Virginia Dental Journal Vol 100#3 July - September 2023

COLUMNS

3 THE SUN IS SHINING

Dr. Cynthia Southern

5 CAN I GET A WITNESS?

Dr. Richard F. Roadcap

7 LETTER TO THE EDITOR

Dr. Jacqueline Carney

9 THE ADA TRIPARTITE— NOW MORE THAN EVER

Dr. Gary D. Oyster

10 INTRODUCING THE VIRGINIA DENTAL ACADEMY’S CERTIFIED DENTAL OFFICE PROFESSIONAL PROGRAM

Ryan Dunn

13 LET ME INTRODUCE MYSELF... VDA ADDS NEW TEAM MEMBER

Karen Kraus

COVER STORY

39 UNIDENTIFIED – TOOTH SLEUTHS

Dr. Sarah Friend

ADVOCACY

30 ADA DENTIST AND STUDENT LOBBY DAY

Laura Givens

30 VDA PAC FUNDRAISER FOR SENATOR TODD PILLION

Laura Givens

31 HAVE YOU STEPPED UP TO SUPPORT YOUR PROFESSION?

Laura Givens

RESOURCES

29 DENTAL DETECTIVE SERIES WORD SEARCH

Dr. Zaneta Hamlin

47 UNDERSTANDING SOCIAL SECURITY

Bobby Moyer

48 ETHICS: INFORMED CONSENT

Dr. Al Rizkalla

51 AUTOMATED INSURANCE VERIFICATION CAN IMPROVE PATIENT SATISFACTION AND REVENUE

Robert McDermott

53 DID YOU KNOW? A SERIES FROM THE VIRGINIA BOARD OF DENTISTRY

54 COSMETIC BOTOX ADMINISTRATION IN THE DENTAL OFFICE: RISK MANAGEMENT & INSURANCE CONSIDERATIONS

E. Andrew Gerner

56 VIRGINIA BOARD OF DENTISTRY NOTES

Dr. Richard F. Roadcap

58 REUSING AND ADAPTING MARKETING CONTENT TO MAKE YOUR LIFE EASIER

Michaela Mishoe

61 OUR REGIONAL WORKFORCE NEEDS

Paul Logan

62 ANSWERING YOUR FREQUENT DELTA DENTAL QUESTIONS

Dr. Brad Guyton

OUTREACH

64 A PARTNERSHIP WITH SPECIAL OLYMPICS, ORGANIZED DENTISTRY, THE COMMUNITY, AND TWO DENTAL SCHOOLS

Phillip Ashkar, Lauren Karr, Ava Kiser, Michelle McGregor, Tara Quinn, Dr. Terry Dickinson, Dr. Matthew Cooke

SCIENTIFIC

32 THROUGH THE LOOKING GLASS THE FANTASTICAL WORLD OF ORAL PATHOLOGY

Dr. Sarah Glass

35 PERIODONTIC ABSTRACTS

UNIVERSITY CONNECTIONS

67 THE SOFT SKILLS OF THE CLINICAL EXPERIENCE

Michaela Banks

68 VDA DENTAL DAYS AT THE CAPITOL RECORD HIGH STUDENT TURNOUT

Lakshya Ramani

69 STUDENT NATIONAL DENTAL ASSOCIATION HOSTS ORAL CANCER WALK

Jaycee Cureton

MEMBERSHIP

70 MEET THE CANDIDATES

74 AWARDS & RECOGNITION

75 NEW MEMBERS

VA DENTAL

JOURNAL

EDITOR-IN-CHIEF Richard F. Roadcap, D.D.S., C.D.E.

BUSINESS MANAGER Ryan L. Dunn

MANAGING EDITOR Shannon Jacobs

EDITORIAL BOARD

Drs. Ralph L. Anderson, Scott Berman, Carl M. Block, Gilbert L. Button, B. Ellen Byrne, Craig Dietrich, William V. Dougherty, III, Jeffrey L. Hudgins, Wallace L. Huff, Rod Klima, James R. Lance, Karen S. McAndrew, Travis T. Patterson III, W. Baxter Perkinson, Jr., David Sarrett, Harlan A. Schufeldt, James L. Slagle, Jr., Neil J. Small, John A. Svirsky, Ronald L. Tankersley, Roger E. Wood

VDA COMPONENT

ASSOCIATE EDITORS

BOARD OF DIRECTORS

Dr. Zane Berry, Dr. Michael Hanley, Dr. Frank Iuorno, Dr. Stephanie Vlahos, Dr. Sarah Friend, Dr. Jared C. Kleine, Dr. Chris Spagna, Lyda Sypawka (VCU Class of 2024)

PRESIDENT Dr. Cynthia Southern, Pulaski

PRESIDENT ELECT Dr. Dustin Reynolds, Lynchburg

IMMEDIATE PAST PRESIDENT Dr. Scott Berman, Falls Church

SECRETARY-TREASURER Dr. Zaneta Hamlin, Virginia Beach

CEO Ryan L. Dunn, Goochland

SPEAKER OF THE HOUSE Dr. Abby Halpern, Arlington

NDC CHAIR Dr. C. Dani Howell

COMPONENT 1 Dr. David Marshall

COMPONENT 2 Dr. Sayward Duggan

COMPONENT 3 Dr. Samuel Galstan

COMPONENT 4 Dr. Marcel Lambrechts

COMPONENT 5

Dr. David Stafford

COMPONENT 6 Dr. Marlon A. Goad

COMPONENT 7 Dr. Caitlin S. Batchelor

COMPONENT 8 Dr. Justin Norbo

ADVISORY Dr. Lyndon Cooper

ADVISORY Dr. Ralph L. Howell, Jr.

ADVISORY Dr. Lorenzo Modeste

EDITOR Dr. Richard F. Roadcap

VCU STUDENT Dr. Brett Siegel, VCU Class of 2023

VCU STUDENT Eric Montalvo, VCU Class of 2024

VOLUME 100, NUMBER 3 • JULY, AUGUST & SEPTEMBER 2023

VIRGINIA DENTAL JOURNAL (Periodical Permit #660-300, ISSN 0049 6472) is published quarterly (January-March, April-June, July-September, October-December) by the Virginia Dental Association, 3460 Mayland Ct, Ste 110, Richmond, VA 23233, Phone (804)288-5750.

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POSTMASTER

MANUSCRIPT, COMMUNICATION & ADVERTISING

Second class postage paid at Richmond, Virginia.

©Copyright Virginia Dental Association 2023

Send address changes to: Virginia Dental Journal, 3460 Mayland Ct, Ste 110, Richmond, VA 23233.

Managing Editor, Shannon Jacobs 804-523-2186 or jacobs@vadental.org

THE SUN IS SHINING

Dr. Cynthia Southern

I’d like to start with a quote by sprinter and Olympic champion Wilma Rudolph: “When the sun is shining, I can do anything; no mountain is too high, no trouble too difficult to overcome.” Summer is my favorite season. Kids and teachers are excited for their time off. There are so many outdoor activities. My husband and I enjoy vacationing with our family, fishing, hiking, kayaking, and playing pickle ball. My time leading up to summer was very busy. I attended Component meetings in Southwest, Southside, and Northern Virginia. I was also able to attend Richmond Dental Society’s Casino night. I hope to make it to other components before my tenure is over. I had the privilege of speaking at the VCU School of Dentistry hooding ceremony. It was wonderful to see so many happy dentists and hygienists entering our profession. Seeing them brought back so many memories. I was also honored to attend the South Carolina and North Carolina state meetings. It was nice to spend time with dentists from other states. I gained some ideas from their meetings that would help in Virginia. It was also nice to discuss the challenges they are facing; most are the same challenges we are facing in Virginia.

Summer is a busy time for the association. We had a very successful fundraiser for Senator Todd Pillion in May. Dr. Pillion introduced legislation, now signed into law, allowing dentists to administer Botox for cosmetic purposes. Please be aware, the Virginia Board of Dentistry is working on what requirements will be required so do not start injecting yet. We will keep you informed as the board works through the logistics.

The Virginia Dental Workforce Council met twice since my last article. The

workforce shortage is still a large problem across the Commonwealth. The VDA in coordination with many other groups related to dentistry are currently gathering data and will report our findings and recommended actions to our board in September. I am hopeful that this group will help to address the problem and find solutions. This will not be a quick fix, but we hope to find ways to improve the workforce and prevent shortages in the future.

Dental Loss Ratio (DLR) is still a very hot topic at the ADA and in many other states. Our Council on Government Affairs was asked by our board to pursue DLR in Virginia. They have created a task force to study DLR and determine if it is right for Virginia. If it is they will work with our legal and lobbying team to promote this initiative in the 2024 General Assembly. As I have mentioned in my other articles and in my speeches, this is going to take all of us working together. With redistricting, we are expecting

numerous changes in the seats of our General Assembly. We had a wonderful turnout at our Dental Days at the Capitol in January. Contacting your legislators will be imperative to accomplish DLR. We will need a record breaking turnout in January ’24 and we will need numerous dentists at the General Assembly each day they are in session. We have had some very large advocacy wins in the past: assignment of benefits, noncovered services, de minimus, silent PPO’s, teledentistry, 30% Medicaid reimbursement rate increase, Botox and hopefully DLR in 2024. Don’t forget to support the VDA Tooth PAC; we need your contributions to continue to advocate for our patients and dentistry.

Our wonderful team at the VDA is preparing for the Virginia Dental Showcase in Norfolk at The Main in September. We are offering a new Dental Office Professional Certificate program to start in Norfolk. Once coursework is completed, participants will receive a certificate from the newly formed Virginia Dental Academy. Hygienists receive a license, Dental Assistants can be certified, but there is not much out there for our front office team members. We hope we will have a good turnout for this program. At the Showcase there will be excellent CE, a sold-out exhibit hall, and numerous social events. I hope you plan on attending. Consider bringing your entire team. Have a great summer, and I look forward to seeing you in Norfolk.

“We are offering a new Dental Office Professional Certificate program to start in Norfolk. Once coursework is completed, participants will receive a certificate from the newly formed Virginia Dental Academy.”

CAN I GET A WITNESS?

Dr. Richard F. Roadcap

In biology, a cell-filled cavity or depression is called a lacuna. In the physical world, a lacuna is defined as a blank space or missing part. For most dentists, their dental education spanned at least four years, perhaps followed by one to two years in a residency program, or even longer in the case of specialty programs. Upon leaving academia and entering practice, many of us felt unprepared in certain disciplines, owing in part to our inattention and, in part, to a lack of instruction in certain subjects.

What were the lacunae in your dental education? It often depended upon the immediate requirements of your first associateship, practice ownership, or employment environment. I served in the military right after dental school, and thanks to a brief (six-week) orientation, I felt better prepared to be a soldier than a dentist in the Army. There were four disciplines that I wish I had studied more carefully or had more opportunities for learning while attending dental school.

The first was a gaping hole, a yawning chasm: practice management. Even in the military, we were expected to supervise both civilians and soldiers in uniform, relate to superiors, and follow protocol. A newly-minted captain or (Navy) lieutenant needs some management skills. I will confess that my academic exposure to the subject was oh-so-brief, and much of what I was taught was well-intentioned but misguided. I needed to disregard or “unlearn” that part of the curriculum.

It wasn’t long before I opened a practice and my lack of management skills transported from subclinical to acute. Loan applications, licenses, permits, hiring staff, insurance…the list goes on and on. And as many of you know, we learn from our mistakes. It would have

been nice to have been given some common-sense guidelines while an undergrad dental student. At the time, my business education was confined

and single-visit cosmetic procedures were all the rage. And performing these procedures demanded an intimate knowledge of the underlying science of technique-sensitive materials. A newfound appreciation of dental materials science was satiated by attendance at CE courses whenever the opportunity arose. In a previous column, I reported that organic chemistry in undergraduate studies was a rite of passage that separated would-be healthcare professionals from those who gained acceptance to medical and dental school. As a dental student, I approached the third stumbling block, pharmacology, with the same enthusiasm reserved for organic chemistry – endurance without appreciation. Not only did I start practice in the Age of Adhesives, but those days were also fast becoming the era of polypharmacy. What were these new drugs, and why were patients taking so many of them at the same time? Had I only paid attention! There were no online resources then, only outdated reference manuals, some of which could be tucked in a shirt pocket owing to their brevity.

to sharing tales of woe with other doctors starting out. I would hope that in the 21st-century dental students are schooled in the basics of dental practice management, free of bias and narrow perspective.

Second, I wish I had paid more attention to dental materials while in school. Our instructor, Dr. Peter Moon, was one of the finest faculty members in this discipline, but I merely endured, thinking coefficients of thermal expansion and Brinell hardness tests were of little use in real-world dentistry. I entered practice at the dawn of adhesive dentistry – visible light curing, dentin bonding, bis-GMA resins,

There were other voids in my professional education, but the fourth and final nod goes to the lack of opportunities for public service. I learned late in my career that service to others is one of the pillars of our profession. But I can’t recall a single extramural or intramural service event during my four years in dental school. Today’s DDS and DMD candidates are afforded a surfeit of pro bono options, which accrues to their benefit and that of the profession. I would hope these events instill an ethic of public service that will remain with them their entire careers. In defense of dental education, my training has served me well. Today’s dental students attend school nearly twelve months a year, and a one- or

“It’s impossible to train dental students for skills needed twenty years hence, let alone the clinical and didactic foundations for wellrounded practitioners. Maybe that’s why the interface between practice and academe, town and gown, is so important.”

two-year general practice residency is de rigueur. It’s impossible to train dental students for skills needed twenty years hence, let alone the clinical and didactic foundations for well-rounded practitioners. Maybe that’s why the interface between practice and academe, town and gown, is so important. Let’s hope the prototype for the dentist of the future is a well-rounded general practitioner keen to fill in the blanks in his or her education.

1. Do you have or have you considered an exit strategy?

2. How long do you plan on being a practice owner? If your health allows, would you like to continue practicing after that point?

3. Do you know what your practice is worth today? How do you know? When was your last Practice Valuation done?

4. Have you met with a financial planner and have a documented plan? Have you established a liquid financial resources target that will enable you to retire with your desired lifestyle/level of income?

If you answered no or do not know to any of these questions, let’s have a

Henry Schein Dental Practice Transitions has your best interests in mind throughout your career. Schedule a complimentary consultation today!

SUSPENDED BY DENTAQUEST, SUPPORTED BY THE VDA

Jacqueline Carney, DDS, MS

It’s hard to believe a year has passed since I reached out for help from the VDA. I wanted to publicly thank all of you for the help you provided me when DentaQuest suspended me from the network. Had I not been a member of the Virginia Dental Association, I believe my situation would have had a horrible outcome that would have bankrupted me, and I am forever grateful for the efforts put forth on my behalf.

On February 9, I placed a patient under general anesthesia for a comprehensive dental rehabilitation. I did not complete any of the dental treatment because the patient developed copious bronchial secretions, a normal consequence to intubation for some people. The patient was stable throughout care and was discharged home at her baseline status. To make a long story short, the mother of the patient was convinced something was wrong with her child and sought emergency room care three times in 72 hours. Either the patient’s mother or a healthcare provider reported me to Medicaid.

Without any inquiry from DentaQuest/ Medicaid, I was immediately suspended from the network on Tuesday, February 22, 2022. Let me state that again, WITHOUT ANYONE REACHING OUT TO ME TO ASK WHAT HAPPENED OR TO REVIEW MY RECORDS; I WAS SUSPENDED FROM THE NETWORK THE SAME DAY I RECEIVED THE EMAIL STATING THIS. I had already selfreported to the Board of Dentistry, and the expert that reviewed my documents found nothing of concern in my care of the patient.

The email I received from DentaQuest did not tell me how the suspension process would work or when I could expect

additional action. This letter simply said, “credible allegations of issues relating to Quality of Care and/or patient safety: Provider has been suspended further investigation.” I have been a provider for DentaQuest since 2001, served on the Medicaid Peer Review Committee, and passed every audit I have ever had when my routine audits came up for evaluation. To have been suspended without even a telephone call to see what happened was stunning.

I reached out to the person who signed the letter to get more information and was simply told that within 24 hours, I would be contacted to explain the process. Because the letter stated specifically that “DentaQuest will no longer pay any claims on or after the Suspension Date,” I asked Ms. Woelfel if I could donate my services to treat the patients already on the schedule as they had waited months for their appointments, and many were in pain. Rather than providing me with a helpful answer, the response I received was, “Read your letter; you were suspended.” When I pointed out that the letter clearly stated I couldn’t bill for services but didn’t say I couldn’t volunteer myself, I was then informed I couldn’t treat Medicaid patients while suspended.

Expecting a phone call or email the next day, I hopefully waited for communication. I never heard from anyone. I reached out to DentaQuest the following day to inquire about the follow-up I was promised within 24 hours. I got no response. I reached out to my local Provider Representative as well as anyone I had previously interacted with at DentaQuest. No one responded. Every day I started an email and telephone campaign with my communications getting more and more desperate. If this process was going to take months, I needed to close the

business and declare bankruptcy before I took on more debt. I bought this practice five months prior to COVID, so the finances have been difficult from the start.

By Friday, February 25, at 4:00 PM, I still hadn’t heard from anyone at DentaQuest. I made a panicked telephone call to the Virginia Dental Association and left a desperate message asking for help. Within 20 minutes, I got a return telephone call from Ms. Shannon Jacobs and then Mr. Ryan Dunn, who assured me that they were going to do everything in their power to find resources to help me. Shortly after that telephone call, I received additional calls from Dr. Cynthia Southern and Dr. Frank Iuorno. They worked all weekend, making connections with people at DentaQuest to get some answers about what was going on and how to get this process moving forward. I believe that had these actions not been taken on my behalf, this suspension would have taken months to resolve, and I would have been out of business.

On Monday, February 28, DentaQuest provided me with a list of eleven patients for a chart audit; what a waste of time to compile all of this when everyone knew the entire suspension was about this one complaint. I quickly compiled the records. I then spent another four days trying to get the records uploaded; DentaQuest uses a system that prevented me from uploading files because I wasn’t the originator of the initial link. DentaQuest argued with me for days about the reason I couldn’t get my files uploaded, even though I had reached out to Microsoft and was certain I had the answer to fix this. I finally persuaded someone at DentaQuest on Friday, March 4, to send the link again with a random file attached to it (this was the solution Microsoft gave me), and sure enough, I could upload my files. Another

week was wasted as I sat canceling patients.

On Thursday, March 10, I received a letter from DentaQuest stating my suspension had been lifted, but it listed only one practice location where the suspension was lifted. And when I went online, I was still not showing as a provider at my primary location. A telephone call and email went unanswered, so I cancelled more patients. I finally got a response on Monday, March 14, that the suspension had been lifted for all locations.

I lost 15 days of revenue for unfounded allegations, and if you think this couldn’t happen to you, think again. The contract we all sign as participating providers with DentaQuest, states:

The Provider acknowledges and agrees that nothing in the Agreement shall be construed to limit: (a) the authority of DentaQuest or DMAS to ensure the Provider’s participation in and compliance with Smiles for Children Program’s quality assurance, utilization management, member grievance and other systems and procedures; (b) DMAS authority to monitor the effectiveness of DentaQuest’s systems and procedures or the extent to which DentaQuest adequately monitors any function delegated to a subcontractor, or to require DentaQuest to take prompt corrective action regarding quality of care or Member grievances and complaints; or (c) DentaQuest’s or DMAS’ authority to sanction or terminate a Provider found to be providing inadequate or poor quality care or failing to comply with DentaQuest’s systems, standards or procedures as stated herein.

And should you experience similar circumstances, DentaQuest is held harmless:

IMMUNITY Provider agrees: (a) That any act, communication, report, recommendation, or disclosure, with respect to the Provider, performed or made in good faith and without malice and at the request of any authorized representative of “Smiles for Children” program, for the purpose of achieving

and maintaining quality dental patient care shall be privileged to the fullest extent permitted by law. (b) That there shall be, to the fullest extent permitted by law, absolute immunity from civil liability arising from any such act, communication, report, recommendation or disclosure, even where the information involved would otherwise be deemed privileged. (c) That such immunity shall apply to all acts, communication, reports, recommendations, or disclosures performed or made in connection with “Smiles for Children” program’s activities related, but not limited to: (1) Applications for Dental Provider Service Agreements. (2) Periodic reappraisals of Dental Provider Service Agreements. (3) Corrective action, including termination by DentaQuest or DMAS of Dental Provider Service Agreement. (4) Dental care evaluations. (5) Utilization review, and, (6) Other “Smiles for Children” activities related to quality patient care and professional conduct. (d) That the acts, communications, reports, recommendations, and disclosures referred to in this Section 9, may relate to a Provider’s professional qualifications, clinical competency, character, mental or emotional stability, physical condition, ethics, or any other matter that might directly or indirectly have an effect on dental patient care.

If anyone questions for a moment whether or not to belong to organized dentistry, my circumstances should convince you that the dues you pay bring resources to your door that won’t be found anywhere else. The efforts that everyone put forth on my behalf have made it possible for me to continue practicing; without this help, I would be bankrupt and in a different profession.

THE ADA TRIPARTITE— NOW MORE THAN EVER

The tripartite, which I will call the “Power of Three,” has brought the profession forward and will continue to carry us through the future. This organizational system has been around for a long time and has been very successful in keeping organized dentistry relevant for its members and the public. We have had “each other’s back,” allowing for statewide and national accomplishments that could not have happened by the individual states or their constituents alone.

Today there are more disruptions for the profession, both now and on the horizon, than ever before. Policymakers, legislators, insurance companies, DSOs, and social media are tearing at the fabric of the profession and challenging the way patient care is being delivered. The educational costs and administrational complexities facing young graduates are causing them to question the value of being a member. We must educate and transactionally help them to want to be a member, or else the ADA will fade into oblivion.

The profession is more diverse; however, we are all dentists and must stick together to have input into the challenges occurring throughout the country. At our ADA-sponsored lobbyist conferences, Board of Trustee meetings, ADA lobby days, and ADA Council and Committee meetings, ideas are openly exchanged, policies are produced, and relationships are made. The result of these meetings is a refocusing and reorganizing of the ADA to meet the challenges occurring at both the national and individual state levels. Members need only look at the upcoming Orlando SmileCon® meeting to see there is something for all dentists, regardless of age or practice model.

I want everyone to remember that you individually may not agree with everything the ADA does; therefore, I challenge you to be involved and have input into the decisions being made. Do not “take your ball” and go home. The tripartite ADA system is very much worth fighting for. I have found the ADA to be much like a family; you will not always agree with every cousin, uncle, aunt, or parent, but you must work together. Remember, “We are better together” when we work towards our goal of “We make people healthy.”

Gary D. Oyster, DDS; ADA Trustee, 16th District “We are all dentists and must stick together to have input into the challenges occurring throughout the country.”

INTRODUCING THE VIRGINIA DENTAL ACADEMY’S CERTIFIED DENTAL OFFICE PROFESSIONAL PROGRAM

Ryan Dunn, CEO

In the VDA’s strategic plan, the Board of Directors charged us to grow and expand VDA offerings to benefit the entire dental team through continuing education, networking, and certifications. No dentist practices alone. While our membership is comprised of dentists, those member dentists employ more than 25,000 team members throughout Virginia, all of whom play an essential role in patient care and practice success. We are not the Virginia Dentists’ Association – we’re the Virginia Dental Association.

We are thrilled to present a new offering for dental team members with the launch of the Virginia Dental Academy’s Certified Dental Office Professional program. Your team members who work in your front office are the first and last impressions your patients have when they visit, the front lines of understanding and managing insurance and billing issues, and just like our members dentists, they’re operating in a business and regulatory landscape that continues to change.

Through the Certified Dental Office Professional program, we’re offering a combined curriculum of in-person and virtual learning that will equip practice managers and other team members with the tools to thrive professionally and elevate your practice. This launch is the culmination of months of discussions with our members, practice managers, and outside experts to ensure we’re addressing the skills and knowledge needed for practice success.

The first in-person portion of the academy will take place during the Virginia Dental Showcase, September 21-24, in Norfolk, to allow the entire dental team to attend and learn at the same time. The virtual courses will be available on-demand to

allow for flexibility in busy schedules. Dental continuing education and meetings have changed significantly in recent years, but what hasn’t changed is the value of trusted peer relationships and time together outside the office for building strong teams. If you’re interested, I encourage you to sign up now as this initial cohort is limited to 25 enrollees, and we expect it to fill quickly.

regulations specific to Virginia alongside a peer group that will serve as an ongoing network to assist one another as they encounter new issues. Whether you have a new team member or someone who’s ready to contribute more and stay ahead of business changes, this course will add value to your practice.

We are excited to present this new offering for our member dentists and their team members. It’s one more reason for you and your entire team to join us at the 2023 Virginia Dental Showcase in Norfolk this September, as we’re expecting one of the largest exhibit halls ever at a Virginia dental meeting, new dynamic speakers and topics, and more fun than ever.

Thank you, and I hope to see you soon.

They will gain essential training in patient experience and communication, HIPAA and OSHA compliance, cybersecurity, scheduling to maximize production, coding and documentation strategies, and much more. They’ll learn about rules and

“Your team members who work in your front office are the first and last impressions your patients have when they visit and the front lines of understanding and managing insurance and billing issues.”

presents

Certified Dental Office Professional Program

Education to Empower Your Front Office Team

The VDA Academy is pleased to introduce the Certified Dental Office Professional Program, a certification program for practice managers and other dental office professionals. This one-year program offers continuing education and a cohort of peers to hone your skills, learn from each other, and take your dental practice to the next level.

The 2023-2024 inaugural Certified Dental Office Professional class is limited to 25 participants who will go through the year-long program together. The program kicks off in Norfolk at the 2023 Virginia Dental Showcase, continues with online learning throughout the year and will conclude with a graduation at the Showcase in September 2024. Secure your spot today!

• Save your practice time and money

• Understand opportunities in insurance and marketing

• Be ready for new trends in scheduling and practice management

For more information, visit vadental.org/academy or contact Elise Rupinski at rupinski@vadental.org or 804-523-2184

2022-2023 Cor e Sponsor s and Suppor ter s

The generosity of our financial supporters helps ensure that we not only improve the oral health of our neighbors in need, but it also helps make the VDAF stronger and more sustainable.

We TRULY APPRECIATE the companies, foundations, and individuals who fully embrace our mission to provide access to dental care for underserved Virginians.

LET ME INTRODUCE MYSELF... VDA ADDS NEW TEAM MEMBER

Karen Kraus; Director of Operations, Virginia Dental Services Corporation

I can’t find the right words to express how thrilled I am to be part of the VDA team. My enthusiasm for the dental profession has never wavered but has been reinvigorated by this new position. My official title is Director of Operations for the Virginia Dental Services Corporation. I promote the endorsed vendors that provide discounts on valuable services that a board of peers has vetted. My unofficial title is VDA cheerleader for dentists and their entire team. The Virginia Dental Association has always been an organization that supports the member dentist and their success – which includes the team. Now, they have an enthusiastic person that knows a dental office backward and forwards through clinical experience, dental sales/ consulting experience, and actual front office/office management experience. I promise I have a life, but I live, eat, and breathe dental. I feel my dental experience has been preparing me for this incredible career opportunity that offers me the opportunity to promote and elevate the entire dental team.

I am so excited to be part of the Virginia Dental Academy, which is offering a new Certified Dental Office Professionals program with details featured on the opposite page. In addition, I’m in the process of organizing a dental study club for front office team members.

The front office/management team is so critical to the success of a practice. Doctors – I implore you to share your ADA/VDA membership information with your office management team. So many tools are available for member success – you are the member, but many of the tools are indicated for other facets of your practice that you are not responsible for daily.

Be on the lookout for learning opportunities that will benefit your practice brought to you through a focus on your front office team. When you are done reading this edition of the Virginia Dental Journal, hand it to your office manager, opened to this page. Let them know your VDA membership supports the entire dental team, not just the dentist. It always has, but there is a new focus on making sure everyone is included. Give them my email address – I welcome feedback on what we can do to support them and your practices. I want to have their direct contact information so I can include them in study club events and other opportunities to advance their careers in your practice. I have been visiting many Richmond practices, and the excitement is palpable for this attention on front office management. I’m positive that excitement will extend to everyone.

I am looking forward to meeting as many of you as I can. Email me, call me, or text me. I would be happy to come to your office to meet with you and see what we can get going in your area to support your front office to make your practice more productive.

Contact Karen Kraus: kraus@vadental.org 804-334-2285

WELCOME!

I have been to dental meetings and taken continuing education courses across the country, and what sets the Virginia Dental Showcase apart as a can’t-miss event is the people. Dentists from around Virginia bring their teams with them for a weekend of learning and fun that reliably carries over to our return to the office.

No dentist can practice alone, and the friendships I have made over the years at the VDA’s meetings have given me a support network that’s led to personal and professional growth throughout my career.

Just as our profession continues to change, so does the Virginia Dental Showcase.

This year we will be featuring new nationally renowned speakers on dentistry, practice management and new trends your practice should know about within the profession.

Our popular exhibit hall will feature new interactive experiences, vendors, and tools to help take your practice to the next level. We have added new events and put a new spin on popular events that we know you won’t want to miss.

The New Dentist Lounge will feature unique refreshments and offerings for dentists and students in the early stages of their careers. Back by popular demand is the Friday Power Hour in the exhibit hall and we will be adding more Spotlight Receptions where you can connect with peers and vendors over drinks and snacks.

The VDA is happy to once again partner with the Virginia Academy of Pediatric Dentistry on this event, and I look forward to seeing you there.

Sincerely,

Dr. Ralph Howell Chair, VDA Council on Sessions

Register Now: vadental.org/showcase

Early Bird Rate ends July 28, 2023

SATURDAY 7:00PM-10:00PM 9.23.23

Buffet dinner with music by Virginia’s own SLAPNATION

PRESENTED BY VDA PRESIDENT DR.

Pediatric Dentistry Track

THURSDAY, SEPTEMBER 21, 2023

2:00pm-5:00pm

Pediatric Dentistry – The Magic Equation

Dr. Eyal Simchi

Learning the magical combination of behavior management techniques and minimally invasive treatment options can help turn an appointment from terrible to terrific!

Objectives:

1. Recognize when and how to implement distraction, misdirection, and other techniques to help manage our patient’s behaviors.

CREDITS: 3

2. Learn how to use minimally invasive techniques, including SDF, Hall crowns, GI fills etc.

3. Gain an understanding of how using both together can work to make pediatric dentistry atraumatic and predictable.

FRIDAY & SATURDAY, SEPTEMBER 22 & 23, 2023

9:15am-5:30pm

The PEEL Technique - A New Paradigm in Pediatric Tongue-Tie Treatment: A Two-day Mini-Residency

Dr. Robert Convissar and Joy Funston

Registration Cost: VAPD/VDA Members: $849, Non-Members: $1049 (Lunch is included on both days.)

In this two-day mini-residency, attendees will be introduced to the concept of laser frenectomies, an increasingly popular method by which dentists and physicians can treat tongue- and lip-ties in their patients. Five percent or more of the babies born in the United States have such tight tongue-ties and frenum pulls that they cannot successfully latch onto their mother’s nipple and breastfeed. For the baby, serious consequences include loss of weight and the label of “failure to thrive.” For the mother, this results in sore and cracked nipples, mastitis, painful engorgement, and post-partum depression due to an inability to nurse her baby. This has classically been treated by a physician taking a scalpel or a pair of scissors to the newborn’s mouth and cutting the attachment. The treatment of choice, however, is for a dentist to use laser technology to painlessly and bloodlessly remove the attachment, allowing the infant to nurse immediately. Though many practitioners perform tongue-tie release, few are trained in the PEEL Technique™. This technique ensures that the four movements the tongue must make in order to nurse successfully can be performed: peristalsis, elevation, extension, and lateralization. Attendance is limited to 32.

Participant Requirements:

CREDITS: 14

(Must complete Part 1 and Part 2 on Friday and Saturday)

• Loupes are recommended.

• Dentists who own diode lasers are encouraged to bring them if they want to be certified on their own units — otherwise, lasers will be supplied for the attendees.

• There is an opportunity to obtain a laser certification which is optional but highly encouraged. The certificate is awarded through the American Board of Laser Surgery. It consists of a 75-question multiple choice exam that is completed by the attendee within 30 days of the completion of this course. There is a processing fee of $150 payable to the American Board of Laser Surgery for the certification application. Once the attendee pays the fee and passes the exam, the attendee will receive an email where they can download and print their certificate. Dr. Convissar will collect the necessary information at the end of this course from attendees interested in taking the certification exam.

More information can also be found at http://www.americanboardoflasersurgery.org/

The certification is based on knowledge gained from the course — the certification is not wavelength or device- specific. Once the attendee passes the exam, they are certified, no matter what wavelength they use in their practice.

The below courses are designated for Pediatric Dentists but open to all attendees.

Front Office Track

The below courses are designated for Front Office team members but open to all attendees.

FRIDAY, SEPTEMBER 22, 2023

12:00pm-2:00pm

Creating a Powerful Patient Experience through Empathy, Curiosity, and Communication

Ms. Stephanie Moritz

In a dental practice, office staff are gifted for much more than supporting patient care and keeping the clinic running smoothly—they have the opportunity to create a memorable experience and make lasting impressions that patients remember, from the appointment confirmation to the final stop at the desk at the end of a visit.

CREDITS: 2

Stephanie Moritz, Chief Customer Innovation Officer at the American Dental Association, believes that leveraging empathy and curiosity in patient communications can help dental office teams take their gifts even further. In this course, Moritz will highlight how best practices—from active listening to body language techniques—can shape personalized care and improve patient retention, satisfaction, and loyalty.

SATURDAY, SEPTEMBER 23, 2023

10:00am-11:00am

Cybersecurity 101: Protecting your Practice & Patients

Mr. Davd Fidanza and Mr. Robert McDermott

Cybersecurity is about more than just keeping your patients’ data safe. It’s about securing your practice and its future while building and maintaining patient trust. The financial cost of an attack can be overwhelming. Furthermore, research suggests that 65% of individuals whose data is exposed in a breach lose trust in the organization that held that data, and 80% of those individuals will leave the business or organization.

Another important, and perhaps obvious, reason cybersecurity is essential for your dental practice is HIPAA compliance. The Health Insurance Portability and Accountability Act (HIPAA) requires that insurers as well as dental and medical practices and providers put measures in place to ensure the safety and security of personal and private information as it relates to healthcare data.

CREDITS: 1

Front Office Track

SATURDAY, SEPTEMBER 23, 2023

1:30pm-3:30pm

HIPAA & OSHA Compliance In Your Practice: Patient Complaints, Data Breaches, and Employee Participation

Mr. Matt Leatherman

Not only is compliance a federal and state requirement for practices across the country but now more than ever, patients and employees are aware of their rights. Complaints and breaches continue to rise year after year which leaves providers and team members alike needing to know what’s required to comply with government standards.

CREDITS: 2

You will learn:

• The Patient Right of Access Initiative and how you should respond to patient requests

• What happens when there’s a data breach and what needs to be reported

• Path to HIPAA Compliance

• State of OSHA Compliance

• Whistleblowers and investigations

• Employee participation in your practice’s OSHA program

• Path to OSHA Compliance

The below courses are designated for Front Office team members but open to all attendees.

CREDITS: 3

Hygiene Track

The below courses are designated for Hygiene team members but open to all attendees.

10:15am-1:15pm

DIAGNOSING A KILLER SMILE: AAP Staging & Grading Parameters + Updates

Ms. Katrina Sanders

Failure to diagnose periodontal disease is consistently a top complaint filed with state dental boards. The first step in treating and managing a patient’s care is diagnosing disease accurately, ethically, and comprehensively. As diagnostics continually evolve, dental providers are encouraged to put down the scaler and pick up the probe to better guide comprehensive diagnostics for optimal care plans.

Walk through the nine distinguished classifications of health, gingival disease, periodontal disease and acquired deformities and conditions of the periodontium as well as reviewing the clinical parameters of periimplant diseases and Staging and Grading as outlined by the American Academy of Periodontology (AAP). Gain guidance and confidence through case-based scenarios aimed to offer a practical application of course acquired knowledge. Receive updates as issued by the AAP for further clarity and understanding in classifying diseases of the periodontium.

CREDITS: 3

1:45pm-4:45pm

LOCAL ANESTHESIA: New Techniques, The Latest Trends and Troubleshooting

Ms. Katrina Sanders

Injection failure not only causes unnecessary patient discomfort and apprehension, it can also frustrate providers, as well. The causes are varied; patient specific considerations, varied anatomical modifications, and injection technique. As a practicing clinician for over a decade, Katrina has never delivered an Inferior Alveolar Nerve Block yet she consistently achieves successful mandibular anesthesia. Learn how you can, too!

Now for the good news. In this interactive, engaging course, Katrina Sanders, RDH, M.Ed. guides participants through the common causes of injection failure, including anatomical and physiological conditions. Explore techniques used in private practice, including appropriate doses of anesthesia, anatomical and armamentarium considerations.

We’ll also discover alternative injection techniques and discuss new trends in the provision of pain management. Building on a solid basis of anatomy, attendees will learn how to deliver and troubleshoot local alternative injections—safely and effectively.

FRIDAY, SEPTEMBER 22, 2023

Hygiene Track

The below courses are designated for Hygiene team members but open to all attendees.

FRIDAY, SEPTEMBER 22, 2023

9:00am-11:00am

SPICE THINGS UP!: Review of C.A.M and Nutritional Supplements and Oral Health

Ms. Heather Tuthill and Ms. LaTesha McLee

The purpose of this course is to discuss complementary and alternative medicine clinical applications and nutritional supplements and the relationships to oral health that dental healthcare professionals may use in practice or come in contact with patients. Evidence-based research shows patients are interested in a holistic approach for oral hygiene care and when visiting the dental practice. This course will include a brief history of complementary and alternative medicine (C.A.M), discussion on therapeutic spices, and different clinical applications of C.A.M. There will be opportunities to interact with several C.A.M approaches including miswak chewing stick, guided imagery, and essential oils (orange). Additionally, please bring an electronic device for an interactive competition.

CREDITS: 2

CREDITS: 2

1:00pm-3:00pm

Ergonomics –What it means to you the dental professional

Ms. Heather Tuthill and Ms. LaTesha McLee

Many dental professionals have been plagued by musculoskeletal disorders (MSDs) and pain throughout their careers. One of the best ways to prevent MSDs is to maintain a neutral posture at all times while treating patients. Maintaining a neutral can be extremely difficult as several areas in the oral cavity are not easily accessible. This course will discuss the most common MSDs among dental professionals and provide helpful hints and chairside exercise to maintain a neutral working position.

New Dentist Track

The below courses are designated for New Dentists but open to all attendees.

FRIDAY, SEPTEMBER 22, 2023

10:15am-1:00pm

Digitally Fabricated Complete Dentures: Not Your Grandma’s Denture Anymore! (Lecture)

Dr. Ronni Schnell

CREDITS: 3

Is Removable Prosthodontics the final frontier of digital dentistry? It has taken only a few years for the denture to become the hottest topic in digital dentistry. Creating great removable prostheses requires a basic understanding of making great denture impressions and obtaining the 7 must-have clinical records, regardless of the method (conventional vs. digital).This presentation will introduce you to the latest advances in digitally fabricated complete dentures and show how you can take a fresh look at Removable Prosthodontics since dental school! This lecture is a prerequisite for the workshop “Do Your Dentures Suck…?” where you will be able to practice techniques learned.

10:15am-11:15am

Protecting a Growing Practice and Growing a Protected Practice

Mr. Andrew Gerner

CREDITS: 1

Since the era of barber shop tooth extractions, there has never been a greater diversity of dental practice models. Among those practice models, group practice and emerging DSOs are some of the fastest growing. While the architecture of growth and risk management is well defined for traditional solopractitioner, owner/associate, and partnership practice models, builders of fast-growth group practices and emerging DSOs often find themselves “building the airplane while in flight” with varying degrees of success. This session is intended to provide current or potential “pilots” of group dental organizations with the foundational risk management and insurance concepts to build a safe, well-protected, high performance group practice or DSO.

12:00pm-2:00pm

Path to Practice Ownership

Mr. Brad Peiffer and Mr. Aaron Tyson

Join us in an intimate setting where dentists will have the opportunity to discuss the various aspects of starting or acquiring their first practice. This presentation will cover everything you’ll need to know to start your new practice or acquire an existing practice, run your business successfully, and plan for your future as a practice owner.

Becoming a practice owner can be the most rewarding experience of your career, both personally and financially. We’ll help you develop strategies to make a successful jump from to owner of your first healthy dental practice. Join us and get all of your questions answered in one place.

CREDITS: 2

New Dentist Track

The below courses are designated for New Dentists but open to all attendees.

FRIDAY, SEPTEMBER 22, 2023

2:00pm-5:00pm

Do Your Dentures Suck? …They Should! Achieving Suction the Digital Way (Workshop)

Dr. Ronni Schnell

This workshop has the previously described lecture Friday morning, Digitally Fabricated Complete Dentures: Not Your Grandma’s Denture Anymore!, as a prerequisite.

CREDITS: 3

The future is already here with digitally fabricated dentures. Many of us may have tried them. Some of us may require a little (virtual) handholding. This workshop was designed to help you get started by experiencing new digital workflows to shortening the number of visits, to demystifying the digital preview, to troubleshooting at the try-in visit, taking the guesswork out of insertion and minimize post-insertion adjustments. This hands-on articulator and laptop practice even has a value-added bio-functional denture to take with you as a visual aid for your practice.

SATURDAY, SEPTEMBER 23, 2023

9:30am-12:30pm

Go Ahead… Bite into that Apple! (Lecture)

Dr. Ronni Schnell

The implant overdenture has become the standard of care for the edentulous mandible. Not only does it enhance retention, improving quality of life for patients, it allows for preservation of the alveolar bone. This course is ideal for those who wish to gain the confidence to predictably incorporate this procedure in a general practice. This scientifically-based instruction will focus on the three most important things you must consider when starting any case (maxilla or mandible).

CREDITS: 3

1:00pm-3:00pm

How to Outsmart the Thief in Your Practice

Dr. David Harris

Using cases drawn from Prosperident’s extensive files as teaching tools, Dr. David Harris will provide his audience with an inside look at embezzlement that is not available anywhere else. His deep understanding of the criminal mindset allows him to take his audience inside the thought process and behavior of embezzlers, and he will dispel many of the persistent misconceptions on this topic. Audiences will acquire the ability to recognize the warning signs of theft and will leave with concrete action steps that will radically lower their risk of being victimized.

CREDITS: 2

Suitable Audience: General dentists and dental specialists.

New Dentist Track

The below courses are designated for New Dentists but open to all attendees.

SATURDAY, SEPTEMBER 23, 2023

1:30pm-4:30pm

The “Nuts & Bolts” of Implant Overdentures: A Hands-on Workshop

Dr. Ronni Schnell

This workshop has the previously described lecture Saturday morning, Go Ahead… Bite into that Apple!, as a prerequisite.

CREDITS: 3

Meeting the demands imposed by many patients, the implant overdenture has become the standard of care for the edentulous mandible. Reinforcing the concepts taught in the AM (prerequisite) lecture, this workshop is ideal for those who wish to gain the skills to successfully incorporate the restoration of the implant overdenture in their practice. Participants will have a hands-on opportunity to work with a variety of attachment systems, place overdenture abutments, retrofit a denture and select and activate retention. Participants will be able to keep the specially designed model as a visual aid for their patients.

2:00pm-3:00pm

Foundational Risk Management & Insurance: concepts and insurance for dentists in early career stages Mr. Michael Fitzpatrick, III and Mr. Michael A. Urbanik

Whether you are in the final days of dental school or residency, signing an initial employment contract, or venturing out to build or buy a practice, various types of insurance need to be secured to protect your investment. This educational session is designed to help dentists identify and understand how to mitigate risks that emerge or increase at certain career milestones. Attendees of this lecture should achieve a foundational knowledge of insurance concepts to protect themselves during their early careers’ stages.

CREDITS: 1

Schedule of Events

Schedule of Events

Schedule of Events

The Main –Hilton Norfolk

100 E. Main Street Norfolk, VA 23510

Event Lodging & Dining

Reserve your room 2 ways:

1. Call: 1 (757) 763-6200

Group Name: 2023 VDA Meeting | Group Code: VDA

2. Online: https://www.hilton.com/en/attend-my-event/2023virginiadentalshowcase/

• Check in: 4:00 PM

• Check out: 11:00 AM

Restaurants

SALTINE

A street level seafood restaurant in Downtown Norfolk, Saltine offers a chic, airy space for diners to savor seasonal shellfish, seafood, and spirits. Enhancing the locally sourced menu, the restaurant’s black distressed millwork, old-world detailing, and mosaic tile floors blend historical authenticity with modern elegance that flows from the dining space to the bar. Exposed brick hints of the historic Decker building and large globe lighting offers an ambient vibe.

• Monday to Thursday: Lunch 11:30am-3:00pm, Raw Bar Menu 3:00pm-5:00 pm, Dinner 5:00pm-11:00pm

• Friday: Lunch 11:30am-3:00pm, Raw Bar Menu 3:00pm-5:00 pm, Dinner 5:00pm-12:00am

• Saturday: Brunch 10:00am-3:00pm, Raw Bar Menu 3:00pm5:00 pm, Dinner 5:00pm-12:00am

• Sunday: Brunch 10:00am-3:00pm, Raw Bar Menu 3:00pm5:00 pm, Dinner 5:00pm-11:00pm

VARIA

Featuring trattoria-style Italian fare, Varia serves as a combination lounge, piano bar and tasting room with a luxe atmosphere and unequaled wine selection. Varia was designed with a luxe interior complete with an open kitchen, reclaimed chandeliers from the historic Cavalier Hotel in nearby Virginia Beach, and two hidden “speakeasy” inspired private dining rooms.

Anchoring the signature lounge atmosphere is a 24-bottle wine cruvinet and live piano entertainment provided nightly to complement a full schedule of culinary workshops and tasting events.

• Thursday 5:00pm-11:00pm

• Friday 5:00pm-12:00am

• Saturday 5:00pm-12:00am

• Open for breakfast daily 6:30am-10:00am

GRAIN

With one of the best selections of craft beer in Norfolk, this rooftop lounge brings the indoors out and the outdoors in with an open air patio and fire pit set against spectacular views of the Elizabeth River. Play a game of lawn chess in the patio’s backyard garden vibe or rack-up a game in the upscale billiards room, Grain is your destination to relax and unwind.

• Monday to Thursday: 12:00pm-until

• Saturday 9:00am-3:00pm and 4:00pm-2:00am

• Sunday 9:00am-3:00pm and 4:00pm-until

For information on things to do nearby , please visit: www.themainnorfolk.com/nearby-attractions

DDS:DentalDetectiveSeries

DENTAL DETECTIVE SERIES

WORD SEARCH

Dr. Zaneta Hamlin

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ADA DENTIST AND STUDENT LOBBY DAY:

MEMBERS GATHER IN D.C. FOR LARGEST LOBBY DAY SINCE PANDEMIC

Laura Givens, Director of Legislative and Public Policy

Over 700 dentists, dental students, state association staff and other dental leaders attended the conference in DC on March 5-7, 2023. VDA representation was strong as usual with many member dentists in attendance: Dr. Mark Crabtree, Dr. Bruce Hutchison, Dr. Kirk Norbo and Dr. Elizabeth Reynolds. Students who joined the Virginia delegation on their legislative visits were Mr. Alex Chmielinski (Penn), Mr. Clifton Enlers (Howard), Ms. Priscilla Opoku-Yeboah (Harvard), and Mr. David Tang (Case Western). We were incredibly appreciative of the member dentists and

students who took time away from their practices, patients, families, and school to attend this important event.

The issues and bills addressed this year included the DOC Access Act (noncovered services), the REDI Act (H.R. 1202 – Student Loans and Postgraduate Educational Debt), and Medicaid Access to Dental Care (S. 570 and H.R. 1342). For more information on ADA advocacy efforts, you may visit their website at https://www.ada.org/advocacy

VDA PAC FUNDRAISER FOR SENATOR TODD PILLION

Laura Givens, Director of Legislative and Public Policy

On May 11th, a large group of dentists and guests gathered at the Commonwealth Club in Richmond to show their support for fellow VDA member dentist, Senator Todd Pillion. Dr. Cindy Southern, VDA President, chaired the event with help from steering committee members Dr. Scott Berman, Mr. Ryan Dunn, Dr. Marlon Goad, Dr. Ralph Howell, Dr. Bruce Hutchison, Dr. Marcel Lambrechts, Dr. Scott Miller, Dr. Sujit Mohanty, and Dr. John Rose. Their involvement in making this fundraiser an incredible success was very much appreciated.

We are very fortunate to have Senator Todd Pillion representing the 6th District in the Virginia Senate. Senator Pillion is a graduate of VCU School of Dentistry and practices pediatric dentistry in Southwest Virginia. As a dentist and small business owner, he understands this profession far better than any other legislator in the

Commonwealth. Through his years in the Virginia legislature, which began in the House of Delegates before assuming his Senate seat, he has been a tireless public servant and been a leader that we can count on to advocate for common sense solutions facing our Commonwealth. He is in a very important role as a member of the all-important Senate Education and Health Committee and works hard every day to ensure that Virginia remains the best state in which to do business. This, among many other reasons, is why it is

important that we step up to the plate and help him with his campaign.

The VDA is thankful to all who made generous contributions to Senator Pillion and to everyone who attended the event.

We encourage members to contribute and attend VDA PAC Fundraisers as they are a wonderful opportunity to gather socially with your friends and colleagues and meet with legislators in an intimate setting.

HAVE YOU STEPPED UP TO SUPPORT YOUR PROFESSION?

Laura Givens, Director of Legislative and Public Policy

As you can see in the below chart, there is much work to be done to reach our VDA PAC goal this year. We thank all members who have opened their wallets this year and in past years - your generosity has played a large part in protecting the dental profession and it is time for all members to step up to the plate and be a part of this imperative effort.

In recent years, we have had many legislative accomplishments, many surrounding issues with insurance companies, including assignment of benefits, non-covered services, and a 30% increase just last year in Medicaid reimbursement rates. Just this year we fought against a bill that would have increased the medical malpractice cap for dentists and oral surgeons and fended off several foreign trained dental bills that had been drafted, all of which would have relaxed education requirements and allowed such dentists to practice in the Commonwealth. We also supported a bill that will allow dentists to administer cosmetic Botox in Virginia. These tangible examples are proof that the support from dentists within the Commonwealth has helped tremendously to advance our positive and forward-looking legislative and regulatory policies.

We are looking to face insurance companies once again, which is one of many reasons why we have never been more honest when we tell members that we need your support more now than ever!

Only 30% of VDA members have contributed to the VDA PAC for the 2023 year. Can you imagine how much more successful the VDA would be if every dentist contributed?

Have you made your 2023 contribution?

If not, you may make a contribution at the level of your choice through the VDA website at www.vadental.org/vdapac. Questions? Contact Laura Givens at givens@vadental.org or 804-5232185. It’s essential that we make 2023 a stronger year for the VDA PAC!

Please review the chart below to see how close your component is to reaching its goal.

MUST RAISE $149,923 TO REACH GOAL

2023 GOAL: $375,000

TOTAL CONTRIBUTIONS: $225,077

LOOKING GLASS THROUGH THE

WITH DR. SARAH GLASS

Explore the Fantastical World of Oral Pathology

Presented by Wasek Chowdhury, a fourth-year dental student at the Virginia Commonwealth University School of Dentistry.

Editor’s Note: Dr. Sarah Glass is a board certified Oral and Maxillofacial Pathologist. She works as an assistant professor at VCU School of Dentistry, and her job responsibilities include teaching, working in the biopsy service, and seeing oral medicine patients.

A 51-year-old male presents to the clinic for an initial evaluation. The patient reports that he had orthognathic surgery 30 years prior. Upon reviewing the radiograph, you notice a well-corticated, radiolucent 5x3 cm lesion located at the midline of the mandible bordered by fixation plates on either side. What is your suspected diagnosis?

A 45-year-old male presents to the clinic with a chief complaint of “a pimple on his gums.” Upon intraoral exam, you see a unilateral, pink, well-defined, sessile, verrucous exophytic growth on the border of the mucogingival junction antero-apical to #22 and roughly 3.5x3.5 mm. What is your suspected diagnosis?

An 11-year-old female presents to the clinic for a regular checkup. Upon extraoral exam you palpate a firm hard swelling in the area of her upper left canine, patient reports no symptoms upon palpation. An intraoral exam reveals no evidence of #11 in the oral cavity. Further imaging shows well-defined, unilocular radiolucency around the crown of impacted #11 that extends just past the CEJ with mild resorption of adjacent structures. What is your suspected diagnosis?

ANSWERS CONTINUED FROM PAGE 33

1. Surgical ciliated cyst - Surgical ciliated cyst is a benign cyst caused by the traumatic implantation, usually surgical, of respiratory epithelium in the gnathic bones. Entrapped sinus or nasal mucosa from either contamination or transfer of epithelium from autologous nasal osteocartilagenous grafts for chin augmentation is the most common etiology for mandibular presentation. Cyst development is usually after a latent period, typically up to 20 years after the surgery.

2. Verrucous Xanthoma is a hyperplastic condition of the epithelium affecting primarily the gingiva, alveolar mucosa or hard palate. It is usually a solitary lesion with a pink/red/white color and a cobblestone/pebbly structure. The underlying fibrous connective tissue contains lipidladen histiocytes. This lesion may be seen in association with other conditions that can disrupt the epithelium.

3. Adenomatoid Odontogenic Tumor (AOT) is a benign encapsulated epithelial odontogenic tumor that contains rosette or duct-like structures and has an indolent behavior. AOT appears most commonly in the anterior maxilla. Three-quarters of cases are associated with an unerupted permanent tooth, usually the maxillary canine. Most cases show a female predilection around the second to third decades of life.

ANTERIOR IMPLANT RESTORATIONS WITH A CONVEX EMERGENCE PROFILE INCREASE THE FREQUENCY OF RECESSION: 12-MONTH RESULTS OF A RANDOMIZED CONTROLLED CLINICAL TRIAL

Siegenthaler et al. J Clin Periodontol. 2022; 49(11):1145-1157

BACKGROUND: Successful implant therapy is characterized by maintaining healthy and stable peri-implant tissues over the lifespan of the implant. Several studies have concluded that peri-implant soft tissue changes occur between implant placement and insertion of final restoration. Changes include, reduction of papilla height, apical displacement of mucosal margin and decreased gingival thickness. In order to counteract these changes, the use of provisional restoration has been suggested. However, the scientific evidence is insufficient as to whether there is an aesthetic or clinical benefit to using implant provisionals and which emergence profile is best.

PURPOSE: The aim of this study is to evaluate whether one of three different treatment modalities (healing abutment only, implant provisional with a concave emergence profile, or implant provisional with a convex emergence profile) results in a more stable mucosal margin 6 and 12 months after insertion of final restoration.

METHOD: Forty-seven patients scheduled to receive a single implant in the anterior maxilla were recruited for the study. They were randomly assigned to one of three groups: (1) CONCAVE (concave emergence profile of provisional and final restoration; (2) CONVEX (convex emergence profile of provisional restoration and final restoration); CONTROL (healing abutment, no provisional and final restoration). Patients were recalled at baseline, 6-months and 12 months after final restoration insertion to evaluate for marginal mucosa stability, clinical, aesthetic, and profilometric outcomes as well as time and costs evaluation.

RESULTS: Forty-four patients were available at 12 months post-final insertion. For mucosal recession, the frequency was 64.3% in CONVEX group, 14.3% in CONCAVE group and 31.4% in CONTROL group. The results of the regression model revealed a significant association of recession with a CONVEX

profile (odds ratio: 12.6, 95% confidence interval). Pink aesthetic scores revealed no significant difference between the groups. Groups CONVEX and CONCAVE had more frequent appointments and higher costs compared to the CONTROL group.

CONCLUSION: The use of implantsupported provisionals with a CONCAVE emergence profile results in a greater stability of the mucosal margin compared with a CONVEX profile up to 12 months of loading. This is accompanied, however, by increased time and costs compared with the absence of a provisional and may not necessarily enhance the aesthetic outcomes.

Dr. Tareq Abdulrasoul; Resident in Periodontics, Virginia Commonwealth University

THE INFLUENCE OF SMOKING ON THE INCIDENCE OF PERIIMPLANTITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Dos Reis et al. Clin Oral Implants Res. 2023;34(6):543-554

BACKGROUND: Peri-implantitis is characterized by loss of peri-implant supporting bone in response to plaque associated inflammation. Identifying key risk factors for peri-implantitis is important for early diagnosis and prevention of this condition. Several risk factors have already been suggested such as a history of chronic periodontitis and poor oral hygiene. Though smoking has been implicated as an important risk factor in the incidence of periodontitis, implant failure, and periimplant marginal bone loss, the evidence for smoking as an important risk factor for peri-implantitis has not been well supported in previous systematic reviews. However, because this review is limited to prospective cohort studies with a wide body of newer research it may be a more appropriate way to analyze this relationship.

PURPOSE: The aim of this study is to determine through systematic analysis if cigarette smoking plays a role in the incidence of peri-implantitis.

METHOD: A literature search was performed by two authors independently

across our electronic databases, National Library of Medicine (MEDLINEPubMed), SCOPUS, EMBASE, and ISI Web of Science, including publication up until November 30 2022. Additionally, sources from Grey literature were hand-picked from OpenGrey (http://www.opengrey. eu) and Grey Literature Report (http:// www.greylit.org). Studies were limited to prospective cohort studies with a smoker and non-smoker control group that evaluated the effect of smoking on the incidence of peri-implantitis. After screening and data extraction, the included articles were subjected to random-effects metaanalysis for peri-implantitis incidence. The Newcastle-Ottawa scale (NOS) was used to assess risk of bias and determine the quality of the literature and the certainty of evidence was analyzed using the GRADE method.

RESULTS: Out of the 4,337 articles, five studies were included in the analysis at an implant level and five studies at a patient level. The analysis supported a strong relationship between smoking and the risk for peri-implantitis both by patient and

by implant, with 2.1 and 2 times increase in risk respectively. Additionally, both an implant and patient-based analysis showed a significant difference in risk for peri-implantitis between smokers and nonsmokers. A subgroup analysis limited to the World Workshop definition of peri-implantitis had similar results. A single included study with an alternative definition did not show a significant difference between the groups. The overall level of evidence was considered moderate.

CONCLUSION: There is a moderate level of evidence to suggest that smoking is associated with a higher risk of periimplantitis based on both an analysis by patient and by implant. Limitations of this study include moderate heterogeneity and insufficient data on confounding variables such as level of smoking.

DENTAL IMPLANT FAILURE

RATES

IN

PATIENTS

WITH SELF-REPORTED ALLERGY TO PENICILLIN

Bagheri et al. Clin Implant Dent Relat Res. 2022;24(3):301-306

BACKGROUND: Implants have high survival and success rates well over 90%. Despite no consensus present regarding the use of antibiotics, most clinicians prescribe antibiotics before and after implant placement to decrease the risk of implant failure. The most widely prescribed antibiotic is beta lactam amoxicillin. In cases of amoxicillin allergy, alternative antibiotics as clindamycin or azithromycin are used. Previous studies had shown higher implant failure rate in patients allergic to amoxicillin.

PURPOSE: The purpose of this retrospective study is to compare the rate of implant failure in patients prescribed amoxicillin to those that report amoxicillin allergy and are prescribed alternative antibiotics.

METHOD: Patients who had one or more dental implants placed in a postgraduate specialty program at New York University College of Dentistry and were followed at 1-2 weeks and 1 or more years after

implant placement were included. Patients who were ASA >1, under 18 years of ages and those who didn’t follow standard treatment protocols were excluded. Between the years 2002 and 2020, 434 patients that reported allergy to penicillin and 404 that reported no allergy to penicillin were included. The mean age was 61.4 years old, with 468 females and 370 males. Patients who reported no allergy to penicillin received 2g of amoxicillin 1 hour prior to implant surgery and a 7-day >

Dr. Whitney Johnson; Resident in Periodontics, Virginia Commonwealth University

THE PROGNOSTIC OUTCOME OF TRANSALVEOLAR SINUS FLOOR ELEVATION WITH OR WITHOUT GRAFTING MATERIALS: A META-ANALYSIS.

Qian-Hui Shu, et al. Int J Oral Maxillofac Implants 2022;37(5):869-878

BACKGROUND: Recently, the increased living standards of the population have made dental implants the first choice for replacement of missing teeth. However, not all tooth losses are suitable for implant rehabilitation, and implant success depends on many factors, with sufficient bone density and residual boneheight (RBH) in the edentulous area being the most important. In the posterior maxilla, the loss of teeth and subsequent sinus pneumatization result in severely atrophic alveolar crests, and implants cannot yield sufficient primary stability after implantation. Fortunately, with the advancements in technology, many clinical approaches, such as maxillary sinus floor elevation, have been developed to increase the bone volume in the posterior maxilla. Maxillary sinus floor augmentations include the lateral window approach and transalveolar surgical approach of maxillary floor elevation. Simultaneous bone grafting after transalveolar sinus floor elevation (TSFE) was used to maintain the volume formed by the elevated sinus membrane,

but its use increases the sinus membrane perforation rate. Moreover, high survival rates and new bone formation in the space after maxillary sinus mucosa elevation have also been reported for TSFE without grafting material, which indicates that the use of grafting material may not be necessary for TSFE.

PURPOSE: The purpose of the present meta-analysis was to assess the effect of nongrafted and grafted materials on the survival rate, crestal/marginal bone loss, and endosinus bone gain of TSFE with immediate implant placement.

METHOD: Relevant studies published between January 1, 1994, and July 31, 2021, were selected by searching Embase, PubMed/MEDLINE, Web of Science, and Cochrane Central Register of Controlled trials. The study was confined to randomized controlled trials, controlled clinical trials, and observational studies (prospective and retrospective cohort) related to TSFE with and without bone grafting materials. The study subjects were restricted to humans, and the language was limited to English. Two

reviewers independently extracted study data and conducted quality assessments.

RESULTS: A total of nine articles were included, including 421 implants in the graft group and 502 implants in the nongraft group. Meta-analysis showed that there was no significant difference in the implant failure rate or marginal bone loss between implant with and without graft materials after TSFE.

CONCLUSION: There are no significant differences in the survival rate and marginal bone loss between TSFE with and without grafts, and both types of TSFE provide the expected results. In addition, more endosinus bone gain is achieved in the graft groups than in the nongraft group.

course of 500 mg to be taken 3 times a day post-surgically. While patients that reported penicillin allergy received similar doses of either clindamycin, azithromycin, ciprofloxacin, or metronidazole. Implant failure was defined as implant removal due to failure of osseointegration presented by implant mobility. Chi-square analysis and logistics regression models were used to evaluate implant failure rates in each group after adjusting for age and sex.

RESULTS: The overall implant failure rate was 12.9% and was unaffected by gender (13.2% for males and 12.6% for females). In patients without reported penicillin allergy the failure rate was 8.4% while those with reported penicillin allergy the failure rate was significantly higher

at 17.1%. Clindamycin and azithromycin were the major antibiotics prescribed as an alternative to amoxicillin and both had high failure rates. Compared to patients prescribed amoxicillin, patients prescribed clindamycin had higher risk of implant failure [adjusted OR = 2.9, 95% CI = (1.77, 4.74)], similar to those prescribed any other antibiotic treatment [adjusted OR = 2.77, 95% CI = (1.77, 4.32)]. In the penicillin allergic group most implant failures occurred in the first 6 months, while in the non-allergic penicillin group implant failure occurred after 12 months of implant placement.

CONCLUSION: A lower implant failure rate in patients taking amoxicillin was noted compared to patients taking other

antibiotics. A significant increase in early implant failure was noted in penicillin allergic group.

Due to the overestimation of reported penicillin allergy, it’s recommended for patients reporting allergy to penicillin to get a routine allergy test. This may reduce implant failure rate by prescribing amoxicillin to patients without a true penicillin allergy.

Dr. Lina Elnakka; Resident in Periodontics, Virginia Commonwealth University

Dr. Roxana Rodriguez; Resident in Periodontics, Virginia Commonwealth University

MARGINAL BONE CHANGES AROUND PLATFORMSWITCHED CONICAL CONNECTION IMPLANTS PLACED 1 OR 2 MM SUBCRESTALLY: A MULTICENTER CROSSOVER RANDOMIZED CONTROLLED TRIAL

BACKGROUND: Peri-implant marginal bone stability has always been considered a crucial factor affecting long-term success of implant therapy. During the first year of function, peri-implant crestal bone undergoes a remodeling process with multifactorial etiology and variable entity. This noninfective process, namely early marginal bone loss (EMBL), is affected by various surgical and prosthetic factors including insufficient bone crest width and/or implant malpositioning, excessive surgical trauma, supracrestal tissue height adhesion, microleakage and bacterial accumulation at the implantabutment microgap, repeated abutment disconnection/reconnections, prosthetic abutment height, implant-abutment connection mechanical stability and structural bone adaptation to functional loading.

PURPOSE: The present crossover randomized controlled trial analyzes marginal bone changes occurring around implants with platform-switching and

conical connection placed subcrestally at different depths (1 vs. 2 mm) and closely followed for 1 year after prosthetic loading.

METHOD: This crossover randomized controlled trial enrolled partially edentulous patients needing two implants in either the posterior maxilla or mandible. Each patient received two platformswitched implants with conical connection inserted 2 mm (Test) and 1 mm (Control) subcrestally. Definitive abutments were immediately connected and, after 4 months of unsubmerged healing, screwed metal-ceramic crowns were delivered. Radiographs were taken at implant placement (TO), prosthesis delivery (T1), and after 1 year of prosthetic loading (T2).

RESULTS: Fifty-one patients (25 males and 26 females; mean age 61.2 ± 12.1 years) totaling 102 implants were included in the final analysis. Mean peri-implant bone level (PBL) reduction from TO to T2 was not significantly different around Test (0.49 ± 0.32 mm) and Control implants

(0.46 ± 0.35 mm; p = 0.66). Multivariate linear regression models highlighted a significant positive correlation between history of periodontitis and PBL reduction. At T2, no Test group implant and 6 Control group implants exhibited PBL below the implant platform (11.8% of Control group implants).

CONCLUSION: No significant differences in peri-implant marginal bone changes were demonstrated after 1 year of prosthetic loading between platformswitched implants with conical connection inserted either 1 or 2 mm subcrestally. However, 2 mm sub-crestal placement resulted in deeper implant positioning at T2, with no exposure of treated implant surface and potential preventive effect against subsequent peri-implant pathology.

Dr. William Porzio; Resident in Periodontics, Virginia Commonwealth University

CONTENT WARNING

THE FOLLOWING PAGES CONTAIN IMAGES OF HUMAN REMAINS

WAS THIS YOUR PATIENT?

On August 16, 2022, these human remains were found off the exit ramp of US-220 North/Franklin Road in Roanoke. This is an area where homeless individuals often camp. As you can see in the following photos, the mandible has been repaired.

Please help in the identification process.

INTERPROXIMAL IMPLANT THREAD EXPOSURE AFTER INITIAL BONE REMODELING AS A RISK INDICATOR FOR PERI-IMPLANTITIS

BACKGROUND: Historically, bone remodeling up to 1-1.5mm has been accepted as physiologically normal after one year of implant placement. Periimplantitis has been defined by the 2017 World Workshop as bone loss exceeding this extent with the addition of inflammation and local factors like bacteria. Other risk indicators have been explored in previous studies including implant design, implant body treatment, number of threads. After bone remodeling occurs in some cases, interproximal thread exposure may occur, which could be a risk for development of peri-implantitis.

PURPOSE: It was the aim of this retrospective longitudinal study to determine if thread exposure is a risk factor associated with developing peri-implantitis. The secondary aim was to evaluate other risk indicators for peri-implant disease.

METHOD: The following study included implants placed at this University of Michigan School of Dentistry between 2000 and 2017. Patients selected had at least one area of edentulism replaced with implant therapy with a follow up at least 2 years with adequate periapical radiographs. No periodontitis could be recorded at time of implant placement. Physical data were screened and collected by four examiners. Of 4325 patients with implants, 165 edentulous patients qualified to be part of the study. Implants with >1 interproximal thread exposed (no implant to bone contact) composed 35% of the subjects, whereas implants without thread exposure (control group) made up 65% of the subjects.

RESULTS: Over a mean follow up of 7.67 years, 2.9% of the implants failed and 9.6% developed peri-implantitis.

There were eight-fold greater odds of development of peri-implantitis in the thread exposure group as compared to no exposed threads group. There was a fourfold increase with each additional thread exposed.

CONCLUSION: Implants with threads exposed are more likely to develop peri-implant disease than those without any thread exposure. Clinicians should monitor cases that they expect to see physiologic remodeling that could result in thread exposure for development of disease progression.

INFLUENCE OF SOFT TISSUE THICKESS ON MARGINAL BONE LEVEL AROUND DENTAL IMPLANTS: A SYSTEMATIC REVIEW

AND TRIAL-SEQUENTIAL ANALYSIS

BACKGROUND: Healthy soft tissue conditions support peri-implant bone stability and act as a protective barrier against peri-implant diseases. Progressive bone loss is a criterion for peri-implant pathology, categorized as early and late marginal bone loss (MBL). Early MBL occurs within the first year after implant placement and is influenced by various local factors, while late MBL, known as peri-implantitis, involves inflammation and progressive bone loss. Thicker gingival tissues may contribute to better peri-implant bone stability. Soft tissue augmentation using grafts has been suggested to reduce marginal bone loss, but the results are controversial, with varying outcomes in clinical, radiographic, and aesthetic aspects.

PURPOSE: The aim of this review and metaanalysis was to evaluate the influence of soft tissue thickness on initial bone remodeling after implant placement.

METHOD: A comprehensive search was

conducted across multiple databases until May 2022, including Cochrane Central Register of Controlled Trials, MEDLINE, Scopus, and Web of Science. Manual searches and reference list reviews were also performed. Two reviewers independently assessed the eligibility of selected studies based on inclusion criteria. Data extraction and quality assessment were conducted using pre-determined forms and the Cochrane Collaboration’s tool for risk of bias assessment. The final search date was May 31, 2022. Studies meeting the inclusion criteria were randomized clinical trials (RCTs) and controlled clinical trials (CCTs) with clearly described marginal bone levels in human subjects, while certain types of studies were excluded.

RESULTS: The analysis focused on 354 implants that were categorized based on their soft tissue thickness, with 194 implants having a thickness of ≥2 mm and 160 implants with <2 mm thickness prior to implant placement. A heterogeneity test

revealed significant heterogeneity among the studies included. Soft tissue thickness was assessed using a periodontal probe, and periapical radiographs with individual bite blocks were used to measure bone level.

CONCLUSION: The meta-analysis revealed a statistically significant difference in marginal bone level between implants with thick and thin soft tissue, favoring thick tissue. However, trial sequential analysis (TSA) indicated that the results were inconclusive, and further studies are encouraged to definitively evaluate the role of soft tissue thickness in marginal bone loss. Age was not found to have a significant influence on the results, and the duration of follow-up did not show a statistically significant impact on bone loss.

Dr. Sara Kube; Resident in Periodontics, Virginia Commonwealth University

Dr. Chris Ricker; Resident in Periodontics, Virginia Commonwealth University

Better Services Better Outcomes Better Rewards

LIBERTY Dental Plan has developed dynamic partnerships with a number of key healthcare payors in your area to increase your patient base.

A Partnership with LIBERTY Dental Plan Adds Value to Your Practice!

• Increased Opportunity Open your office up to a high growth patient population with great dental benefits.

• Ease of Administration

All Virginia Plans are PPO reimbursement. Enhanced Provider Portal accessible 24 hours a day, 7 days a week.

• Dedicated Support

Access to Clinical Staff and dedicated local Network Managers for one-on-one support.

All this means increased oral health outcomes and more money to your bottom line.

WOUND HEALING AFTER RIDGE PRESERVATION: A RANDOMIZED CONTROLLED TRIAL ON SHORT-TERM (4 MONTHS) VERSUS LONG-TERM (12 MONTHS)

HISTOLOGIC OUTCOMES

Zellner et al. J Periodontol. 2023; 94(5):622-629

BACKGROUND: It is common that following tooth extraction ridge atrophy and resorption are seen. Alveolar ridge preservation is a routinely utilized to augment inadequate ridge dimensions in a site planned for future implant placement. Important outcomes following ridge preservation are vertical height, ridge width, and vital bone, residual graft material present, and connective tissue present. Previous studies have investigated and seen a correlation between healing times and the formation of more vital bone and less residual graft. While the hope of both the practitioner and the patient would be to place the implant only a few months after augmentation, the success of the subsequent implant placement can depend on many factors. Few studies investigate the augmentation outcomes after a 6-month period in regard to vital bone.

PURPOSE: The aim of this study is to examine the histologic wound healing in ridge preserved sites over 12 months with outcome measures of percent vital bone, residual graft material, and connective tissue.

METHOD: Patients were enrolled if they followed the inclusion criteria of needing a single tooth replacement, not including second and third molars, and were planned for replacement with a dental implant. A total of 57 patients were enrolled and 43 patients completed the study. Sites were grafted with a combination of allograft and patients were placed into the ST (short-term) or LT (long-term) healing groups. At time of implant placement, an 8-mm core biopsy was harvested using trephine drills during osteotomy preparation. The resulting core biopsies were examined histologically to determine the percentages of vital bone formation, residual graft particles, and connective tissue.

RESULTS: A total of 21 bone cores in the ST group and 22 in the LT group were harvested and analyzed. A significantly higher vital bone percentage was found in the LT group (51.38%) versus the ST group (31.39%). The LT group also had significantly less residual graft particles (18.04%) compared to the ST group (28.16%).

CONCLUSION: Allowing a ridge augmented site to mature for 12 months or longer results in greater percentage of vital bone and less residual bone particles. However, the relationship between the amount of vital bone present at the time of implant placement and the final amount of bone-to-implant contact is unknown.

Dr. Catherine Ramundo; Resident in Periodontics, Virginia Commonwealth University

IMPLANT STABILITY CHANGES OVER TIME FOLLOWING IMPLANT PLACEMENT IN ELDERLY PATIENTS: A PROSPECTIVE STUDY

Choi et al. Clin Oral Implants Res. 2023 Mar 15. doi: 10.1111/clr.14064. Epub ahead of print

BACKGROUND: Elderly patients undergoing implant surgery are at higher risk compared to younger patients owing to their medical conditions and the adverse effects of medications being taken. Moreover, differences in bone quality and metabolism between elderly and young patients could result in differences in osseointegration patterns following implant placement. Changes in implant stability over time during the healing period could reveal more definite results upon comparing the physiological responses following implant placement in young and elderly patients. In this prospective study, implant stability was evaluated over time in patients of varying ages.

PURPOSE: This study aimed to evaluate the effect of aging on the changes in implant stability over time following implant placement

METHOD: A total of 104 patients in four age ranges (<60 years, 61–70 years, 71–80 years, and >80 years) who desired implant treatment between 2020 and 2022 were included in this

study. They were designated as Groups 1-4. Bone-level tapered implants were placed without implementing any bone augmentation procedure. To measure implant stability following the determined timetable, all implants were placed in a non-submerged state. Final torque value displayed on the implant engine during implant insertion was recorded. Conebeam computed tomography (CBCT) was performed immediately after surgery to analyze the bone quality around the implant. Implant stability was measured immediately after surgery and 2, 4, and 8 weeks after surgery. The stability was measured with a damping capacity analysis device (Anycheck®, Neobiotech Co.) instead of a resonance frequency analysis device since the process of releasing the healing abutment for measuring resonance frequency analysis in the early osseointegration stage could unfavorably affect the interface between the implant and alveolar bone.

RESULTS: While groups 3 and 4 showed no significant difference in the outcomes assessed at various timepoints, groups 1

and 2 showed decreased implant stability values at 2 and 4 weeks compared to right away and 8 weeks after surgery. The insertion torque values between age groups did not differ significantly. Higher grayscale values were seen in the CBCT picture in the following groups: group 1, group 2, and groups 3 and 4, with statistical significance.

CONCLUSION: Within the study limitations, the results of this prospective study suggest that implant treatment in elderly patients is successful showing a settled implant stability over time following implant placement when the implant is appropriately engaged in the alveolar bone in the absence of bone augmentation.

Dr. Sarang Saadat; Resident in Periodontics, Virginia Commonwealth University

UNDERSTANDING SOCIAL SECURITY

Bobby Moyer; Chief Investment Officer, ACG Wealth Management

Most Americans will depend on Social Security, at least in part, to help support them in retirement. While most Americans acknowledge the importance of Social Security, many do not take the time to understand the options or consequences of when to begin receiving Social Security benefits. While the decision may be complicated, it is important when putting together your retirement plan.

Many individuals question if Social Security will even be around throughout their lifetime. While the math concerning the future of Social Security is admittedly cloudy, there are solutions being studied:

• Increase the maximum earnings subject to Social Security tax (currently $147,000 in 2022).

• Raise the normal retirement age.

• Lower benefits for future retirees.

• Reduce cost-of-living adjustments.

Any of these changes could be implemented in some form, but most experts believe anybody close to retirement should expect to receive full benefits. Younger individuals, however, may receive a reduced benefit.

You Could Begin Receiving Social Security at 62. But Should You?

Many individuals are tempted to claim their benefit as early as possible, which is age 62. There are times when claiming early makes sense, but more often than not, it is better to wait. If you claim early, your overall benefit will be reduced. Here are some factors to bear in mind when considering when to apply:

• Health status

• Life expectancy

• Need for income

• Whether or not you plan to continue to work

• Survivor needs or spouse’s life expectancy

For most Americans, Social Security will not be enough to live on in retirement, so plan accordingly to put yourself in the best situation for a successful retirement. In order to receive your full benefit, you can’t begin receiving Social Security before your full retirement age (FRA), which for most Americans is between age 66 and age 67. Depending on these factors, if you decide to take benefits early, you will receive a lower benefit. However, should you delay receiving benefits, you will receive an 8% annual credit. Your income will not only be higher in the first year but the cost-of-living adjustment will be compounded annually off that higher figure in future years. Chances are you could be leaving a significant amount of money on the table by claiming early.

If you do not know your estimated Social Security benefit, you can obtain your statement at www.socialsecurity.gov/ myaccount. Your statement will be updated annually. You should review your statement on an annual basis to make sure it is accurate. Verify the reported income is correct, check to see if any years are missing, or use the calculator to see if working longer will provide a bigger benefit.

Widowed or Divorced

If you are a widow(er) or divorced, you may be entitled to divorce or survivor benefits. Survivor benefits will depend on the age at which the deceased spouse originally claimed their benefit and the age at which the widow(er) claims the survivor benefit. If a spouse dies while both are receiving benefits, the widow(er) may switch to the higher benefit.

Working With an Advisor

The process of choosing when to begin taking benefits is complicated but important. Making the wrong decision

could have a dramatic, negative impact on your retirement. We strongly encourage future retirees to educate themselves and work with an advisor who can help optimize you and your family’s Social Security benefits.

For important disclosure information please visit: https://acgwealthmanagement.com/ important-disclosure-information/

ETHICS: INFORMED CONSENT

Dr. Al Rizkalla; Chair, VDA Ethics Council

What is informed consent in the context of dental practice? Does it refer to only those ethical expectations mandated by and enforceable in a legal context? Or does it govern the quality of communication between dentists, physicians, and other healthcare professionals in all of their interactions with their patients when discussing risks, benefits, costs, and possible outcomes of treatment options?

The expectations surrounding informed consent have a foundation in the notion that patients have a right of self-determination in choosing medical and dental treatment. However, to be meaningful, consent must be informed. This puts the practitioner in a sensitive position requiring clear interpersonal communication skills, but also clarity in communicating across the bridge between his or her professional knowledge of the healing arts to the layman patient, whose technical knowledge is usually limited.

The formation of informed consent is at the core of the ethical practitioner/ patient relationship. It is in this area that the quality of the relationship, on both professional and ethical levels, is most crucial and where, while the success of any given procedure cannot always be certain, the responsibility for failure to discuss all the contingencies rests with the healthcare provider.

Early discussions of issues and problems with informed consent seem first to appear in the United States as early as the 18th Century. There was an early recognition of a patient’s dignity and interest in knowing choices at the time medical options were chosen. The older reported literature on the subject is more focused on the simple threshold issue of ensuring that a patient in some way

accepts the necessity of the proposed health intervention. As time passed, the issue became as much legal as ethical until the 20th Century; a substantial body of professional and legal examination of the topic had accumulated. The foundation of all these discussions is the concept of a patient’s personal autonomy as manifested by his or her ultimate decision-making power.

professionals, therapeutic options for dental patients must be presented holistically, not only as to the potential outcomes of alternatives but also as to cost, including the alternative of doing nothing.

This requires focus and clarity of presentation on the part of the dental practitioner and a detached, objective effort to assist the patient in making a rational, clinically appropriate, and costeffective choice of options. That choice must include cost as a component. But cost to the patient is only one of several factors that the dentist may be considering. Many continuing education courses focus on “Presenting the Treatment Plan in a Way to Get the Patient to Accept it.” If this is the starting point, the ensuing conversation often launches from a structural tension between the clinician’s beneficent desire for ideal dentistry or, in some cases, the dentist’s pecuniary desire to maintain his or her practice and the patient’s concern for comfort, available time, and budget, among others.

There will always be many other factors that need to be considered. In today’s environment, some factors that should always be out on the table between the clinician and the patient and which may also influence the decision include:

1. Availability of dental insurance.

However, the development of the concept of informed consent increasingly focused on efforts to objectify the information necessary to ensure that any patient decision is, in fact, “informed”. Decisions about the courses of treatment in dental settings are often less dramatic than in medical contexts. However, while lifeand-death stakes of dental procedures are far less common than for medical

2. Availability of Medicare/ Medicaid.

3. Comfort, expertise, and skill of the clinician with the recommended treatment.

4. Probability of success of the recommended treatment.

“Continuing to be cognizant that informed consent is for the benefit of the patient might help improve the patientclinician relationship, which, in the end, might be the best way to counteract the influence of external pressures on dentists to maximize the billable return from the patient.”

5. Less costly procedures and their advantages and disadvantages.

6. What remediation would be required if necessary.

While a dentist must financially sustain a practice, ethics demands the following factors should not influence which of the appropriate treatment options the dentist recommends:

1. Rising costs of dental education.

2. Rising costs of dental office overhead.

3. Rising costs of staff salaries.

4. Profits for Health Management Services.

5. Inflation and rising costs of living in general.

6. Financial incentives for performing the recommended procedure.

7. External pressures on the dentist to increase office profits.

A dentist who fails to recognize when these factors are driving the recommended procedure is not allowing the patient to make an “informed” decision about the course of treatment.

When the Hippocratic Oath was formulated, there existed only a tripartite relationship in medicine: between the patient, physician, and illness. Continuing to be cognizant that Informed consent is for the benefit of the patient might help improve the patient-clinician relationship, which, in the end, might be the best way to counteract the influence of external pressures on dentists to maximize the

billable return from the patient. The bottom line for the profession is: Do we see dentistry as primarily a healing profession, or is it simply an incomeproducing business?

Editor’s Note: Dr. Rizkalla is an Assistant Professor in the Department of Comprehensive Care at Howard University School of Dentistry and teaches Interdisciplinary Healthcare Ethics to Medical, Dental, and Pharmacy students.

AUTOMATED INSURANCE VERIFICATION

CAN IMPROVE PATIENT SATISFACTION AND REVENUE

Robert McDermott; President and CEO, iCoreConnect

Patient satisfaction is a key component for assessing the overall health of your dental practice. It’s about quality care as much as it is about other factors.

One of the toughest parts of measuring patient satisfaction is understanding which contributing factors are truly under your control. Sometimes how happy a patient may not be an exclusive result of the quality of care you provided.

Some factors, like those listed, are related to quality of care you provide and impact patient satisfaction:

• Communication

• Scheduling

• Staff friendliness/attitude

• Time spent with patients

• Technology

• Cleanliness/Appearance of office and staff

• And, in some cases, care provided and patient outcomes

In addition to those are other factors some of which you can mitigate and others where you have very limited locus of control.

• Patient outcomes- You can only do what you can. Failure to follow/ continue at home efforts to mitigate conditions is only within the patient’s control. Regardless, it can impact overall outcome, and ultimately patient satisfaction.

• Costs- Whether it’s an unplanned procedure, a shortfall in insurance or simply something that isn’t covered, patients who are caught off guard by an unexpected cost can have lower patient satisfaction scores.

• Convenience- Is it difficult to get to your office? Limited parking? How convenient it is for patients to actually get to your dental practice can have a huge impact on patient satisfaction.

• Patient Expectations- Some may come to your office with very high hopes, but due to other aggravating factors, you just can’t deliver what they expect.

across healthcare organizations, price transparency is vital. Research reveals that over 90% of patients report billing and payments can really shape their experience with your practice.

That means, as a practice manager or dentist, determining the best way to be clear and transparent about the costs for treatments and procedures is a crucial part of your practice management.

Preparing and planning a dental treatment plan for your patients is a great way to ensure they not only know what their treatment goals are but also how those procedures will be scheduled.

Under normal circumstances, your administrative staff would have to spend countless hours mapping out treatment plans and matching them to benefits, especially if there are benefits or insurance changes. However, automated dental insurance verification software puts all of that information at your fingertips.

Not only will you be able to see, instantly, whether a patient has an existing treatment plan, but you’ll also have vital information regarding their coverage. This way, as you schedule the next treatment or procedure in their plan, you can review the coverage and costs and prevent any confusion or surprises later.

While some of those issues may be out of your control, communication around expectations, aftercare, outcomes, and costs can help alleviate some of those frustrations and improve your patient satisfaction scores.

One of the biggest factors that can impact patient satisfaction is cost of care. Thankfully, this is one area where you can really help. Experts suggest that,

This can be even more important when it comes to budgeting for much needed care that isn’t covered or is only partially covered by insurance. With the right automated dental insurance verification software, you, and your patients, can know well ahead of time what’s covered and what costs your patient will incur.

And, with satisfied patients, you can

“Experts suggest that, across healthcare organizations, price transparency is vital. Research reveals that over 90% of patients report billing and payments can really shape their experience with your practice.”

reap the additional rewards that brings, including boosted revenue.

Not only does insurance verification software free up your staff and other resources from time-consuming callbacks and insurance denials, but your ability to schedule and leverage coverage (because you can see those opportunities) means your practice can capitalize on them while improving patient care. Not only are you saving money on overhead, denials, and missed treatment opportunities, but you’re also enhancing the patient experience.

In addition to keeping a full schedule, you’ll also have satisfied patients in the community leaving reviews and passing on, via word of mouth, the positive experiences they’re having with your dental practice. As most dental practices know, monitoring patient metrics, such

as patient retention and new patient numbers, can be a very strong indicator of practice health.

It’s pretty simple: more returning patients, and new patients you earn through patient referrals, mean more revenue for your practice. Boosting patient satisfaction scores, for that reason, is a good way to boost practice revenue.

If you’re trying to figure out how you can boost patient satisfaction while also improving your efficiency and increasing revenue, then automated insurance verification software may be the answer. From decreased denials to transparent billing and communications, your relationship with patients and insurers can improve. In short, automated insurance verification software can help you improve both revenue growth and patient satisfaction.

VDA Member Perks endorses iCoreVerify

Automated Insurance Verification by iCoreConnect. iCoreVerify stands out among the others for its comprehensive, accurate and instantaneous verifications. In seconds, you will see patient verification information for every patient on the schedule for that week, along with instant error identification for quick corrections. See how it can boost your revenue by booking a demo at iCoreConnect.com/VA13 or calling 888.810.7706. VDA members receive a substantial discount on iCoreVerify.

KNOWING IS HALF THE BATTLE

Regulations

DID YOU KNOW? A SERIES FROM THE VIRGINIA BOARD OF DENTISTRY

SB1539- Allowing General Dentists to utilize Botulinum Toxin (Botox) cosmetically

This bill will become law on July 1, 2023. However, the bill requires that the Board of Dentistry create regulations, prior to a General Dentist administering botulinum toxin injections cosmetically. Therefore, a dentist cannot administer botulinum toxin injections cosmetically until the Board has approved regulations. The Board will convene a regulatory advisory panel over the next year, which may meet a few times prior to presenting to the Regulatory Committee and then ultimately the full Board for approval of final draft regulations.

Licensees may become informed on the regulatory process by going to the website of the Virginia Register of Regulations (http://register.dls.virginia.gov/process.shtml). Typically, regulatory actions take about 18 to 24 months from proposed to finish. Regulations do not become proposed until the full Board approves and submits to the Virginia Register of Regulations. This is not a process that the Board can circumvent or make faster.

Please note, this bill is only for botulinum toxin injections (cosmetically) and does not include other cosmetic injectable medication or material (e.g., cosmetic fillers).

CE Broker

Virginia Board of Dentistry has engaged with CE Broker as its official CE tracking system. The utilization of CE Broker is currently completely voluntary. The benefits of utilizing CE Broker are that it tracks and lets licensees know precisely how many continuing education hours a licensee has completed and how many hours are remaining for licensure renewal. It also has a comprehensive course search to help a licensee find a course that is needed for their requirements of continuing education for licensure renewal.

Licensees will never have to pay for the free, basic account. However, licensees do have the option to subscribe to an upgraded account which offers additional CE tracking tools. You can activate your free CE Broker account at https:// cebroker.com/va/account/basic/. If you already have a CE Broker account, you can add your Virginia license to your already existing account.

Information will be sent to licensees via email (if the Board has an active email address) and additional information will be available on the Virginia Board of Dentistry website. The Board highly encourages licensees to utilize CE Broker for the assistance of Continuing Education Audits.

COSMETIC BOTOX ADMINISTRATION IN THE DENTAL OFFICE: RISK MANAGEMENT & INSURANCE CONSIDERATIONS

E. Andrew Gerner, CFP; President, R.K. Tongue Insurance

Virginia dentists can legally administer Botox for purely cosmetic indications under § 54.1-2711.21 thanks to Senator Todd Pillion’s SB 15392. This amendment is great news for Virginia dentists seeking to expand the services offered in their cosmetic practices and, like most new laws and regulations, raises questions and practical considerations. This article does not attempt to provide an exhaustive list of considerations and questions surrounding cosmetic administration of Botox in the dental practice, nor is it an authoritative catalogue of answers or recommendations. Rather, this article serves to identify common considerations related specifically to regulatory compliance, risk management, and malpractice insurance.

Compliance Considerations:

Before offering cosmetic injectables, Virginia dentists should consider the qualifications required to comply with the Code of Virginia governing Dental Practice. The passage of SB 1539 does not automatically allow dentists to immediately begin offering cosmetic Botox injections. Rather, SB 1539 amends title 54.1 of The Code to add language allowing dentists to possess and administer botulinum toxin injections for cosmetic purposes, but even more importantly, requires that the Board of Dentistry, in consultation with the Board of Medicine, to amend its regulations to establish training and continuing education requirements for dentists related to the administration of

botulinum toxin injections for cosmetic purposes. The Board of Dentistry shall amend its regulations related to cosmetic certifications for oral and maxillofacial surgeons to remove from such regulations subdivision B 9 of 18VAC 60-21-350.

Stated simply, dentists need to complete Botox training and continuing education as required by the Board of Dentistry to be qualified to administer Botox. As of the writing of this article, no such training or CE requirements have been published by The Board. Dentists cannot comply with requirements that don’t yet exist and those seeking to do so may unwittingly find themselves practicing outside the scope of dentistry, thus imperiling their license and risking claims for which malpractice insurance will not respond.

L-R: Dr. Brett Siegel, Dr. Darrell Boyce, VDA President Dr. Cindy Southern, Governor Glenn Youngkin, Senator Todd Pillion, DDS; VDA CEO Ryan Dunn, Dr. Marcel Lambrechts, Dr. Harold Martinez. Official Photo by Christian Martinez, Office of Governor Glenn Youngkin.

Insurance Considerations:

Before obtaining training and purchasing the supplies to administer Botox, Virginia Dentists should consult with their malpractice insurance agent to understand how various insurers handle procedures from an insurance contract perspective. Some insurers will not provide coverage for Botox administered by general dentists. Some insurers provide coverage for specific procedures like botulinum toxin injections for cosmetic purposes, but not until the new procedure is disclosed to and approved by an underwriter and additional premium charges are paid. Others, like the VDA Member Perks-endorsed Professional Protector Plan program, will provide cosmetic dermal procedure coverage for a modest additional charge, so long as the procedure meets the definition of dentistry under statute and regulation.

Once the Board of Dentistry specifies the training and education requirements necessary for Virginia dentists to legally administer Botox, and after a dentist complies with those requirements, insurance companies may still use underwriting discretion to select against certain risks. For example, the Board of Dentistry may choose to craft regulations that allow dentists to administer Botox in settings other than a dental office. Insurance companies, however, may limit coverage to only Botox administered in a dental office setting. Under such a scenario, house visits or “Botox Parties” would not be covered under a primary dental malpractice insurance policy. Dentists wishing to offer botulinum toxin injections outside of a dental office should obtain a separate insurance policy to cover such an exposure if not covered by primary dental malpractice insurance. Additionally, an insurance company could require proof of training that exceeds the requirements set forth by the Board before providing malpractice coverage for elective cosmetic injectables. Insurance companies may also question the extent to which Botox injections relate to a dental practice’s treatment model or philosophy. If a dentist establishes a practice focused predominantly on administering cosmetic injectables, a dental malpractice insurance underwriter may feel that a policy designed for a medi-spa is more appropriate than a policy for a dental practice and decline to cover the practice despite dentist ownership and/or service delivery.

There is no dispute that dentists routinely administer precise injections and are familiar with the anatomy of the head and neck, making them well suited to administer botulinum toxin injections for cosmetic purposes. It is therefore no surprise that Sen. Pillion’s SB 1539

overwhelmingly passed both the House and Senate. Notwithstanding these facts, prudent risk management dictates that Virginia dentists carefully evaluate not just clinical practices, but also legal, regulatory, and insurance considerations before offering patients Botox for purely cosmetic indications. Dentists should speak with their insurance agent and legal advisors about changes they wish to make to their practice because of Virginia’s new Botox law.

References:

1. https://law.lis.virginia.gov/ vacode/title54.1/chapter27/ section54.1-2711/

2. https://lis.virginia.gov/cgi-bin/ legp604.exe?231+sum+SB1539

“Stated simply, dentists need to complete Botox training and continuing education as required by the Board of Dentistry to be qualified to administer Botox. As of the writing of this article, no such training or CE requirements have been published by the Board.”

VIRGINIA BOARD OF DENTISTRY NOTES

JUNE 16, 2023

Richard F. Roadcap, DDS; Editor

The meeting at the Perimeter Center in Richmond was called to order at 9:00 a.m. by Board President Dr. Nathaniel Bryant. There were no speakers for the public comment period. The minutes of previous meetings (March 3, March 8, April 28, May 26, and June 2) were approved without changes.

James Jenkins, R.N., represented Department of Health Professions Director Arne Owens at this meeting. He reported that the Department was working to carry out the directives of the General Assembly, which included increased access to mental health services and expanding the healthcare workforce. He said DHP had hired the RAND Corporation to identify workforce needs in Virginia.

Jamie Sacksteder, Executive Director of the Board of Dentistry, and Dr. Bryant attended the Health Occupations Student Association Conference, where they served as judges for students presenting table clinics. The students were Virginia high school students competing for trips to attend a national conference. Ms. Sacksteder also reported that she attended the VDHA conference, where she spoke on workforce issues related to dental hygiene.

Board member Margaret Lemaster, RDH, reported she and Dr. Bryant served as examiners for a combined CDCA-WREBCITA licensure exam in Danville. Three sets of seven to eight students were judged in a full-day event. Dr. Bryant noted that Virginia now accepts only the ADEX exam for licensure, and a national conference of ADEX examiners would be held this year in Colorado.

Matt Novak, DHP Policy and Economic Analyst, reported that regulations

for training in infection control, now required of dental assistants, were being developed. The training would include either a class or Continuing Education and will be documented in the employee record. In reply to a question from Dr. Sultan Chaudhry, he said that annual OSHA training is acceptable as a form of training for this requirement.

position on this proposal and has done nothing to promote it. Dr. Bryant spoke in opposition to the Compact for a number of reasons. Dr. Dag Zapatero said the Compact could allow a dentist to be sanctioned or suspended in another state and then relocate to a participating state without consequences.

Ms. Sacksteder said there was no cost estimate for Virginia to participate, and it was unclear under what circumstances a license could be denied. Also, dentists who had not completed a CODAapproved program would be granted licenses according to the Compact. Dr. Bryant then asked each Board member to give their opinion of the proposal, and none spoke in favor of it. Dr. Zapatero and Dr. Jamiah Dawson said further study of the concept might be valuable.

Mr. James Rutkowski, Assistant AttorneyGeneral for the Board, reported that a court case had been decided in favor of the Board, and the plaintiff had dropped the appeal.

Ms. Sacksteder submitted the 2024 Board calendar, which was approved unanimously.

The Board has been studying the Dentist and Dental Hygienist Compact, in which participating states agree in advance to accept each state’s licensees and also accept the other states’ regulations and permits. A letter in support of this proposal was submitted by the Association of Dental Support Organizations. The VDA has submitted a letter to the Board from Ryan Dunn and Scott Johnston, legal counsel, stating that the VDA has no

Ms. Sacksteder reported that SB 1539, passed by the 2023 General Assembly and signed into law, directs the Board to develop regulations that will allow general dentists to administer Botox for cosmetic treatment. She said the Regulatory Committee of the Board would make recommendations to the entire Board of Dentistry. The bill only allows Bwotox injections and not dermal fillers. Any training or CE completed prior to the issuance of regulations will not meet requirements. In response to a Board member’s question, she said 18 months would be the minimum time for developing these regulations. Dr. Zapatero reported that he had used Botox in his practice for therapeutic reasons and had encountered no clinical problems.

“The Board has been studying the Dentist and Dental Hygienist Compact, in which participating states agree in advance to accept each state’s licensees and also accept the other states’ regulations and permits.”

Ms. Sacksteder reported that the online registry CE Broker® was available on the Board’s website as of May 13 and could be used as a tool to aid licensees in keeping records of CE completion. An audit of 1% of Virginia DDS and RDH licensees has been completed.

It was noted that this meeting was Dr. Bryant’s last as Board President, and Board members thanked him for his service, and congratulated him on his accomplishments during his term.

For the good of the order, Dr. Zapatero said the Board needed to investigate Artificial Intelligence and ChatGPT

and determine how they would affect practicing dentists. Ms. Sacksteder reported that the DHP already has a study underway.

The meeting was adjourned at 10:20 a.m.

Editor’s Note: Dr. Roadcap serves as Editor of the Virginia Dental Journal Information is presented here for the benefit of our readers and is deemed reliable but not guaranteed. All VDA members are advised to read and comprehend all Board of Dentistry regulations and policies.

REUSING AND ADAPTING MARKETING CONTENT TO MAKE YOUR LIFE EASIER

Michaela Mishoe, Account Executive at The Hodges Partnership

Whether you manage to find a few minutes to dedicate to your dental practice’s marketing channels or members of your staff help carry the load, coming up with new content can take time.

Fortunately, there are several ways to create an efficient, long-term content plan for your practice’s social media pages, website and other marketing channels.

Here are a few tools and strategies to help you build weeks of consistent content, plan around important dates and recognitions, and create a content plan that’s strategic, creative and aligned with your marketing goals.

Create an Editorial Calendar

One tool marketers use is a social media editorial calendar. An editorial calendar is a document used by businesses to create and plan content across different channels on a daily, weekly or monthly basis.

An editorial calendar lets you highlight important dates throughout the year so you can plan ahead to capture or create content, and you’re not scrambling at the last minute to share something. You can also leverage an editorial calendar to plan content for different channels, such as your Instagram page, Facebook page and email communication.

Here are a few basic elements that every social media editorial calendar should have:

• Date

• Post copy

• URL

• Hashtags

• Tagging notes

• Platforms

• Creative (Photos or video, for example)

There are several tools you can use to build your editorial calendar, including Google Sheets, Trello and Monday.com

To make the most of your editorial calendar, sit down monthly or quarterly and highlight oral health days, office milestones, employees’ birthdays and other dates that you will want to share content around.

There are many ways to create and manage an editorial calendar. It’s about finding what works for you and your team.

Build a Bank of Photos, Quotes and Testimonials

Stock images are great to use in a pinch, but these days, you don’t need an expensive camera to take photos that are aesthetically pleasing and authentic.

Set aside a few hours at the beginning of each quarter to take photos of your office, staff and with permission, patients. This will allow you to build a bank of your own “stock images” to use when you don’t have new content to post.

Remember to follow HIPAA guidelines whenever you’re sharing visuals of your

office to protect your patients and your staff. If you’d like to use photos of patients in email or social media posts, make sure to receive permission from the patient or a parent or guardian. The ADA provides a sample photo release that’s available for members to adapt to use in their practices. The release can be found on its website under Resources for Managing Patients.

Similar to a photobank, you can build up a bank of quotes from patients and staff. These quotes and testimonials can be used on your website, email newsletter or social media graphics.

Tools like Canva allow you to create professional graphics quickly. You can use one of the site’s free templates or create your own.

“Slice” and Recycle Your Content

To manage your content like a marketing pro, make your content work for you. Instead of using one piece of content one way, think about how you can cut it up and spread it out.

If you have a long testimonial or blog post, extract smaller quotes, especially

Here is an example of what your editorial calendar could look like. This was created in Google Sheets.

when they contain important facts or impactful statements. You can create graphics with these quotes, share on your website or email newsletter.

Using trends such as #throwbackthursday allow you to share content you previously posted, and even highlight updates around the content, such as new additions to your office space or staff growth.

If you send out a newsletter with data and facts around oral health, pull out important points and create graphics for social media.

Finally, consider taking advantage of trusted third-party content from organizations like the ADA and

VDA. Follow both organizations on social media and engage and reshare content.

For example, the ADA recently shared an article on keeping family smiles healthy all summer long as part of its Mouth Healthy Campaign. You could reshare this article and add your own tips. When sharing third-party content, make sure to always credit the original source.

Recycling and stretching your content across channels keeps it fresh and consistent with your brand image and messaging. It will also save you and your staff time and energy, allowing you to focus on taking care of patients.

C o n s i d e r i n g a P r a c t i c e T r a n s i t i o n ?

" I w a s i n c r e d i b l y p l e a s e d t h e y f o u n d t h e p e r f e c t b u y e r f o r m y p r a c t i c e . I l e f t k n o w i n g m y p a t i e n t s w o u l d b e w e l l t a k e n c a r e o f . "

D r . P e t e r L a n z a r o - F a i r f a x S t a t i o n , V A

" T o d d a n d S h e r y l m a d e i t p o s s i b l e f o r m e t o r e t i r e a n d r e s t f i n a l l y .

T h e i r d e v o t i o n , h a r d w o r k a n d e m p a t h y i s u n m a t c h e d . " D r G o p a l S i v a r a j P a l - S t e r l i n g , V A

" N o t h i n g f e l l t h r o u g h t h e c r a c k s a s t h e y w e r e a t t u n e d t o a l l t h e d e t a i l s a n d a t i m e l y r e s o l u t i o n o f o u t s t a n d i n g m a t t e r s . " D r . M i c h a e l F R u b i n - A r l i n g t o n , V A

" W e h i g h l y r e c o m m e n d T o d d a n d S h e r y l t o a n y o f o u r c o l l e a g u e s f o r t h e i r p r a c t i c e t r a n s i t i o n . " D r s . A p r i l T o n a n d Q u a n N g u y e n - B u r k e , V A

S e e W h a t O t h e r V i r g i n i a D e n t i s t s a r e S a y i n g a b o u t T h e i r E x p e r i e n c e w i t h D D S m a t c h : i t a l l s t a r t s w i t h a c o n v e r s a t i o n . b e g i n y o u r t r a n s i t i o n t o d a y

T o d d & s h e r y l g a r f i n k e l ( 4 4 3 )

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OUR REGIONAL WORKFORCE NEEDS

Paul Logan, Director of Strategic Initiative/Innovation

As the Virginia Dental Workforce Council, chaired by VDA President Dr. Cindy Southern, has continued its work, one point of agreement has been the need for state resources and local partnerships to address regional needs.

Some parts of the Commonwealth have a significant imbalance of dentists and hygienists, particularly Northern Virginia and the Richmond region. And there are parts of the state where it’s clear there are barriers to dentists being able to practice that must be addressed.

In Northern Virginia alone, if we had a ratio of hygienists to dentists comparable to the national average, we would have approximately 400 more dental hygienists, able to provide about 60,000 more Virginians with access to dental care at an appointment every month.

We can talk about state-level stats, in which Virginia is the bottom ten states in its ratio of dentists to hygienists but above average in its concentration of dentists.

But there isn’t a “one size fits all” solution to our dental workforce in Virginia. To address the oral healthcare needs in our communities on an ongoing basis, we need to make it easier for dentists to practice where there are shortages and to address areas where there’s an imbalance in our workforce. Our needs in Pulaski are different from Purcellville.

The good news is that our trajectory is better than many other states. We had 220 more dental hygienists licensed in Virginia in 2022 than in 2021, bucking a national trend that saw seven percent fewer dental hygiene graduates from CODA-accredited programs year-overyear.

Addressing regional needs can include but will go beyond simply expanding and developing new allied dental programs. Existing programs have significant faculty recruitment and retention needs. VDA member dentists can make a difference by supporting those programs as adjunct faculty.

The Workforce Council is exploring additional ways to support these programs, including recruitment, providing support to increase graduation rates and address reasons students may not finish the programs, making clear pathways for transitioning veterans to pursue civilian careers in dentistry, and creating closer partnerships with free and charitable clinics for clinical instruction. We will pursue closer relationships with high school counselors and engage in creative ways to educate students early about the promise in dental careers.

Furthermore, the VDA continues to advocate for additional flexibility from the Commission on Dental Accreditation (CODA) around strict faculty-to-student ratios in instruction and other factors that increase the challenge of operating a dental program. CODA has responded with an Ad Hoc Committee to review faculty-to-student ratios within the Accreditation Standards, and the VDA is among 19 other state dental associations urging this committee to commit to a meaningful scope in its review.

The Virginia Dental Workforce Council has brought together a talented and committed group of leaders in oral health, workforce development, and state government working together for better oral health in all parts of Virginia. Members interested in learning more about its work and how they can be involved can contact Laura Givens at Givens@vadental.org

ANSWERING YOUR FREQUENT DELTA DENTAL QUESTIONS

Dr. Brad Guyton; Delta Dental of Virginia, Chief Dental Officer

At Delta Dental of Virginia (DDVA), we find ourselves repeatedly answering the same questions from dentists. So, I wanted to use this space to address some of those questions and to shed some light on how the Delta Dental system works. Allow me to give you a front-row seat to an imaginary conversation between a Virginia dentist, let’s call her Dr. Jane, and me.

Dr. Jane: What is Delta Dental of Virginia, and how does it operate?

Dr. Brad: Delta Dental of Virginia, or DDVA, is a member of the national Delta Dental Plans Association and is one of 39 Delta Dental member companies operating in all 50 states, the District of Columbia, and Puerto Rico. Most Delta Dental companies are independent and have their own boards of directors. As of 2022, Delta Dental companies served more than 89 million Americans and more than 166,000 groups. DDVA covers more than two million members and serves 5,000 employer groups. Since DDVA is headquartered in and licensed to offer dental coverage only in Virginia, our customers consist of employers that are headquartered in Virginia and individuals, such as retirees, small business owners, or employees who don’t have access to an employer-sponsored dental plan.

In a typical year, DDVA will answer more than 670,000 phone calls and process more than four million dental claims – all from our office in Roanoke. About 70% of those phone calls will be from dentist offices. We also have dedicated network professionals throughout the state to ensure that we maintain close and personal contact with Virginia dentists and their staff.

Dr. Jane: How does claims processing work when I see a patient who is a member of another Delta Dental member company?

Dr. Brad: Since some of our group customers are among the world’s largest companies, DDVA has members who live and work in other states. Likewise, many Virginians are employees of companies headquartered in other states – think Amazon and Walmart, and are members of Delta Dental of Washington and Delta Dental of Arkansas, respectively.

The Delta Dental Plans Association maintains a National Provider File (NPF) system, which contains the contracted fees for each Delta Dental member company. When an out-of-state claim is filed, it flows through the NPF, allowing the claim to be processed in accordance with the correct contract. All of this happens in a matter of seconds so that quick claims turnaround is possible.

Dr. Jane: So, what happens when I treat a patient who lives in Virginia but works for an outof-state company and is covered by another state’s Delta Dental company plan? I didn’t agree to abide by their fee amount.

Dr. Brad: As a DDVA participating dentist, your claims are paid according to your fee arrangement with DDVA, regardless of whether your patient is covered by DDVA or another Delta Dental member company. When a Virginia dentist reads an article about another state’s Delta Dental member company making changes to its fee amounts, it’s understandable to wonder, “how will it impact me if some of my patients work

“In a typical year, Delta Dental of Virginia will answer more than 670,000 phone calls and process more than four million dental claims — all from our offices in Roanoke. About 70% of those phone calls will be from dentist offices.”

for an out-of-state company and receive treatment in my office?” The short answer is Member Companies will process their Virginia employees’ claims using the Delta Dental of Virginia fee data that they will access on the NPF.

Dr. Jane: Why should my practice participate in your or any other carrier’s network?

Dr. Brad: Millions of Americans have dental coverage through their employers and programs such as Medicaid or through individual and family plans that they choose to purchase. In fact, dental insurance consistently ranks as one of the top most desired benefits offered by an employer. According to the Delta Dental Plans Association 2022 State of Oral Health Report, 93% of Americans say that having dental coverage gives them a reason to visit the dentist at least once a year. And 82% of adults with

coverage report having visited the dentist, compared to only 55% of those without coverage.

According to a National Association of Dental Plans (NADP) study, approximately 5.7 million Virginians have some form of commercial dental coverage (not counting those with Medicaid). That is a lot of Virginians looking for a dentist who will take their insurance plan.

Of course, each dentist office has to weigh the benefits of having access to a large population of covered patients versus the cost of agreeing to provide services at the contracted rate.

Dr. Jane: I’m glad you mentioned contracted fees. Many carrier reimbursements are not keeping up with inflation. When do you plan to address that?

Dr. Brad: Each year, we evaluate information to ensure that our fee amounts are competitive. While it may vary for individual practices, in general, Delta Dental doesn’t always have the lowest fee amounts. We want to provide higher fee amounts, but we also are competing against dental carriers that are negotiating lower fee amounts so that they can offer lower premium rates to employer groups. That said, in 2021, DDVA increased fee amounts for our Delta Dental PPO network dentists, and we increased the fee amounts again on the most heavily-utilized codes for our Delta Dental PPO and Delta Dental Premier dentists in January of 2023. Based on our current evaluation, it is anticipated that another fee increase will be implemented in January 2024, barring any unforeseen regulatory changes that could drive up administrative costs.

That’s about all of the space I can take up this time. I hope to have another opportunity to address other topics of interest. In the meantime, if there are specific questions you would like answered, feel free to email me at ProviderRelations@deltadentalva.com

A PARTNERSHIP WITH SPECIAL OLYMPICS, ORGANIZED DENTISTRY, THE COMMUNITY, AND TWO DENTAL SCHOOLS

Phillip Ashkar, BS, MS 1 ; Lauren Karr, BA 2 ;Ava Kiser, RDH3; Michelle McGregor, RDH, M.Ed4; Tara Quinn5; Terry Dickinson DDS6; Matthew Cooke, DDS, MD, MPH7

For thirty-year-old Shelby, access to dental care has never been within reach. At birth, Shelby was diagnosed with Cerebral Palsy, a neuromotor condition that affects muscle movement, coordination, and balance. Shelby’s Cerebral Palsy demands specialized care: an operatory that can reasonably fit her wheelchair and a dental provider who can safely stabilize her head and neck, among many other nuances. Yet, few dentists in her rural community possess the resources to comprehensively manage her dental treatment.

Unfortunately, Shelby’s story is commonplace as thousands of Americans with complex medical conditions find themselves struggling to identify a dental home that can aptly cater to their needs. Among marginalized populations, patients with special needs are arguably one of the primary groups facing this oral health disparity. When referring to “special needs”, the American Academy of Pediatric Dentistry (AAPD) delineates the term as “any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs.”1 Healthcare professionals cannot fall into the trap of assuming that special

needs patients make up a minute subsect of the population. According to the Residential Information Systems Project, nearly 7.39 million Americans were classified as having Intellectual or Developmental Disabilities (IDD) in 2019.2 Going further, the Journal of the American Dental Association estimates that 12% of patients with intellectual or developmental disabilities require some type of specialized care, ranging from moderate sedation to providers trained in advanced behavioral management. These intellectual and developmental disabilities directly influence different facets of oral health and are some of the many reasons why expanding dental access is vital to these groups.

Regarding the profound presence of oral health disparities within this group, a study from the International Journal of Pediatric Dentistry states that caries and periodontal disease are highly prevalent in individuals with IDD conditions.5 Rationale for why this specific population suffers in extreme from oral health challenges can be attributed to medications, specialized diets, neuromuscular problems, and poor oral hygiene.6 Because of the proven impact of oral health on systemic health, this correlation underscores the necessity of comprehensive care for this higher-risk population.

With a high prevalence of disease and a lack of adequate intervention, the oral health care needs of the IDD population remain unmet. While it is not realistic to address all possible contributors to this ongoing burden, various factors including psychological and educational barriers, along with a lack of overall accessibility and availability of dental care contribute to the current oral health disparity among individuals with IDD. It is worth mentioning that continuous efforts

are being made across the country to cater to the special needs population. Unfortunately, this worldwide disparity remains just as substantial due to the vast number of patients in comparison to the inadequate number of providers making an effort to provide care for them.

In 1997, Special Olympics Healthy Athletes began to address this discrepancy in access to care for patients with special needs. This program was designed around inclusivity, as it provides free healthcare tests and information to Special Olympics athletes competing. In 2011, Virginia Special Olympics Healthy Athletes: Special Smiles and the Mission of Mercy project began to collaborate in order to provide comprehensive dental care to Special Olympics athletes. 2022 marked the first year that the organizations in Richmond extended the invitation to members of the local underserved community. With a large community presence in 2023, in addition to the athletes participating in Special Olympics, volunteers were able to appreciate that oral health disparity was not only observed in the special needs population alone. Instead, it was undeniably prevalent in our own community around us in Richmond. When considering patients who lack access to care, we cannot overlook individuals without health and/or dental insurance. Although government aid such as Medicaid and Medicare are available to those who qualify, the Virginia Dental Association (VDA) states there is a profound nationwide shortage of dental providers who accept Medicaid and little to no dental coverage provided for those receiving Medicare.7 According to a report by Data USA in 2020, 18.7% of the population in Richmond are on Medicaid, 10.4% are on Medicare, and 11.5% are without any type of health insurance.8 With

this data, it is reasonable to conclude that there is a sizable portion of the population in Richmond that is faced with difficulties in access to appropriate oral health care.

Aside from health insurance coverage, it is known that a greater likelihood of poor oral health status is directly and most commonly linked to low socioeconomic status.9 Additionally, poor oral health status is most likely to be seen by those who are uninsured, of a racial/ ethnic minority, or immigrants. In order to gauge the significance of how many may be affected by this oral health disparity, it is worth considering that 12.5% of individuals residing in Richmond are foreign-born, and the third largest ethnic group is Hispanic, at 7.08%.10

The prevalent oral health disparity in this population is likely a result of social determinants and underutilization of dental care.11 An additional factor that must be considered is how health equity is affected by languages spoken and cultural literacy in healthcare.9 This translates to possible difficulties communicating with healthcare providers and apprehensiveness in seeking needed services.

On Saturday, June 10, 2023, dental students from the University of Pittsburgh School of Dental Medicine and Virginia Commonwealth University School of Dentistry collaborated to provide free surgical, restorative, and prophylactic services to these patients. Services were primarily student-led, with monitoring from both universities’ staff as well as local dentists, dental hygienists, and assistants, offering an environment

promoting significant opportunities for teaching and learning. In Robins Center at the University of Richmond, over 175 patients were seen that day. Counting patients that were seen in the Special Smiles screening, Mission of Mercy, or both, there were a total of 527 procedures completed: 119 examinations, 50 cleanings, 50 fluoride varnishes, 105 restorations, 60 extractions, 142 periapical and bitewing x-rays. Some inconsistencies in numbers were due to patient records not being returned after treatment. Services valued at more than $48,000 were supplied completely free to athletes of all ages, friends with significant needs, and members of the local community.

Although the outcomes of public outreach events like these are impressive, free dental clinics cannot compensate for the unwavering oral health disparity of patients with Intellectual or Developmental Disabilities (IDD) or any other individuals suffering from lack of access to dental care for any reason. Every year, we continue to see the ceaseless prevalence of profound oral and dental diseases that affect individuals in our community. Yet as the years go by, the question of why there is no immediate remedy to this ongoing burden goes unanswered. The multifactorial collection of barriers to access to care for these patients must be unraveled and addressed in order to make a positive change for those displaying unequal opportunities for optimal oral health. The many other injustices endured by our vulnerable populations are why widespread influence and prevention at multiple levels must be used in order to deconstruct the barriers to access to dental health care.

Thank you to all who volunteered to make our event amazing. We look forward to 2024 and hope you can join us.

References

1. https://www.aapd.org/ research/oral-healthpolicies--recommendations/ special-health-careneeds/#:~:text=Special%20 health%20care%20needs%20 include,of%20specialized%20 services%20or%20programs.

2. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC4527687/

3. https://publications.ici.umn. edu/risp/infographics/peoplewith-idd-in-the-united-statesand-the-proportion-whoreceive-services

4. https://www.sciencedirect. com/science/article/pii/ S000281771464681X?via% 3Dihub

5. https://onlinelibrary.wiley.com/ doi/pdf/10.1111/ipd.12274

6. https://www.sciencedirect. com/science/article/pii/ S1013905222001109

7. https://www.vdaf.org/ourprograms/mission-of-mercy. html

8. https://datausa.io/profile/geo/ richmond-va

9. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC7125002/

10. https://www.rva.gov/ immigrant-engagement/about

11. https://www.sciencedirect. com/science/article/pii/ S0002817715008740

Author Endnotes

1 & 2 Senior (4th year) Dental Student, University of Pittsburgh School of Dental Medicine

3 Private Practice Dental Hygiene, Pittsburgh

4 Director of Community and Collaborative Partnership; VCU School of Dentistry, Department of Dental Public Health, and Policy

5 Executive Director; Virginia Dental Association Foundation

6 CEO, Emerging Leadership LLC; Former Executive Director, Virginia Dental Association; and “Trail Boss,” Virginia Mission of Mercy

7 Healthy Athletes Special Smiles

Clinical Director, Special Olympics of Virginia; Associate Professor of Anesthesiology and Pediatric Dentistry, University of Pittsburgh School of Dental Medicine.

Newport News Area Beau�ful, FFS/PPO prac�ce with 5 operatories and room for 3 more. Located in a standalone building with 3300 sq/�. Prac�ce collectes $450K /year with a very strong hygiene program. Paperless and digital. Tons of treatment is referred out. Real estate is available for sale or lease.

Norfolk Collec�ng over $800K per year. Currently has 7 operatories with room for expansion. Office is paperless with digital x-ray. Seller is re�ring.

Seller working very part-�me. Prac�ce is priced to sell.

Arlington The prac�ce operates out of a 1,600 sq � beau�ful condo space that is also available for purchase. Collects $275K per year in revenue on a mix of PPO/FFS pa�ents. 4 equipped operatories, digital x-ray, digital pano, and CBCT.

under contract

Northern Virginia This lovely prac�ce is located in a beau�ful town just outside the city. The prac�ce operates out of a 1,500 sq � rented space and generates over $625K per year in revenue on a mainly PPO pa�ent base. There are three equipped operatories, digital x-ray, Dentrix dental so�ware, and a strong staff in place.

Newport News Grossing around $800K per year. Currently has 7 operatories with room to grow in a 2500+ square feet space. The office is paperless and fully digital.

NOVA Modern ortho prac�ce iwth 4 chairs and room to expand. Mainly FFS pa�ents. Collec�ng $500K/year. Very profitable. Fully digital. Real estate for sale or lease. Plenty of visibility, ample parking.

Lynchburg Area This prac�ce has 4 equipped operatories with room for expansion. Consistently generates over $500K in revenue per year with incredibly high cashflow. Pa�ent base is a blend of FFS and PPO pa�ents. Real estate is available for sale. Seller wants to re�re.

Dr. Demir Tulunoglu has joined the prac�ce of Dr. Joe McIntyre Bridgewater, Virginia

under contract

Hampton Roads Collec�ng $400K per year. Mainly PPO pa�ent base. 4 ops with room to expand. Seller wishes to stay on. Great satellite opportunity.

SW Virginia Well established prac�ce for sale on a busy road with great visibility. Collects over $750K working only 10 months out of the year. Seller refers out oral surgery, ortho, endo, & perio.

Greater Tyson Endo This prac�ce has a CBCT and laser. Mix of PPO and FFS pa�ent base with 2 very spacious operatories.

Dr. Jhosdyn Barragan & Dr. Joshua Anderson have acquired the prac�ce of Dr. Eric Mestas

Alexandria, Virginia

THE SOFT SKILLS OF THE CLINICAL EXPERIENCE

Michaela Banks; Class of 2024, VCU School of Dentistry

The clinical experience at the VCU School of Dentistry is an unmatched, rigorous schedule that has allotted me multiple learning opportunities in not only perfecting the technical aspects of our craft but also the soft skills that come with patient management. Under the guidance of attentive and passionate faculty, I have been encouraged to leave my comfort zone to educate, treat, and advocate for my patients.

While my goal as a provider has always been to give patients comprehensive and personalized care, stepping into the clinic for the first few months was an overwhelming experience. The clinical aspects of dentistry became the easy part of appointments. Learning to communicate with my patients regarding their treatment needs,

explaining the disease processes in layman’s terms, and reassuring anxious patients became the most challenging. While I earned the confidence of some patients immediately, others took longer to establish this trusting relationship. Navigating these conversations during my first few patients was difficult. I remember stumbling over my words when communicating with my patients regarding their treatment plans. I have learned many tips and tricks by listening to faculty, such as Dr. James Vick (Director of Predoctoral Practice Group 5) and Dr. Fredrica Mackert (Assistant Professor), about how to phrase and steer these conversations in the right direction. I admire their abilities to instantly connect with all patients and soothe apprehensive ones. I picked up some of their mannerisms and techniques and then added my own twist that worked best for me. It became

about listening to the patient first and utilizing my own analogies to effectively communicate their dental needs.

The ultimate goal is to have a trusting relationship with patients, and I have seen that implementing soft skills in my appointments has allowed me to cultivate these relationships. As I continue to improve upon my communication skills, other areas of my appointments continue to run more smoothly. My time management has improved greatly, my ability to direct my team and express my needs became easier, and my capacity for empathy continued to be unwavering. As a novice dentist, I know these are skills I will use for the entirety of my career and homing in on them now will continually prove to be beneficial for my patient population.

VDA DENTAL DAYS AT THE CAPITOL RECORD HIGH STUDENT TURNOUT

Lakshya Ramani; Class of 2024, VCU School of Dentistry

Dental Days at the Capitol 2023 kicked off bright and early at the Omni Hotel in downtown Richmond on Friday, January 27, 2023. Dozens of students clad in wine-colored scrubs sat at round tables with dentists from across the Commonwealth. A palpable, nervous bubbling of chatter and anticipation ebbed over the room.

For many students, Dental Days marked our first foray into the world of political advocating. For most of us, our last (and frankly, most lasting) exposure to the legislative process was Schoolhouse Rock’s “I’m Just a Bill.” Somewhere along our educational path, we decided to forgo Political Science to re-learn the Krebs cycle for the third time, so it was nervewracking, to say the least! The VDA took this challenge head-on and was instrumental in bridging the gaps in our knowledge and providing students with talking points so that we could better advocate for the future of our profession. By the end of our welcome breakfast, we felt comfortable enough to speak with our legislators and fellow dentists regarding the issues facing dentistry in the Commonwealth. It was a gift to connect with dentists from

across the commonwealth all the while helping advance the future of dentistry.

During Dental Days 2023, the VDA advocated to amend the mental health attestation question on licensure application, which directly helps combat the stigma against providers seeking mental health support by removing language that implied illness and impairment as being synonymous. Additionally, due to the increase in violence against healthcare providers in the wake of the COVID-19 pandemic, we also advocated for harsher penalties for those that threaten healthcare providers verbally or physically. Virginia only offered this protection to providers working in a hospital or emergency room. This protection did not previously extend to providers working in an urgent care setting, doctor’s offices, or pharmacies, which left a large portion of healthcare providers unprotected.’

Finally, Senator Todd Pillion’s (VCU DDS, 2001) Cosmetic Botox Bill SB 1539 was passed and signed by Governor Younkin to go into effect July 1, 2023. This bill will allow dentists to

administer Botulinum toxin injections for cosmetic purposes following proper training as set forth by the Board of Dentistry in Virginia. The VDA will be engaged with the Board of Dentistry on the development of these regulations to ensure they are fair and reasonable.

Dental Days 2023 was an incredibly rewarding and eye-opening experience for the students lucky enough to participate. The VDA’s close relationship with VCU allows students to be actively engaged in the future of dentistry while we are still undergoing our training. This relationship has proven to be vital in protecting the impeccable legacy of the dental profession in our state and ensuring that the future of dentistry and dentists is safeguarded. I would like to take this opportunity to thank VCU School of Dentistry for allowing third-year dental students to participate in this event as well as the VDA for helping promote student involvement on such a large scale. This experience was a highlight of my dental career thus far, and I look forward to continuing to foster a close relationship with the VDA throughout my career.

STUDENT NATIONAL DENTAL ASSOCIATION HOSTS ORAL CANCER WALK

Jaycee Cureton; Class of 2024, VCU School of Dentistry

On Sunday, April 16, 2023, the Virginia Commonwealth University’s Student National Dental Association (SNDA) hosted its 12th Annual Oral Cancer Walk. This event aimed to promote oral cancer awareness and raise money for oral cancer research. A portion of the proceeds were donated to the Philips Institute for Oral Health Research. This year the proceeds were included in the VCU School of Dentistry Giving Day fund, which will support the Phillips Institute’s research fund goal of $250,000.

Oral cancer is twice as common in men than in women. According to the Oral Cancer Foundation, approximately 54,000 people will be diagnosed with oral cancer this year. Oral and pharyngeal cancers are attributed to tobacco, heavy alcohol use, and HPV. The good news is that early detection significantly reduces the risk of death. The walk is committed to raising awareness of the cause.

The Student National Dental Association (SNDA) originated from concerned dental students at Meharry Medical College in 1970. SNDA was formed to give a structured mechanism to promote contact between minority dentists and dental students. Since its humble beginning, SNDA has grown to approximately 1,100 minority dental student members across the nation. Our mission has been to

promote, support, and encourage recruitment and retention of minority dental students. We are committed to engaging in outreach efforts, providing oral hygiene education, and improving access to care, emphasizing our efforts on minorities and the underserved. We were honored to host this event this year to increase the detection of oral cancers and help save lives.

MEET THE CANDIDATES

VOTING BEGINS JULY 17, 2023 AT VADENTAL.ORG/VOTE

Dr. Justin Norbo

It would be my honor to serve as your next President-Elect of the Virginia Dental Association. The Virginia Dental Association has been a part of my life long before I even considered becoming a dentist. As a kid, I remember traveling with my parents to the annual VDA meetings at the Cavalier Hotel in Virginia Beach. My childhood memories from these beach trips included watching the friendships my father had with his colleagues; friendships that have certainly transcended the years. Many years later, as I entered the profession, it became apparent to me how the VDA helped provide the network for these friendships. I, too, have made friends with so many colleagues through the VDA, and I expect these relationships to enrich my personal and professional life. I think we can all attest to the network and strength of our VDA. For over 150 years we have successfully advocated for our patients and the profession through our history of strong leadership and robust membership. That tradition must continue for us to maintain our relevancy in such a dynamic market. It is appropriate for us to tout our historical victories, such as non-covered services, de minimis clause legislation, increased Medicaid reimbursements, etc., but the adversities facing our profession are only growing. Third party intrusion, workforce

shortages, and increased governmental regulations are just a few of the current issues facing our members. I mention these challenges not as a doom-and-gloom for our new members but as a reality check that the profession needs the Virginia Dental Association…and the VDA needs its members in order to overcome these adversities. I don’t think anyone would argue that the dental landscape seems to be changing exponentially faster than it has in years past. This is an opportunity for the VDA to capitalize on forward-thinking concepts to continue to poise ourselves for success. I believe that as an organization of nearly 4,000 member dentists, we should leverage our size to exploit opportunities for our membership. These opportunities exist; we simply need the courage to explore them. I am truly excited about the future of the VDA. Our previous leaders have poised our association for success at every turn. With your support, I am ready and willing to put forth the effort needed and required to continue to lead the VDA. I am running for the position of President-Elect because I am committed to the future success of the VDA.

VDA President-Elect (1 position available)

ADA DELEGATE (4 positions available)

Having served as Delegate in the past, I feel this is not only an honor, but a responsibility I take very seriously as we approach a very pivotal time in ADA history. Membership and younger member involvement is not only needed, but we need to affect changes that enable younger member investment in the ADA and organized dentistry. As a delegate with some experience, I feel that I can help make positive change for the ADA and dentistry in the years to come.

Dr. Justin Norbo

I have been very fortunate to serve on the 16th District Delegation for the past several years. I am running for another term as Delegate on the delegation because I am passionate about contributing all I can to the tripartite. Last year I served on the ADA’s Strategic Forecasting Task Force which evolved, through passage in the House of Delegates, into the Strategic Forecasting Committee. The Task Force spent a tremendous amount of time and effort to develop a very forward-thinking concept and model to advance the ADA. It was a very rewarding experience serving on the Task Force, and I intend to continue to bring that same forward-thinking mindset and attitude to the ADA’s House of Delegates in the future. At a very important time in our Association’s history, it is going to require full commitment from volunteers to maintain relevancy for the ADA. I wish to fulfill my commitment and serve the members of the ADA. I appreciate your consideration and for allowing me to serve you.

It has been an honor and a pleasure to serve as an ADA alternate delegate over the past four years, and I am hoping you will allow me to serve as one of your ADA delegates in the coming term. At a time when the trend is to pull away from group involvement outside of office and home, there is nothing more important than being a part of an organization that has your wellbeing and your back as its highest priority. From our grassroots local components to our national ADA, we are working to strengthen support for our members and facilitate communication from local to national and vice versa. Our 16th district delegation works hard to help bring legislation and support efforts of the ADA to be more flexible and adaptive to the changing needs of our profession and our members. What keeps me so passionate about organized dentistry? The future of our profession for the next generation. I want our profession to be as vibrant and impactful for my daughter, who is finishing her 2nd year of dental school (VCU!), my young partner, and all their colleagues as it has been for us all these years. If we don’t preserve and protect our profession, who will? I am so appreciative of your support over the years, and I humbly ask for your vote to allow me to continue to serve and represent your voice on a national level.

Dr. Brenda Young

As a current ADA delegate, I ask for your support as I seek another term in this position. I feel there is so much more I can do to support and promote our profession as an ADA Delegate. We have many changes ahead of us and I would like to be a Virginia voice of dentistry. I have currently been active on a local level at addressing the workforce shortage issue. Our problem is not unique and as a profession, we need to find solutions. Virginia is a great state to practice dentistry, and I want to make our voices heard in organized dentistry. Thank you for allowing me to be a part of this great community, and I hope you allow me to continue as your ADA Delegate.

Dr. Frank Iuorno, Jr.

Dr. Benita Miller

At Commonwealth Oral & Facial Surgery, we know we have to earn the trust of referring dentists every day. So we do all we can to ensure that your patients are treated with the utmost care and expertise for services such as wisdom teeth removal, dental implants, bone grafting, jaw surgery, facial trauma and oral pathology. This team of friendly, patient-focused doctors includes surgeons voted as Top Dentists by other dentists in Richmond Magazine and Virginia Living. With six locations — we also make our practice convenient for your patients. Please call us to learn more. And from all of us, thank you for your continued referrals.

Left to right: Dr. Greg Zoghby, Dr. Nick Broccoli, Dr. Sean Eccles, Dr. Ammar Sarraf, Dr. Mike Miller, Dr. Lauren Kaplan, Dr. Drew Ferguson, Dr. Charlie Boxx, Dr. Jeff Cyr, Dr. Walt Murphy

ADA ALTERNATE DELEGATE (5 positions available)

I would like to impact our Association by guiding us in the best direction for our members, patients, and profession. I’m supportive of ideas that grow our membership but don’t compromise the integrity of our profession.

Dr. Jeena Devasia

Serving on the delegation since 2019 has been a rewarding experience and one that I’d love to continue as an Alternate Delegate. Representing our state and voting on resolutions that allow our organization to support the best interests of its members and the communities that we serve is an honor. It has been incredibly humbling to work alongside colleagues with a vast knowledge of our organization’s history and to watch their tireless efforts to support the needs of younger dentists like myself. I look forward to continuing to learn on the delegation and appreciate your support.

I have served as Richmond Dental Society President and on the VDA Board of Directors. I would like to continue serving my component and the member and nonmember dentists of Virginia as an Alternate Delegate for the ADA House of Delegates to help guide the association into the future.

As a dentist anesthesiologist (DA), a basic tenet of what we do is to serve both our patients and our fellow dentists. There is no need for a dentist anesthesiologist without our operating dentists; we cannot exist independently without violating our parameters of care. Many of my colleagues forget this, but I believe the participation of DAs in the ADA is long overdue and we must move on from the past and move forward together. In this case, I believe the best way to encourage such is to lead by example. In doing so, I believe my demonstrated skill set and involvement in advocacy, education, and organized dentistry will be an asset to the Virginia Dental Association.

I humbly ask for your vote to allow me to serve as an ADA alternate delegate. As someone who was born and raised in Virginia and continues to live, serve, and practice in the Commonwealth, I have been involved in organized dentistry since dental school. I have served in numerous leadership capacities on the local, state, and national levels. I am a Past President of the Lynchburg Dental Society, a member of the American Association of Endodontists, a board member of the Piedmont Dental Society, and currently serve as PresidentElect of the Virginia Dental Association. I have served on the Infection Control Committee, Non-renew Task Force, and currently serve on the Council for Membership and Marketing. I am actively involved in the Southern Endodontic Study Group and volunteer at both the VCU and WVU School of Dentistry, all while maintaining a successful private Endodontic practice that is both evidence-based and patient-focused. I hope to continue my service to the profession of dentistry at the national level by serving as an Alternate Delegate for the 16th District. If we don’t advocate for ourselves, no one else will. I want to ensure that Virginia Dental Association members and our neighboring 16th District members continue to bring ideas and advancements to the ADA and the profession that we are all so blessed to be a part of. I feel confident that I possess the passion, enthusiasm, and skill set needed to fill this position.

Dr. Marcel Lambrechts, Jr.

Dr. Jonathan Wong

Dr. Scott Berman

Dr. Dustin Reynolds

AWARDS & RECOGNITION

WELCOME NEW MEMBERS THROUGH JUNE 1, 2023

Dr. David Russell – Norfolk – Virginia Commonwealth University School of Dentistry 2022

Dr. Joseph Russell – Portsmouth – Virginia Commonwealth University School of Dentistry 2022

Dr. Ankita Warkhankar – Norfolk – Rutgers School of Dental Medicine 2022

Dr. John Howard – Lynchburg – Virginia Commonwealth University School of Dentistry 2003

Dr. Robert Naffah – Roanoke – Herman Ostrow School of Dentistry of USC 1987

Dr. Maria Jividen – Fairfax – Virginia Commonwealth University School of Dentistry 2021

Dr. Julie Jung – Arlington – University of Florida College of Dentistry 2012

Dr. Jailan Khorsheed – Fairfax – Columbia University College of Dental Medicine 2020

Dr. Helena Kilic – Fairfax – Tufts University School of Dental Medicine 2011

Dr. Chin Kim – Fairfax – Indiana University School of Dentistry 2019

Dr. Michael Davis – Chesterfield – University of North Carolina Chapel Hill 2020

Dr. Kirkland Fehrman – Richmond - Missouri School of Dentistry and Oral Health 2021

Dr. Hunter Lee – Richmond – Virginia Commonwealth University School of Dentistry 2019

Dr. Katherine Louscher – Chesterfield –University of Iowa College of Dentistry 2022

Dr. Frederica Mackert – Richmond –University of Washington-Health Sciences School of Dentistry 2016

Dr. Thomas McConnelr – Richmond –Virginia Commonwealth University School of Dentistry 2017

Dr. Rasha Touma – Henrico – University of Aleppo Syria 2005

Dr. Rebaz Waise – Winchester – Virginia Commonwealth University School of Dentistry 2019

Dr. Karen Kozak – Alexandria – Virginia Commonwealth University School of Dentistry 2020

Dr. Yasamin Mojarad – Fairfax – Virginia Commonwealth University School of Dentistry 2022

Dr. Natalie Muir-Young – Arlington – Howard University College of Dentistry 2005

Dr. Sulekha Abdi – Fairfax – The Ohio State University College of Dentistry 2013

Dr. Juliana Bermudez – Fairfax – Loma Linda University School of Dentistry 2008

Dr. Tonya Budala – Fairfax – Howard University College of Dentistry 2021

Dr. Yueh Chung – Loudoun – Howard University College of Dentistry 2019

Dr. Gauri Desai – Fairfax – New York University College of Dentistry 2021

Dr. Savreen Gill – Fairfax – University of Pennsylvania School of Dental Medicine 2022

Dr. Layth Hamid – Loudoun – University of Alabama School of Dentistry 2022

Dr. Nojan Jafari – Fairfax – Indiana University School of Dentistry 2022

Dr. Zachary Neitzey -Prince William – Tufts University School of Dental Medicine 2017

Dr. Emily Norton – Fairfax – University of Pittsburgh School of Dental Medicine 2019

Dr. Roshanak Rastegar – Fairfax –University of Alabama School of Dentistry at UAB 2021

Dr. Jingjing Wu – Fairfax – New York University College of Dentistry 2020

>> CROSSWORD ANSWERS CONTINUED FROM PAGE 29

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