Virgina Dental Journal Vol 100#4 October - December 2023

VOLUME 100, NUMBER 4 | OCTOBER, NOVEMBER & DECEMBER 2023

MEET YOUR NEW VDA PRESIDENT DR. DUSTIN REYNOLDS >> PAGE 5

PEER REVIEWED

THE USE OF SILVER DIAMINE FLUORIDE BY DENTISTS IN VIRGINIA >> PAGE 40

VADENTAL.ORG

Since 1996, our team of experts have provided successful transition services exclusively to dentists. Choice prides itself on its reputation for integrity, service and results.

Considering selling to a DSO? Scan the QR code to watch a brief and informative video to help you decide.

Choice walked me through the process, presented the best offers, and made the experience much less stressful by handling all the negotiations. In the end, I received more for my practice than I ever expected. The best part is that Choice provided all the consultation and services to me without charging any fees!

If you are considering selling to a DSO, I highly recommend you contact Choice instead of directly contacting the DSOs.

Commission free. DSO Choice.

(774) DSO-INFO • choicetransitions.com

IN THIS ISSUE

VOLUME 100, NUMBER 4 • OCTOBER, NOVEMBER & DECEMBER 2023

COLUMNS

ADVOCACY

3 MOVING FORWARD Dr. Dustin Reynolds

19 VDA PARTICIPATES IN VCU SCHOOL OF DENTISTRY FEVER WEEK Laura Givens

5 INTERVIEW WITH DR. DUSTIN REYNOLDS, VDA PRESIDENT 8 MAGICAL MYSTERY TOUR Dr. Richard F. Roadcap 11 HAPPY 164 BIRTHDAY TO THE AMERICAN DENTAL ASSOCIATION Dr. Gary D. Oyster TH

13 BUILDING BRIDGES TO ADDRESS VIRGINIA’S WORKFORCE NEEDS Ryan Dunn 15 LET ME INTRODUCE MYSELF… Sorin Holland

OUTREACH 16 $50 MILLION AND COUNTING MOM’S IMPACT ON DENTAL CARE FOR VIRGINIANS Barbara Rollins 17 WISE MOM EVENT PROVIDES LIFE-CHANGING EXPERIENCE FOR PATIENTS AND DENTAL STUDENTS Vernon Freeman, Jr.

21 WHAT’S A PAC, AND WHY DOES IT MATTER TO ME? Dr. Bruce R. Hutchison 23 COUNCIL ON GOVERNMENT AFFAIRS UPDATE: ADDRESSING IMPORTANT LEGISLATIVE AND REGULATORY ISSUES AND PROPOSALS Dr. Roger A. Palmer

RESOURCES 25 DO THE MATH: YOUR SOCIAL SECURITY BENEFIT Bobby Moyer 26 USING ARTIFICIAL INTELLIGENCE IN YOUR OFFICE’S CONTENT MARKETING EFFORTS Michaela Mishoe 29 DID YOU KNOW? A SERIES FROM THE VIRGINIA BOARD OF DENTISTRY 31 DENTAL DETECTIVE SERIES WORD SEARCH Dr. Zaneta Hamlin

30 VIRGINIA IMPLANT EXCELLENCE WEEK (VIEW) NOVEMBER 6-10, 2023 32 THE VALUE OF LUNCH AND LEARNS Lily Mlynarczyk 33 INTERPROFESSIONAL HEALTHCARE – A CORNERSTONE OF VCU’S DENTAL EDUCATION Anneliese Goetz

SCIENTIFIC 40 THE USE OF SILVER DIAMINE FLUORIDE BY DENTISTS IN VIRGINIA Drs. Eisenberg, Madurantakam, Brickhouse, Jayaraman, Carrico, and Caudill 45 ORAL SURGERY ABSTRACTS 54 THROUGH THE LOOKING GLASS THE FANTASTICAL WORLD OF ORAL PATHOLOGY Dr. Sarah Glass

MEMBERSHIP 64 AWARDS & RECOGNITION 67 CATHY GRIFFANTI, NORTHERN VIRGINIA DENTAL SOCIETY EXECUTIVE DIRECTOR, RETIRES Dr. Christopher Spagna

NE

V

AR

D

0

SIL

ER

68 NEW MEMBERS

R OF T HE 2 02

WI N

18 CHIP SHOTS FOR CHARITIES CVDC GOLFERS TEE OFF IN JUNE Dr. Michael Hanley

AWARD WINNING PUBLICATION

UNIVERSITY CONNECTIONS

SCROLL A

W

1

VA DENTAL JOURNAL

EDITOR-IN-CHIEF BUSINESS MANAGER MANAGING EDITOR EDITORIAL BOARD

VDA COMPONENT ASSOCIATE EDITORS BOARD OF DIRECTORS PRESIDENT PRESIDENT ELECT IMMEDIATE PAST PRESIDENT SECRETARY-TREASURER CEO SPEAKER OF THE HOUSE NDC CHAIR COMPONENT 1 COMPONENT 2 COMPONENT 3 COMPONENT 4 COMPONENT 5 COMPONENT 6 COMPONENT 7 COMPONENT 8 ADVISORY ADVISORY ADVISORY EDITOR VCU STUDENT VCU STUDENT

Richard F. Roadcap, D.D.S., C.D.E. Ryan L. Dunn Shannon Jacobs 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 Dr. Zane Berry, Dr. Michael Hanley, Dr. Frank Iuorno, Dr. Stephanie Vlahos, Dr. Sarah Friend, Dr. Jared C. Kleine, Dr. Chris Spagna, Anneliese Goetz (VCU Class of 2025)

Dr. Dustin Reynolds, Lynchburg Dr. Justin Norbo, Purcellville Dr. Cynthia Southern, Pulaski Dr. Zaneta Hamlin, Virginia Beach Ryan L. Dunn, Goochland Dr. Abby Halpern, Arlington Dr. C. Dani Howell Dr. David Marshall Dr. Sayward Duggan Dr. Samuel Galstan Dr. Marcel Lambrechts Dr. David Stafford Dr. Marlon A. Goad Dr. Caitlin S. Batchelor Dr. Melanie Hartman Dr. Lyndon Cooper Dr. Ralph L. Howell, Jr. Dr. Lorenzo Modeste Dr. Richard F. Roadcap Eric Montalvo, VCU Class of 2024 Wendy Yu, VCU Class of 2025

VOLUME 100, NUMBER 4 • OCTOBER, NOVEMBER & DECEMBER 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.

SUBSCRIPTION RATES

Members $6.00 included in your annual membership dues.

Members – Additional Copy: $3.00 Non-Members- Single Copy: $6.00 Non-Member outside the US: $12.00 Annual Subscriptions in the US: $24.00 outside the US: $48.00

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

2

MESSAGE FROM THE PRESIDENT

MOVING FORWARD Dr. Dustin Reynolds

I am both honored and humbled to serve as the next President of the Virginia Dental Association. I often wonder what the nine Virginia dentists who gathered on November 3, 1870, to form what we now know as the VDA would think about dentistry today. One thing is for sure, a lot has changed, and I am sure that we will see more change and continue to face challenges in the future. But what a long way we have come! Many of our members, I’m sure, can remember belt-driven handpieces and porcelain cuspidors. Now, cone beam computed tomography and digital scanners have become the mainstay in modern dental practices. Let me also say that thirdparty payers are a topic for a whole other article. One thing is for sure, the VDA still exists to promote advocacy and improve the dental profession, its members, and the patient populations we serve, all while supporting dental education, public health, and continuing education and collaboration with our peers.

I hope my leadership ability falls somewhere between cautious reserve and reckless abandon. I know that without the unwavering support of our talented CEO, Ryan Dunn, and excellent staff at the central office (that we are so incredibly fortunate to have) to support our endeavors, as well as some of the best lobbyists in the business to advise and support our efforts at the capitol, this job would be all but impossible to do. I have had the honor and pleasure of serving on the Board of Directors with our previous seven past presidents, Drs. Vince Dougherty, Benita Miller, Sam Galstan, Elizabeth Reynolds, Frank Iuorno, Scott Berman, and our outgoing President, Dr. Cindy Southern. I applaud their leadership and am thankful for the advice they shared with me along the way. To say I have big shoes to fill would

“ To say I have big shoes to fill would be an understatement. There have been so many influential people in my life who have instilled in me the desire to serve others, whether in a volunteer capacity or leadership role.”

be an understatement. There have been so many influential people in my life who have instilled in me the desire to serve others, whether in a volunteer capacity or leadership role. Piedmont Dental Society has not had a VDA president since Dr. Mark Crabtree, who continues to make his mark on organized dentistry every day. Dr. David Black encouraged me to fill his vacant spot on the board of directors. The first fire chief I served with, Ralph Crawley, truly showed me what selflessness meant. My own Endodontic mentor, Dr. Tom Borgia, taught me the importance of organized dentistry and involvement in a profession that I absolutely love. And, of course, my family, who always supported me and gave me opportunities.

My path to dentistry was not what some would call “traditional.” I grew up in a rural part of Appomattox County, where I graduated from our one and only public

high school. I was a three-sport varsity athlete, somehow managed to maintain a 4.0 GPA, and served as class president for three of my four years. Perhaps it was during these formative years I learned what it was like to be part of a team and have your peers look up to you for leadership and guidance. I was the first in my immediate family to attend a four-year college. I chose HampdenSydney College, an all-male, liberal arts college that happens to share the same birthday as the United States Marine Corps (November 10, 1775), making it the second oldest college in Virginia and the tenth oldest college in the country.

I was confident that I wanted to be an engineer; doesn’t every little boy want to drive trains for a living? But in all honesty, I chose Engineering because I was always fascinated with how things work.

I earned a Bachelor of Science degree in Physics from HSC and played football for the Tigers. During my time in college, I became a volunteer firefighter and emergency medical technician; I fell in love with serving others and really had my eyes opened to the amazing and diverse population of Prince Edward and the surrounding counties that we served. So, what better way to combine working with your hands, problem solving, and helping others?! Become a dentist, no doubt. I must admit that at 40 years old, I have yet to have my first cavity, so I thought the assistants and hygienists did all the work, and the dentist just came in at the end of the visit and said, “great job, keep up the brushing and flossing.” I soon realized that I had a lot to learn!

I departed my home state of Virginia to pursue further education at what was described to me as the number one dental school in the world, West Virginia University, by then Dean of Students Dr. Robert Wanker (although Dean Cooper

>> CONTINUED ON PAGE 4 3

MESSAGE FROM THE PRESIDENT >> CONTINUED FROM PAGE 3 may disagree with me). I gained a very hands-on clinical education while at WVU and flourished in our dental class of 50 students, where I also served as class president. I had every intention of returning to my hometown of Appomattox and begin my practice of general dentistry at the conclusion of my four years. Along the way, I realized that in the practice of general dentistry, you must be the expert in everything! That job is incredibly tough, and I applaud those of you who have mastered it. I, however, realized that I should pick one thing and get good at it.

I chose Endodontics and was fortunate enough to remain at WVU, where I earned my post-doctoral master’s degree and Certificate of Advanced Education in Endodontics. After residency, I returned to Virginia and have been in private practice

4

in Lynchburg ever since.

We are all aware of the challenges that we face moving forward: workforce shortages, reimbursement rates, challenging third-party payers that essentially try to dictate treatment for our patients, and our relationship with the Board of Dentistry and the state legislators that represent us. While I am realistic enough to know that these problems won’t be solved overnight, I can assure you that the VDA is poised to advocate for our profession and our membership. I encourage each member to reach out to non-members and open the door for them to join our membership.

I also call on each of you to make a difference, whether that is involvement on the local, state, or national level, and

get involved no matter how big or small; we can each make a difference through our time, talents, and pocketbooks. I challenge each member to contribute to our Tooth PAC because, no doubt, this year on Capitol Hill we will be facing other lobbyists with very deep pockets.

Again, I thank you for placing your trust in me to lead the VDA during the upcoming year. I appreciate and look forward to the opportunity to serve you. I look forward to visiting all our components, sharing ideas, and listening to your concerns. My door is always open. I also look forward to seeing everyone at the Greenbrier, America’s Resort, next September for the Virginia Dental Showcase, so please mark your calendars!

COLUMNS

INTERVIEW WITH DR. DUSTIN REYNOLDS, VDA PRESIDENT First of all, why did you want to be VDA President?

I have always believed in organized dentistry. I became involved early in my dental career, serving as the president of my dental class and as a member of the American Student Dental Association.

Often, it takes the voice of many to be heard. The VDA gives Virginia dentists that voice. Without the VDA, it is likely that people other than those actively involved in the profession would be telling us how to govern ourselves, run our practices, control our small businesses, and put in place rules and regulations without the valuable insight of those of us in the trenches. What an honor it is to serve at the helm of this organization. I hope to embody the mission of the VDA to promote advocacy and improve the dental profession, its members, and the patient populations we serve, all while supporting dental education, public health, and continuing education and collaboration with our peers.

Is there anything you can mention that helped you prepare?

I have always taken an active role in leadership. From the time I was in high school, I served as class president and captain of my respective sports teams. In college, I further developed my leadership skills by serving as president of numerous clubs and organizations as well as being involved with our student honor court. As a volunteer firefighter/EMT, I rose to the rank of Captain and President. During dental school I continued my leadership role as class president. After returning to Virginia to begin private practice, I became the President of the Lynchburg Dental Society and a member of the Board of Directors of the Piedmont Dental Society and, subsequently the VDA. These experiences and the very special

people I met along the way have shaped me into the leader I am today. Although I am not a basketball player, I often give my take on leadership as a basketball bouncing on the ground; if no one picks it up and runs with it, it will simply fizzle out.

I always picked up the ball and ran with it.

“ Without the VDA, it is likely that people other than those actively involved in the profession would be telling us how to govern ourselves, run our practices, control our small businesses, and put in place rules and regulations without the valuable insight of those of us in the trenches.”

Next year the VDA intends to introduce legislation in the General Assembly to require insurance companies to adhere to a Medical Loss Ratio (MLR) for dental procedures. Explain to us how an MLR works.

The simple definition of an MLR is the share of premiums paid to a plan that are spent on medical claims. The remainder is the share spent on administration,

fees, and profits earned. This became mandatory for medical practices during the Affordable Care Act; however, dentistry has always been excluded from this. The real question to ask is, what is an appropriate DLR (dental loss ratio)?

The fact is we don’t know how much of dental insurance premiums go toward patient care and how much of those premiums paid by patients turn into profit after administrative costs. It is important that we hold insurance companies accountable to ensure the proper use of premium dollars, and patients have access and are getting the care they deserve and that they are paying for.

If this legislation is passed, how will this benefit Virginia dentists?

The introduction of a DLR similar to an MLR would hopefully return a portion of premiums paid back to the patients rather than into the pockets of executives. In turn, patients would have more dollars to spend with Virginia dentists. This would also hopefully encourage insurance companies to evaluate what procedures they cover and what they reimburse for those procedures. Insurance coverage should never dictate a patient’s treatment, but I am afraid we see that every day in our practices.

Do you expect the VDA to pursue any other initiatives in the legislature next year?

I think a DLR initiative is going to take a lot of time and resources and will be a tough battle. The VDA will continue to uphold our position statements and support or fight any legislation that affects our dentists and the families of patients. I cannot stress the importance of contributing to our VDA Tooth PAC. We are fortunate to have some of the best lobbyists in the business.

>> CONTINUED ON PAGE 6 5

COLUMNS >> CONTINUED FROM PAGE 5 Do you have any ideas for making VDA membership a Value Proposition? What are they?

I want the VDA to be of value to ALL our members. Our membership encompasses a wide range of ages and experience. It is vital to recruit new members, whether they are just out of school or perhaps a dentist who has been practicing for many years but never joined. We also must retain our current members and continue to show them the value of membership.

The networking, continuing education, camaraderie, and advocacy efforts put forth by the VDA are invaluable. I hesitate to use the word COVID, but just imagine trying to navigate that storm without the guidance of an organization like the VDA. Our officers and board members worked tirelessly to make sure that we had a seat at the table so that we could operate our practices safely and treat the patients who so desperately needed care, not to mention guidance on issues like PPP and other assistance programs.

VCU intends to build a new dental school. How do you see the VDA playing a role in this major undertaking?

The VDA fully supports our one and only dental school here in the Commonwealth.

Dean Cooper has been an excellent addition to Richmond, and we will support him with our time, talents, and pocketbooks to see that he is able to achieve a proper footprint at VCU to ensure we are producing quality dentists here in the Commonwealth.

Who are your heroes and mentors?

Give us examples of how they’ve changed your life.

I must first acknowledge my Lord and Savior, Jesus Christ, for with him, all things are possible. We must be reminded that Jesus came to save, not condemn. Secondly, my family. I have a loving wife and two amazing children who have supported me during this journey. My parents - I watched my dad work countless hours to provide for his family, and that work ethic was instilled in him by his father. He provided me with opportunities, and for that, I am forever grateful. My mom continues to be my

6

rock. She has always put her children first and goes above and beyond to make sure we feel loved, whether that is offering advice or just a simple listening ear. The late Ralph Crawley was the first fire chief I ever served under. He showed me what it meant to truly serve. Dr. Anthony “Tom” Borgia was my endodontic mentor. Dr. B. took a chance on me and provided me with the opportunity to become an endodontist. He also taught me about the real importance of organized dentistry. Dr. Borgia was truly a second father to me while in Morgantown.

You have a unique hobby. Tell us more about it.

Most of our members know about my “tractor pulling” hobby. But let’s face it, I am all boy. I love loud and fast, whether it is flying airplanes, riding motorcycles, or tinkering with muscle cars. I began building “Pullin’ Teeth” in 2016. I compete with Dragon Motorsports in the 10,000-pound Super Pro Farm Class.

The idea is that we have taken a stock 125 horsepower farm tractor and created a machine that makes 1500 horsepower that we use to pull a weighted sled. We compete to see how far your machine can pull the weighted sled. We have had a great season pulling from Pennsylvania

to North Carolina and everywhere in between. Right now, we are number one in the points championship with one more hook to go. I have an incredible team, and it gives me the opportunity to spend time with my dad, who may just love tractor pulling more than I do!

Finally, what do you plan to be doing five years from now?

In five years, I hope to continue building a successful private endodontic practice to serve my community and my patients, while continuing my philanthropic efforts as well as volunteering and mentoring students. I hope the VDA will be poised for continued growth and success and I would like to try my hand at leadership on the next level, the American Dental Association.

Join us in elevating oral health experiences As a LIBERTY Dental Plan Provider, you have access to our members and we streamline the administrative work, leaving you more time to focus on your patients.

Benefit from our network • Ease of administration

Our credentialing process makes it easy to enroll.

We provide efficient claims processing and low administrative burden to increase profit margin.

• Provider self-service tools

Our enhanced portal includes real-time eligibility, benefits, and improved history search for claims and prior authorizations.

• Dedicated support

We assign an experienced Network Manager to provide one-on-one support. We offer peer-to-peer consultations with clinical staff.

Scan the QR code to get started today!

Visit us at www.LIBERTYDentalPlan.com 7

MESSAGE FROM THE EDITOR

MAGICAL MYSTERY TOUR Dr. Richard F. Roadcap

One of the characters in the 1968 movie 2001: A Space Odyssey is HAL, a supercomputer. HAL (whose name is a riff on a major US corporation) is endowed with a human personality, even to the point that he is disciplined for bad behavior. Astronauts Dave and Frank attempt to talk in private about HAL’s behavior, but by means of surveillance HAL reads their lips and uncovers their plot to disconnect him. The planning for Space Odyssey began in 1964, and the movie was inspired by a short story, “The Sentinel,” published by Arthur C. Clarke in 1951. Concerns over the use and misuse of technology were apparent as far back as 70 years ago.

The November 2022 launch of ChatGPT, Open AI’s artificial intelligence software, broke all records for the use of a computer software application. Artificial Intelligence (AI) has long been predicted whereby rational decisions, incorporating emotional and cognitive input, could be made apart from human intelligence. Of course, ChatGPT has its own Wikipedia page (what celebrity doesn’t?), and it wryly notes: “Some observers expressed concern over the potential of ChatGPT to displace or atrophy human intelligence and its potential to enable plagiarism or fuel misinformation.”1 As practicing dentists and professionals, we wonder where this most recent technology eruption will lead. Will AI prove to be disruptive, as many predict, or just another brick in the wall? Let’s address these concerns one at a time.

The atrophy of human intelligence has continued unabated for many years.

Indolence and the lack of academic rigor are hardly new. But will these new

8

opportunities prompt doctors to forego a careful differential diagnosis and objective treatment planning in favor of prefabricated digital analysis, all the

“ AI is perpetuating sick stereotypes we’ve hardly confronted in our culture. It’s disseminating misleading health information. And it’s fueling mental illness by pretending to be an authority or even a friend.”

– The Washington Post

while pretending they originated it? Many fear that this technology could provide education without learning, devoid of the critical thinking so necessary for healthcare professionals to do what’s right for their patients.

Of course, AI may aid and abet the ancient art of plagiarism. Oxford University defines plagiarism (in 2023) as “Presenting work or ideas from another source as your own… by incorporating it into your work without full acknowledgment.”2 Editors are beset with the cat-and-mouse game of discovering purloined text, while miscreants rely heavily on technology to avoid being discovered. Each generation of software

designed to catch word thieves can be outsmarted by other resources that camouflage the crime. Some software now inserts spelling and grammatical errors to promote this tomfoolery. The real victims are the individuals who fall back upon these digital resources, giving up the opportunity for critical thinking and learning.

Neither is misinformation a new development. Persons of power and influence have for centuries tried to deceive the gullible and unsuspecting.

The fear that arises with AI is that the perpetrators will have at their disposal a new digital tool. Tooth whitening, aligners, periodontal therapy, and DIY dentistry dovetail nicely with the capability.

Anorexia sufferers often search for images online that promote and prolong their disease. The Washington Post reported recently that despite filters placed by AI vendors, the victims are able to easily skirt the restrictions. The reporter notes: “AI is perpetuating sick stereotypes we’ve hardly confronted in our culture.

It’s disseminating misleading health information. And it’s fueling mental illness by pretending to be an authority or even a friend.”3 I’d like to avoid being labeled a curmudgeon or a Luddite. I find it amusing that MS Word decorates my sentences with squiggly lines that indicate a misspelling or incorrect grammar.

Word’s limited vocabulary sees words it does not recognize and says that surely I meant to use another. In the office, I’m learning to use intraoral scanners. I asked the staff if the software ever resorts to sarcasm regarding users’ efforts. They told me no, but one day, I expect to see remarks such as “You call that a crown

MESSAGE FROM THE EDITOR

prep?” or “Doctor, more CE, please!” The day is close at hand when chatbots will critique our procedures with comments that don’t spare our feelings. But I make no predictions on how AI will disrupt dental practice, dental education, or the delivery of dental care itself. Many times we’ve been confronted with the bromide: “You don’t know what you don’t know.” A benign outcome of Artificial Intelligence would be to tell us what we don’t know.

In Space Odyssey (directed by Stanley Kubrick), HAL retaliates by turning off Frank’s life support system during an antenna repair, and Frank dies. But Dave succeeds in disconnecting HAL, despite the supercomputer begging him not to.

Will AI lead to dystopia or utopia, nirvana or pandemonium? An army of pundits awaits. Finally, a disclaimer: Artificial Intelligence was not used as a resource in the presentation of my thoughts.

References 1. https://en.wikipedia.org/wiki/ ChatGPT 2. https://www.ox.ac.uk/students/ academic/guidance/skills/ plagiarism 3. Fowler, Geoffrey. “AI is acting ‘pro-anorexia.’ Tech companies aren’t stopping it.” Washington Post, 13 August, 2023.

PROTECT THE VALUE of Your Practice

Practice owners should always have an up-to-date Practice Valuation,

meaning a professional appraisal that has been completed or updated in the past 12 months.

Besides helping you set a listing price when you are ready to sell your practice, Practice Valuations are needed to: • Evaluate what factors are affecting the value of your practice

To get started on your practice valuation, give me a call at:

443-936-9324 or scan the QR code to schedule a complimentary consultation.

• Write a Letter of Instruction (LOI) • Apply for financing • Form merger/partnership agreements A Henry Schein Dental Practice Transitions valuation considers both tangible and intangible assets of the practice and can provide the many key factors that influence the practice’s value.

Contact me today to learn more!

Tricia Aponte, Transition Sales Consultant 443-936-9324 | Tricia.Aponte@henryschein.com n PRACTICE TRANSITION PLANNING

www.henryscheinDPT.com

n SALES & VALUATIONS

n BUYER REPRESENTATION

© 2023 Henry Schein, Inc. No copying without permission. Not responsible for typographical errors. 23PT2801

9

W E ARE P LE A S E D TO A N N O U N C E

Dr. Melika Rahmani has joined the prac�ce of Dr. Milton Cook Smithfield, Virginia

Dr. Mayur Patel & Dr. Amit Patel have acquired the prac�ce of Dr. Kirk Hawn Love�sville, Virginia

Dr. Sydney Browder & Dr. Aaron Parks have joined the prac�ce of Dr. Glen Miller Franklin, Virginia

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.

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

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

Prac�ces for Sale 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/�. Collectes $450K /year with a very strong hygiene program. Real estate is available for sale or lease.

Vienna The prac�ce generates $480K per year in revenue on a mixed FFS/PPO t pa�ent base. Seller will t stay raoncfor 1-2 n o c a week. There are years working r days e 2operatories, d four equipped digital x-ray, n u digital pano. Real estate for sale or lease.

NOVA Ortho Modern prac�ce with 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.

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.

Lynchburg Area This prac�ce has 4 equipped operatories with room for expansion. 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.

Virginia Beach Ortho Collec�s $650K/year.

2,300 sq � office located in a popular shopping center. 5 equipped operatories, digital x-ray, digital pano. Seller wants to stay on part �me for 2-4 years.

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.

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.

PRACTICE TRANSITIONS & A S S O C I AT E P L A C E M E N T

Looking to hire an associate? Call us about our Associate Placement Services!

800-516-4640 | www.bridgewaytransi�ons.com | info@bridgewaytransi�ons.com 10

TRUSTEE’S CORNER

HAPPY 164TH BIRTHDAY TO THE AMERICAN DENTAL ASSOCIATION Gary D. Oyster, DDS; ADA Trustee, 16th District

I’m sure there have been many changes in the ADA over the last 164 years.

Although some of you might think I witnessed each and every one of them, I have not. Jokes aside, I have little doubt that many years have seen more changes than in 2021 and continuing into 2023. COVID-19 has changed the way all health care is administered, and dentistry is no exception. We are dealing with a workforce problem that states and the ADA are striving to overcome in innovative ways.

Due to the diversity of young dentists and dental students, the ADA Board and administration have had to pivot by introducing governance reform and streamlining ADA operations. It has been a challenge to determine how best to appeal to young dentists and simultaneously connect with seasoned dentists. Keeping the tripartite strong by engaging the Salesforce® system free to all states will help reduce operating expenses and allow for data sharing.

The ADA currently spends a lot of time and money working with states that have different platforms. Microsoft 365 and the ADA app, when totally functional, will make the ADA specifically interactive to the individual member.

Proposing a tiered membership, based on the utilization of products and benefits used by the member, is an innovative idea to make the ADA the place to go for dentists.

Advocacy at the state and national level is also more important than ever. The Washington office handles issues like working with CMS to strive for adequate reimbursement and administrative simplicity, if dentistry is to be included in Medicare. There is also a task force working on Medicaid reform. Dental

“ I hope that each of you will reach out to a nonmember and share with them reasons why you are a member. Remind them that the ADA is working hard to make all dentists feel welcome, regardless of their work model.”

about how important the tripartite system is for dentistry; no state individually can achieve what we collectively do together.

I hope that each of you will reach out to a nonmember and share with them reasons why you are a member. Remind them that the ADA is working hard to make all dentists feel welcome, regardless of their work model.

Any of you who attended the SmileCon meeting in Orlando, please share with your colleagues how you enjoyed the experience. We are trying hard to make it something for everyone.

Loss Ratio (DLR) legislation is being pursued by 33 states after the success in Massachusetts, which was supported by the ADA and the MDS members.

I am sure that 164 years ago, the Standards Program, Universal Codes, Science and Research Institute, Health Policy Institute, and Credentialing Service were not on anyone’s radar. Many dentists today are not even aware of these very important areas, which the ADA supports to serve its members.

It can be challenging to take the high road when dealing with criticism of the ADA on social media. I’ve enjoyed seeing the positive messages created on many of the platforms by young, enthusiastic members.

Organized dentistry’s engagement and membership market share are the envy of nearly all other professional associations, especially medicine. My last article talked

11

12

MESSAGE FROM THE CEO

BUILDING BRIDGES TO ADDRESS VIRGINIA’S WORKFORCE NEEDS Ryan Dunn, CEO

Dentistry in Virginia is mostly practiced in small offices with fewer than 20 employees, but it’s a big deal. Today, 25,900 Virginians work in dental offices.1 That’s more Virginians than work across Dominion Energy’s footprint or for Capital One in Virginia. Those employees, spread out across the Commonwealth are responsible for the dental treatment and education of 8.6 million people who live and work in Virginia.

Dentists know the predictable course of oral disease when left untreated. Cavities are the most prevalent chronic disease in children, and the leading cause of them missing time from the classroom.2 More than 90 million hours of work and school are lost annually due to emergency dental treatment.3 Having a dental workforce where it’s needed is critical to the health of Virginians.

More than a third of dental practices report that they can’t see a full patient load due to staffing issues. And in many rural areas in Virginia, there aren’t any nearby options for dental care, or the dentists in the area are approaching retirement, leaving the area at risk of losing their provider.

As the Virginia Dental Workforce Council has met throughout the year and prepares to present its findings and recommendations to the VDA House of Delegates in Richmond January 1820, they have two broad challenges to address.

1. The distribution of dental practices across the state 2. The distribution of allied dental professionals in regions throughout the state

Distribution is the key word here, because Virginia overall is faring better than the national average in our dentist to population ratio, and we are one of the most attractive states in the country in the migration of early career dentists.4

“ Virginia overall is faring better than the national average in our dentist to population ratio, and we are one of the most attractive states in the country in the migration of early career dentists.”

However, there are areas – most pronounced in Fairfax and Henrico Counties and the City of Richmond – where we have a significant mismatch in the number of dentists and the number of dental hygienists in the workforce.5 That mismatch means those dentists and their teams can’t see as many patients as they otherwise would, and longer wait times for patients who need dental care.

And there are some rural counties in Virginia without a practicing dentist, and still more in which more than half of the practicing dentists are approaching retirement. We all believe that dental care is essential health care, and to make it accessible to all Virginians, we must address those barriers to attracting new dentists to rural areas.6

Thankfully, the Virginia Dental Workforce Council has been diligent in its work throughout the year, gathering new data, building bridges between dental program directors, the business community, high school educators, military veterans, charitable clinics and policymakers. I have personally had productive conversations with the new Virginia Community College System Chancellor David Doré and am encouraged by his recognition of the importance of VCCS programs to our ability to provide dental care.

The report that the Workforce Council presents at the VDA House of Delegates in January will put our oral health workforce needs in sharp relief and address short and long-term solutions to our workforce challenges.

There is still time for VDA members to get involved in this effort, and it can’t be successful without their engagement throughout Virginia.

Make plans to join us January 18-20 in Richmond for Dental Days at the Capitol. Registration is now open at vadental.org and it’s critical that your representatives hear directly from you – nothing moves unless it’s pushed, and no other group can carry this message with the credibility that our members have with their elected representatives.

Connect with the nearest allied dental program in your area and build a relationship. Ask what they need. Most of our newly licensed dentists are trained outside Virginia, but most of our dental hygienists get their professional education in Virginia. Just as dental offices are struggling to hire, our allied dental programs have challenges recruiting full-time and adjunct faculty. They often can accept expired materials for practice

>> CONTINUED ON PAGE 28 13

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

To the dentists of Virginia: thank you for making your patients our patients.

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.

Referred by Dentists | Preferred by Patients

Information & Appointments (804) 354 -1600 | commonwealthofs.com Brandermill 5942 Harbour Park Drive Midlothian, Virginia 23112

14

Chester 12220 Iron Bridge Road, Suite B Chester, VA 23831

Mechanicsville 7009 Lee Park Road Mechanicsville, VA 23111

Midlothian/Bon Air 1807 Huguenot Road, Suite 120 Midlothian, Virginia 23113

Patterson at Parham Road 8503 Patterson Avenue, Suite A Henrico, Virginia 23229

Westerre Commons near Broad & Cox 3811 Westerre Parkway, Suite A Henrico, Virginia 23233

COLUMNS

LET ME INTRODUCE MYSELF… Sorin Holland, Program Manager, Donated Dental Services and Give Kids A Smile

The COVID-19 pandemic had alarming implications for individuals’ and communities’ mental and emotional health. Isolation and feelings of uncertainty negatively impacted mental health across the board and manifested as increased anxiety, loneliness, depression, insomnia, and, in some cases, self-harm. A substantial portion of the population experienced job loss, and economic difficulties exacerbated mental health issues.

The pandemic took a toll on oral health; practices were closed for lengthy periods of time, “elective” dental procedures were postponed, and access to preventive care was delayed. The pandemic disproportionately affected many groups, including populations with a higher risk for poor oral health, those with other chronic diseases and comorbidities, low socioeconomic groups, and minority populations.

With this lens, I focus on my role as Program Manager for Donated Dental Services and Give Kids A Smile. I am thrilled to join the VDA Foundation (VDAF) Team and to be working alongside the VDA to ensure that all Virginians have the opportunity to access the care they need to improve their oral health.

I spent several years managing hotlines, emergency shelters, and other programs centered around assisting survivors of intimate partner violence. It is astounding work and so critically needed – it also taught me how important it is for people who are overcoming barriers to feel comfortable in their own bodies. A huge part of being able to seek out help - to ask for help or even to apply for jobs that will provide the means to overcome those barriers - is rooted in your smile and how

you imagine others perceive you. This is where I think we can make huge strides in the future.

I look forward to better understanding the subtleties surrounding the dental community here in Virginia and enjoyed meeting many of you at the 2023 Virginia Dental Showcase. I hope also to be working with many of you to find solutions that will provide access to primarily Spanish-speaking communities, the LGBTQ+ communities, and to further expand the work that’s being done for patients with varying ability levels.

timing that has brought me to this path, and hope that I can connect with as many of you as possible in the coming months.

Please feel free to call, text, or email me, and we can go for coffee/tea next time I am in your neighborhood. sholland@vadental.org 804-523-2182 (Direct)

“ I am thrilled to join the VDA Foundation (VDAF) Team and to be working alongside the VDA to ensure that all Virginians have the opportunity to access the care they need to improve their oral health. ” It is an exciting time when technology is now allowing many who are so remote that they may not have ever visited a dentist in the past to connect virtually with providers who can erase common misconceptions and inform folks about the importance of oral health. Innovations in care are allowing expensive procedures to be done more affordably and sustainably for both practices and patients. I am grateful for the universe’s

15

OUTREACH

$50 MILLION AND COUNTING MOM’S IMPACT ON DENTAL CARE FOR VIRGINIANS Barbara Rollins, Director of Logistics – Mission of Mercy

A mobile, MASH-type, dental clinic originated in Wise County and became known as the Mission of Mercy (MOM) Project in 2000. Wise MOM first started in an airport hangar at the Lonesome Pine Airport in Wise, but outgrew that space and moved to the Wise Fairgrounds and now, for the past four years, has been held at the beautiful UVA Wise Prior Convocation Center. MOM returned to the Convocation Center for the two-day event on July 19-20, 2023. Nearly 500 Southwest Virginia residents received over $592,000 in free dental care this year alone.

MOM projects came about as a response to the substantial need for access to affordable dental care in remote areas of Virginia. Hundreds of volunteers come together to offer their time and talents, including dentists, dental hygienists, dental assistants, support staff, and dental and dental hygiene students from all parts of the state. Over the last 24 years, MOM clinics have provided much-needed dental care to those who could not afford such treatment. Clinics have been held across the state from Virginia Beach, Norfolk, and the Eastern Shore to Wise, Roanoke, and Martinsville, from Northern Virginia to Emporia, Suffolk, and Petersburg, from Warrenton to Gloucester, Chesapeake, and Yorktown. Since 2000, 128 projects have been held statewide.

Dr. Terry Dickinson, former Virginia Dental Association Executive Director, who founded the MOM project in 2000, stated, “From the beginning, MOM has been about making a difference in the lives of people who struggle to get dental care.”

Helping patients meet their dental needs was, first and foremost, the purpose of MOM clinics. However, it was quickly recognized that MOM projects brought awareness to the many areas needing

16

access to dental care throughout the year.

As a result, several permanent brick-andmortar clinics have opened to provide ongoing care. MOM projects spawned the Gloucester Mathews Dental Clinic, Piedmont Regional Dental Clinic, and most recently, the Owens & Hill Dental Health Clinic in Wise.

In 2020, COVID-19 brought on changes since gathering large numbers of volunteers and patients together indoors was not possible due to public health concerns. The Mini-MOM emerged as an option to provide smaller-scale, acute dental care in established free and charitable dental clinics. Appalachian Highlands Community Dental Center (AHCDC) in Abingdon was the first MiniMOM project. Extractions and dentures were offered at three separate Mini-MOM events in 2020 and have continued to the present day. AHCDC is expanding its number of operatories and will increase the number of Mini-MOM projects annually. Other Mini-MOM projects have been held at Chesapeake Care Clinic and Central Virginia Health ServicesPetersburg.

Legislative changes came about through the awareness MOM events have brought to the need for affordable dental care.

Medicaid expansion was passed in 2021 for Virginia Medicaid recipients, which greatly increased the type and number of dental procedures available to that population. Medicaid reimbursement was increased in 2023 in hopes of increasing the number of dental providers.

The need for access to dental care has been a statewide concern from the onset, but Virginia wasn’t alone in this plight. The need was soon identified as a national concern, and the MOM format became a model for similar clinics in over 30 states.

To date, MOM has provided over 71,000 Virginians with free dental care valued at $50.7 million.

Over the past 24 years, MOM and its many volunteers have significantly impacted access to dental care for Virginians who otherwise would not be able to get the care they need and deserve.

OUTREACH

WISE MOM EVENT PROVIDES LIFE-CHANGING EXPERIENCE FOR PATIENTS AND DENTAL STUDENTS

Vernon Freeman, Jr., Digital Content Specialist, VCU School of Dentistry

This year’s contingent of volunteers who traveled to the Wise MOM Project included approximately 60 VCU School of Dentistry students, faculty, residents, and staff.

“With remarkable talent and heartwarming care, we provided oral health care to so many in need. A challenging unmet need for oral health care still exists in our rural communities, and the MOM clinic is just one step in addressing it,” said Dr. Lyndon Cooper, Dean of the VCU School of Dentistry. “We are committed to finding solutions to access oral health care throughout the Commonwealth and educating our students of this need through such service-learning experiences.”

MOM events are an important tool for addressing the need for access to oral health care. It’s something that’s all too familiar to third-year dental student Madelyn Lawrence. She grew up in a small town of 150 people, with the closest dentist more than an hour away.

“I am very familiar with how a lot of the residents here feel. Access to dental care is just not great everywhere, and that’s a hard reality to face,” said Lawrence.

Lawrence is also a graduate of UVA-Wise, where she played volleyball and earned her bachelor’s degree in biochemistry.

The UVA-Wise David J. Prior Convocation Center has generously hosted the Wise MOM project since 2018.

“Coming to Wise reminded me a lot of home—the small-town feel. Everyone here is so amazing. They love each other. They’re such a close community, and they’re very deserving of access to health care, yet they just don’t have it,” Lawrence explained.

Lawrence was first introduced to the MOM project after meeting several VCU School of Dentistry students who were in town for the event. From that point forward, she targeted the VCU School of Dentistry for dental school, got connected, and began volunteering for the event.

Now, as a dental student, she has an opportunity to be more involved.

Students play a vital role in the success of the MOM project, from setting up equipment, sterilizing instruments, assisting dentists, and providing free dental care. They also work behind the scenes to help coordinate the event and drive trucks full of supplies to Wise.

“I urge anyone who has not volunteered at a MOM project to do so,” said Lawrence. “It’s so rewarding. There are people who have severe pain for months and months because they need an extraction, but they haven’t been able to go to the dentist or afford it. We can do that for them. Seeing people smile after receiving their treatment builds confidence and self-esteem. It’s lifechanging.”

the Wise MOM project with finding her purpose of serving the underserved.

“My dad has always told me. ‘Keep as many doors open as you can, and your path will choose you.’ I feel like that’s what happened when I was first introduced to this event. It changed my life,” said Lawrence. “I was a puddle of tears whenever I first volunteered here.

I’m pretty sure I cried last year, too.

There’s just something that touches me every time that I’m here. It just made me want to choose this path. The doors were open, and this path chose me.”

Although the 2023 Wise MOM project is over, there is always a need for volunteers to participate in MOM projects throughout the Commonwealth.

Visit the VDA Foundation’s website at www.vdaf.org for details on upcoming opportunities for a life-changing experience.

That was the message Lawrence had for hundreds of volunteers on day one of this year’s event when she delivered a speech during the team huddle.

“You are going to change a lot of lives today,” said Lawrence. “I hope you continue to serve and volunteer for communities like this who need it, and hopefully, one day, they won’t need it anymore.”

The project is not only life-changing for patients. It’s life-changing for the students and volunteers as well. Lawrence credits

17

OUTREACH

CHIP SHOTS FOR CHARITIES CVDC GOLFERS TEE OFF IN JUNE

Dr. Michael Hanley; Associate Editor, Southside Dental Society

Central Virginia Dental Care, PLC, held its third annual Charity Golf Tournament on June 3, 2023, and raised $29,000 to support the dental clinics of Crossover Healthcare Ministries, Goochland Cares, and the Wise Mission of Mercy (MOM) project. Special thanks to all the sponsors and volunteers who made this year’s tournament a huge success. This year’s major sponsors included Benco, 3M, Paramount Dental Studios, Payday Payroll, and Wellington Retirement Solutions.

The fairway, to describe the event, calls on me to draw on years of covering golf events, not stymied by my advanced age, and give you a slice of the day’s action. A beautiful day at Lake Chesdin in Chesterfield County brought out nearly 60 golfers. Pictured is NOT the winning team…however, we were voted “Most Photogenic.”

To find out more about the annual Central Virginia Dental Care Charity Golf Tournament and how you can participate in supporting these dental charities and the communities they serve, please reach to them at: info@centralvirginiadentalcare.com

USPS REQUIRED POSTINGS – STATEMENT OF OWNERSHIP

18

ADVOCACY

VDA PARTICIPATES IN VCU SCHOOL OF DENTISTRY FEVER WEEK:

VCU DENTAL STUDENTS ARE EAGER TO ADVOCATE FOR DENTISTRY! Laura Givens, Director of Legislative and Public Policy

The VDA hosted a two-part advocacy event for VCU dental students on August 9th to help them kick off a great school year. The first part of the program was a lunch and learn with special guest Delegate Schuyler VanValkenburg.

He spoke to a group of around 50 students about the General Assembly and expressed the importance of their involvement in advocating for dentistry.

Part two of the program was a fun evening at the Diamond, where nearly 50 students gathered with VDA staff and member dentists to enjoy a Squirrels game. It was a great day and a wonderful opportunity to interact with many dental students who are eager to learn more about advocacy and the opportunities and resources that the VDA has to offer. We thank all students for their participation!

SEE WHERE YOUR COMPONENT IS AND WHAT YOU NEED TO DO TO MEET YOUR 2023 GOAL

Component

% of 2023 Members Contributing to Date

2023 VDA PAC Goal

Amount Contributed to Date

Per Capita Contribution

% of Goal Achieved

1 (Tidewater)

35%

$45,000

$30,150

$311

67%

2 (Peninsula)

35%

$27,500

$17,685

$338

64%

3 (Southside)

27%

$14,000

$12,350

$294

88%

4 (Richmond)

20%

$67,750

$51,820

$335

76%

5 (Piedmont)

31%

$30,000

$20,500

$294

68%

6 (Southwest VA)

43%

$25,250

$33,450

$330

132%

7 (Shenandoah Valley)

26%

$30,000

$21,250

$355

71%

8 (Northern VA)

24%

$135,000

$92,197

$302

68%

TOTAL

30%

$375,000

$279,402

$320

75%

TOTAL CONTRIBUTIONS: $279,402 2023 GOAL: $375,000 WE NEED YOUR CONTRIBUTIONS TO RAISE $95,598

19

Legislative Process

Member Legislation Ideas Members submit proposals to the VDA Council on Government Affairs (CGA) by sending a form to Laura Givens at givens@vadental.org. They should include background information and potential monetary impact.

Sponsors & Witnesses The CGA, VDA staff and VDA lobbyists solicit sponsors and establish witnesses to introduce Board-approved legislation in the upcoming General Assembly session.

CGA Review

Council Votes

All proposals submitted by May 1 are shared with the CGA Chair to be considered for the following year’s General Assembly. The Chair then shares with the full Council for review and discussion during their May meeting.

The Council votes on what will be considered. If the proposal falls outside existing VDA policy, the submitting member may pursue policy adoption in the upcoming VDA House of Delegates and resubmit to the CGA.

Board Review

Board Presentation

The Board of Directors determines if legislation should be pursued and included in the VDA legislative package for the upcoming year.

The CGA presents approved proposals to the VDA Board of Directors for review.

Engage with Legislators The VDA is involved in the process from the time the bill is introduced throughout the General Assembly Session. The VDA lobbying team and VDA members communicate information on legislation as necessary throughout the Session.

20

*VDA Committees and Councils are asked to comply with the procedure outlined above. *The Council on Government Affairs realizes that there will be some extenuating circumstances that will require the procedure to be circumvented. *Not all good ideas have a legislative solution. They can sometimes be addressed within existing law and/or through the regulatory process.

ADVOCACY

WHAT’S A PAC, AND WHY DOES IT MATTER TO ME? Dr. Bruce R. Hutchison; Chair, VDA PAC

Political Action Committees (PACs) have been an important part of our democracy for nearly 80 years. They exist to pool resources from like-minded individuals, contribute to political campaigns, and advocate on behalf of their members’ common interests. PACs focus on policy, not politics, and remain among the most transparent and regulated campaign finance entities.

There are three types of PACs; 1. Association PACs- representing professional organizations, like our VDA PAC 2. Corporate- established by businesses, labor unions, trade associations 3. Ideological PACs- groups organized for a mission or single issue cause Federal and state laws prevent professional dues money from being used for political activities. Dues money can support issues and advocacy on behalf of the VDA members but cannot be used

for funding or supporting candidates.

Our VDA PAC is funded by voluntary contributions from our member dentists to support members of the Virginia legislature who are positioned to advocate on dental care issues on behalf of our profession and our patients. Our VDA PAC does not, and cannot, earmark contributions to specific members of the state legislature based on any single issue or legislative effort.

Our VDA PAC Board considers and evaluates candidates seeking financial support based on their leadership positions, committee assignments that more directly deal with dental issues and a history of supporting our issues. While the controlling party can dictate certain reimbursement decisions, VDA PAC has a history of balanced giving. Again, we focus on issues and not politics.

Health care policy (dental care policy) is constantly changing, with or without input from dentists. Dentists recognize the changing trends and challenges in

health care and know what is best for our profession and the oral health care of the public we serve. As the legislators consider issues that affect the future of dental care, reimbursement by insurance companies, the scope of practice, patient care, and the practice of dentistry, DENTISTS must be at the table.

To continue the history of the Virginia Dental Association’s advocacy for the profession of dentistry, we must continue to support our VDA PAC. Our VDA PAC helps develop relationships with legislators and encourages them to at least listen to our story with an open ear.

And our story is ALWAYS based on what is best for our patients – period.

Please make or increase your contribution to support your VDA PAC by visiting https://www.vadental.org/vda-pac. Your future and the future of dental care in Virginia depend on it.

21

REGISTER TODAY!

VDA Legislative Reception Thursday, January 18, 2024 6:00 p.m. - 8:30 p.m. | Omni Richmond Sample hors d’oeuvres and cocktails while you advocate for your profession and patients!

SAVE THE DATE

VDA Lobby Day Friday, January 19, 2024 Omni Richmond 7:00 a.m. - 11:00 a.m.

Buffet Breakfast & Visit with Legistators

11:00 a.m. - 12:30 p.m.

VDA House of Delegates (2nd Session on Saturday, January 20)

12:30 p.m.

Lunch and Presentation

Visit vadental.org/dental-days for more information!

22

ADVOCACY

COUNCIL ON GOVERNMENT AFFAIRS UPDATE:

ADDRESSING IMPORTANT LEGISLATIVE AND REGULATORY ISSUES AND PROPOSALS Roger A. Palmer, DDS; Chair of the VDA Council on Government Affairs

As most of you know, the VDA Council on Government Affairs (CGA) is very active, and this past year has been no exception.

We have had several items to address of importance to all of us.

One item on our list is perhaps the most important to practicing dentists – insurance issues. We have faced many more challenges with insurance companies in our practices, especially since the COVID-19 pandemic. Dealing with dental insurance companies is one that affects nearly every one of us. We have companies cutting reimbursement schedules, extending the time between replacement of restorations, denying virtually everything the first time it is submitted, reducing preventative services to 80%, and extending the time between radiographs. We are also seeing more procedures down-coded, bundled, and disallowed.

Our CEO, Mr. Ryan Dunn, is working on a questionnaire that we will be sending out to have members submit specific problems we are having with insurance benefits. We will also be asking for examples of claims and EOBs, which will need to be totally redacted with no identifying patient information on them.

We will need a significant amount of data for it to be possible to work towards potential solutions to the many issues we are facing.

Below is a report from the August 30, 2023, CGA meeting. I am sharing this to make the membership aware of the important work that we do – these important regulatory and legislative issues and concerns begin with the CGA.

VDA Council on Government Affairs Meeting Report August 30, 2023 Licensure: Dentist and Dental Hygienist Licensure Compact Mr. Matt Rossetto, from the ADA Department of Government Affairs, presented an update on the dental and dental hygiene licensure compact legislation.

The ADA seems very supportive of establishing Dental Licensure Compacts. Mr. Rossetto stated that all dentists wishing to participate must have completed a CODA (Council on Dental Accreditation) approved program, either predoctoral or an approved specialty program. Essentially, if your state participates in a Dental Compact then you can practice in any of the other states in the Compact (with some requirements). One of the main proponents for this Compact Program is the Department of Defense. With this compact, spouses of military personnel can move with their spouse and be able to practice.

Board of Dentistry Licensing Workgroup Report Mr. Ben Traynham shared an update on the Board of Dentistry Licensing Workgroup.

The Board of Dentistry and most dentists in Virginia support the concept of licensure for candidates who have completed a CODA-approved program. It was reported that at this time, Licensure by Credentials, when properly submitted to the Board of Dentistry, is very quick.

CGA Consensus After discussing the information shared

by Mr. Rossetto and Mr. Traynham, a motion was made and seconded, and the members voted unanimously to support the following recommendation: The CGA is not supportive of the ADA licensure compact but would recommend to the VDA Board of Directors that the VDA review licensure with the Board of Dentistry and consider alternative pathways if needed.

License Plate Survey Update • Mr. Paul Logan provided an update on the survey that the VDA has conducted on a possible VDA license plate.

• We are trying to determine support for a VDA-themed license plate. A majority of respondents to our survey indicated they would be interested in purchasing at least one set.

Safe Haven Legislation • Mr. Traynham shared background on the Safe Haven legislation and program in Virginia.

• A motion was made and seconded with unanimous support of the following recommendation to the VDA Board: The Council on Government Affairs recommends that the VDA Board of Directors support draft legislation that would add dentists and dental students to those who can benefit from Safe Haven.

Remote Supervision – Proposed Revisions to Current Law • Mr. Ryan Dunn and Dr. Frank Iuorno shared background on the remote supervision law and shared

>> CONTINUED ON PAGE 28 23

Growing Your Practice Should Be Easy. We Make Easy Happen.

At ProSites, we support the success of over

7,500 dental practices with personalized tools and marketing solutions designed to keep your chairs full, increase efficiencies, and (most importantly) save time so you and your staff can focus on patient care.

Whatever kind of easy you need, we’re here to make it happen. Scan to make easy happen or visit prosites.com/vda.

Best of all, VDA members receive exclusive discounts on select ProSites solutions.

24

RESOURCES

DO THE MATH: YOUR SOCIAL SECURITY BENEFIT

Bobby Moyer, CFA®, CFP®, CAIA®; 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 $160,200 in 2023).

• 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.

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

See Important Disclosure Info: https://acgwealthmanagement.com/ important-disclosure-information/

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 or divorced, you may be entitled to divorced 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 claims the survivor benefit. If a spouse dies while both are receiving benefits, 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

25

RESOURCES

USING ARTIFICIAL INTELLIGENCE IN YOUR OFFICE’S CONTENT MARKETING EFFORTS Michaela Mishoe, Account Executive at The Hodges Partnership

The launch of ChatGPT by Open AI in November 2022 changed the way people conduct research and create content.

Seemingly overnight, a few sentences could be used to create a new recipe, write a screenplay, or craft a speech.

Artificial Intelligence isn’t a new concept in the dentistry field, but using it beyond a clinical setting to help streamline your content marketing efforts may be unknown territory.

What is ChatGPT, and how can I use it in my marketing efforts?

There are many AI tools that can be used for content marketing, but ChatGPT is a great place to start.

ChatGPT, which stands for Chat Generative Pre-trained Transformer, is a large language model-based chatbot driven by AI technology that can answer questions and assist you with tasks, such as composing emails, essays, and much more. When provided with a prompt, it pulls data from the internet to formulate a response. It is currently free to the public, and all you need is an email address to create an account.

Beyond a clinical setting, dental offices can use AI tools like ChatGPT to create new content for their websites and social media platforms, write emails to current and potential patients, and more.

Here’s how you can use AI to support your office’s content marketing efforts.

Content Ideas and Creation

Planning and creating content can take time. AI tools such as ChatGPT can help your team come up with new ideas for blog topics, social posts, and videos and even help you draft them. ChatGPT will also save your “chats” so you can go back and access them anytime.

26

Blogs

According to HubSpot Marketing, businesses that share regular blog content get 55% more website visitors than those without one. While creating regular blog posts is a great way to keep your web content fresh and showcase your practice’s expertise and personality, it can be a time commitment.

Whether you’re looking for new ideas for a blog post, want to work off an outline, or simply need a draft that you Figure A can edit to fit your voice, AI tools can save you time. Figure A shows part of a blog post written by ChatGPT using the prompt, “write a blog post about the importance of flossing.”

Social Media Content

Using ChatGPT for your social media channels is another way to keep content fresh and save time. Experiment with different prompts such as “generate a 30-day social media calendar about oral cancer awareness” or “generate ten social media posts about children’s dental health.” Figure B shows a social media post that ChatGPT generated using the latter prompt.

Even if the copy isn’t exactly what you’re looking for, ChatGPT can be a helpful brainstorming tool.

Video

Whether your practice has been making video content for years or you’ve just started testing the water through Instagram Reels, ChatGPT can help you generate some creative ideas. Figure C shows a result from the prompt “Generate ideas for Instagram Reels for dental offices.”

Email and Newsletter Communication AI software can also be used for direct patient communication. If you’re looking to freshen up your monthly newsletter or create eye-catching subject lines, ChatGPT can help.

Using prompts such as “generate five persuasive subject lines for an email about scheduling a biannual exam” and “generate an email about healthy oral habits” in ChatGPT will create

RESOURCES

Figure B

Figure C

outlines that can give you a place to start or a message to personalize. Figure D shows one of the results for “generate an email about healthy oral habits.”

Tips for Using ChatGPT

The capacity for AI tools such as ChatGPT can be hard to capture in just one article. The best way to get started is to sign up and start experimenting with prompts and refine your searches.

Keep in mind that while AI platforms can be incredibly helpful, they should always be used with oversight like any other tool. You’ll want to review and edit any content you’re producing through ChatGPT. AI shouldn’t be viewed as a replacement for human interaction in marketing activities and communications, but as an additional “team member” that inspires creativity and spurs production to save you time so that you can focus on serving your patients.

Figure D

27

COLUMNS >> CONTINUED FROM PAGE 13 on mannequins and have other needs for donations. Their success benefits all of our patients, so please support them.

You’ll see updates from us in the weeks ahead, including a new dental workforce dashboard that will provide dentists and policymakers alike access to the latest data on our dental workforce. Thank you to everyone who has been involved in addressing these issues, particularly the 35+ members of the Virginia Dental Workforce Council, and I look forward to seeing you in Richmond in January.

References 1. US Census, The Number of Firms and Establishments, Employment, and Annual Payroll by State, Industry, and Enterprise Employment, Release Date: 2/11/2022

2.

3.

4.

5.

6.

https://www.vcuhealth. org/news/cavities-are-theleading-cause-for-kids-tomiss-class-vcu-dentistsays#:~:text=According%20 to%20the%20Centers%20 for,of%20missed%20 school%20among%20children. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC5772383/ https://www.vadental.org/ vda-hub/2023/08/08/hpi-studyvirginia-among-top-statesfor-net-in-migration-of-earlycareer-dentists Virginia Healthcare Workforce Data Center, accessed 9/15/23 Virginia Healthcare Workforce Data Center, accessed 9/15/23

>> CONTINUED FROM PAGE 23 the proposed revisions that were presented to the VDA by the Virginia Health Catalyst. The revision in the language that indicates an increase from 90 days to 180 days for the patient to be examined by a dentist was acceptable to the CGA; however, they had concerns with allowing the option of an initial exam to be conducted via telehealth. The CGA would also like to see data supporting the need for these revisions, and Ms. Laura Givens indicated that she would request this data from the Virginia Health Catalyst. Mr. Tripp Perrin also expressed the importance of the VDA taking the lead in obtaining patrons (and other supporters) if we agree to support amendments to the legislation.

28

• The consensus from the CGA was for Mr. Dunn and staff to take these concerns and questions back to the Workgroup and to also have the VDA legal team review the legislation and provide guidance. Mr. Dunn and staff will report back to the CGA with feedback and further information as requested.

Discussion of Other Insurance Issues • As you may be aware, the Affordable Care Act requires medical insurance companies to spend a certain amount of their received premiums on patient care reimbursements.

This is called a Medical Loss Ratio.

There was no provision for dental insurance companies to have a similar requirement. The VDA is

interested in being able to have some transparency in the amount of premiums that actually go to patient care.

• The CGA members agreed that it would be a good idea for the VDA to create a repository for third-party payer complaints to include supportive redacted claims/correspondence to create a database with evidence to support those grievances. Mr. Dunn indicated that this could be implemented within the next few months, and we would then begin promoting the system to the membership and encouraging submissions to this repository.

RESOURCES

KNOWING

Regulations IS HALF THE BATTLE

DID YOU KNOW?

A SERIES FROM THE VIRGINIA BOARD OF DENTISTRY aintaining current training M certification in basic cardiopulmonary resuscitation The Board is currently conducting a Continuing Education Audit of 2022 licensing renewals. The most common issue of noncompliance has been maintaining a current certification in basic cardiopulmonary resuscitation with hands-on training and with the approved continuing education provider.

A dentist shall maintain current training certification in basic cardiopulmonary resuscitation with hands-on airway training for health care providers or basic life support unless he is required by 18VAC60-21-290 or 18VAC60-21-300 to hold current certification in advanced life support with hands-on simulated airway and megacode training for health care providers.

18VAC60-21-250.A.2 Online training without hands-on training is not sufficient or in compliance with regulations when obtaining basic cardiopulmonary resuscitation training or advanced life support training.

Reportable Events It is a requirement of a dentist to submit a written report to the board within 15 calendar days following an unexpected patient event that occurred intra-operatively or during the first 24 hours immediately following the patient’s departure from his facility, resulting in either a physical injury or a respiratory, cardiovascular, or neurological complication that was related to the dental treatment or service provided and that necessitated admission of the patient to a hospital or in a patient death. Any emergency treatment of a patient by a hospital that is related to sedation anesthesia shall also be reported. 18VAC60-21-100 Please submit your report to the Board at Attn: Jamie Sacksteder, Executive Director 9960 Mayland Drive Suite 300 Henrico, VA 23233. Including evidence to support your report is important for the Board when reviewing the information. Please note that if patient records are not received with the report, the Board may ask for additional information or may send your report to Enforcement for an investigation.

A dentist must obtain their basic cardiopulmonary resuscitation training or advanced life support training from an approved continuing education provider, which can be found at 18VAC6021-250.C.1-15. Obtaining training from a provider not approved in the regulations is not in compliance.

29

VCU EVENT

VIRGINIA IMPLANT EXCELLENCE WEEK (VIEW) NOVEMBER 6-10, 2023

VCU School of Dentistry (VCU SoD) invites the oral health community to participate in Virginia Implant Excellence Week (VIEW) November 6-10. Various departments of VCU SoD will host Lunch and Learn courses on a variety of topics related to implant dentistry.

The week of continuing education events will center on all aspects of the dental implant process and involve oral health professionals at a variety of levels. The week will conclude with a symposium at the Richmond Westin Hotel on Friday, November 10. The event will feature various processes of dental implants from different perspectives: Periodontics, Prosthodontics, and Oral and Facial Surgery. Participants will receive 7 hours of continuing education credits for attending the symposium.

In addition to VCU School of Dentistry speakers Dean Lyndon Cooper and Director of Implant Dentistry, Dr. Karen McAndrew, Friday’s symposium will feature a number of nationally renowned experts: • Brandon Kofford, D.M.D., M.S., F.A.C.P. • Lee Culp, C.D.T., CEO of Sculpture Studios • Mariano Polack, D.D.S. • Mark Ludlow, D.M.D. • Amar Katranji, D.D.S., M.S. • Gary Jones, D.D.S.

THANK YOU TO OUR EVENT SPONSORS: Titanium Sponsor

Silver Sponsor

Reception Sponsor

Exhibitor Level

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

30

RESOURCES

DDS: Dental Detective Series DENTAL DETECTIVE SERIES WORD SEARCH Dr. Zaneta Hamlin O YW I Z T I J V G B A R B I E A C O V N N J MU Z X E A R E J Q A R O R A S C O P T I C H B Y G F D L MB X X Z V K H UQ F Q C E B UD V B ND Y P M E D I C A LWA S T E Y V R Q V A U S M V QWN D V Z K M E F L O Q U I N E S T O X U T B T Z T J E T I G X A E E E B Q T N N Q P K O Z ZWUMH G P D I D I F K N E Z D B I J K B K S X P X F H T BM E C J U R L N A F I I T CWT A S P E R I A P I C A L C Y S T GMV E V K C Z J H E Z N S I K N T DN N B D R Z V E O L X H I B P G T A NO A R HDHD B P R U I NG E P S N I O S I X F O C N L RWA L NW J U S UMM E R F E S T I R A P Y P OQ T H P I L H I U A F F F E GG Y B OH B C V GNO E P I F NO E X A E Z U I T A B WM H Y U N I L A T E R A L F X E M L X C I I E M T M I WW I V D A F A X A I V L S C O S S R O Y G K O R W F F S O P V D I I S G L E A D E R S H I P N R MW I R A R T O S S N C O P P E NH E I M E R R C AMOD E P I U HWS X V D E A R T V D B Q D F B U L B F D L R NM F R H B K R C WM G R L A L WU X K Z I M B C O E L C B T D A O M L S T H Z P R V Z X WM N J NW P M L Y N Z F P L A C U J X J H F A I S G I U V S L C J C V K S Q J N E D A I N E C E L J O G N S V P C U H VWO B Y WX L E E M X H D J E G H CW Y WG E G H D EWZ C S N Y T H R J T C N S T E V O B A T K V C B L U B E S G J U I T R O B I V H Y MZ E K Z U S R J WR A WM J Y A P F T I R E E L X C X G D D S Z O M S L DWH G S I E I H O J QM K K S S O D A T H H A QWOWC Y L Y C B EWR O F Q V QQGO T E G E S D K B L A C K M I R R O R U Q S C G T NQ V Z I WE A Y O X K D T R R G AW J T QOUD G I U U J K K B S C Z D R F AWZ S ZM S K Y L OU NG E Y D B R E Z H H R M Y R P C S R E Y F Z P S N R HW L Y C X E P F Y QQ R D R P H J Y HQ L X I K UDG V U U E P T R OQ M L K S K I P Z ND F Z AM Y B G P X A G I L E R R I K J C

PERIAPICAL CYST

PIERRE FAUCHARD

INTERNATIONAL

PIERRE FAUCHARD CYST INTERNATIONAL VCU OPPENHEIMER UNCONTESTED MEDICAL WASTE PERIAPICAL MEDICAL BLACKWASTE MIRROR

UNCONTESTED OPPENHEIMER SUMMER SEOFEST SPONTANEOUS

LEADERSHIP BLACK MIRROR

MEFLOQUINE SPONTANEOUS SUMMER FEST UNILATERAL

SKY LOUNGE LEADERSHIP

RESEARCH UNILATERAL MEFLOQUINE

CHECK SKY PREP LOUNGE

CYTOLOGY MOM PROJECT ORASCOPTIC RESEARCH

PREP CHECK

CYTOLOGY

ORASCOPTIC

SHOWCASE

SERVICE

MERCURY

REVIEWS

CARLEE

CHANEL

AGILE

SHOWCASE REVIEWS CHANEL BOTOX

BOTOX

SERVICE CARLEE AGILE VCU

BARBIE VDAF

MOM PROJECT MERCURY BARBIE VDAF SEO >> ANSWERS ON PAGE 72 31

®

UNIVERSITY CONNECTIONS

THE VALUE OF LUNCH AND LEARNS Lily Mlynarczyk; Class of 2025, VCU School of Dentistry

The American Student Dental Association (ASDA) at Virginia Commonwealth University (VCU) hosts numerous “lunch and learns” each year. Lunch and learns are valuable to students for a number of reasons. They provide information relevant to students, allow current ASDA members to interact with one another, and allow students to gain a perspective on the business side of dentistry. The responsibility of planning each event is given to the ASDA representatives of the secondyear class. As the previous ASDA Representative of the second-year class, I had the opportunity to organize the Lunch and Learns during the 20222023 school year. I cannot begin to express how valuable these meetings are for dental students’ education.

Many of the topics presented are not necessarily covered in our didactic or clinical education, so these events serve as supplemental learning opportunities for VCU School of Dentistry students and provide an excellent introduction to organized dentistry. This past year, students had the opportunity to learn about different dental companies, brands, and organizations involving a variety of different topics. These events give students the opportunity to network with and learn from different companies, in addition to eating delicious food!

For many students, their knowledge of the business side of dentistry comes from companies willing to share their expertise at these events. One of my favorite events was held after school, a “dinner and learn!” Shared Practices is an admired dental company that has a podcast that many dental students at VCU listen to. I used that knowledge

32

and reached out to the company and asked if they wanted to fly in to speak about the business side of dentistry. This event was exceptionally informative on all things related to practice ownership, business management, and what to look for in a practice.

My ultimate goal when planning the lunch and learns was to provide students a space where they can learn about topics outside of our current curriculum and ask questions in a comfortable, relaxing environment. The opportunity of planning these events with my fellow ASDA representatives allowed me to network with numerous dental companies and meet amazing people along the way. The information I have gained through these sessions will follow me through my career as a future dentist!

I am grateful that Virginia Commonwealth University School of Dentistry gives students numerous opportunities to learn outside of the normal classroom setting and to the Virginia Dental Association for coming in every year to speak to the students!

UNIVERSITY CONNECTIONS

INTERPROFESSIONAL HEALTHCARE – A CORNERSTONE OF VCU’S DENTAL EDUCATION Anneliese Goetz, Associate Editor; Class of 2025, VCU School of Dentistry

First-year dental students at Virginia Commonwealth University (VCU) have just moved their materials and instruments into their Woolwine Simulation Laboratory benches when they are introduced into the world of interprofessional healthcare.

VCU’s IPEC 501: Foundations of Interprofessional Practice kicks off about two weeks into our fall semester of the first year and includes faculty and students from VCU’s DDS and Dental Hygiene, Doctor of Physical Therapy, Doctor of Occupational Therapy, Nursing, Doctor of Pharmacy, and Master of Public Health programs.

In this course, students are placed into multidisciplinary small groups, where they learn the fundamentals of interprofessional collaborative care and, via online or in-person meetings, work through example cases that delve into real-life scenarios in which collaboration across healthcare disciplines takes place. Not only does this course give us more insight into what each of these healthcare fields does on a day-to-day basis, but it also fosters an environment where we are able to learn how to communicate appropriately across disciplines. We learn about different types of team decision-making and the levels of care at which collaborative practice can take place, including the patient level, the group level, the organizational level, and the societal level.

Concurrently, early in our first year, we begin our first periodontology course, where we are again placed in small groups with other firstyear dental students as well as first-year dental hygiene students.

This course essentially sets the stage for our careers as dentists – working directly alongside our dental hygiene colleagues to make accurate diagnoses, formulate proper treatment plans, and deliver high-quality, evidence-based treatment.

This emphasis on interprofessional care is continued throughout our first and second years as we enter didactic courses such as Gross Anatomy, Physiology, General Pathology, and Pharmacology, taught by faculty from the Schools of Medicine and Pharmacy.

During this time, we learn about the importance of a proper medical consultation or referral. Combining what we have learned from our physiology, pathology, and pharmacology courses, we are taught what warrants a medical consult and ways in which we can intelligibly and respectfully communicate with our healthcare colleagues to ensure the best healthcare outcomes for our patients as we enter clinic in the summer of our second year. In addition to gaining an appreciation for our partners from other healthcare disciplines, we also are provided opportunities to work with the specialties of dentistry, including pediatric dentistry, periodontics, endodontics, prosthodontics, orthodontics, oral and maxillofacial surgery, orofacial pain, oral pathology, oral radiology, oral medicine, and dental public health through didactic courses as well as clinical rotations.

Simulation. In this course, dental students, dental hygiene students, and nurse practitioner students collaborate on a patient simulation activity to gain an accurate and thorough health and social history through patient interviewing and formulate a comprehensive patient management plan.

We are extremely fortunate to have a vast array of health professionals at our fingertips (or across the street) on the Medical College of Virginia campus.

Not only is this beneficial to us as students, but it enables our patients to access the highest quality of care from students and faculty who have been well-trained in interprofessional care management.

In our third year at VCU, we once again are exposed to formal training in interprofessional healthcare through the Interprofessional Health Assessment

33

www.acgwealthmanagement.com

34

VDA Career Center connects employers with premier dental professionals

Employers:

Job Seekers:

• EMAIL your job directly to job seeking professionals • PLACE your job in front of our highly qualified members • SEARCH our resume database of qualified candidates • MANAGE jobs and applicant activity right on our site • LIMIT applicants only to those who are qualified

• POST multiple resumes and cover letters or choose an anonymous career profile that leads employers to you • SEARCH and apply to hundreds of fresh jobs on the spot with robust filters • SET UP efficient job alerts to deliver the latest jobs right to your inbox • ASK the experts advice, get resume writing tips, utilize career assessment test services, and more

• FILL your jobs more quickly with great talent

— CAREERS.VADENTAL.ORG —

2023

“ Loved it!”

“ We had a wonderful time, thanks again!”

36

Please visit us on Facebook to see more photos.

2023 “ the Event exceeded expectations.”

“ Fun and truly useful information.”

Please visit us on Facebook to see more photos.

37

2023

“ I think the meeting was a great success.”

“ Thank you well done!”

38

Please visit us on Facebook to see more photos.

AI: The Future of Dentistry

SAVE THE DATE

September 13-14, 2024 The Greenbrier | White Sulphur Springs, WV

JOINT MEETING WITH:

Virginia Academy of Pediatric Dentistry

39

SCIENTIFIC

THE USE OF SILVER DIAMINE FLUORIDE

BY DENTISTS IN VIRGINIA

Dr. Jessica Eisenberg, Dr. Parthasarathy A. Madurantakam, Dr. Tegwyn H. Brickhouse, Dr. Jayakumar Jayaraman, Dr. Caroline K. Carrico, and Dr. Carol Caudill

ABSTRACT:

Purpose: To determine the use of silver diamine fluoride (SDF) by dentists in Virginia and the factors that affect their decision.

Methods: A survey was sent to members of the Virginia Dental Association (VDA) by email and posted on the VDA’s social media.

Results: Practitioners who graduated from dental school within the last five years report significantly more SDF use than those who have been practicing longer (p-value=0.0053). Practitioners also reported greater use of SDF if they reported adequate training on its use (p-value<0.0001).

Conclusion: Training on SDF and appropriate reimbursement are important to increase SDF utilization among dentists in Virginia.

INTRODUCTION:

Silver diamine fluoride (SDF) is a caries arresting and desensitizing liquid medicament that has been utilized in dentistry in Japan and other countries as early as the 1960s.1 In 2014, the Food and Drug Administration (FDA) approved SDF in the United States for reduction of dentin sensitivity, and it is also used off-label to arrest caries.2,3 SDF may be recommended as a treatment option for patients to avoid general anesthesia or when traditional dental restorations are not possible due to behavior, financial concerns, or lack of access to definitive dental care.4 Studies have shown a caries arrest rate of greater than 80 percent with application of SDF.5 However, the success of SDF is affected by the location of the caries; anterior teeth have a higher rate of caries arrest compared to posterior teeth.3 The use of SDF to arrest caries in primary teeth is conditionally recommended by the American Academy of Pediatric Dentistry per GRADE based on low-quality evidence, suggesting that the benefits of SDF likely outweigh the downsides, but that more high-quality research needs to continue to be conducted in future.6

40

As with any dental procedure, it is important for the practitioner to review risks, benefits, and alternatives of SDF with the patient or guardian and obtain informed consent. One advantage of SDF is that it is a minimally invasive and relatively quick treatment that can be used to delay or prevent the need for dental treatment with sedation or general anesthesia.2,7,8 Another benefit of SDF is that it can be applied without producing aerosols, which was an important consideration during the height of the pandemic.9 On the other hand, the major disadvantages of silver diamine fluoride are permanent staining of the carious tooth structure, staining of clothes, as well as temporary staining of soft tissue and metallic taste which may be unpalatable to the patient.10,11 SDF should be avoided in people with a silver allergy.6 Reapplication of SDF may be required to continue to arrest caries, and there is no guarantee that it will arrest the caries.4,6 Previous studies in the United States have examined pediatric dentists’ use, education, knowledge and attitudes regarding SDF.4,7,12 However, to the best of the authors’ knowledge, no studies have examined this in dental practitioners

in Virginia. The aim of this study was to determine the use of silver diamine fluoride (SDF) by dentists in Virginia and examine the factors affecting their decision.

METHODS:

This study was a cross-sectional 40-item survey. With the author’s permission, it was developed by modifying a previous survey of American Academy of Pediatric Dentistry members in the United States about their SDF use by Dr. Marita Inglehart.4 The survey contained demographic questions including years since dental school graduation, sex, VDA component, type of dental practitioner, type of practice, and additional training.

The primary outcome in this study was the use of SDF in dentistry in Virginia. Survey items included questions on SDF use and on the influences on the practitioner’s use of SDF including education on SDF, esthetics, cost, and guardian/patient attitudes. At the end of the survey, an example of an SDF consent form and a guide to using SDF titled “Chairside Guide: Silver Diamine Fluoride in the Management of Dental Caries Lesions” were available to download.13 This study was approved as exempt by the Institutional Review Board of Virginia Commonwealth University with the study ID number HM20023939.

Members of the Virginia Dental Association (VDA) were recruited for participation in the survey via email, the VDA Facebook page, and the VDA LinkedIn page. The email was sent to 3,688 VDA members. At the time of the survey, the VDA Facebook page had 3,444 followers and the VDA LinkedIn account had 564 followers. An explanation of the survey was provided in the email and on the websites. Survey responses were collected through Research

SCIENTIFIC

Table 1: Personal and Practice Characteristics of Respondent Providers

Table 2: Self-Reported Utilization of Silver Diamine Fluoride (SDF)

second email on July 9, 2022 to all email addresses that had not opened the initial survey request email. The survey request was also included in the VDA Hub Digest that was emailed to members on July 12, 2022; July 26, 2022; and August 23, 2022. The VDA posted the survey request to the VDA social media (Facebook, LinkedIn) on July 7, 2022 and again on August 13, 2022. Being a member of the VDA was an inclusion criteria for this study.

Electronic Data Capture (REDCap) hosted at Virginia Commonwealth University.14 The responses were not connected to the email address to maintain anonymity.

The first survey request was emailed to members on July 7, 2022, with a

Responses were summarized using descriptive statistics including counts and percentages for categorical variables and mean, standard deviation for numeric responses. Differences in responses were compared using chi-squared and Fisher’s exact test, as appropriate. The average knowledge rating was compared between users and non-users with t-test.

All analysis was performed with SAS EG v.8.2 (SAS Institute, Cary, NC) and a significance level of 0.05.

RESULTS:

145 practitioners responded to the survey (3.9% approx. response rate).

Most were general dentists (77%) with

ten or more years in practice (69%), in a solo or group practice (64%). Nearly all dentists reported treating children in their practice (95%), while only 40 percent reported accepting patients with Medicaid insurance. There was a nearly equal distribution of male (51%) and female respondents (45%), and the distribution of providers across the various VDA regions was representative with more respondents in the more heavily populated regions (Richmond: 26%, Northern Virginia: 22%, Tidewater: 13%). A complete summary of practitioner demographics is provided in Table 1.

Of the responding providers, 66 percent reported currently using SDF in their practice (Table 2). Of those providers who reported using SDF, the most common clinical situations reported were for arresting caries in children with behavioral issues (77%), to delay restorative treatment (73%), in medically fragile patients (67%), for root caries (60%), and for patients with severe dental anxiety (54%). Respondents were also asked about their frequency of SDF use in various clinical situations (Figure 1).

Respondents indicated frequency with a

>> CONTINUED ON PAGE 42 41

SCIENTIFIC >> CONTINUED FROM PAGE 41 5-point Likert scale ranging from “Never” to “Very Often,” with the addition of “Previously but no longer” as a choice.

Practitioners reported using SDF “Often” or “Very Often” to arrest caries in primary teeth (51%), to arrest caries in permanent teeth (31%), and to arrest caries in patients with special health care needs (41%).

Those who reported using SDF in their practice were asked on a 5-point Likert scale (-2 =Major Deterrent to 2= Major Benefit) whether various aspects of SDF were Deterrents or Benefits (Figure 2). Eighty-four percent of practitioners who reported using SDF considered esthetics to be a deterrent. Thirty-six percent of practitioners chose “concern with effectiveness” as a deterrent to the use of SDF. The most commonly selected benefits were to delay restorative treatment (82%), patient comfort (71%), and the cost for the patient (59%).

Figure 1: Self-reported SDF use for various clinical scenarios.

Figure 2: Influence of Characteristics of SDF on Treatment Decisions

42

Practitioners who perceived that they had received adequate training on SDF were significantly more likely to report using it than those who did not feel that they had adequate training (86% vs 28%, p-value<0.0001). In addition, practitioners who graduated from dental school within the last five years reported significantly more SDF use than those who have been practicing longer (89% versus 60%, p-value=0.0053). The other characteristics tested (gender, VDA region, treating pediatric patients, and accepting Medicaid) were not significantly associated with self-reported use of SDF (Table 3).

Only 65 percent of respondents felt they had received adequate training on SDF (Table 4). Respondents indicated “selfguided learning” as the most common method of education on SDF (43%).

Only 20 percent of practitioners reported having a lecture on SDF in dental school, sixteen percent reported they had never received any education on SDF ever.

When asked if more training would make providers feel more comfortable using SDF, 73 percent responded with a “Yes” (44%) or “Somewhat” (29%).

SCIENTIFIC

Respondents were asked to rate their knowledge of various aspects of SDF on a Likert scale from 1 (“Not at all Familiar”) to 5 (“Very Familiar”). Providers who reported using SDF had significantly higher reported knowledge ratings in all categories than those who reported not using SDF (p-value <0.0001 for all statements). The largest difference in average reported knowledge was regarding potential problems associated with SDF use which had an average score of 4.2 (95% CI: 4.00-4.45) among users of SDF compared to 2.7 (95% CI: 2.27-3.18).

Table 3: Association of Personal and Practice Characteristics and Self-Reported Use of Silver Diamine Fluoride (SDF)

DISCUSSION:

The self-reported frequency of SDF use while in dental school was “never” for 81 percent of the participants. This percentage is likely so high because 69 percent of the practitioners reported being in practice for ten or more years, so they had graduated from dental school before SDF was FDA-approved in the US.2 This outcome was similar to a 2019 study which found that over 90 percent of pediatric dentists had not received education on SDF in dental school.4 The majority of participants (73%) who did not perceive they had adequate training with SDF did not utilize SDF. This finding also mirrored the 2019 survey of pediatric dentists.4 Together, these results suggest that there is a continued need for quality continuing education courses on SDF to help increase dentists’ utilization of it in Virginia.

The majority of practitioners found the unesthetic appearance of SDF to be a deterrent to its use. However, one study found that guardian acceptance rate of SDF on primary anterior teeth was as high as 60.3 percent if applying SDF meant that the patient could avoid general anesthesia, so practitioners should not automatically assume that a guardian would not accept the appearance of SDF.8 In addition, 28 percent of respondents rated “reimbursement” as a deterrent to the use of SDF. This finding suggests that education alone may not be enough to increase SDF usage. Dentists will need to continue to lobby for better insurance reimbursement as well.

The major limitation of this study was the low response rate to the survey. Because of this, it is difficult to generalize the outcomes of this study to all dentists in Virginia. Also, only VDA members were surveyed, which may be a potential source of bias as the results may not be representative of nonmembers. Future research should ideally achieve a higher response rate.

CONCLUSION:

Based on this study’s results, the following conclusions can be made: 1. Practitioners who recently graduated from the dental school utilized SDF more than those who have been practicing longer, likely due to training on SDF while in school.

2. Overall, practitioners who utilized SDF had higher selfreported knowledge levels on SDF. Increased CE courses and higher reimbursement could encourage more practitioners to use SDF in Virginia in the future.

>> CONTINUED ON PAGE 44 43

SCIENTIFIC >> CONTINUED FROM PAGE 43 Table 4: Self-Reported Training on Silver Diamine Fluoride (SDF)

References: 1. Yamaga R, Yokomizo I. Arrestment of caries of deciduous teeth with diamine silver fluoride. Dent Outlook Archieve. 1969;33: 1007-1013.

2. Desai H, Stewart CA, Finer Y. Minimally invasive therapies for the management of dental caries—a literature review.

Dent J (Basel). 2021;9(12). doi:10.3390/dj9120147 3. Crystal YO, Niederman R. Evidence-Based Dentistry Update on Silver Diamine Fluoride. Dent Clin North Am. 2019;63(1):45-68. doi:10.1016/j. cden.2018.08.011 4. Antonioni MB, Fontana M, Salzmann LB, Inglehart MR. Pediatric Dentists’ Silver Diamine Fluoride Education, Knowledge, Attitudes, and Professional Behavior: A National Survey. J Dent Educ. 2019;83(2):173-182. doi:10.21815/jde.019.020 5. Fluoride Therapy. The Reference Manual of Pediatric Dentistry.

Published online 2021:302-305.

6. Crystal YO, Marghalani AA, Ureles SD, et al. Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents, Including

44

Those with Special Health Care Needs. The Reference Manual of Pediatric Dentistry. Published online 2017:E135-E145.

7. Johnson LL. The Association Between Wisconsin Dentists’ Use of Silver Diamine Fluoride (SDF) and the Theory of Planned Behavior (TPB) A Thesis Submitted to the Faculty University of Minnesota. 2020.

8. Crystal YO, Janal MN, Hamilton DS, Niederman R. Parental perceptions and acceptance of silver diamine fluoride staining.

Journal of the American Dental Association. 2017;148(7):510518.e4. doi:10.1016/j. adaj.2017.03.013 9. Mohammed IE, Shariff N, Mohd Hanim MF, et al. Knowledge, Attitudes and Professional Behavior of Silver Diamine Fluoride among Dental Personnel: A Systematic Review. Children. 2022;9(12). doi:10.3390/children9121936 10. American Academy of Pediatric Dentistry. Policy on the use of silver diamine fluoride for pediatric dental patients. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry;

2022:72-5.

11. Chai HH, Kiuchi S, Osaka K, Aida J, Chu CH, Gao S. Knowledge, Practices and Attitudes towards Silver Diamine Fluoride Therapy among Dentists in Japan: A Mixed Methods Study. Int J Environ Res Public Health. 2022;19(14). doi:10.3390/ijerph19148705 12. Crisp JD, Wright JT, Divaris K, Sanders AE. Influences on Dentists’ Adoption of NonSurgical Caries Management Techniques: A Qualitative Study.; 2020.

13. Chairside Guide: Silver Diamine Fluoride in the Management of Dental Caries Lesions. The Reference Manual of Pediatric Dentistry. Published online 2022:596-597.

14. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381. doi:10.1016/j.jbi.2008.08.010 Corresponding Author: Carol Caudill, DDS Assistant Professor Department of Pediatric Dentistry Virginia Commonwealth University Box 980566 520 North 12th Street, Richmond, Virginia 23298-0566 (804) 828-2362 cacaudill@vcu.edu Acknowledgment: This research was supported by the Alexander Fellowship Fund.

ORAL SURGERY ABSTRACTS

AMERICAN ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGEON’S POSITION PAPER ON ORAL MUCOSAL DYSPLASIA Carlson ER, Kademani D, Ward BB, Oreadi D. J Oral Maxillofac Surg 2023; 81(8):1042-1054

Leukoplakia, erythroplakia, erythroleukoplakia, lichen planus, and oral lichenoid lesions are oral potentially malignant disorders (OPMDs). In the field of oral health care, these lesions are commonly detected during oral cancer screenings. Given sufficient time, these OPMDs have a high likelihood of evolving into oral cancers. Early detection and proper treatment can help to lessen the morbidity and mortality associated with these lesions. As oral healthcare providers, it is essential to remain upto-date on the latest terminology and treatment recommendations for these common pathologies.

Leukoplakia, defined as a white plaque, can be an easily overlooked and undervalued finding during the routine head-neck examination. Its prevalence is cited to be 2% internationally; leukoplakia can be graded as dysplastic or nondysplastic. Literature reports the incidence of oral dysplasia overall ranges from 2.5% to 10%. Erythroplakia is defined as “a fiery red patch that cannot be characterized clinically or pathologically as any other definable disease.” Primarily occurring in middleaged and elderly people, its prevalence ranges between 0.02% and 0.83%.

Erythroplakia histologically demonstrates at least moderate or severe dysplasia, with carcinoma in situ occurring as well. A majority of erythroplakic lesions will undergo malignant transformation given the appropriate time. Lichen planus of the oral mucosa is a chronic inflammatory autoimmune disease that is characteristically identified by lacy white lesions with or without erosive or atrophic areas. It is estimated to affect 1.32 % of the European population, having a malignant transformation of 1.14%.

Histological examination of the OPMDs is the single most important diagnostic factor for proper identification and treatment.

There are multiple classification systems used for grading of dysplasia. Currently, oral epithelial dysplasia is graded by

the 3–tear method of classification: mild dysplasia, moderate dysplasia, and severe dysplasia/carcinoma in situ. There has been a recent increase in HPV-associated cancers of the oropharynx. HPV-associated dysplasia is more common in males (M: F = 6: 1) and commonly identified in the sixth decade. This paper did not comment on the differences in treatment between HPV-associated OPMDs and non-HPVassociated ones.

Although there have been vast advances in medicine over the past few decades, the five-year survival rate of patients diagnosed with oral squamous cell carcinoma (OSCC) has remained stagnant, currently ranging from 50 to 55%. OSCC has a predilection for males greater than 40 years old with a history of regular exposure to tobacco products and alcohol. In patients who have heavy use of tobacco and alcohol, there is 38 times the risk of developing oral cancer when compared with those who abstain. The annual rate of malignant transformation for all types of leukoplakia varies by study; literature reports an annual malignant transformation between 4.5% and 6.3%. Those that have a higher risk of malignant transformation include leukoplakia in non-smokers, nonhomogeneous in type, long duration of the leukoplakia, females, presence of epithelial dysplasia, and lesions greater than 2 cm².

Research demonstrates no uniform data on the most efficacious treatment modality for OPMDs. However, a recent retrospective study of 120 patients with oral epithelial dysplasia (OED) demonstrated that patients who underwent treatment using scalpel excision, laser excision, or laser ablation saw a statistically significant decrease in transformation rate when compared with untreated patients. One cited study in particular, reported rates of malignant transformation of high-grade OED being as high as 28.6% in the

untreated population, with a reduction to 12.3% in patients who received treatment. The most common treatment modalities include surgical excision, laser excision, and laser ablation. Treatment of choice should be based on clinical and histopathologic findings.

Newly emerging technologies have potential in predicting malignant transformation of oral mucosal dysplasia using quantitative tissue phenotyping.

Phenotypically distinct cell types are being assigned a score which is associated with an increased propensity for malignant transformation. In the coming decades this may prove to be of important predictive value for determining treatment modalities.

In summation, OPMDs are commonly detected during routine head and neck examinations. All patients with suspicious lesions should have a biopsy completed.

If a provider is unfamiliar or uncomfortable with managing the lesion appropriate referral to an oral medicine specialist and/ or oral and maxillofacial surgeon should be completed. Routine follow-up and surveillance of the OPMDs is essential, and almost always lifelong follow up is recommended. Clinical surveillance should be based on the site of the lesion, the grade of dysplasia, and the patient’s presence or absence of risk factors.

Documentation of clinical symptoms and appearance as well as quality clinical photography allows for early detection of progression. Early detection of progression and expedient treatment will help to decrease morbidity associated with these lesions.

Melchoir Savarese, DDS; Resident, Oral & Maxillofacial Surgery, VCU Medical Center

45

ORAL SURGERY ABSTRACTS

SELECTIVE SEROTONIN REUPTAKE INHIBITORS AND THE RISK OF OSSEOINTEGRATED IMPLANT FAILURE Wu X et al. J Dent Res. 2014; 93(11): 1054-1061

Depression is a major health issue affecting over 280 million people across the globe, and selective serotonin reuptake inhibitors (SSRIs) are commonly used antidepressant medications.

Serotonin regulates bone cells by acting on serotonin receptors (5-HTTs), which normally transmit both osteoblast and osteoclast signals. Thus, the use of SSRls influences bone metabolism and are associated with decreased bone formation and decreased bone quality.

This is a result of the increased osteoclast differentiation, which results from blocking the serotonin receptor. Dental implant success depends widely on the ability of the bone and implant to fuse, otherwise known as osseointegration. The aim of this study investigates whether there is a relationship between the use of SSRls and the failure for osseointegration of implants.

A retrospective cohort analysis was carried out on patients who underwent dental implants between January 2007 and January 2013. There were 490 patients overall with 916 dental implants.

Among these, 94 implants were placed in patients who used SSRls, whereas 822 were placed in patients who did not. SSRI usage was defined as filling a prescription for SSRls at the time of implant placement (citalopram, dapoxetine, escitalopram, fluoxetine, fiuvoxamine, indal pine, paroxetine, sertraline, venlafaxine, and zimelidine. Numerous elements were taken into account, including smoking patterns, implant features, and patient demographics. In order to evaluate the relationship between SSRls and implant failure, the study used statistical analyses

46

such as Cox proportional hazards, generalized estimating equation models, and Kaplan-Meier analysis.

Patients were excluded if they had severe systemic disease (American Society of Anaesthesiology Ill or IV), were pregnant, or had a medical disorder known to substantially affect bone metabolism, such as osteoporosis, osteomalacia, Paget’s disease, vitamin D deficiency, hyperthyroidism, cancer (excluding nonmelanoma skin cancer), or alcoholism, as were those on corticosteroids, antiepileptic drugs, antihypertensive drugs, proton pump inhibitors, or bisphosphonates. After a follow-up period of 3 to 67 months, eight dental implants failed, and 784 succeeded in the non-SSRI users group, while ten failed and 84 succeeded in the SSRIusers group. Implants with at least one of the following complications were defined as failures: pain on function; mobility; radiographic bone loss equivalent to onehalf of the implant length; uncontrolled exudate; or implant no longer in mouth (Misch et al., 2008). The overall failure rates were 4.6% for non-SSRI users and 10.6% for SSRI users. SSRI use was found to be associated with a significantly increased risk of dental implant failure (hazard ratio, 6.28; 95% confidence interval, 1.25-31.61; p = .03). Smoking habits and small implant diameters (54 mm) were also associated with higher implant failure risk.

The investigation supported the hypothesis that SSRI use increases the likelihood of dental implant failure as a result of failed osseointegration. The

systemic and demographic parameters of SSRI users and non-users did not significantly differ; however, SSRI users had a greater risk of implant failure. Instead of late failures linked to variables like peri-implantitis, the timing of implant failures among SSRI users revealed a probable association with mechanical loading difficulties. This suggests that SSRIs prevent mechanical loading-induced bone remodeling, which increases the risk of implant failure. This is in agreement with previous in vivo studies demonstrating that serotonin plays an important role in the anabolic response of bone to mechanical loading (Sibilia et al., 2013) In conclusion, the study shows a strong relationship between SSRI use and dental implant failure due to a lack of osseointegration. This study emphasizes the importance of considering various factors when planning dental implant procedures for patients on antidepressant medications. According to the research, individuals who need dental implants but are using SSRIs should carefully arrange their surgeries. It is our responsibility as providers to record both an accurate health history and medication history, as this study shows how medications like SSRIs can have negative effects on treatment outcomes.

Dr. Mohammed Obeid; Resident, Oral & Maxillofacial Surgery, VCU Medical Center

ORAL SURGERY ABSTRACTS

COMPARATIVE EFFICACY AND SAFETY OF DIFFERENT CORTICOSTEROIDS TO REDUCE INFLAMMATORY COMPLICATIONS AFTER MANDIBULAR THIRD MOLAR SURGERY: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS Dos Santos Canellas JV, Ritto FG, Tiwana P. Brit J Oral Maxillofac Surg 2022; 60(8): 1035-1043

Whether erupted or via odontectomy, the removal of third molars is a commonly performed procedure that requires special attention to minimize post-operative complications. Numerous interventions have been introduced in hopes of addressing patient pain and limiting the inflammatory response, which can alter the quality of life during healing.

In addition, reducing inflammation and edema can prevent adverse outcomes such as airway compromise. Available options include the use of corticosteroids, concentrated platelet therapies, nonsteroidal anti-inflammatory agents, and prescription rinses, to name a few.

Corticosteroids limit the inflammatory response through inhibition of prostaglandin and leukotriene release, which can decrease edema, erythema, and post-operative pain. However, clear recommendations have not been published regarding preoperative dosing or administration routes to best control post-operative complications.

The British Journal of Oral and Maxillofacial Surgery published a systematic review conducted to compare five corticosteroids over multiple doses and administration routes to patients undergoing mandibular third molar extractions. A network meta-analysis was performed using PubMed, Embase, and Cochrane Library using 61 randomized control trials encompassing 3561 patients in 22 countries. Dexamethasone, betamethasone, methylprednisolone, prednisolone, and triamcinolone were studied over seven different routes of pre-operative administrations, including submucosal injection, pterygomandibular injection, intraosseous injection, extraoral intramuscular injection, intramasseteric injection, oral tablets, and intravenous

injection versus placebo. A relative ranking of preoperative corticosteroids was determined based on their effects on the prevention of trismus, edema, and pain. Participants included healthy humans of any age, gender, or ethnicity who had been submitted to mandibular third molar surgery. Excluded studies included those observing groups with particular comorbidities, pediatrics, or procedures under general anesthesia.

Pain following mandibular third molar surgery was evaluated via a visual analog scale on post-operative days (POD) one and two. Compared to other interventions and placebo, 8mg dexamethasone via submucosal injection had the highest significance (p=0.95) in reducing pain on POD-1 and POD-2, followed by 8mg dexamethasone via pterygomandibular injection. Corticosteroid effects on maximum incisal opening were measured on POD-2. Only 4mg of dexamethasone via submucosal infiltration and intravenous 125 mg methylprednisolone proved to be more effective than placebo in reducing trismus. Increased doses of corticosteroids or intramuscular infiltration had no increased benefit in trismus reduction. Facial edema was analyzed via two extraoral measurements: Tr-Ch, the distance between the tragus and the commissure of the mouth; and Ex-Go, the distance between the lateral canthus of the eye and the gonion angle of the mandible. Differences in methodologies regarding edema measurements resulted in decreased number of studies for this variable. However, 8mg dexamethasone via submucosal infiltration and 8mg dexamethasone oral tablets had the highest probability in reducing edema following third molar extraction (p = 0.71, p=0.75 respectively). No adverse effects

were reported with corticosteroid use.

The study concluded 8mg dexamethasone was the most effective corticosteroid for improving inflammation in comparison to other doses and medications observed. However, 12 of 61 studies included a high risk of bias and post-operative analgesic dosing not being reported, which may confound results of pain, trismus, and edema.

Other limitations to this study include the subjectivity of the VAS as well as perioperative variables such as difficulty of extraction, operator experience, and length of procedure that can affect patient response. Further research is necessary to directly compare multiple routes of administration to determine the most advantageous methods for the reduction of inflammation following third molar surgery.

Dr. Breanna Irizarry; Resident, Oral and Maxillofacial Surgery, VCU Medical Center

47

ORAL SURGERY ABSTRACTS

IS PSYCHIATRIC ILLNESS ASSOCIATED WITH RISK FOR POSTOPERATIVE COMPLICATIONS IN THE OUTPATIENT SETTING? Verma P, Curtis C, Darisi RD, Tewari A, Triana RR, Krishnan DG. J Oral Maxillofacial Surg. 2023; 81(6): 763-771

Individuals with psychiatric illness represent a rapidly growing demographic in the American populace and globally, with an estimated 22.8% of the world’s population being affected by a DSM-5 diagnosable mental illness. The rates of psychiatric illness have been steadily increasing over the last 20 years, but the approach to treatment and management of this patient demographic has remained largely unchanged for oral healthcare providers. Little is known in regard to how mental illness may affect the postoperative healing course of the patients we treat and how the experiences of these patients may be impacted by their underlying psychiatric conditions. This article aims to shed light on this issue and provide statistical analysis of the rates of post-operative complications experienced in this demographic compared to individuals with no DSM-5 diagnosable psychiatric condition.

The article provides a retrospective cohort study conducted by chart review of electronic health records using the inclusion criteria of any patient over 15 years old who underwent an outpatient OMS procedure at the OMS clinics at the University of Cincinnati. The study identified 3874 patients, and none were excluded. The study aimed to analyze the risk of postoperative complications for patients with a confirmed history of psychiatric illness

48

versus those patients with no history of psychiatric illness diagnosis. Patients with identified psychiatric disorders were subsequently categorized into seven classifications as categorized by the DSM V: I- Neurodevelopmental Disorders, II- Schizophrenia Spectrum and Other Psychotic Disorders, III- Bipolar and Related Disorders, IV- Anxiety and Depressive Disorders, V- Substance Use and Addictive Disorders, VI- Personality Disorders, and VII- Other disorders.

The patients were also subcategorized based on gender, race, ASA status, and procedure performed.

The study ended up finding no statistically significant difference in the rates of post-surgical complications reported by patients with diagnosed psychiatric illnesses. The identifying factors that were determined to make a significant impact on the complication rates were gender, with women 1.5 times more likely to experience post-operative morbidity than men, sedation, which showed that patients who were sedated for treatment had higher morbidity, and procedures performed.

This study contrasts the findings of other recent studies, which have found statistically significant differences in the infection rates of psychiatric patients compared to patients without psychiatric diagnoses, though the author writes this off as outpatient OMS procedures

are generally not associated with high morbidity rates and studies into those morbidity rates may be difficult without pooling massive groups to find statistical significance.

Overall, the study brings up an interesting topic that is encountered day in and day out in the OMFS clinic, but with few controls and such a broad sweeping analysis of so many different psychiatric disorders and so many different OMFS procedures, putting any weight on the findings of the study is difficult. The study provides low-level evidence for the question of whether or not psychiatric patients experience higher rates of postoperative morbidity or mortality. However, the point of this retrospective cohort study likely was to draw attention to a relatively poorly studied risk factor that could impact our patient care as oral and maxillofacial surgeons. There is room for more study on the impact of psychiatric disorders on patient experience with oral and maxillofacial surgery, and, in the future, better-controlled analysis of data in this area would likely produce interesting findings that could impact everyday practice in the OMFS clinic.

Dr. Gabriel French; Resident, Oral & Maxillofacial Surgery, VCU Medical Center

ORAL SURGERY ABSTRACTS

OSTEORADIONECROSIS: A REVIEW OF PATHOPHYSIOLOGY, PREVENTION AND PHARMACOLOGIC MANAGEMENT USING PENTOXIFYLLINE, Α-TOCOPHEROL, AND CLODRONATE Rivero JA, Shamji O, Kolokythas A. Oral Surg Oral Med Oral Path Oral Radiology. 2017; 124(5): 464–471

Head and neck cancer is a malady that is commonly encountered in all oral health specialties, and therefore, all providers in the dental field should be knowledgeable about general diagnosis and treatment guidelines associated with complications such as osteoradionecrosis (ORN). It is important to note that up to 60% of head and neck cancer patients undergo radiation therapy as part of their treatment. For patients who are diagnosed with head and neck cancer and have undergone or are soon to begin treatment, a thorough oral examination should be completed, and treatment completed as needed. Ideally, all dental treatment should be completed prior to radiation. Radiotherapy targets cells with a high turnover rate, ideally affecting the primary tumor site, but this radiation therapy is not specific and will also negatively impact native host tissues.

This effect on surrounding tissues can have many manifestations, most notably reduced regenerative capacity and poor healing after procedures or injury. Although mechanisms are not clearly understood, the general principle is that a radiated patient has much less regenerative capacity and healing potential compared to a nonradiated patient. This is important in the oral environment when treatment planning, especially when planning tooth extractions.

A devastating complication of tooth extraction in a patient that has been radiated to the head and neck is a condition called osteoradionecrosis.

Osteoradionecrosis (ORN) is a condition defined as an area of exposed, irradiated, and devitalized bone that has been present for three months without evidence of tumor recurrence. Common symptoms of ORN include pain, dysesthesia, paresthesia, and trismus, to name a few.

Clinically, this appears as an area of exposed bone for three or more months, usually with ulceration of the surrounding mucosa. If extensive, ORN can lead to pathologic fracture, overlying infection, and draining fistulas. One of the most common etiologies cited for ORN is tooth extraction, and up to 18% of ORN cases can be associated with tooth extraction as the inciting factor. Other risk factors for ORN include trauma or surgical procedures to radiated bone, social habits such as alcohol and tobacco, and poor oral hygiene, which includes caries and periodontal disease, which lead to chronic inflammation.

There is no clear protocol for the prevention of ORN; however, there is weak evidence that hyperbaric oxygen therapy (HBO), both pre and postoperatively, will reduce the risk of ORN. HBO is extremely expensive and not the mainstay of treatment at this time.

The best preventive measure for dental providers is to ensure all dental care is completed prior to radiation therapy if at all possible.

Patients with diagnosed medicationrelated osteonecrosis of the jaw (MRONJ) should still continue with routine dental care and also follow closely with an Oral and Maxillofacial surgeon. Dentists must continue to follow closely with these patients to ensure they are treating active caries and periodontal disease to reduce the risk of future ORN. The nonsurgical management of ORN includes treating any infection with antibiotics as needed, improving oral hygiene, and a regimen of daily Pentoxyphylline (PTX) and a-tocopherol (Vitamin E). These two medications are showing promise in multiple studies to help manage patients with ORN of the jaws and possibly prevent ORN in head and neck

cancer patients. Alpha-tocopherol, or Vitamin E, is an antioxidant agent that will theoretically reduce reactive oxygen species (ROS) and reduce inflammation in this inflammatory condition of the jaws.

PTX is a medication that is prescribed in the management of peripheral vascular disease and acts by promoting vasodilation, thereby increasing blood flow. This medication also has anti-tumor necrosis factor-a (TNF-a) activity, which may slow and reduce the progression of the ORN disease process. The typical regimen for PTX and a-tocopherol is 800 mg PTX and 1000 IU of vitamin E daily.

It is reasonable for dental providers to be knowledgeable about these management strategies and could consider prescribing the above mentioned medications to their patients either prophylactically before tooth extraction or when obvious ORN is discovered.

Although this disease process is still largely understood, it is important to stay up to date on the latest management strategies and upcoming treatment modalities that may improve patients’ quality of life. It is important for dental practitioners to have a general familiarity with conditions such as ORN in order to better understand the disease process and better communicate with other medical providers on the treatment team, including oral and maxillofacial surgeons, radiation oncologists, and otolaryngologists.

Dr. Hunter Watson; Resident, Oral & Maxillofacial Surgery, VCU Medical Center

49

ORAL SURGERY ABSTRACTS

CLINICAL ADVANTAGES OF IMMEDIATE POSTERIOR IMPLANTS WITH CUSTOM HEALING ABUTMENTS: UP TO 8-YEAR FOLLOW-UP OF 115 CASES Akin R, Chapple AG. J Oral Maxillofac Surg.2022;80(12):1952-1965

Implants have had ongoing advancements with planning, guided surgery, and robotic support in recent years, which has allowed for more reliable and productive strategies in placing final implant restorations. Specifically, advances utilizing computed tomography and digitally guided implant placements have allowed for more reliable and consistent duplication of natural anatomic elements, including emergence profiles.

Nonetheless, implant failures have been associated with implant length, diameter, surface characteristics, and oral hygiene.

Though, appropriate management and care of the peri-implant soft tissue and crestal bone interface could lessen the chances of failure.

In immediate implant surgery, proper care of the subgingival parts allows for the restorative dentist and dental laboratory to understand the anatomy of the extracted tooth site, as well how it varies after osseointegration. Proper surgical management of the socket allows for long-term biologic interaction of the implant. Akin et. al presents the Anatomic Harmony Abutment (AHA) procedure, which focuses on extracting the tooth, immediately placing a custom healing abutment, implant, and bone graft in the posterior region. The purpose of the AHA technique was to allow surgeons to create a predictable method to gaining softtissue emergence anatomy.

Akin and Chapple aimed to measure survival rates of immediate posterior implant placement with custom healing abutments to assess if this treatment option presents with adequate implant survival rates. This retrospective study included patients who presented over a 34-month period for molar implant placements. The inclusion criteria consisted of patients older than 20 years

50

old who consented to the extraction of a non-restorable maxillary or mandibular molar and have immediate implant placement. The exclusion criteria were inability to immediately place an implant into the extraction site, which was determined preoperatively using clinical, radiographic, and software analysis.

The authors placed the implants using a flapless protocol with a 6 mm tapered 2-piece titanium root-form dental implant with an insertion torque of 15 ncm or greater. Grafting was completed with 50% mineralized human allograft and 50% bovine xenograft. A customized immediate chair-side healing abutment was placed. Final restoration was placed after three months of osseointegration.

The outcome variables were early implant failure, implant loss due to pain, or implant mobility.

The study consisted of 115 cases with 66 female and 49 male patients from 2011 to 2014, with a 98.26% overall survival rate, with two implant failures. The maxilla had 34 first molar sites and 21 second molar sites. The mandible had 50 first molar sites and 10 second molar sites. Maxillary and mandibular first molar sites presented with 97% and 98% survival, respectively, with 100% survival in 31 second molar sites. Similar 1-year and 5-year survival rates were present, with median follow-up time being 1 year.

The intent of this study was to assess if implants placed into molar extraction sites with fabricated immediate custom healing abutments were restorable. Given that the overall survival rate was 98.26%, the AHA technique utilized demonstrates itself as a potential method. Since the AHA approach is minimally invasive without the use of mucoperiosteal flaps, sutures, or invasive surgery, this technique permits the capture of the

emergence profile. Furthermore, the AHA technique of immediate molar implant placement permits the use of widerdiameter implants. In traditional 2-staged implant placements, narrower platforms are typically used because of buccal and lingual alveolar remodeling in the extraction site. With the AHA technique, a wider diameter implant placement allows for decreased changes in buccolingual alveolar dimension, which lessens the occlusal stresses and allows for improved implant and restorative platform matching.

To further illustrate, the study utilized implants with 6.0 mm diameter, and the authors claim that a wider implant diameter is vital to retain osseointegration as it accounts for variations in occlusal loading throughout the patient’s life.

The study presents limitations as the AHA technique can still be used in traditional 2-stage procedures, even though it was aimed at improving workflow for immediate implant placement. For example, a custom healing abutment can technically be fabricated at the second stage. In addition, the study could have utilized computed tomography to assess the buccolingual alveolar dimensional changes. A larger sample size with a prospective randomized study design to compare immediate implant placements vs traditional 2-stage approach would be beneficial in comparing survival rates, healing, and esthetic outcomes.

In retrospect, the AHA approach allows for an accelerated model that aims at enhancing soft-tissue contours and increasing survival rates.

Dr. Nayab Khan; Resident, Oral & Maxillofacial Surgery, VCU Medical Center

ORAL SURGERY ABSTRACTS

COMPARISON OF PLATELET-RICH FIBRIN AND IODOFORM GAUZE IN THE TREATMENT OF DRY SOCKET Wang XL. J Oral Maxillofac Surg. 2023; 81(9):1155-1160

Alveolar osteitis, also known as fibrinolytic alveolitis or localized alveolitis, is a wellknown and common complication which can occur after simple dental extractions.

Even though most commonly seen in mandibular third molar sites, alveolar osteitis can occur in any extraction socket with an incidence of 1 to 5% after simple extractions and 5 to 45% after extraction of impacted third molars.

Increased risk factors include smoking history, duration of extraction, positioning of the tooth, and prior history of alveolar osteitis. Symptoms will present around 2 to 4 days following extraction and can manifest as erythema, malodor, severe pain, and clinically appear as an empty socket. Currently, the conventional treatment consists of local debridement under anesthesia and placement of iodoform gauze packing into the socket.

Iodoform exhibits anti-inflammatory, analgesic, and anti-corrosive properties, as well as encouraging granulation tissue formation. Limitations of this procedure include easy dilution from saliva, which can prolong healing time and aggravate patients’ discomfort. Recently, there have been multiple studies proposing the use of platelet-rich fibrin (PRF) in treating alveolar osteitis. During PRF preparation, platelets in the plasma release various growth factors, which combine with fibrin and release slowly as it degrades, inevitably promoting tissue healing. PRF can continuously release growth factors for at least seven and up to 28 days.

This study aimed to compare the effects and treatment with platelet-rich fibrin compared to iodoform gauze packing in patients with alveolar osteitis.

This prospective randomized control trial included sixty patients who underwent non-surgical extraction of mandibular third molars from January 2018 to July 2021. Inclusion criteria included severe pain within 2 to 3 days after extraction

that radiated to the auriculotemporal and mandibular areas, failure of general analgesics, and emptiness or blood clots in the extraction socket. Patients were divided into a control group (Iodoform gauze) and an experimental group (Platelet-rich fibrin). The primary outcome was defined as the degree of pain relief and bone wall pressure in the alveolar fossa. Success of treatment was classified as cured (pain disappeared with no tenderness), effective (pain relieved with mild tenderness), and ineffective (no pain relief with tenderness). Secondary outcome variables included granulation tissue formation, analgesic drug dosage, and pain scores.

third and seventh day postoperatively, subsequently leading to a decreased need for analgesic drug medications. In conclusion, the use of platelet-rich fibrin for the treatment of alveolar osteitis is associated with higher healing rates, faster promotion of granulation tissue, better relief of pain, and lower intake of analgesic pain medications compared to conventional treatments with iodoform gauze.

Peter Broccoli, DDS; Resident, Oral & Maxillofacial Surgery, VCU Medical Center

Platelet-rich fibrin was collected from the patient in a standard fashion. Venous blood was drawn from the patient and centrifuged in order to separate the sample into three layers. The PRF is described as the pale-yellow gel located in the middle layer. For both groups, sockets were debrided of all existing granulation tissue until bleeding occurred under local anesthesia. Platelet-rich fibrin was then placed in each socket with one suture for gingival approximation in the experimental group. As for the control, iodoform gauze was packed into each socket tightly enough to not require sutures. Follow-up was then conducted one week post-operatively, and clinical efficacy was evaluated.

According to the results, the PRF group demonstrated overall higher healing and total effectiveness over the control group.

Specifically, the healing rate in the PRF group showed 93.3% healing (28 cured, two effective, 0 ineffective) versus 60% healing (18 cured, ten effective, two ineffective) seen in the control group, as well as higher granulation tissue regeneration. Additionally, the PRF group showed lower pain scores on the

51

ORAL SURGERY ABSTRACTS

MAXILLARY FULL ARCH RESTORATIONS - BIOLOGICAL COMPLICATIONS: A NARRATIVE REVIEW OUTLINING CRITERIA FOR LONG-TERM SUCCESS Block M. J Oral Maxillofac Surg. 2023; 81(9): 1124-1134

Full arch implant borne maxillary prostheses require a significant investment of resources on the part of the surgeon and the patient. The surgeon’s hope and the patient’s expectation of longevity naturally follow such investment.

Technical issues, such as prosthesis fracture and detached teeth, are widely reported in the literature but largely unrelated to the overall prosthesis survival rate and thus not the focus of this review.

This article explores the literature to highlight the biological causes of periimplant disease in full arch reconstruction with the goal of helping clinicians achieve greater long-term success.

Pub Med was searched for articles related to biological complications of full arch maxillary restorations from the year 19902022, excluding case reports and papers lacking statistical analysis. Descriptive statistics were used to interpret the outcomes. A total of 53 articles were ultimately included. The author hints at a general bias in the literature toward the publication of short-term successes with a paucity of long-term studies.

Total biologic complications were reported up to roughly 10%, 50%, and 90% at “early years, five years, and ten years, respectively. Age and smoking were found to be positively correlated with complications. Specifically, one article found that patients over the age of 60 had a threefold increase in rates of peri-implantitis. Peri-implantitis was found in 6% to 28% of implants, while 12% to 57% of patients had peri-implant

52

mucositis in several studies. One study of implants in grafted maxillary bone with an average follow-up of 9 years found mean bone loss of 2.3 mm and 11% of implants having pockets greater than 5 mm. Plaque index was found to have a significant inverse correlation with bone level, with several articles supporting the higher rates of failure in patients with poor hygiene or poorly cleansable prostheses.

Smooth vs. rough implant surfaces were not found to have significant differences in biological complications, but implant length greater than 10 mm was shown to be protective in one article.

The author then looked at specific differences between hygienic protheses and those with limited access to the implants. The average marginal bone loss was found to be 1.39 mm after six years in the former group and 1.79 mm after ten years in the latter. One study of hygienic prostheses after 15 years showed that only 1.3% of implants had greater than 3 mm bone loss.

Given that 38% of patients had hygiene issues associated with maxillary hybrid prostheses, a consistent recall system was deemed critical to minimize biologic complications heralded by bleeding indices and probing depths. Soft tissue recession, tissue hyperplasia, and bone loss greater than 2 mm were observed in higher rates with hybrid prostheses with flanges.

When failed implants result in the loss of a full arch fixed prosthesis, overdentures

represent a satisfactory alternative.

Consistent with the theme of the narrative review, overdentures were found to have low rates of failure, likely due, in part, to improved accessibility for hygiene.

Studies showed a success rate as high as 97% for overdentures, with 94.2% 5-year implant success rate and mean crystal bone loss of 0.32-0.7 mm.

The literature consistently demonstrates the direct correlation of plaque accumulation with peri-implant disease and the need for routine patient hygiene to mitigate the risk of implant failure.

Full-arch prostheses should be designed with hygiene as a priority, and this, in turn, should help guide implant positioning.

Flange design, in particular, should balance the need for soft tissue support and hard tissue substitution without compromising access to the implants.

Optimal patient treatment for full arch implant rehabilitation requires foresight of both the surgeon and restorative dentist beyond the immediate peri-operative period with an appreciation of the etiology of long-term biologic complications.

Peter Arvanitis, DDS; Chief Resident, Oral and Maxillofacial Surgery, VCU Medical Center

ORAL SURGERY ABSTRACTS

AMERICAN ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGEONS’ POSITION PAPER ON ORAL LESION EVALUATION, BIOPSY TECHNIQUES AND REFERRAL CRITERIA FOR GENERAL PRACTITIONERS https://www.aaoms.org/practice-resources/aaoms-advocacy-and-position-statements/white-papers

Cancer is a major public health problem worldwide and the second leading cause of death in the United States. Annually, head and neck cancer accounts for approximately 67,000 cases and 15,400 deaths in the United States. This position paper serves as an overview for general practitioners in the initial evaluation and diagnosis of oral, head, and neck lesions.

The single most important prognostic indicator in patient survival rates of head and neck cancers is the stage at presentation, with five-year survival rates of 70 to 90 percent in patients with stage I or stage II disease, compared to 20 to 40 percent in patients with stage III or stage IV disease. As oral health care providers, we play an essential role in identifying the earliest signs of oral mucosal abnormalities by conducting a thorough head and neck examination at patient visits. Other benign or malignant lesions of the oral cavity which can be detected through this examination as well. It is recommended by The American Association of Oral and Maxillofacial Surgeons that oral health care providers perform a thorough oral, head, and neck exam at each dental visit. Providers should also obtain a full medical history, social history, and review of systems in order to assess for risk factors or signs of head and neck cancer or other oral pathologies. Established and strongly suggestive risk factors include smoking,

chewing tobacco, snuff dipping, alcohol misuse, and sunlight (lip). Physical examination should begin with an inspection of the extraoral and perioral tissues, including palpation of regional lymph nodes and preauricular regions.

When directing attention to the oral cavity, AAOMS recommends following a systematic approach to examine every mucosal surface in order to avoid missing any sites. Biopsy should be considered for definitive diagnosis of any suspicious lesions such as red, white, mixed red/white lesions, lesions with chronic ulceration, and new or enlarging pigmented lesions.

When considering a biopsy, the general practitioner should take into account specific considerations regarding the lesion, location, and healing of the biopsy wound. Locations such as attached gingiva and hard palate do not allow for easy primary closure, so wounds in those areas typically heal by secondary intention. Local hemostatic measures such as absorbable collagen can be placed in these areas to assist with healing. For proper fixation, specimens are placed in 10% neutral buffered formalin solution or a water-based solution such as Michel’s solution if the specimen requires immunofluorescence.

AAOMS provides a brief overview of three different biopsy techniques for the general practitioner: incisional, excisional, and punch biopsy. An incisional biopsy should be performed when the lesion may be malignant, as it consists of removing a small piece of the lesion to be sent to the pathologist while leaving a majority of the lesion behind and intact. It is important to incise the most representative part of the lesion and avoid areas of ulceration or necrosis when performing. An excisional biopsy should only be performed on a benign lesion as it consists of removing the lesion in its entirety. A punch biopsy is advantageous for collecting a diagnostic, full-thickness specimen, which requires an incisional biopsy, or even for excising a small lesion.

Referrals should be made to an oral and maxillofacial surgeon for the management of more complex lesions or patient cases, including vascular or pulsatile lesions, lesions with red, purple, or blue coloration, cancerous lesions, and lesions in patients with complex medical conditions.

Kristin Randolph, DMD; Resident, Oral & Maxillofacial Surgery, VCU Medical Center

53

THROUGH THE

LOOKING GLASS WITH DR. SARAH GLASS

Explore the Fantastical World of Oral Pathology 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.

Your 72-year-old female patient mentions that she occasionally develops small vesicle-like lesions that she can pop with her tongue. Once they burst, the area is slightly uncomfortable for a day. She just happens to have one today. What is the clinical diagnosis?

54

SCIENTIFIC

A 30-year-old female presents with a “hole” in the right anterior hard palate. She states that it has been present for 1 year and that she finds herself exploring the area with her tongue.

Clinically the cleft is 5.0 mm in diameter near the palatal rugae. A panoramic radiograph shows an associated unilocular radiolucency. The biopsy specimen was not cystic in nature.

What is the diagnosis?

Since you are a dental professional, your friend, a 40-year-old male, shows you his unusual blue-gray tori.

Why are his tori this color?

>> ANSWERS ON PAGE 56

55

SCIENTIFIC

>> THROUGH THE LOOKING GLASS ANSWERS CONTINUED FROM PAGE 55

1. The soft palate and retromolar pad are uncommon areas for mucoceles but are common locations for superficial mucoceles.

Superficial mucoceles are the result of superficial mucin spillage from minor salivary glands. They rupture spontaneously or with pressure. Patients may develop repeat lesions in the same location.

Superficial mucoceles have also been reported in some lichenoid conditions.

56

2. The diagnosis is central odontogenic fibroma. The histopathology of this benign odontogenic tumor shows inactive rests of odontogenic epithelium sprinkled throughout a fibromyxoid connective tissue.

Most maxillary tumors occur anteriorly and can create a depression as clinically noted in this case. Central odontogenic fibromas are more common in females and the mean age at diagnosis is 34. These tumors almost never recur after removal.

3. M inocycline is a common antibiotic given in childhood for acne. This medication can cause intrinsic discoloration of the teeth.

Additionally, in certain individuals, it can cause discoloration of the skin, mucosa, nails, sclera, and bone. For this patient, past minocycline use resulted in a blue-gray appearance of the bone, which shows through the thin mucosa of the mandibular tori.

ORAL SURGERY ABSTRACTS

VARIATION OF MANDIBULAR CANAL BRANCHING RELATED TO ANATOMICAL REGIONS IN MANDIBLE: A RADIOGRAPHIC STUDY WITHOUT CONTRAST Koç A, Talmaç AGO, Keskin S. J Oral Maxillofac Surg. 2022; 80(12): 1966-1977

This article explores the prevalence and distribution of branching in the mandibular canal, a crucial anatomical structure containing a vessel-nerve bundle. The mandibular canal extends from the mandibular foramen to the mental foramen and plays a crucial role in dental procedures such as dental implant surgery, orthognathic procedures, and extractions.

The study was a retrospective cohort study that involved 180 Turkish patients who underwent cone-beam computed tomography (CBCT) imaging for various dental indications. The researchers analyzed the CBCT images to identify the presence of mandibular canal branching (MCB) and classified them based on the regions where the branches separated from the terminal canal. These regions included the ramus, retromolar, molar, premolar, and mental foramen areas.

The key findings of the study were as follows: Prevalence of MCB: MCB was detected in 72.2% of the patients included in the study. This high prevalence underscores the significance of considering MCB in dental treatment planning to minimize the risk of complications and ensure successful surgical outcomes.

Gender: The prevalence of MCB did not significantly differ between males and females, indicating that MCB is a common anatomical variation that affects both genders equally.

Side: MCB was more commonly observed unilaterally than bilaterally.

However, bilateral MCB occurred in a greater percentage of cases (38.5%) than previously reported in some studies.

Anatomical regions: The regions where MCB was most frequently observed were the molar and retromolar regions. These regions are particularly critical during dental extractions and restorations, and knowledge of MCB distribution in these areas can help in achieving adequate anesthesia and in preventing nerve injury.

Trifid and quadrafid branching: Trifid branching (three extra branches) occurred in 5.56% of cases, while quadrafid branching (four extra branches) was observed in 1.11% of cases. This study reported the occurrence of quadrafid mandibular branching for the first time.

Foramina related to MCB: Foramina were detected at the ends of some branches, particularly in the retromolar region. Clinicians should be mindful that the presence of lingual foramina in the mental foramen region represents an anatomical variation. It is crucial to distinguish this variation from a fracture line, particularly in patients with dental trauma, to avoid misinterpretation and ensure accurate diagnosis and treatment planning.

The study’s findings emphasize the importance of identifying and understanding MCB variations in the mandible for dental practitioners. By doing so, they can tailor their anesthetic and

surgical approaches, mitigate potential risks, and enhance patient outcomes.

Additionally, the research highlights the value of using CBCT imaging for detailed visualization of the mandibular canal and its branches, providing a comprehensive understanding of this complex anatomical structure.

Despite the study’s strengths, such as its use of CBCT, there are inherent limitations to consider. As a retrospective study, certain biases may have influenced the data collection process and there was a relatively small sample size.

Further research and the use of magnetic resonance imaging and histopathological examinations could validate these findings and provide a deeper understanding of mandibular canal branching.

In conclusion, the article provides valuable insights into the prevalence and distribution of MCB in the mandible, aiding dentists in better understanding and managing this anatomical variation during dental procedures. The study’s results underscore the importance of diligent preoperative assessment and meticulous surgical planning to minimize potential risks and complications associated with MCB, ultimately contributing to improved patient care and outcomes.

Ross Gemmill, DDS; Resident, Oral & Maxillofacial Surgery, VCU Medical Center

57

ORAL SURGERY ABSTRACTS

WHAT HAPPENS TO FULL-MOUTH EXTRACTION PATIENTS? A RETROSPECTIVE REVIEW OF PATIENT MORTALITY AT AN ACADEMIC MEDICAL CENTER Rabinowitz YA, Hooker KJ, Hanseman DJ, Khan MTF, McLaurin WS, Krishnan DG. J Oral Maxillofac Surg. 2022; 80(11): 18271835

Full-mouth extractions (FME) is a common dental procedure done by general dentists, periodontists, and oral and maxillofacial surgeons to treat severe caries and periodontal disease.

The National Center for Chronic Disease Prevention and Health Promotion estimates that 17% of adults 65 years or older are completely edentulous.

With an aging population due to medical advancements, providers are now being forced to address the oral health needs of an aging and sick population. The purpose of this study was to quantify death among patients who undergo full-mouth extractions (FME) and to measure a timeline from the time of surgery to the time of death. Rabinowitz, et al. conducted a retrospective cohort study that included all individuals who underwent FME due to symptomatic or asymptomatic caries and periodontal disease from July 2012 to December 2019 at the University of Cincinnati Medical Center. The exclusion criteria was FME that was secondary to anything

58

nonelective, such as pathology of deep fascial space infections. The FME were either done in the clinic under sedation of local anesthesia or completed in the operating room with the assistance of a designated anesthesia team. Next, the National Death Index was used to identify patient mortality. A total of 1,829 patients were included in the study. The median age was 49 years, of which 89% were on Medicaid or Medicare. Of the patients included in the study, 1,709 were categorized as ASA 2 or higher, with the most common illnesses being psychiatric, diabetes mellitus, coronary artery disease, congestive heart failure, and COPD. As of December 2019, 170 patients (9.3%) of the patients were identified as deceased. Within the first two years of the FME 51% of the deaths had occurred, and 86% occurred within the five years. A Cox proportional hazard model was generated, and statistically significant factors that were associated with mortality included age, ASA>3, nursing home residence, hepatic

disease, and cancer. Overall, this study helps shed light on mortality after FME. While palliative care has been shown to improve the quality of life of terminally ill patients, there is not much evidence to support surgical palliative care. As providers, it is important to consider a more comprehensive treatment plan, if possible, instead of extractions for acute symptomatic relief. Additionally, this study reminds us that while a motivating factor for FME may be prosthetic rehabilitation with dentures, some of these patients may not survive to receive the prosthetic outcome. Special treatment plans and patient-centered discussions should be conducted with the patient and the patient’s family before subjecting chronically ill patients to FME.

Talal Beidas, DDS; Resident, Oral & Maxillofacial Surgery, VCU Medical Center

ORAL SURGERY ABSTRACTS

WHAT IS THE RISK OF DEVELOPING OSTEONECROSIS FOLLOWING DENTAL EXTRACTIONS FOR PATIENTS ON DENOSUMAB FOR OSTEOPOROSIS? Colella A, Yu E, Sambrook P, Hughes T, Goss A. J Oral Maxillofac Surg. 2023; 81(2): 232-237

Medication-related osteonecrosis of the jaw (MRONJ) is a serious side effect of various medications used to treat osteoporosis and cancers such as multiple myeloma. Denosumab has replaced bisphosphonates as the first-line medication for the treatment of osteoporosis. Denosumab (Prolia®) is typically administered as a 60 mg subcutaneous injection. The effects of denosumab typically last around six months, and repeat injections are administered four to six weeks prior to this six-month mark.

Denosumab works as a monoclonal antibody, inhibiting osteoclastogenesis and leading to a reduction in bone turnover. This leads to increased bone density, which is beneficial for the prevention of bony fractures related to osteoporosis and various malignancies.

The decrease in bone turnover can be of consequence when undergoing tooth extraction and subsequent healing.

Dental extractions and related procedures are the most common trigger for inciting MRONJ. The risk of developing MRONJ after extraction on a patient taking denosumab has warranted further investigation but was summarized to be similar to that of those taking oral bisphosphonates (0-0.2%).

This study, which took place at the Oral and Maxillofacial Surgery Unit at the University of Adelaide, Australia, was a prospective cohort study that took advantage of a high-volume extraction clinic to attempt to further define the risk of developing MRONJ following tooth extraction for patients taking denosumab.

The cohort consisted of 426 patients, all of whom were taking denosumab for osteoporosis. They underwent 561 episodes of treatment and 1081 extractions. The control group consisted of 299 patients not taking denosumab or any other antiresorptive medications who underwent 315 episodes of treatment and 669 extractions. If possible, extractions were deferred until six months after the last denosumab injection. All patients were prescribed chlorhexidine mouth rinses, analgesics, and antibiotics if they had soft tissue infections.

Ten patients in the study sample went on to develop MRONJ. No patients in the control group developed MRONJ. The risk of MRONJ in this same was 10 out of 427 or 2.3%. This is a magnitude higher than the current estimated risk of patients undergoing extractions on oral bisphosphonates for osteoporosis (00.15% per AAOMS white paper).

The study is limited by junior staff record-keeping, socioeconomic status of the patient population, the fact that the majority of extractions were performed by dental students, and sample size. The study also does not consider the length of treatment time on denosumab.

In conclusion, this study demonstrates a relatively higher risk for the development of MRONJ for patients taking denosumab for osteoporosis (2.3%) when compared to those taking oral bisphosphonates (0-0.15%). Clinicians should take into consideration the length of time a patient has been treated, and the number of extractions that need to be performed.

It is best practice to limit the number of extractions to be performed at any given time. Extractions are best performed six months after the last denosumab injection, and sockets should be allowed to heal before resuming further injections.

Chlorhexidine mouth rinses should be prescribed prophylactically, and patients should be monitored with close follow-up.

Kane Louscher, DDS; Resident, Oral & Maxillofacial Surgery, VCU Medical Center

59

ORAL SURGERY ABSTRACTS

PHARMACOLOGICAL AND NON-PHARMACOLOGICAL METHODS OF POSTOPERATIVE PAIN CONTROL FOLLOWING ORAL AND MAXILLOFACIAL SURGERY: A SCOPING REVIEW Elmowitz JS, Shupak RP. J Oral Maxillofac Surg. 2021; 79 (10): 2000-2009

Postoperative pain is an expected outcome following oral surgical procedures, with 93% of patients reporting pain. The duration and severity of postoperative pain can vary from patient to patient and are determined by multiple factors. These factors include physiological and psychological factors, as well as the extent and duration of the surgery. The effect of postoperative pain can prevent patients from performing routine daily tasks, such as eating.

With some patients unable to take non-steroidal anti-inflammatory drugs (NSAIDs), exploring multiple courses of action to manage postoperative pain is in our patients’ best interest.

A scoping review was conducted to evaluate the efficiency of different methods of pain management that surgeons and dentists can apply to control postoperative pain in patients undergoing surgical third molar extractions. It is inferred that management techniques evaluated here can be applied to other oral surgery procedures, including surgical extractions of erupted teeth and alveoloplasty. The treatment modalities investigated in this review included both pharmacological and nonpharmacological methods of control, such as nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, local anesthetics, corticosteroids, curcumin, hyaluronic acid, antibiotics, antiseptics, topical gel, platelet-rich fibrin, low-level laser therapy, socket irrigation with tap water, suture type, and different suturing techniques.

A literature search was primarily conducted on PubMed for randomized controlled trials (RCTs) published after 2014. These trials included pharmacological or non-pharmacological methods of managing postoperative pain for third molar extractions. Selected studies were required to include the timing of the intervention (preoperative, intraoperative, or postoperative), the 60

assessment of postoperative pain, the time post-procedure, and the use of rescue analgesics. In total, 35 RCTs were selected, involving a total of 731 subjects receiving non-pharmacological pain control and 3,060 subjects receiving pharmacological pain control.

The study provided recommendations for postoperative pain management for the three phases of intervention that were determined to be the most feasible for providers. The authors concluded that the most effective preoperative pain management intervention would be to have the patient take 8mg of oral dexamethasone one hour before extractions. If the provider can place an IV, then administering 150 mg of oral pregabalin along with 400 mg of IV ibuprofen resulted in a significant decrease in postoperative pain for the first 3 to 10 hours after surgery.

For intra-procedure intervention, combining 0.5% bupivacaine with 1:200,000 epinephrine with another local anesthetic was most effective for pain management for up to 8 hours post procedure. If the patient is at a higher risk of alveolar osteitis (dry socket), then placing a bio-adhesive chlorhexidine before closure reduced the occurrence of dry socket by 2.3 times. Suture type and material did not have significant differences in postoperative pain, but primary closure of third molar extraction sites resulted in increased pain and swelling compared with secondary closure.

Postoperatively, the authors agreed that opioids should be used sparingly.

A combination of 400 to 600 mg of ibuprofen (not to exceed 3200 mg/day) and 325 to 1,000 mg of acetaminophen (not to exceed 4000 mg/day) every 4 to 6 hours was deemed the superior regimen over opioids as the first-line pain management. Celecoxib was determined

to have superior analgesic effects and can be recommended over ibuprofen if tolerated by the patient. Using a 0.12% chlorhexidine mouth rinse twice a day for 1 week post third molar extractions reduced alveolar osteitis by 63%. When 0.12% chlorhexidine was used to irrigate the extraction sites via a plastic syringe, alveolar osteitis decreased by another 24%. Irrigating extraction sites with tap water from a syringe 48 hours post extraction also decreased the incidence of dry socket related pain.

There is still inconclusive evidence on novel pain management therapies.

In one study, advanced platelet-rich fibrin (A-PRF) was more effective than leukocyte platelet-rich fibrin (L-PRF) at reducing postoperative pain. However, not every provider will have access to this equipment. Other therapies like submucosal injection of dexamethasone may reduce signs of trismus and swelling but are not shown to have a significant effect on postoperative pain. Additionally, in the studies selected, ice, acupuncture, hyaluronic acid spray, and benzydamine did not show a significant effect in reducing postoperative pain.

This study provided additional pain management techniques that demonstrate opioids are best used as supplemental tools for pain management of third molar extractions. Further studies will need to be conducted on how these methods of pain management apply to extractions of infected, non-restorable teeth with or without associated dentoalveolar abscesses. Additional studies will be needed to investigate non-pharmacological based methods of postoperative pain management.

Dr. Stuart Hentz; Resident, Oral & Maxillofacial Surgery, VCU Medical Center

ORAL SURGERY ABSTRACTS

ASSESSMENT OF DIFFICULTY IN MANDIBULAR THIRD MOLAR SURGERY BY LAMBDA-DAWANE-MALI’S INDEX Lambade P, Dawane P, Mali D. J Oral Maxillofac Surg. 2023; 81(6): 772-779

Establishing a systematic approach to evaluating patients before any procedure is vital to patient safety and success.

When specifically talking about third molar extraction, it is important for a dental provider to know when a case may be best suited for a specialist, such as an Oral and Maxillofacial Surgeon (OMFS).

Mandibular third molar extractions are the most common procedures performed

by OMFS, and these extractions come with their own unique challenges and complications. When speaking to patients during consultations, it is vital to provide informed consent about the procedure.

This includes discussing the benefits of the procedure, alternative treatments, and informing the patient of any potential complications and difficulties that may arise during the procedure.

This prospective cohort study aimed to measure the association between the preoperative and post-operative difficulty of mandibular third molar extractions using a pre-operative index called the LambadeDawane-Mali (LDM) M3 difficulty index.

This index included several demographic, clinical, and radiographic variables to assign a difficulty score to the tooth, such as Easy (15-25 points), Moderate (25-30 points), and Difficult (greater than 30 points). Postoperatively, the difficulty of extraction was categorized by the time it took to perform the extraction and used the Modified Parant’s scale (MPS), which

defined four levels of difficulty required for extraction (Easy I - forceps extraction, Easy II - requiring osteotomy, Difficult III - coronal sectioning, and Difficult IV complex extraction).

The hypothesis was that through using the LDM index, a set of distinct variables could be used to categorize the difficulty of extraction and provide a pre-operative score, which could classify the extraction as easy, moderate, or difficult. This index would be compared postoperatively to the MPS and the gold standard Peterson index. This study included 1000 subjects.

Inclusion criteria were patients with impacted third molars. Exclusion criteria were patients who were medically compromised, had any bleeding/ clotting disorder, were undergoing any chemotherapy or radiation therapy, were pregnant or lactating, had any cystic lesions, or had any malignancy.

The study found that the teeth that were pre-operatively assessed to be “easy” or “difficult” using the LDM score were found to be correctly categorized as “easy” or “difficult” postoperatively using the MPS 99% and 99% of the time, respectively. There were statistically significant agreements between the LDM index with respect to the preoperative time, MPS, and Peterson index (one of the most widely used scales to evaluate radiographic findings to determine

difficulty of extraction of mandibular third molars). When comparing the LDM index to the Peterson scale (gold standard), 73% were correctly identified as easy, 51% were correctly identified as moderate, and 50% were correctly identified as difficult. Some important factors that were identified in the LDM and correlated to increased difficulty of extraction were increasing age, male gender, decreased interincisal distance, macroglossia, stiff cheeks, pericoronitis, and bony or soft tissue impaction.

In practice, going through lengthy indices to assign a difficulty score for every mandibular third molar is time-intensive and is likely not feasible for every practitioner. It is important, however, to recognize the factors which may make a mandibular third molar extraction more difficult. Using these indices and knowing which factors may contribute to more difficult extractions (subsequently placing patients at higher risk for complications) can help general practitioners identify when appropriate referral to a specialist, such as an OMFS, may be necessary for the safety and comfort of their patients.

Dr. Nicole Youd; Resident, Oral & Maxillofacial Surgery, VCU Medical Center

61

ORAL SURGERY ABSTRACTS

ALVEOLAR OSTEITIS: A REVIEW OF CURRENT CONCEPTS Oliver C et. al. J Oral Maxillofac Surg. 2020; 78(8):1288-1296

Alveolar osteitis is a commonly encountered complication following dental extractions. A thorough understanding of the pathogenesis and etiology of this condition is paramount to providing effective, evidence-based treatment when diagnosed. Preventative steps should be taken to reduce its incidence.

Alveolar osteitis, better known as “dry socket,” is a frequently debated process characterized by pain at or near the site of a recent tooth extraction, often accompanied by halitosis. Incidence ranges widely in literature, but larger sample-sized studies indicate a rate of around 5%. The pathogenesis can be linked to the development of a fibrin meshwork that forms shortly after extraction, which facilitates fibrin deposition and blood clot formation.

Fibrinolysis occurs in alveolar osteitis when tissue kinases are released, leading to the formation of plasmin, which disintegrates the clot. Trauma, bacteria, smoking, medications, and anatomy can play a large role in the etiology of alveolar osteitis. Bacteria, often in the context of poor oral hygiene, can cause premature degradation of the

62

clot by producing enzymes. Trauma from the extraction activates inflammatory mediators, triggering the release of tissue activators, leading to fibrinolysis and clot degradation, as previously outlined.

Smoking can lead to negative pressure, which may dislodge the clot, and nicotine intake may translate to vasoconstriction of the extraction site, reducing the blood supply and subsequent fibrin deposition. Medications, specifically oral contraceptives, increase fibrinolysis by reducing levels of plasminogen activator inhibitor. Anatomically, alveolar osteitis occurs at a much higher percentage in mandibular extractions relative to the maxilla.

Management of alveolar osteitis is largely based on improving symptoms rather than treating the disease process.

Irrigation and placement of dressing into the sockets are often the first effort made to address the complaint. Medicated dressings containing eugenol, butamine, and iodoform have been shown to provide effective short-term relief. Lowlevel laser therapy may supply some symptomatic improvement comparative to that of medicated dressings. Antibiotic

prescription is discouraged as the number needed to treat is unreasonably high given the more common incidence of harmful side effects and development of antibiotic resistance.

In terms of prevention, chlorhexidine gluconate mouth rinses can significantly reduce the incidence of alveolar osteitis.

Patients with poor oral hygiene have been found to have a three times higher risk of developing alveolar osteitis. Alteration in surgical techniques, such as the use of triangular flaps in third molar extraction and atraumatic surgical technique, improve post-operative pain and the development of alveolar osteitis. A lack of operator experience has been cited as a large contributing factor, likely secondary to increased trauma during the procedure.

Appropriate management and referral may reduce the likelihood of your patients developing this complication.

Kipley Powell, DDS; Resident, Oral & Maxillofacial Surgery; VCU Medical Center

Considering a Practice Transition?

See What Other Virginia Dentists are Saying about Their Experience with DDSmatch: "I was incredibly pleased they found the perfect buyer for my practice. I left knowing my patients would be well taken care of."

Dr. Peter Lanzaro - Fairfax Station, VA "Todd and Sheryl made it possible for me to retire and rest finally.

Their devotion, hard work and empathy is unmatched."

Dr Gopal Sivaraj Pal - Sterling, VA "Nothing fell through the cracks as they were attuned to all the details and a timely resolution of outstanding matters."

Dr. Michael F Rubin - Arlington, VA "We highly recommend Todd and Sheryl to any of our colleagues for their practice transition. " Drs. April Ton and Quan Nguyen - Burke, VA

it all starts with a conversation. begin your transition today Todd & sheryl garfinkel (443) 422-9509

|

sgarfinkel@ddsmatch.com

Serving MD, D.C. & VA 63

MEMBERSHIP

AWARDS & RECOGNITION DR. HARSHIT AGGARWAL

DR. SCOTT BERMAN

Presidential Citation

Leadership Award

Virginia Dental Association

Virginia Dental Association

GWEN DUONG

DR. JOHN EBY

Dental Team Member Award Virginia Dental Association

64

Special Service Award Virginia Dental Association

DR. MARLON A. GOAD

CATHY GRIFFANTI

Presidential Citation

Presidential Citation

Virginia Dental Association

Virginia Dental Association

DR. ABBY L. HALPERN

KATHY HELLER

Leadership Award

Dental Team Member Award

Virginia Dental Association

Virginia Dental Association

MEMBERSHIP

SHANNON JACOBS 20 Year Service Virginia Dental Association

DR. URSULA KLOSTERMEYER Presidential Citation Virginia Dental Association

DR. SCOTT R. MILLER Emanuel W. Michaels Distinguished Dentist Award Virginia Dental Association

DR. LEONEL PEREZ Presidential Citation Virginia Dental Association

>> CONTINUED ON PAGE 66

65

MEMBERSHIP

AWARDS & RECOGNITION (CONTINUED)

66

DR. RICHARD ROADCAP

BARBARA ROLLINS

Presidential Citation

25 Year Service

Virginia Dental Association

Virginia Dental Association

ELISE RUPINSKI

DR. ALEXANDER V. SADAK

20 Year Service

New Dentist Award

Virginia Dental Association

Virginia Dental Association

DR. BRETT A. SIEGEL

DR. SALEH SMADI

Presidential Citation

Special Service Award

Virginia Dental Association

Virginia Dental Association

DR. CYNTHIA M. SOUTHERN

BRENDA MARTIN YOUNG

President’s Award

Dental Team Member Award

Virginia Dental Association

Virginia Dental Association

MEMBERSHIP

CATHY GRIFFANTI, NORTHERN VIRGINIA DENTAL SOCIETY EXECUTIVE DIRECTOR, RETIRES Dr. Christopher Spagna; Component Editor, Northern Virginia Dental Society

In 2005, Cathy Griffanti stepped into the role as Executive Director of the Northern Virginia Dental Society (NVDS). She had served as the Assistant Director for three years prior and already knew many of the members and what the job would entail. What she didn’t know was that she would dutifully serve in this new capacity for the next 18 years - and over the course of which, make a profoundly positive impact on all of those she served.

During her tenure, she gracefully and professionally embraced the mission of the NVDS in representing the more than 1,400 member dentists and the public by fostering quality oral health care through continuing education, open communication, and legislation. A true leader with tireless devotion to our society and the profession of dentistry, Cathy helped to make the Northern Virginia Dental Society one of the most wellrespected component societies in the American Dental Association.

From 2010-2015, she served on the American Dental Association Executive Director’s Advisory Council and, during that time, was President of the ADA Association of Component Society Executives (ACSE) from 2011-2012. Duly recognized for her contributions, Cathy was bestowed Honorary Membership in the VDA in 2012. Her NVDS career was marked by many highlights, as she was the recipient of three VDA Special Service Awards, two VDA Presidential Citations, and the ACSE Outstanding Component Award in 2022. However, she would probably tell you that her biggest accomplishment was the 15-year span of the Northern Virginia Mission Of Mercy (MOM) project. Cathy really enjoyed working with those who “championed” each individual component of MOM. She always said it was the greatest honor and privilege to work with the most wonderful,

giving, and caring people on the planet.

But beyond these professional accolades, I think what really set Cathy apart was her sincerity and depth of compassion. I remember right after graduation, as I was beginning to get involved with the NVDS, though quite young and new to it all, Cathy made me feel so comfortable and welcome. I would often joke with her that it was like she was my “mom” - every time looking out for me as she did for so many others.

While the dentists of the society were busy taking care of our patients, Cathy was always busy taking care of us.

Without fail, she had that smile or hug when you needed it. She was a great listener and such a wealth of knowledge; no problem or challenge was too tough to figure out together. And as much as we appreciated all that she did for us, I think she truly enjoyed us, too. I can recall many fond memories of office holiday parties, new dentist happy hours, CE meetings and social events, or the way she’d somehow be able to greet almost any member by name. She would always ask how my family was doing or to update her now and then with an e-mail picture of my boys as they were growing up. The thing is, Cathy truly cared. She did that with me, and she did that with everyone.

She was part of our NVDS family and will always be.

Ms. Griffanti

Speaking for myself and on behalf of the entire Northern Virginia Dental Society, we are incredibly grateful for everything Cathy has done for us over these 21 years. As she begins this next chapter in life, filled with travel, family, and whatever new adventures may come her way, we wish her all the best. And we hope that the years ahead are even brighter than the ones we’ve shared before!

67

MEMBERSHIP

WELCOME NEW MEMBERS THROUGH SEPTEMBER 1, 2023

Dr. Ananth Anupindi – Virginia Beach – University of Maryland School of Dentistry 2023

Dr. Hajir Aldaod – Hampton – Mount Sinai BI/Jacobi/Albert Einstein College of Medicine 2023

Dr. Nadia Abdul-Ghafoor – Henrico - Virginia Commonwealth University School of Dentistry 2023

Dr. Maria Batista – Virginia Beach – Tufts University School of Dental Medicine 2023

Dr. Ali Baghalian – Yorktown – Rutgers School of Dental Medicine 2023

Dr. Darrell Boyce – Chesapeake - Virginia Commonwealth University School of Dentistry 2023

Dr. Soohan Chung – Newport News – Loma Linda University School of Dentistry 2023

Dr. Vickas Agarwal – Glen Allen – Virginia Commonwealth University School of Dentistry 2017

Dr. Hillary Diffee – Norfolk – University of Alabama School of Dentistry at UAB 2018 Dr. Charles Kane – Norfolk – State University of New York at Buffalo School of Dental Medicine 2023 Dr. Najah Lewter – Hampton – Virginia Commonwealth University School of Dentistry 2023 Dr. Mitava Patel – Suffolk – University of Pittsburgh School of Dental Medicine 2023 Dr. Brianna Peeples – Chesapeake Meharry Medical College School of Dentistry 2023

Dr. Islam Elderbashy – Hampton – Nova Southeastern University College of Dental Medicine 2023 Dr. James Jones – Middlesex – University of Louisville School of Dentistry 2023 Dr. Declan Kingston – Yorktown – University of Pittsburgh School of Dental Medicine 2023 Dr. India Martin – Hampton – Marquette University School of Dentistry 2023 Dr. Sarah Stulen – Williamsburg - Virginia Commonwealth University School of Dentistry 2023

Dr. Morgan Sabol – Virginia Beach – Virginia Commonwealth University School of Dentistry 2022 Dr. Ramya Thammineni – Chesapeake – New York University College of Dentistry 2023

Dr. Nicole Chambers – Chester - Virginia Commonwealth University School of Dentistry 2023 Dr. Sri Sai Jaahnavi Kodali – N Chesterfield – University of Kentucky College of Dentistry 2023 Dr. Chandler Reed – Chesterfield – Virginia Commonwealth University School of Dentistry 2023

Dr. Vandhana Ahuja – Hanover – Howard University College of Dentistry 1999 Dr. Mackenzie Bates – Richmond – Virginia Commonwealth University School of Dentistry 2021 Dr. Clara Bergeron – Glen Allen – Virginia Commonwealth University School of Dentistry 2018 Dr. Richard Boyd – Glen Allen – Medical University of South Carolina James B. Edwards College of Dental Medicine 2020 Dr. Vivian Bui – Richmond – Virginia Commonwealth University School of Dentistry 2023 Dr. Layla Chaoul – Powhatan - Virginia Commonwealth University School of Dentistry 2023 Dr. Kara Dunegan – Henrico – Virginia Commonwealth University School of Dentistry 2020 Dr. Luke Fischer – Richmond – University of Florida College of Dentistry 2023 Dr. Ryan Gaffner – Midlothian - Virginia Commonwealth University School of Dentistry 2023 Dr. Christina Gordon – Richmond – Virginia Commonwealth University School of Dentistry 2023 Dr. Kurtis Hauck – Richmond – University of Utah School of Dentistry 2023

68

MEMBERSHIP

Dr. Nayab Khan – Richmond – New York University College of Dentistry 2023 Dr. Minatallah Ibrahim – Richmond – Virginia Commonwealth University School of Dentistry 2022 Dr. Jeffrey Johnson – Richmond – University of Kentucky College of Dentistry 2001

Dr. Christel Will – Richmond - Virginia Commonwealth University School of Dentistry 2023 Dr. Carter Wright – Richmond – Virginia Commonwealth University School of Dentistry 2023

Dr. Malik Lowe – Richmond – Virginia Commonwealth University School of Dentistry 2023

Dr. Sara Chehreh – Christiansburg – Midwestern University College of Dental Medicine-Illinois 2023 Dr. Manuel Perez – Galax - Virginia Commonwealth University School of Dentistry 2023 Dr. Jalen Sykes – Haysi - Virginia Commonwealth University School of Dentistry 2023

Dr. Jessica McBride – Midlothian - Virginia Commonwealth University School of Dentistry 2023

Dr. Justin Conduff – Dublin - Virginia Commonwealth University School of Dentistry 2023

Dr. Mitra Mirmotahari – Henrico – Midwestern University College of Dental Medicine 2023

Dr. Hannah Ehreth – Roanoke – Virginia Commonwealth University School of Dentistry 2020

Dr. Joanna Scott – Richmond - Virginia Commonwealth University School of Dentistry 2023

Dr. Ardalan Nabizadeh – Lynchburg Virginia Commonwealth University School of Dentistry 2023

Dr. Aaron Barborka – Winchester – University of Nevada Las Vegas School of Dental Medicine 2020

Dr. Saleh Smadi – Richmond – Virginia Commonwealth University School of Dentistry 2023

Dr. Mark Stephens – Lynchburg - Virginia Commonwealth University School of Dentistry 2023

Dr. Sean Finley – Waynesboro - Virginia Commonwealth University School of Dentistry 2023

Dr. Vandana Sobnach – Glen Allen – University of Minnesota School of Dentistry 2023

Dr. David Tang – Roanoke – Case Western Reserve University School of Dental Medicine 2023

Dr. Melissa Hart – Charlottesville – Virginia Commonwealth University School of Dentistry 2023

Dr. Vu Ta – Richmond – Virginia Commonwealth University School of Dentistry 2023

Dr. Ann Wheelock – Roanoke – Virginia Commonwealth University School of Dentistry 2018

Dr. William Lizardo – Harrisonburg – University of Minnesota School of Dentistry 2023

Dr. Samuel Tack – Richmond – Virginia Commonwealth University School of Dentistry 2017 Dr. Daniah Tikreeti – Fredericksburg – Columbia University College of Dental Medicine 2022 Dr. Erin Wheeler – Richmond – Virginia Commonwealth University School of Dentistry 2023 Dr. Caleb Widner – Henrico - Virginia Commonwealth University School of Dentistry 2023

Dr. Lauren Moe – Harrisonburg – University of Minnesota School of Dentistry 2023 Dr. Lindsey Putnam – Charlottesville Virginia Commonwealth University School of Dentistry 2023 Dr. Greg Traver – Winchester – West Virginia University School of Dentistry 2023

>> CONTINUED ON PAGE 70

69

MEMBERSHIP >> CONTINUED FROM PAGE 69 Dr. Angelica Leano – Fairfax – University of Illinois at Chicago College of Dentistry 2023 Dr. Marshall Adzima – Gainesville - Virginia Commonwealth University School of Dentistry 2023 Dr. Mina Adnan – Woodbridge – Howard University College of Dentistry 2023

Dr. Faranak Mahjour – Fairfax - Boston University Goldman School of Dental Medicine 2018

Dr. Mestire Solomon – Arlington – Tufts University School of Dental Medicine 2010 Dr. Tamana Spingher – Prince William – Howard University School of Dentistry 2023

Dr. Crystal Al-Eid – Fairfax – Howard University College of Dentistry 2023

Dr. Andrea Marquez Saturno – Prince William – Virginia Commonwealth University School of Dentistry 2022

Dr. Zhanna Ali – Woodbridge - Virginia Commonwealth University School of Dentistry 2023

Dr. Monica Moon – Alexandria – University of Maryland School of Dentistry 2017

Dr. Duy-Kha Thai – Fairfax – Boston University Goldman School of Dental Medicine 2023

Dr. Ava Arabshahi – Reston – Virginia Commonwealth University School of Dentistry 2023

Dr. Sara Najah – Arlington - Virginia Commonwealth University School of Dentistry 2023

Dr. Dylan Thomas – Chantilly - Virginia Commonwealth University School of Dentistry 2023

Dr. Manraj Bhangra – Ashburn – Temple University The Maurice H. Kornberg School of Dentistry 2023

Dr. Horatio Nguyen – Prince William – LECOM College of Dental Medicine 2022

Dr. Alex Truong – Fairfax – Howard University College of Dentistry 2023

Dr. Trang Nguyen – Fairfax - Virginia Commonwealth University School of Dentistry 2023

Dr. Gianandrea Wotfe – Fairfax – Dade County Dental Research Clinic d/b/a Florida Institute for Advanced Dental Education 2023

Dr. Lina Bobadilla Bello – Ashburn – University of Illinois at Chicago College of Dentistry 2023 Dr. Jeanhee Chung – Orange – Tufts University School of Dental Medicine 2023 Dr. Marianna Detwiler – Loudoun – Virginia Commonwealth University School of Dentistry 1996

Dr. Paulina Oldland – Fredericksburg – OHMetrohealth Medical Center 2023 Dr. Andrea Pajarillo – Woodbridge – University of Texas School of Dentistry at Houston 2022

Dr. Ali Fahimi – Reston – University of Maryland School of Dentistry 2023

Dr. Quinnie Phan – Fauquier - Virginia Commonwealth University School of Dentistry 2023

Dr. Sofie Fazel – Great Falls - Virginia Commonwealth University School of Dentistry 2023

Dr. Stephanie Phan – Fairfax – Western University of Health Sciences College of Dental Medicine 2023

Dr. Sahyli Febles – Fairfax – University of Minnesota School of Dentistry 2022

Dr. Heba Rashed – Fairfax – Virginia Commonwealth University School of Dentistry 2019

Dr. Quang-Minh Huynh – Alexandria Virginia Commonwealth University School of Dentistry 2023

Dr. Damon Roozbehan – Loudoun – Howard University College of Dentistry 2023

Dr. Avneet Kaur – Fairfax - Columbia University College of Dental Medicine 2023

Dr. Yamen Safadi – Fairfax – University of Alabama School of Dentistry at UAB 2023

Dr. Jeffrey Kim – Vienna - Virginia Commonwealth University School of Dentistry 2023

Dr. Diana Saffarini – Fairfax – University of Detroit Mercy School of Dentistry 2023

Dr. Lazokat Komilova – Fairfax – University of Maryland School of Dentistry 2023 Dr. Farzad Koosha – Fairfax – State University of New York at Stony Brook School of Dental Medicine 2021

70

Dr. Amir Maghsoudi – Gainesville – Howard University College of Dentistry 2023

Dr. Brett Siegel – Leesburg - Virginia Commonwealth University School of Dentistry 2023

Dr. Mustafa Shaghati – Loudoun – State University of New York at Buffalo School of Medicine 2023 Dr. Ruchir Shah – Loudoun – Howard University College of Dentistry 2023

Dr. Nattasha Srikongyos – Fairfax – Tufts University School of Dental Medicine 2023

Dr. Sana Yousaf – Falls Church – University of Missouri-Kansas City School of Dentistry 2016 Dr. Syeda Zaim – Prince William – Howard University College of Dentistry 2021 Dr. Naz Zijerdi – Fairfax – State University of New York at Buffalo School of Dental Medicine 2023

MEMBERSHIP

IN MEMORY OF: Name

City

Date

Age

Dr. Glenn H. Birkitt

Leesburg

7/14/23

92

Dr. David J. Cantor

Rockville, MD

6/27/23

84

Dr. Joseph C. Cox

Glen Allen

6/18/23

84

Dr. Robert L. Deal

Henrico

7/17/23

86

Dr. Charles S. Fralin

Richmond

11/22/21

92

Dr. Lloyd A. Green

Midlothian

1/2/23

84

Dr. Nicholas Ilchyshyn

Virginia Beach

7/17/23

74

Dr. Dennis Katz

Hampton

6/13/23

81

Dr. Raymond C. Obertone

Fairfax

6/13/23

77

71

RESOURCES

DDS: Dental Detective Series

>> CROSSWORD ANSWERS CONTINUED FROM PAGE 31

O YW I Z T I J V G B A R B I E A C O V N N J MU Z X E A R E J Q A R O R A S C O P T I C H B Y G F D L MB X X Z V K H UQ F Q C E B UD V B ND Y P M E D I C A LWA S T E Y V R Q V A U S M V QWN D V Z K M E F L O Q U I N E S T O X U T B T Z T J E T I G X A E E E B Q T N N Q P K O Z ZWUMH G P D I D I F K N E Z D B I J K B K S X P X F H T BM E C J U R L N A F I I T CWT A S P E R I A P I C A L C Y S T GMV E V K C Z J H E Z N S I K N T DN N B D R Z V E O L X H I B P G T A NO A R HDHD B P R U I NG E P S N I O S I X F O C N L RWA L NW J U S UMM E R F E S T I R A P Y P OQ T H P I L H I U A F F F E GG Y B OH B C V GNO E P I F NO E X A E Z U I T A B WM H Y U N I L A T E R A L F X E M L X C I I E M T M I WW I V D A F A X A I V L S C O S S R O Y G K O R W F F S O P V D I I S G L E A D E R S H I P N R MW I R A R T O S S N C O P P E NH E I M E R R C AMOD E P I U HWS X V D E A R T V D B Q D F B U L B F D L R NM F R H B K R C WM G R L A L WU X K Z I M B C O E L C B T D A O M L S T H Z P R V Z X WM N J NW P M L Y N Z F P L A C U J X J H F A I S G I U V S L C J C V K S Q J N E D A I N E C E L J O G N S V P C U H VWO B Y WX L E E M X H D J E G H CW Y WG E G H D EWZ C S N Y T H R J T C N S T E V O B A T K V C B L U B E S G J U I T R O B I V H Y MZ E K Z U S R J WR A WM J Y A P F T I R E E L X C X G D D S Z O M S L DWH G S I E I H O J QM K K S S O D A T H H A QWOWC Y L Y C B EWR O F Q V QQGO T E G E S D K B L A C K M I R R O R U Q S C G T NQ V Z I WE A Y O X K D T R R G AW J T QOUD G I U U J K K B S C Z D R F AWZ S ZM S K Y L OU NG E Y D B R E Z H H R M Y R P C S R E Y F Z P S N R HW L Y C X E P F Y QQ R D R P H J Y HQ L X I K UDG V U U E P T R OQ M L K S K I P Z ND F Z AM Y B G P X A G I L E R R I K J C

PIERRE FAUCHARD

PERIAPICAL CYST

INTERNATIONAL

PIERRE PERIAPICAL CYST INTERNATIONAL VCU OPPENHEIMER UNCONTESTED MEDICALFAUCHARD WASTE MEDICAL WASTE BLACK MIRROR

UNCONTESTED SUMMERSEO FEST SPONTANEOUS OPPENHEIMER

LEADERSHIP BLACK MIRROR

UNILATERAL MEFLOQUINE SUMMER FEST SPONTANEOUS

SKY LOUNGE LEADERSHIP

RESEARCH MEFLOQUINE

UNILATERALMOM PROJECT

PREPLOUNGE CHECK SKY

CYTOLOGY RESEARCH

ORASCOPTIC MOM PROJECT

PREP CHECK

CYTOLOGY

ORASCOPTIC

SHOWCASE

SERVICE

MERCURY

REVIEWS

CARLEE

BARBIE

CHANEL

AGILE

VDAF

SERVICE

SHOWCASE

CARLEE

REVIEWS

AGILE

CHANEL

VCU

BOTOX

MERCURY BARBIE VDAF SEO

BOTOX ®

72

Build your own custom worksheet at education.com/worksheet-generator © 2007 - 2023 Education.com

Private Banking Solutions for Dental Practices & Practitioners

Our consultative Private Bankers are always available to help.

• Loans & Lines of Credit* • Dedicated Local Bankers • Custom Mortgage Solutions* • Business & Private Banking • Practice Acquisition/Buy-out Options Michelle S. Butler | ExEcutivE vicE PrEsidEnt | dirEctor of PrivatE Banking t 757-638-7521 | MichEllE.ButlEr@townEBank.nEt

TowneBank.com/DentalBanking | Member FDIC | NMLS#512138 | Equal Housing Lender

| *Credit approval required

73

Virginia Dental Association 3460 Mayland Ct., Ste. 110 Richmond, VA 23233

Abyde abyde.com | 800-594-0883 x1 ACG Wealth Management acgworldwide.com/vda | 800-231-6409

Peer Reviewed Members-Only Benefits ENDORSED PRODUCTS & SERVICES

brought to you by the Virginia Dental Services Corporation, a for-profit subsidiary of the Virginia Dental Association.

Professional Protector Plan (PPP) protectorplan.com | 800-683-6353

ADA Visa Credit Card from U.S. Bank adavisa.com/36991 888-327-2265 ext 36991

ProSites prosites.com/vda | 888-932-3644

Bank of America Practice Solutions bankofamerica.com | 800-497-6067

Prosperident prosperident.com | 888-398-2327

Best Card BestCardTeam.com | 877-739-3952

RK Tongue, Co., Inc. rktongue.com | 800-683-6353

CareCredit carecredit.com/dental | 866-246-9227

The Dentists Supply Company tdsc.com/virginia | 888-253-1223

Dominion Payroll empower.dominionpayroll.com/vda 804-355-3430 ext. 118

TSI tsico.com/virginia-dental | 703-556-3424

Credit Card Processing

VDA Member Perks is a service mark of the Virginia Dental Association. VDA Member Perks is a program

iCoreConnect land.iCoreConnect.com/VA8 888-810-7706