Virginia Dental Journal Vol 100#1 January - March 2023

SERVICE ORGANIZATIONS

Robert McDermott 34 ETHICS AND PROFESSIONALISM

Dr. Dana Chamberlain 36 DO YOU KNOW HOW TO PREVENT FINANCIAL FRAUD IN YOUR DENTAL PRACTICE?

Phil Nieto 38 HOW CAN FINANCIAL PLANNING SOFTWARE HELP YOU PLAN FOR RETIREMENT?

Jimmy Pickert 47 DENTAL ASSISTANT IIs BUILD CAPACITY AND PATHWAYS TO CARE Sarah Bedard Holland

Sypawka

VA DENTAL

JOURNAL

EDITOR-IN-CHIEF Richard F. Roadcap, D.D.S., C.D.E. BUSINESS MANAGER Ryan L. Dunn MANAGING EDITOR Shannon Jacobs

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

VDA COMPONENT ASSOCIATE EDITORS

BOARD OF DIRECTORS

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

PRESIDENT Dr. Cynthia Southern, Pulaski

PRESIDENT ELECT Dr. Dustin Reynolds, Lynchburg

IMMEDIATE PAST PRESIDENT Dr. Scott Berman, Falls Church

SECRETARY-TREASURER Dr. Zaneta Hamlin, Virginia Beach

CEO Ryan L. Dunn, Goochland

SPEAKER OF THE HOUSE Dr. Abby Halpern, Arlington COMPONENT 1 Dr. David Marshall COMPONENT 2 Dr. Sayward Duggan COMPONENT 3 Dr. Samuel Galstan COMPONENT 4 Dr. Marcel Lambrechts COMPONENT 5 Dr. David Stafford COMPONENT 6 Dr. Marlon A. Goad COMPONENT 7 Dr. Caitlin S. Batchelor COMPONENT 8 Dr. Justin Norbo ADVISORY Dr. Lyndon Cooper ADVISORY Dr. Ralph L. Howell EDITOR Dr. Richard F. Roadcap VCU STUDENT Brett Siegel, VCU Class of 2023

VIRGINIA DENTAL JOURNAL

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POSTMASTER

MANUSCRIPT, COMMUNICATION & ADVERTISING

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

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

YEAR OFF RIGHT!

As you read this, we’ll be celebrating a New Year. I look forward to what 2023 will bring. There was a huge victory in Massachusetts for the profession and patients this past November: over 70% of the voters there cast a ballot in favor of requiring insurance companies to implement a dental loss ratio of 83%. This requirement has been in effect for medical Insurance companies since the Affordable Care Act was passed. Until now, nothing has been implemented to hold dental Insurance companies accountable. My hope for this year is that all other states, including Virginia, will follow Massachusetts and seek legislation for dental loss ratios to be established. This gives us hope that reimbursement rates will increase and that patients will be able to receive the dental treatment they need with insurance covering more procedures at an increased rate. An increase in yearly maximums and less out-of-pocket expense for our patients - wouldn’t that be nice! I know I’m dreaming, but sometimes dreams do come true. If you want to see this happen in our Commonwealth, then we need your help. We need your contributions to the VDA Tooth PAC, and we need you to recruit your colleagues who are not members to become members and join us in the pursuit. As I said in my address in September, our strength is in our numbers. I challenge every member to recruit one non-member to join. Ask the non-member: Why shouldn’t insurance companies be held accountable to their subscribers and their providers?

In my last Journal article, I mentioned the 30% increase in Medicaid reimbursement rates. There have been close to one million adults added to this program. There are still many adults who have not been able to see a dentist. We have had a few complaints about the program from

members. I encourage you to read the article by Dr. Roger Palmer in this edition, as he addresses some of the issues we are seeing. As a Medicaid provider myself, I recommend you review the Office Reference Manual to make sure you provide the proper documentation for the treatment you provide, and to be aware of what procedures require prior authorization. Please be patient as we work with DMAS to make billing and reimbursements easier for the providers.

I encourage you to attend Dental Days at the Capitol beginning January 26, 2023. Let’s show our strength in our numbers, and inform our General Assembly that Virginia needs to follow Massachusetts with a dental loss ratio of at least 83%. Lastly, I wish everyone a Happy New Year! Let’s start this year off right and flood the Capitol in our Lab Jackets. I’ll see you in Richmond.

The workforce shortage is still a burden to many dental offices in Virginia. The Northern Virginia Dental Society has a task force working on this issue in their region. Unfortunately, there is no quick solution. Many industries are facing workforce shortages. It takes time to educate members of the dental team. There may be resolutions submitted to our House of Delegates in January relating to this issue. I encourage members to communicate with your delegates and alternate delegates about resolutions we’ll review and vote on so your voice is heard.

LET’S START THE

Dr. Cynthia Southern

“We need your contributions to the VDA Tooth PAC, and we need you to recruit your colleagues who are not members to become members and join us in pursuit.

SCHOOL DAYS

In the 1980s Garrison Keillor hosted a radio program which took place in the fictional town of Lake Wobegon. Every episode of Keillor’s monologue on life in central Minnesota ended with the reminder that, among other things, “…all the children are above average.” He perhaps foresaw a time in our modern culture where no one fails and every child gets a trophy.

As a college undergraduate I and other classmates perceived Organic Chemistry as a threat to a higher GPA and thereby admission to postgraduate education.

The instructor, Dr. T. (not his real name), didn’t care that we had plans beyond college and wanted to imbue us with the fundamentals of a discipline needed for aspiring chemists. I don’t remember much from the classes, but I do recall the thick tome we carried to class was authored by Morrison and Boyd. My hope was to escape the two semesters with a “C” and later score an “A” in courses such as Ornithology and International Relations to improve my transcript. Fate smiled upon me and I never had to appear before a tribunal and defend my poor performance, although my lack of prowess in the subject was revealed several years later when I took the Dental Aptitude Test.

At New York University, undergrads still fear their grades in “Organic” will hurt their GPAs. During the spring 2022 semester a group of malcontents petitioned the school administrators and demanded that the instructor, Dr. Maitland Jones Jr., be fired for his merciless grading protocols. The brass responded by sacking Dr. Jones, who had retired previously from Princeton, and was adjunct faculty at NYU.1 Jones is a textbook author2 and is considered a legend in his academic career. Prior to his firing, he alerted the university to students’ declining

performance and attendance, and even produced a series of videos to improve their grasp of the subject.

Rumors surfaced that the supplicants were, for the most part, hoping to gain admission to medical school. I suspect that there were some prospective dental students in the cohort. The New York Times reported another chemistry professor at NYU, when he confronted

rankings keep going higher.”4 I asked a friend who serves on the adjunct faculty at NYU College of Dentistry his opinion. He said he didn’t know much about events on the academic campus, but Dr. Jones’s firing was “the talk of the town.”

In the clinical practice of dentistry, failures are commonplace. I was astonished to hear a colleague say, once, that he never had a crown that didn’t fit. For reasons I can’t disclose he is no longer practicing dentistry. Rather than accept failure and become complacent, we strive to overcome our shortcomings, becoming better practitioners in the process. Much like my tour of duty in Organic Chemistry, I struggled with complete dentures and the restoration of endodontically treated teeth. Eventually I mastered peripheral border molding and impression taking with modern elastomeric materials, along with accurate bite registrations and occlusal records. I learned the importance of conserving tooth structure and prompt full coverage in teeth with root canals. A series of failures taught me how to achieve clinical success.

students about cheating on online tests, was told “they were not given grades that would allow them to get into medical school.”3 Meanwhile, other faculty members in the chemistry department and students, as well, defended Dr. Jones’s teaching skills and fairness. Chemistry professor Dr. Paramjit Arora said, “The deans…want happy students who say great things about the university so more people apply and the US News

The events at NYU’s academic campus raise questions on several fronts. First, should academic standards be relaxed for physicians and other healthcare professionals? Should we continue to demand excellence from our providers at the risk of diminishing the supply serving our ever-growing healthcare demands? Tradition holds that students who excel as an undergraduate are the first admitted for training in the healing arts. Whom would you want to serve as your surgeon, oncologist, or general practice dentist?

Second, are the petitioners suffering an injustice or expressing an entitlement? Should the university accede to the demands of the privileged? Tradition also

Dr. Richard F. Roadcap

“Should academic standards be relaxed for physicians and other healthcare professionals? Should we continue to demand excellence from our providers at the risk of diminishing the supply serving our ever-growing healthcare demands?”

holds that healthcare providers are set apart by their desire to serve others, not by proclaiming to be disadvantaged.

The clinical practice of dentistry teaches us failure is a part of life. We don’t get a mulligan for our mistakes. Rumor has it that the NYU collegians sought not only a tuition refund for the course, but also to have the failing grades expunged from the record. At this point, Dr. Jones and academic integrity are the victims of feeble administrators. Other aggrieved parties may follow suit. I suspect this scenario has played out at other universities with lesser-known faculty members.

Maybe your son or daughter has missed opportunities due to a professor’s unfair grading algorithm, and your sympathies lie with the NYU petitioners. There are two sides to every argument. But until we address the academic and ethical questions raised by this controversy, all students will be deemed above average.

References

1. https://www.nytimes. com/2022/10/03/us/nyuorganic-chemistry-petition. html

2. Jones, Maitland Jr. and Steven A. Fleming. Organic Chemistry (Fourth Edition) W.W. Norton and Co. New York, 2009

3. https://www.nytimes. com/2022/10/03/us/nyuorganic-chemistry-petition. html

4. Ibid.

REFLECTIONS ON DENTISTRY IN THE YEAR 2022

Gary D. Oyster, DDS; ADA Trustee, 16th District

As COVID and various viruses continue to hang on and mutate, many offices still have workforce issues. Some hygienists and assistants will never return to the profession, so the challenge for the ADA and states is getting more staff members in the pipeline. Several new dental schools will be opening, so will there be enough staff members to enable practices to be efficient? The ADA and states are looking at various ways to address this situation.

The SmileCon meeting in Houston generated much energy by having interactive podcasts, street vendors, a great band, and many more transactional events. Dental students from different schools competed in games of skill and fun. Over 500 first-time dentists attended the meeting. I asked several of them if they might attend next year and got a resounding yes. We hope to build on this meeting to have even greater attendance at next year’s meeting in Orlando.

The Strategic Forecasting Committee has been chosen and a timeline has been established by our Executive Director for the Caucus chairs with help from the Trustees of the regions to establish how subcommittee and work group members are chosen. This will require much work but, once in place, should help the ADA be more effective and interactive with members.

The Mobile App has about 7000 members signed up at this time and is being designed to be personally directed to the member. In other words, whatever products or services the member uses, the app will direct information to that person based on their previous usage. Microsoft 365 is now set up for the ADA staff and will soon be available for Board members. Eventually, it will be available

for all members replacing Aptify and ADA connect.

The recent success of a referendum setting a Medical Loss Ratio for dental plans in Massachusetts, with 71% in favor, has the ADA encouraging all states to introduce legislation asking for at least 83% being paid toward treatment. This was a great effort by many individuals, dental societies, and consumer groups. As of now, over 30 states plan to introduce legislation. This is a consumer issue and is a positive public relations win for Dentistry. The ADA State Government Affairs is putting out a tool kit to help states with their legislation. At the ADA Lobbyist Conference in March of 2023, legislative initiatives will be discussed, and we will have a report on how states are doing with their MLR legislation. Some ADA members are hosting dinners in their homes for new members and nonmembers. The one I attended had about 20 new members, and the enthusiasm and interaction was very positive. E-mail addresses were exchanged, and opportunities to join study clubs or other gatherings were well received. We need to make all new members feel welcome.

As I have stated before, membership in the tripartite system remains our number one priority. Working with ASDA and the dental schools to develop values that encourage young dentists to join the ADA is critical. We have more members but are losing market share. It is now 59% and has been going down for a decade. We must make all dentists feel welcome regardless of their work model. The ADA is working with DSOs to find common ground to have their members join since every year a greater number of dentists work for DSOs.

I am enjoying being the 16th District Trustee and always welcome questions or comments. If I do not have an answer, I will get one. I hope everyone had safe and happy Holidays.

Editor’s Note: Dr. Oyster serves as ADA Trustee for the 16th District, and practices in Raleigh.

ADA

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This is just one way the ADA and VDA empower our members to make the best decisions for their patients and practice.

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TAKE ACTION TO ADDRESS VIRGINIA’S DENTAL WORKFORCE NEEDS

Ryan Dunn, CEO

Everyone in a dental office team plays a role in providing our communities with essential dental care. When I joined the Virginia Dental Association in 2019, two of the twenty careers projected to grow fastest in Virginia were dental assistants and dental hygienists. The growing workforce demand from dentistry predates the pandemic. Today’s hiring challenges aren’t unique to dentistry. Also, we can’t expect anyone else to come up with short and long-term solutions. Before we get to that, let’s start with a few facts.

FACT - Virginia has more dentists than the national average, and our population of licensed dentists is growing faster than our overall population.

We had 5,857 dentists in our workforce in 2021, about 550 more dentists than we had 8 years ago. That’s 68 dentists per 100,000 people, compared to an average of 61 dentists per 100,000 people in the U.S.

FACT - It’s harder to find a dentist in rural areas than in the urban crescent.

We have about twice as many dentists per 100,000 people in Northern Virginia as we do in Southwest Virginia. If you have to drive 30 miles to see a dentist, it doesn’t matter much to you what our state average is. We have a distribution issue and need to find ways to make it easier for dentists to practice in areas of need. That includes recruiting dental students from those areas.

FACT - Enrollment is up at Virginia’s Community College dental programs.

Of the programs run through the Virginia Community College System, there’s been a 20 percent increase in enrollment for hygienists and assistants in the last 3

years from 480 to 578. That’s better than the national average which dipped during the pandemic and has only recently recovered.

FACT - Dental offices are still struggling with hiring.

There are currently 550 listings on the VDA’s Career Center, which launched this June, most of those for staff members. The October ADA Health Policy Institute report found nearly a third of dentists surveyed couldn’t see a full patient load because of staffing issues.

Addressing Virginia’s dental workforce needs is up to us. Here are four ways you can make a difference.

1. Stay informed through the VDA. Our president, Dr. Cindy Southern, is focused on dental workforce needs. We regularly share opportunities to serve on workforce leadership boards for the state and make recommendations for appointees to the Governor’s office. The VDA is a G3 Program Ambassador partnering with our community college system to promote those in-demand careers. We are the only group representing our members’ interests when it comes to licensure issues that could affect you and your team. You are already reading the Virginia Dental Journal – watch for our regular e-Digest newsletters and other communications for the latest news and opportunities to help. You can also sign up for text alerts by texting “VDA” to 52886.

student to faculty ratios for accredited dental hygiene and dental assisting programs. The VDA has joined other state dental associations in lobbying for flexibility around those ratios. But in the meantime, finding and retaining qualified faculty continues to be a challenge for nearly every dental program in the state. If you’re able to donate your time as an adjunct faculty member, hosting students for clinic hours, or donating extra dental supplies to a local program, you can make a difference in allowing them to train students who are seeking a career working in dental practices. There’s a listing of those programs on page 25 in the Journal.

2. Call your local community college dental program to see how you can help. CODA requires strict

3. Make sure our VDA leadership and staff are armed with your stories. If you face a challenge in licensure, credentialing, hiring or other aspects of your practice, please share it with a member of the VDA staff or leadership. We have regular meetings with members of the administration and legislative leaders on workforce issues. Conveying those personal stories from constituents to your representatives in the General Assembly and through the media can be one of the most impactful catalysts for change. If you’re working on unique solutions in your community, want to talk to your local community college about starting a new program or have ideas to address challenges, share that too. There are many VDA members working on solutions. I want to particularly commend Dr. Emily Bowen, who shared her story about launching a new dental assisting program in this edition of the Journal,

OUR SUCCESS IS YOUR SUCCESS!

Laura Givens, Director of Legislative and Public Policy

Thanks to the hundreds of VDA members and students who met with their legislators, called them, wrote letters, spoke out in the media and fought for this funding, the budget includes a 30% increase in dental Medicaid reimbursement rates. As of July 1, 2022, $116 million dollars was included in new state and federal funding dedicated to boosting the lagging reimbursement rates for the approximately 1,900 Virginia dentists currently participating in the dental Medicaid program.

The 2023 Virginia General Assembly session began on January 11th and the VDA is on the ground advocating for the profession. We need your help in this process!

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 patients are foremost in the General Assembly’s eyes. If you haven’t already contributed to the VDA PAC for the 2023 year, please make your contribution today! You can contribute when paying your VDA dues through the VDA website at https://www.vadental.org/ my-vda/renew/payment-options 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.

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UPDATE: SMILES FOR CHILDREN PROGRAM (MEDICAID)

Roger Palmer, DDS; Chair, VDA Council on Government Affairs; Member, DMAS Dental Advisory Committee

I was introduced to Medicaid while a D-2 at VCU in 1973 by Drs. Riggs and Yost, who were dental consultants for the Medicaid Program. They were instructors in the clinic where I did my first restorations and they were recruiting future dentists to participate in the program.

After graduation when I started practice, I began seeing Medicaid patients and have done so for 46 years, only holding off for a brief time when the state gave the program to several different insurance companies. These companies were very difficult to deal with and their medical coverage determined the patient’s dental coverage and that changed frequently. Many dentists left the program never to return. The state took the program back to fee for service and participating dentists were given a significant fee increase and the VDA encouraged us to participate by treating at least a few children.

The current Smiles for Children program is administered by DentaQuest, a company that administers many other states’ programs.

Up until July 1, 2021 only children and eligible pregnant women were covered for treatment with those over 21 only having access to relief of pain and infection, for example, extractions and I&Ds. In July of 2021 this all changed and literally hundreds of thousands of adults became eligible for comprehensive dental care. Now covered services include endodontics, crowns, partials, dentures, periodontal treatment and all of the basic restorative treatments.

The General Assembly did not appear to take into account that there were not enough dentists to treat these new patients who have a tremendous amount

of dental disease and needs. We routinely see new patients that need as many as twenty appointments to get their treatment completed. We are turning away sometimes five or six new patients a day in our small town. With the COVID-19 problem receding, we are having more and more people calling. We did receive a 30% across the board increase in fees as of July 1, 2022, which puts the reimbursement on a level with several low paying PPOs. This was the first increase in over 16 years.

Needless to say, there have been some bumps in the road that Dr. Zachary Hairston, Chief Dental Consultant, DMAS, and members of the Dental Advisory Committee (DAC), including myself and current VDA President, Dr. Cindy Southern, are trying to smooth out. We encountered some procedure codes not being included in the adult program and treatment plans valid for only six months (now a year). Some of our patients have taken over a year to complete, with periodontal treatment, extractions, endodontics, crowns and partial dentures as well as restorations. We have a couple of other problems that we are working on, including what constitutes an acceptable clinical fill in endodontic cases. We are hopeful that these issues will be resolved by the time you read this.

Now, the reason for this article: we desperately need more dentists to step up and treat these disadvantaged fellow citizens of Virginia. When I graduated from dental school in 1976, the Dean at VCU made it a point to say that, by virtue of the education we had received at minimal cost to us for the value we received and the lifestyle we would have, we had an obligation to give back to the people, especially the poor.

A great number of these patients need comprehensive treatment and it is satisfying to take a broken down and diseased mouth and restore it to function and restore the appearance of someone. Although the fee schedule is lower than your usual fee, there is no deductible, co-pay or yearly maximum to worry about. Once you determine a treatment plan, you can proceed to completion knowing you will be paid 100% of the fee schedule without any accounts receivable problems.

Many of the adult patients are more difficult to treat because of medical problems and the fact that they are not used to having a scheduled appointment. This can be handled on the first visit interview and refer the patient elsewhere or to VCU if you don’t think that they will be a good fit in your office.

I would encourage many VDA dentists to participate in the Smiles for Children program, soon to be Cardinal Dental Program. Even if you choose to treat only a few patients, you will enjoy the satisfaction of helping people who really need it.

Please contact me if you have questions about the Smiles for Children Program at rapalmer@telpage.net or (434) 594-4401.

and Dr. Erika Anderson, who led a work group with the Northern Virginia Dental Society to recommend unique solutions to their regional workforce challenges.

make changes to address workforce challenges unless we show up and ask for them. Please register to join us at Dental Days. And if you’ve already registered, talk to a colleague about joining you.

4. Get Involved. We will be considering options to address workforce needs when the VDA House of Delegates meets at Dental Days at the Capitol this January. We will also be meeting with legislators to impress on them how dentists are being squeezed by rising costs, third party payers and other challenges, including hiring. Legislators won’t be able to

We can all play a part in ensuring Virginia has the oral healthcare workforce it needs. Just by being a part of organized dentistry, you are already doing more than some. If you have the ability to do so, I ask you to consider taking additional steps through the VDA to support existing dental programs and to set us on a long-term path to meeting the needs in communities across Virginia.

Regulations KNOWING IS HALF THE BATTLE

DID YOU KNOW?

A SERIES FROM THE VIRGINIA BOARD OF DENTISTRY

Sedation Permit Not Required

Did you know the requirement for a moderate and deep sedation permit shall not apply to an oral and maxillofacial surgeon who maintains membership in the American Association of Oral and Maxillofacial Surgeons (AAOMS) and who provides the board with reports that result from the periodic office examinations required by AAOMS? Such an oral and maxillofacial surgeon shall be required to post a certificate issued by AAOMS. If you meet this criterion, please do not apply for a sedation permit or let your sedation permit expire.

18VAC60-21-290 (A) and18VAC60-21-301(A) of the Regulations Governing the Practice of Dentistry.

Moderate Sedation

Did you know “Moderate sedation” means a drug-induced depression of consciousness, during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation? Reflex withdrawal from a painful stimulus is not considered a purposeful response. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.

18VAC60-21-10 (D)of the Regulations Governing the Practice of Dentistry.

Deep Sedation

Did you know “Deep sedation” means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation? Reflex withdrawal from a painful stimulus is not considered a purposeful response. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.

18VAC60-21-10 (D)of the Regulations Governing the Practice of Dentistry.

General Anesthesia

Did you know “General anesthesia” means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation? The ability to independently maintain ventilator function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.

18VAC60-21-10 (D) of the Regulations Governing the Practice of Dentistry.

LOOKING GLASS THROUGH THE

EXPLORE THE FANTASTICAL WORLD OF ORAL PATHOLOGY

A 13-year-old female patient presents to the dental clinic. Upon intraoral examination, you note a pedunculated, wellcircumscribed, hard nodule in front of the foramen cecum of the posterior dorsal tongue. The patient said she does not feel any pain. It measures 6 mm. What is your suspected diagnosis?

Editor’s Note: Dr. Sarah Glass is a board certified Oral and Maxillofacial Pathologist. She works as an assistant professor at VCU School of Dentistry, and her job responsibilities include teaching, working in the biopsy service, and seeing oral medicine patients. Cases are presented by Saleh Smadi, a dental student at the Virginia Commonwealth University School of Dentistry.

WITH DR. SARAH GLASS

A 73-year-old female patient presents for a recall exam. Upon oral cancer screening, you note a papillary lesion, shaped like a cauliflower, on the left posterior lateral border of the tongue. The patient reports that there is no pain associated with it, and it has been growing. What is your suspected diagnosis?

A 67-year-old male patient presents to the clinic with a 10 mm ulcer on the right lateral border of the tongue with a white/ hyperkeratotic border. You also notice a sharp tooth in the area. What is your suspected diagnosis?

1. Osseous choristoma: The histopathology shows a benign mass of matured bone covered by normal tongue epithelium. The treatment of choice is excisional biopsy. Treatment has an excellent prognosis with a very low recurrence rate.

2. Squamous cell carcinoma: The histopathology shows an invasive neoplasm of epithelial origin that invades deeper structures with atypical architecture and cytological features. Although the lesion looked benign on clinical exam, a biopsy showed a malignant tumor. Histopathologic examination is important for a definitive diagnosis.

3. Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE): The histopathology shows an ulceration with a deep pseudo-invasive inflammatory reaction. When the muscle gets involved, we see intense stromal eosinophilia. Since the lateral tongue is a high-risk site for cancer, a biopsy is recommended for any non-healing ulceration. The lesion is traumatic in origin due to an adjacent sharp tooth, and this source of trauma should be removed for complete healing.

OUTCOME OF VITAL PULP THERAPY IN DEEPLY CARIOUS MOLARS AFFECTED WITH MOLAR INCISOR HYPOMINERALISATION (MIH) DEFECTS: A RANDOMIZED CLINICAL TRIAL

Al-Batayneh O, Abdelghani M. Eur Arch Pediatr Dent. 2022; 23(4): 587-599.

Molar incisor hypomineralization (MIH) is a prevalent developmental condition affecting enamel in the permanent and primary dentition. It has been observed that teeth affected by MIH have increased sensitivity due to increased porosity in enamel and dentin as well as increased pulpal innervation and immune cells. Patients with teeth affected by MIH often avoid brushing regularly due to increased sensitivity making them more prone to dental caries and it is believed that patients experience sensation even after administration of local anesthesia. Due to increase in leukocytes, capillary blood flow, and serum proteins in pulpal tissue of teeth affected with MIH, it is hypothesized that the pulpal response in molars affected with MIH will differ from normal teeth. Caries on molars with MIH can progress rapidly so early intervention and treatment is key to maintain a vital pulp. At this time, there is little evidence regarding the outcomes of vital pulp therapy of carious molars affected by MIH and how these teeth may respond differently histologically. The goal of this study is to evaluate the clinical and radiographic outcomes of deeply carious young permanent molars affected by MIH treated with vital pulp therapy.

The study was designed as a prospective randomized clinical trial. Participants were screened and evaluated by a pediatric dentist using the ICDAS-II to score caries. The study included six 16-year-old children with at least one molar affected by MIH with caries exposing the pulp or extending more than two thirds into dentin on the periapical radiograph. The participants were randomly allocated into two groups. The first group was treated with indirect pulp therapy using 2.5% sodium hypochlorite, triplex water, and Vitrebond®. The second group was treated with a pulpotomy using 2.5% sodium hypochlorite, MTA, and Vitrebond®. Both groups were restored with glass ionomer cement filling material (Ketac®) and a stainless steel crown. Patients in both groups were recalled for clinical and radiographic evaluation at 3, 6, 12, and 24 months.

A total sample size of 50 patients or teeth were included in the study with 26 females and 24 males and 14 upper molars and 36 lower molars. The mean age of the total participants was 11.3 years of age. At the initial visit, 76% of the patients presented with pain. In total, 30 cases had a preoperative diagnosis

of reversible pulpitis, and 20 cases were diagnosed with irreversible pulpitis with all normal periapical tissues. At the 3, 6,12, and 24 month follow up periods, there were no significant differences in the clinical and radiographic success rates between the two groups even though all failures were diagnosed in teeth with irreversible pulpitis. There was no significant difference in success rates of pulp vitality regardless of vital pulp therapy treatment.

Overall, in deeply carious young permanent molars affected by molar incisor hypomineralization, vital pulp therapy is a good treatment option, with indirect pulp therapy showing slightly higher success rates at 96% vs. pulpotomy at 86%. The difference between the two vital therapies was not statistically significant.

Elizabeth Kleefisch, DDS; Resident, Pediatric Dentistry, VCU School of Dentistry

SUCCESS OF MEDICAMENTS AND TECHNIQUES FOR PULPOTOMY OF PRIMARY TEETH: AN OVERVIEW OF SYSTEMATIC REVIEWS

Tewari N, Goel S, Vijay Prakash M, et al. Int J Paediatr Dent. 2022; 32(6):828-842.

Pulpotomy is a widely accepted treatment for cariously affected primary vital teeth. Debate exists regarding medicament selection to carry out the procedure. This article serves as a review of previously completed systematic reviews. This overview will help to inform clinical decision-making for pulpotomy and identify areas for further research. Two authors completed a comprehensive literature review following the a priori protocol published in the International Prospective Register for Systematic Reviews. Over 255 documents were reviewed culminating in a critique of 62 full text articles ultimately leading to the inclusion of eight systematic reviews discussed in this article. The systematic reviews were evaluated for quality and confidence using AMSTAR-2. Additionally, each article was reviewed for potential bias using the ROBIS tool. Available meta analyses were reviewed from the included articles and trends were identified in the performance of medicaments at 6, 12 and 24 months.

This article found that calcium hydroxide did not perform as well at all time periods

when compared to MTA, formocresol, and ferric sulfate. At 6, 12, and 24 months MTA, formocresol and ferric sulfate had greater than an 80% success rate. Between these leading options, it was found that MTA has greater radiographic success when compared to formocresol at 24 months. There was little appreciable difference in the clinical success of MTA, formocresol, and ferric sulfate at all time periods. Four of the 8 included systematic reviews lacked an a priori protocol resulting in low-quality of evidence. Metaanalysis overlap of primary literature was considered generally high.

Overall, there is a paucity of primary studies that present challenges to conducting systematic reviews. To further refine conclusions from research, the authors call for uniformity of study designs consisting of randomized control trials with published protocols that can limit bias in the results. Of the 21 material evaluations, many newer materials and techniques such as Biodentine and diode laser utilization have been studied in a limited capacity and for short periods of duration. Finally, there is a need to

improve the quality of systematic reviews and meta analyses. A registered a priori protocol should be submitted by the researchers in addition AMSTAR-2 should be used in systematic reviews to evaluate confidence and quality of the results from primary studies.

This study shows the current state of pulpotomy research and provides a path forward. MTA, ferric sulfate and formocresol perform well in all time comparisons as evidenced in this review. Calcium hydroxide does not perform as well as the materials at all time periods. MTA appears to be a superior medicament radiographically when compared with formocresol at 24 months. With the advent of new materials and techniques in the future, we must have research that includes new materials while also looking at the clinical outcomes at 24 months and beyond.

Richard Greene, DDS; Resident, Pediatric Dentistry, VCU School of Dentistry

PREVALENCE, TRENDS, AND SEVERITY OF EARLY CHILDHOOD CARIES IN THE UNITED STATES: NATIONAL HEALTH AND NUTRITIONAL

EXAMINATION

SURVEY DATA 2013 TO 2018

Kotha

A,Vemulapalli A, Mandapati S, Aryal S. Pediatr Dent

Between 2015 and 2016, one in six children in the US between the ages of two and five was confirmed to have caries. The prevalence of caries among children two to five years old has steadily decreased, from 28% between 1988 and 2004 to 23% between 2011 and 2016. Early childhood caries (ECC) is still a typical chronic pediatric disease in the US. In children under the age of 6, ECC is described as “the presence of one or more decaying (non-cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth.” The exact definition applies to severe early childhood caries (S-ECC), which is described as “the presence of any smooth surface caries in children younger than three, or one or more cavitated, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth, or a decayed, missing or filled score in children from ages three through five.”

Results of the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2016 showed that children aged two to five had a lower prevalence of caries (21.4%) than those aged six to eleven (50.5%) and those aged twelve to nineteen (53.8%). Compared to their Caucasian counterparts, preschool-

2022;44(4):261-267

aged Hispanic and African American children are more likely to have untreated dental caries. Similarly, children from poorer socioeconomic homes have a twofold increased risk of developing caries compared to those from better socioeconomic families. ECC may also affect kids’ general health and development.

There are no reports or studies on the prevalence of S-ECC at a national level, according to the National Center for Health Statistics (NCHS) data brief from the Centers for Disease Control and Prevention (CDC). Although S-ECC is included in the definition of ECC, reporting merely ECC prevalence is insufficient to grasp the full scope of severe illness in these children. The objectives of this study were to: (1) assess the prevalence and demographic distribution of S-ECC and ECC overall in children under the age of six in the United States; and (2) look at changes in ECC prevalence and severity from 2013 to 2018.

The study design was data withdrawn from the NHANES from 2013 to 2018 that the authors examined. The NCHS conducts the NHANES, a series of continuous cross-sectional surveys, every

two years. To enable generalization, NHANES uses many stages of probability sampling and a range of weights. Socioeconomic, demographic, nutritional, and health-related issues are covered in the home interview. Examinations are conducted in transportable examination facilities, where skilled medical professionals carry out dental, medical, and laboratory examinations. Dentists, with further training, do thorough surfaceby-surface inspections of the mouth to check for untreated caries and dental restorations.

Overall, 57.2 percent of the children with ECC had severe caries (S-ECC); throughout the three survey cycles, this proportion grew linearly (P=0.048). Between 2013 and 2018, there were significantly more five-year-olds with S-ECC than children with ECC (P=0.013), people with Federal Poverty Guidelines incomes below 100% (P=0.003), males (P=0.037), and children with a recent dental visit more than six months prior (P=0.001).

Jenan Alahmad, DDS; Resident, Pediatric Dentistry, VCU School of Dentistry

PSYCHOSOCIAL MATERNAL PERCEPTION OF THE OUTCOME OF PRE-SURGICAL INFANT ORTHOPEDICS IN INFANTS BORN WITH CLEFT LIP AND

PALATE

Bhutiani N, Tripathi T, Priyank R. J Clin Pediatr Dent. 2022;46(4):299-306

The birth of a child with a cleft lip and/ or palate has a great effect on a family. The location of the orofacial cleft can be a great cause of distress to the parents of the affected child, who may feel uncomfortable getting the child out in public. Physical appearance, speech difficulties, feeding problems, repeated infections, commitment to attend clinical appointments causing absence from school/work, and financial burden are amongst the various problems that the defect causes. There are limited studies that assess the psychosocial and mental status of mothers with children with cleft of lip and palate.

Presurgical Infant Orthopedics is an idea that was introduced in 1950 to help reduce the distortion of orofacial tissues. The primary aim of such procedures includes the reduction in the width of the cleft defect, and alignment of the distorted cleft segments prior to cheiloplasty. This study assessed maternal opinion of the effect of PSIO on their infant’s

facial appearance and how the change impacted their psychosocial status.

The study design was conducted on 50 mothers with children that were born with cleft lip and palate. The recruited mothers had children less than two months old and agreed to having the pre-surgical infant orthopedic therapy completed on their infant. An assessment was completed before the start of the therapy for the mother to rate certain facial features deemed to be deformed due to clefting on Likert’s scale before or after PSIO. The depression, anxiety, and stress in mothers related to their baby’s congenital deformity was evaluated using Depression Anxiety and Stress Scale (DASS-42).

The average treatment time was three months and there was noticed significant improvement of the facial appearance after PSIO therapy. The parents observed an overall change in their child’s facial appearance and nasal appearance. The

mean depression score pre-treatment was 22.54 (severe), and the posttreatment score was 7.10 (normal). The mean anxiety score pre-treatment was 20.64 (extremely severe) and posttreatment 6.46 (normal). The mean stress score was 24.7 (severe) and decreased to 8.4 (normal) after PSIO was accomplished.

In conclusion, in this study children born with cleft lip and/or palate severely increased the mother’s depression, anxiety, and stress. After pre-surgical infant orthopedic therapy was completed, mothers noticed changes in their child’s facial morphology and nasal appearance. This therapy has allowed for a decrease in maternal depression, anxiety, and stress levels.

Darlene Jean, DDS; Resident, Pediatric Dentistry, VCU School of Dentistry

BREATHING OUT DENTAL FEAR: A FEASIBILITY CROSSOVER STUDY ON THE EFFECTIVENESS OF DIAPHRAGMATIC BREATHING IN CHILDREN SITTING ON THE DENTIST’S CHAIR

Levi M, Bossù M, Luzzi V, Semprini F, Salaris A, Ottaviani C, Violani C, Polimeni A. Int J Paediatr

Dental fear and anxiety are commonly used interchangeably, and thus mistaken for the same terms. The impact of dental fear can lead to neglect, expenditure of time and resources for both patient and provider, and even to poorer quality of life for the patient. Identifying anxiety in the pediatric population is best done via objective assessments. Anxiety and fear responses are usually accompanied by changes in the autonomic nervous system (ANS) activity, and some of what can be observed is sweating and an increase in heart rate. Thus, those measurements would be useful in assessing fear in children in a dental setting. Furthermore, managing dental fear in children may involve multiple strategies, some of which are non-pharmacologic. Psychological intervention allows for healthy processing and coping skills, feelings of increased control, and a reduction in feelings of anxiety. One exercise that is believed to be of benefit to fearful patients is diaphragmatic breathing. Just by deepening the inhalation and exhalation, it can reduce stress and anxious states, and increasing oxygenation.

Though diaphragmatic breathing can be useful in alleviating anxiety, there is a lack of studies to support this. Thus, it was hypothesized that the duration of dental treatment is likely to decrease, and that the reduced anxiety would lead to increased cooperation. The purpose of this study was to test the feasibility

of financially feasible and easy-toteach procedures to reduce negative experiences and emotions of children undergoing dental treatment.

This study was conducted at the Pediatric Dentistry Unit of the Department of Oral and Maxillofacial Science of Sapienza University of Rome, Italy. It consists of 20 children between 7 and 13 years who need to receive dental treatment such as caries excavation or extraction. Children were assigned to two groups: the treatment as usual group (TAU) or diaphragmatic breathing condition using computer generated random numbers. During the first visit, the children were asked to fill out the following questionnaires: CFSS-DS, the Multidimensional Anxiety Scale for Children (MASC), The Children’s Depression Scale (CDS), and the Children’s Response Style Questionnaire (CRSQ). The questionnaires allow the children to rate subjectively their symptoms of depression, physical symptoms, and fear. Visual analogue scales were used to assess happiness, fear, anger, sadness, and pain. Finally, the physiological assessment was completed with a portable device which detected heart rate and heart rate variability.

The results showed that abdominal breathing exercise was effective in reducing heart rate. Scores on the social anxiety subscale of the MASC correlated

Dent. 2022;32(6):801-811

with fear, with socially anxious children reporting to be more fearful at the beginning of the dental visit. Furthermore, there seemed to be more self-reported fear at baseline which correlated with the rumination subscale of the SRSQ with children characterized by a higher tendency to engage in ruminative thoughts and having greater fear at the beginning of the dental appointment. With the reduction in sympathetic dominance caused by diaphragmatic breathing, participants reported to feel less pain, fear, sadness, and anger. Diaphragmatic breathing can be a promising intervention to enhance physiological relaxation, decrease self-reports of pain, and increase subjective well-being. It is low cost, easy to teach, and easy to implement

Liara Vinson, DDS; Resident, Pediatric Dentistry, VCU School of Dentistry

THE ASSOCIATION OF DEVELOPMENTAL DENTAL DEFECTS AND THE CLINICAL CONSEQUENCES IN THE PRIMARY DENTITION: A SYSTEMATIC REVIEW OF OBSERVATIONAL STUDIES

Portella PD, Dias BC, Ferreira P, de Souza JF, Wambier L, Assunção LRDS. Pediatr Dent. 2022;44(5): 330-341

The risk of dental caries in primary teeth seems to be greater in the presence of developmental defects of enamel (DDE). DDE is defined as changes in enamel appearance, resulting from biological imbalances that affect the cells in charge of enamel formation and maturation. DDEs can be classified as quantitative (hypoplasia), when enamel thickness is reduced, or qualitative, when enamel translucency is affected (demarcated or diffuse opacities). The relationship between the presence of these defects and an increase in the risk of dental caries can be explained by structural changes in the dental enamel that eventually lead to larger biofilm accumulation. Therefore, the purpose of this study is to compare children with developmental defects of enamel (DDE) in primary teeth and children without DDE, in terms of having a higher risk of having dental caries or a higher prevalence of clinical consequences.

Multiple databases were utilized to collect the literature, these included: PubMed, Scopus, Web of Science, Cochrane Library, LILACS, BBO, Embase and in gray literature. The task of completing the study selection, data extraction and bias assessment was accomplished by three independent reviewers. NewcastleOttawa Scale was utilized to evaluate the risk of bias. DDE and its subtypes

were considered as exposure, and the subtypes included: demarcated opacities, hypoplasia, hypomineralized second primary molar (HSPM), and fluorosis. Additionally, assessment of dental caries and clinical consequences of untreated caries were completed. The random effect model for dichotomous outcomes was used in the off ration (OR) of the metaanalysis. The Grading Recommendation Assessment, Development and Evaluation (GRADE) were utilized to assess evidence quality.

The results showed that 5,750 studies were included, the studies included in the systematic review were 39m and 20 in the meta-analysis. Primary caries lesions were associated more with the following: children with DDE (OR=2.79; 95% CI:1.29-6.03), demarcated opacities (OR=1.75; 95% CI: 1.09-2.78), hypoplasia (OR=2.84; 95% CI:1.73-4.67), and HSPM (OR=2.89; 95% CI: 1.65-5.06). There was no association between dental caries and fluorosis (OR=1.39; 95% CI: 0.97-1.98). The association between DDE and dental caries were high, in relation to tooth as a unit, (OR=2.34; 95% CI: 1.74-3.16). Only qualitative analysis was conducted for the clinical consequences of caries, and the studies showed no consensus.

DDEs are considered important predictors of the development of carious lesions

in primary teeth. In the present metaanalysis, children with DDE were more than twice as prone to caries experience in primary teeth than those without DDE. The clinical characteristics of teeth with DDE, including structural and morphological aspects related to incomplete enamel maturation, can predispose to biofilm accumulation in retentive areas and, consequently, to colonization by cariogenic bacteria at the base of the defect and in contact with the exposed dentin. Thus, as dentin is less calcified, caries in teeth with DDE can develop more quickly and more severely than in those teeth with healthy surfaces.

In conclusion, developmental defects of enamel and its subtypes are associated with higher caries experience in primary teeth. As for the clinical consequences of caries, only the qualitative analysis was conducted and there was no consensus in the studies. Therefore, longitudinal studies are needed so that the association of DDE with dental caries and its clinical consequences can be better established.

Sarah Balal, BChD, MChD; Resident, Pediatric Dentistry, VCU School of Dentistry

VIRGINIA BOARD OF DENTISTRY NOTES

DECEMBER 2, 2022

Ursula Klostermyer, DDS, PhD

Board president Dr. Nathaniel Bryant called the meeting to order at 9:00 a.m., and Mr. Scott Johnson, general counsel of the VDA, made a short public comment that the VDA is supportive of the changes the BOD made with the recent regulations. No other public comments were presented.

Mr. Arne W. Owens was introduced as the new Director of the Department of Health Professions. DHP chief deputy director Jim Jenkins was also introduced. Both Mr. Owens and Mr. Jenkins have previous experience with health regulatory boards.

Mr. Owens stated that they are aware of the medical and dental shortages in the workforce and new ideas will be introduced to address the problem.

The minutes from the previous meetings were unanimously approved.

Ms. Jamie Sacksteder spoke about the AADA and AADB meetings. She noted that it was rewarding to join the AADA meeting as it was a well-organized and informative meeting. The AADB meeting, though, was not as well organized. The participants from the Virginia board felt they were not included, and Dr. Dag Zapatero stated he was pleased that the Virginia BOD does not belong to this dysfunctional organization. For the last six years, they felt that the AADB meetings are not productive and that they don’t welcome new members. The idea was presented that the Virginia BOD should form a new organization by inviting and hosting boards of neighboring states to interact with other state boards and possibly solve present issues.

Dr. Bryant reported about his CODA accreditation site visit at the Wytheville Community College, which is located in

southwest Virginia between Roanoke and Bristol. Wytheville is a small town with only 6,000 to 8,000 residents, and the main focus is the college in town. He states they are having a good quality dental hygiene program of 25 students right now, and are, of course, in need of funds and instructors for students to be well prepared to enter the dental market.

Ms. Barrett went over the current regulatory actions handed in to the Governor’s office by the Legislation and Regulation committee. She was excited that the governor finally approved technical corrections of oversights in regulation and reducing cost of reactivation of an inactive license after being 2.7 years on the fast-track action. She went extensively through all the anticipated changes for the chapters 15, 21, 25, 30 and the clinical competency guidance Document 60-12. The motion from the BOD was to move these items for fast track and they were accepted by the BOD with all in favor.

What does it mean for the dental community in Virginia? Most of these changes were eliminations because they were either repetitions in the code of Dentistry or they were unclear, not necessary or outdated. Ms. Barrett and the committee are trying to keep the code in clear language and make it as easy as possible to read to avoid unnecessary duplications.

The BOD discussed and it was clarified what was included in ‘vital sign taking’ before, during and in the end of a sedation procedure. Besides the usual vital signs like blood pressure, heart and respiratory rate, and oxygen saturation levels, temperature should be taken before the procedure, and during the procedure when clinically indicated. It is

not necessary to take the temperature of a patient in the end of the procedure. The other vital signs though have to be taken at the end of a sedation procedure.

In the section for Continuing Education, the Board increased the hours for dentists and dental hygienists from two to three hours of the 15 required hours for the annual renewal that may be satisfied through the delivery of dental services, without compensation, to low-income individuals receiving health services through a local health department or a free clinic organized in whole or primarily for the delivery of those services.

The disciplinary report from January to November 2022 was introduced. Of 449 received cases 314 cases were closed without violation. Of a total of 389 closed cases, 75 cases were closed with a violation. Most cases were patient care related. In sedation cases, proper record keeping was the main issue where CCAs (Confidential Consent Agreements) were issued. In three cases license suspensions were issued.

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.

MEMBER SPOTLIGHT – DR. EMILY BOWEN PROGRAM

DIRECTOR FOR MOUNTAIN EMPIRE COMMUNITY COLLEGE

DENTAL ASSISTING PROGRAM

Paul Logan, Director of Strategic Initiatives/Innovation

Dr. Emily Bowen started a new dental assisting program amid a global pandemic. She shares how VDA members can support dental education programs in their areas and talks about a new partnership that’s allowed Mountain Empire Community College to offer the second expanded function dental assistant training program in the Commonwealth.

From a young age, Dr. Emily Bowen wanted to be a dentist. “My family tells me I started talking about it in the third grade, and I don’t even remember. But dentistry was always on my radar.”

“When I got to dental school, I realized I really liked dentistry, but honestly, I didn’t love the clinical aspect of it. Which seemed at the time problematic! By the time I graduated, I wasn’t sure where I would end up.”

Dr. Bowen got started in dental education almost by accident. She returned home

after graduation and applied to the local community college for an adjunct position to teach anatomy and physiology, thinking it would be a temporary holdover.

She started working with administrators at the school and found the opportunity to develop a new dental assisting program. “That’s really when I found my niche. I should have been somewhere in education or public health outreach all along. This is where I feel like I fit.”

Overcoming Unexpected Challenges

With funding from the Virginia Tobacco Commission, Dr. Bowen and school administrators spent 2019 developing the curriculum, renovating their building, and putting in operatories. “We had a tremendous support system within our community. The local health department donated equipment. A local FQHC was repurposing some of its existing dental clinic space. If it had not been for those donations, we would not have been able to open when we did in 2020.”

Mountain Empire, in Big Stone Gap, welcomed the first cohort of dental assisting students in January 2020. And then, along with dentists across the state, they hit pause in March.

“Construction was delayed, and there were supply chain issues. A lot of that tells you how valuable the support of the community is. We got so much help beyond that initial grant allocation, which was really important.”

Despite challenges, the timing for the program’s launch also meant graduates were entering a hot job market. “We consistently have more job offers and job opportunities than we have graduates.”

Dr. Bowen sees the program at Mountain Empire as setting a foundation for dental professionals who will continue to invest in their careers.

“If they’re committing a year of their education to advance their career, they tend to be more satisfied and stay in their career long-term. Those who’ve gone through an educational program tend to last longer and go on to earn additional certifications. We also know that a lot of people – not all, but many – will continue to climb the ladder to another specialty.”

A New Partnership

Dr. Bowen stays engaged with other educators and policy advocates through the VDA and groups like the Virginia Health Catalyst. She connected with Misty Mesimer, who leads the dental hygiene and dental assisting program at Germanna Community College, near Fredericksburg. Germanna offered, at the time, the only expanded function dental assisting program in Virginia.

“The easiest way to describe a DAII is that they can do any reversible procedure under the supervision of a dentist. The

High school students participate in dental explorer day at Mountain Empire Community College

Dr. Emily Bowen

CODA-ACCREDITED SCHOOLS AND PROGRAMS IN VIRGINIA

Dental Hygiene - Virginia Peninsula Community College Williamsburg https://www.vpcc.edu/health/dental Program Director: Kelly Tanner, Ph.D., RDH

Dental Hygiene - Germanna Community College Locust Grove Program Director: Ms. Misty Lynn Mesimer

Dental Hygiene - ODU Gene W. Hirschfeld School of Dental Hygiene Norfolk http://www.odu.edu/dental Associate Professor and Chair: Ann M Bruhn, BSDH, MS, RDH

Dental Hygiene - VCU School of Dentistry Richmond https://dentistry.vcu.edu/programs/dentalhygiene/ Program Director: Marion C. Manski, MS, RDH

Dental Hygiene - Virginia Western Community College Roanoke www.virginiawestern.edu/academics/health-professions/ dental-hygiene/ Program Director: Ms. Marlana Thomas

Dental Hygiene - Northern Virginia Community College Springfield http://www.nvcc.edu Program Director: Elizabeth J. Di Silvio, RDH, MEd

Dental Hygiene - Danville Community College Danville (VWCC Distance Site) Site Coordinator: Robin Mitchell

Dental Hygiene - Laurel Ridge Community College Middletown (VWCC Distance Site) Site Coordinator: Lori Ellington

Dental Hygiene - Wytheville Community College Wytheville Program Director: Ms. Amber Shuler

Dental Assisting - Germanna Community College Locust Grove Program Director: Ms. Misty Lynn Mesimer

Dental Assisting - Centura College - Norfolk Norfolk Program Director: Ms. Tamika Davis

Dental Assisting - J. Sargeant Reynolds Community College Richmond http://www.reynolds.edu Program Director: Dr. David Minoza

Dental Assisting - Fortis College - Richmond Richmond Program Director: Ms. Angela Smith

Dental Assisting - Northern Virginia Community College Springfield http://www.nvcc.edu Program Director: Dr. Sumera Rashid

dentist must still drill the tooth, but a DAII can fill it. For a restoration, the dentist can turn the reins over to the assistant to finish or personally complete the procedure if it is more appropriate. We offer three certifications: composite resin, amalgam, or crown and bridge. For the pros part, DAII can never prep the tooth, but they can cement the crown on, take the final impression, things of that nature.”

Working with Misty, Dr. Bowen developed a curriculum that allows students to fulfill the requirements for a DAII, supplementing their in-person instruction with virtual sessions from Germanna.

“For places like where I live, which is in far Southwest Virginia, we have clinics with wait lists that are sometimes months long. I talked with one dentist who said it was over six months to get an appointment. So, with DAIIs we can hopefully minimize some of that wait. Particularly for those straightforward restorative cases. That’s a big opportunity for patient care.”

Addressing Workforce Challenges in Rural Areas

“We know that there’s a huge workforce need right now, and those needs transcend state borders. I can be in eight

state capitals faster than Richmond. Kentucky licensure affects us directly because some of our closest dental, dental hygiene, and assisting programs are in other states.”

Dr. Bowen notes that many dental hygiene students from Southwest Virginia go to Kentucky for their training, which starting in January, will not offer an exam recognized by the Virginia Board of Dentistry, which means additional steps to licensure in Virginia. “If our practices and policies looked beyond state borders, that would help with the workforce issues.”

And while Virginia as a whole has a higher concentration of dentists than the national average, there are regional disparities, particularly in rural areas. Dr. Bowen worked with the VCU School of Dentistry to help address that need.

“For parts of Southwest Virginia, it’s an eight-plus hour drive to get to Richmond. That’s not attainable for a lot of students. In May, we did a roadshow ‘impressions camp’ where some VCU faculty members used our facilities to present a day-long program to area high schoolers. They got to take impressions on each other and make bleaching trays. It was a great introduction and was also a way for our students to connect with some people in admissions at VCU.”

“We need to start doing recruitment early on. When I talk to high school students, many of them say they want to go into the medical field, which tends to be code for ‘I want to be a doctor or a nurse.’ And that’s great; we need those. But we want them to start thinking about dentistry as an option too.”

What Does the Future Hold?

“In five years, maybe we will be able to grow to offer a hygiene program at Mountain Empire as well. And for adding DAII certification, collaborative partnerships like the one we have with

Germanna Community College could be beneficial to spread to other schools throughout the state. That way, we have more training centers for DAII and hygiene.”

In the meantime, new and established programs around Virginia can use assistance in the form of donations, adjunct instructors, and offices that welcome students to do clinical rotations. “Maybe your office has expired materials – you can’t use them in clinic anymore, but our manikins won’t mind. If you get samples and can’t use them, that’s an opportunity to donate. A lot of times, if you call up a faculty member, they’ll come to you to take it off your hands.”

Editor’s Note: Dr. Emily Bowen can be reached at EBowen@mecc.edu

Mountain Empire Community College Dental Assisting Program

High school students participate in dental explorer day at Mountain Empire Community College

SOCIAL MEDIA TRENDS AND TIPS FOR 2023

Michaela Mishoe, Account Coordinator at The Hodges Partnership

To leverage social media platforms for your practice, it’s important to keep your ear to the ground and stay informed of new social media trends. While some changes may be difficult to predict, such as how Elon Musk’s acquisition of Twitter led to a frenzy in the tech world, we are able to forecast how app updates, consumer behavior, and past and current trends may impact platforms.

Here are some social media trends and best practices for 2023 to help guide your marketing strategy.

Short-Form Videos Will Continue to Increase

TikTok and Instagram Reels aren’t going away. Social media platforms make money by keeping people on the platform so they can be shown ads, and creative videos keep people engaged. While there is still a mystery behind how the Instagram algorithm works, Reels and videos get rewarded by Instagram by getting pushed up in newsfeeds more often as compared to static posts. In 2021, Instagram for Business reported that 91% of surveyed active Instagram users said they watch videos on Instagram at least once a week, indicating that videos are reaching audiences and are becoming more popular on the platform.

If creating Reels or videos sounds daunting to you, Instagram has simple editing tools that allow you to string together multiple photos, use effects and filters, and add music clips to create fun and engaging content. Keep in mind that new content will also be prioritized in feeds, so if you’re hoping to increase your views and engagement, make time to create posts on a regular basis. Remember to follow HIPAA guidelines whenever you’re sharing visuals of your office to protect your patients and your staff.

Educate

According to the Global Web Index, the average number of social media accounts a millennial or Gen Z (postmillennial) has is 8.4 worldwide, and each of those accounts is packed to the brim with information. For your content to break through all the clutter, it must add value. Creating content about yourself, your staff, and your practice is a great place to start when establishing yourself on social media platforms, but what information can you give your audience that adds value to their lives and establishes you as a resource?

Take advantage of observances such as National Gum Disease Awareness Month in February or National Dental Hygiene Month in October to emphasize oral health. You could also reshare educational content coming from the VDA or ADA or highlight new dental

VDA Secretary-Treasurer Dr. Zaneta Hamlin’s practice, Cusp Dental Boutique in Virginia Beach, does a great job of posting a few times a week on Instagram. The content is thoughtful and creative without being repetitive. There is a mix between staff photos, creative Reels, patient testimonials, and exciting milestones and accomplishments. (Photo Credit: Cusp Dental Boutique Instagram)

studies that would be relevant to patients. However, if you decide to educate your audience, make sure your content is engaging, concise, and easy to understand for those unfamiliar with dental terminology.

Collaborations with Providers and Micro-Influencers

Micro-influencers are everyday people with smaller audiences that tend to be loyal and highly engaged. There are a few ways you can identify and engage with influencers in your community. You can search through online influencer marketplaces such as Izea or Aspire, see who has tagged other businesses in your community for other campaigns, or use hashtags to find influencers in your area. A Google search also can be a powerful tool. Collaborating with an influencer could involve a visit for their routine checkup, and sharing that experience with their followers. You also could partner with a family influencer for National Children’s Dental Health Month to highlight the importance of oral health for children. (Note: there often will be a fee when working with influencers and using influencer marketplaces.)

Consider a collaboration with other healthcare experts. Record a virtual discussion or have them come to your office to discuss a topic that your

followers would find valuable, such as the correlation between gut health and oral health, the importance of preventive care, or even cosmetic dentistry. These videos could address common questions or give users an overview of issues. Another way to make the most of your partnerships is taking advantage of Instagram’s “Collab” feature. An Instagram Collab post allows you to tag partners and influencers in a single post that appears in both of your Feeds or Reels for free. When you create a Collabs post, you’re making it easier for users who follow your partner/collaborator to find your Instagram profile and interact with your content.

Switching Up Social Media Platforms

Has your practice been posting the same content on the same pages? The New Year is the perfect opportunity to revisit your platforms and decide what stays

This is an example of an Instagram Collabs post between Richmond Virginia Orthodontics and Richmond Virginia Orthodontics Pediatric Dentistry. It will show up in feeds for both accounts’ followers. It’s also a great example of a post that educates by providing valuable information about taking advantage of insurance benefits before the end of the year. (Photo Credit: Richmond Virginia Orthodontics and Richmond Virginia Orthodontics Pediatric Dentistry)

and what goes. As a business account, you have access to analytics and can see how your well your posts have been performing and how many followers you’ve gained. You can compare this data against the previous month or even the previous year to determine what’s working and what’s not. If you’re not seeing the growth you would like to see, it may be time to put your time and energy towards another platform. Another way to take advantage of analytics is to see what kind of posts perform better than others. For example, you may notice that educational Reels are outperforming other posts. This could be a sign to add more educational content to your editorial calendar. It feels like you need to follow a rulebook when it comes to your social media presence, but as the trends change, so can you.

Be Authentic

A final trend for 2023, and maybe the most important one, is that authenticity is paramount. Creating fun, unique content to share on social media can be a great way to communicate your values and expertise as a practice. But, make sure you never lose sight of the mission behind your message.

DENTAL DETECTIVE SERIES

DDS:DentalDetectiveSeries

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VDA MEMBER PERKS ANNOUNCES EXPANDED ENDORSEMENT WITH iCORECONNECT

Elise Rupinski, VDA Director of Marketing and Programs

The VDA Member Perks Program and the Virginia Dental Services Corporation Board of Directors are pleased to announce the addition of five new services from iCoreConnect to the endorsed vendor portfolio. Building upon the endorsement of iCoreExchange HIPAA-compliant encrypted email in 2015, the addition of iCoreRx cloud ePrescription software in 2020, and the endorsement of iCoreVerify automated insurance verification in 2021, VDA Member Perks chose to endorse iCoreConnect’s full cloud-based software platform to provide its members with the tools needed to increase productivity and profitability.

“After several years of positive member experiences with their HIPAA-compliant email, ePrescribing, and automated insurance verification services, we are pleased to expand the offering to include new recommended services.”

– Dr. Frank Iuorno Jr.

member experiences with their HIPAAcompliant email, ePrescribing, and automated insurance verification services, we are pleased to expand the offering to include new recommended services. The team at iCoreConnect is dedicated to helping dental offices run efficiently and dedicated to providing VDA Members with exclusive savings on these helpful services.”

VDA Member Perks endorses the following iCoreConnect products:

• iCoreRx allows doctors to electronically prescribe all medications, including controlled substances. They can prescribe from any location using any internetconnected device. Doctors have direct access to drug dosing and contraindication information to care for their patients efficiently and safely. Meets all state and federal requirements.

• iCoreVerify automates the insurance verification process, checking every patient on the schedule beginning a week in advance of their appointment. Staff can now spend their time on patient care and revenue-generating tasks instead of spending 20+ hours a week dealing with payors.

• iCoreCloud offers HIPAA-compliant backup of all data and is stored in iCoreConnect’s world-class, secure data centers.

Medical coding for dental procedures doesn’t need to be complicated.

iCoreCodeGenius takes the complexity out and helps ensure your patients get the care they need, and you get insurance payments on time and in full.

• iCoreExchange allows doctors to transmit HIPAA-compliant encrypted email with no file size restrictions.

iCoreExchange enables practices to share patient information securely and safely with anyone in or outside of the network.

• iCoreHuddle analytic software aggregates massive amounts of real-time data to a simple dashboard that lets practices see and act on the metrics that matter most to their revenue.

• iCoreHuddle+ provides expanded iCoreHuddle capabilities to include detailed practice metrics, including recall status, production numbers, new patient count and outstanding A/R, treatment plan potential, and lists. Doctors will be able to use this actionable information to set goals and track daily, weekly, monthly, and annual progress.

• iCoreIT Managed IT services, ensures your hardware and software protections are up to date and that your network is monitored for vulnerabilities and attack indicators.

Frank Iuorno, Jr., D.D.S., President of the Virginia Dental Services Corporation, noted, “The VDA Member Perks program has been working with iCoreConnect since 2015. After several years of positive

• iCoreCodeGenius provides doctors with rapid, accurate ICD-10 medical coding and dental cross-coding.

Additionally, all iCoreConnect solutions integrate with most major practice management systems in the United

States, expediting processes, improving patient safety, and better protecting the dental practice.

Robert McDermott, President, and CEO of iCoreConnect commented, “The VDA is a terrific organization, and its subsidiary, the VDSC, works hard to vet any product or service they endorse. The fact that they now have more than doubled the number of iCoreConnect endorsed products is yet another confirmation of the quality and reliability of our software and services. The iCoreConnect platform has proven itself as a leader in solving the biggest issues related to staff shortages, workflow efficiencies, and identifying revenuegenerating opportunities.”

VDA Members receive exclusive savings on the full range of iCoreConnect services. Find out more at www.icoreconnect.com/VA10 or call 888-810-7706 to schedule a demo today.

REDUCE COSTS AND BOOST PROFITS

DENTAL SOFTWARE FOR SOLO PRACTICES TO DENTAL SERVICE ORGANIZATIONS

Robert McDermott, President and CEO, iCoreConnect

One of the biggest challenges a dental practice faces is the amount of time it takes to manually verify insurance. Many dental offices are already finding themselves short-staffed. Most practices assign at least one staff member to insurance claims, for at least 20 hours per week. You’re paying a staff member to make phone calls rather than provide support or patient services. You may also be losing money on uncollected payments.

The challenges of taking care of insurance verifications and other business are not limited to small practices. If you manage or own a couple of locations or are a DSO, who’s helping optimize your workflows and maximize your revenue growth?

With the end in mind, practices (especially DSOs and multi-location practices) must overcome the following additional challenges to revenue success:

• Managing multiple locationsConsistency and conformity, when it comes to managing crucial business tasks, especially those that generate revenue, are essential. That means standardizing, across all locations, methods for validating insurance, filing claims, billing patients, and collecting payments. With multiple procedures and multiple timelines at different locations, revenue can be difficult to predict and cash flow management becomes a struggle.

• Ensuring business continuityStaffing issues sometimes mean a practice may be without the dentist, hygienists, or front desk staff to maintain existing client loads. Business continuity then becomes a revenue issue. Additionally, if you aren’t continually assessing revenue and productivity in your single practice or across all locations, then

money is just sitting unclaimed, and revenue is lost.

• Patient Retention- In the same way that staff may leave during a major transition, the same is true of patients, especially as new procedures or policies take effect. Most people don’t like change, and this is definitely true when it comes to their health and dental care. This means you want to be prepared strategically and financially to run your business well.

DSOs Need Better Ways to Streamline Business

For many small practices or practices with a couple of locations, even the move to a DSO is an effort to reduce costs. The principal idea is that shifting non-clinical tasks to a shared centralized business office promises to reduce costs for dental practices.

A DSO’s primary focus is the business and administrative tasks associated with a dental practice. The proactive DSOs identify ways to speed up standard, repetitive required tasks like coding, billing, patient and provider communications, and dental insurance verifications.

Thankfully, there are solutions on the market that can improve the dental care workflow helping you maximize staff, cut costs, and realize more revenue.

Automated Dental Insurance Verification for Cost Savings

Automated processes are lauded across all industries for their ability to improve efficiency and boost productivity. They simplify repetitive and time-consuming tasks, freeing up your team to work on other initiatives and tasks.

In dental practices, one of the most time-

consuming non-clinical tasks is dental insurance verification. From gathering initial patient information to working with and calling, insurance providers to confirm coverage, verify information, and rectify errors, your staff spends nearly 30 hours a week on these tasks. Imagine what you could do with another nearly full-time employee without the overhead. How would that productivity and those cost savings allow you to grow your organization? Automating dental insurance verification can be as good as gaining an extra employee without hiring one.

But automated dental insurance verification solutions do more than save you money. A truly comprehensive software solution can also help identify revenue and treatment opportunities based on patient benefit allowances. Not only

“For many small practices or practices with a couple of locations, even the move to a DSO is an effort to reduce costs.

The prinicpal idea is that shifting non-clinical tasks to a shared centralized business office promises to reduce costs for dental practices.”

do you free up time and resources and save money, but you also improve overall patient care.

Revenue Analytics to Boost Profits

Identifying opportunities for patients to utilize their benefits means revenue for your dental practice or practices, but that’s not the only untapped revenue opportunity. When you review revenue analytics, often there are unfulfilled treatment plans and uncollected accounts.

With revenue analytics tools, you can stay on top of patient eligibility and coverage, ensuring your patients receive the treatment they need, and you can schedule it before they leave.

In addition to unrealized insurance revenue, there are tools which pull realtime data from your practice management software and present you with a simple-to-

use, easy to visualize dashboard of your revenue metrics, allowing you to focus on missed revenue opportunities.

Driving growth and boosting revenue isn’t a single-solution goal, Few things in a dental practice are. That means finding the right tools and the right solutions to help you meet your growth and financial goals.

Making the right strategic business decisions is why DSOs and private dental practices turn to VDA Member Perks-endorsed iCoreConnect platform of products to boost productivity and increase revenue. Cloud-based iCoreVerify automated insurance verifications and iCoreHuddle practice revenue analytics will revolutionize the way you do business. If you’re ready to cut costs and boost revenue, while improving patient care and experience, book a demo today at iCoreConnect.com/VA9!

VDA Member Perks endorses the entire iCoreConnect product platform for dentists. VDA members receive big discounts on all endorsed iCoreConnect products.

ETHICS AND PROFESSIONALISM

Dana Chamberlain, DDS

As you might expect, the process of gathering information for this article began with a “Google search” for dental ethics. One quickly discovers that ethics is a broad, confusing, and complex subject. Answers to ethical questions frequently contain the phrase “it depends.” We would hope that ethics could be clearly based on “universal truths”; however, the reality is that religious, cultural, and situational variations can modify these truths.

than a standard of grooming and dress or public behavior. Being a member of a learned profession confers on us certain privileges as well as corresponding responsibilities.

The key idea is that “as a professional, patients, who are vulnerable, can count on us to serve them well. Our patients do not understand their dental situation deeply and must rely on us to care for them. In fact, they must trust us to tell them what they need to know and to do an excellent job. They have no effective way to evaluate what we did, so they must assume we did the right thing. This difference in the power and informational dynamics of the relationship is what makes it unique and makes professional behavior so important.”

The authors describe five components of their definition of professionalism.

these two concepts are defined by our profession.

Third, in exchange for our autonomy, we have an obligation to be competent and trustworthy. As Dr. G. V. Black wrote, “Every professional person has no right to be other than a continuous student.” This implies a “social contract”. If the public is to trust us, we must be trustworthy. Should we, as a profession, misbehave and lose that trust, legislators and lawyers may choose, for the public good, to write more restrictive rules.

I was fortunate to stumble across a working draft of the 2017 edition of the “Dental Ethics Primer” written for dental students and residents by Drs. Bruce Peltier and Larry Jenson. I am basing this article on their section on professionalism and the nature of professions. While I have attempted to use enough of my own verbiage and understanding to avoid plagiarism, I give them total credit for their clear discussion of the topic.

The concept of professionalism is an integral part of Dental Ethics and is more

First, professionals possess valuable and exclusive expertise that is rare and requires years of difficult training, at considerable expense to learn and maintain. We use materials and instruments that are unavailable to the public, and our skills are of considerable value to the community. Professionals refrain from taking advantage of their status for undue personal gain. Our specialized expertise and status constitute a monopoly that is protected by licensure under the law.

Second, we are allowed to practice autonomously. While insurance plans may seem to try, no one outside of dentistry tells us how to practice. Of course, some laws may appear to be written to constrain dentistry; however, their purpose is to, for the public good, ensure that we practice within a Standard of Care and our Scope of Practice. Fortunately,

Fourth, “professionals create a structure for themselves in the form of professional organizations such as the American Dental Association” to provide a formal platform to set standards and ensure that members are trustworthy and to safeguard the profession in the public interest. They also provide codes of conduct and set standards for continuing education.

Fifth, at times, dentists must be willing to make sacrifices of their personal interests in order to serve their patients properly and accept these greater-thannormal risks.

1. Health Risk: Denying patient care due to the patient’s infectious disease would be considered unprofessional except in rare cases.

2. Legal Risk: Every patient encounter carries the risk of malpractice litigation.

3. Financial Risk: The business of dentistry is unique from other forms of commercial enterprise. We have duties to our patients that can be somewhat independent of their financial status. Their health and well-

“The key idea is that ‘as a professional, patients, who are vulnerable, can count on us to serve them well. Our patients do not understand their dental situation deeply and must rely on us to care for them.’”

being come first. Money, while important, is secondary.

4. Inconvenience and Personal Discomfort: Patient’s needs can occur at any time and are not isolated to normal business hours. “Dentistry is physically, emotionally and mentally challenging” and often takes a toll on the dentist’s body.

5. Levels of Uncooperative Patient Behavior: Many patients are lovely people who manifest their anxiety and fear of dentistry with poor behavior.

The authors summarize this chapter with a brief discussion of a few qualities that true professionals can be counted on to share. Professionals have mastered their skills and continue to sharpen and develop those skills throughout their careers. Professionals posses a service orientation. They focus primarily on the service they can provide to the public, and they tend to make a good living by doing so. Professionals manage their own behavior and the behavior of fellow practitioners on behalf of the public. Professionals refrain from taking advantage of their status and do not hustle the public or make false claims.

Professionals remain fully present when interacting with patients and do not allow themselves to be distracted.

While this section was only a small part, I found the whole “Dental Ethics Primer” to be an informative and easy-to-understand handbook and can recommend it to anyone seeking to better understand the subject of ethics.

Editor’s Note: Dr. Chamberlain, a VDA member, serves on the staff of the Appalachian Highlands Community Dental Center in Abingdon.

DO YOU KNOW HOW TO PREVENT FINANCIAL FRAUD IN YOUR DENTAL PRACTICE?

Phil Nieto, Best Card

Embezzlement in the practice is something that most dentists prefer not to think about. Your team members often feel like an extension of your own family, and it can seem like betrayal to consider that they could be stealing from you. However, over the course of their career, it’s estimated that between 20%-60% of dentists will be affected by fraud.

Best Card, the endorsed credit card processor of VDA Member Perks and the ADA Member Advantage Program, works with thousands of dental offices. Unfortunately, every year we uncover embezzlement in some of our member dentists’ practices. We know that dentists are busy and may not have the time or

experience to know where to start in preventing embezzlement in the practice. With that in mind, we’ve compiled some tips that every dentist can implement today to minimize the risk of becoming a victim of embezzlement.

The nature of fraud changes constantly, but the steps that you can take to minimize your risk also accomplish two very important things: you get to verify financial details in areas of the practice that can be high risk and show staff that those high-risk areas are being monitored to minimize the opportunities to commit fraud. To accomplish these goals, let’s review some steps to implement in your office.

Do this now -

Utilize the security functions of your practice management software. Dental software can be very helpful in running your business and ensuring that finances line up correctly; however, the number of offices that do not use their software capabilities to protect themselves from fraud is staggering. When looking at your dental software, you should always have two different settings in place. First, you, as the owner, should be the only person with the highest-level user permissions. Second, you should use those permissions to set up audit logs for all data entries and changes made to records in the software. Audit logs (or audit reports) are a record of activities

performed by the users, so it makes it MUCH easier to track if fraud is occurring. Example: If you had a person in your practice who was pocketing cash payments made by patients and then deleting balances due so that the patients weren’t double charged, turning on an audit report would show receivables being adjusted or written off without being paid!

Do this every day -

Check every day to see if there were any returns to patients in cash, check, or credit card, and scrutinize those returns to make sure they are legitimate.

The vast majority of payment activity in your practice will be patients paying you for providing dental services, while you should rarely be paying your patients via refunds. Since returns can be fraudulently exploited, this is a great area to review daily.

• As a rule of thumb, returns owed to the patient should always be made with the same payment method as the original payment. For example, a credit card payment should be returned to the same card as the original transaction. Any returns that don’t fit this rule should be well documented.

• Verify that all returns correspond to off-setting sales and are consistent with expected balancing for the practice.

• The average dental office nationwide runs 0.5% of transactions as returns – so on average you should have 1 return for every 200 sales. If you have significantly more returns than this, it may be worth checking on your billing practices and the legitimacy of those returns.

Do this weeklyWeekly audits should include a highlevel review to ensure that the practice

finance numbers are consistent. While it’s true that any inconsistencies could be a sign of fraud, it’s a great reason to talk to your front office or finance staff and get a better understanding of the normal procedures and systems in place in the office. Remember, the perception that you understand the practice operations well enough to prevent fraud is a huge deterrent to embezzlement.

supplies/services ordered are not excessive.

• While micro-managing every aspect of your practice might not be practical, getting into the habit of taking just a few minutes a day to keep an eye on things could save you from potentially serious losses down the road.

Best Card is the endorsed credit card processor of ADA Member Advantage and VDA Member Perks and saves the average dental practice $4,221 (28%) per year on their credit card processing fees while also offering outstanding customer service and streamlined solutions that can auto-post payments to a variety of dental software. If you’re interested in what they can do for your practice, call us at (877) 739-3952 or email them at Compare@BestCardTeam.com

• Pick at least one day of the week and make sure that your payments received (cash, credit card, check) balance to your daysheet, and that all bank deposits match your daily credit card settlement reports and accounts receivables. Be sure to follow up on any inconsistencies.

• Review any vendor invoices to ensure payments match and

“Your team members often feel like an extension of your own family, and it can seem like betrayal to consider that they could be stealing from you. However, over the course of their career, it’s estimated 20%-60% of dentists will be affected by fraud.”

HOW CAN FINANCIAL PLANNING SOFTWARE HELP YOU PLAN FOR RETIREMENT?

Jimmy Pickert, Portfolio Manager; ACG Worldwide

How much money will you need in retirement? How much can you afford to spend each year? These are tricky questions because of the unknowns and surprises that the typical retiree may encounter in the decades that follow their working years. That list of unknowns is seemingly infinite: life expectancy, health care expenses, investment returns, and inflation are just a few variables that every retiree must consider. What if you change your mind seven years into retirement and opt to buy that vacation home after all? What if philanthropic giving becomes your top priority later in life? These contingencies abound for almost every retiree and figuring out what is and isn’t possible can seem daunting.

Fortunately, technology has come a long way in recent years to enable retirees to build a plan for retirement that is unique to their expectations and concerns. Financial Planning software doesn’t provide crystal ball insights into what the market will do next or how long someone will live, but it does allow someone to be informed about what is possible in retirement.

Using planning software provides several distinct advantages when it comes to planning. Before diving into those advantages, it’s useful to understand a more rudimentary approach.

The Four Percent Rule

The four percent rule is a quick calculation to determine what you can draw from your portfolio each year. Take the total value of your portfolio and multiply it by four percent. Congratulations—you’re done. According to the rule, that number is how much you can sustainably draw from your portfolio each year in retirement, adjusted for modest inflation. The four percent rule came from Financial Planner William Bengen in 1994, after studying stock data

from 1926–1976. His analysis determined that withdrawing four percent annually from a retirement portfolio would leave a retiree with enough money for over 30 years.

While the four percent rule is a ballpark estimate of retirement readiness, its simplicity is also a flaw because it fails to account for the nuances of the average retiree’s finances.

Another confounding issue with the four percent rule is that many retirees might want or need to spend different amounts over the course of their retirement. They might aspire to spend more in their early retirement as they are catching up on travel and long-deferred hobbies. In the middle phase of retirement, many retirees see their spending decrease as they stay closer to home and spend more time with their families. In the later stages of retirement, increased expenses related to health care and assisted living may expand a retiree’s budget to surprising amounts. With such a variable cost of living, it is impractical to rely on the four percent rule throughout retirement.

The Modern Approach to Planning

Modern planning software simplifies the unique nuance and complexity of a retiree’s plans.

Here is how it works. Along with the guidance of your financial advisor, you consider everything relevant to your financial life:

• Assets: this includes your investment portfolio, real estate, business interests, insurance policies, and anything else that might apply to your situation.

• Liabilities: your mortgage, auto loan, and any other debts that sit on your balance sheet.

For instance, a retiree can draw their Social Security retirement benefit any time between ages 62 and 70. The longer one waits, the higher their monthly benefit will be. If someone retires at 65 and wants to delay Social Security benefits until 70, they might have difficulty calculating what they can draw from their portfolio between ages 65 and 70. Presumably, it is OK to withdraw a little bit more than four percent in the first five years if you withdraw less than four percent thereafter, but by how much?

• Retirement income sources: social security, rental property income, etc.

• Expenses: This depends on your expectations in retirement. Is it your goal to simply maintain your current standard of living, or do you want to maintain that and begin traveling more? Perhaps you want to pay for a child’s wedding in 10 years or include a legacy bequest as part of your goals. Be as creative as you want, because the goal is to build upon what’s possible.

“Financial Planning software doesn’t provide crystal ball insights into what the market will do next or how long someone will live, but it does allow someone to be informed about what is possible in retirement.”

After entering this data into the planning program, you’re ready to run the forecast. The most common forecasting methodology is Monte Carlo Simulation.

Contrary to the name, Monte Carlo Simulation is not a gambling exercise. It is a statistical process in which many trials (let’s say 1,000 trials for our purposes) are run using our previously discussed inputs. In some of these inputs, you may be able to fund all the expenses or goals that you have listed, while in some trials you may run out of money before every goal can be funded. The number of successful trials achieved in the simulation translates into a percentage probability of success—900 successful trials out of 1,000 is a 90% success rate.

Why are we getting different results if we use the same inputs each time? Because our simulation is controlling for one of the biggest, and yet underappreciated, risks in retirement: Sequence of Return Risk. This refers to the phenomenon that, while we might be able to estimate the longterm return of your portfolio over the long run based on the amount of risk you’re taking, the actual returns your portfolio experiences in any given year may be well above or below that long-term average. This doesn’t matter when you’re still working and accumulating assets, but once you retire and begin to draw funds from your investments, experiencing a bad sequence of returns can have a detrimental impact on the success of your retirement. It is much better to experience strong returns early in your retirement and bad returns later than vice versa. Experiencing a bear market early in your retirement can be particularly devastating if your portfolio is taking on too much risk. No one can predict the sequence of their investment returns, and Monte Carlo Simulation controls for this uncertainty.

Monte Carlo Simulation is a huge advantage offered by modern planning technology that is lacking in simpler approaches from the past. In addition, the ability to make quick changes, and build out different scenarios (adjusting investment strategy, taking Social Security at a different age, etc.) is extremely helpful in cutting through complexity. Planning software also enables the retiree to stress test their preferred scenario: can I spend what I want in my 60s even if I have unexpected long-term care needs later in life? What happens if Social Security gets cut? What happens if we deal with above-average inflation in my retirement? If you can conceive of the threat, it can be modeled using planning software. Finally, a retiree’s plan can be saved and revisited over time to make sure he or she is still on track and to update one’s goals as priorities change in retirement.

Important Disclosure Info: acgwealthmanagement.com/importantdisclosure-information

GROWTH AND ADVANCEMENT THROUGH CHANGE

Lyda Sypawka, Associate Editor; Class of 2024, VCU School of Dentistry

VCU School of Dentistry has recently improved its curriculum, giving students a more clinically based experience. The class of 2024 was the first class to experience these changes and advancements, and their responsibility included providing constructive feedback on the modifications. The school and students were able to learn together, and the results were proven through students’ abilities and knowledge both clinically and academically in the following years.

Throughout the D1 year, preclinical courses were accelerated towards the end of the spring semester and focused on fixed prosthetics. Students are challenged through multiple crown prep technical assessments and the associated didactic course exams. This change in curriculum allowed students to advance their hand skills and baseline knowledge of fixed prosthodontics, creating a strong

foundation for upcoming courses and clinical experiences.

During the D2 year, an Advanced Restorative and Digital Dentistry course was added with the intention of an increased focus on digital and esthetic dentistry. Students had the opportunity to have hands-on experience with veneers, staining, glazing, milling, 3D printing, and digital scanning. Students were very enthused about the course, and its addition was a huge success.

The D2 Clinical Dentistry course was also altered to give students more clinic time and exposure. Every Thursday, D2 students would shadow, assist, and work with a D4 student assigned to them at the beginning of the year. D2 students also had requirements for procedures completed during their clinic time. These requirements included dental dam placement, local anesthetic administration, and operative procedures.

Once the class of 2024 transitioned to clinic, it was obvious they had a stronger footing and were more comfortable with the change in curriculum. Their experiences the previous year provided an understanding of protocols the school has in place for various procedures and specialties. Students were also more familiar with the faculty assigned to the general practice clinic, creating a more harmonious transition.

As a student from the class of 2024, I was very grateful for the extra time I spent building a strong preclinical foundation. The preparation allowed me to maximize my time in clinic. I now have an understanding of the expectations, protocols, and procedures. I am excited to see where my education will take me next.

VCU School of Dentistry, Class of 2024

MOM IS BACK

Barbara Rollins; Director of Logistics, VDA Foundation

For several years MOM events were curtailed as the risks from COVID-19 outweighed the benefits of the free dental care provided by MOM. While COVID is still with us, the risks of delivering dental care in a large group setting were judged to be manageable by the Virginia Dental Association Foundation’s Board of Directors, and MOM project plans moved forward. As such, “MOM IS BACK!” became the rallying motto, and the number of MOM events increased to nine projects in 2022. Through those nine MOM (and Mini-MOM) projects, some 1,029 patients across the state received over $1.3 Million in free dental care.

Not only was the number of MOM events increased, but the underlying structure of MOM projects was also broadened by developing partnerships with several nonprofit safety net clinics, including Appalachian Highlands Community Dental Center (2020;Abingdon), Chesapeake Care Free Clinic (Chesapeake), and Central Virginia Health Services (Petersburg). Hence the Mini-MOM model was born, where MOM supported oneday dental clinics respectively. With an increase in the number of communitybased Mini-MOM clinics, a single-day MOM event is now an excellent way to substantially decrease the clinic’s patient backlog for extractions and fillings. Because clinics already have the required

equipment, there is no need for the large transfer of portable equipment necessary for a larger event, like the projects held in Wise. The funding needs are also substantially lower. And, because the clinics are located throughout the state, travel time for the volunteers is significantly reduced, which opens the pool of potential volunteers. A 2021 survey of Virginia dentists found that volunteers would be more willing to participate in MOM projects if they did not require long-distance travel and being away from home for several days.

Appalachian Highlands Community Dental Center (AHCDC) is a unique Mini-MOM where Dr. Scott Miller and Dr. Stephen Alouf, through the clinic’s residency program, hold three Mini-MOM projects annually, one extraction clinic in the Spring and two denture clinics later in the year.

On average, 100 complete dentures are delivered to over 50 patients per event. Drs. Miller and Alouf, previously the lead dentists for the Wise MOM Denture Team, along with the AHCDC GPR residents, can now help return smiles to many more Southwest Virginia residents.

In addition to returning to the annual Special Olympics MOM and Wise MOM projects, the first one-day Piedmont Smiles MOM was held at Warrenton High School gymnasium in Warrenton after months of planning and rescheduling. This

partnership with Fauquier Free Clinic and the support of the PATH Foundation and the VCU School of Dentistry and Dental Hygiene provided 211 patients with 1,297 dental procedures, which included exams, X-rays, extractions, fillings, and root canals.

After MOM’s 2-year absence in Wise, the patient turnout was diminished, possibly due to a surge in COVID cases in the area, concern about gathering in large group environments, and the high price of gas to travel at the time. The good news is that time allowed for each Southwest Virginia patient who did attend Wise MOM to receive more dental treatment than in previous years. The average value of dental care provided was $1,252.57 per patient (a 54% increase from 2019). Wise MOM will be in full swing at the UVA College at Wise Convocation Center, July 28-29, 2023.

While COVID made us pause MOM events for a while, we used the time and what we have learned at recent MOM events to evolve into a broader array of formats for MOM-sponsored events. We are continuously reviewing needs and requirements to see what other forms can be used for MOM and Mini-MOM projects. The goal is to provide dental care to as many patients as possible. Please join us as a MOM volunteer or partner with us to host a mini-MOM project!

Tara Quinn and Vickie Brett

Dr. Elizabeth Reynolds and Dr. Carole Pratt

Michelle McGregor and Kevin McGregor

HOMECOMING

MOM RETURNS TO WISE AFTER THREE YEARS ABSENCE

Madelyn Lawrence; Class of 2025, VCU School of Dentistry

Nestled in the Appalachian Mountains, in the southwest corner of Virginia, is a small liberal arts college–The University of Virginia’s College at Wise. To passersby, the town of Wise looks like every other rural, small town. What they don’t necessarily see are the local Ma ‘n Pa restaurants, the stunning hikes and outdoor activities, and most importantly, the family-like community of the local residents. I have experienced all these things, as an alum of UVA-Wise. It’s a beautiful place, and I have many wonderful memories of my time there, but none more life-affirming than my experiences with the Mission of Mercy (MOM) project hosted by the VDA.

During the summer of 2019, I was living in Wise and performing research, when I was fortunate enough to meet some visiting students from the VCU School of Dentistry. I learned that they were in town for the MOM project, providing free dental care to those unable to afford it. As I was a biochemistry major looking to pursue a career in dentistry, the student coordinators for the project were able to sign me up as a volunteer for the next day. I spent over 12 hours witnessing how dedicated caregivers provided free dental care to the underserved people of the local mountains and surrounding areas. Their smiles and sometimes

tears of gratitude solidified my passion for dentistry and led me to my bigger purpose of serving the underserved. It also conveyed to me the extreme need for accessible and affordable dental care in small, rural communities.

Now, two years later, I found myself returning to Wise to once again participate in the Mission of Mercy project, but this time as a student in the VCU

School of Dentistry. It’s hard to describe the joy I experienced in returning to my rural roots. In the short period of one year as a dental student, I found I had so much more to offer. Over the course of the two-day clinic, I was met with more challenges than I could have imagined. Yet my challenges seemed minor when compared to those experienced by the people we were serving. I felt connected to every patient that I interacted with, so it was heartbreaking to hear their stories and know that many more are in that same position, unable to access or afford basic dental care. Hearing each patient’s story only made it more rewarding to watch them leave with brand-new smiles and newfound confidence.

Remote and rural communities like Wise deserve the same accessibility and affordability to dental care as the rest of the country. Efforts like the MOM project are wonderful steps in the right direction, but there is so much need for more to be done. My resolve has grown, as I believe we all have a responsibility to provide dental care to everyone in need. I urge every dental student, dental hygienist, dental assistant, and dentist to volunteer at a MOM project, or a similar clinic. It will change your life for the better, just as it did mine.

Ms. Lawrence at the UVA-Wise Convocation Center

WELCOME NEW MEMBERS

THROUGH SEPTEMBER 1, 2022

Dr. Matthew Cawley – Norfolk – University of Pittsburgh School of Dental Medicine 2020

Dr. Brandon Duncan – Virginia Beach –Columbia University College of Dental Medicine 2014

Dr. Ezra Goldberg-O’Neil – Virginia Beach – State University of New York at Buffalo School of Dental Medicine 2020

Dr. Zachary Horace – Virginia Beach –Baylor College of Dentistry 2015

Dr. Kat Ligon – Chesapeake – Marquette University School of Dentistry 2009

Dr. Shelbi Young – Virginia Beach –Boston University Goldman School of Dental Medicine 2020

Dr. Tareq Abdul Rasoul – Richmond –University of Missouri-Kansas City School of Dentistry 2018

Dr. Velma Barnwell – Henrico – Howard University College of Dentistry 1983

Dr. Mohamad Fawaz – Richmond –Midwestern University College of Dental Medicine-Arizona 2022

Dr. Tyler Guido – Richmond – University of Connecticut School of Dental Medicine 2022

Dr. Katherine Hayes – RichmondUniversity of Missouri-Kansas City School of Dentistry 2022

Dr. Breanna Irizarry – Richmond –University of Connecticut School of Dental Medicine 2022

Dr. Jinju Kim – Richmond – University of Kentucky College of Dentistry 2022

Dr. Sarah Koury – Richmond – University of Pittsburgh School of Dental Medicine 2022

Dr. Charles Clemens – Rocky Mount –Virginia Commonwealth University School of Dentistry 1995

Dr. Wesley Gillette – Roanoke – University of Minnesota School of Dentistry 2022

Dr. Bintou Mariko – Lynchburg – Temple University The Maurice H. Kornberg School of Dentistry 2022

Dr. Elizabeth Stapleton – Roanoke –Virginia Commonwealth University School of Dentistry 2020

Dr. Elisabeth Combs – Christiansburg –University of Louisville School of Dentistry 2020

Dr. Ryan Munton – Radford – LECOM College of Dental Medicine 2022

Dr. Sepehrdad Badei Fereidani –Williamsburg – Texas A&M University College of Dentistry 2022

Dr. Alan Booth – Hampton – University of Pittsburgh School of Dental Medicine 2022

Dr. William Cheng – Hampton – New York University College of Dentistry 2013

Dr. Kyle Orr – Newport News – Missouri School of Dentistry and Oral Health 2017

Dr. Kane Louscher – Richmond – University of Iowa College of Dentistry 2022

Dr. Vishnu Obulareddy – Henrico –University of Pennsylvania School of Dental Medicine 2022

Dr. Alyssa Patterson – Richmond –Columbia University College of Dental Medicine 2022

Dr. Robert Rudnicki – Richmond - Texas A&M University College of Dentistry 2021

Dr. Matthew Barrick – Charlottesville –Virginia Commonwealth University School of Dentistry 2019

Dr. Holly Legg – Harrisonburg – Virginia Commonwealth University School of Dentistry 2016

Dr. Candice Logan – Chesterfield –University of Connecticut School of Dental Medicine 2019

Dr. Sunny Bae – Fairfax – Case Western Reserve University School of Dental Medicine 2018

Dr. Zainab Baker – Spotsylvania – University of Maryland Dental School, Baltimore College of Dental Surgery 2022

Dr. Julia Bronson – McLean – Midwestern University College of Dental Medicine 2015

Dr. Bryan Choi – Fairfax – University of Louisville School of Dentistry 2016

Dr. Robert Guanci – Fairfax – University of Detroit Mercy School of Dentistry 2016

Dr. Curtis Henderson – Arlington –Marquette University School of Dentistry 2022

Dr. Viet Huynh – Fairfax – Virginia Commonwealth University School of Dentistry 2022

Dr. Jayden Kwak – Fairfax – University of Pennsylvania School of Dental Medicine 2020

Dr. Rebecca Lee – Fairfax – University of Michigan School of Dentistry 2001

Dr. Benjamin Lin – Arlington – University of Maryland Dental School, Baltimore College of Dental Surgery 2020

Dr. Zohra Madad – Fredericksburg - Howard University College of Dentistry 2021

Dr. Stephanie Mark – Sterling –University of Pennsylvania School of Dental Medicine 2021

Dr. Jasmine Mohandesi – Fairfax –University of Pennsylvania School of Dental Medicine 2017

Dr. Mohammad Moien Monzavi – Loudoun - Columbia University College of Dental Medicine 2022

Dr. Ann Nardozzi – Vienna – Rutgers School of Dental Medicine 2015

Dr. Tina Nguyen – Gainesville – LECOM College of Dental Medicine 2022

Dr. Mohamad Osman – Arlington –University of Pennsylvania School of Dental Medicine 2019

Dr. Daniel Pinto – Fairfax – State University of New York at Buffalo School of Dental Medicine 2016

Dr. Craig Rainer – Prince William – Meharry Medical College School of Dentistry 2012

Dr. Kristen Riehl – Loudoun – Virginia Commonwealth University School of Dentistry 2021

Dr. Adrian Rudiak – Arlington – New York University College of Dentistry 2019

Dr. Chaghayegh Sobhani – Loudoun –Columbia University College of Dental Medicine 2022

Dr. Brandon Tran – Fairfax –University of Pennsylvania School of Dental Medicine 2021

Dr. Jorge Vivoni – Dumfries – University of Puerto Rico School of Dental Medicine 2005

IN MEMORY OF:

Name City Date Age

Dr. Curtis G. Bennett Cary, NC 9/27/22 86

Dr. John Dwight Bradshaw Suffolk 11/17/22 78

Dr. David D. Childress Danville 7/5/22 61

Dr. Marshall C. England Maryville, TN 9/21/21 89

Dr. Thomas R. Geary Yorktown 1/9/22 82

Dr. Kurt Rolf McLean 10/18/22 68

Dr. Jeremy Shulman Virginia Beach 9/25/22 91

Dr. Harvey K. Thompson Courtland 8/30/22 76

Prac�ces for Sale

Loudoun County The prac�ce generates over $500K per year in revenue. The cash flow is strong and pa�ent base is 100% FFS. There are 4 ops, digital x-ray, and a strong staff in place. Real estate is for sale which includes a nice apartment above the dental prac�ce that buyer can occupy or rent out.

Alexandria This prac�ce has 6 treatment rooms and consistently generates over $900K per year in revenue with a mix of PPO and FFS pa�ents. Located in highly desirable area.

Southwest Virginia Collec�ng $400K per year. 100% FFS pa�ent base. Free standing building for sale or lease. Seller flexible on transi�on. Lots of room for growth.

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.

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

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.

Southwest Virginia Charming southwest Virginia town with the real estate available. This prac�ce has 5 operatories and consistently generates over $300,000 per year with 95% FFS pa�ent base. This is a fantas�c growth opportunity.

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

Greater Tyson Endo Incredible growth opportunity in highly desirable area of Tysons. This prac�ce has a CBCT and laser. Mix of PPO and FFS pa�ent base with 2 very spacious operatories. Seller working very part-�me. Prac�ce is priced to sell.

Charlo�esvile Amazing loca�on. PPO/FF pa�ents. Great merger or satellite opportunity. Three operatories. Seller is re�ring.

Dr. Josh Pennington has acquired the prac�ce of Dr. Ma�hew Glasgow Blacksburg, Virginia

DENTAL ASSISTANT IIs BUILD CAPACITY AND PATHWAYS TO CARE

Sarah Bedard Holland; CEO, Virginia Health Catalyst

Incorporating dental assistant IIs (DAIIs) into your team could help you maximize the capacity of other dental providers and better meet the needs of your patients. Dentists that use a DAII in their practice report that their office capacity increased by as much as 30% and that the assistance contributed to more positive mental health and enjoyment of work.

DAIIs became a reality in Virginia in 2011 when, at the request of the Virginia Dental Association and other partners, the legislature directed the Board of Dentistry to codify the position. They are trained to perform additional dental operative duties, freeing the dentist’s time to develop treatment plans, deliver more extensive care, or see additional patients. It’s important to note that dentists remain in the driver’s seat for this service model; they perform the irreversible portions of the treatment and directly oversee the final product.

Outside of the dental clinic, DAIIs can help improve access to care in Virginia. Dental offices can accept more patients with the increase in both production and efficiency in treatment as a result of a DAII. This is especially important in rural

areas of Virginia where there are not enough dental providers to care for the entire population.

DAIIs must participate in a training program in order to be certified, but in 2021, the only DAII program in Virginia was at Germanna Community College (GCC) outside of Fredericksburg. Through connections on a Virginia Health Catalyst workgroup supported by ARPA (American Rescue Plan Act of 2021) funds from the Virginia Department of Health, staff at Mountain Empire Community College (MECC) in Big Stone Gap partnered with GCC staff to launch a companion DAII program in October 2022. The partnership will double the number of DAII graduates each semester and enable Virginians from Southwest Virginia to enroll in the program.

The success of this program could lead to a replicable curriculum model, and the ARPA funds could be leveraged to spread it throughout the community college system in Virginia. “We now have the opportunity to eliminate educational barriers and utilize other community colleges to provide the training closer to

home,” explains Dr. Emily Kate Bowen, the Dental Assistant Program Director at MECC.

“DAII’s are one piece of the puzzle that will help to improve access to quality oral health care in Virginia,” says Misty Messimer, the Dental Assisting and Dental Hygiene Program Director at GCC. Thanks to the partnerships and ARPA funding, we can support ideas to fit the remaining pieces together so that all Virginians have access to dental care and each member the dental team reaches their fullest potential.

Learn more here:

• GCC Program: www.germanna.edu/ dental

• MECC Program: https://www.mecc. edu/pathways/dental-assistant-iiexpanded-function-gcc-2/

• Virginia Health Catalyst workgroup: https://vahealthcatalyst.org/ future-of-public-oral-health/fpohworkforce-workgroup/

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Virginia Dental Association

3460 Mayland Ct., Ste. 110 Richmond, VA 23233

Abyde abyde.com | 800-594-0883 x1

ACG Wealth Management acgworldwide.com/vda | 800-231-6409

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

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

Best Card BestCardTeam.com | 877-739-3952

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

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

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

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

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

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

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

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

VDA Member Perks is a service mark of the Virginia Dental Association. VDA Member Perks is a program brought to you by the Virginia Dental Services Corporation, a for-profit subsidiary of the Virginia Dental Association.