Virginia Dental Journal Vol 101 #3 July - September 2024

SLEUTHS:

>>PAGE 9 VDA ANNOUNCES WISECHOICE HEALTHCARE ALLIANCE

IN THIS ISSUE

VOLUME 101, NUMBER 3 • JULY, AUGUST & SEPTEMBER 2024

COLUMNS

3 STAY ACTIVE AND GET INVOLVED

Dr. Dustin Reynolds

5 ARE YOU LISTENING?

Dr. Sarah Friend

7 THE ADA IS WORKING HARD TO ADDRESS MEMBER PAIN POINTS

Dr. Gary D. Oyster

9 VDA MEMBERSHIP: ANOTHER WISECHOICE

Ryan Dunn

FEATURE

13 TOOTH SLEUTHS

Dr. Elif D. Aksoylu

RESOURCES

17 DENTAL DETECTIVE SERIES WORD SEARCH

Dr. Zaneta Hamlin

21 VIRGINIA BOARD OF DENTISTRY MEETING NOTES - JUNE 21, 2024

Dr. Ursula Klostemyer

22 BOARD COMPLAINTS WHAT YOU NEED TO KNOW

Jamie C. Sacksteder

28 FACING A MALPRACTICE CLAIM? WHAT TO DO AND WHAT NOT TO DO

E. Andrew Gerner and Thomas L. O’Carroll

31 VDA MEMBER PERKS ENDORSES DENTAL HQ DENTAL MEMBERSHIP PLAN SOFTWARE

Karen Wood

43 INTRODUCING - VDA DENTAL MEDICAID BENEFITS LIAISON

Paul Logan

51 SAFEHAVEN: SUPPORT FOR THE DENTAL TEAM TO RECLAIM WORKLIFE BALANCE AND JOY

Dr. Bruce Overton

53 TRANSFORMING DENTAL OPERATIONS: THE ROLE OF AI IN STREAMLINING BACK-OFFICE FUNCTIONS

Robert McDermott

56 GOOGLE ANALYTICS 4 –WHAT YOU NEED TO KNOW

Paulyn Ocampo

57 ARTIFICIAL INTELLIGENCE AND DENTISTRY

Dr. Al Rizkalla

59 PROSITES IS NOW THE OFFICIAL WEBSITE HOST OF VDA MEMBER PERKS

Karen Wood

SCIENTIFIC

18 THROUGH THE LOOKING GLASS THE FANTASTICAL WORLD OF ORAL PATHOLOGY

Dr. Sarah Glass

40 PERIODONTICS ABSTRACTS

ADVOCACY

33 ADA DENTIST AND STUDENT LOBBY DAY: RECORD ATTENDANCE OF DENTISTS AND DENTAL STUDENTS CHARGE THE HILL

Laura Givens

34 VDA PAC UPDATE

Laura Givens

35 HAVE YOU HAD ENOUGH? THEN SHOW IT!

Dr. Bruce Hutchison

OUTREACH

61 VOLUNTEERING IN VIRGINIA’S FREE & CHARITABLE CLINICS

Rufus Phillips

62 HEALTHY SMILES FOR ALL: ORAL HEALTH INITIATIVES FOR VIRGINIA’S SPECIAL HEALTH CARE NEEDS PATIENTS

Dr. Brad T. Guyton

63 MOM CELEBRATES 25 YEARS OF SERVICE

Barbara Rollins

SHOWCASE

36 BOOK YOUR GREENBRIER ACTIVITIES NOW!

UNIVERSITY CONNECTIONS

65 REFLECTIONS FROM THE CLINIC: GROWTH, CHALLENGES, AND LESSONS LEARNED IN DENTAL EDUCATION

Anneliese Goetz

66 THE HEAD AND NECK EXAM REVISITED: INSIGHTS FROM VCU’S ORAL FACIAL PAIN AND ORAL MEDICINE CLUB

Kelsey Guraya

MEMBERSHIP

67 MEET THE CANDIDATES

71 NEW MEMBERS

VA DENTAL

JOURNAL

EDITOR-IN-CHIEF Sarah Friend, DDS, FAGD

BUSINESS MANAGER Ryan L. Dunn, CEO

MANAGING EDITOR Shannon Jacobs

EDITORIAL BOARD

VDA COMPONENT

ASSOCIATE EDITORS

BOARD OF DIRECTORS

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

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

PRESIDENT Dr. Dustin Reynolds

PRESIDENT ELECT Dr. Justin Norbo

IMMEDIATE PAST PRESIDENT

Dr. Cynthia Southern

SECRETARY-TREASURER Dr. Zaneta Hamlin

CEO Ryan L. Dunn

SPEAKER OF THE HOUSE

Dr. Abby Halpern

NDC CHAIR Dr. C. Dani Howell

COMPONENT 1

COMPONENT 2

COMPONENT 3

COMPONENT 4

COMPONENT 5

COMPONENT 6

COMPONENT 7

COMPONENT 8

Dr. David Marshall

Dr. George Jacobs

Dr. Samuel Galstan

Dr. Marcel Lambrechts

Dr. David Stafford

Dr. Marlon A. Goad

Dr. Caitlin S. Batchelor

Dr. Melanie Hartman

ADVISORY Dr. Lyndon Cooper

ADVISORY Dr. Ralph L. Howell, Jr.

ADVISORY Dr. Lorenzo Modeste

EDITOR Dr. Sarah Friend

VCU STUDENT Wendy Yu, VCU Class of 2025

VCU STUDENT Shalin Kapil, VCU Class of 2025

AWARD WINNING PUBLICATION

WINNER OF THE2020 SILVERSCROLLAWARD

VOLUME 101, NUMBER 3 • JULY, AUGUST & SEPTEMBER 2024

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

SUBSCRIPTION RATES VDA member subscriptions are included in your annual membership dues. No other subscription options are available.

POSTMASTER Second class postage paid at Richmond, Virginia. ©Copyright Virginia Dental Association 2024

MANUSCRIPT, COMMUNICATION & ADVERTISING

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

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

STAY ACTIVE AND GET INVOLVED

Dr. Dustin Reynolds

Greetings, fellow members! By the time you read this, we will be well into the dog days of summer. I hope that you each can take time away from your practice for family vacations and all the activities warmer weather brings as well as take time for yourselves for both physical and mental well-being. As I reflect on the past year that has flown by, like most do these days, I am grateful for the opportunity to have served as your VDA President. Together, we have accomplished milestones. I have had the opportunity to visit many of our component societies and am confident that the VDA is poised for success in the years to come!

I recently had the privilege of giving the commencement address to the dental and dental hygiene students at the VCU School of Dentistry’s graduation. It was a humbling experience to see this generation of healthcare providers take the next step toward what will be a rewarding and fulfilling career. During my address, I gave the graduates four pearls of wisdom that I think we should all apply to our lives.

Pearl Number One: Surround yourself with the right people, whether this is your office staff, colleagues, professional team of accountants and attorneys, or simply your friends. Mark Twain reminds us that we should “keep away from people who belittle your ambitions. Small people always do that, but the really great make you feel that you too can become great.” Find people in your circle that lift you up and support you.

Pearl Number Two: Reward yourself. Dentistry is a demanding profession both physically and mentally. One of my mentors told me that no matter what, once a quarter, do something other than dentistry. Whether it is taking a day off to spend time with your family, taking a hike, going fishing, going shopping, or taking a trip, a change of scenery can do the mind and body good.

Pearl Number Three: Build on the foundation that you have learned in dental school. Graduation signifies the beginning of your career. The education received in school provides you with enough knowledge to be dangerous. Be sure to stay up to date on continuing education and technology. Dentistry is constantly evolving and changing. Never stop learning. A new chapter in life is like a clean slate, full of possibilities and opportunities. Do something today that your future self will thank you for.

Pearl Number Four: Become involved in organized dentistry. Keep your membership active in the national, state, and local dental associations. Organizations such as the VDA are the voice of organized dentistry where, often, accomplishments and advancements are made behind the scenes. Local and state government officials rely on organizations like ours to provide insight, advice, and information on subject matter most know nothing about. Remember, there is strength in numbers. The VDA has successfully sponsored legislation that literally allows us to practice with the best interest of our patients, staff, and community in mind. If we do not continue to stand up for ourselves so that our voices are heard, you can bet that there will come a time when we no longer have these freedoms, and we will be told how to practice.

I want to add one additional pearl of wisdom to this list. I recently attended the funeral of my childhood best friend’s mother, who passed suddenly and unexpectedly. While we were gathered during a time of sadness, we were also there to celebrate the life of a woman who touched so many. As the pastor gave the eulogy, he made the comment that we often measure a person’s life by the number of years they were here on Earth. Other times, their life is measured by the number of children, grandchildren,

or nieces and nephews they had. I was reminded that this would be an inaccurate way to describe the life someone lived. Rather, we should measure a person’s time on the third rock from the sun by the amount of LOVE they gave. I encourage each of you to be remembered not by the number of years you have been in your profession or here on Earth but rather by the amount of love you have shown to your families, patients, staff, communities, friends, and to yourselves.

During my time as President, I have enjoyed being able to connect with other like-minded individuals both here in the Commonwealth as well as in North and South Carolina which, along with Virginia, make up the 16th District. I am looking forward to exciting collaboration opportunities! In addition to our neighboring colleagues and our wonderful members, I cannot say enough about our incredibly talented staff at VDA Headquarters! We have the best staff in the world, and they have been a pleasure to work with. I encourage each of you to make it a point to get involved and attend VDA events so that you make this association your own. Organizations are often like other areas in life in that you truly get out what you put in. Engage your peers by encouraging membership, and make sure that you utilize all the available resources so that you get the most out of your membership. My time in leadership has been rewarding and fulfilling, both personally and professionally. Despite the lack of compensation and the insane amount of time this position requires, I still encourage you to become involved in leadership! There is much work left to be done and many challenges we will continue to face. I thank each of you for being the reason that the VDA is such a wonderful community supporting organized dentistry in the Commonwealth. I look forward to seeing each of you in September at The Greenbrier for our Dental Showcase! God Bless!

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ARE YOU LISTENING?

Dr. Sarah Friend

On a recent May day, my husband and I set out early one morning to move our daughter out of her college dorm for the summer. As my husband carefully wrapped the hand truck in a moving blanket and secured it in the truck bed, I noticed that it resembled a dead body. After I verbalized my observation, my husband responded, “Well, it might be by the end of the day.”

We’ve done this a few times already, and it’s never an experience we look forward to. We are arthritic, overweight, and out-of-shape Gen Xers. Climbing and descending multiple flights of stairs while carrying heavy loads in high heat differs from our idea of fun. Combine that with fighting hours of stop-and-go traffic on I-81, inadequate parking, and dealing with the emotions of an exam-weary, sleep-deprived, and hangry teenager, and something is bound to give. Inevitably, things never go to plan. We would be “dead,” figuratively speaking, by the end of the day.

Several hours later, just two barrels and one rocker short of being ready for an episode of The Beverly Hillbillies, we were on our way back home. Typically, once fed, the daughter puts in her earbuds and sleeps the whole way home. She is not a talker. Neither am I. That day, though, she talked the entire trip, which ended up being a couple of hours longer because of traffic. Carefully listening, I gleaned a lot of information and perspective on how she and her friends in Generation Z are making career choices. The members of Generation Z, also known as Gen Z, the iGeneration, and Zoomers, were born between 1997 and 2012. This group of individuals is expected to overtake the Baby Boomers in the full-time workforce. You might wonder what this has to do with dentistry. I’ll get to that.

My daughter grew up in a family made up of healthcare professionals. She has heard the good, the bad, and the ugly about medicine, dentistry, pharmacy, and nursing her entire life. Her longterm goal upon entering college was to prepare to go to medical school to be a dermatologist. Shortly after her first semester, the tide changed. She’d experienced the ramifications of a weed-out class and exams with content she’d never seen and didn’t know. She

“Zoomers can provide us with additional innovative ideas to help us successfully make the changes needed to improve and preserve our profession.”

to dental school. The daughter became discouraged. I’d walked a similar path at the same institution thirty years ago. I knew what she was feeling, but I didn’t want her to give up on achieving her career goals because of one class. Medicine and dentistry can be gratifying careers. The daughter is also acutely aware that the proceeds of jobs in healthcare are paying for her education and that her lifestyle has been better than many of her peers because of dentistry. There have been many conversations and more tears since that first semester. Fast forward to going into her third year, and my daughter has now completely given up on a healthcare career, as have some of her friends. She’s known some of these friends since middle school, and they have won awards for their contributions to research and innovative ideas for the future of medicine. Notably, their parents were also in healthcare. These Zoomers are now pursuing degrees in technology. I wanted to know why these brilliant young minds were changing, so I asked.

and her friends spent countless hours studying and preparing yet did not get their expected return for their efforts. They were convinced the professor gave challenging exams for sport, as his reputation on social platforms preceded him. There’s nothing like the feeling of tanking your GPA in the first semester of college, knowing full well that an almost perfect GPA is needed to be competitive in gaining entrance to coveted healthcare programs. Some people will tell you that it now takes a higher GPA to get into dental school than medical school, which is the reverse of when I applied

My daughter’s first statement was, “Because it’s depressing”. What? That made no sense. Just a few minutes prior, she had excitedly told us that she had taken part in a few medical studies to earn extra spending money and was fascinated by them. I was expecting her to tell me that she didn’t want to have to deal with death or delivering bad news. She explained that she and her friends spent an extraordinary amount of time and energy studying, leaving little time to enjoy life as a young adult. One friend she knew was essentially working an unpaid, full-time research position on top of a full class load to boost her odds of getting into her desired healthcare program. That friend was exhausted and burned out, and she had not even graduated college yet. The daughter had met several medical

students at the gym and said they were always tired, and even though they were young, their hair had already started turning gray. The daughter could not see herself spending the next decade of her life trading her mental and physical health for a profession that would continue to demand so much of her even beyond her initial education. Every resource I consulted regarding her generation noted that Generation Z is a hard-working generation that prioritizes mental health and overall well-being. They also aim to make work fit their lifestyle as they recognize that life is more than work.

Zoomers also aspire to achieve financial milestones relatively early in their careers. According to Forbes, “Gen Z usually prefer industries that tend to boast higher salaries, especially from the entry-level, including tech and consulting, both of which are dominated by world-famous companies within Big Tech and the Big Four.” My daughter had also been talking to cousins who, with only an undergraduate degree, made twice what I make as a seasoned general dentist. These Zoomers are well-informed and well-connected, with access to information and decision trees that many of us could not have imagined tapping into during our youth. The daughter went on to expound on all the TikToks she had watched where medical and dental students and graduates would talk about the extraordinary amount of debt they incurred pursuing their careers and the daily professional and financial stresses they faced. She was afraid of taking on so much debt early in life. The financial riskrewards balance on the healthcare vs. tech scale had also tipped and played into the decision. “Oh, Mom, I was going to forward you some of these discounts and freebies for healthcare professionals, but you’re a dentist and don’t qualify. I think you’re more of a doctor than a nurse. That’s just not fair.”, she said. Stab to the heart.

As we rolled and scrolled, a social media post in one of my dental groups mentioned that dentistry had dropped to #70 on the US News and World Report’s 100 Best Careers of 2024. Just eleven years ago, we were ranked #1.

Why? What’s changed? In this post, our colleagues at all career stages opined all kinds of reasons. The most frequently cited ones were insurance, corporate dentistry, physical and emotional stress, inflation, workforce issues, and debt. Each of these things affects me and my colleagues daily.

According to the American Dental Education Association, the average reported debt for indebted students in the class of 2023 was $296,500. I’ve seen a much higher range of indebtedness other graduates have posted on social media platforms, some approaching a million dollars. According to studentloanplanner.com, which ranked the top 30 professions with the highest student loan repayments based on a standard 10-year repayment plan, the top six positions were awarded to orthodontists, periodontists, oral surgeons, endodontists, pedodontists, and general dentists. These numbers can be very off-putting to a young person researching careers and factoring in debt into their decisions based on published data.

Dentistry and medicine are suffering from various outside burdens beyond our direct control, which have created a wave of frustrating challenges for our professions. As a result, those of us already in the profession are suffering. We are also losing interested and talented young people to industries that offer a better work-life balance, less mental and physical stress, and similar income to general dentists without the barter of their youth and finances for a degree. According to Rachel Wells, a contributor at Forbes, Gen Z “forces employers to do one of two things: either adjust to the wave of young talent which is set to dominate a 30% share of the global workforce by 2030 or remain stuck in tradition and refuse to change. The downsides are evident. If employers want to remain relevant and maintain their employer branding to attract fresh, innovative talent, they must move with the time and embrace change, adapt to Gen Z’s expectations, and respect their concerns.” We all agree that we must grow and maintain dentistry as a healthy

profession for future generations. Gen Z is right. It makes sense to want to pursue a low-stress profession with an excellent work-life balance and a high income without mountains of debt. It is also in the best interests of dentistry, medicine, and our communities to want to continue to attract the best and the brightest to take care of us. When Gen Z speaks, we should listen. Maybe, if we pay attention and ask for their help, Zoomers can provide us with additional innovative ideas to help us successfully make the changes needed to improve and preserve our profession.

References

https://blog.dentalnachos. com/dentists-are-dropped-70career#:~text=In%20a%20plot%20 twist%20that,left%20your%20 anesthetic%20at%20home.

https://blog.vantagecircle.com/ espectations-gen-z-employees/

https://money.usnews.com/careers/ best-jobs/rankings/the-100-best-jobs

https://www.adea.org/GoDental/ Money_Matters/Educational_Debt.aspx

https://www.forbes.com/sites/ rachelwells/2023/10/29/is-gen-z-askingfor-too-much-how-gen-z-is-definingthe-future-of-jobs/

https://news.stanford.edu/ report/2024/02/14/8-things-expect-genz-coworker/

https://www.studentloanplanner.com/ jobs-highest-student-loan-payments/

THE ADA IS WORKING HARD TO ADDRESS MEMBER PAIN POINTS

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

As we are moving into the summer and vacation months, it is important to know that your ADA keeps on working for you.

The ADA Member App is moving forward and helps graduates explore career paths and contact seasoned colleagues for mentoring. As the app continues to evolve, it will become an important membership service for young dentists, allowing them to communicate with colleagues throughout the country.

The ADA continues to educate federal policymakers and lawmakers on how to support Medicaid rate increases both financially and administratively. Efforts are also underway to work with the Centers for Medicaid and Medicare Services to make Medicare a reasonable option for dentists to participate in for the elderly population. The ADA emphasizes that oral health is essential for overall health, and it must be administered differently than the medical Medicare program.

Dental insurance reform, including Dental Loss Ratios (DLR) at reasonable percentages, is gaining traction in many state legislatures. This is a consumer issue and is already included in medical insurance and even medical Medicaid policies, at 85%.

Another membership benefit of the ADA is support in navigating insurance claims. This is the number one pain point for most dentists.

There is also legal support with contract analysis and employment best practices. This is an advantage for both the buyer and seller of a dental practice.

For the young dentists, offerings range from career guidance and job alerts to current opportunities in the career center.

Dental sound bite podcasts created for dentists by dentists, with real talk about dentistry’s daily wins and sticky situations, are helpful in countering some of the misinformation often found on social media.

“Another membership benefit of the ADA is support in navigating insurance claims. This is the number one pain point for most dentists.”

be accessed within these directories and tools.

Member discounts can save time and money with top-quality products and services for your practice and personal life. The ADA is going to work with the tripartite system to expand the products and services offered and as you transactionally use them, your membership dues will be reduced.

The ADA is striving to be the place for members to go for their needs. It is going to be the premier place for oral health information, both for its members and the public.

The ADA Standards and Seal program is being enhanced by the merger with the Forsyth Institute. This merger has created a worldwide research entity that will enhance the status of the ADA and will be a source of non-dues revenue.

ADA leadership opportunities are also being expanded by the Strategic Task Force work groups. These groups will perform like a task force with short-term obligations to recommend solutions for a specific problem. ADA Councils and Commissions will remain in place to deal with more comprehensive issues.

The ADA is very involved with resource directories and tools to manage stress. Wellness has become an issue for many dentists due to workforce issues, government policies, and insurance overreach. Crisis support can also

IT’S LIKE ONE-STOP SHOPPING, JUST FOR INSURANCE .

R.K. Tongue, Co., Inc. is exclusively endorsed by the Virginia Dental Services Corporation to provide insurance and employee benefits to VDA members. In addition to offering vetted products and services, VDA members uniquely qualify for discounts and programs that may equal or exceed the cost of membership.

When you make R. K. Tongue your agent/broker, R.K. Tongue provides financial support to the VDA’s Virginia Dental Services Corporation. You can support the cause and benefit from all the following:

MALPRACTICE AND COMMERCIAL INSURANCE

Professional Protector Plan

Malpractice & Office Insurance Program

• Discounted rates for VDA members

• Coverage for cosmetic Botox administration

• Additional discounts available for bundling with practice property insurance

HOME AND AUTO INSURANCE

• Exclusive discounts for VDA members, staff, employees, and family

• Multiple carriers shopped on your behalf by experienced brokers

INDIVIDUAL DISABILITY AND LIFE INSURANCE

• Access to the Top Carriers in the dentist-specific, own-occupation marketplace

• Experienced brokers to help VDA members obtain new policies or update and increase existing coverage even if obtained from another broker

HEALTH INSURANCE & BENEFITS

WiseChoice Virginia Healthcare Alliance: Explore great benefits and lower healthcare costs by becoming part of a large, self-funded group.

Small Business Special Enrollment Period: begins November 15. Group plan – contribution and participation requirements waived.

Medicare Annual Enrollment Period:

Dedicated brokers for VDA members looking to enroll in or make changes to Medicare Supplement plans

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.

VDA MEMBERSHIP: ANOTHER WISECHOICE

Ryan Dunn, CEO

The Virginia Dental Association is excited to announce an exclusive offering to our members that may be the health insurance solution for you and your team. The VDA has joined the Virginia Chamber of Commerce’s WiseChoice Healthcare Alliance. This unique offering was created by business and community leaders for the purpose of offering competitive, employer-based group insurance to members of local chambers and associations, like the VDA.

The WiseChoice Alliance offers a selffunded employee healthcare benefit plan to eligible employer groups with 2-50 employees. The Alliance has partnered with Anthem to provide a portfolio of health benefit options that are unique to these small businesses. While the benefits and plans that are offered may not be the best solution for all of our VDA members, this is a unique offering that will leverage the purchasing power of hundreds, and eventually thousands, of small businesses across the Commonwealth.

This Multiple Employer Welfare Arrangement (MEWA) model is similar to the association health plans that existed prior to the passage of the Affordable Care Act and allowed small businesses for whom it would otherwise be out of reach to offer employee healthcare benefits. Fully licensed and

“This unique offering was created by business and community leaders for the purpose of offering competitive, employer-based group insurance to members of local chambers and associations, like the VDA.”

regulated by the Bureau of Insurance, the requirements of the WiseChoice Alliance are the same as all insurers domiciled in Virginia. Through the partnership with Anthem, WiseChoice will provide members with the tools, resources, and financial protection to feel confident in their healthcare decisions. The Alliance is an important step forward in the expansion of access to better health coverage for small businesses, which account for over 90% of employers in the Commonwealth.

In addition to potentially saving VDA members money over their current health insurance offerings or providing the savings needed to allow your practice to offer health insurance for the first time, the VDA will benefit as well. For every VDA practice and individual that enrolls and finds WiseChoice to be a great solution, the VDA will receive non-dues revenue.

This is a great opportunity to help our members succeed, show value in VDA membership, and create long-term financial security for our association. All you need to do to find out if this is right for you is…USE, SAVE, SUPPORT.

WISECHOICE EXPANDS

ACCESS TO HEALTHCARE PLANS FOR SMALL BUSINESSES

EXCLUSIVE VDA MEMBERS OFFERING

USE

• This benefit is only for VDA members.

• 2-50 Employees.

• It’s easy to enroll. Simply check with our VDA Broker RK Tongue.

• Some experience 15-20% savings compared to current small group rate.

• It creates an opportunity for some to offer healthcare benefits for the first time.

• It allows you to remain competitive: You can attract the best workforce because prospective employees are looking for these benefits.

SAVE SUPPORT

• While taking advantage of group purchasing power, you can help sustain the VDA.

• VDA receives non-dues revenue for every person enrolled in a WiseChoice Alliance Plan.

Arlen B. Penfield, CfP | Vice President | PriVate Banking Officer t 804-249-2289 | m 804-418-2203 | arlen.Penfield@tOwneBank.net

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THE ROLE OF THE GENERAL DENTIST IN FORENSIC HUMAN IDENTIFICATION

Elif D. Aksoylu, DMD, MPH

Imagine this scenario: A deceased, unidentified individual in your community is presumed to be one of your patients. The county’s medicolegal death investigator contacts your office and requests dental treatment records and radiographs. What happens next? How is this information used? And most importantly, what is your role in the outcome?

Postmortem dental identification is a scientific form of human identification, alongside anthropological identification (comparison of skeletal imaging and medical hardware), friction ridge analysis (fingerprinting), and DNA comparison (Berman et al., 2013). Forensic odontologists are dentists with additional training in dental identification, dental age assessment, bitemark analysis/ comparison, and expert witness work for dental civil litigation claims.

A forensic odontologist will use the dental records you provide to either help confirm the identity of the deceased individual or exclude them as the individual in question. In the event of poor quality or quantity of antemortem evidence or postmortem remains, the case outcome may be classified as a “possible” identification or as having “insufficient evidence” for identification (Loomis, 2022).

All methods of human identification possess advantages and drawbacks. Two major disadvantages associated with the use of DNA and fingerprints include the need for both a reference sample and adequate soft tissue. A key disadvantage of anthropological identification is its reliance on medical records and radiographs. Therefore, dental identification is particularly useful in circumstances involving fragmented, incinerated, mixed, decomposed,

or skeletonized remains with poorly preserved, inadequate tissues that limit the use of other forms of identification (Berman et al., 2013).

Dental identification is also more expedient and economical than other forms of scientific identification (Loomis et al., 2018). Additionally, dental features are distinct from individual to individual (de Villiers & Phillips, 1998). Furthermore, teeth (and dental restorations) are exceptionally resilient relative to other tissues in the human body (Loomis et al., 2018). The calcium phosphate content in teeth (Lacruz et al., 2017) allows them to withstand extreme heat, cold, humidity, desiccation, and acidic environments with a high degree of fidelity, as demonstrated in Figures 1 and 2 (Loomis et al., 2018).

Note. Anterior teeth are the least protected by facial soft tissues (Source: American Board of Forensic Odontology [ABFO], 2016).

Note. 1.2-million-year-old maxilla of Paranthropus boisei (top) and 60,000-yearold maxilla of Homo sapiens (bottom) (Sources: ABFO, 2016; Schroer, 2011).

Forensic dental identification relies upon a skill dentists have used and honed in daily clinical practice for centuries: pattern recognition. Morphological features of the craniofacial complex can be compared from an earlier time (antemortem) to a later time (postmortem) to establish elements of concordance, identified as “consistencies” (Figure 3). This is typically achieved radiographically but can also be accomplished using photographs.

Figure 1. Resistance of Teeth to Thermal Destruction

Figure 2. Resilience of Hominin Dentition

Consistencies in Comparative Dental Radiography

AM and PM radiographs illustrating the matching morphology of alloy at #K (ABFO Image Series).

Note. Consistencies between these antemortem and postmortem radiographs include root morphology of the lower left first premolar (yellow arrows), and morphology of the alloy restoration at the lower left primary second molar (orange ovals) (Source: ABFO, 2016).

In addition to normal dentition, dental restorations, and dental anomalies, craniofacial elements used in comparison can include the palatal rugae, cranial shape, orbit and sinus morphology, fixation hardware, bony trabeculation patterns, and beyond (Figures 4, 5, and 6). Dental casts and removable appliances, such as full and partial dentures, orthodontic aligners, bleaching trays, and occlusal guards, are also useful to the forensic odontologist (American Board of Forensic Odontology [ABFO], 2016). The patient identifiers that accompany these items, such as names and identification numbers, can be particularly helpful as well for establishing a treating dentist and presumptive identification. As illustrated by Figure 7, even a single consistent, distinct feature present in both the antemortem and postmortem dental records can establish a positive identity.

Adequate antemortem records for use in comparison against the results of postmortem examination can promote positive identifications. This punctuates the importance of acquiring and

Figure 4

Antemortem and Postmortem Consistencies in Palatal Rugae

Note. Yellow arrows illustrate consistencies between the antemortem stone model on the left and the postmortem human remains on the right (Source: ABFO, 2016).

maintaining high quality radiographic images, treatment notes, and odontogram charting in day-to-day practice.

Positive identification of human remains is valuable for multiple reasons: closure for survivors, insurance settlements, estate transfers, adoption, remarriage

of a surviving spouse, and criminal prosecution (Berman et al., 2013). If you are asked for records of a patient involved in a medicolegal death investigation, consider the positive ramifications of providing those records, including both x-rays and treatment notes. Forensic odontologists work to identify the

Figure 3.

5

Antemortem and Postmortem Consistencies in Frontal Sinus Morphology

Note. Consistencies illustrated by red arrows (Source: ABFO, 2016).

Figure 6

Comparative Dental Radiography in the Absence of Dental Restorations

Note. Pulpal morphology (purple arrows) and bone trabeculation (green arrows) can be distinctive and help establish identity in the absence of dental treatment. (Source: ABFO, 2016).

Figure 7

Utilization of a Single Distinctive Dental Feature in a Human Identification

Note. This positive identification was made from a single dislodged alloy restoration postmortem (right), whose morphology is illustrated by the orange rectangles (Source: ABFO, 2016).

deceased and do not judge your dentistry. Every piece of evidence could help identify an individual. By collecting and maintaining comprehensive, accurate and timely dental records, you may one day provide a vital puzzle piece in the death investigation process. Laws dictating the minimum period dentists must retain patient records vary from state to state; consider keeping records beyond the minimum required by law. Your professional diligence has the capacity to give a name to an unidentified decedent and help return them to their loved ones.

References

• American Board of Forensic Odontology (2016). Image series [PowerPoint slides]. https://abfo.org/

• Berman, G. M., Bush, M. A., Bush, P. J., Freeman, A. J., Loomis, P. W., & Miller, R. G. (2013). Dental identification. In D. R. Senn & R. A. Weems (Eds.), Manual of forensic odontology (5th ed., pp. 75–127). CRC Press.

• de Villiers, C. J., & Phillips, V. M. (1998). Person identification by means of a single unique dental feature. Journal of Forensic Odontostomatology, 16(1), 17–19.

• Lacruz, R. S, Habelitz, S., Wright, J. T., Paine, M. L. (2017). Dental enamel formation and implications for oral health and disease. Physiological Reviews, 97(3), 939–993. https://doi.org/10.1152/ physrev.00030.2016

• Loomis, P. W. (2022). Human identification: Dental identification [PowerPoint slides].

• Loomis, P. W., Reid, J. S., Tabor, M. P., & Weems, R. A. (2018). Dental identification and radiographic pitfalls. In T. J. David & J. M. Lewis (Eds.), Forensic odontology: Principles and practice (pp. 25–46). Academic Press.

• Schroer, K. (2011, February 11). Developing models of premolar molarization in primates. George Washington University Center for the Advanced Study of Human Paleobiology. https://cashp. columbian.gwu.edu/developingmodels-premolar-molarizationprimates

Figure

DDS: Dental Detective Series

DENTAL DETECTIVE SERIES WORD SEARCH

Dr. Zaneta Hamlin

A B X V Q A Z S K E X S Z S K E H R B U F X Q X O O A K B X

H D K G U T A H Y P O A L L E R G E N I C V L K T H N Y H O

U T A C I I M C M O N O M E R K D T S O H R K X Z L O Y X E

S Y D C T O S K V D C T R E A S U R E R U U U Q X R F P M L

H Z V V Y N G G C J Z C I K U F S L P J B T S P C N U Z O E

L O O N E E Z S A T T R I B U T I O N W U Z I Z K W R W N C

E T C J H V A O A F E G Q J N I E E D N I E R W N R I I O T

T W A M B W H S M O U Y Q W Y E C L P E Z K Y D G E O Y L I

I W T E B F R O K X V N C U M V H Q O V H O H Z W F S U I O

N K E A E F B P O R T A B I L I T Y P E M I Y B A E A N T N

Q K H S N Y S J U R K E Y L Q T M N W G S C Q L Q R L T H T

Y O I L C L U L B A X X J E C Q N

Election

Tableau Monomer Advocate

SMILECON

TREASURER

AIRWAY

Treasurer

LOOKING GLASS THROUGH THE

Explore the Fantastical World of Oral Pathology

A 27-year-old female patient presents to the clinic for an initial oral examination. She states that she has never been to a dentist before and has recently noticed some facial swelling on the right posterior mandibular region. She reports no pain or discomfort during her clinical examination. A panoramic radiograph demonstrates a large, honeycomb, multilocular radiolucency causing displacement of tooth #31 and #32 and root resorption of tooth #30 and #29. What is your suspected diagnosis?

WITH DR. SARAH GLASS

Student: Cases are presented by Yash Patel, a third-year dental student at the Virginia Commonwealth University School of Dentistry.

A 67-year-old female presents to the clinic for evaluation of a painful, bulbous swelling on her upper lip. On clinical exam, the lesion is a palpable, well-defined, nodule on the upper lip with a slightly yellow appearance. What is your suspected diagnosis?

A 34-year-old female presents to the clinic for a recall appointment. The patient was seen 6 months ago and had no signs of oral pathology during that appointment. She is concerned about a mass on her left cheek that has been bothering her when eating. Clinical exam shows an exophytic, lobulated, and erythematous nodule on the left buccal mucosa. What is the suspected diagnosis?

1. The diagnosis is Ameloblastoma

This is a benign, locally aggressive neoplasm of odontogenic epithelium. Histopathology reveals an odontogenic tumor with islands of ameloblastic epithelium. Clinical manifestation occurs mainly during the 3rd and 5th decade for multilocular lesions. Patients may present with a slow growing expansile mass causing a painless and firm facial or intraoral swelling. Radiographic examination typically reveals an expansile radiolucent lesion with internal septation in a honeycomb or soap bubble presentation. The most common site of occurrence is the posterior mandible along the body and the ramus. Treatment consists of wide surgical excision of the lesion.

2. The diagnosis is Chronic Granulomatous Inflammation to Foreign Material

Histopathology reveals granulomas surrounding basophilic foreign material. A granuloma consists of lymphocytes, epithelioid histiocytes, and multinucleated giant cells. The foreign material appears most consistent with hyaluronic acid. This clinical presentation is a delayed complication of dermal fillers. Treatment is conservative excision with histopathologic examination.

3. The diagnosis is Pyogenic Granuloma. This is a reactive lesion typically in response to local irritation, poor oral hygiene, or hormonal factors. The most common site of occurrence is the gingiva, but pyogenic granulomas can also occur at the other sites in the oral cavity such as lower lips, alveolar mucosa, tongue and buccal mucosa. Histopathology reveals granulation tissue, with numerous blood vessels, fibroblasts, and inflammatory cells. Treatment is conversative excision with histopathologic examination.

VIRGINIA BOARD OF DENTISTRY MEETING NOTES

JUNE 21, 2024

Ursula Klostermyer, DDS, PHD

Board of Dentistry (BOD) President, Ms. Margret Lemaster, RDH, called the Board to order at 9:00 AM. Nine Board members were present.

There were no public comments.

All the minutes from the previous meetings in March, April, and May 2024 were unanimously accepted. Mr. Arne Owens, the Department of Health Professions Director, reported that the General Assembly is moving forward with regulatory actions. He stated that Governor Youngkin signed the budget and that the fiscal year will start on July 1, 2024. Twelve new full-time employees have been approved for assistance with licensing and processing work for all the boards. He mentioned they intend to make the licensing process as efficient and easy as possible. They already have contractors working on this process. One of their tasks is establishing comparable wages with other state agencies to ease retaining and hiring staff.

Mr. Rutkowski had nothing to report.

Ms. Sacksteder briefly reported on the American Association of Dental Boards (AADB) mid-year conference held in April in Chicago. One focus of the conference was to determine what dental boards need. Twenty-four states participated in the conference, and the AADB made it clear that all states have similar issues to work on. Ms. Sacksteder stated that the round-table discussions between the individual states were good.

Dr. Chaudhry informed the BOD about his attendance at the CDCA WREB CITA Exams. The board members accessed the exam process over a period of two days. He stated that the board examiners were paid for their efforts.

Ms. Barrett discussed the laws and regulation updates. The changes to the dentistry opioid counseling requirements were unanimously adopted. Before prescribing an opioid medication, practitioners must counsel the patient on the risks of addiction and overdoses, explain the reasons why the medication is necessary, suggest alternative treatment, and document this counseling in the patient’s medical record. Section 18VAC60-21-108 includes further details.

Many regulations on the Governor’s desk are still in progress, and some were proposed anywhere from two to five years ago. The question was posed as to whether or not to remove these long-held regulatory actions from the Governor’s or secretary’s office or present them again.

Recently, the regulation for training requirements for botulinum toxin injections for cosmetic purposes was enacted. Please see 18VAC60-21-55.

The Board has approved the new BOD calendar, which has been published.

Ms. Weaver introduced the disciplinary report. From February 1 to May 30, 2024,182 new cases were received. Two hundred twenty-five cases (including older cases) were closed without violation. Forty-five cases were closed with a violation. As usual, most cases closed with a violation were related to patient care, which included instances of improper diagnosis or patient treatment. In six cases, poor record-keeping was cited. One suspension of a dental license was issued. Ms. Weaver stated that the disciplinary team appreciated the reviews by the BOD members so cases could be evaluated promptly. She reported that they are fortunate that the disciplinary

team will receive a new coordinator to help with the workload.

Ms. Sacksteder advocated for the Board to reinstate its membership with the AADB. This membership should be supportive, as boards from different states can exchange their experiences in resolving issues. The BOD voted unanimously to rejoin.

The second item on Ms. Sacksteder’s agenda was the election of a Virginia Compact Commissioner. This item was crossed off on the copies distributed during the meeting and was not addressed.

Board member Dr. Bryant will end his second term. He expressed gratitude for serving on the BOD and said he would leave soon.

BOARD COMPLAINTS

WHAT YOU NEED TO KNOW

Jamie C. Sacksteder;

Executive Director, Virginia Board of Dentistry

HOW ARE COMPLAINTS RECEIVED AND PROCESSED?

Complaints are received through the enforcement division of the Department of Health Professions. Complaints are not received directly by the Board of Dentistry. Anyone can make a complaint. The Board also receives information through the National Practitioner Data Bank (NPDB), which will prompt investigations (malpractice settlements). All complaints are received through an intake coordinator through the Enforcement Division, and the following determinations are made: is there enough information to investigate the complaint (some complaints are anonymous and don’t contain enough information to move forward with an investigation), is the complaint within the jurisdiction of the Agency (unlicensed practice can sometimes fall to the Commonwealth’s Attorney), and does the complaint pose as imminent danger to the public (impaired practice).

Once it is determined that a complaint can be investigated, it is assigned to an investigator within the Enforcement Division (not an employee of the Board). Investigators will investigate the complaint and then submit the investigative report with evidence to the Board to determine if there is probable cause. A Board Member or the Dental Review Coordinator (Board Staff) will review the investigative report and evidence and determine if there is probable cause.

A determination about probable cause can be closed (no violation or undetermined), sent an advisory letter, sent for an informal conference, offered a Pre-hearing Consent Order (PHCO), Confidential Consent Agreement (CCA), or a Summary Suspension. The Respondent (licensee) will receive notification regarding the decision from the Board in the form of a letter (if the

case is closed) or in the form of a notice (if there is a finding of probable cause).

Please note that the investigation process of the complaint is not done directly by the Board of Dentistry, and therefore, any questions or concerns about the investigative part of the process should be directed to the Enforcement Division at the Department of Health Professions.

You can find a more detailed process here: Virginia Department of Health Professions - Enforcement Division at https://www.dhp.virginia.gov/ PractitionerResources/Enforcement/ TheEnforcementProcess/

The Respondent (licensee) will receive contact from an investigator with Enforcement. The licensee is required to cooperate with an investigation in accordance with 18VAC60-21-70.A.5. Once the case is received at the Board and reviewed for probable cause, the Respondent will receive communication regarding the decision of the Board.

HOW LONG DOES THE PROCESS TAKE?

“In 2023, The Department of Health Professions received 8,115 complaints, and the Board of Dentistry received 610 complaints.”

There isn’t a set timeframe. Each case is different; therefore, the processing time from start to finish may vary. The Agency thoroughly reviews every complaint, aligning with our mission to ensure safe and competent patient care. The Agency does have a goal of reviewing patient care (non-patient care cases can take longer) cases within 250 business days from receipt of the complaint.

There are no set investigators who just work on dentistry cases; investigators cover the entire Agency and 13 regulatory boards. In 2023, The Department of Health Professions received 8,115 complaints, and the Board of Dentistry received 610 complaints.

WHAT SHOULD I EXPECT IF I RECEIVE A COMPLAINT ON MY LICENSE?

Complaints are processed upon receipt, and the source (the person who complained) is notified by letter of the status of their complaint. When information received by the Department of Health Professions indicates a violation of law or regulation within this agency’s jurisdiction may have occurred, it is the responsibility of the Enforcement Division to obtain whatever additional information is needed to prove or disprove that a violation has occurred.

WHAT IS AN INFORMAL CONFERENCE?

An informal conference is comprised of two to three Board Members. You may hire an attorney to represent you, but you are not required to have an attorney at the informal conference. Neither the Board nor the Commonwealth will appoint an attorney for you. If you do hire an attorney, the attorney should notify the Board as soon as possible by a letter of representation.

In an informal conference, no witnesses will testify under oath. Still, there may be witnesses, but it is up to the Chair of

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the Committee to decide to allow anyone to testify, and there is no court reporter. If the committee chair allows for witnesses, neither you nor your attorney can crossexam the witnesses. In an informal conference, there is no cross-examination.

Any interested public (news media, source of the complaint, students from dental school, etc.) can attend the informal conference. The Special Conference Committee (SCC/Board Members), Board Staff, and Adjudication Specialist may ask you questions. You will have an opportunity to respond to the allegations.

A decision will be made regarding the case the same day. The SCC will go into a closed session, and everyone will leave the room except for Board Staff and SCC members. When the informal conference comes back into open session, then all other members can come back into the informal hearing and a decision is read to the Respondent (licensee).

There is no set time limit for the informal conference. The proceeding will be concluded when the Committee or Panel of the Board is certain that you have had the opportunity to be heard and that it has received and considered all evidence necessary to make a fair decision in your case.

You are not required to be present at your informal conference for the Board to hear the case and decide on your license. The Board will convene the informal conference whether you are present or not. If you do not appear, you will not have the chance to respond to any questions Board members or staff may have regarding the allegations against you.

If you want to attend but are unable to attend the informal conference on the scheduled date, you should request a continuance in writing as soon as possible. Please refer to your notice for filing deadlines and take note that you must provide “good cause” for not being able to attend. It is up to the Board to decide whether to grant or deny your request for a continuance.

WHAT IF I HAVE EVIDENCE THAT CONTRADICTS THE ALLEGATIONS MADE AGAINST ME?

When you receive notice of an informal conference or formal hearing, you will have deadlines listed on that notice to submit additional evidence. If you decide to bring evidence with you on the day of an informal hearing, then it will be the decision of the Chair of the Committee if they will accept the additional evidence; the Committee is not required to accept evidence that is not submitted by the deadlines listed on the notice. Please note that you will be required to have an adequate number of copies to give to the Committee, and the Board Staff will not make copies for you.

If you bring additional evidence on the day of the formal hearing, the Commonwealth (Assistant Attorney General) may object to the additional evidence and it will be the Chair of the Committee’s decision, based on the Board Counsel’s advice. Again, it is your responsibility to have the correct number of copies for the Board Panel to review. The committee will not amend PHCOs prior based on additional evidence. If you have additional evidence that you want the Board/Committee to consider, it must be presented by the deadlines in the notice, and it must be presented at an informal conference or formal hearing to be considered. Board Staff will not discuss or negotiate the allegations with you ahead of time based upon additional evidence; additional information must be reviewed and presented at an informal conference or formal hearing.

WHAT LEGAL STANDARD OF PROOF DOES THE BOARD USE IN CONSIDERING WHETHER TO FIND ME IN VIOLATION OF LAWS AND REGULATIONS?

The Board must find that disputed facts have been proven by “clear and convincing” evidence to find a Respondent in violation of applicable laws and regulations and to impose a sanction. This standard of proof is less burdensome than proof “beyond a reasonable doubt”,

which is the standard in criminal cases. In cases where an individual seeks a license or reinstatement of a license, the individual has the burden of proving that they meet the requirements for licensure or reinstatement and are safe and competent to practice, not the Board or the Commonwealth.

WHAT IS A FORMAL HEARING?

A formal hearing is similar to a courtroom trial. Witnesses testify under oath, and the proceedings are recorded by a court reporter. At a formal hearing, you may present any witnesses you believe may have relevant testimony. However, the formal hearing Chair may limit repetitive or irrelevant testimony. Board members are acting as triers of fact. The Assistant Attorney General serving as Board Counsel, Board Staff, Court Reporter, Adjudication Specialist, Assistant Attorney General serving as Prosecutor, Respondent (and Counsel, if applicable), and Witnesses will be at the formal hearing. The source of the complaint and any interested members of the public are allowed to be at the formal hearing.

The Commonwealth (Assistant Attorney General) and Respondent make opening statements, present documentary evidence, call witnesses, cross-examine the other party’s witnesses, make closing arguments, and present proposed findings of fact and conclusions of law. You may testify. The Hearing Chair rules on any objections and other motions with the advice of the Board Counsel. Board members, Board Staff, the Assistant Attorney General, or Adjudication Specialist may ask the Respondent or Witnesses questions.

A decision will be made regarding the case on the same day, or if a hearing is scheduled for several days, then it will be done on the last day. The panel will go into a closed session, and everyone will leave the room except for Board Staff, Board Members, and the Board Counsel (Assistant Attorney General). When the formal conference comes back into open session, then all other members can come back into the formal hearing and a decision

is read to the Respondent (licensee). There is no set time limit for the formal hearing. The proceeding will be concluded when the Committee or Panel of the Board is certain that you have had the opportunity to be heard and that it has received and considered all the evidence necessary to make a fair decision in your case.

You are not required to be present at your formal hearing for the Board to hear the case and make a decision regarding your license. The Board will convene a formal hearing whether you are present or not. If you do not appear, you will not have the chance to respond to any questions Board members or staff may have regarding the allegations against you.

If you want to attend but are unable to attend the formal hearing on the scheduled date, you should request a continuance in writing as soon as possible. Please refer to your notice for filing deadlines and take note that you must provide “good cause” for not being able to attend. It is up to the Board to decide whether to grant or deny your request for a continuance.

WHY DO SOME LICENSEES RECEIVE A CONSENT ORDER AND OTHERS DO NOT?

There are several different factors as to why a consent order is considered in lieu of a conference or hearing. The Board considers the egregiousness of the allegations and if there are previous Board Orders on whether to offer a PHCO. However, not all cases can be resolved by a consent order. In some cases, the Respondent (licensee) wants to surrender their license, which can only be done by a consent order.

IF I SIGN A PRE-HEARING CONSENT ORDER, DO I STILL NEED TO COME TO THE HEARING?

Typically, if you sign a consent order, it is in lieu of an administrative proceeding, and the pending informal conference or formal hearing will be canceled. However, please note that if the consent order is submitted close to the day of the scheduled proceeding, you must contact the Board regarding your need to appear. A consent order must be accepted by

the Board before it is considered a final resolution of the matter.

WHAT HAPPENS AFTER I HAVE HAD AN INFORMAL CONFERENCE OR FORMAL HEARING?

For Informal Conferences conducted by a Special Conference Committee: Although the decision may be announced at the conclusion of an informal conference conducted by a Special Conference Committee, the decision does not go into effect until 33 days following the date the order is signed and entered. During the 33 days, you may appeal the decision, and a formal hearing will be convened before the Board. Upon receipt of your appeal, the informal conference order will be vacated and will not go into effect. You will receive a copy of your order via USPS mail.

For Formal Hearings: Although the decision may be announced at the conclusion of a formal hearing, the decision does not go into effect until the written order is signed and entered by the Board. This is a final decision of the Board and may only be appealed to the circuit

court. The Board’s order includes the date it becomes final and deadlines for appealing the decision. Once a deadline has passed, your right to appeal has expired. It is your responsibility to ensure all paperwork is filed with the circuit court pursuant to Rule 1A:4 of the Rules of the Supreme Court of Virginia at https:// www.courts.state.va.us/courts/scv/ forms/pro_hac_vice_rule_inst.pdf. See also Guidance Document 76-20, The Adjudication Process. You will receive a copy of your order via USPS mail.

ARE THE BOARD’S DISCIPLINARY ACTIONS PUBLIC OR PRIVATE?

All notices of proceedings and orders are public information pursuant to Virginia Code § 54.1-2400.2(G) https://law. lis.virginia.gov/vacode/54.1-2400.2/ Notices and the resulting orders, which contain findings of fact and conclusions of law, will be published on the DHP website. If your case was ultimately dismissed following a proceeding, the notice will not be published on the Agency’s website, although it remains public information by law. However, on the

Agency’s website, the following statement will be posted to your license in the License Lookup section: This practitioner was the subject of a proceeding that did not result in disciplinary action. If you want further information, you may contact the [relevant Board]. Please see Guidance Document 76-10.17 at https:// www.dhp.virginia.gov/media/dhpweb/ docs/guidance/76-10.17.pdf

Please note that Confidential Consent Agreements and Advisory Letters are not considered disciplinary and, therefore, are not made public.

WHO WILL RECEIVE NOTIFICATION OF THE BOARD’S DECISION REGARDING DISCIPLINE?

The Board’s final decision is provided to the source of the complaint made against you pursuant to Virginia Code §54.1-2400.2 at https://law.lis.virginia. gov/vacode/54.1-2400.2/. Additionally, the decision is provided to the National Practitioner Data Bank. The decision will also be provided to other state boards.

Board decisions are posted on the Agency’s website in the License Lookup at https://dhp.virginiainteractive. org/Lookup/Indexsection pursuant to the Department of Health Professions Policy #76-1.17 at https://www.dhp. virginia.gov/media/dhpweb/docs/ guidance/76-10.17.pdf

IF MY LICENSE IS SUSPENDED OR REVOKED, CAN I GET MY LICENSE BACK?

If your license is revoked, you are eligible to apply for reinstatement after three years from the date of entry of the revocation order, pursuant to Virginia Code §54.1-2408.2 at https://law.lis. virginia.gov/vacode/54.1-2408.2/. If your license is suspended, the Order will indicate when you are eligible to apply for reinstatement. When you apply to reinstate your license following a suspension or revocation, the burden of proof will be on you to demonstrate to the Board that you are safe and competent to return to practice.

“You

We are pleased to announce

We are pleased to announce

Dr. Stevie Ervil has acquired the practice of Dr. Wes Anderson, Virginia Beach, Virginia.

Dr. Reed Chandler has joined the practice of Dr. Davis Gardner, Richmond, Virginia. (Pictured left.)

Dr. Arin Abrahamian has joined the practice of Dr. Thomas Lenz, Washington, DC.

someone considering a start-up or looking for an additional location. Operating just one day a week, consistently generating $200K in revenue.

Fairfax Fully digital and paperless practice generating around $300K per year in revenue on a mix of mainly PPO/FFS patients. 4 equipped ops with the ability to expand to 5, a personal office, digital x-ray, digital pano, and Intraoral scanner.

Loudoun County This lovely practice is located in a growing area with lots of potential. The practice generates around $550K per year in revenue on a mainly PPO patient base working only 3 days a week. 3 equipped ops with room to expand to four, digital x-ray, Eaglesoft dental software, and a strong staff in place.

revenue on a mix of PPO/FFS patients. There are 5 equipped ops with room to add 2 more, digital x-ray and digital PAN.

NOVA Ortho Modern practice with 4 chairs and room to expand. Mainly FFS patients. Collecting $500K/year. Very profitable. Fully digital. Real estate for sale or lease. Plenty of visibility, ample parking.

Lynchburg Area This practice has 4 equipped operatories with room for expansion. Generates over $500K in revenue per year with incredibly high cashflow. Patient base is FFS/PPO. Real estate is available for sale.

Roanoke Beautiful practice collecting $725K/year on a mix of FFS/PPO patients. Located in 3,000 sq/ft with 5 treatment rooms, plenty of storage, a private office

with bathroom, and staff break room with lockers. Digital and paperless.

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

Arlington The practice operates out of a 1,600 sq ft beautiful condo space that is also available for purchase. Collects $275K per year in revenue on a mix of PPO/FFS patients. 4 equipped operatories, digital x-ray, digital pano, and CBCT.

PRACTICE TRANSITIONS & ASSOCIATE PLACEMENT

FACING A MALPRACTICE CLAIM?

WHAT TO DO AND WHAT NOT TO DO

E. Andrew Gerner; President, R.K. Tongue Co., Inc. and Thomas L. O’Carroll, Hinshaw & Culbertson, LLP

It will happen. Virtually every practicing dentist will face either a malpractice claim, or the threat of a malpractice claim during their career. The good news is that if you have adequate malpractice coverage, there is a very low likelihood that you would ever face the risk of losing personal assets or significant consequences to your license.

Nonetheless, defending a medical malpractice lawsuit, without question, is stressful. Lawsuits may feel like they go on forever with no end in sight and only misery to look forward to in both the near and long term. You cannot let it get to you. Your job is to focus on the patient who is in your chair now and allow both the attorney and claims team of your malpractice insurance company to be the ones who are worrying about the claim. If and when that day comes, here is a list of dos and don’ts at the onset of a dental malpractice claim.

What to do:

• Contact your malpractice carrier immediately. It should be your first call. This is why you buy insurance. Trust them. Let the team give you guidance and allow them to select an attorney they know rather than someone you know. Let them do what you have already hired them to do. Not only is this your best move, but you are also likely contractually bound to notify the carrier as soon as possible. Do not fall into the trap of thinking this case is different from others. Your carrier will tell you if there is coverage, but failure to notify them could jeopardize your first and best line of protection.

• Thoroughly review the patient’s chart and your own notes to refresh

your memory of the case. This will help in assisting your attorney in building a defense. Be honest with your attorney and provide additional information, even if harmful, that may not be in the chart. It is better for the attorney to know bad facts up front rather than to get sandbagged during depositions.

• Create a file. You want to be informed on developments within the case. Your attorney should give you reports on court appearances, depositions, and major motions. The more you are informed of the case, the more you will feel a sense of control. You are contractually obliged to assist in your defense to maintain coverage. The more organized you are, the better you will feel that you have a handle on the case.

• Talk about an end game with the attorney. Even at the onset of the case, get your attorney’s impression on the likelihood that the damages could exceed your coverage. You also want to find out whether your policy requires your consent to settle the claim. Not all of them do. You need to know that any settlement, even minor settlements, is reported to the National Practitioner Database, which is shared by other insurance carriers and state licensing boards.

What NOT to do:

• Do not make any changes whatsoever to the medical records. Any change, whether you are adding to, deleting from, or otherwise making any alterations in a patient’s chart, even if it appears benign, is a good

way to turn a defensible case into a real nightmare. Cover-ups tend to be worse than the crime and this is a good way to really put your professional license in jeopardy. In the days of electronic medical records, even opening the chart creates a digital footprint.

• Do not contact the patient’s lawyer. When you get a request for medical records from an attorney, it may be tempting to try to convince the lawyer to see things your way and try to dissuade the attorney from bringing the case. Do not do it. There is nothing you can say that will dissuade the attorney; all you are going to do is give information that may be used against you. The law does not allow an attorney to contact an opposing party when they are represented, so there is nothing gained by speaking to the attorney.

• Do not talk about the specifics of the case. This is a qualified don’t. It is often cathartic to discuss the stresses and disappointments caused by litigation with significant others and colleagues who have been through the same thing before. However, there is no need to make any statements that are specific about a case that can come back to haunt you. You may be asked in a deposition to identify the people who you have spoken to about the case. The warning that one receives while under arrest applies just as equally in a malpractice claim: “Everything you say can and will be held against you in a court of law.”

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• Do not try to “win” a deposition. Attorneys will tell you that while you can certainly lose in a deposition, there is no way to really win one. Giving an answer based on what you think would be the best answer rather than your sincere recollection of events is always a bad idea. Most attorneys will tell you that “I do not remember” is a perfectly satisfactory answer almost all of the time.

• Do not believe that this case defines your career. It does not. The mere fact that a claim is filed against you does not mean that you are a bad doctor. The vast majority of cases reach a settlement or a judgment in the provider’s favor. Again, it is the attorney and claims team’s job to worry about the case—not yours.

• Do not expect things to move quickly. The average medical malpractice case could take four years. That is 10% of a forty-year career. Litigation is slow, and courts are burdened by large backlogs. Your attorney may not be focused on your case at all times, but if you trust your attorney, you also should trust that you will have your attorney’s focus when it is required.

Just seeing your name and your practice’s name on a summons can feel daunting. But you must keep in mind that your patients feel the same way when you give them bad news. Trust the team of professionals who are there to help you navigate this unfamiliar world the same way you would want your patients to trust you. Just like your patients who have initial anxiety and perhaps pain at first, you are going to get through it, and more times than not, you are going gain perspective and learn lessons that will only make you a better provider in the future.

VDA MEMBER PERKS ENDORSES DENTAL HQ DENTAL MEMBERSHIP PLAN SOFTWARE

Karen Wood; Director of Operations, Virginia Dental Services Corporation

VDA Member Perks is excited to announce a new partnership with DentalHQ. This collaboration brings together two amazing forces: DentalHQ award-winning dental membership plan software and the trusted network and benefits of VDA Member Perks, creating a partnership that enhances the success of dental practices across Virginia.

DentalHQ is renowned for its innovative dental membership plan software, which helps practices increase revenue, improve patient loyalty, and streamline operations. Their user-friendly platform includes some pretty powerful benefits, such as Guaranteed Plan Payments, advanced marketing tools, insightful reporting functionalities, patient financing options, and more. These features are designed to supercharge practice growth and profitability, making DentalHQ the most awarded solution on the market.

The Virginia Dental Services Corporation (VDSC), a subsidiary of the VDA, has been recommending top-tier products and services to its members since 1997. Through the VDA Member Perks program, members can access peerreviewed and endorsed vendors, ensuring peace of mind, special benefits, and discounted pricing.

This partnership offers VDA members exclusive access to DentalHQ’s cuttingedge software at a discounted rate, providing unparalleled support for their practices. By choosing DentalHQ through the VDA Member Perks program, members empower their practice management and contribute to the ongoing support of the VDA and its affiliates.

Dental membership plans benefit your practice and your patients. If you have

considered offering a plan for your practice, contact DentalHQ, and they can answer your questions. If you already have a plan that you are managing inhouse, consider having a conversation with DentalHQ about the efficiency and convenience of using their software platform to manage this for you.

For more information on how DentalHQ can benefit your practice and the exclusive discounts you will receive as a VDA Member, visit them at https:// www.dentalhq.com/vda-perks. And as always, you can contact me directly about any of the VDA Member Perks offers at: wood@vadental.org or 804-334-2285.

SUPPORT THE FUTURE OF DENTISTRY

It’s Time to Step Up Your VDA PAC Contribution!

The 2024 General Assembly Session was unquestionably the most successful session for the VDA in recent history. All legislation that the VDA supported has officially been signed by Governor Youngkin.

Transparency for Dental Insurance Carriers

Requires dental carriers to annually report their Actual Loss Ratio and the Board of Insurance (BOI) to make it publicly available. A workgroup with the staff of the BOI will vet and develop solutions for persistent problems VDA members have with insurance carriers.

Dentist and Dental Hygienist Licensure Compact

Permits eligible licensees to practice in participating Compact states. It’s a step forward to improve licensee mobility and to address relocating challenges for those in our military and public health services.

Safe Haven for Dentists and Dental Hygienists

Extends the civil liability protections of Virginia’s provider wellness program to dentists and dental hygienists and strengthens those protections for providers seeking voluntary inpatient treatment for mental health services.

Remote Supervision of Dental Hygienists

This bill simply gives more flexibility in the time (90 days to 180 days) between seeing a hygienist remotely and having an in-person visit with the supervising dentist. This change should help provide more access for underserved populations.

Funding a New VCU School of Dentistry Building

VCU is authorized to utilize up to $5,200,000 in funds to consider and evaluate alternative sites, designs, and operational alternatives for replacement of the present dental school facilities.

ADA DENTIST AND STUDENT LOBBY DAY:

RECORD ATTENDANCE OF DENTISTS AND DENTAL STUDENTS CHARGE THE HILL

Laura Givens, Director of Legislative and Public Policy

Attendance for the ADA’s annual Lobby Day nearly doubled from 2023, with over 1,200 dentists, dental students, state association staff, and other dental leaders advocating for dentistry on April 7-9, 2024, in Washington, DC. VDA representation included member dentists in attendance: Drs. Casey Gringer, Abby Halpern, Dani Howell, Ralph Howell, Stephanie Hoyos, Bruce Hutchison, Frank Iuorno and Elizabeth Reynolds. We were fortunate to have several students from schools around the country who reside in Virginia join us on our legislative visits. We appreciated the member dentists and students who took time away from their practices, patients, families, and schools to attend this important event.

The issues and bills addressed this year included:

• DOC Access: The Dental and Optometric Care Access Act (S. 1424/H.R.1385) seeks to prevent dental and vision plans from dictating fees for services not covered by the insurance, addressing federal loopholes, and enhancing patient and provider protections against insurance plan overreach.

• Student Debt Issues: H.R. 1202/S. 704 (the REDI Act) and H.R. 7814/S. 2172 (the Dental Loan Repayment Assistance Act), legislation aimed at easing the financial burden of educational debt for dental and medical residents and dental faculty

through deferred interest and taxexempt loan repayment assistance.

• Workforce: S.2891, the Action for Dental Health Act of 2023, addresses workforce shortages and enhances access to dental care by funding workforce training, expanding dental services to underserved areas, and supporting oral health education initiatives.

For more information on ADA advocacy efforts, you may visit their website at https://www.ada.org/advocacy

VDA PAC UPDATE

Laura Givens, Director of Legislative and Public Policy

Have you made your 2024 contribution? If not, you may make a contribution at the level of your choice through the VDA website at www.vadental.org/vda-pac

Questions?

Contact Laura Givens at givens@vadental.org or 804-523-2185. It’s essential that we make 2024 a stronger year for the VDA PAC!

REVIEW THE CHART

$146,615 TO REACH GOAL

HAVE YOU HAD ENOUGH? THEN SHOW IT!

Bruce Hutchison, DDS; Chair, VDA PAC

Each of us (dentists of Virginia) has a choice to make. Do we sit back and allow the insurance industry to continue to push us around, or do we, as a group, stand up and say “ENOUGH!”? The VDA fights for our ability to practice the way we choose to provide the absolute best dental care for our patients. The insurance companies continue to compromise that care with downcoding, refusing to pay legitimate claims, demanding excessive, and often unnecessary, documentation, and delaying payments on claims. I’m not sure what you see in your offices, but in mine, these problems and interferences with patient care are getting worse each and every year.

What can we do?

Frankly, as an individual, there’s not much one can do other than continue to write appeal letter after appeal letter and hope they actually get read and generate a response! That takes time, effort, and money, which you could be putting into continued patient care. It drives up the costs of dental care and increases your office overhead. How does this help patients? It doesn’t!

As a group, however, we have a stronger voice. Contributing to your VDA Political Action Committee (PAC) helps that voice be heard. Your VDA PAC contribution will be combined with those of your colleagues to support legislators who will listen to our story. And our story is a good one. Simply put, we continue to push and fight for better and improved dental care for the citizens of Virginia, our patients, and their constituents. Our story rings true for those legislators. But we must get to the table to tell that story.

Your VDA PAC contribution goes a long way to opening the doors and getting us

a seat at that table. Many of us contribute annually at the GOLD level of giving ($1,250), SILVER level ($750), and many more at the BRONZE level ($300). But three out of four dentists in Virginia contribute nothing to our efforts – zero! Personally, I am shocked. If every dentist in Virginia gave $300, or even $100, to our VDA PAC, our combined voices would resound in the legislative halls of Richmond.

Be strong! Support your profession! Give to VDA PAC today! Any amount, large or small, shows that you care about your patients and your profession and that you stand with dentists across Virginia.

Give today at https://www.vadental.org/ vda-pac. Make your voice heard!

ENJOY OVER 55 ACTIVITY OPTIONS

The Greenbrier offers an abundance of resort activities, providing guests with a diverse range of experiences, including championship golf courses, outdoor adventures, spa retreats, historical tours, and exclusive events, ensuring a memorable stay filled with relaxation, exploration, and recreation.

Below are just a few of the activities they offer. Please visit www.greenbrier.com/resort-activities to see all the activities.

Aerial Adventure Course

Bunker Tours

Fishing

Polaris RZR Off-Road Driving

Bowling

Croquet

Arcade

Bike Rentals

Falconry

DINING

Gather around one of their coveted tables. Savor every bite of your Greenbrier getaway in the refined elegance of their fine dining venues, the laid-back charm of our casual eateries, and their mosaic of restaurants, lounges, and bars that celebrate the best of tradition and innovation. Welcome to Southern resort dining at its grandest, where every dish is served with soul and style.

Please visit www.greenbrier.com/dining to see all the dining options.

Draper’s Cafe

Prime 44 West

Tree Tops Café

Slammin’ Sammy’s

Twelve Oaks

The Forum

Main Dining Room

42 Below In-Fusion

HOTEL RESERVATIONS

THE GREENBRIER RESORT

101 Main Street West

White Sulphur Springs, WV 24986

The VDA’s group rate is $379 plus taxes and fees. The group discount expires on August 28, 2024, OR when the block is full. We highly recommend making your reservation at your earliest convenience.

To book your room, please call 1-855-815-4441 and mention the group VDA Showcase. You may also book your reservation online.

Check in is 4:00pm and Check out is 11:00am.

Included in Your Rate and Daily Resort Fee:

• Self-Parking (Valet - $30/day)

• Hairdryer

• Robes and Slippers

• USB Charging Stations

• Daily Turndown Service

• Greenbrier Mineral Spa Toiletries

• Digital Newspaper

• Daily Ice Service

• Flat-Screen TV

• Iron and Ironing Board

• Private In-Room Safe

• Keurig Coffee Maker

• Lighted Vanity Mirrors

• Morning Coffee Service

• Afternoon Tea

• Nightly Movies in the Theatre, Historical Tours and Presentations (Bunker Tours excluded)

• On-Property Transportation

• Resort-Wide Wireless Internet Connectivity, Cyber Café with Complimentary High-Speed Internet

• Champagne Toast in the Casino Club

• Culinary Demonstrations

• Hiking Trails, Use of the Resort’s Fitness Center (at Tennis Center or Indoor Pool)

• Use of the Resort’s Indoor and Outdoor Pools

• Local and Toll-Free Phone Charges and Entertainment Provided by the Casino Club’s Beverage Entertainers

*These amenities are subject to change based on seasonality or availability.

MINIMALLY INVASIVE NON-SURGICAL PERIODONTAL THERAPY OF INTRABONY DEFECTS: A PROSPECTIVE MULTI-CENTRE COHORT STUDY

Mehta et al. J Clin Periodontol. 2024;1–10. DOI: 10.1111/jcpe.13984

BACKGROUND: Intrabony defects are associated with periodontal disease progression and tooth loss and tend to persist after initial therapy. Surgical regenerative therapies have been recommended by clinical practice guidelines. Despite its successes, regenerative surgery is associated with morbidity, complications and high material costs.

Minimally invasive interventions were first applied to surgical treatment by limiting flap extension to reduce trauma and enhance blood clot stability. These principles have also been applied to non-surgical periodontal therapy with the emergence of minimally invasive non-surgical therapy (MINST). MINST has been proposed as an alternative treatment approach for intrabony defects, aimed at reducing tissue trauma and optimizing wound healing while avoiding surgical incisions and suturing.

PURPOSE: The aim of this study was to assess the potential benefits of MINST in teeth with intrabony defects and to explore the potential effects of center (operator/instruments used), patient and defect characteristics on 12-month outcomes.

METHOD: A prospective cohort multicentre trial was conducted by seven periodontists in the UK, Spain, and Italy. One hundred periodontitis patients with radiographic intrabony defects of depth ≥3 mm were enrolled. Steps 1 and 2 periodontal therapies, including MINST, were provided. Clinical and radiographic data were analyzed at baseline, 6 and 12 months after treatment, with the primary aim being change in radiographic defect depth at 12 months. Patients were placed on a 3-month maintenance recall.

RESULTS: Eighty-four patients completed the 12-month follow-up. The mean total radiographic defect depth reduced

by 1.42 mm and the defect angle increased by 3 degrees (both p < .05). Statistically significant improvements in probing pocket depth (PPD) and clinical attachment level (CAL) were seen at 12 months compared to baseline (p < .001). Fifty-six defects (66.7%) achieved pocket closure (PPD ≤ 4 mm) and 49 defects (58.3%) achieved the composite outcome (PPD ≤ 4 mm and CAL gain ≥3 mm). Deeper and narrower angled defects were positively correlated with radiographic and clinical improvements, respectively.

CONCLUSION: Improvements in clinical and radiographic outcomes were seen after MINST. This study highlights the generalizability and wide applicability of this approach, further supporting its effectiveness in the treatment of intrabony defects.

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

ALVEOLAR RIDGE CHANGES 1-YEAR AFTER EARLY IMPLANT

PLACEMENT, WITH OR WITHOUT ALVEOLAR RIDGE PRESERVATION AT SINGLE-IMPLANT SITES IN THE AESTHETIC REGION: A SECONDARY ANALYSIS OF RADIOGRAPHIC AND PROFILOMETRIC OUTCOMES

FROM A RANDOMIZED CONTROLLED TRIAL

Strauss FJ, Fukuba S, Naenni N, et al. Clin Implant Dent Relat Res. 2024;26:356–368.

BACKGROUND: After tooth extraction, alveolar bone resorption occurs more on the buccal side than the palatal/ lingual side, often necessitating guided bone regeneration (GBR) during implant placement. To address this, alveolar ridge preservation (ARP) was introduced. ARP

involved filling the extraction socket with a bone substitute, reducing bone loss, and simplifying subsequent surgeries. Recent studies indicate that ARP, combined with early implant placement, offers limited additional benefits up to one-year post-loading. If an implant is

placed within two months of extraction, ARP might be unnecessary. This aligns with recommendations suggesting ARP is beneficial when implant placement is significantly delayed.

ARP is also noted for reducing the >

RISK FACTORS IMPACTING THE SURVIVAL OF IMPLANTS REPLACED FOLLOWING FAILURE: A RETROSPECTIVE STUDY

Lee et al. Clin Implant Dent Relat Res. 2023;25(6):1008-1018 DOI: 10.1111/cid.13265

BACKGROUND: Overall survival of dental implants usually ranges from 94%-100%. However, implants can fail for a multitude of reasons. Early implant failure is usually due to a lack of osseointegration. Late implant failure may be influenced by many factors including location, bone quality, mechanical overload and peri-implantitis. After initial implant failure, many providers and patients would still like to pursue implant treatment. Unfortunately, reported survival rates of replaced implants can range from 71%-93%, and third-time implant placement survival rates may be even lower (60-85%). Given this, it is important to investigate potential risk factors, including those associated with the primary implant failure, to better understand how to achieve success with implant replacement.

PURPOSE: The aim of this study was to assess potential factors affecting the survival of replaced dental implants after initial implant failure.

METHOD: A retrospective chart review was performed on data from March 2005 to December 2021 from the Department of Periodontology of Seoul National University Dental Hospital’s implant removal cohort database. Included patients had primary replaced implants and excluded patients had missing records, insufficient surgical records, or cases of abandonment or rejection of implant replacement. Variables including demographics, health data, implant factors, reasons for tooth loss and implant loss were collected and statistically analyzed.

rate of replaced implants was 89.1 ± 0.27% as compared to 93.9 ± 0.14% at non-GBR sites (p = 0.032). Additionally, the 5-year survival rate was 97.6 ± 0.13% in replaced implants with GBR and 90.3 ± 0.17% in replaced implants without GBR (p = 0.026). Multivariable analysis adjusted for clinical variables found periodontitis history (adjusted hazard ratio [aHR] = 3.417; 95% confidence interval [CI] = 1.161–10.055), GBR at first implant placement (aHR = 2.152; 95% CI = 1.052–4.397) and non-GBR at primary implant replacement (aHR = 0.262; 95% CI = 0.088–0.778) to be independent risk factors for second implant removal.

need for additional bone grafting during implant placement and preventing buccal concavity. However, evidence supporting ARP’s effectiveness in improving aesthetic outcomes remains limited.

PURPOSE:

The aim of this study was to evaluate the radiographic and profilometric outcomes of early implant placement with or without ARP, using two different ARP techniques, after 1-year of loading.

METHOD:

Seventy-five patients with a failing anterior tooth were randomly assigned to three groups:

• ARP-CM: ARP with demineralized bovine mineral (DBBM-C) and a collagen matrix

• ARP-PG: ARP with DBBM-C and an autogenous soft tissue “punch” graft

RESULTS: Included in the study were 464 replaced implants from 370 patients. Of those included 429 replaced implants survived and 35 implants were removed. In sites with a history of periodontitis the 5-year survival rate of replaced implants was 90.2 ± 0.18% as compared to 97.0 ± 0.15% at sites without a periodontitis history (p = 0.008). In sites where first implant placement had guided bone regeneration (GBR) the 5-year survival from the palate.

• Control: Unassisted socket healing

RESULTS:

Fifty-five datasets were analyzed (ARP-CM 19; ARP-PG 17; Control 19). Additional guided bone regeneration (GBR) was required in 31.6% (ARP-CM), 29.4% (ARP-PG), and 68.4% (control) cases. Both residual buccal bone height and additional GBR significantly impacted alveolar changes at one year (p < 0.05). Bone convexity was observed in 36.0% of ARP cases without additional GBR, increasing to 72.7% with GBR (p = 0.042). Profilometric measurements showed a trend toward agreement with radiographic findings.

CONCLUSION:

Early implant placement with ARP can lessen alveolar ridge changes at one-

CONCLUSION: History of periodontitis, GBR at first implant placement, and nonGBR at primary implant replacement were all identified as potential risk factors for the survival of replaced implants.

Dr. Whitney Johnson; Resident in Periodontics, Virginia Commonwealth University year post-loading by reducing both radiographic and profilometric alterations. However, implant placement with simultaneous GBR consistently leads to superior outcomes, regardless of whether ARP is performed.

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

MULTIPLICATIVE EFFECT OF STRESS AND POOR SLEEP QUALITY ON PERIODONTITIS: A UNIVERSITY- BASED CROSS- SECTIONAL STUDY

Marruganti C, Gaeta C, Romandini M, et al. J Periodontol. 2024 Feb;95(2):125-134.

BACKGROUND: Stress and lack of adequate rest are among the major issues of the modern lifestyle. Both have negative effects on systemic healing, which can involve systemic inflammation, oxidative stress, immune system impairment, and indirect mechanisms related to the associated compensatory behaviors.

Since inflammation and oxidative stress are contributing factors to the pathogenesis of periodontitis, high levels of perceived stress and poor sleep quality have been proposed as modifiable risk indicators for periodontitis. However, there is already evidence that these factors have a multiplicative effect on mortality risk for cardiovascular disease due to the reciprocal association between stress and sleep quality. Therefore, it is hypothesized that the combination of high stress and poor sleep quality may have an effect on the periodontium that is greater than the two factors alone.

PURPOSE: The aim of this study was to evaluate the multiplicative effect of stress and poor sleep quality on periodontitis prevalence and severity in a universitybased cohort of individuals.

METHOD: A cross-sectional study was conducted with all patients receiving a full-mouth periodontal examination by two calibrated examiners. The Italian version of the validated 10-item questionnaire (IPSS-10) was administered to measure patients’ perceived stress levels and were categorized as moderate/high (IPSS-10 >13) and low perceived stress (IPSS ≤13). Sleep quality was assessed using the Italian version of the Pittsburgh Sleep Quality Index (PSQI) and categorized as “poor sleep quality” (5 or higher) and “good sleep quality”.

RESULTS: Two hundred thirty-five participants were included with a mean age of 53.9 years, with majority females (57.9%) and never smokers (45.5%). The prevalence of periodontitis, according to the EFP/AAP classification, was 85.5%. Approximately 52% of subjects were

in the moderate/high-stress subgroup, and 48% were in the poor sleep quality subgroup.

Participants with moderate/high perceived stress presented a significantly higher periodontitis severity, and clinical parameters were significantly worse. Participants with poor sleep quality presented a significantly higher periodontitis severity, and clinical parameters were significantly worse.

CONCLUSION: The study indicated a multiplicative association of perceived stress and sleep quality with periodontitis. Specifically, individuals whose lifestyle is characterized by both moderate/ high perceived stress and poor sleep quality have 5- to 6 times increased odds of suffering from severe forms of periodontitis.

Dr. Anamika Khosla; Resident in Periodontics, Virginia Commonwealth University

INTRODUCING - VDA DENTAL MEDICAID BENEFITS LIAISON

Paul Logan, VDA Director of Strategic Initiatives/Innovation

Through a partnership with the Virginia Department of Medical Assistance Services (DMAS), the VDA is pleased to offer members personalized assistance with Medicaid claims.

Dr. Zachary Hairston, a VDA member dentist, and DMAS Dental Consultant, can assist and help resolve issues with Medicaid claim submissions.

“The Office Reference Manual (ORM) and the benefit limitations therein are purposeful. The ORM is a very useful guidance document. There are instances in our day-to-day practice when dental procedures may stand out as different. Even when dentists do all properly, denials can occur for various reasons. Denials may receive approval with another level of oversight and further discussion.”

“DMAS is thankful for our providers and wishes for them to be compensated fairly. To this end, the VDA has established a concierge relationship with DMAS. I encourage you to use this resource and share it with fellow dentists as we work to make Virginia’s dental Medicaid program one of the best in the country.” Dr. Hairston said.

Claim documents for consideration should be submitted to CardinalCareSmiles@ dmas.virginia.gov

“Even when dentists do all properly, denials can occur for various reasons. Denials may receive approval with another level of oversight and further discussion.”

BEFORE YOU SUBMIT YOUR CASE:

When submitting your email, please be sure to provide an office contact name and phone number should Dr. Hairston need to speak with someone regarding the issue. You can expect to receive a response within two business days. Please consider the information below before proceeding with your inquiry:

• The member must have Medicaid coverage for the procedure or payment in question on the date of service in consideration.

• Payment has been denied by DentaQuest, or the pre-authorization for work has been denied.

• A copy of the EOB denial and/or preauth denial should be sent to Dr. Hairston.

• A summary of a few sentences stating why the claim should be allowed should be included.

Dr. Zachary Hairston

Certified Dental Office Professional Program

Education to Empower Your Front Office Team presents

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

The 2024-2025 Certified Dental Office Professional class is limited to 25 participants who will go through the year-long program together. The program kicks off at The Greenbrier at the 2024 Virginia Dental Showcase, continues with online learning throughout the year and will conclude with a graduation at the 2025 Showcase in Norfolk. Secure your spot today!

• Save your practice time and money

• Understand opportunities in insurance and marketing

• Be ready for new trends in scheduling and practice management

THE EFFECT OF A MULTICOMPONENT ORAL CARE REGIMEN ON GINGIVAL INFLAMMATION: A

RANDOMIZED CONTROLLED CLINICAL TRIAL

Amaral et al. J Periodontol. 2024; 95:350–359. DOI: DOI: 10.1002/JPER.23-0361

BACKGROUND: Gingivitis is a common inflammatory condition caused by bacterial plaque. Treatment for this condition is accomplished through inoffice cleanings and home care by the patient. There are many different products on the market that are successful in helping to reduce gingival inflammation. Patients typically use, and practitioners typically recommend, a combination of products to restore oral health in the face of gingivitis. Antibacterial adjuncts can also be added to home care routines to reduce dental biofilm and gingivitis. Dual zinc plus arginine (DZA) fluoride dentifrices have been shown to disrupt dental biofilms and have antimicrobial activity. Mouthwash containing 0.075% cetylpyridinium chloride and zinc lactate (CPC + Zn) has also been shown to decrease levels of dental plaque and biofilm.

PURPOSE: The purpose of this study was to evaluate the efficacy of a combined home care routine with DZA fluoride dentifrice and CPC + Zn mouth rinse in reducing gingival bleeding scores in patients with gingivitis.

METHOD: Ninety-four participants were randomly assigned to one of two groups. The experimental group was assigned the DZA fluoride toothpaste, CPC + Zn mouth rinse and a soft toothbrush. The control group was assigned a fluoride toothpaste, a placebo mouth rinse with water and food additives, and a soft toothbrush. Both participants and study personnel were blinded to the groups. Patients were screened, then told to discontinue any home care (brushing, flossing, or mouthrinses) for 12 hours prior to their first examination. At the first exam, plaque index (PI) and gingival index (GI) were recorded, and patients were allocated

to the experimental or control group. Rigorous oral hygiene instructions were given. Patients were followed up at 1, 3, 6, and 9 months. At each follow-up visit, oral hygiene was reinforced, and PI and GI measurements were recorded.

RESULTS: Both groups presented statistically significant reductions in all clinical parameters compared to baseline. The DZA/CPC + Zn group exhibited significantly greater reductions in GI and PI, particularly in interproximal sites, compared to the control group at 1, 3, and 6 months. Furthermore, DZA/CPC + Zn significantly decreased the percentage of patients with generalized gingivitis over a 6-month follow-up period. However, both groups had similar levels of gingivitis after 9 months.

CONCLUSION: A combination of DZA fluoride toothpaste and CPC + Zn mouth rinse is successful in treating gingivitis and shows superior results to conventional fluoride toothpaste and placebo mouth rinse at 6 months. However, after 9 months of use, the two home care product regimens have similar results.

Dr. Joanna Scott; Resident in Periodontics, Virginia Commonwealth University

ASSOCIATION BETWEEN PERIODONTITIS AND MORTALITY OF PATIENTS WITH CARDIOVASCULAR DISEASES:

A COHORT STUDY BASED ON NHANES

Chen F, Song Y, Li W, et al. J Periodontol. 2024 Feb;95(2):175-184. doi:10.1002/JPER.23-0276.

BACKGROUND: It is widely accepted that periodontal disease results from a disruption in the balance between the normal microbiome and the host’s immune response. Dysbiosis can increase the overall bacterial burden and lead to a substantial systemic inflammatory response that may trigger cardiovascular disease (CVD), diabetes, pregnancy complications, and various other systemic illnesses. Many studies have investigated the link between periodontitis and CVD, which reveals a positive correlation between periodontitis and the onset and progression of CVD. However, the impact of periodontitis on the mortality of patients with CVD remains largely unknown.

PURPOSE: To verify the effect of periodontitis on the mortality of CVD patients from a nationally representative sample of U.S. adults with CVD.

METHOD: 2,135 individuals with CVD from the NHANES Survey were included in this study. CVD was

diagnosed based on a combination of self-reported doctor diagnoses and standardized medical questionnaires completed during individual interviews. Periodontal examinations were done by randomly selecting one maxillary and one mandibular quadrant to record clinical attachment loss (CAL) and periodontal probing depth (PPD) of two sites. Participants were divided into no/ mild periodontitis and moderate/severe periodontitis groups. Data from National Death Index records provided information on the multiple causes of death.

RESULTS: The all-cause mortality in CVD patients with moderate/severe periodontitis was significantly higher than in those with no/mild periodontitis (hazard ratio [HR]: 1.32; 95% CI: 1.07–1.63; P < 0.01). After adjustment for age, sex, race/ethnicity, and socioeconomic status (SES), consistent results were observed. The all-cause mortality in participants with severe clinical attachment loss was significantly higher (HR: 1.07; 95% CI: 1.01– 1.14; P = 0.01). However, there was no discrepancy in CVD or cancer

mortality was observed between CVD patients with different periodontal status. Participants suffering from moderate or severe periodontitis were smokers, older, more likely to be men, had low BMI, were low SES individuals, and were less likely to be non-Hispanic White. Trend tests revealed that participants with moderate periodontitis had higher all-cause mortality compared to those with no or mild periodontitis. However, there was no observed link between the severity of periodontitis and mortality from CVD or cancer.

CONCLUSION: This study indicates that all-cause mortality is significantly, though slightly, higher in CVD patients with moderate to severe periodontitis compared to those with no or mild periodontitis.

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

VOLUMETRIC CHANGES AND GRAFT STABILITY AFTER LATERAL WINDOW SINUS FLOOR AUGMENTATION: A

RANDOMIZED CLINICAL

TRIAL

Sedeqi A, Koticha T, Al Sakka Y, Felemban M, Garaicoa-Pazmino C, del Amo F-L. Clin Implant Dent Relat Res. 2024;26: 138–149. DOI: 10.1111/cid.13283

BACKGROUND: In patients that have lost posterior maxillary teeth, significant dimensional changes occur due to sinus pneumatization and changes in the alveolar process. These dimensional changes can be overcome through extensive treatments such as ridge augmentation, lateral sinus augmentation or vertical sinus augmentation. Lateral sinus augmentation has the major challenges of visualization and the ability to perform major grafting procedures in the sinus.

Different aspects of grafting in the sinus have been explored including biocompatibility, outcomes of different grafting materials, histologic analysis, and dental implant survival. These all lend to understanding of the healing process of graft material with lateral sinus augmentation, which is of utmost importance for implant placement.

PURPOSE: The aim of this study was to compare the stability and volumetric changes of anorganic bovine bone

mineral (ABBM) compared with a mixture of ABBM and mineralized cortical allograft in lateral window sinus augmentation (LWSA).

METHOD: This randomized clinical trial examined 16 patients and a total of 20 maxillary sinuses planned for lateral window sinus augmentation. The sinuses were placed in one of two groups; either 100% ABBM alone or a mixture of ABBM and MCA in a 0.8:1 ratio. The sinuses were evaluated at the pre-operative visit and postoperatively from the LWSA at the 2-week and 6-month time points through cone beam computed tomography (CBCT). The following parameters were evaluated on CBCT: sinus anatomy, residual bone height/thickness (RBH/ RBT), and Schneiderian membrane thickness. Lateral window height, length, location, and dimension (mm3) were all measured intraoperatively. A threedimensional segmentation analysis was performed to evaluate changes of bone graft volume/height.

RESULTS: Ten sinuses were allocated to each group. Bone graft volume reduction between groups was not significantly different. Schneiderian membrane thickness was significantly increased in the ABBM alone group compared to the AABM+MCA group at 2 weeks. Sinus width was weakly positively correlated with graft height reduction at the 6-month time point.

CONCLUSION: This randomized clinical trial showed that both ABBM and ABBM + MCA are suitable grafting options for lateral window sinus augmentations. Both show acceptable graft stability and similar volumetric and linear dimensional changes at the 6-month postoperative time point.

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

IMPACT OF SURFACE CHARACTERISTICS ON THE PERI-IMPLANT

MICROBIOME IN HEALTH AND DISEASE

Sinjab K, Sawant S, Ou A, Fenno JC, Wang HL, Kumar P. Impact of surface characteristics on the peri-implant microbiome in health and disease. J Periodontol. 2024; 95:244–255.

BACKGROUND: Peri-implantitis (PI) is a biofilm-induced disease affecting the tissues that surround and support endosseous root- form implants. Nearly one in five implants are affected by PI, with disease occurring as early as years following functional loading. Most implants currently being used are engineered with moderately rough surfaces, with roughness levels ranging from 1.0 to 2.0 μm. However, with a view to improving osseointegration, additional surface modifications have been incorporated into implant design. These include machining, sand blasting, acid-etching, sintering, oxidizing, plasmaspraying, hydroxyapatite coating, lasermodification, or a combination of these procedures.

PI is a dysbiosis driven disease, and determining its impact on the peri-implant microbiome is important to understanding disease etiology.

PURPOSE:

The aim of this study was to examine the influence of implant surface topography on the peri-implant microbiome in both health and diseased conditions in humans using a comprehensive, open-ended, cultivationindependent approach to characterize and quantify the peri-implant microbiome.

METHOD:

Participants aged 18 years or older with PI and healthy implants were recruited. The participants were divided into three groups based on the following surface coatings: anodized surface (AN), sandblasted and acid-etched surface (SLA), and hydroxyapatite-coated surface (HA). Within each group, individuals were further divided into those with PI and those with healthy implants.

RESULTS:

One hundred-six participants were recruited, including 30 healthy controls and 76 with PI. In individuals with healthy implants, the peri-implant microbial community is not influenced by implant surface modifications.

This indicates that the effect of periimplant disease on the peri-implant microbiome community is more significant than the effects of implant surface type.

CONCLUSION:

Surface roughness was not a factor in determining the composition of the microbiome surrounding healthy implants. There is less significance of surface coating when the healthy implant is placed at or below the level of the alveolar crest and is sealed from the peri-implant sulcular environment by the soft tissue attachment apparatus. Therefore, it is logical that modifications to the surface of the implant body will not impact microbial colonization in the sulcus.

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

OSSEODENSIFICATION VERSUS LATERAL WINDOW TECHNIQUE FOR SINUS FLOOR ELEVATION WITH SIMULTANEOUS

IMPLANT PLACEMENT: A

RANDOMIZED CLINICAL TRIAL ON PATIENT-REPORTED OUTCOME

MEASURES

Gaspar J, Botelho J, Proença L, et al. Clin Implant Dent Relat Res. 2024;26(1):113-126.

BACKGROUND: The lateral window technique remains a reliable and established method for sinus floor elevation, often considered the primary approach when residual bone height is ≤4 mm. However, despite its efficacy, this technique is not without limitations, as it frequently leads to significant patient discomfort. In contrast, osseodensification (OD) represents an innovative surgical approach to implant site preparation. By employing specially designed burs in a counterclockwise (CCW) motion with ample irrigation, OD aims to conserve bone tissue. Unlike traditional drilling methods, OD facilitates bone compaction along the osteotomy walls and within the trabecular spaces, thereby enhancing bone density at the site.

PURPOSE: This study aimed to assess patient-reported outcomes and surgical results following sinus floor elevation (SFE) using osseodensification (OD) compared to the lateral window (LW) approach, both performed alongside implant placement.

METHOD: Twenty individuals with residual bone height (RBH) ≤4 mm, requiring single-implant restoration, were included. Pain levels, quality of life (QoL) measured by the Oral Health Impact Profile-14 (OHIP-14), analgesic usage, and other symptoms were self-reported daily for a week. Surgical duration, complications, and implant stability quotient at baseline (ISQ T0) and after six months (ISQ T6) were recorded. Participants were followed up for one year.

RESULTS: From the day of surgery (Day 0) to Day 3, the OD group reported significantly lower pain levels (p < 0.05). OHIP-14 scores were significantly lower (p < 0.05) in the OD group on all postoperative days except Day 5. Analgesic consumption was significantly lower (p < 0.001) in the OD group. The average surgery duration was significantly longer (p < 0.001) in LW compared to OD (71.1 ± 10.4 vs. 32.9 ± 5.3 minutes). Following the osseointegration period, all implants were successfully restored with screw-retained crowns.

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

SAFEHAVEN: SUPPORT FOR THE DENTAL TEAM TO RECLAIM WORK-LIFE BALANCE AND JOY

Dr. Bruce Overton; Chair, VDA Caring Dentist Council

As some of you might know, the Caring Dentist Council (CDC) is here to support dentists and hygienists who need personal help. The CDC is a valuable part of the Virginia Dental Association and is composed of eight committee members, each representing their respective components. We work with the Board of Dentistry and the Health Practitioners Monitoring Program.

The mission of the Caring Dentist Council is to identify, intervene, and assist members of the dental profession and their families who suffer consequences of alcohol and substance misuse, stress and professional burnout, and other psychological and mental impairments.

Our program prevents the destruction of a career or professional reputation. The Council provides confidential peer support and professional advocacy through complete assessment, treatment, recovery, and monitoring of activities that, if followed, may assist the dental professional in license retention.

Most recently, the CDC has another ally in helping dental professionals. In the 2024 session, the Virginia General Assembly passed two identical bills which:

1. Expand access to the SafeHaven program to dentists and dental hygienists.

2. Authorize the SafeHaven program to provide outpatient health care to healthcare professionals.

3. Encourage healthcare professionals to voluntarily seek behavioral health services without fear of mandatory reports to health regulatory boards in every circumstance.

SafeHaven was founded in 2020 after recognizing a greater need to provide physicians, physician assistants, and other members of the healthcare team with the support they need to stay well and prevent burnout. So, why do providers choose not to seek help for their burnout or other issues such as depression and substance misuse (alcoholism and other addictions)?

• First, there is the ever-present “denial” that a problem exists. Denial happens in all humans when confronted with a traumatic or threatening situation.

• Second, there is the fear of losing their license to practice, potential loss of their job, and potential reputational damage that could affect their future path, as well as referrals from other clinicians.

As dental professionals, we feel like we must always be strong for our patients. This spirit certainly carries over to our personal lives, where we might be seen as leaders of our families. At times, the stress of these responsibilities might seem insurmountable. Many of us feel that if we ask for help, we may look weak, certainly flying in the face of that strong persona many of those in our lives have conceived. But we are all human and cannot continue to give to others unless we have taken care of ourselves. SafeHaven is another resource that ensures we don’t have to bear the burden alone.

Until the passing of the 2024 legislation, dental professionals only had access to the Caring Dentist Council and the Health Practitioners Monitoring Program

(of course, this does not include any private counseling service). The mission of the CDC has been previously stated. The Health Practitioners Monitoring Program (HPMP), under the auspices of the Virginia Health Regulatory Board, assists dental providers with a substance use diagnosis, and a mental health or physical diagnosis, which may alter their ability to practice their profession safely. Unfortunately, dental and hygiene students do not qualify for admission to the HPMP.

The good news is that the recent 2024 legislation accomplishes three goals:

• First, it expands the types of healthcare providers who can avail themselves of the SafeHaven program to include any person registered, certified, or licensed by the Board of Dentistry, together with any student at a dental school or school of dental hygiene in the Commonwealth. The rationale for this addition stemmed from the significant prevalence of suicide and behavioral health needs of dental professionals. In fact, the American Dental Association reported in February of 2022 from their “2021 Dentist WellBeing Survey” that depression and anxiety disorders are higher among dentists than the general population.

• Second, the scope of services that may be provided by the SafeHaven program was expanded to include the “arranging for outpatient health care related to career fatigue and wellness for health care professionals.” The rationale for this expansion stemmed from healthcare workforce shortages and lack of timely access. Allowing SafeHaven to schedule appointments or directly provide outpatient health care services greatly enhances achieving successful outcomes.

• Third, bureaucratic red tape in reporting to the health regulatory board can be dealt with more easily. With this statutory revision, a professional can seek voluntary admission, be treated for a few days, a week, or thirty days, and so long as the treating physician, physician

assistant or nurse practitioner certifies in writing to the CEO or Chief of Staff that the professional is no longer a danger, no reports will be required to the health regulatory board.

Governor Youngkin signed both bills on March 20, 2024, and the legislation became effective July 1, 2024. We encourage all healthcare professionals to enroll in SafeHaven to proactively maintain their well-being.

If you wish to learn more about the SafeHaven program, go to https://www.msv.org/program/ safehaven/.

TRANSFORMING DENTAL OPERATIONS:

THE ROLE OF AI IN STREAMLINING BACK-OFFICE FUNCTIONS

Robert McDermott; President and CEO, iCoreConnect

Artificial Intelligence (AI) is no longer just a buzzword in the technological landscape; it has become a pivotal force in transforming various industries, including dentistry. While AI’s role in clinical applications such as diagnostics and treatment planning is widely recognized, its impact on the operational side of dentistry is equally transformative yet less discussed.

Back-office operations in dental practices are crucial for seamless functioning and directly affect the patient’s experience. These operations encompass a range of activities, from appointment scheduling and billing to compliance management and patient data handling.

Traditionally, these tasks have been labor-intensive and prone to human error, leading to inefficiencies that can affect the overall service quality. However, with the integration of AI, dental practices are witnessing a significant overhaul in their operational workflows.

Enhancing Efficiency and Accuracy in Appointment Scheduling

One of the fundamental areas where AI is making a mark is in appointment scheduling. AI-powered scheduling systems can predict peak times, manage appointment slots efficiently, and even handle rescheduling and cancellations dynamically. This not only optimizes the dentist’s time but also enhances patient satisfaction by reducing waiting times and improving accessibility to dental care.

Streamlining Billing and Claims Processing

Billing and insurance claims processing are other critical areas where AI can dramatically improve efficiency. Through AI algorithms, dental practices, or

contracted billing & claims professionals, can automate much of the coding and billing processes, reducing the chances of human error. These systems are also capable of analyzing and auditing billing statements and insurance claims in real-time, ensuring accuracy and transparency. This not only speeds up the reimbursement process but also minimizes the incidence of claims denials due to errors.

essential. AI is significantly transforming this aspect by automating the process of ICD-10 and CPT coding. AI systems can quickly analyze treatment details to help accurately assign the appropriate medical codes, which is crucial for dental practices that provide services that may also be covered under medical insurance.

Additionally, AI systems are continually updated with the latest coding changes and regulations, ensuring that the practice remains compliant with current medical and dental billing standards.

“With the integration of AI, dental practices are witnessing a significant overhaul in their operational workflows.”

Predictive Analytics for Increased Revenue

Beyond billing and claims processing, AI engages in predictive analysis helping practices manage aspects like cash flow and resource allocation. Predictive analytics in AI systems can forecast future appointment bookings, patient cancellations, and even predict seasonal variations in patient flow. Furthermore, predictive analysis extends to financial operations, where AI tools analyze accounts receivable information from patient charts.

Revolutionizing ICD-10 and CPT Coding with AI

In the realm of dental billing, especially when cross coding with medical insurance, accurate and rapid coding is

Enhancing Patient Care with AIEnhanced Electronic Prescribing

AI-enhanced electronic prescribing software is revolutionizing the way dental professionals manage and dispense medications. This technology automates the prescription process, significantly reducing the potential for human error and ensuring that prescriptions are accurate and tailored to each patient’s specific needs.

With AI, electronic prescribing systems can analyze patient records, prior prescriptions, and even allergy information to suggest the most appropriate medications and dosages. This helps in preventing adverse drug interactions and enhancing the safety and effectiveness of treatment.

The speed of AI-driven electronic prescribing also means that prescriptions can be sent instantly to pharmacies, dramatically reducing wait times for patients and improving the overall efficiency of the dental practice.

Considerations and Challenges in AI Adoption

While the advantages of AI in dentistry are significant, there are two areas to pay attention to moving forward.

First, there are ethical and privacy concerns related to the use of AI in healthcare. Dentists must ensure that they comply with all relevant privacy regulations, such as HIPAA, when implementing AI solutions that handle sensitive patient data.

Second, while AI can significantly reduce the workload on dental staff, it is crucial to maintain a balance between automation and human oversight. AI should be seen as a tool to enhance, not replace, the professional judgment and personal interaction that are critical to quality dental care.

The Future of AI in Dental Operations

By automating routine tasks, enhancing accuracy, and improving efficiency, AI is not just streamlining back-office operations but also enabling dental professionals to focus more on patient care rather than administrative tasks. As

technology advances, the scope of AI in transforming dental practice operations will only expand, paving the way for more innovative and efficient healthcare solutions.

Learn more about transforming your dental practice with smart solutions from VDA Member Perks Partner and VDA Keystone Investor, iCoreConnect. Please call 888.810.7706 or visit iCoreConnect. com/VA21 to book a demo of their endorsed services.

GOOGLE ANALYTICS 4 –WHAT YOU NEED TO KNOW

Paulyn Ocampo; Vice President of Client and Agency Operations at The Hodges Partnership

If you have a website, it’s likely that you or someone on your team are already familiar with Google Analytics and are using it to analyze site traffic. If you’re new to Google Analytics, now is a great time to take advantage of this web analytics tool. As part of that analysis, you may be looking at how visitors reach your site (e.g., direct, organic, or paid traffic) and the interactions they’re making during their time on your site (sessions). On July 1, 2023, Google sunsetted its previous version of Google Analytics, also known as Universal Analytics (UA), and launched a new version, Google Analytics 4 (GA4).

The differences between Universal Analytics and GA4

One of the key differences between UA and GA4 is how user data is measured and presented. Where UA relied on a session-based model, GA4 focuses on user events. In this new model, GA4 tracks each user interaction (clicks, downloads, scrolling on a page, completing a purchase, etc.) as an individual event rather than grouping the events together as a session. In GA4, website owners also have the ability to define custom events. This means you can track and measure whether a visitor to your website downloaded a new patient form, clicked to learn more about your practice, or clicked to look at your online schedule to view open appointment times.

Another key difference between the two is that GA4 offers enhanced measurement capabilities, including the ability to track users across multiple devices and platforms, which provides a more holistic view of visitors’ behavior.

What do these changes mean?

For the most part, the biggest change for marketers is getting used to a new user interface. The same data that was

available in UA is also available in GA4, but where to find that data and how to navigate to those reports is different. What once used to be accessible in a few clicks now takes more time, as setting up a report to give you the data you’re looking for takes more configuration. As users become more comfortable and versed with the new user experience (UX), most will find GA4 allows you to build reports that are more tailored to the insights your practice needs. You can build reports that would not have been possible to build in UA, but it requires a deeper understanding of the platform.

Additionally, there are metrics that can be tracked in GA4 that aren’t as easily tracked in UA, including engagement rate, video engagement, scrolling, file downloads, outbound link clicks, and site search. To access this data, you’ll need to enable enhanced measurement in GA4.

Ready to get started with GA4?

To begin using GA4 on your website, here are some steps to get started:

• First, you’ll want to set up a GA4 property in your Google Analytics account.

• Once you’ve set up your GA4 property, you’ll want to install the GA4 tracking code on your website.

• After setting up your GA4 property, you’ll want to then add a data stream. The data stream is what sends data from your website to your GA4 property.

• To track conversions (such as downloads, form submissions and purchases) you’ll need to set up conversion tracking in GA4.

The list above is a simplified version of the steps involved in setting up GA4. For more detailed information on implementing GA4 on your website, Google has some great resources available, and a number of other online tutorials can be found with a quick search.

ARTIFICIAL INTELLIGENCE AND DENTISTRY

Dr. Al Rizkalla, Chair, Ethics Council

Today, there is considerable public debate about Artificial Intelligence (AI) and how this new technology will alter our lives in the future. As dentists, we need to consider, analyze, and thoughtfully guide the development of AI as it relates to the practice of dental medicine.

The term AI describes the ability of machines to perform tasks that traditionally have required human intelligence. This technology is evolving at a lightning-fast speed. ChatGPT, a free program that allows amateurs to use AI to produce an intelligent-appearing product, was launched only a little over a year ago. Since then, we have been experiencing the AI frenzy surrounding us as we consume products from companies like Google, Meta, and Anthropic. This technology is present in our everyday lives and is not tech hype. Investors are pouring money into its development. According to an article in The Economist magazine, Microsoft, a tech giant, is partnering with OpenAI to build a $100 billion data center (Economist.com, 2024).

Many hope that the results of AI will be both significant and beneficial. In oral medicine, lesions may be detected and diagnosed earlier. In oral and maxillofacial surgery, robotic surgery may provide more accuracy and safety. In oral pathology, more accurate predictability of oral cancer may be possible. Histological analysis may be faster and completed with more precision. (Chakravorty, 2024) Periodontics, prosthodontics, orthodontics, pediatric dentistry, and endodontics may all benefit from AI as well. Other benefits may include smoother practice management, improved scheduling, coordinating insurance benefits, streamlining reimbursement, and minimizing insurance fraud.

As this or any technology develops and is implemented, we must ask ourselves who may be involved, benefit, or be affected by it. Solo clinicians, clinicians employed by large organizations, investors, insurance companies, Medicare/Medicaid and other federal or state organizations, leaders in organized dentistry, educators, dental students, and patients could all benefit. But will they all be positively affected, or might some experience negative effects?

At this point, it is prudent to thoughtfully recognize the vulnerability of this technology to be exploited for pure profit, or, in essence, greed. Profitability can be enhanced by those programming the technology and later by the technicians to skew the weight of the technology in decision-making by overstating the importance of the AI’s conclusions.

As dental practitioners, we have an ethical obligation to ensure that our profession upholds the highest standards of honesty and integrity. We must not embrace AI or any other new technology without prioritizing the patient’s care in the most patient-centered way. This potentially wonderful progress must be approached with a deliberate desire to benefit the patient.

As we think about the future of dentistry in a world where AI becomes pervasive, we need to consider some questions that come to mind:

• Who is going to influence these algorithms? What are their values?

• These days, we know that many patients “fact check” the diagnoses and proposed treatments presented by their clinicians on the internet. Will AI be used as a tool that our patients trust more than they trust their human clinician?

• Will we, as clinicians, use AI to justify our treatment recommendations?

• Just as we adjust the contrast of a digital radiograph, can we adjust the opinion of the AI program based on which software we use and who financed or developed it?

• Will AI continue to gain experience as it collects data and can apply this experience accurately and justly without human input or supervision?

• Who will own, guard, or profit from collecting the patient’s data?

Receiving training datasets for dentistry is another moral issue because it involves someone’s private information. Even if they freely give up their dental data, their identity is still compromised. When used in training AI systems, it’s crucial that these datasets are anonymized to protect patient identities. Perfect anonymization will always be challenging; small details in the data might still lead to re-identification of the individuals, especially when combined with other data sources.

The following is a quote from an article in the Journal of Law and Ethics:

• “It is crucial for developers of AI/ ML-driven tools to recognize the shortcomings of HIPAA to gain a better understanding about the challenges related to compliance and be mindful about developing appropriate solutions. To achieve this, AI developers and vendors should be familiar with very common scenarios where HIPAA does not extend its coverage to sensitive health data of patients or consumers. This understanding has a critical role in paving the way for addressing these scenarios in a manner that aligns with the policy objectives and the spirit of HIPAA” (Rezaeikhonakdar, 2023) (Heartland Dental, 2023). >> CONTINUED ON PAGE 58

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• Will the clinician be able to make independent treatment decisions based on the patient’s individual situation and the clinician’s experience and training without being criticized for disregarding the AI recommendations?

• How much will AI influence the standard of care? Will every carious lesion have to be surgically treated or will the use of evidence-based approach like CAMBRA be included in the algorithms?

As we are moving very rapidly into the future, we must acknowledge that AI is here. It will significantly impact us sooner than any of us could have expected just five or ten years ago. According to a Heartland Dental news release:

“A study across 470,000 patients showed a significant increase in the identification of clinical needs for doctors to discuss with their patients. With world-class imaging and workflow support, it [AI]

enables patients to better receive the care they need and want” (Heartland Dental, 2023).

A human clinician knows that there are situations where a procedure may appear to be called for, yet doing so would not provide an improvement for the patient and would just incur added expense and discomfort. While AI may identify more potential clinical needs, we must not let a computer program be used to generate a costly procedure that might better be handled with a “monitor and wait” approach. We must be prepared to embrace those aspects of AI that are good, and we must not accept those aspects that cause negative results for our patients.

The predominant question that we, as dentists, must consider is whether we will passively allow AI to take control of our practices or affirmatively maintain control.

References:

• Chakravorty, A.S. (2024). Role of Artificial Intelligence in Dentistry: A literature review. J Pharm Bioallied Sci.

• (2024, April 17) Economist. https:// www.economist.com/scienceand-technology/2024/04/17/largelanguage-models-are-gettingbigger-and-better

• Heartland Dental (2023, December 5). Heartland Dental Brings BestIn-Class-Dental AI to the Nation’s Leading Supported Footprint. Prnewsire.co. https://www. prnewsire.com/news-releases/ heartland-dental-brings-bestin-class-dental-ai-to-thenations-leading-supportedfootprint-302005247.html

• Rezaeikhonakdar, D.(2023). AI Chatbots and Challenges of HIPAA Compliance for AI Developers and Vendors. The Journal of Law, Medicine, and Ethics, 51(4), 988-995.

PROSITES IS NOW THE OFFICIAL WEBSITE HOST OF VDA MEMBER PERKS

Karen Wood; Director of Operations, Virginia Dental Services Corporation

Our members who use ProSites give positive feedback about their experience. So, when it came time to choose who to work with to give the Member Perks program a fresh and new website, it was an easy choice to ask ProSites. The customer service I have received working with ProSites as an endorsed vendor and VDA supporter has been a top-notch experience. They are prompt and clear with communications, responsive to inquiries and suggestions, and they are proactive with content and opportunities for our VDA members to expand their marketing programs. I look forward to passing on the content to you that they regularly share, as it is relevant and timely.

The thought of changing websites was daunting, as all I had was a very rough idea in my mind of what I wanted with color and layout and zero knowledge about designing or managing a website. That was as far as my creativity was taking me until I had a conversation with the team at ProSites. All I gave them was the link to the existing VDA Member Perks website, a couple of websites I had found that I liked, and a brief description of what I wanted it to grow into down the road.

“Once the first website design was created, I could point, click, and comment on any changes I wanted to make directly on the website mock-up!”

Within about a week, the design team turned around a draft “mock” website for me that incorporated my ideas and the improvements they added in.

Once the first website design was created, I could point, click, and comment on any changes I wanted to make directly on the website mock-up! All this work was happening in the background until the website went live. The design team would receive my comments and make the changes quickly. I can also make changes through secure access to the website for editing, but they can take care of anything you need by notifying them by email or phone. I enjoyed making some of the smaller changes and will continue to do so, as the tutorial they provided

gave me the information, education, and confidence to do so while knowing I have a trusted partner to help me when I need or want it.

ProSites was the first dental website design company to offer a way for dental practices to have greater control to edit their websites in seconds with a simple “point and click.” ProSites has kept up the growing internet trends and today has a powerful and comprehensive set of website design and internet marketing services to help dental practices attract, engage, and connect with patients in a way that helps deliver an ideal experience and lasting online impression. The VDA Member Perks’ relationship with ProSites will continue to grow as we are able

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to offer more of their services to VDA members. (More exciting news will come soon from our partnership with them!)

I can’t wait to see how I can expand the capabilities of our website with ProSites. If you do not have a website for your practice or want to refresh the one you have, consider looking at ProSites for your practice. ProSites offers excellent customer service and product offerings and will allow you to enjoy exclusive discounts for being a VDA member.

Check out our new image at https://www. vdamemberperks.com or scan the QR code to take you directly to the ProSites landing page on the new VDA Member Perks website! As always, please don’t hesitate to reach out to me with any questions, comments, or suggestions at wood@vadental.org.

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

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

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

4. Have you met with a financial planner and have a documented plan? Have you established a liquid financial resources target that will enable you to retire with your desired lifestyle/level of income? Henry Schein Dental Practice Transitions has your best interests in mind throughout your career. Schedule a complimentary consultation today! If you answered no or do not know to any of these questions, let’s have a conversation!

VOLUNTEERING IN VIRGINIA’S FREE & CHARITABLE CLINICS

Rufus Phillips, CEO, Virginia Association of Free and Charitable Clinics

Volunteers are the lifeblood of Virginia’s clinics.

Virginia’s free and charitable clinics serve as a safety net for people and families in need. They are an integral component of the communities they serve, providing high-quality health care to underserved populations with compassion, dignity, and respect. Volunteers greatly impact clinics, helping to keep operating costs down so free clinics can continue offering equitable and accessible care. As nonprofit organizations, volunteers are a critical workforce component for clinics that leverage their support to provide the underserved with high-quality health care. Leaders with the Health Brigade in Richmond report, “We couldn’t do our work without our volunteers because our business model is built on volunteers working side by side with us to deliver our services.”

Volunteers are down by half in Virginia’s clinics.

Sadly, recent data has shown that volunteerism in health clinics has decreased by 50% -- from approximately 11,600 volunteers at clinics in 2018 to only 5,800 volunteers in 2022, mirroring national nonprofit trends. The decline in volunteers is happening across the U.S., according to a Census Bureau and AmeriCorps report from last year. Approximately 23% of Americans formally volunteer with an organization, the lowest percentage since the organizations started tracking participation in the early 2000s.

Patient demand for services is increasing at Virginia’s clinics.

Free clinic usage by vulnerable Virginians continues to grow with patient demand up 11.5% from July 2023 to March 2024, compared to the same period a year prior (and clinic usage was already up 28% in fiscal year 2023 versus 2022). The latest growth follows national trends,

which saw 80% of free clinics across the country serving more patients last year. The ongoing demand underscores the critical need for the state’s nonprofit clinics. Higher living costs and additional needs for dental and mental health care are some of the primary drivers of this increases as well as the ongoing Medicaid unwinding process which is a contributing factor. Approximately 442,000 Virginians have lost Medicaid coverage as part of the state’s return to normal enrollment after the COVID-19 federal public emergency ended in March 2023. The state still needs to review eligibility for about 119,000 people.

Connect directly to volunteer needs in Virginia’s clinics.

Realizing the critical role volunteers play as well as the need to support volunteer recruitment, the Virginia Association of Free & Charitable Clinics (VAFCC), which represents 69 clinics across the state, created a centralized system for connecting those that are interested in volunteering directly with current needs in free clinics. The VAFCC’s Volunteer Opportunity Board allows interested volunteers to locate clinics around the state, connect with current volunteer needs, as well as add themselves to a registry of interested volunteers for clinics to contact in the future. The leaders of

By the Numbers:

Dentistry is one of the most requested services at free and charitable clinics.

• 61% of the 68 VAFCC member clinics offer on-site dental services.

• Of their dental workforce, 895 are volunteers in the following roles:

- Dentists: 246

- Oral Surgeons: 16

- Dental Hygienists: 46

- Dental Assistants: 168

- Other Dental: 419

the Charlottesville Free Clinic confirm that volunteers are always in high demand, and this new software is a game changer. “It informs potential volunteers from all over Virginia that we’re here, and if we’re not in their vicinity, then there’s likely another free clinic in their area where they can volunteer.”

To get started, visit https://volunteer. vafreeclinics.org/.

HEALTHY SMILES FOR ALL:

ORAL HEALTH INITIATIVES FOR VIRGINIA’S SPECIAL HEALTH CARE NEEDS PATIENTS

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

For nearly 57 million people in the U.S. with intellectual or developmental disabilities, visiting a dentist’s office can be an overwhelming experience. Unfamiliar sights and sounds, physical examinations, new textures, and strange lighting all work together to create an environment that can be uncomfortable and, at worst, traumatic. The visit can be equally stressful for a caregiver who accompanies, arranges, and assists with getting their loved one to a dental appointment.

That’s why Delta Dental of Virginia launched the Special Health Care Needs Dental Benefit Program for most group contracts.* In addition to enhanced treatment delivery options, the expanded benefit provides covered members with intellectual or developmental disabilities the chance to visit a dental office, get acquainted with the environment, familiarize themselves with the tools and get to know the staff before ever being asked to “open wide.”

What’s included in the Special Health Care Needs Benefit?

1. Exams: Additional dental visits are covered as needed to help patients and their families understand what to expect before treatment.

2. Cleanings: Up to four dental cleanings in a benefit year.

3. Treatment delivery modifications that are necessary for dental staff to provide oral health care for patients with sensory sensitivities, behavioral challenges, severe anxiety, or other barriers to treatment. (Procedure code D9997: dental case management for patients with special health care needs)

4. The use of anesthesia when necessary to provide dental care.

The American Academy of Pediatric Dentistry defines special health care needs as any physical, developmental, mental, sensory, behavioral, cognitive, emotional impairment, or limiting condition requiring medical management, health care intervention, and/or the use of specialized services or programs.

If you want to learn more about the Special Health Care Needs Benefit, there is an online library of information at https://deltadentalva.com/special-healthcare-needs-resources.

The Special Health Care Needs Benefits Program is just one piece of a broader strategy to reduce barriers to oral health care for Virginia residents with disabilities. The Delta Dental of Virginia Foundation also partnered with the Virginia Department of Health to develop and fund Centers for Inclusive Dentistry.

While many safety-net clinics have long served Virginians with special healthcare needs, the new partnership funds adaptive equipment and specialized training to help even more providers meet the oral healthcare needs of persons with disabilities in their region.

The certification program launched in early 2023 with two participating clinics, Augusta Regional Dental Clinic, and Eastern Shore Rural Health System. Teams of four from both clinics attended a three-day training at the NYU Dentistry Oral Health Center for People with Disabilities. Through a combination of didactic and hands-on sessions, attendees learned how to better serve patients and families with special health care needs through effective communications, ergonomics, patient workflow adjustments, and desensitization techniques. Upon their return, staff from

both clinics participated in a year-long learning collaborative to put what they were taught into practice and share lessons learned.

Since its launch in 2023, two Virginia clinics are now certified Centers for Inclusive Dentistry, and the Foundation has recruited Carilion Clinic Dental Care and the VCU School of Dentistry to earn the certification later this year.

Oral health is integral to a person’s overall health, and like you, we believe everyone deserves a healthy smile. The development of certification programs and the introduction of new benefits to expand access to oral health care is just the start. It’s now about spreading the word and educating more families that care for loved ones with special health care needs about the resources and benefits that are accessible in Virginia.

Thank you for joining us on this journey to expand care and help improve the overall health and wellness of Virginia’s special healthcare needs population.

Note: The Delta Dental of Virginia Foundation is committed to improving the oral health of all Virginians. Created in 2012 by Delta Dental of Virginia, the Foundation supports education, program development, and community partnerships that help create healthy smiles in Virginia through improved access to oral health care, education, and research.

*Additional Special Health Care Needs Benefits are covered at 100% with no deductible. Some benefits may be subject to the annual maximum based on the member’s group benefit plan. The Special Health Care Needs Benefit is not currently available under Delta Dental of Virginia’s Individual and Family™ plans.

MOM CELEBRATES 25 YEARS OF SERVICE

Barbara Rollins; Director

of Logistics, Missions of Mercy, Virginia Dental Association Foundation

Back in 2000, access to dental care was a challenge for Southwest Virginia’s uninsured or underinsured residents. To help with that access problem, Dr. Terry Dickinson created the Missions of Mercy (MOM) project. The project expanded, and MOM soon addressed oral health needs in underserved communities and areas throughout the state by providing preventative, restorative, and surgical dental care. MOM quickly became a model dental project for thirty-one states across the country.

MOM has changed greatly over twentyfive years. The first project was an open-air MASH-type unit compared to the current venue, which was transformed into a climate-controlled dental clinic. The range of dental procedures has increased from the basic exams, cleanings, fillings, and extractions to the addition of digital Panorex X-rays, PAs and bitewings, oral surgery procedures by oral surgeons, root canals by endodontists, gross debridements by dental hygienists and a wide range of dentures and denture procedures by prosthodontists. Dental volunteers and patients have traveled

from all parts of Virginia and other states year after year.

The first Wise MOM was held in a single airplane hangar at Lonesome Pine Airport in Wise, VA, in July 2000. Full-sized, non-adjustable office dental chairs were donated for use (some volunteers stood on cinder blocks and used flashlights to provide dental treatment while another dentist was seen kneeling next to a pediatric patient’s chair). The environment was open-air and unairconditioned with a limited water source. Procedures offered were exams, cleanings, fillings, and extractions. The question remained. Would people show up for free dental care at such an event? The answer was a resounding “Yes!”. Patients lined up outside through the night without shelter, waiting to see a dentist. Seven hundred thirty-nine patients received 2,956 procedures over those two and a half days, with 53% of the dental procedures being extractions and 14% fillings. Another 1,000 patients were turned away that first day once clinic capacity was reached. The value of care provided per patient was $257 of free dental care.

The number of patients and procedures continued to rise each year.

Partners supporting Wise MOM 2000 included Virginia Dental Association, Virginia Health Care Foundation, VCU School of Dentistry and School of Dental Hygiene, Health Wagon, DMAS, Virginia Department of Health, along with 133 dental volunteers who travelled from all regions of Virginia.

Due to the increasing number of patients each year, a larger space was needed. In 2003, Wise MOM was moved to the Wise County Fairgrounds. Patients would arrive days before the clinic and camp in the fairground parking lot in their trucks and cars for an opportunity to wait in line to see a dentist. The Wise County Fairgrounds provided an open-air setting for the clinic under a large pavilion and circus tent. Heat, rain, wind, storms, and even cool spells were challenging for patients and dental volunteers. MOM now has portable dental equipment (chairs, units, and lights). Thank you to our many donors and funders who continue to make MOM possible! Procedures offered

MOM then (left) and now (right).

>> CONTINUED FROM PAGE 63

included exams, X-rays, cleanings, fillings, extractions, root canals, dentures, and denture procedures. During this event, 1,149 patients were treated and received 5,652 dental procedures. Fortyeight percent of the dental procedures provided were extractions and 19% were fillings. The value of care per patient increased to $600 for free dental care. Over 291 dentists, dental hygienists, dental assistants, dental and hygiene students, and general volunteers made MOM possible that year. Partners included VCU School of Dentistry and School of Dental Hygiene, Virginia Health Care Foundation, Virginia Dental Association, North Carolina Dental Society (X-ray van), DMAS, Health Wagon, Virginia Department of Health, and others. The largest number of patients treated at Wise MOM occurred at the 2009 project, where 1,545 patients received free dental care. The value of care per patient was $986, made

COMPARING PAST AND PRESENT

“Thanks to all who have made this project the model for the rest of the country. Without you, we simply couldn’t have done it. You have done amazing things and have helped so many of those who desperately needed dental care. You have much to be proud of.”

– Dr. Terry Dickinson

possible by 441 volunteers. Wise County Fairgrounds remained the location for Wise MOM through 2017. In 2018, Wise MOM moved to UVA College at Wise. The Prior Convocation Center at UVA Wise offers air-conditioned space for patients to wait for and receive dental care. Concerns about weather conditions at the Wise County Fairgrounds have been eliminated! Patients can now arrive for morning dental care and be seated in the comfortable and patient-friendly Prior Convocation Center upon arrival. Procedures offered include medical triage, exams, cleanings, fillings extractions, dentures, partials, denture relines and adjustments, and root canals. Panorex X-rays are taken on all patients. Approximately 350 volunteers are needed for all MOM projects, including dentists, hygienists, dental assistants, general volunteers, dental and dental hygiene students, nurses, nursing students, and dental assistant students. Wise MOM 2018 had 953 patients who received 7,487 free dental procedures during the event. The value of care per patient was $1,373 in free dental treatment. Thirty-three percent of dental procedures were extractions, and 28% were fillings (an overall increase in fillings

at any one project compared to a decrease in extractions). Due to a decrease in the number of patients seeking care on Sundays, the clinic has been reduced to a two-day clinic for future events.

“The unfortunate reality is that many people don’t have access to dental care. Attending a MOM Project is always emotional for me in many ways. The need is so great, but we are making an impact, and it brings me joy to see people relieved of pain and receiving care. I know I speak for the VCU dental and dental hygiene students who volunteer when I say we are blessed to participate in serving communities in need.” - Michelle McGregor.

MOM led the way twenty-five years ago in raising awareness of the need for access to dental care not only in Virginia but throughout the country. Through twenty-five years of service to Virginians statewide and 135 MOM projects, some 71,582 patients have received $51.3 million in free dental care! We thank each and every volunteer who gave their time and expertise over these years.

REFLECTIONS FROM THE CLINIC: GROWTH, CHALLENGES, AND LESSONS LEARNED IN DENTAL EDUCATION

Anneliese Goetz, VCU School of Dentistry, Class of 2025

As we enter the first weeks of this year’s summer clinic, it feels like an appropriate time to reflect on what we have learned this past year and what we hope to learn in the coming year. This time last year, the Class of 2025 was just beginning to see our first patients in the clinic. Although we spent time in the clinic during our first and second years assisting our third and fourth year “vertical buddies” and completing simple operative and periodontal procedures, stepping into the clinic during those first few weeks of the third-year summer semester was daunting to say the least. Third-year students have to become acquainted with the nuances of axiUm software, learn how to manage and schedule patients and start to form relationships with our clinical faculty, all while carrying out high-quality dental care. It all felt extremely overwhelming at the start, but things gradually became easier and less stressful.

Reflecting on this past year, it’s remarkable how much we’ve grown both personally and professionally. The transition from preclinical coursework to clinical practice is a significant milestone in our dental education journey. We’ve gone from learning about dental procedures in theory and practicing them on mannequins to actually performing them on real patients. The responsibility that comes with providing dental care to individuals is not lost on us, and it’s something we take very seriously. One of the most valuable lessons we’ve learned is the importance of communication and teamwork in the clinical setting.

Whether it’s collaborating with faculty members to develop treatment plans or working closely with our peers during patient care, effective communication is key to delivering the best possible outcomes for our patients. We’ve also come to appreciate the value of seeking feedback and continuously striving to improve our skills and knowledge.

Another aspect of clinic life that we’ve had to adapt to is the use of technology in dental practice. In particular, axiUm software has become an integral part of our daily routine. From patient charting to treatment planning to scheduling appointments, we rely on this software to streamline our workflow and ensure that we’re providing efficient and effective care to our patients. While there was definitely a learning curve in the beginning, we now feel much more comfortable navigating the various features of axiUm.

Looking ahead to the year to come, there is still much more for us to learn and experience. We’re excited to continue honing our clinical skills and expanding our knowledge base across various areas of dentistry. Whether it’s mastering new techniques in restorative dentistry, delving deeper into the intricacies of periodontal therapy, or exploring emerging technologies in the field, we’re eager to embrace the challenges and opportunities that lie ahead. In addition to clinical proficiency, we also recognize the importance of developing strong patient rapport and chairside manners. Building trust and rapport with our patients not only enhances their overall experience but

also plays a crucial role in achieving successful treatment outcomes. We’re committed to fostering meaningful connections with our patients and providing them with compassionate, patient-centered care.

As we embark on this next year of our dental education journey, we’re grateful for the support and guidance of our faculty mentors, our classmates, and the entire dental community. Together, we will continue to learn, grow, and strive for excellence in everything we do. With each patient encounter, we are reminded of the privilege and responsibility that comes with being a dental professional, and we are committed to upholding the highest standards of care in service to our patients and our profession.

THE HEAD AND NECK EXAM REVISITED:

INSIGHTS FROM VCU’S ORAL FACIAL PAIN AND ORAL MEDICINE CLUB

Kelsey Guraya, VCU School of Dentistry, Class of 2025

At both the VCU School Of Dentistry and dental practices across the nation, a head and neck examination is the standard of care at every intake appointment and subsequent periodic exam. But what exactly encompasses a true head and neck exam? For most of us, a quick assessment of the floor of the mouth and lateral border of the tongue to rule out oral cancer takes precedence in the midst of busy schedules and clinical requirements. However, a comprehensive approach to patient care necessitates attention to the entire oral cavity, including the head and neck region.

VCU’s Oral Facial Pain and Oral Medicine (OFPOM) Club, with the help of orofacial pain specialist Dr. Shawn P. McMahon and oral medicine specialist Dr. Alexandra Howell, conducted a head and neck workshop this past school year to address proper techniques and possible findings of a routine head and neck exam. Through this workshop, we found that a systematic approach to a head and neck exam is vital not only for the early detection of various pathologies but also important for identifying pain that mimics symptoms of odontogenic origin.

During our workshop, Dr. Howell emphasized a systematic approach to an intraoral and extraoral examination. For most of us, inspecting the lips, buccal mucosa, tongue, floor of the mouth, palate, and gingiva for any abnormalities, such as lesions, ulcers, or swelling, is routine. Another important aspect of the intraoral half

of the exam is assessing the occlusal scheme and TMJ function to identify parafunction and TMD signs and symptoms. The tonsillar area is a commonly forgotten area which is often difficult to assess. The tonsils have a profound impact on swallowing and maintaining the airway. A thorough intraoral exam is key in detecting pathologies such as squamous cell carcinoma and oropharyngeal cancer.

The extraoral half of the exam proved to be the most insightful when learning to palpate the muscles of mastication, facial muscles, and lymph nodes. Palpating perpendicular to the muscle fibers can reveal trigger points as well as referred pain that can mimic tooth pain. The temporalis, masseter, trapezius, anterior digastric, and more can refer pain to any correlating part of the maxillary or mandibular dentition. The pain can resemble a dull throbbing ache normally associated with pulpal inflammation. If cold or percussion testing appears inconclusive, referred pain could be the culprit of tooth pain. As patients often see their general dentists more often than their primary care doctors, palpating the lymph nodes for firm, unmovable masses in the submandibular and cervical region is vital in the early diagnosis of malignant diseases.

The main insight the OFPOM Club gained through this hands-on workshop was the interdisciplinary nature of the head and neck exam. Dental students and practitioners proficient in conducting thorough examinations play a vital role in facilitating interdisciplinary

communication and referral pathways. By fostering partnerships with primary care doctors, ENTs, and other dental specialists, we can ensure that patients receive timely and appropriate care. By prioritizing the integration of these exams into clinical practice, dental professionals can enhance patient outcomes and contribute to the holistic aspect of overall healthcare.

MEET THE CANDIDATES

VOTING BEGINS JULY 16, 2024 AT VADENTAL.ORG/VOTE

VDA President-Elect (ONE position available)

Dr. Marlon Goad

As I humbly present my candidacy for the presidency of the Virginia Dental Association (VDA), I am driven by an unwavering passion for advancing our noble profession and safeguarding the interests of dental practitioners across the Commonwealth. First and foremost, I profoundly respect the incredible work done by the VDA in championing the cause of dentistry. The VDA has been at the forefront, tirelessly advocating for the betterment of our profession and ensuring our voices are heard. Yet, challenges persist, notably in the realm of low reimbursement rates imposed by dental insurance companies. For far too long, dentists have grappled with inadequate reimbursement rates, posing financial hardships and limiting the scope of exceptional care we strive to provide. This issue remains a critical concern, impacting the vitality of our practices and the quality of care we deliver to our patients. My candidacy is anchored in a commitment to address these challenges head-on. I aim to spearhead a vigorous campaign with the VDA, leveraging our collective strength and influence to push back against dental insurance companies. It’s time to demand fairness, transparency, and equitable reimbursement rates that reflect the

true value of our services. Transparency and fairness must be the cornerstone of our profession. As President, I pledge to uphold these principles, guiding the VDA in finding innovative ways to ensure that dentists across Virginia receive just compensation for their invaluable contributions to oral health care. Moreover, I am steadfast in my resolve to bolster our association’s membership. The VDA serves as the unequivocal Voice of Dentistry in our state. However, to amplify this voice and effect substantial change, we need the unwavering support and unity of every dentist within the Commonwealth. Together, we are stronger, and together, we can drive meaningful transformation. I invite each of you to join me on this pivotal journey. Our profession’s future depends on our collective action and collaboration. Let us stand united under the banner of the VDA, advocating for our rights, our profession, and the well-being of our patients. As I step forward to seek your trust and support in this endeavor, I am committed to serving each and every dentist in Virginia with dedication, integrity, and an unwavering focus on advancing the interests of our profession. Thank you for considering my candidacy. Together, let us shape a future where dentists thrive, patients receive exceptional care, and the VDA continues to be an unwavering force for positive change.

VDA Secretary/Treasurer (ONE position available)

Dr. Cynthia Southern

I have spent many years serving the Virginia Dental Association and its members. I would like to serve again as your Secretary-Treasurer. The experience I have from serving on the Council on Finance as Secretary-Treasurer and President will help me to serve as Secretary-Treasurer. I feel I have the experience and knowledge to run and serve in this position. I ask for your support.

ADA DELEGATE

(FOUR positions available)

Dr. Caitlin Batchelor

It would be my honor and privilege to serve the members of the Virginia Dental Association as a delegate to the American Dental Association’s House of Delegates. My experience as an alternate delegate has prepared me for the responsibility of doing the important business of the ADA and representing our state’s interests on a national level. With issues like dwindling membership facing the VDA and ADA, and workforce shortages facing dentists across the country, the policy and actions of the ADA are more important than ever in offering solutions to help shape the future of our profession. I appreciate your consideration and support.

Dr. Abby Halpern

In my professional career thus far, the Virginia Dental Association has been exceptional in allowing me to humbly serve the dentists and patients of our great state. I have enjoyed learning alongside my colleagues to further understand the pulse of the profession, both on the state and national levels. I have seen how the parliamentary process acts as a conduit for the desires of our membership, by way of the House of Delegates, to allow for this pulse to be heard and then disseminated as a united and effective voice. Having served as both a Delegate and Chair for ASDA’s delegation to the ADA, I have experienced this process first-hand. I believe wholeheartedly that such involvement in organized dentistry is vital to keeping dentistry poised to evolve while simultaneously allowing us to protect the profession. I have enjoyed expanding my knowledge and serving as an Alternate Delegate to the ADA on behalf of the 16th District for this last term. Due to my previous experience and enthusiasm for service, I earnestly ask for your support and vote to continue to represent the Virginia Dental Association’s voice as an Delegate to the ADA. It would be my honor and privilege to serve dentistry in this way as we move ahead as a united force, voice, and profession through the challenges that lie ahead. I sincerely thank you for your consideration.

Dr. Scott Berman

I would like to serve as a VDA Delegate to the ADA to represent our state’s interests at the ADA level and try to influence the direction of our profession. I’d like to work to make the ADA and VDA relevant to ALL practicing dentists. After spending several years as an Alternate-Delegate to the ADA, I have gained some experience that makes me more prepared to participate in the governance of the ADA.

Dr. Ralph Howell, Jr.

The profession of dentistry has faced many challenges over the years and would look drastically different today if it were not for the ADA’s tripartite organization and the dedicated volunteers that preceded us. The issues that we face today are even more complex with third-party payers, increased regulations, and the introduction of artificial intelligence into healthcare. It’s vital that we send representatives who understand these issues. Having served as a delegate and on two ADA Councils, I feel that I can effectively represent Virginia on the 16th District Delegation and would appreciate your support.

ADA ALTERNATE DELEGATE

(SIX positions available)

Dr. Vince Dougherty

Dentistry has always been a part of my life. I watched my father practice without all of today’s technological advancements. So much change has occurred. I want to continue to help direct the change in a way that benefits the practice of dentistry and our patients. I have the will, the confidence, and the passion for the position. I promise to represent you in the best way possible. Serving as ADA Delegate, as past president of NVDS, and past president of VDA, I have acquired leadership and decisionmaking skills to act confidently on your behalf. I have also served as chair of the Virginia Dental Association’s Covid “Back to Work Task Force” and a member of the ADA’s Council on Dental Benefits. I have just completed my term as chair of the ADA’s 16th District Delegation. This leadership position helped to solidify my confidence in all delegation matters. Many strong relationships were formed which enables cohesion within the delegation. My experience on the CDBP enables me to understand that there are many other threats against our great profession, including the ability to practice quality dentistry while delivering exceptional patient care without insurance interference. With all my past and present involvement in organized dentistry, I feel I have the knowledge to make informed decisions. I will cast any vote based upon the following question: “Does this strengthen the doctor/patient relationship?” I respectfully ask for your vote. I understand that in fulfilling the position, it will be an ongoing responsibility to our profession.

Dr. Zaneta Hamlin

As a current ADA Alternate Delegate, I am seeking your valuable support to continue serving in this crucial role. The privilege of learning from esteemed colleagues with extensive experience in organized dentistry has been both enlightening and humbling. Given the imminent changes in organized dentistry, I am eager to contribute a unique perspective that could prove invaluable. My past experiences in various leadership roles within my local component, state leadership, and as an appointee to the ADA pensions committee have equipped me with an evolving comprehensive understanding of our profession. I firmly believe that by securing another term, I can further enhance my capabilities to effectively serve and support our state and the ADA in achieving unprecedented progress. Your support will not only be an endorsement of my commitment but an investment in the advancement of organized dentistry as a whole. I am eager to continue working collaboratively toward our shared goals.

Dr. Melanie Wilson Hartman

There are many reasons I am seeking to serve another term as an ADA Alternate Delegate. I have served on Northern Virginia Dental Society’s delegation to the VDA House of Delegates since early in my career. I am a long-time member of our component’s Board of Directors and have been a member of our VDA Board of Directors since September 2023. I am both able and willing to present the opinions of my colleagues as well as to offer my own. We are blessed with great leaders in the current ADA House of Delegates—leaders who strive to protect our beloved profession, the public, our future, and the future of those dentists who will practice after us. I believe that we can only protect what we have worked so hard to establish by staying involved in and committed to organized dentistry. Only then may we wisely and proactively address the challenges that come our way. It goes without saying that our profession has confronted a myriad of unique challenges and rapid changes in how we practice our profession in the last few years, and I have never been more proud to be an ADA member and Alternate Delegate. If re-elected, I will continue to make myself available to my peers and colleagues and work to facilitate our shared goals. I am fully committed to the duties and responsibilities of the position, and it would be an honor and privilege to continue serving our great profession at the national level.

ADA ALTERNATE DELEGATE continued (SIX positions available)

Dr. Alexandra Howell

It would be an honor to serve the VDA as an Alternate Delegate for the ADA House of Delegates. My journey in organized dentistry began in dental school when I had the opportunity to serve as National ASDA Vice President and to represent dental students as an ADA Student Delegate. I now serve on the Board of Directors for the Richmond Dental Society. My involvement in organized dentistry has equipped me with a deep understanding of our profession’s challenges and opportunities. As the sole Oral Medicine Specialist in Virginia and an Assistant Professor at VCU School of Dentistry, I have witnessed firsthand the critical need for collaboration between medical and dental fields. My role as an educator allows me to nurture the next generation of dental professionals, instilling in them the importance of a holistic approach to patient care. I believe that effective advocacy starts with education, and I am committed to conveying to my students the importance of staying informed and actively participating in the broader dental community. I aim to advocate for policies that recognize oral health as integral to overall well-being and promote interprofessional education and collaboration. In this pivotal time for dentistry, with evolving healthcare landscapes and emerging oral-systemic connections, I believe my blend of clinical expertise, academic insight, and advocacy experience uniquely qualifies me to serve as an Alternate Delegate.

Dr. Alexander Sadak

I’m a solo owner of a small practice in McLean, VA. Ever since I moved to Virginia in 2017, I’ve been encouraged to apply for positions in organized dentistry. I’ve settled into being a programs chair and have declined any other positions due to having a new practice and two little kids. My goal as program chair was to add value to members and wow them with our offerings. This year, I took on another role as a member of VDSC, and I’ve been so thankful to meet so many amazing people with the aligned goal of making our organization grow and add value to our members. I love to bring fresh ideas and energy to groups and organizations that I’m involved in. As a dentist who’s been out less than ten years, I hope to bring some ideas to encourage new development within the ADA that would resonate with younger dentists and add membership value. I’m excited to meet and socialize with dentists from other regions to see what’s important to their component members and what organized dentistry can do for them. I’m looking forward to finding new mentors and to one day give back as a mentor for someone else.

Dr. Jeremy Jordan

Involvement in organized dentistry has been an intrinsic part of my personal and professional development since before my first day of dental school. Now that I’ve been in practice for several years, I’m even more aware of the challenges we face as dentists each day. Active and engaged participation is crucial to ensure our profession remains strong. Our decisions as a national organization affect the way we practice and how we’re perceived by the public—it is imperative to represent the interests of our association, the communities we serve, and the patients we treat. Because of my past involvement at multiple levels of the VDA and other dental organizations, I understand how those policies enacted by the House of Delegates shape the future direction of our profession and help the ADA remain the voice of dentistry. Continuing my participation by being selected to serve as an Alternate Delegate would be an honor, and I genuinely appreciate the opportunity to be considered.

Dr. David Stafford

I am running to serve as an ADA Alternate Delegate. With a track record of leadership and dedication within the dental community, I am eager to contribute to the advancement of our profession at the national level. I have had the privilege of serving on various committees and boards, including the Ethics and New Dentist Committee. As President of the New Dentist Committee, I worked to create initiatives aimed at empowering and supporting new and future members of our profession. This includes organizing question-and-answer sessions with dental students and securing funding for new dentist events at the component level for networking opportunities for colleagues. In response to the evolving landscape of dentistry, our committee organized the New Dentist Webinar Series, which provides accessible and relevant continuing education opportunities for early-career professionals. Currently serving on the Component 5 Board and on the VDA Board of Directors, I actively engage in strategic decision-making for our member’s best interests. Advocating for our profession on the Council on Government Affairs and for our members on the Caring Dentist Committee enhances my ability to be effective on the ADA delegation. In summary, my prior service and my passion for advancing dentistry qualify me to be an ADA Alternate Delegate. I am eager to bring my unique perspectives and experiences to the table, working with fellow delegates to shape the future of our profession.

WELCOME NEW MEMBERS THROUGH JUNE 1, 2024

Dr. David Bitonti – Virginia Beach –University of Pittsburgh

Dr. Steven Rassi – Norfolk – State University of New York at Buffalo School of Dental Medicine 2013

Dr. Jennifer Schlesinger – Norfolk – Temple University’s Maurice H. Kornberg School of Dentistry 2013

Dr. Terrall Thurman – Virginia Beach –University of Texas School of Dentistry at Houston 2016

Dr. Corry Brown – Manakin-Sabot –University of Maryland School of Dentistry 2015

Dr. Sobia Carter – Glen Allen – Virginia Commonwealth University School of Dentistry 2001

Dr. Rajesh Devisetti – Richmond – Columbia University College of Dental Medicine 2013

Dr. Sravanthi Papisetti – Chesterfield - West Virginia University School of Dentistry 2022

Dr. Priyal Patel – Richmond – Virginia Commonwealth University School of Dentistry 2023

Dr. Asya Marsh – York – Western University of Health Sciences College of Dental Medicine 2018

Dr. Joseph Booth – Chesterfield – Boston University Goldman School of Dental Medicine 2007

Dr. Alexander Hawkins – Midlothian –Virginia Commonwealth University School of Dentistry 2004

Dr. Leandro Petrella – Mechanicsville – University of Rochester Eastman Department of Dentistry 2023

Dr. Brandon Schafer – Mechanicsville –University of Pittsburgh School of Dental Medicine 2014

Dr. Sarah Yi – Mechanicsville – Virginia Commonwealth University School of Dentistry 2019

Dr. Brady George – Montgomery – LECOM College of Dental Medicine 2020

Dr. Wael Zakkour – Lynchburg - Louisiana State University School of Dentistry 2021

Dr. Kelechi Okereke – Danville – University of North Carolina School of Dentistry 2020

Dr. Yasser Khedr – Luray – University of Connecticut School of Dental Medicine 2009

Dr. Peter Fredrickson – Albemarle – New York University College of Dentistry 2017

Dr. Camila Negron Garcia – Harrisonburg – Marquette University School of Dentistry 2022

Dr. Ann Nicholas – Charlottesville – Tufts University School of Dental Medicine 2012

Dr. Ammar Al-Mahdi – Fairfax – Ohio State University Medical Center 2016

Dr. Salma Faraz – Falls Church –Midwestern University College of Dental Medicine 2016

Dr. Vaishnavi Garapati – Alexandria –University of California at San Francisco School of Dentistry 2022

Dr. Jordan Jarrett – Fairfax – West Virginia University School of Dentistry 2017

Dr. Sybil Jones – Loudoun – Meharry Medical College School of Dentistry 2021

Dr. Sophie Moon – Arlington – University of Michigan School of Dentistry 2020

Dr. Mahdokht Sadeghvishkaei – Loudoun –University of Louisville School of Dentistry 2023

Dr. Abasin Safi – Falls Church – Midwestern University College of Dental Medicine 2015

Dr. Corinne Tran – Fairfax – Howard University College of Dentistry 2023

Dr. My Trinh – Fairfax – Virginia Commonwealth University School of Dentistry 2015

Dr. Munira Muluke – Fairfax – University of Kentucky College of Dentistry 2021

Dr. Shikha Nanda – Fairfax – Boston University Goldman School of Dental Medicine 2020

Dr. Eleeka Nejat – Great Falls – University of Tennessee College of Dentistry 2022

Dr. Francisco Rodriguez Lopez – Fairfax –University of Puerto Rico School of Dental Medicine 2009

Dr. Olga Spivak – Fairfax – Boston University Goldman School of Dental Medicine 2016

IN MEMORY OF:

DDS: Dental Detective Series

>> CROSSWORD ANSWERS CONTINUED FROM PAGE 17

K X V N C U M V H Q O V H O H Z W F S U I O

N K E A E F B P O R T A B I L I T Y P E M I Y B A E A N T N

Q K H S N Y S J U R K E Y L Q T M N W G S C Q L Q R L T H T

Y O I L C L U L B A X X J E C Q N C J D L M J F L R T K I E

I Q C E H E S R J U K N

Medical Adherence Hypoallergenic Transparency SQL

MEDICAL ADHERENCE

HYPOALLERGENIC

SALESFORCE

EHB benchmark Portability Attribution ADA

EHB

PORTABILITY

NONCOMPETE

BENCHMARK

CAPITATION

LEGISLATION

Capitation Legislation Salesforce

CONVERSION

Monolithic Conversion Noncompete

MONOLITHIC

REFERRALS

New Orleans Referrals Greenbrier

NEW ORLEANS

MEASLES

Election Measles Mid career

ELECTION

MONOMER

Tableau Monomer Advocate

TABLEAU

GREENBRIER

MID CAREER

ADVOCATE CHROMA BURNOUT

FURIOSA

SMILECON

TREASURER

EQUITY

Smilecon Furiosa Chroma

TRANSPARENCY

Treasurer Equity Burnout

AIRWAY

Airway

SQL ADA

ATTRIBUTION

®

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

VDA Career Center connects employers with premier dental professionals.

Employers: Job Seekers:

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