy a healthy practice to grow. Please email Practice Transitions Group for more information, info@ practicetransitionsgroup.

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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 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 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 3-1/2 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.

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

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(no Medicaid), with collection ratio above 95%. Providing general dental and cosmetic procedures, producing mid-6 figure gross collections. Contact Christopher Dunn at 800930-8017 or Christopher@DDRDental.com and reference “Lufkin General or TX#540”. HOUSTON ñ 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 800-9308017 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. 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—

PEDIATRIC (NORTH HOUSTON) This practice is located in a highly sought-after upscale neighborhood. It is on a major thoroughfare with high visibility in a strip shopping center. The practice has three 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 in mid-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”.

SAN ANGELO: To those desiring the perfect balance between work and play: Are you interested in taking over a successful readymade practice with a great salary low-to-mid 6 figures? Located in west central Texas, San Angelo is a city of 100,000+ but offers a small town feel and excellent quality of life. The city was named the Visual Arts Capital of Texas in 2021 and is alive with a vibrant mixture of arts and culture for children and adults.

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It is consistently ranked as one of the best small cities for business and employment. San Angelo is home to award winning Angelo State University, 3 lakes, the beautiful Concho Riverwalk, an incredible nationally ranked Art Museum, and one of the best preserved forts in the nation, Fort Concho—all with numerous kid-involved programs. As a Texas friendly city, live music is offered almost daily at one of many venues and one-of-a-kind restaurants in town. The community is diverse, with an active young professional group, outstanding medical facilities, ranked sports teams, great hunting and fishing, and a low cost of living. Easy traffic takes you anywhere in the city within 10 minutes. It’s a great place to raise a family and a great place to live, work, and play. The 2,400 sq ft newly remodeled dental office, built to accommodate two dentists, is a free-standing building with natural light in each operatory. An extremely healthy hygiene program is in place with 2 hygienist. There are 6 operatory rooms—4 equipped. The majority of practice is FFS cash, with over 3,000 active patients. The practice has an excellent reputation in the local community. A bonus package is included for preferred equipment needs. Contact Geremy Haseloff @ 806-777-4732 or geremy.haseloff@ henryschein.com.

SAN MARCOS: Small dental office for sale. San Marcos, approximately 1,000 sq ft. Great location. 2 Operatories. Fully equipped and functional. Office only, no practice transfers. Recently retired. Email for info and photos. stevenmaycockdds@gmail.com.

WATSON BROWN PRACTICES FOR SALE:

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

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 512517-2826 or drzoch@yahoo.com.