Virginia Dental Journal Vol 101#1 January - March 2024 by Virginia Dental Association

VOLUME 101, NUMBER 1 | JANUARY, FEBRUARY & MARCH 2024

A FAREWELL TO

DR. RICHARD ROADCAP VDA’S LONG-TIME EDITOR STEPS DOWN >> PAGE 28

PATIENT AND PARENT PERSPECTIVES

TREATMENT ACCESS AND OUTCOMES FOR CRANIOFACIAL CARE >> PAGE 20

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IN THIS ISSUE

VOLUME 101, NUMBER 1 • JANUARY, FEBRUARY & MARCH 2024

COLUMNS

SCIENTIFIC

3 CHALLENGES AND CHANGE Dr. Dustin Reynolds

16 THROUGH THE LOOKING GLASS THE FANTASTICAL WORLD OF ORAL PATHOLOGY Dr. Sarah Glass

5 THE PROFESSIONAL STUDENT Dr. Sarah Friend

8 WHERE WE HAVE BEEN AND WHERE WE’RE GOING IN 2024 Dr. Gary D. Oyster

20 TREATMENT ACCESS AND OUTCOMES FOR CRANIOFACIAL CARE: PATIENT AND PARENT PERSPECTIVES Drs. Benjamin F. Lowe, III, Bhavna Shroff, Steven J. Lindauer, Caroline K. Carrico, and A. Omar Abubaker

9 LET ME INTRODUCE MYSELF… Leslie Hicks

30 CHEILOSCOPY Dr. Sarah Friend

15 ADVOCATING FOR TRANSPARENCY AND BETTER PATIENT CARE Ryan Dunn

34 PEDIATRIC ABSTRACTS

6 FAREWELL Dr. Richard F. Roadcap

ADVOCACY 12 WE’RE TAKING ON THE FIGHT FOR FAIRNESS AND TRANSPARENCY WE NEED MORE DENTISTS TO JOIN THE FIGHT! Laura Givens 12 VIRGINIA 2023 ELECTION ALTERS POWER IN THE GENERAL ASSEMBLY Charles Duvall, Tripp Perrin, and Missy Wesolowski 14 IT’S TIME TO RALLY TOGETHER AND ADVOCATE FOR DENTISTRY Laura Givens

FEATURE 28 AN INTERVIEW WITH DR. RICHARD ROADCAP VIRGINIA DENTAL JOURNAL EDITOR (2007 – 2023)

48 LAWMAKERS, MEDIA, AND PATIENTS: CONVEYING KEY MESSAGES WITH AUTHORITY Michaela Mishoe 52 VDA MEMBER PERKS ANNOUNCES ENDORSEMENT OF TORCH THE ALL-IN-ONE DENTAL SUPPLY PLATFORM

UNIVERSITY CONNECTIONS 50 VIRGINIA IMPLANT EXCELLENCE WEEK ELEVATES RESTORATIVE DENTISTRY IN THE COMMONWEALTH John Wallace 51 VDA SCHOLARSHIP PROVIDES PEACE OF MIND FOR THIRD-YEAR DENTAL STUDENT ANNELIESE GOETZ John Wallace

OUTREACH

41 ETHICAL OR LEGAL? Dr. William J. Bennett

27 SERVING THE PETERSBURG COMMUNITY: VDA FOUNDATION COLLABORATION WITH CENTRAL VIRGINIA HEALTH SERVICES Dr. Colleen Davis

43 THE MORE REGULATIONS YOU KNOW A FEATURE FROM THE VIRGINIA BOARD OF DENTISTRY

44 PIEDMONT SMILES MOM EVENT – BACK FOR SECOND YEAR Michelle McGregor, RDH

45 DENTAL DETECTIVE SERIES WORD SEARCH Dr. Zaneta Hamlin

MEMBERSHIP

RESOURCES

46 VIRGINIA BOARD OF DENTISTRY MEETING NOTES DECEMBER 8, 2023 Dr. Ursula Klostermyer

53 NEW MEMBERS 55 AWARDS & RECOGNITION

VA DENTAL JOURNAL

EDITOR-IN-CHIEF BUSINESS MANAGER MANAGING EDITOR

Sarah Friend, DDS, FAGD Ryan L. Dunn, CEO Shannon Jacobs

EDITORIAL BOARD

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

VDA COMPONENT ASSOCIATE EDITORS

Drs. Zane Berry, Michael Hanley, Frank Iuorno, Stephanie Vlahos, Jared C. Kleine, Chris Spagna, Anneliese Goetz (VCU Class of 2025)

R OF T HE 2 02

WI N

AWARD WINNING PUBLICATION

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. Sarah Friend Eric Montalvo, VCU Class of 2024 Wendy Yu, VCU Class of 2025

SIL

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

SCROLL A

VOLUME 101, NUMBER 1 • JANUARY, FEBRUARY & MARCH 2024 VIRGINIA DENTAL JOURNAL

SUBSCRIPTION RATES

POSTMASTER MANUSCRIPT, COMMUNICATION & ADVERTISING

(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. VDA member subscriptions are included in your annual membership dues. No other subscription options are available. Second class postage paid at Richmond, Virginia. ©Copyright Virginia Dental Association 2024 Send address changes to Virginia Dental Association, 3460 Mayland Ct, Ste 110, Richmond, VA 23233. Managing Editor, Shannon Jacobs 804-523-2186 or jacobs@vadental.org

MESSAGE FROM THE PRESIDENT

CHALLENGES AND CHANGE Dr. Dustin Reynolds

I hope this message finds each of you well. Time really does fly; I realize that more as I get older. It seems as though it was just yesterday our membership was gathered in Norfolk for the Virginia Dental Showcase, and I was installed as your new President. It has certainly been a busy three months. As a new year begins, I hope we each take a moment to give thanks for all that we have blessed with, and it is my hope for each of you that 2024 brings happiness, health, and prosperity. I was honored to represent the VDA at this year’s Virginia Dental Hygiene Association annual meeting in Richmond. Associations provide crucial member support. The 140 members of the Virginia General Assembly and the members of the Virginia Board of Dentistry could not create good policies around oral healthcare without serious input from credible, trusted associations that truly represent their members and the communities they serve. I also presented at the November Dental Advisory Committee meeting in Richmond. Several key issues which affect our profession were topics of discussion at both gatherings. Chief among those topics is our workforce. I know our members can all agree that we can do a better job supporting all our dental education programs in the Commonwealth. I will continue to make sure our members understand the needs of allied dental programs and work together to find ways to address those needs for faculty, funding, donations, clinic space, and anything else that stands as a barrier to providing the next generation of students a world-class education that will prepare them for the next step in their professional careers. This workforce challenge is a

“ Dentistry is constantly changing, and we will continue to face challenges. I am truly optimistic about the future of dentistry and access to oral health care in Virginia.”

national problem, and it will require us to work together in Virginia for a solution. If a practice cannot schedule hygiene appointments every six months for their current patients, which is becoming increasingly common, how can they schedule three hygiene checks a year that are now covered by Virginia’s adult Medicaid plan? The ADA recently released a study that found since the pandemic, half of dentists have taken on duties previously assigned to hygienists, dental assistants, and others in the office due to staffing challenges. This is bad for our practices, and it harms the patients who spend more time waiting for appointments and often give up trying to obtain one. More than two-thirds of our licensed hygienists in Virginia graduated from an in-state dental hygiene program. One of our five community college-based dental hygiene programs has paused admissions indefinitely due to staffing, resources, and curriculum challenges. The VDA and local component leaders have been urging school administrators, VCCS leadership,

the Governor’s administration, and local General Assembly leaders to help address the issues at Virginia Peninsula Community College that have led to a pause in admissions for the program. We cannot afford to lose this program, and the VDA will continue fighting to ensure it has the resources and support it needs. In addition, VCU is the largest dental Medicaid provider in Virginia. Still, its current facilities, with tens of millions of dollars in deferred maintenance, are not suited to its growing role in providing dental care to patients from across Virginia. The VDA will be advocating for planning authorization for the school in the upcoming biennial budget. For about 80 percent of dentists and 33 percent of hygienists who receive their education out of state, the VDA will support legislation this coming General Assembly Session to enter the dental and dental hygiene interstate licensure compact. This compact will provide a new predictable pathway for dentists and hygienists coming from other states to see patients in Virginia. The compact effort was spearheaded by the ADA in partnership with the Department of Defense, recognizing the benefits to our significant population of veterans and military spouses in Virginia and the benefits of straightforward licensure processes. The VDA will also be supporting legislation this coming General Assembly Session that will require dental insurance companies to publicly report the percentage of premium dollars that go to patient care. Having this information will allow employers and individuals to make better-informed decisions about how they will pay for their dental care. Dental insurance has been a challenge for our members. We saw an overdue

>> CONTINUED ON PAGE 4 3

MESSAGE FROM THE PRESIDENT >> CONTINUED FROM PAGE 3 increase in reimbursement rates in the Medicaid program last year. Still, there is broad frustration among dentists that the current model for dental insurance is increasingly not keeping pace with the cost of providing dental care to patients. Dental insurance has always operated differently than health insurance, and our members are concerned that patients do not understand what their dental benefits cover. Dentists believe that the lack of transparency around dental plans thwarts patients from using their dental benefits in a timely and cost-effective manner. Dentistry is constantly changing, and we will continue to face challenges. I am truly optimistic about the future of dentistry

and access to oral health care in Virginia. I also hope you join us at the Greenbrier Resort for this year’s Virginia Dental Showcase just across the border in Wild Wonderful West Virginia for a focus on Artificial Intelligence and how innovative technology is shaping the practice of dentistry! Those who do not recognize the opportunities from innovative technology and new practice models risk being left behind. Dentistry is a deeply personal practice; we get to know, understand, and treat the whole patient sitting in our chair, not just their mouth. Innovative technology will not change that fundamental dynamic, but we will have opportunities to embrace modern technologies that allow us to keep our patients and communities healthier.

MESSAGE FROM THE EDITOR

THE PROFESSIONAL STUDENT Dr. Sarah Friend

Someone once asked me what I would have chosen to be had I not become a dentist. Being a professional student would have been my top choice if I had been independently wealthy. Learning new things has always been my passion. Forensic dentistry caught my attention two decades ago, and I always wanted to complete more education. However, life got in the way of my plans. Recently, as a middle-aged dentist, I was finally able to tackle this goal. Those of us who have been out of school for some time know that learning new things becomes more difficult as we age. Before I began my fellowship in forensic dentistry, the only technology I used routinely in the dental office consisted of simple word processing software for communication, e-mail, and an occasional digital scan. The fellowship quickly gave me a crash course in computing. I had to learn to both master different software programs and function at an expert level in real time so that I could finish my assignments. I often lost my patience and relied on my teenagers, husband, and younger colleagues to help me navigate the technological challenges. The dental content of this program was and continues to be fascinating to me. The intense immersion into using new technology and learning in a digital format was mind-bending and often humbling. Having faced these challenges head-on, I am now more resilient, capable, and confident in my personal and professional abilities. The world of dentistry is becoming more technical by the day. Dentalrelated social media pages overflow with advertisements about exciting new technologies and techniques. The younger generation of dentists immerse themselves in technology, and because of their upbringing in the digital world,

they are comfortable with it. Those of us who grew up in the analog world are more likely to be creatures of habit and be averse to change. Change can be uncomfortable and hard until we embrace it. Dentistry and the world we live in will continue to advance technologically. If we want to succeed and stay current in our profession, we must be willing to bend and learn about the things we need help understanding.

simpler and more enjoyable in ways we cannot predict. We are students of our profession, and our profession is quickly changing. We must all be professional students to carry dentistry forward.

“ Dentistry and the world we live in will continue to advance technologically. If we want to succeed and stay current in our profession, we must be willing to bend and learn about the things we need help understanding.”

In this new year, I challenge you to expand your comfort level and learn more about the digital world of dentistry. Take a class, learn a new technique, or listen to a podcast about something interesting. Be bold and ask your younger colleagues how to use more recent technology. So many resources are available to us now, some free, that weren’t present even a few years ago. The more you learn, the more resilient and educated you will become. Technology might make life

GUEST EDITORIAL

FAREWELL

Dr. Richard Roadcap; Editor, Virginia Dental Journal 2007-2023

You’re reading my last column as Editor of the Virginia Dental Journal. Before I vanish in the gloaming, I’d like the privilege of reflecting on the last sixteen and a half years and to take this opportunity to thank the many people who’ve supported and encouraged me during that time. At the outset, the Journal was a communication device, designed to keep readers informed in a timely fashion. As we have transitioned from analog to digital, it’s now a (very important) archive of where our profession began and where it’s headed. In 2007, proofreading was performed on paper with Post-It® notes and red pencils, with copies of paper proofs shuttled back and forth by not-soreliable couriers. Somewhere along the way we adopted the document storage app Dropbox, which proved to be a game changer in managing our deadlines and content. Now, all proofreading is done in the cloud, which allows us to have a “social” aspect in creating the final product. But that’s enough about the mechanics of publishing. My vision was always to create a sense of community for our readers. You will note I did not say “VDA members.” I wanted everyone who laid eyes on paper or digital devices, that is, doctors, staff, advertisers, authors, students, or anyone else, to feel included. It was not my publication, but theirs, one to which they belonged. One of the greatest compliments an editor can receive (and other members of the Fourth Estate will agree) is a letter or email taking issue with a recent article. Complaints tell us we’re being read, contemplated, and debated. As a peer-reviewed publication, the members of the Journal’s Editorial Board

are unsung heroes. When a scientific manuscript is presented for publication, our reviewers make certain it’s of benefit to our readers. Because we employ a

“ I wanted everyone who laid eyes on paper or digital devices, that is, doctors, staff, advertisers, authors, students, or anyone else, to feel included. It was not my publication, but theirs, one to which they belonged. ”

single-blind system of review, where the names of reviewers are not disclosed to authors, we cannot recognize publicly the doctors who devote many hours to the process. Because of their anonymous efforts, we can publish quality research for our readers. Some state journals have abandoned science altogether and publish no original content. Thanks to the Journal’s participation in the ADA’s Digital Commons, and the newly formed Virginia Dental Archive, our content is searchable online and no longer at the mercy of the National Library of Medicine and PubMed. Again, my sincere gratitude goes out to all our reviewers (whose names can be found on the masthead) and their service on behalf of our readers.

Three people are very important in the life of an editor. Behind and in support of every editor is a Managing Editor. Shannon Jacobs and I have worked together for the last sixteen years, producing the Journal on time every time. Even when the VDA offices burned down in the summer of 2010, we managed to meet the deadlines for the following issue. I can’t begin to thank her enough for her efforts on my behalf. Any creative endeavor can bring with it frustration and discouragement, but at all times she has exhibited both courage and understanding, allowing the process to move forward. I’m terminally leftbrained, but she has always tolerated my shortcomings (yes, editors miss their own deadlines), and made every effort to produce one of, if not the best, state dental journals. My wish for her is success and professional fulfillment in her future endeavors. Second, every editor reports to his or her publisher. In my case, I’ve been fortunate to work for two of the best. Dr. Terry Dickinson gave me his unqualified support when I started out (and was learning the ropes) and encouraged me at every step. Ryan Dunn, as CEO, has continued the tradition and never fails to express his support and admiration. At no time in my tenure was I micromanaged, secondguessed, or asked to change course. I’m grateful to both Dr. D. and Ryan for their confidence in me. Finally, behind every successful editor, if he or she is so fortunate, is a supportive spouse. My wife Norma has without fail encouraged me to continue and prosper. Oh, there have been sacrifices – for a while nearly every trip was Journalrelated, and many vacation hours were spent on a laptop with article reviews and editing. But she never once complained,

GUEST EDITORIAL

or suggested I find another outlet for my energies. Soon after I was asked to serve as Editor, I told her I could think of a number of other members who were more qualified than me. Her reply was, “They didn’t ask them to serve. They asked you.” In a roundabout manner, the time served as Editor has allowed us to spend more time together as a couple, for which I am grateful. I could not have succeeded without her love and support. I met with the VDA Board of Directors for the last time on December 1. Before signing off (we met on Zoom), I thanked them for sixteen years of support and encouragement and asked them to afford the new VDA Editor, Dr. Sarah Friend, the same consideration as she steps into the role. I would be remiss if I did not also thank the VDA staff for the kindness and understanding they have given me since the summer of 2007. There have been many staff changes over the years, but at

all times I enjoyed their cooperation and best efforts. Izaak Walton said, “Good company in a journey makes the way seem shorter.” For the last sixteen years, I’ve been blessed to have good company. How the years have flown by! I’ve heard it said a member receives two things from their association: a bill for dues and a journal. I know you’ll always receive a bill for dues; I hope you will always receive, whether printed, digital or in some format we can’t imagine, a Journal.

TRUSTEE’S CORNER

WHERE WE HAVE BEEN AND WHERE WE’RE GOING IN 2024 Gary D. Oyster, DDS; ADA Trustee, 16th District

As I am starting my final year as your 16th district trustee, I would like to reflect on some of the changes that have occurred during my tenure on the Board of the American Dental Association (ADA). In late 2021, the change in the Executive Director role challenged the Board of Trustees (BOT) and the entire membership to adapt to a more rapid, nimble, and global way of thinking about our Association and its activities to be viable and remain relevant. The declining membership market share for the preceding five or more years, especially among recent graduates, and the retirement of the baby boomer dentists necessitated a dramatic change in governance. Executive Director Dr. Ray Cohlmia came up with the idea of a Strategic Forecasting Committee (SFC), made up of some Board members and twice as many House members. The ultimate goal of this SFC, as they work with the BOT, Councils, and Committees, is to pivot and be more responsive to issues that arise throughout the year as they flex and adapt our rolling five-year strategic forecast. Recently, the joining of the ADA with the Forsyth Institute to form the ADA Forsyth Institute is an excellent example of how the ADA quickly responded to an emerging opportunity, all done in a much more rapid fashion than the ADA has traditionally approached business. This new venture will make the ADA one of the premier research institutes. Interactions with the New Dentist Committee, the American Student Dental Association (ASDA) Board, and dental school deans were initiated and seemed to be working toward the goal of a unified

“ The ultimate goal of this SFC [Strategic Forecasting Committee], as they work with the BOT, Councils, and Committees, is to pivot and be more responsive to issues that arise throughout the year as they flex and adapt our rolling five-year strategic forecast.”

profession. By working with these three groups and strengthening the relationship with the tripartite members, we hope to reverse the downward market share of the ADA. We’ve also worked this year to re-emphasize the value of our tripartite infrastructure. The many ways the ADA helps dentists and our profession thrive are made possible in partnership with our state and local societies. Replacing Aptify with Salesforce/Fonteva will provide a streamlined, single source of membership data, offering personalized value to all our members. Having a single system will enable all levels of our tripartite to follow members as their careers evolve. The redesign of the annual budget to a Financial Operating Plan (FOP) will allow more flexibility to react quickly to

program changes. Much like in your office or workplace, when something is not working or something better comes along, you can make a change. The FOP will be reviewed quarterly by the BOT. This flexibility will allow programs that are not performing or inherent to the ADA mission to be placed in the parking lot. The Board did a great deal of work to build an understanding of the yearly outlook, as well as the specifics of the first quarter FOP for 2024. The Board reviewed a comprehensive FOP by program and defined the requirements for an appropriate summary report for distribution to the House of Delegates on or soon after December 31. Throughout 2024, each quarterly iteration of the FOP will be shared as it is developed. There will be ongoing communications about the new FOP process in the new year. As most of you know, the pain points of workforce shortages and dental benefits programs, including Medicaid and Medicare, are constantly being addressed by all levels of the tripartite. Funding and administrative issues must be resolved. Dental Compacts (agreements among participating state governments) and the relationship between the ADA and dental service organizations (DSOs) are also being assessed. I look forward to seeing everyone at SmileCon® 2024 in New Orleans as we come together to propel dentistry into the future. Stay tuned for more details to come. Through the perspectives, foresight, and collaboration of our tripartite, we’re positioning our association – and all dental professionals – to thrive in this new day that’s dawning for our association and our profession.

COLUMNS

LET ME INTRODUCE MYSELF… Leslie Hicks, Manager of Member Relations

I am very excited to be a part of the team here at the Virginia Dental Association. My position is Manager of Member Relations for the VDA, and I know that this is an ideal position for me. I am originally from North Carolina and completed my degree in accounting at North Carolina State University. Following graduation, I worked in the accounting field for several years, learning both the value of building chemistry to develop a good team and the value of building professional relationships to benefit that team. Upon marriage, I moved to my husband’s hometown of Goochland, Virginia, where we still live with our two young boys. Over the next six years, I truly learned to appreciate the value of building strong professional and personal relationships as we traveled to various parts of the United States for my husband’s professional baseball career, balancing the unique challenges of raising two young boys while simultaneously providing a strong and stable home environment for everyone. Following his retirement, I then decided to resume my professional career. The core concepts of my position as Manager of Member Relations are to develop, manage, and execute membership outreach and engagement efforts for both existing and prospective members. This involves actively listening to members and non-members first to identify their needs and then actively addressing them. By building and maintaining strong professional relationships with our current membership, our potential membership, and our vendors, the VDA will be better positioned to recommend our products and services and ensure that any and all issues relating to membership in the VDA, whether payment, benefit, or product

“ The core concepts of my position as Manager of Member Relations are to develop, manage, and execute membership outreach and engagement efforts for both existing and prospective members. This involves actively listening to members and non-members first to identify their needs and then actively addressing them.”

relationships among both current and prospective members. This type of effort ultimately strengthens our profession by encouraging active dialog amongst our members. It is my personal goal to reinvigorate the recruitment efforts of our association. I will seek to facilitate the relationships between the VDA and its members, nonmembers, our vendors, and more. I am a team-first employee, and I won’t be satisfied until all of the necessary work has been done to accomplish our goals. I am truly looking forward to this exciting opportunity and am eager to meet and get to know all of you. There has never been a better time to be a member of the VDA. Feel free to reach out to me at hicks@vadental.org at any time.

driven, are immediately addressed and resolved. One program that we are currently in the process of implementing is called the “Lead 3” program. The primary function of the program is to seek current VDA members who will volunteer their time and efforts to actively recruit three new members into the VDA. The recruitment efforts will be based on geographic proximity and include additional key factors. The ultimate goal is not only to increase membership in our organization but also to encourage “peer-to-peer” recruitment and mentorship by building and maintaining strong professional

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.

*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

WE’RE TAKING ON THE FIGHT FOR FAIRNESS AND TRANSPARENCY WE NEED MORE DENTISTS TO JOIN THE FIGHT! Laura Givens, Director of Legislative and Public Policy

It is unclear how much of a patient’s annual premium is spent on actual dental care in Virginia. VDA legislation will increase transparency and accountability in dental insurance by requiring dental insurance carriers to simply disclose their actual loss ratio annually. A detailed one-pager on this legislation can be found on the next page. We NEED YOUR HELP. Please share this information with your colleagues.

How can you help in this initiative? • Contact your legislators and ask for their support of this legislation.

Need help finding your state legislators? Visit https://whosmy. virginiageneralassembly.gov/. • Connect with the VDA Grassroots Network. Receive VDA Action Alerts by texting VDA to 52886. • Make a contribution to the VDA PAC. Be sure to make your contribution when paying your 2024 VDA dues (your statement was mailed in mid-November), or you may give directly now through our website at https://www.vadental.org/vdapac.

The bottom line is that patients deserve the right to know what is spent on dental care. Better transparency and simple reporting equals more robust dental benefits for patients and more families empowered to seek essential care. Please help us in this necessary and important effort! Questions? Contact Laura Givens at givens@vadental.org.

VIRGINIA 2023 ELECTION ALTERS POWER IN THE GENERAL ASSEMBLY Charles Duvall, Tripp Perrin, and Missy Wesolowski, VDA Lobbyists As a result of the elections on November 7, 2023, Democrats narrowly control both chambers of the Virginia legislature in January 2024 (51-49 in the House of Delegates and 21-19 in the Senate). Both parties combined spent close to $200 million during the election campaign cycle, breaking all kinds of records in the process. Because of redistricting and a wave of retirements, there will be 51 new legislators (out of 140) – the most turnover in recorded history and wiping out over 700 years of combined legislating experience in the process. Delegate Don Scott (D-Portsmouth) was elected in November by his peers to be the Speaker-designee of the House and

was formally elected on January 10, 2024 by the full House. Speaker Scott’s wife, Dr. Mellanda Colson Scott, is a VDA member dentist practicing in Norfolk. Charniele Herring (D-Alexandria) was elected to her second stint as Majority Leader, and Kathy Tran (D-Fairfax) will be caucus chair. The Majority Leader in the Senate is now Scott Surrovell (D-Fairfax).

What does this mean for the VDA membership?

• We have a lot of new friends to make and some education to do in nearly every corner of the Commonwealth. • Our key committees in the House and Senate will look vastly different with new Committee Chairs and members.

• The approach the VDA has taken through the years to assign specific members to legislators has never been more important. RELATIONSHIPS are the name of the game, and we need to build them with the new faces quickly. If you know any of the newly elected Senators or Delegates, please contact Laura Givens at givens@ vadental.org or 804-523-2185.

Representing 4,000 dentists who employ over 25,000 Virginians.

Support Dental Insurance Transparency Encourage Competition, Patient Utilization & Improve Access to Essential Dental Care in Virginia The Issue: It is unclear how much of a patient’s annual premium is spent on actual dental care in the large group market. • Transparency in how dental plans are structured and how much a plan pays out over time in claims will give employers and patients information that can be used to make informed decisions in how they will pay for essential dental care. • Health insurance carriers are required by the ACA to spend at least 80% of patient premiums on patient care – dental plans have no such requirement. Meanwhile, Dental insurers in Virginia are not currently required to publicly report the actual ratio of claims paid to the premium revenue they take in the large group market. • This lack of transparency could lead employers to partner with hollow dental plans and no easy way to understand what portion of their premiums go to insurance company overhead/profits.

The Solution: Support Virginia Dental Association Legislation for Dental Loss Ratio (DLR) Reporting VDA legislation will increase transparency and accountability in dental insurance by requiring dental insurance carriers to simply disclose their Actual Loss Ratio (ALR) annually in the large group, small group and individual markets. What will this legislation require? • The Bureau of Insurance (BOI) will post annual dental insurance carriers ALRs on their website. A two-year lookback will allow patients and employers to understand and compare trends among dental insurance companies and how much of their premium dollars are spent on dental care. • A work group will also be convened of stakeholders including dental carriers to evaluate the need for changes regarding ethics and fairness in dental carrier business practices. How will Virginians benefit from this legislation? • It will enable employers and patients to make informed decisions with regards to their healthcare dollars. This bill only requires uniform reporting so that dentists and patients can make informed decisions. It does NOT mandate or even contemplate a specific DLR ratio – it is reporting only. • It will incentivize the dental plans to encourage patients to actually USE the benefit. • Transparency and accountability will protect patients and provide incentives for insurers to operate efficiently. Important Notes Regarding this Legislation • This is NOT a bill to mandate a specific dental loss ratio – this is a simple transparency and reporting bill. This legislation should NOT be burdensome to the plans or BOI. • The VDA team has incorporated all technical suggestions recommended by the BOI. • Delta Dental of Virginia and the Virginia Association of Health Plans reviewed and offered suggestions for this legislation and are NOT opposed. • This bill could significantly bolster competition in this market. Setting a standard, easy-to-understand benchmark levels the playing field and will incentivize insurers to put more dollars back into patient care versus using it for overhead. • There is a delayed effective date for this legislation.

Bottom Line: Patients Deserve the Right to Know What is Actually Spent on Dental Care Better transparency and simple reporting = More robust dental benefits for patients and families!

To learn more about dental loss ratio legislation in Virginia, please contact Laura Givens at givens@vadental.org or 804-523-2185. 13

ADVOCACY

IT’S TIME TO RALLY TOGETHER AND ADVOCATE FOR DENTISTRY Laura Givens, Director of Legislative and Public Policy

The 2024 Virginia General Assembly session began on January 10th and the VDA is on the ground advocating for the profession. We need your help in this process!

patients are foremost in the General Assembly’s eyes. If you haven’t already contributed to the VDA PAC for the year 2024, please make your contribution today! You can contribute when paying your VDA dues through the VDA website at https://www.vadental.org/renew or separately at vadental.org/ vda-pac. Contact Laura Givens at 804-523-2185 or givens@vadental. org for more information on how to become more involved in VDA PAC efforts. YOU can make a difference by effectively advocating for your profession! • Attend Dental Days at the Capitol: If you haven’t already registered to attend this event, please register today at https://www.vadental.org/ dental-days.

The VDA is pursuing dental insurance reform legislation that will increase transparency and accountability. The General Assembly is also considering dental licensure changes and legislation that will give dentists better access to mental health resources. It’s important to have members engaged in this important legislative activity.

How can you help?

• Contribute to the VDA PAC: VDA members must make sure that dentistry’s voice is heard and ensure that the interests of your

We would like to thank all 2023 VDA PAC contributors for your generosity! Below are our highest-level contributors. Please visit vadental.org/vda-pac to find a list of all 2023 contributors.

Gold Club Members ($1,250 or higher) Dr. Harshit Aggarwal Dr. Caitlin Batchelor Dr. Scott Berman Dr. William Bigelow Dr. Hugo Bonilla Dr. Dana Chamberlain Dr. Peter Cocolis Dr. William Dougherty Dr. Sayward Duggan Dr. Timothy Finkler Dr. Samuel Galstan Dr. Marlon Goad Dr. Brooke Goodwin

>> CONTINUED ON PAGE 27

2023 FINAL CONTRIBUTIONS REPORT

Component

% of 2023 Members Contributing to Date

2023 VDA PAC Goal

Amount Contributed to Date

Per Capita Contribution

% of Goal Achieved

1 (Tidewater)

32%

$45,000

$37,350

$375

83%

2 (Peninsula)

34%

$27,500

$18,635

$345

68%

3 (Southside)

25%

$14,000

$13,350

$335

95%

4 (Richmond)

20%

$67,750

$59,070

$418

87%

5 (Piedmont)

30%

$30,000

$23,500

$341

78%

6 (Southwest VA)

39%

$25,250

$35,950

$377

142%

7 (Shenandoah Valley)

25%

$30,000

$23,000

$379

77%

8 (Northern VA)

24%

$135,000

$108,722

$399

81%

TOTAL

29%

$375,000

$319,577

$371

85%

TOTAL CONTRIBUTIONS: $319,577 2023 GOAL: $375,000 $55,423 SHORT OF GOAL Congratulations to Southwest Dental Society for surpassing their goal!

MESSAGE FROM THE CEO

ADVOCATING FOR TRANSPARENCY AND BETTER PATIENT CARE Ryan Dunn, CEO

In the changing landscape of dentistry, the role of VDA members extends beyond patient care. We advocate for our patients, ensure they are treated fairly, and help them understand their options and role in accessing essential dental care. Now, more than ever, being a member of professional associations such as the VDA holds immense importance, particularly in advocating for transparency and balance from dental insurance companies. For over 150 years, the VDA has educated and safeguarded the profession and our patients in Virginia. As dental benefits have evolved, we are seeing a widening rift between patient expectations and the reality of what is covered by their dental benefits when they use them to pay for dental care. When there are misunderstandings, the dentist and the dental team are placed in the position of explaining the gap between their expectation and the reality of what their “insurance” covers. The VDA and ADA have fought for years to address the challenges our members and their patients face with insurance companies. This year, we have a chance to address a fundamental issue of transparency, by requiring dental insurance companies to disclose how much of the money they take in premiums is used for patient care. For employers and individuals, knowing this ratio can help them make informed decisions about the value they are getting in pre-paid dental benefits, and weigh that value against alternative ways of paying for dental care. Transparency in insurance is fundamental. A patient who understands their benefits walking into a dental office can focus the time in the dental chair on what is best for their oral and overall

health, rather than parsing why they are paying out of pocket for essential care they thought was covered. Transparency also empowers employers, particularly small businesses, to choose plans for their employees not solely based on cost but on the value that they provide to their employees. I am proud of the many VDA members who have thoughtfully put forward this common-sense policy to the benefit of patients throughout Virginia and look forward to standing shoulder-toshoulder with our members to ensure our new legislators in Virginia understand its importance. We recently surveyed our members to better understand their specific challenges with dental insurance, and loss ratios are just one issue that is on their minds. Rural dental providers overwhelmingly feel reimbursement models put a particular financial burden on them and limit patient care. Not a single dentist surveyed believed their reimbursement rates had kept up with the cost of providing care. Beyond reimbursement rates, the top reasons cited by dentists who have dropped insurance plans in recent years have been denial of claims, limited scope of services covered by the plan, dissatisfaction with customer service, timeliness and inconvenience of processing, patient eligibility and verification, and issues with down coding.

year, we are including a mandate that insurance companies meet at regular intervals with representatives with the VDA to review the Fair Business Practices Act (FBPA) to determine if any updates or enhancements are warranted. The FBPA addresses many rules of the road including down coding and claims submission, processing, and payment. This is a significant opportunity for our members to raise concerns and challenges they have faced from business practices that come between them and providing patient care and enact meaningful changes to improve their ability to care for patients. We will have a very busy legislative session with this and several other initiatives important to dentistry on the agenda. Sign up for VDA text alerts to make sure you do not miss an important legislative action alert by texting “VDA” to 52886. I hope to see many of you at Dental Days at the Capitol this year. For those unable to join in person, your membership and active involvement in the VDA PAC help support our mission and our seat at the table to improve oral healthcare in Virginia. Thank you for all you do for organized dentistry.

For every single VDA member who says they are planning to participate in additional insurance plans in the next three to five years, there are twelve who say they plan to participate in fewer. Members are understandably frustrated with a payment model that is archaic and unsustainable for a practice that has seen its cost of doing business continue to rise, and the workforce pool continue to fall. As part of our legislative initiative this

THROUGH THE

LOOKING GLASS WITH DR. SARAH GLASS

Explore the Fantastical World of Oral Pathology Student: Cases are presented by Lauren Smolenski, a fourth-year dental student at the Virginia Commonwealth University School of Dentistry.

A 60-year-old female patient reports to the clinic for a recall. She states that she has recently noticed dark red areas on her gums and has been bleeding a lot when she brushes her teeth. On clinical exam, you are able to appreciate erythematous and edematous facial gingiva and gingival margins of teeth #6-11 and #22-27. What is your suspected diagnosis?

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A 9-year-old male patient reports to the pediatric clinic for his recall appointment and you notice that he hasn’t had a panoramic radiograph yet. Once taken, you immediately notice that one of his teeth has quite a large radiolucency around the developing crown. The patient reports no pain, swelling, or discomfort. What is your suspected diagnosis?

A 67-year-old female patient presents to clinic for an initial oral examination with the chief complaint, “I have a bump on my gums.” The patient reports noticing the bump about five months ago and reports no pain associated with the area. Upon intraoral exam, you see an exophytic raised lesion with speckled leukoplakia and a granular texture located on the facial gingiva spanning teeth #9-13, measuring roughly 5 cm x 4 cm. What is your suspected diagnosis?

>> ANSWERS ON PAGE 18

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>> THROUGH THE LOOKING GLASS ANSWERS CONTINUED FROM PAGE 17

1. The diagnosis is Mucous Membrane Pemphigoid. This is a type of autoimmune subepithelial blistering disease that affects mucous membranes of the body. It most commonly manifests itself as desquamative gingivitis, yielding red and edematous lesions. A referral to a specialist is recommended for biopsy. Topical steroids are recommended for managing the oral lesions. Collaborative care with dentistry, dermatology, and ophthalmology is heavily encouraged.

2. The histopathology shows uninflamed cystic epithelial lining, and the diagnosis is Dentigerous Cyst. This is a developmental odontogenic cyst, which develops due to fluid accumulation between the crown of the tooth and the dental follicle. The affected tooth and cyst can be removed, or in cases of larger cysts, marsupialization can be performed.

3. The diagnosis for this case is Squamous Cell Carcinoma (SCC). The histopathology of this lesion shows invasion of atypical malignant epithelial cells with increased mitotic activity. The most common places to find SCC include the tongue, soft palate and oropharynx, floor of mouth, and the lower lip, but it may also be found on the gingiva, such as in this case.

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

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TREATMENT ACCESS AND OUTCOMES FOR CRANIOFACIAL CARE: PATIENT AND PARENT PERSPECTIVES Drs. Benjamin F. Lowe, III, Bhavna Shroff, Steven J. Lindauer, Caroline K. Carrico, and A. Omar Abubaker

Abstract

Introduction: The purpose of this study was to evaluate craniofacial patients and parent attitudes toward access to care, quality of care, and use of telehealth. Methods: An original survey was sent to families in treatment with the Virginia Commonwealth University craniofacial team to assess opinions toward various aspects of care. Results: On average, no factors were considered a barrier to care. Quality of care was highly rated. Respondents felt neutral about telehealth overall, but those with past telehealth experience were significantly more likely to find value in its use (p < 0.01). Conclusion: Respondents had satisfactory treatment outcomes and good access to care regardless of income and insurance status.

Introduction

Normal development of the head and facial complex is critical to physical, mental, and social well-being, and abnormalities within these processes can lead to complex problems that affect the quality of life of both patients and their families. Cleft left lip and palate (CLP) is one of the most common craniofacial anomalies, affecting around one in 700 births.1 Care for those with CLP or other craniofacial often extends from shortly after birth into early adulthood, requiring multiple surgeries, speech/audiology therapy, and multiple years of orthodontic treatment, depending on the specific diagnosis and its severity.2 Much of the research dedicated to craniofacial care falls into two primary categories. A large body of research is

understandably focused on the specific clinical procedures and practices that are performed to treat these patients. Another subset of research that analyzes logistics and administration emerged in the 1990s as craniofacial teams and centers began improving their ability to systematically compare outcomes.3 This research continued to expand as the field progressed and improved, but literature focused on outcome perceptions and access to care is lacking. Much of the current research on patient and parent perceptions of treatment administration and outcomes is empirical in nature.4,5 A number of studies have identified some of the primary barriers limiting access to care for patients with craniofacial anomalies. Cassell et al. found that nearly half of all CLP patients in their study population had to drive an hour or more for care.6 It was also shown that minorities, Spanishspeaking families, and those with public insurance had more missed appointments and interferences due to other health issues.7 These concerns led to patients failing to complete their care, and it was demonstrated that about 50% of CLP patients were lost from the care system before age 14. The same study also found that cost and failure to see a need for treatment were the primary factors leading to withdrawal of patients.8 From these findings, it is clear that barriers to care in this population exist. In recent years, telehealth has emerged as an increasingly popular means of enhancing access to care. This is defined as the provision of care remotely via a number of communication tools such as telephones and laptops. Despite limitations in what can be accomplished and communicated virtually, telehealth is purported to greatly improve convenience

and access to healthcare.9 For patients with craniofacial anomalies, the timeline of care requires regular visits to the craniofacial team from infancy through early adulthood. Offering telehealth as an option for certain appointments may decrease the burden of care for these families. The purpose of this study was to improve our knowledge concerning patient and parent experiences with a craniofacial team and access to craniofacial care. Specifically, we assessed whether patients and their families had adequate access to care, perceived this care as being of high quality, and believed teledentistry would benefit the current system of craniofacial care. The study also aimed to determine whether any demographic or environmental factors were predictive of these opinions. The null hypothesis was that differences in income and insurance would not cause significant differences in patient access to care nor in perceived outcomes of treatment. It was predicted that the opinion of telehealth services would not differ regardless of whether the patient or parent had used telehealth previously.

Methods

This research study was approved by the Virginia Commonwealth University Institutional Review Board with the identifier HM20023928. An original survey was developed and split into four primary categories based on the topics of inquiry: demographics, access to care, outcomes, and telehealth. The demographics section obtained background information about the study population, including some healthcarespecific information such as diagnosis and treatment location.

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The access section first determined whether patients had completed treatment, and assessed for any major barriers that prevented them from receiving care. Subjects were asked to score various factors related to their access to care using a 0-100 visual analog scale, where 0 was labeled as “completely prohibited care,” 50 was labeled as “no effect,” and 100 was labeled as “greatly improved access.” A barrier was defined as anything scoring less than 50.

Table I: Patient and Respondent Demographics

The outcomes section inquired about patient and parent attitudes toward the actual clinical treatment they received and the manner in which they were treated by the craniofacial team. Fivepoint Likert scales accompanied positive statements about clinical care, patient experience, and various healthcare specialties in order to assess perceptions of care outcomes.

Patient Sex

Finally, the telehealth section briefly explored if patients and parents thought that the use of virtual visits could enhance the current system of care. A 5-point Likert scale accompanied positive statements about telehealth use and was used to assess attitudes toward incorporation of telehealth into their craniofacial care. The survey was tested on ten individuals who were not part of the study population to assess validity and refine questions. Patients receiving care with the craniofacial team at Virginia Commonwealth University were then directly contacted for the study through the orthodontic department via email with a survey link and description. Families were also approached in person at their orthodontic appointments, where they could take the survey on a secure computer in a private area. It was ensured that patients/parents approached in person had not yet taken the survey through email. Follow-up emails were

Patient Age

Mean

13.6

3.08

Treatment Status Completed

Actively in Treatment

91%

Parent or Guardian of a Patient

93%

Craniofacial Team Patient

Male

53%

Female

47%

Asian

18%

Black or African American

20%

Hispanic or Latino

White or Caucasian

49%

Multi-racial

Not Listed

78%

Adopted Internationally

18%

Choose not to answer

Annual Income < $15,000

$15,000 - $24,999

$25,000 - $34,999

$35,000 - $49,999

11%

$50,000 - $74,999

16%

$75,000 - $99,999

14%

$100,000 - $149,999

23%

$150,000+

20%

Parent/Guardian Highest Education High school diploma or GED

13%

Some college

11%

Associate's degree

16%

Bachelor's degree

36%

Master's degree

16%

Doctoral/Professional degree

Private

71%

Medicaid

29%

Private

68%

Medicaid

27%

None

Unsure

Yes

131%

Unsure

17%

Orthodontic Care Included

State for Majority of Craniofacial Care Florida

Georgia

Virginia

93%

Washington

2% 14%

Geographic Region

Family Composition Biological Child

Dental Insurance

Respondent

Patient’s Race

n Medical Insurance

Urban

Suburban

73%

Rural

14%

Clefting Bilateral Cleft Lip/Palate

47%

Unilateral Cleft Lip/Palate

29%

Isolated Cleft Lip

11%

Isolated Cleft Palate

No Cleft

18%

Cleidocranial Dysplasia

Treacher Collins Syndrome

Pierre Robin Sequences/ Syndrome

Syndromes

Other

No Known Syndromes

82%

>> CONTINUED ON PAGE 22 21

SCIENTIFIC >> CONTINUED FROM PAGE 21 Table II: Potential Barriers to Accessing Craniofacial Care: Insurance Barrier (n, %)

All (n=45)

Private Insurance (n=29)

Medicaid (n=13)

P 0.2418

Cost of Treatment

6, 13%

62.9 (22.37)

60.2 (22.70)

69.0 (21.20)

Availability of Parent/Guardian

2, 4%

73.2 (24.65)

71.7 (25.82)

76.7 (22.40)

0.5497

Travel to clinic/hospital

10, 22%

59.6 (20.99)

61.9 (22.17)

54.6 (17.89)

0.3069

Comprehension of treatment needs

2, 4%

72.2 (21.89)

72.9 (21.11)

70.8 (24.37)

0.7864

Comprehension of the primary language used in the clinic

2, 4%

68.3 (23)

69.7 (23.02)

65.1 (23.54)

0.5515

Patient behavior during appointments

0, 0%

66.9 (20.61)

67.6 (20.85)

65.2 (20.81)

0.7366

Patient behavior and cooperation with instructions outside of appointments

0, 0%

71.3 (20.79)

75.2 (20.60)

62.6 (19.21)

0.0698

Other health needs of the patient

1, 2%

56.2 (14.48)

56.9 (13.82)

54.8 (16.37)

0.6819

Relocation of your family to a new area

1, 2%

52.9 (11.82)

54.2 (14.10)

50 (0.00)

0.1164

Barrier defined as score <50; P indicates p-value from t-test between privately-insured and Medicaid-insured or families making above and below $75,000 annually

sent to non-responders four weeks after the initial email. Patients aged 6-17 had a parent/guardian complete the survey on their behalf. Patients 18 or older completed the same survey themselves. Patients younger than 6 years of age were not included in the study. Participants could also stop completing the survey at any time. None of the questions were required, so sample size may vary from question to question. Study data were collected and managed using Research Electronic Data Capture (REDCap) tools hosted at Virginia Commonwealth University. REDCap is a secure, web-based software platform designed to support data capture for research.10 Responses were summarized with descriptive statistics (counts, percentages and means, standard deviation). Associations between demographic factors and responses were compared with chi-square and t-tests as appropriate. Significance level was set at 0.05. SAS EG v8.2.1 (SAS Institute, Cary, NC) was used for all analyses.

Results

A total of 144 subjects were contacted, and 45 patients or guardians of patients participated in the survey. Forty-one (91%) were parents or guardians, while 4 were patients. Among patients, 53%

were male and 47% were female with an average age of 13.6 (range of 9-23). Ninety-three percent received their craniofacial care in Virginia. No patient or parent-reported early cessation of treatment, and 9% had completed treatment. Seventy-one percent had private medical insurance, 67% had private dental insurance, and 84% had orthodontic care covered by their insurance. Table I displays complete demographic data. Regarding barriers to care, traveling to the clinic was the factor most frequently scored as a barrier, with 10 respondents scoring less than 50 (22%). Treatment cost was the next most-frequent barrier, with 6 respondents scoring less than 50 (13%). All other factors were only scored as a barrier by two or less respondents. The mean score for each factor included in the survey was above 50, and thus none were viewed as a barrier by the average respondent. The average scores of each factor were not significantly associated with the respondents’ medical insurance type nor level of income. For income-based statistical tests, the median family income recorded in Virginia from 2017-2021 ($75,000) was used as a threshold to split the respondents into two groups.11 Complete results are provided in Tables II and III.

Regarding quality of care, most respondents indicated satisfaction with their craniofacial treatment. The statements assessed by respondents pertained to their treatment comprehension, scheduling, provider communication and attitude, and overall treatment satisfaction. On a scale from “Strongly Disagree = -2” to “Strongly Agree = 2”, all factors received an average score of at least 1 (“Agree”) except for timely/convenient scheduling. All individual specialties included in this survey were also assessed by respondents as having provided satisfactory care. On a scale from “Poor = 1” to “Excellent = 5”, all specialties received an average score of at least 4 (“Very Good”) except for mental health services, which averaged a score of 3.9. Complete results are provided in Tables IV and V. Overall, respondents felt neutral toward inclusion of telehealth into their craniofacial care. However, there were significant differences when comparing those who reported previous use of telehealth appointments to those who did not. Eight respondents (18%) had previous telehealth experience and were significantly more likely to think telehealth would improve their care and more likely to participate in these types of visits (p < 0.01 and p < 0.05, respectively).

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Table III: Potential Barriers to Accessing Craniofacial Care: Income Barrier (n, %)

All (n=45)

Private Insurance (n=29)

Medicaid (n=13)

P 0.0509

Cost of Treatment

6, 13%

62.9 (22.37)

70.6 (23.84)

56 (18.63)

Availability of Parent/Guardian

2, 4%

73.2 (24.65)

76.7 (27.60)

68.7 (21.92)

0.4865

Travel to clinic/hospital

10, 22%

59.6 (20.99)

62.9 (23.73)

56.3 (17.84)

0.3920

Comprehension of treatment needs

2, 4%

72.2 (21.89)

76.3 (24.78)

67.4 (19.00)

0.3425

Comprehension of the primary language used in the clinic

2, 4%

68.3 (23)

68.0 (24.34)

67 (22.04)

0.8533

Patient behavior during appointments

0, 0%

66.9 (20.61)

71.8 (22.67)

61.8 (17.83)

0.1972

Patient behavior and cooperation with instructions outside of appointments

0, 0%

71.3 (20.79)

70.8 (22.05)

69.9 (20.24)

0.7866

Other health needs of the patient

1, 2%

56.2 (14.48)

56.0 (17.22)

55.9 (11.79)

0.8762

Relocation of your family to a new area

1, 2%

52.9 (11.82)

54.7 (16.17)

51.3 (6.20)

0.4303

Barrier defined as score <50; P indicates p-value from t-test between privately-insured and Medicaid-insured or families making above and below $75,000 annually

Complete results are provided in Tables VI and VII.

Discussion

The study sample consisted mostly of patients who had received the majority of their craniofacial care in the state of Virginia. Keeping the study population limited to Virginia improved comparability of the sample, as the respondents were subject to similar insurance regulations, socioeconomic norms, and more. The geographic spread of the respondents must be kept in mind when interpreting the results. The results demonstrated that most parents and patients did not perceive any significant barriers to receiving craniofacial care. These findings contrasted with previous research, which indicated that language barriers, cost, travel, and comprehension of treatment needs all may inhibit access to craniofacial care.7,8 In the current study, travel to the clinic was the factor most commonly reported as a barrier, but that was only reported by approximately onefifth of participants. No factors were recognized as a barrier when looking at the average scores among all participants, but it was interesting to see that environmental

factors were viewed as a barrier more often than non-environmental factors. As described by Nelson et al., environmental factors are endemic to the system of care, and include cost, parent availability, travel, communication of treatment needs, and language barriers.12 At least two respondents (4%) found each of these to be a barrier to care, with up to 13% and 22% for cost and travel, respectively. Non-environmental factors originate within the family, and include patient behavior, patient cooperation with treatment instructions, competing health needs, and family relocation.12 No more than one respondent found any of these four factors to negatively impact their access. Thus, it may be concluded that environmental factors were more likely to limit access in the event that a family did experience a barrier. Because previous studies have indicated cost as a prominent barrier to care, we assessed whether respondent income and insurance affected access. The results demonstrated no significant differences between those with public and private insurance, as well as between those making above or below the median family income for Virginia. Additionally, all four of these subgroups – private insurance, public insurance, income below median, income above median – averaged scores at or above

50, indicating adequate access to care for every surveyed factor. There could be a number of reasons for the lack of difference between these subgroups, despite other studies indicating financial issues as a prominent factor in healthcare access.7,8 One reason is the increased importance ascribed to craniofacial care. The knowledge that treatment will last for multiple years may also allow for a more consistent and expected pay schedule that makes meeting costs easier. Additionally, maintaining adequate insurance policies likely removes much of the financial burden from these families. The fact that publicly-insured patients perceived their access to be similar to privately-insured families also indicates that both private insurance and Virginia’s Medicaid program are functioning well in the area of special healthcare needs. The current Virginia Medicaid contract for children indicates a requirement for coverage of “medically necessary procedures” for those with cleft palate and ectodermal dysplasia.13 Virginia-based private insurers must also cover treatment specifically for infants with cleft lip and palate and ectodermal dysplasia.14 It appears that these policies and laws are effectively making long-term craniofacial care accessible to those holding Virginiabased insurance policies, regardless of financial status or insurance type. This

>> CONTINUED ON PAGE 24 23

SCIENTIFIC >> CONTINUED FROM PAGE 23 Table IV: Satisfaction with Aspects of Craniofacial Care Satisfaction

Mean

You maintained a thorough understanding of treatment needs

1.23

1.03

There were enough appointments to meet their treatment needs

1.33

0.90

Follow-up appointments and scheduling were timely and convenient

0.98

1.14

Members of the craniofacial team all seemed to have a shared understanding of the specific treatment needs and progress

1.27

1.04

The craniofacial team communicated effectively with the parent/guardian

1.33

1.04

The craniofacial team communicated effectively with the patient

1.36

1.05

The craniofacial team treated parent/guardian with kindness

1.60

0.89

The craniofacial team treated the patient with kindness

1.64

0.91

I am satisfied with the overall outcomes of the patient's treatment

1.44

1.03

Results were measured on a 5-point Likert Scale with 2=Strongly Agree, 1=Agree, 0=Neutral, -1=Disagree, -2=Strongly Disagree SD=Standard Deviation

Table V: Self-Reported Quality of Outcomes for Domains of Craniofacial Care Quality of Outcome

Mean

Plastic Surgery

4.6

0.72

Orthodontics

4.6

0.67

Speech/Language pathology

4.5

0.72

Non-orthodontic dental care (general dentist or pediatric dentist)

4.5

0.78

Oral Surgery

4.7

0.51

Counseling/Mental health services

3.9

1.08

Social Work

4.0

1.15

n indicates the number of respondents who indicated they received care in each domain Results were measured on a 5-point Likert Scale with 5=Excellent, 4=Very Good, 3=Good, 2=Fair, 1=Poor

may not be the same across the country, as mandated coverage for cleft lip and palate and other craniofacial anomalies has a large amount of variation among states.15 This study indicated that these mandates make care accessible to families. While clinical procedures and administration have been systematically refined throughout the previous decades, there has been little assessment of patient or parent perceptions of these outcomes. The results showed a high degree of satisfaction with all aspects of craniofacial care, including communication, scheduling, and overall clinical outcomes. This agreed

with previous qualitative research and provided quantitative measurements that indicated a very consistent perception of care outcomes.4 This study sought to assess whether families would be interested in incorporating virtual visits into their care. Across all respondents, there was a fairly neutral attitude toward use of virtual healthcare. However, when assessing differences between those with and without previous telehealth experience, significant differences were noted. Those with previous usage were much more likely to find value in virtual delivery of craniofacial care, while those without previous experience were more likely to think negatively of its use. Telehealth

experienced rapid growth throughout the 2020 COVID-19 pandemic and its use has continued to accelerate.16 It is likely that more individuals will experience virtual delivery of healthcare as time progresses. Given the results, it would be expected that more craniofacial families will begin experiencing telehealth in other areas of life, which may cause them to become more accepting of telehealth in their system of craniofacial care. Geographic representation of the sample has previously been discussed as a limitation of this study. Other study limitations include selection bias, as all participants were actively in treatment or had completed treatment. The study

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Table VI: Resources for Receiving Craniofacial Care n

Yes

18%

70%

Unsure

11%

Previous Telehealth Use

Type of Virtual Visit (n=8) Primary Care

13%

Plastic Surgery

25%

Speech Language Pathologist

25%

Counseling/Mental Health

38%

Other

25%

Not Listed

did not capture any subjects who had declined or prematurely ended their craniofacial treatment. This unreached sector of the population likely would have experienced significant barriers to care by virtue of never having received it in full. The study, therefore, likely underestimated all barriers, but it is unknown by how much or for what reasons. The study population was also more educated and earned a greater average income than the Virginia population as a whole.11 The improved socioeconomic status of these survey respondents may have influenced the access to care and perception of outcomes. Adequate craniofacial care is critical for patients born with craniofacial anomalies, and thus it is critical to ensure that all families access care with ease and approve of the overall outcomes. This study indicated that all families, regardless of economic status or insurance coverage, find their access to care adequate and outcomes of care satisfactory. While those without previous telehealth experience do not see a need for its use, those familiar with virtual care are more enthusiastic about its incorporation, a trend that will likely continue as telehealth use expands.

Conclusions

Patients and parents of patients undergoing craniofacial care: • Perceived good access to

care regardless of income and insurance status. • Reported excellent treatment outcomes. • Expressed minimal desire to incorporate telehealth into the current system of craniofacial care, but will likely become more amenable to its use as it becomes more widespread. Acknowledgments This study was supported by the Virginia Commonwealth University CTSA Award (UL1TR002649), the Alexander Fellowship, and the Southern Association of Orthodontists. References 1. Mai CT, Cassell CH, Meyer RE, et al. Birth Defects Data from Population-based Birth Defects Surveillance Programs in the United States, 2007 to 2011: Highlighting Orofacial Clefts. Birt Defects Res A Clin Mol Teratol. 2014;100(11):895-904. doi:10.1002/bdra.23329 2. Slavkin HC, Sanchez-Lara PA, Chai Y, Urata M. A Model for Interprofessional Health Care: Lessons Learned From Craniofacial Teams. CDA J. 42:8. 3. Long RE, Semb G, Shaw WC. Orthodontic Treatment of the Patient with Complete Clefts of Lip, Alveolus, and

Palate: Lessons of the past 60 Years. Cleft Palate Craniofac J. 2000;37(6):113. doi:10.1597/15451569_2000_037_0533_ ototpw_2.0.co_2 Myhre A, Agai M, Dundas I, Feragen KB. “All Eyes on Me”: A Qualitative Study of Parent and Patient Experiences of Multidisciplinary Care in Craniofacial Conditions. Cleft Palate Craniofac J. 2019;56(9):1187-1194. doi:10.1177/1055665619842730 Billaud Feragen K, Myhre A, Stock NM. “Exposed and Vulnerable”: Parent Reports of Their Child’s Experience of Multidisciplinary Craniofacial Consultations. Cleft Palate Craniofac J. 2019;56(9):1230-1238. doi:10.1177/1055665619851650 Cassell CH, Krohmer A, Mendez DD, Lee KA, Strauss RP, Meyer RE. Factors associated with distance and time traveled to cleft and craniofacial care: Travel Time and Distance and Orofacial Clefts. Birt Defects Res A Clin Mol Teratol. 2013;97(10):685695. doi:10.1002/bdra.23173 Zaluzec RM, Rodby KA, Bradford PS, Danielson KK, Patel PK, Rosenberg J. Delay in Cleft Lip and Palate Surgical Repair: An Institutional Review on Cleft Health Disparities in an Urban Population. J Craniofac Surg. 2019;30(8):23282331. doi:10.1097/ SCS.0000000000005740 Cooper DC, Peterson EC, Grellner CG, et al. Cleft and Craniofacial Multidisciplinary Team Clinic: A Look at Attrition Rates for Patients With Complete Cleft Lip and Palate and Nonsyndromic SingleSuture Craniosynostosis. Cleft Palate Craniofac J. 2019;56(10):1287-1294. doi:10.1177/1055665619856245 Dorsey ER, Topol EJ. State of Telehealth. Campion EW, ed. N

>> CONTINUED ON PAGE 26 25

SCIENTIFIC >> CONTINUED FROM PAGE 25 Table IV: Satisfaction with Aspects of Craniofacial Care Total (n=44)

Previous Telehealth Use (n=8)

No Previous Telehealth Use (n=31)

P-value

Virtual health appointments with care team members would have improved the patient's experience

-0.1 (1.15)

0.6 (0.74)

-0.5 (1.06)

0.0086

Virtual health appointments with care team members would have improved the parents' experience

-0.1 (1.24)

0.9 (0.83)

-0.5 (1.12)

0.0029

The patient would have participated in virtual visits if offered

0.3 (1.19)

1 (0.53)

-0.1 (1.21)

0.0010

The parent/guardian would have participated in virtual health visits if offered

0.3 (1.18)

1.1 (0.64)

0 (1.18)

0.0141

Results were measured on a 5-point Likert Scale with 2=Strongly Agree, 1=Agree, 0=Neutral, -1=Disagree, -2=Strongly Disagree and means are displayed with standard deviations in parentheses. For P-value from t-test, 5 respondents indicated “Unsure” when asked if they utilized telehealth visits and were excluded from analysis

Engl J Med. 2016;375(2):154161. doi:10.1056/ NEJMra1601705 10. 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 11. U.S. Census Bureau QuickFacts: Virginia. Accessed January 30, 2023. https://www.census. gov/quickfacts/fact/table/VA/ INC110221#INC110221 12. Nelson LP, Getzin A, Graham D, et al. Unmet dental needs and barriers to care for children with significant special health care needs. Pediatr Dent. 2011;33(1):29-36. 13. Pleasants C (DMAS). Medallion 4.0 Managed Care Services Agreement. 14. § 38.2-3411. Coverage of newborn children required. Accessed February 1, 2023. https://law.lis.virginia.gov/ vacode/title38.2/chapter34/ section38.2-3411/ 15. Wanchek T, Wehby G. StateMandated Coverage of Cleft

Lip and Cleft Palate Treatment. Cleft Palate Craniofac J. 2020;57(6):773-777. doi:10.1177/1055665620910529 16. Fauteux N. The Growth of Telehealth. AJN Am J Nurs. 2022;122(3):1617. doi:10.1097/01. NAJ.0000822960.95263.e5

Authors

Benjamin F. Lowe III, D.D.S, M.S.D. Virginia Commonwealth University, Department of Orthodontics Bhavna Shroff, D.D.S., M.Dent.Sc., M.P.A.* Virginia Commonwealth University, Postgraduate Program Director, Department of Orthodontics Steven J. Lindauer, D.M.D., M.Dent.Sc. Virginia Commonwealth University, Chair, Department of Orthodontics Caroline K. Carrico, Ph.D. Virginia Commonwealth University, Biostatistician, Department of Dental Public Health and Policy A. Omar Abubaker, D.M.D., Ph.D. Virginia Commonwealth University, Chair, Department of Oral and Maxillofacial Surgery *Corresponding author: 520 N 12th St, #222 Richmond, VA 23298 (804) 828-9326 bshroff@vcu.edu

OUTREACH >> CONTINUED FROM PAGE 14 Dr. William Goodwin Dr. Michael Gorman Dr. A. Garrett Gouldin Dr. Edward Griggs Dr. Abby Halpern Dr. Zaneta Hamlin Dr. Dani Howell Dr. Ralph Howell Dr. Bruce Hutchison Dr. Frank Iuorno Dr. George Jacobs Dr. Pooja Kasperowski Dr. Chad Kasperowski Dr. Marcel Lambrechts Dr. Jeffrey Leidy Dr. Melanie Love Dr. Harold Martinez Dr. Michael Miller

Dr. Benita Miller Dr. French Moore Dr. Madelyn Morris Dr. Kirk Norbo Dr. Justin Norbo Dr. Niels Oestervemb Dr. Shaun Rai Dr. Elizabeth Reynolds Dr. Dustin Reynolds Dr. Chris Richardson Dr. Walter Saxon Dr. Cynthia Southern Dr. David Stafford Dr. Kimberly Swanson Dr. Ronald Vranas Dr. Sharone Ward Dr. Roger Wood Dr. Dagoberto Zapatero

Silver Club Members ($750) Dr. Greg Cole Dr. C. Mac Garrison Dr. Evan Garrison Dr. Reena Gupta Dr. Jeffrey Kenney Dr. Michael Link Dr. Anthony Peluso Dr. Jessica Russo Revand Dr. Alex Sadak Dr. Nathan Schoenly Dr. Ted Sherwin Dr. Al Stenger Dr. Alyssa Stout Dr. Dennis Vaughan

SERVING THE PETERSBURG COMMUNITY: VDA FOUNDATION COLLABORATION WITH CENTRAL VIRGINIA HEALTH SERVICES

Dr. Colleen Davis; Staff Dentist, Central Virginia Health Services, Inc. On Saturday, November 11, 2023, the Virginia Dental Association Foundation (VDAF) collaborated with Central Virginia Health Services (CVHS) to host a Missions of Mercy Project in Petersburg. This one-day event was the second joint project for the two organizations to enhance access to dental care for residents in Petersburg and the surrounding areas.

L-R: Kamilah Craighead, Dr. Colleen Davis, Dr. Melba Bryant

Seventy-three volunteers, including dentists, dental assistants, dental hygienists, dental support staff, and dental students, joined together to provide free dental extractions for thirty-six patients in the region with an estimated value of $18,356 in donated dental care. The event was hosted at CVHSPetersburg. CVHS-Petersburg is one of twenty CVHS health centers that provide comprehensive healthcare, including dental, medical, behavioral health, and pharmacy services, to medically underserved families in the Central Virginia region. CVHS is a non-profit community health center with Federally Qualified Health Center (FQHC) status. Since 1970, the patient-centered organization has focused on providing care to people with limited access to healthcare. CVHS serves anyone and everyone regardless of one’s insurance status. A sliding scale discount

Dental student Abdul Mohamed (D3) consults with a patient

is also available based on the patient’s family size and income. For more information about CVHS or to find the locations of their health centers, please visit www.cvhsinc.org.

FEATURE

AN INTERVIEW WITH DR. RICHARD ROADCAP

VIRGINIA DENTAL JOURNAL EDITOR (2007 – 2023) Tell us how your journey as editor began.

My standard answer is, “I skipped a meeting.” I remember a busy day at the office when (Dr.) Gus Vlahos called and asked me to serve. After the shock wore off, I told him I would think about it. I reached out to some of my confidantes, and they encouraged me to take the job.

“ ...My greatest satisfaction is being able to recognize someone, in a publication, for their accomplishments and service. So many members of our community are never recognized for making the world a better place, and I am glad we had that opportunity.”

Looking back, what are some of the most memorable moments in your career as editor?

Of course, I will not forget the first issue in 2007 with my very first editorial, seeing the photos and text, and feeling the shiny paper. Interviews were always memorable. When you sit across the table from someone and ask them to tell you their thoughts, both you and the subject

are changed. You have made a new friend. The fire in 2010, when everything burned, taught me there is always a way to overcome obstacles.

Can you identify any significant industry trends or shifts that have impacted how publications are managed and edited?

Everything was analog, print only, when I started. We soon created a digital version, and it was not long before the print and digital versions were integrated, with links to outside content. Communication in the dental community now is very layered. You do not need to be an expert in every format, but you need to have a presence in most of them. The transition to digital has been measured (i.e., slow) during my time. To use a sports analogy, they keep “moving the goalposts.”

What were some of the most challenging aspects of your role as an editor, and how did you overcome them?

No surprises here. Receiving promised content on time, if at all, is always a challenge. My hat’s off to correspondents who consider deadlines sacred. We are like the airlines – we overbook, knowing some “passengers” will not show up. Soliciting advertisers is also challenging. It can be hard to convince some companies that we represent an affluent market for their goods and services.

On the flip side, what aspects of the job brought you the most satisfaction and fulfillment?

I have mentioned interviews as a great way to get to know a person. I was especially proud that we produced the VDA’s first online publication, Etch, which

ran for five years. Online newsletters have a short shelf-life. But maybe my greatest satisfaction is being able to recognize someone, in a publication, for their accomplishments and service. So many members of our community are never recognized for making the world a better place, and I am glad we had that opportunity.

What strategies did you find most effective in working with contributors and writers to bring out the best in their work?

Most folks are far more talented than they realize. I often hear, “I’m not a very good writer.” I tell them that our job is to make them look good in print (and online). Writing is much like practicing dentistry – you perfect your craft by repeating it many times, until it becomes second nature. I will pitch ideas or concepts to individuals that are qualified in the subject. Sometimes it takes more than one reminder, but they are always glad that you asked.

What advice do you have for aspiring editors entering the field, especially in the context of association publications?

First, purchase several reference books that are available to writers. Use them as you would a polishing wheel for a restoration. Next, find a subject that interests you and expand upon it. Photos and graphics will garner attention. Finally, be persistent. Ask the editorial staff for suggestions and ways to improve. If you do not give up, you will see your work published.

FEATURE

In your opinion, what role does the editor play in shaping the narrative and impact of an association through its publications? The editor does not act as a censor or gatekeeper for information. Yes, a journal can be a bully pulpit, but it is important to provide a forum for debate and opposing views. Someday those in the minority now might hold the upper hand, so it is important that no one feels minimized.

As you move on from the Virginia Dental Journal, what legacy do you hope to leave behind? I hope the Journal remains a viable publication that meets the needs of the members and the readers and is amenable to necessary change.

Where do you see the future of the association and the Journal, and what potential challenges or opportunities do you foresee?

All associations struggle with membership recruitment and retention. It has been a thorn in my side. I wish I had an answer. In most states, the journal is a muchappreciated member benefit, as it is here. Maybe that value can be leveraged in some fashion to boost membership and reverse the trend.

Are there any personal or professional goals that you look forward to pursuing in your retirement?

I am in the twilight of my clinical career. I enjoy practicing, but clinical dentistry is hard work (as it should be) and nothing lasts forever. One goal is to start a new online publication with another dental organization that highlights public service. But I have had a wonderful opportunity for the last sixteen years that allowed me to achieve many of my personal and professional goals, and for this I am grateful.

SCIENTIFIC

CHEILOSCOPY Dr. Sarah Friend

WHAT IS CHEILOSCOPY? Cheiloscopy is a field of forensic odontology dedicated to the identification of humans based on the analysis of human lips.

Fun Facts about Cheilsocopy:

• Each human has a lip print as specific to the individual as the palm print and fingerprint. • These lip patterns develop during the 6th week in utero. Twin studies have shown that each twin has different lip prints. • Lip prints do not change over time unless there is injury, disease, putrefaction, and/or intentional alteration. Lip patterns typically recover after minor trauma, inflammation, and/or herpes labialis. Salivary and sebaceous glands

around the vermillion border aid in the formation of latent lip groove patterns.

• Lip prints can be retrieved from glass, cigarette and cigar butts, clothing, food, windowpanes, cups, letters, etc.

• Lip prints behold the potential for recognition of the sex and ancestry of an individual.

• Lip patterns have been studied well in living individuals, but not the deceased. Postmortem lip groove patterns must be obtained within twenty-four hours of death.

• Certain lip prints have geographical prevalence with different patterns reported worldwide. Lip prints are inherited and trace familial lineage. • There are specific types of lip prints associated with the occurrence of non-syndromic cleft lip with or without cleft palate.

• Lip prints have been admissible in court as evidence in the USA since 1923. • Most of the published cheiloscopy studies have originated in Africa, Asia, and South America.

SCIENTIFIC How are lip prints collected, developed, studied, and used?

Lip prints have typically been collected from an individual using photography and/or lipstick with a transferable medium, such as paper, cellophane tape and mirrors, and finger roller printers. Some cheiloscopy studies reference using digital software, such as Adobe Photoshop and MATLAB to digitize, invert, and analyze images of lip prints alone or in combination with overlays. The TRIOS Scanner, used commonly for digital dental impressions, has been used off-label to capture surface detail in the fabrication of maxillofacial prosthetics. Such scanners could potentially be developed to obtain lip prints. As technology advances, particularly with scanners in dentistry, lip prints could theoretically be collected as part of routine dental examinations and become a permanent addition to a person’s electronic health record. This information could help practitioners monitor changes in soft tissue over time, as well as retain information for the potential need for personal identification. Lip prints are also viable evidence of someone’s presence at a crime scene and three types of lip prints can be detected: visible, latent, and three-dimensional prints. There are a variety of ways to develop latent prints using physical and chemical methods. However, there is no current standardized method that would allow for the practical, repeatable, and universally accepted application of cheiloscopy as a forensic tool in the judicial system. Likewise, there have been no studies on lip prints as a method of identification of the dead. Advances in research of cheiloscopy in the dead could be very beneficial to criminal investigations and in mass disasters.

Lipstick

CHEILOSCOPY CLASSIFICATION SYSTEMS: • S antos • Renaud • Afchar-Bayat • Kasprzak • S uzuki and Tschuchihashi (1971)

Graphic of the Suzuki and Tschuchihashi (1971) classification system.

Serial Lipstick Paper Prints

Print Inversions

>> CONTINUED ON PAGE 32 31

SCIENTIFIC >> CONTINUED FROM PAGE 31

Packaging Tape Transfer to Paper

Lipstick/Clear Packaging Tape

Tape Print (No Lipstick) on Black Background

Digital Scan using a TRIOS Scanner (No Lipstick)

Digital Scan Inversion

References: 1. Kaushai A., Pal M. Cheiloscopy: A Vital Tool in Forensic Investigation for Personal Identification in Living and Dead Individuals, Int J Forensic Odontol 2020; 5: 71-4. 2. Chandha et al., Lip print evaluation of Indian and Malaysian-Chinese subjects by manual and digital methods: a correlational study with gender and ethnicity. Egypt J Forensic Sci 2022; 12, 15. 3. Dineshshankar et al., Lip prints: Role in forensic odontology, J Pharm Bioallied Sc 2013; 5(1): 95-97. 4. Herrerra et al., Evaluation of Lip Prints on Different Supports Using a Batch Image Processing Algorithm and Image Superimposition, Journal of Forensic Sciences 2017, 63:122-129.

7. 8.

Abedi et al., Lip print enhancement: review. Forensic Sciences Research, 2020; 7(1); 24-28. Prabhu et al., Digital method for lip print analysis: A New Approach, J Forensic Dent Sci, 2013; 5(2):96-105. Jurim, B., A quick technique for digital maxillofacial prosthetics, Perio Implant Advisory, 2019. Thermadam, et al., Cheiloscopy in gender determination. A study on 2112 individuals. Journal of Family Medicine and Primary Care 9(3): p1356-1390, March 2020. Williams, Tr. Lip Prints – Another Means of Identification. Journal of Forensic Investigation, Volume 41, Issue 3, p 190-194, May/June 1991.

Note: Graphics and images used in this article belong to Sarah R. Friend, DDS, FAGD.

Digital Scan in TRIOS Bite Registration Mode

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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

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PEDIATRIC ABSTRACTS

ASSESSMENT OF THE RELIABILITY OF YOUTUBE™ VIDEOS ABOUT ZIRCONIA CROWNS IN PEDIATRIC DENTISTRY Monteiro CMG, Silva KS, Tavares FOM, Dias MO, Maia LC, Pithon MM.Eur Arch Paediatr Dent. 2023 Oct; 24(5): 585-590 The increasing demand for aesthetic dental restorations highlights the superiority of ceramic materials such as zirconia crowns (ZCs). It is common for patients and guardians to seek aesthetic information online, with YouTube™ being one of the more prominent platforms. Studies have shown that, not only do patients seek health information online, but healthcare professionals also are using platforms such as YouTube™ to educate patients. With any information available online, there is a risk of misinformation. Most of the authors of videos on this platform are not verified, so the risk of obtaining misinformation is a risk one must factor in when browsing. Since there is a lack of research on the validity of information presented on YouTube™ about zirconia crowns, this study aimed to evaluate the reliability of such videos. The eligibility criteria for this study focused on finding videos on zirconia crowns in pediatric dentistry. A search was carried out on YouTube™ by researchers

from Brazil using Google ChromeTM. Exclusions were made for non-English videos, duplicates, and off-topic content. The first 100 videos produced were selected and analyzed. Research has shown that 90% of YouTube™ users do not search past the first three pages, hence why the first 100 videos produced were examined. Metrics include the number of views, likes, comments, channel followers, upload date, duration (in seconds), and category rating. The examiners also grouped the videos into three groups: technical, informative, and clinical care. Two examiners evaluated the information’s reliability using the DISCERN questionnaire, which is a tool that assesses the quality of healthrelated information. Descriptive and inferential analyses were performed with a significance level of p < 0.05. Out of the 100 videos examined, 72 were excluded. The remaining 28 videos had average metrics, including 3.5 comments, 8,896.18 channel followers, 5,614.00 views, 19.14 likes, and a duration of 840.32 seconds. The average view rate

was 7.54 per day, with a notable standard deviation. Statistical analysis revealed significant differences between views and comments (p < 0.001), likes and comments (p < 0.001), and likes and views (p = 0.006). Using the DISCERN scale, none of the videos achieved the maximum grade for reliability. Two were graded as good, nine as fair, fourteen as poor, and three as very poor. Since most of the YouTube™ videos on zirconia crowns in pediatric dentistry were found to be unreliable based on the DISCERN questionnaire, caution is advised when using the information presented on this platform.

Hanan Naser, DDS; Resident, Pediatric Dentistry, VCU School of Dentistry

TRAUMATIC DENTAL INJURIES IN THE PRIMARY LOWER INCISORS Del Negro B, Kimura JS, Menezes AN, Mendes FM, Wanderley MT. International Journal of Paediatric Dentistry. 2023; 33: 498-506 Traumatic dental injuries (TDI) are common occurrences observed in young children with primary dentition. The severity of the sequence observed is often associated with the extent of traumatic injury. The cascading effects of TDIs in primary dentition also include esthetic impairment, occlusion disorders, pain, and emotional distress affecting both patients and parents. The purpose of this study was to evaluate the prevalence of TDI in primary mandibular incisors, the factors associated with this occurrence,

and the effects on the primary teeth and the permanent successors. The data on children who sought treatment at the center was collected over 22 years, from 1998 to 2020. Dental records of 2,926 pediatric patients were assessed by three examiners for the inclusion criteria consisting of TDI in primary lower incisors with complete records consisting of the description of TDI, clinical photographs, and dental radiographs. Out of the 2,926 eligible

patients for the study, 113 of the patients met the eligibility criteria, and 208 traumatized primary lower incisors were gathered for analysis. The research focused on identifying two outcomes within the study. The primary outcome was to analyze the occurrence of severe TDI in primary teeth, and the secondary outcome was to observe the occurrence of sequelae in the permanent successors. The primary outcome, TDI severity, and type were classified according to the classification of Glendor and a modified >>

PEDIATRIC ABSTRACTS

ARTICAINE INFILTRATION VERSUS LIDOCAINE INFERIOR ALVEOLAR NERVE BLOCK FOR PRIMARY MANDIBULAR MOLARS: A DOUBLE-BLIND RANDOMIZED CONTROLLED CLINICAL TRIAL Garcia J, Kratunova E, Shah A, Zhang IL, Marion I, da Fonseca MA, Han M. Pediatric Dentistry. 2023; 45: 299-306 Local anesthesia, when administered, causes temporary loss of sensation and pain from a localized part of the body without depressing the cognitive state of a patient. One of the useful behavior management techniques while treating the pediatric population is relieving their pain and anxiety, thus gaining their trust in return. The inferior alveolar nerve block technique is comparatively more painful and uncomfortable than the local infiltration technique. The aim of this study was to compare the effectiveness of 4% articaine hydrocholoride with 1:100,000 epinephrine via mandibular infiltration to the effectiveness of 2% lidocaine hydrocholoride with 1:100,000 epinephrine via inferior alveolar nerve block in the treatment of primary mandibular molars. This study also assessed the level of pain and discomfort related to each technique. This prospective, double-blind, paralleldesign randomized controlled trial recruited participants who were medically healthy, between 4 - 10 years of age, had a history of dental treatment under

>> version of Andreasen, respectively.

The secondary outcome, the sequelae, was classified through Andreasen’s classification. The study’s results revealed a 3.9% incidence of TDI in the primary lower incisors, which were mainly observed in young children between ages 0-2 years old. Children older than four years old displayed a 57% lower prevalence of suffering a severe TDI than children two years or younger. Interestingly, most of the children presenting with TDI in the primary lower incisor also had two to four

local anesthesia, had a Frankl 4 behavior, and were in need of primary mandibular molar restorations. Each patient was randomly allocated to either the articaine infiltration group or the lidocaine inferior alveolar nerve block group. The examiners recorded patients’ reactions during local anesthesia administration and treatment using the Modified Behavioral Pain Scale (MBPS), along with the blood pressure and pulse throughout the procedure. Participants were also asked to rate their pain perception of the entire procedure using the Wong-Baker FACES Pain Rating Scale (WBFS). Data analysis was performed using the Mann Whitney-U test, P-value of <0.05 for statistically significant difference, and Cohen’s kappa for assessing examiner reliability. In total, 110 participants were assessed for this study. The mean age was 6.42 years and 60% were male. They were equally divided into each anesthesia group. It was noted that the mean Modified Behavioral Pain Scale rating during local anesthesia administration was 3.89 for the lidocaine group as compared to 2.24 (p<0.001) in

additional teeth affected by the TDI, which may be attributed to the incisor’s small dimension and proximity to other teeth in the dental arch and/or the severity of the TDI. Avulsion of the primary lower incisor was found to be the most common type of TDI and presented with complicated sequelae in the permanent successors compared to avulsion injuries on maxillary primary incisors. The study results revealed that severe TDI had a four times higher risk of sequelae occurring in the permanent teeth compared to less severe TDI. Enamel hypoplasia and discoloration were found to be the most common

the articaine group. Also, all through the appointment, the mean MBPS for the lidocaine group was higher at 2.51 versus 1.69 (p=0.012) for the articaine group. Regarding the WBFS score throughout the appointment, the mean for the lidocaine group was higher at 1.64 versus 0.872 (p=0.089) for the articaine group. All other hemodynamic determinants were within the normal range between each group. It was concluded that local infiltration with articaine is as effective as using lidocaine via inferior alveolar nerve block for restorative treatment on primary mandibular molars in children aged 4 to 10 years. Thus, it was implied through this study that local infiltration with articaine can be considered the safest and potent alternative to lidocaine inferior alveolar nerve block technique in treating primary mandibular molars in children.

Alpna Khatri, BDS, DMD; Resident, Pediatric Dentistry, CU School of Dentistry

sequelae observed in the succedaneous teeth. By understanding the factors associated with TDI in primary incisors and the sequelae patterns, treatment can be better tailored to the specific patient’s needs and relieve some of the emotional distress associated with the trauma.

Nicole Fischer, DDS; Resident, Pediatric Dentistry, VCU School of Dentistry

We are pleased to announce Dr. Dorothy Dunker has acquired the prac�ce of Dr. Wes Anderson, Virginia Beach, Virginia. Dr. Hassan Abdulwahid has acquired the prac�ce of Dr. Chad Kim, Leesburg, Virginia. (Pictured left.)

Dr. Arin Abrahamian has joined the prac�ce of Dr. Thomas Lenz, Washington, DC.

Prac�ces for Sale Newport News Area Beau�ful, FFS/PPO prac�ce with 5 operatories and room for 3 t more. Located in a standalone racbuilding t n with 3300 sq/�. Collectes r co $450K /year with a very u strong ndehygiene program. Real estate is available for sale or lease. Fairfax County Collec�ng $220K per year on a mix of PPO/FFS pa�ents. There are three equipped operatories, a personal office, digital x-ray, digital pano, and Intra Oral Camera. Beau�ful condo available for sale or lease. 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. 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.

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PEDIATRIC ABSTRACTS

EFFECTS OF NASOALVEOLAR MOLDING ON MAXILLARY ARCH DIMENSIONS AND MALOCCLUSION CHARACTERISTICS IN PRIMARY DENTITION PATIENTS WITH CLEFT LIP AND PALATE Ocak I, Akarsu-Guven B, Karakaya J, Ozgur F, Aksu M. International Journal of Paediatric Dentistry. 2024; 34: 94-101

Cleft lip and palate (CLP) is an orofacial anomaly that results in deformity of the maxilla, lip, and nose. The anomaly is prevalent worldwide and varies in severity. Presurgical infant orthopedics (PSIO) is the first procedure performed to manage this deformity. The procedure aims to reduce the cleft size and alleviate the presurgical tissue tension. Nasoalveolar molding therapy (NAM) is a modified PSIO technique. Nasoalveolar molding therapy consists of using a nasal stent attached to an acrylic molding plate to approximate the alveolar segments and reduce the alveolar cleft size. Many studies were conducted to evaluate both the long and short-term effects of the NAM therapy on alveolar morphology in patients with CLP. The results were varied. Malocclusions have been observed in patients with CLP, but limited data is available about the malocclusion characteristics. NAM therapy can reduce the severity of malocclusion. Since the outcomes of NAM therapy remain a controversial issue in the literature, this study aimed to evaluate the effects of NAM therapy on maxillary arch dimensions and malocclusion parameters

in patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCL P) in primary dentition via digital models. For this retrospective study, fifty-four (54) patients (29 boys and 25 girls) were included based on the criteria. They were divided into two groups according to cleft type and then divided into two subgroups according to whether NAM therapy was applied or not. Dental arch relationships were evaluated with the 5-year-old index in patients with UCLP and with the BCLP primary dentition yardstick index in patients with BCLP. In the NAM group, therapy was started within ten days after birth. After three or four months, NAM therapy was completed, and lip surgery was performed. Then, the hard palate was repaired at approximately twelve months of age. A one-way ANOVA test with the Bonferroni correction was performed to investigate the influence of the cleft type and molding on the maxillary arch measurements. Maxillary arch measurements showed that intercanine and intermolar widths were statistically affected by the type of CLP

(p<0.05). No statistical significance was observed for the effect of NAM therapy on maxillary arch measurements in patients with UCLP and BCLP (p>0.05). Nasoalveolar molding therapy did not have a statistically significant effect on malocclusion characteristics in either type of CLP (p>0.05). The absence of standardization of the cleft type and surgical procedures, as well as the insufficient sample size and inability to maintain a regular follow-up of patients, may have complicated the design and results of NAM studies. Although these factors were eliminated in the present study, there were also some limitations. While NAM therapy was not found to affect either parameter, the cleft type was the main factor causing a significant difference in maxillary intercanine and intermolar widths. Future studies should be conducted with larger patient sample sizes and varied parameters.

Fatemah Almaqate, DMD; Resident, Pediatric Dentistry, VCU School of Dentistry

PEDIATRIC ABSTRACTS

ALTERNATIVE ROOT CANAL FILLING MATERIALS TO ZINC OXIDE EUGENOL IN PRIMARY TEETH: A SYSTEMATIC REVIEW OF THE LITERATURE Rhaiem M, Elelmi Y, Baaziz A, Chatti M, Maatouk F, Ghedira H. European Archives of Paediatric Dentistry. 2023; 24: 533-547

Pulpectomy is an endodontic procedure performed on teeth with irreversible pulpitis and pulpal necrosis. The preferred material to fill the root canals of primary dentition has been zinc oxide eugenol (ZOE) due to its analgesic and antiinflammatory properties. It is important to consider some disadvantages of ZOE treatment, including a slower resorption rate of ZOE than the root, irritation of periapical tissues, permanent tooth ectopic eruption, and the necrosis of osseous tissues and the cementum. This review compared presently available materials to fill root canals to find a satisfactory alternative for ZOE. Five databases were systematically searched using the “MeSH terms” option. In total, 480 articles were found in the initial search, and only eight were included in the systematic review based on the inclusion standards. Nine different root canal-filling materials were compared to ZOE and those were further divided into four groups: ZOE

with iodoform, calcium hydroxide with iodoform, a mixture of ZOE/calcium hydroxide/iodoform, and a mixture of zinc oxide with propolis, aloe vera, 10% sodium fluoride, and ozonated oil. The ZOE with iodoform group showed a similar clinical success rate (100%) but a lower radiographic success rate (94%) compared to ZOE (97%). The calcium hydroxide with iodoform group showed significantly lower success rates compared to ZOE, with a resorption rate faster than that of the root. However, furcation and periapical radiolucencies resolved better in the calcium hydroxide and iodoform group compared to ZOE. The ZOE mixture containing calcium hydroxide and iodoform resulted in higher success rates compared to ZOE with a significant difference. Resolution of extruded particles was observed in almost all teeth within three months; it also showed the largest decrease (50%) in the size of pre-operative furcal radiolucencies compared to the minimum reduction with ZOE (15%). The last group showed a

statistically significant higher success rate than ZOE. Among all materials, ZOE with calcium hydroxide and iodoform had the greatest clinical and radiographic success rate, similar resorption rate compared to the roots, quicker resolution of extruded material, and the greatest furcal radiolucency size decrease relative to ZOE. Although various materials can be used as alternatives to ZOE for root canal filling, none of the reviewed materials could be proposed as the optimal material to use. This shows that to allow the emergence of materials with ideal performance and properties, more high-quality and well-planned randomized controlled trials are indicated.

Siuneh Minassian, DDS; Resident, Pediatric Dentistry, VCU School of Dentistry

PEDIATRIC ABSTRACTS

NONPHARMACOLOGICAL BEHAVIOR GUIDANCE FOR THE PEDIATRIC DENTAL PATIENT Dhar V, Gosnell E, Jayaraman J, Law C, Majstorović M, Marghalani AA, Randall CL, Townsend J, Wells M, Chen CY, Wedeward R. Pediatric Dentistry. 2023; 45(5): 385-410

Dental visits can be distressing, and nonpharmacological behavior guidance techniques can be used to provide most of the care in dental offices. The American Academy of Pediatric Dentistry (AAPD) published its first clinical practice guideline on nonpharmacological behavior guidance prior to, during, and after dental visits. The Work Group (WG) developed evidence-based recommendations for basic and advanced nonpharmacological behavior guidance techniques for pediatric patients and pediatric patients with special health care needs (SHCN) undergoing preventive dental care or treatment visits. In this Clinical Practice Guidelines, the effectiveness of nonpharmacological behavior guidance techniques on anxiety, procedural discomfort, and cooperative behavior in children undergoing preventive care or dental treatment was evaluated in eight systemic reviews by the workgroup. The techniques evaluated included: communication (verbal/ nonverbal), positive imagery, direct

observation/modeling, desensitization, various distraction techniques, tellshow-do, tell-play-do, ask-tell-ask, voice control, positive reinforcement, memory restructuring, biofeedback relaxation, breathing relaxation, animal-assisted therapy, a sensory-adapted dental environment, a combination of basic behavior guidance therapies, a picture exchange communication system, cognitive behavioral therapies and protective stabilization. The authors found that the use of mobile applications and modeling as distraction showed a significant reduction in anxiety levels in children and adolescents receiving preventative care. In addition, basic behavior guidance techniques such as positive reinforcement, modeling, relaxation methods, animal-assisted therapy, and a combined therapy of audiovisual distraction and tell-showdo may also prove beneficial for apprehensive patients throughout their dental appointment. The results also

showed that patients with severe anxiety receiving dental treatment may benefit from the implementation of advanced nonpharmacological behavior guidance techniques, including cognitive behavior therapy and hypnosis, when employed in a suitable manner. For children with SHCN, it was found that audiovisual distraction, a sensory-adapted dental environment, a picture exchange communication system (PECS), or other visual schedules and social stories may help relieve anxiety. In conclusion, this guidance serves as a valuable resource for dental practitioners and is meant to be of assistance in clinical decision making. The authors cautioned that the recommendations mentioned are meant to supplement clinical judgment and are not meant to supersede it.

Kulsum Iqbal, BDS, DDS; Resident, Pediatric Dentistry, VCU School of Dentistry

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ETHICAL OR LEGAL? Dr. William J. Bennett

Ethical

A long time ago (400 BC), the Hippocratic Oath was established. To this day, health professionals take this oath. The basic principles are: Do No Harm, Do Good, Be Fair, Provide Beneficial Treatment, and Be Truthful. The Oath remains the foundation for professional behavior in healthcare today. As an American Dental Association/ Virginia Dental Association member, one agrees to abide by the ADA’s Principles of Ethics and Code of Professional Conduct (available at ADA.org/ethics). In effect, the ADA code is the written expression of the obligations arising from the implied contract between the dental profession and society at large. As a condition of membership, one must abide by this code, which was first adopted in 1866. Committing to the high ethical standards of conduct, members can be assured of the public trust in the dental profession. The ADA code has three main components: The Principles of Ethics, The Code of Professional Conduct, and the Advisory Opinions.

Dental insurance did not exist. Radiographs were developed in a darkroom. There were few dental specialists and dental auxiliaries. It was routine for crown casting and denture processing to be done in the office. Computers and the internet were unavailable—manual typewriters and telephones did the job. Misleading claims, discounts, promotions, and poor care were addressed.

Legal

Today, group practices and corporations exist with practice names that are not limited to a practitioner’s name. Many practitioners commonly utilize billboards, the internet, mailers, television, and radio to promote and advertise their practices. Office location is not limited to professional offices and areas. Dental insurance is a common payer for services. The internet is utilized for payment and record keeping, including storing digital X-rays. There are many more dental specialists and auxiliaries. There are more dental labs and newly available computerized fabrication techniques. Continuing education does not have to be in person. Dental practices are influenced today to a greater degree by non-dentists.

Those who have been in dental practice for a while can attest to many changes that have occurred to practice operating requirements. In the past, dental care was provided by single practitioners who could advertise only upon the opening or the end of their practice. Only dentists could own a practice. Offices had to be located within professional (rather than retail) buildings and areas. The dentist’s name had to be on the office and was limited to no more than three inches in height. Continuing education was offered mainly at dental schools.

There are a lot of moving parts that influence professional and patient decisions now. However, in experiencing all of this, it must be noted that while what is considered legally acceptable practice may have changed, ethical concepts and behavior have not. While overtreatment may be legally overlooked, it is not considered ethical. Statements such as “permanent solutions” for missing teeth presented in advertisements may attract patients but are inaccurate and can be misleading. Are discounts offered to patients without insurance acceptable? YouTube education may substitute for hands-on education of invasive procedures, but does it adequately qualify a practitioner to provide the service?

Virginia dentists must adhere to the regulations promulgated by the Virginia Board of Dentistry. They can be found on their website http://dhp.virginia.gov/ dentistry.

While change is inevitable, with every change, we must consider whether the components of the change are ethically acceptable. If not, the change should not be implemented. If existing laws do not have an ethical base, they should be examined. If not ethically based, serious consideration for their removal should be given. Shouldn’t Virginia patients receive highquality healthcare and not be misled or mistreated for business purposes? High ethical standards must be the foundation for healthcare decisions and laws. Unethical activity - both business and clinical - should not be acceptable. Virginia officials and dental professionals are obligated to the public to legally implement and uphold high legal/ethical standards. Are Virginia dentists and regulators adequately working together to provide the best possible care to patients here in Virginia? A Virginia Dental Association (VDA) member’s commitment and obligation to ethical behavior and patient care are valuable to patients. Advertising your membership is legally acceptable today, so be proud of your VDA commitment and what we all strive to provide for our patients. Both our personal and professional reputations are at stake. Dentistry in Virginia has held high public respect both locally and nationally. Is it losing ground? If you feel it is, then make a commitment to support VDA efforts to support you and your patients. Encourage non-members to join. There is power in numbers, especially if it benefits dental patients and our profession. Ethical behavior is the cornerstone. Editor’s Note: Dr. Bennett is a retired life member of the VDA.

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THE

MORE REGULATIONS YOU KNOW

A feature from the Virginia Board of Dentistry

Requirements for continuing education • A dentist shall complete a minimum of 15 hours of continuing education, which meets the requirements for content, sponsorship, and documentation for each annual renewal of licensure except for the first renewal following initial licensure and for any renewal of a restricted volunteer license. (See 18VAC60-21-250.A) • Continuing education credit may be earned for verifiable attendance at or participation in any course, to include audio and video presentations. (See 18VAC60-21-250.C) • All continuing education programs shall be directly relevant to the treatment and care of patients and shall be:

• Continuing education must be taken by a Board Approved Provider which are listed in 18VAC60-21-250. C. 1 through 15. • All licensees are required to maintain original documents verifying the date and subject of the program or activity, the sponsor, and the amount of time earned. Documentation shall be maintained for a period of four years following renewal. (See 18VAC60-21-250. G.) • Additional information regarding continuing education can be found in regulation section 18VAC60-21-250.

- Clinical courses in dentistry and dental hygiene; or - Nonclinical subjects that relate to the skills necessary to provide dental or dental hygiene services and are supportive of clinical services (i.e., patient management, legal and ethical responsibilities, and stress management). Courses not acceptable include estate planning, financial planning, investments, business management, marketing, and personal health. (See 18VAC60-21-250. B. 1,2)

OUTREACH

PIEDMONT SMILES MOM EVENT – BACK FOR SECOND YEAR Michelle McGregor, RDH; Director of Community and Collaborative Partnerships, VCU

Last year, the PATH Foundation and the Fauquier Free Clinic teamed up with the Virginia Dental Association Foundation (VDAF) Missions of Mercy (MOM) team to host the Piedmont Smiles Free Dental Day in Warrenton. It was so successful MOM joined Piedmont Smiles for the second year to host a one-day popup event to provide free dental care to citizens in and around Fauquier and Rappahannock Counties. Dr. Terry Dickinson of the VDAF started MOM projects in 2000, prompted by unmet dental needs in Virginia, and the first MOM project took place in rural Wise County. MOM projects serve many communities across the Commonwealth, and next summer in Wise, they will mark their 25th anniversary. Thanks to many volunteers, the Fauquier High School was transformed into a large dental care facility in a matter of hours. Beginning on Friday, October 6, with students from Virginia Commonwealth University (VCU) Dental School, Henry Schein Dental representatives, the PATH Foundation and Fauquier Free Clinic representatives, and general volunteers, the gym turned into a MASH-like dental clinic. The volunteers ran temporary plumbing, air, and water service- set up radiology equipment and 36 mobile dental chairs. In addition, supply tables, sterilization areas, lighting, waste receptacles, and multiple seating areas for patients were needed. Starting at 1:00 PM on Friday, seventy-five patients were triaged by VCU students, faculty, and general dentists to begin receiving care Saturday morning. Dr. Awab Abdulmajeed and Dr. Aous Abdulmajeed, VCU faculty, attended to assist the 22 VCU students who volunteered. Dr. Reginald Salter from Howard University brought 10 of his dental students. By 5:00 AM, patients were lining

up in the darkness, waiting to receive free X-rays, cleanings, fillings, extractions, oral surgeries, and endodontic services. The volunteers arrived at 6:00 AM Saturday and were joined by many local dental and medical professionals, and following a few motivational words from Dr. Dickinson and Dr. Tontra Lowe, care began. Patients received cleanings, fillings, extractions, endodontic therapy, and oral health education all day Saturday. The clinic wrapped up the last patient (who needed two root canal procedures) 12 hours later at 5:00 PM. “Families with limited incomes really struggle to obtain dental care, often putting it off until the consequences or the pain become too much,” says Rob Marino, Executive Director of the Fauquier Free Clinic, the local host organization for the Piedmont Smiles event in Warrenton. “It’s a shame because if we could get to the patients sooner, we could prevent a lot of pain and suffering.” “I can’t express my gratitude for the care I received,” shares a patient who had not received this kind of care in a decade due

to lack of dental insurance and the high cost of dental treatment. “It was a lifeline for me. The dentists and volunteers were so professional and kind.” Piedmont Smiles owes its success this year to its sponsors and partners: • PATH Foundation • Culpeper Wellness Foundation • Virginia Dental Association Foundation - Mission of Mercy • Dominion National • VCU School of Dentistry • Howard University College of Dentistry • Drs. Woodside, Sentz & Associates • Fauquier Health • Fauquier High School • Just Neighbors • Meyer Clinic • Chick-fil-A • Golf Spot 29 • Ledo Pizza • Atlantic Union Bank • Virginia Emergency Medicine Associates • Piedmont Environmental Council • The Bridge Community Church • Shawn’s Barbecue

>> CONTINUED ON PAGE 47 44

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DENTAL SERIES DENTALDETECTIVE DETECTIVE SERIES WORD SEARCH Dr. Zaneta Hamlin MG X A E L I F MV K A T O X X P S B Z N N K S Y RM I G X B T X U I N O S M U I X X WM V K R Q N G L Z A T S B P O S KWP I C K L E B A L L C B T NG L E X R C P N Z H L Y K U F U K L R H S T O C J V R G B L I G Z T Y Y B T M E Q S HW WK D I V E R S I F I E D B S I V S Z T R O K A C R T V O K WA Q Q N HWB MO I G X E X G X A C T C E Y SWB D A J T A R DMMU F L N P V N Y L O HMU C I S G A G K A R X D D VMA S T E RM I ND J ONO T F U Y A E R U T U C U L T D C L F Z DO C H Z H X GH T B S S ND Y T N T X E E Z RM Y Q O T F F T D T U Y V K Y K M I O F I WD I C B S OWB O K V OQ X O P D P MK J U L R C DQ B K F T NO E J UG L L U A L X I H L QU A D R A F I D E A D Y C E D L N K S B R E K P C GH X V K T X I D V DGHD F R I V F Y E C F Q C E C B K C L I N C H P O R T I O R X X Q CW I R S G L T D A DU Y P Y U S X G B O T U L I N UM J U L MX R P I AM L Y A L T L I N F L A MM A T O R Y J WV O H P R L L S R V S Z C A G N QO H T V J N D I Z H T C U R KWU Y B A L E O F Z H R G A C E Q P G I T T I N S P I R A T I O N F S A T K Z RWD H A B K B Z OMB E A S V V L G VWA DN I I T R QOHGD T WT Y B I D A F F R HQ T O C K Y U S C N A I OG Y X F U H O J MH A Y X T F N R YWK X Y P J P D B F O R AM I N A O R T R O A HG X P V QO B E I P H E I U U QNQ J WT J Z L K Y F T Y L I T F Z I I I Q S P S C N X K C P Z V GD P P I F J K S G CWV X QN R O R O R O P XWB E NO L OG Y UD O H I E C C N H T WOM P F N B R J Q U G I M J A D H R I A R G F A A P YWV X Y N S NO E MA L I C A C I D S I V U Y CW I TWF X Y N S P A Y HMQ K Z H Y T B C N C D A K DH E N Z I N Z D L O B Y Z B F A C F H P R O T O C O L O Y T H Q Z Q F Q J K N V I O I C OMMO NWE A L T H N X UWP B WR P A Z U D T WG N V U C O R P O R A T E P P J I E A Z X

INFLAMMATORY

COMMONWEALTH

OMNISCIENCE

INFLAMMATORY INSPIRATION

COMMONWEALTH DIVERSIFIEDOMNISCIENCE HERBACEOUS

INSPIRATION LEGISLATION

DIVERSIFIED HERBACEOUS PICKLEBALL CLINCHPORT

MASTERMIND LEGISLATION

CORPORATEPICKLEBALL CLINCHPORT

MALIC ACID

MOLECULAR MASTERMIND

LIGHTSIDE MALIC ACID CORPORATE

QUADRAFID

BOTULINUM MOLECULAR

WORKFORCE LIGHTSIDE QUADRAFID

DYSPLASIA

BOTULINUM

WORKFORCE

DYSPLASIA

VACATION

FORAMINA

ENOLOGY

PROTOCOL

TERROIR

HOTSEAT

HOLIDAY

SONOMA

RETREAT

CLARET

BIOPSY

SANTA

VACATION

PROTOCOL

FORAMINA TERROIR SONOMA

HOLIDAY

BIOPSY

CLARET

ENOLOGY HOTSEAT RETREAT SANTA >> ANSWERS ON PAGE 56 45

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VIRGINIA BOARD OF DENTISTRY MEETING NOTES DECEMBER 8, 2023 Ursula Klostermyer, DDS, PhD

The September BOD business meeting was canceled. The December 8, 2023, meeting was opened by BOD President Dr. Nathaniel Bryant. He introduced and welcomed a new BOD member, Dr. Jennifer Szakaly, of Carrollton. No public comments, made in person or in written form, were submitted to the Board. Dr. Bryant received the approval of the BOD members for the minutes of the five past meetings since June 2023. Department of Health Professions Director Arne Owens reported that Governor Youngkin will present his budget list later this month. He stated that the DHP’s major concern is still the shortage of employees in the healthcare workforce and that they are actively working on it. James Rutkowski, Assistant AttorneyGeneral, reported that there are no legal issues presently under review. Dr. Nathaniel Bryant’s term as President of the BOD has ended, and he introduced and welcomed Margaret F. Lemaster, RDH, to replace him. He introduced Mr. Michael Martinez as the new Vice-President. Dr. Bryant reported from the ADEX 2023 meeting that there are no major changes as to how dental board exams will be given in 2024, with the exception that the clinical section will be offered exclusively on manakins/ typodonts and not live patients. This is a departure from the current situation where the students have a choice if they would like an examination using typodonts on a manakin or a live patient. Virginia might be the only state in the US that does not allow compensation for a patient for participation in the exam. Jamie Sacksteder, Executive Director of the Board of Dentistry, attended

the CLEAR conference and reported that this appears to be a very well-run organization. She enjoyed the informative conference and values the ability to report on what other states do, what solutions they devise, and how they cooperate. Ms. Sacksteder and Dr. Bryant will attend the upcoming Southern Deans and Dental Examiners Annual Conference in January 2024 and will report at the next meeting on how different boards interact and communicate with each other.

“ The Board approved the draft botulinum toxin regulations as proposed by the regulatory committee/workgroup. The budget requires these regulations to pass through as emergency regulations, so there will soon be a public comment period before they quickly become effective.”

Ms. Erin Barrett introduced the BOD’s current regulatory actions as of November 9, 2023. Nothing has changed so far. There are diverse subject matters pending in the Governor’s and Secretary’s offices.

The Board approved the draft botulinum toxin regulations as proposed by the regulatory committee/workgroup. The budget requires these regulations to pass through as emergency regulations, so there will soon be a public comment period before they quickly become effective. Concurrently, the regulations will need to go through the regular regulatory process (as a NOIRA). This will take at least eighteen months, with a couple of opportunities for public comment. The training requirements for the administration of botulinum toxin injections for cosmetic purposes are: • Completion of twelve (12) hours of training, including at least four (4) hours of clinical training. In-person training on at least two (2) live patients is required. • Eight (8) of the twelve (12) hours of training may be didactic and may be obtained online or in person. • The training program attended must be accredited by CODA, the ADA, constituent associations, or the AGD. The Guidance Document updates were accepted and approved by the Board. The content of the documents was not altered – they were re-organized to allow an easier read. It includes a section on policy regarding the recovery of disciplinary costs for licensees with more than one disciplinary action. The Board will charge, in addition to the monetary penalty, $5,000 for dentists and $1250 for dental hygienists. Mr. Matt Shafer (Council of State Governments) and Dr. Arthur Jee (current president of the American Association of Dental Boards) spoke regarding a dental licensure compact. They are representatives of two agencies that could consolidate the licensing process

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for licensees who seek, in a simplified process, to obtain licensure in multiple states. Participants who seek this must have a CODA-accredited license and be in good standing as a dentist or dental hygienist. This process would be a vehicle to expedite licensure across state lines. It could be obtained within minutes. This would be a much faster process than the traditional licensing process. Should a dentist or hygienist not be in good standing with their license, this information would be shared within minutes as well. This topic of compact licensing could be interesting for mobile dentists who work in diverse states in the US and may save licensure fees. DSOs should benefit from this streamlined process as well. These presentations were organized to help educate the BOD on the compact process. The

Board cannot weigh in on any legislation introduced to the General Assembly regarding this topic. Erin Weaver reported the statistics of the disciplinary actions from May to November 2023. The violations seem to be standard in comparison with other times. Of the 283 cases that were received, 241 cases were closed with no violation, and 29 cases were closed with a violation. These violations were mostly standard-of-care patient-related diagnosis and treatment issues. One license was suspended.

Editor’s Note: Dr. Klostermyer, a VDA member, practices prosthodontics in Richmond. Information is presented here for the benefit of our readers and is deemed reliable but not guaranteed. All VDA members are advised to read and comprehend all Board of Dentistry regulations and policies.

The Board of Dentistry reports a healthy cash balance of $3,626,000.00. This concluded the Board of Dentistry meeting on December 8, 2023.

>> CONTINUED FROM PAGE 44 “Our team is thrilled to be a part of the Second Annual Piedmont Smiles event,” says Margy Thomas, Senior Program Officer at PATH Foundation. “Dental health is a fundamental part of overall health; it’s very difficult for the uninsured or underinsured to routinely visit a dental provider, so Piedmont Smiles offers dental care to folks in our community who often lack access to this critical service. If you’re looking for evidence that our community sticks together and shows up for each other, this is it. Everyone deserves access to dental care— everyone.” “Our dental students, dental hygiene students, residents, and faculty are committed to community service,” says Michelle McGregor, Director of Community and Collaborative Partnerships at VCU School of Dentistry. “As we look to the future, we will remain steadfast in our commitment to promoting oral health and backing up communities that support their people. Piedmont Smiles was a unique opportunity for our students to work directly with their peers at Howard University, which fosters the

kind of collaboration that is needed for our profession to meet these needs everywhere.” Dr. Tontra Lowe of Awesome Smiles in Gainesville served as the Dental Director for the event. She also expressed her gratitude for the many volunteers whose compassion and dedication to this cause are critical to its success. The impact of service as a student can have a lasting impact on communities. Several previous graduates from VCU

who attended as students returned as licensed professionals. Dr. Marshal Adzima organized a social event on Saturday evening so the Howard and VCU students could relax and get to know each other better. Both schools hope to continue this collaboration. The project treated 259 people and provided over $152,851 of donated dental services. More information about VDAF and past Missions of Mercy dental day projects is available at www.vdaf.org/ourprograms/mission-of-mercy.html.

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LAWMAKERS, MEDIA, AND PATIENTS: CONVEYING KEY MESSAGES WITH AUTHORITY Michaela Mishoe, Account Executive at The Hodges Partnership

The Virginia Dental Association’s Communications Team leverages media relations – the practice of engaging journalists to inform the public about an issue or story – to advocate for the dental profession and oral health initiatives. To help members and VDA leadership feel comfortable and confident engaging with reporters, the team regularly conducts media training. The sessions highlight best practices and tips for effectively delivering a key message. It turns out that many of the strategies are helpful when it comes to engaging with other key constituents, like lawmakers or patients. With the 2024 General Assembly already in session, here are some tips for communicating key messages. Whether you are talking with a legislator, journalist, or patient, these tips can help you convey messages persuasively and effectively.

Keep it simple

Communicating complex information to your patients is already one of your strengths as a dentist. When speaking with reporters who are communicating to the public, you should use the same mindset. This involves breaking down intricate dental jargon into terms that the public will understand without sacrificing accuracy. Whether you are discussing oral health tips, explaining how dental insurance works differently than medical insurance, or advocating for higher reimbursement rates for Medicaid, simplicity ensures that your message resonates with a broad audience. One resource to explore is PlainLanguage.gov, a website with best practices from government communicators on how to craft language

“ Communicating complex information to your patients is already one of your strengths as a dentist. When speaking with reporters who are communicating to the public, you should use the same mindset.”

that is clear and concise. While it is intended for government agencies, the guidelines can help all communicators.

Rely on key messages

Key messages help you stay focused and speak with authority. Keep messages simple and short; rely on experience to share real-life examples. We always equip members with key messages before interviews, but you can also use key messages for any important meeting. Write them down beforehand, and it will help you stay on track.

Use a problem-solution framework Media interactions often revolve around addressing challenges and providing solutions. Whether you are communicating with the media or your patients, adopting a problem-solution framework will keep you from getting caught up in details that overwhelm or confuse your audience.

You probably use this framework often. For example, when discussing the importance of regular dental check-ups with your patients, you highlight the problem of undetected oral health issues and emphasize the solution of preventive care. This structured approach ensures that the audience receives actionable insights. A wonderful way to prepare for interviews is to include the problem-solution framework in your key messages or talking points. Here are some talking points for interviews on Oral Cancer Awareness Month, Children’s Dental Health Month, and oral health tips for Halloween: • [Problem]: About 11,580 annual deaths in the U.S. are from oral and oropharyngeal cancers. About 70%, or 38,100 of the cases diagnosed are attributed to HPV. [Solution]: Early detection and prevention are the two most important tools to increase long-term survival from oral cancers. • [Problem]: Many children’s dental hygiene visits were disrupted at the onset of the pandemic, resulting in an uptick in cavities. [Solution]: To mitigate the effects of delayed dental care, parents and caregivers should schedule regular dental appointments for children while ensuring they brush their teeth daily, drink fluoridated tap water, and cut back on sugary drinks and foods. • [Problem]: While candy in moderation is not always bad, too much candy and too often can lead to concerns about cavities. [Solution]: Some oral health tips to consider when eating candy during Halloween and the holidays include:

RESOURCES

- Brush your teeth or swish your mouth with water after a treat. - Do not consume candy throughout the day; save it for a treat after a meal. - Avoid sticky or sour candies. - Look for dark chocolates that are low in sugar. - Do not keep a stash of candy on hand. Have your family pick their favorites and donate the rest. You may look at these talking points and feel you would like to elaborate on other details, but having key messages to lean on will help you keep your interview focused, easy to digest, and actionable for your audience.

an individual basis or with a small team and a camera, the VDA communications team offers several media training courses throughout the year. By practicing responses to challenging questions, handling both proactive and reactive interviews, and honing nonverbal communication, you can build experience and confidence. If you have any questions about media interviews, please contact Paul Logan (logan@vadental.org) and Elise Rupinski (Rupinski@vadental.org) at the VDA.

Practice

Media training is incomplete without hands-on practice. Through role-playing exercises, mock interviews, and scenariobased simulations, you can refine your communication skills in a controlled environment. While these can be done on

UNIVERSITY CONNECTIONS

VIRGINIA IMPLANT EXCELLENCE WEEK ELEVATES RESTORATIVE DENTISTRY IN THE COMMONWEALTH John Wallace; Communications Director, VCU School of Dentistry Reprinted with permission from VCU School of Dentistry

“Oral health is awesome. We can take people from nearly any state to their ideal state,” said Dr. Mark Ludlow during his presentation Friday, November 10, 2023 at the Virginia Implant Excellence Week Symposium. His comment underscored the possibilities associated with restorative dentistry as well as the aspirations of the first-annual event held by VCU School of Dentistry, which sought to elevate the quality of dentistry to benefit residents throughout the Commonwealth. “VIEW reflects our obligation as Virginia’s only dental school in ensuring oral health professionals throughout the commonwealth are knowledgeable of the best and newest technologies and skills. This is how we affirm the better care of our patients,” said VCU School of Dentistry Dean Dr. Lyndon Cooper. The symposium at the Westin Hotel in Richmond was attended by more than 150 oral health professionals from across Virginia. It featured nationally renowned experts in implant dentistry, who discussed everything from clinical care and digital workflows to implant materials and practice management. “It’s pretty cool to learn not only about one scope of dentistry,” said Dr. Wael Zakkour, a prosthodontist at Thomson Drive Dental in Lynchburg. “The last lecture was nothing about inside the mouth, it was all about the practice, the management, the business. Another one was about the dental lab, more or less the digital side. The surgeries, the implants–that diversity in one event is priceless.”

While Friday’s symposium was the main event, activities had already begun with lunch-and-learn presentations and other educational endeavors occurring at VCU School of Dentistry throughout the week. “Our students have a unique opportunity to practice implant dentistry at a level many others don’t due to our thriving predoctoral clinic and the expertise available in our various residency programs. In addition to engaging our colleagues in the community, we wanted VIEW to provide unique learning opportunities that our students can apply during their education,” said Dr. Karen McAndrew, associate professor and director of implant dentistry at VCU School of Dentistry, who spearheaded much of the planning efforts with Dean Cooper. Throughout the week, faculty experts in periodontics, oral and maxillofacial surgery, and prosthodontics discussed

a variety of advanced techniques and complex implant cases. The week even featured an implant-themed scavenger hunt hosted by the Department of Periodontics, where participants learned about implant dentistry, solved riddles, and gathered implantrelated items. “Virginia Implant Excellence Week exceeded our expectations, and we’re already looking forward to next year,” said Cooper. “I’d like to thank all of our participants for engaging with us throughout the week, as well as everyone who devoted their valuable time and energy to make our vision a reality.” View more pictures from VIEW on VCU School of Dentistry’s Flickr account at https://www. flickr.com/photos/vcudentistry/ sets/72177720312705173/ and stay tuned for details on next year’s Virginia Implant Excellence Week.

UNIVERSITY CONNECTIONS

VDA SCHOLARSHIP PROVIDES PEACE OF MIND FOR THIRD-YEAR DENTAL STUDENT ANNELIESE GOETZ John Wallace; Communications Director, VCU School of Dentistry

Growing up in Reston, repeated visits to an orthopedic surgeon in high school to repair a torn ACL led Anneliese Goetz to consider a career in health care. However, a volunteer opportunity at a Remote Area Medical (RAM) event in Charleston, W. Va., pointed her on a path to dentistry. “I was assigned to the dental clinic, and it was amazing to see the impact we had on so many people in just a few short days,” said Goetz, who was pursuing her undergraduate degree in biology at the University of Virginia. “I volunteered for a couple more RAM clinics and started shadowing a local dentist in Charlottesville during the semester and another at a clinic back home during summer breaks.” Instead of entering dental school at the height of the COVID-19 pandemic, Goetz took a gap year to gain additional experience. VCU School of Dentistry was always Goetz’s top choice for dental school due to its reputation for clinical training and the lower in-state tuition rate. However, even with in-state tuition, dental school is an expensive reality that every student must face. When Goetz found out she was the 2023/2024 recipient of the Virginia Dental Association (VDA) Scholarship, she was extremely grateful. “Loans are something that my classmates and I think about on a daily basis. They can seem impossible to pay off,” said Goetz. “I was honored to be chosen for this scholarship, and I’m very thankful for the VDA’s support.

It gives a little more peace of mind knowing that some of that burden is off of my shoulders.” The VDA established an endowed scholarship for students at VCU School of Dentistry in 2014 after becoming concerned about the exponential growth of dental student indebtedness. VDA Scholars are chosen from a pool of applicants who have expressed interest in practicing in Virginia and participating in organized dentistry. Now in her third year and transitioning to providing patient care in the school’s pre-doctoral clinic, Goetz appreciates the resources that VDA provides to help students grow their professional network and learn practicemanagement skills. “I look forward to attending VDA’s Dental Days at the Capitol,” said Goetz. Each year, the VDA invites dental students to join their legislative reception and lobby day events. Recently, VCU School of Dentistry began incorporating participation in the VDA’s lobby day event as part of the Practice Management course, which is required for all third-year students. “It is a great opportunity to advocate for our profession and also meet and get advice from established dentists.”

Anneliese Goetz

Goetz is considering whether she wants to continue her education and gain additional experience in a specialty program or begin her professional career. However, she is fairly certain that she wants to practice in Virginia, close to where she grew up, and she plans to remain involved in organized dentistry.

RESOURCES

VDA MEMBER PERKS ANNOUNCES ENDORSEMENT OF TORCH THE ALL-IN-ONE DENTAL SUPPLY PLATFORM VDA Members receive a $300 Torch Dental Reward and Free Account when they sign up with Torch Dental. Ordering dental supplies is timeconsuming and complicated. Dental offices are wasting hours pricing checking, negotiating, training new staff, running into backorders, dealing with distracting reps, and shopping from multiple vendors when they should be using their time giving the best patient treatment. The VDA is endorsing Torch Dental for its cutting-edge technology and innovation to improve dental offices effectively. Our board members have tested their capabilities, and Torch has proven to reduce unnecessary overhead and increase productivity. Torch Dental is designed to streamline dental practice operations, simplify supply orders and optimize on spend. Practices that use Torch Dental save an additional 16%+ on their dental supplies from authorized dealers. Staff members spend

hours of their week making sure inventory is stocked and ready for patients. Without proper supplies, dentists cannot provide the best patient treatment. However, there is a way to complete this task more efficiently than wasting hours of your staff’s time. Torch Dental allows your staff to move faster and work smarter. Their technology automatically creates your custom inventory portal with all your favorite products and brands from 110+ vendors and manufacturers. Their software optimizes for the best prices, fastest shipping, free shipping, and product availability. Torch Dental reduces 64% of the time wasted ordering supplies and increases your office productivity. Schedule a demo to learn how Torch Dental can offer you peace of mind dental supplies today!

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Questions?

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MEMBERSHIP

WELCOME NEW MEMBERS THROUGH DECEMBER 1, 2023

Dr. Lynne Faxio – Howard University College of Dentistry 1992 Dr. Levi Miller – Suffolk – The Ohio State University College of Dentistry 2022

Dr. Sianoush Badei – Williamsburg – Texas A&M University Baylor College of Dentistry 2023 Dr. Alaa Elamin – Williamsburg – Herman Ostrow School of Dentistry of University of Southern California 2023 Dr. Loan Lieu – Williamsburg – Herman Ostrow School of Dentistry of University of Southern California 2009

Dr. Jordan Boyd – Glen Allen – Medical University of South Carolina James B. Edwards College of Dental Medicine 2020

Dr. Joanna Al Obaidi – Roanoke – Boston University Goldman School of Dental Medicine 2022

Dr. Payton Cook – Richmond – Virginia Commonwealth University School of Dentistry 2021

Dr. Andrew Henritze – Roanoke – Virginia Commonwealth University School of Dentistry 1997

Dr. Colleen Davis – Hanover – East Carolina University School of Dental Medicine 2018

Dr. David Hodges – Roanoke – New York University College of Dentistry 2022

Dr. Gabriel French – Richmond – University of Pittsburgh School of Dental Medicine 2023

Dr. Zachary Rubin – Roanoke – University of North Carolina School of Dentistry 2023

Dr. Mridula Manoj – Powhatan – University of North Carolina School of Dentistry 2022 Dr. Swetaben Patel – Glen Allen – University of Tennessee HSC College of Dentistry 2023 Dr. Nicole Rogers-Lee – Sandston – Virginia Commonwealth University School of Dentistry 2019

Dr. Ian Larson – Abingdon – University of Pittsburgh School of Dental Medicine 2023

Dr. Rohini Shah – Glen Allen – University of Kentucky College of Dentistry 2010

Dr. Yara Haj Mohamed – North Chesterfield - Howard University College of Dentistry 2020 Dr. Melika Rahmani-Mofrad – Smithfield – University of Maryland Dental School, Baltimore College of Dental Surgery 2022 Dr. Ayhson Shafiq – Midlothian – New York University College of Dentistry 2021 Dr. Kenneth Yuth – North Chesterfield – University of New England College of Dental Medicine 2017

Dr. Camille Vasquez – Richmond – University of Pittsburgh School of Dental Medicine 2023 Dr. Triet Vuong – Richmond – University of California at San Francisco School of Dentistry 2015 Dr. Sara Youssef – Henrico – Temple University Maurice H. Kornberg School of Dentistry 2023

Dr. William Pell – Winchester – University of Maryland Dental School, Baltimore College of Dental Surgery 2023 Dr. Gary Poppe – Fishersville - University of Nebraska Medical Center College of Dentistry 1989

Dr. Anna Zhang – Richmond – University of North Carolina Chapel Hill 2022

>> CONTINUED ON PAGE 54 53

MEMBERSHIP >> CONTINUED FROM PAGE 53 Dr. Vero Nica – Fairfax - University of Maryland Dental School, Baltimore College of Dental Surgery 2022 Dr. Arin Abrahamian – Alexandria – University of Maryland Dental School, Baltimore College of Dental Surgery 2017 Dr. Mohammed Abdulateef – Woodbridge – University of Pennsylvania School of Dental Medicine 2019 Dr. Waleed Alkakhan – Arlington – Virginia Commonwealth University School of Dentistry 2019 Dr. Nathanael Dejene – Alexandria – New York University College of Dentistry 2022 Dr. Natalia Duque-Gomez – Fairfax – University of Illinois at Chicago College of Dentistry 2023 Dr. Salar Ebrahimi – Loudoun – Howard University College of Dentistry 2019 Dr. Anwar Gebremichael – Fairfax – Howard University College of Dentistry 2022 Dr. Iya Ghassib – Arlington – University of Michigan School of Dentistry 2023 Dr. Christy Han – Prince William – Temple University Maurice H. Kornberg School of Dentistry 2023 Dr. Jiaxi Hu – Fairfax – Virginia Commonwealth University School of Dentistry 2022 Dr. Izza Khan – Alexandria – Columbia University College of Dental Medicine 2023 Dr. Timothy Liu – Fairfax – University of Maryland Dental School, Baltimore College of Dental Surgery 2022 Dr. Romina Mercado – Fairfax – University of Connecticut School of Dental Medicine 2010 Dr. Mahsasadat Mortazavi – Fairfax – University of the Pacific Arthur A. Dugoni School of Dentistry 2021 Dr. Sina Mousavi – Fairfax – University of Washington Health Sciences School of Dentistry 2018 Dr. Lance Myers – Fairfax – University of Tennessee HSC College of Dentistry 2022 Dr. Lyndsey Nagy – Arlington – University of Pennsylvania School of Dental Medicine 2022

Dr. Hima Bindu Reddy – Loudoun – New York University College of Dentistry 2005 Dr. Sreepreethi Sundaram – Loudoun – New York University College of Dentistry 2001 Dr. Georgi Talmazov – Arlington – Virginia Commonwealth University School of Dentistry 2019 Dr. Rachel Taylor – Fairfax – University of Pittsburg School of Dental Medicine 2022 Dr. Nicholas Thomas – Fairfax – University of Michigan School of Dentistry 2017 Dr. Nancy Trang – Prince William – Howard University College of Dentistry 2021 Dr. Priya Vasa-Ludington – Loudoun – Tufts University School of Dental Medicine 2015 Dr. Ionut Viski – Fairfax – Virginia Commonwealth University School of Dentistry 2020 Dr. Alicia Zabalegui Marco – Alexandria – University of Southern California School of Dentistry 2023

AWARDS & RECOGNITION

VIRGINIA SECTION RECOGNIZED BY ACD Dr. Michael Hanley; Associate Editor, Component 3

At the recent ADA meeting in Orlando, the Virginia section of the American College of Dentists was recognized as a model section. The College was formed in 1920 to elevate the standards of dentistry, promotes ethics, excellence, professionalism, and leadership. Seven new fellows were inducted at the meeting. Our section helps sponsor the Mirmelstein Ethics Seminar at the VCU School of Dentistry. We also sponsor an ethics lecture and workshop at our annual VDA meeting. Working with the school, we honor the student of the year and faculty of the year. VCU School of Dentistry, under the leadership of Dr. Carlos Smith, does a great job of ensuring that our graduates have a solid foundation in the ethical treatment of patients. Speak to an ACD Fellow to learn more about the mission of the College.

DR. TED SHERWIN Pierre Fauchard Academy Fauchard Gold Medal

IN MEMORY OF: Name

City

Date

Age

Dr. Joseph Cary Bryant

Dillwyn

August 20, 2023

Dr. Thomas J Eichler

Reston

July 12, 2023

Dr. Robert G Futrell

Aylett

October 22, 2023

Dr. Joaquin M Perez-Febles

McLean

October 14, 2023

Dr. Harry Edward Ramsey

Norfolk

March 4, 2023

Dr. Mark L Tummarello

Fairfax

September 15, 2023

RESOURCES

DENTAL DETECTIVE SERIES

>> CROSSWORD ANSWERS CONTINUED FROM PAGE 45

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INFLAMMATORY

COMMONWEALTH

OMNISCIENCE

INFLAMMATORY INSPIRATION

COMMONWEALTH HERBACEOUS DIVERSIFIED OMNISCIENCE

INSPIRATION LEGISLATION

DIVERSIFIED CLINCHPORT

HERBACEOUS PICKLEBALL

MASTERMIND LEGISLATION

CORPORATE CLINCHPORT

PICKLEBALLMALIC ACID

MOLECULAR MASTERMIND

LIGHTSIDE CORPORATE

MALIC ACIDQUADRAFID

BOTULINUM MOLECULAR

WORKFORCE QUADRAFIDDYSPLASIA LIGHTSIDE

BOTULINUM

WORKFORCE

DYSPLASIA

VACATION

FORAMINA

ENOLOGY

PROTOCOL

TERROIR

HOTSEAT

HOLIDAY

SONOMA

RETREAT

CLARET

BIOPSY

SANTA

FORAMINA

VACATION

TERROIR

PROTOCOL

SONOMA

HOLIDAY

BIOPSY

CLARET

ENOLOGY HOTSEAT RETREAT SANTA

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