Virginia Dental Journal Vol 100#2 April - June 2023

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COLUMNS

3 ABUZZ WITH ACTIVITY

Dr. Cynthia Southern

5 THE STORY IN YOUR EYES

Dr. Richard F. Roadcap

7 A MUCH-NEEDED INCREASE: REIMBURSEMENT RATES RAISED BY 30% FOR VIRGINIA MEDICAID SMILES FOR CHILDREN PROGRAM

Dr. Sarah Koury and Dr. Elizabeth Berry

8 WHAT IS YOUR “WHY”?

Dr. Gary D. Oyster

9 GARY OYSTER, D.D.S., RECEIVES INAUGURAL ADPAC LIFELONG LEGACY AWARD

Jennifer Garvin

COVER STORY

30 WIRE TO WIRE

DR. POND’S CAREER IN AUTOS AND ORTHODONTICS

Dr. Richard F. Roadcap

ADVOCACY

10 AN ARMY OF ONE = AN ARMY OF NONE

Ryan L. Dunn

12 VDA’S 2023 DENTAL DAYS AT THE CAPITOL HAS RECORD ATTENDANCE

Laura Givens

13 ADVOCACY FOR DENTISTRY IS ALIVE IN VIRGINIA BUT WE STILL NEED YOUR HELP

Dr. Bruce Hutchison

15 VIRGINIA 2023 GENERAL ASSEMBLY SESSION REPORT

Charles Duvall, Tripp Perrin and Missy Wesolowski

SCIENTIFIC

16 THROUGH THE LOOKING GLASS THE FANTASTICAL WORLD OF ORAL PATHOLOGY

Dr. Sarah Glass

19 ENDODONTIC ABSTRACTS

RESOURCES

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

28 VIRGINIA BOARD OF DENTISTRY NOTES

Dr. Ursula Klostermyer

38 WHAT’S CHANGING IN VIRGINIA’S DENTAL WORKFORCE?

Paul Logan

39 WHAT’S THE VDA DOING TO ADDRESS THE VIRGINIA DENTAL WORKFORCE ISSUE?

Shannon Jacobs

40 MANAGING RISK AS YOU PREPARE FOR RETIREMENT

Dylan Mills

42 USING EMAIL MARKETING TO STAY CONNECTED WITH PATIENTS

Michaela Mishoe

46 FINDING AND HIRING THE RIGHT CANDIDATE FOR YOUR DENTAL PRACTICE

Sydney Andersen

49 DENTAL DETECTIVE SERIES WORD SEARCH

Dr. Zaneta Hamlin

58 HOW IS ORAL HEALTH IN VIRGINIA?

Sarah Bedard Holland

UNIVERSITY CONNECTIONS

35 EXPLORING SPECIALTIES AS A THIRD-YEAR DENTAL STUDENT

Jack Madigan

37 PERFECT PRACTICE MAKES PERFECT

Lyda Sypawka

MEMBERSHIP

50 OPEN VDA LEADERSHIP POSITIONS

51 AWARD NOMINATIONS –NOW OPEN

52 NEW MEMBERS

54 AWARDS & RECOGNITION

On the cover: Dr. Pond clears the windshield on Car 54 during a pit stop.

AWARD WINNING PUBLICATION

WINNER OF THE2020 SILVERSCROLLAWARD

VA DENTAL

JOURNAL

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

BUSINESS MANAGER Ryan L. Dunn

MANAGING EDITOR Shannon Jacobs

EDITORIAL BOARD

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

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

VDA COMPONENT

BOARD OF DIRECTORS

PRESIDENT Dr. Cynthia Southern, Pulaski

PRESIDENT ELECT Dr. Dustin Reynolds, Lynchburg

IMMEDIATE PAST PRESIDENT Dr. Scott Berman, Falls Church

SECRETARY-TREASURER Dr. Zaneta Hamlin, Virginia Beach CEO Ryan L. Dunn, Goochland

SPEAKER OF THE HOUSE Dr. Abby Halpern, Arlington

NDC CHAIR Dr. C. Dani Howell

COMPONENT 1 Dr. David Marshall

COMPONENT 2 Dr. Sayward Duggan

COMPONENT 3 Dr. Samuel Galstan

COMPONENT 4 Dr. Marcel Lambrechts

COMPONENT 5 Dr. David Stafford

COMPONENT 6 Dr. Marlon A. Goad

COMPONENT 7 Dr. Caitlin S. Batchelor

COMPONENT 8 Dr. Justin Norbo

ADVISORY Dr. Lyndon Cooper

ADVISORY Dr. Ralph L. Howell, Jr.

ADVISORY Dr. Lorenzo Modeste

EDITOR Dr. Richard F. Roadcap

VCU STUDENT Brett Siegel, VCU Class of 2023

VCU STUDENT Eric Montalvo, VCU Class of 2024

VOLUME 100, NUMBER 2 • APRIL, MAY & JUNE

2023

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

SUBSCRIPTION RATES Members $6.00 included in your annual membership dues. Members – Additional Copy: $3.00

Non-Members- Single Copy: $6.00 Non-Member outside the US: $12.00

Annual Subscriptions in the US: $24.00 outside the US: $48.00

POSTMASTER Second class postage paid at Richmond, Virginia. ©Copyright Virginia Dental Association 2023

MANUSCRIPT, COMMUNICATION & ADVERTISING

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

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

ABUZZ WITH ACTIVITY

Dr. Cynthia Southern

As I’m writing this article, spring is just beginning. The daffodils are blooming, the Bradford pears are full of white blooms, and the grass is getting greener. Spring has always amazed me. It gives us hope that the warmer months are coming. We are part of an amazing Association and I have hope that wonderful things are still to come. Many great things have already occurred this year. Dental Days at the Capitol was a huge success. It was wonderful to see so many dentists in their white coats. We had a record number of dental students attend. Thanks are due to VCU School of Dentistry for emphasizing the importance of organized dentistry to the future leaders of our profession.

Our House of Delegates met after our visits to the General Assembly. Senator Todd Pillion, a pediatric dentist in Abingdon, introduced a bill allowing dentists to administer Botox for cosmetic purposes. This bill was passed in the Senate and the House and is currently awaiting the approval of Governor Youngkin. A VDA policy was created in support of dentists being able to administer Botox and dermal fillers for cosmetic purposes. Dentists have the knowledge and expertise to provide this service to their patients. If this becomes law, there will be additional training required and dentists will be able to decide if it is something they want to add to their practice.

Our House of Delegates also approved a policy to establish a Virginia Dental Workforce Council. The workforce shortage is still burdening many of our members, including myself. In coordination with many other groups related to dentistry, we are currently gathering data and will report our findings and recommended actions to the board in September.

Our House of Delegates also created a policy to pursue legislation creating a dental loss ratio in the Commonwealth and additionally encourage the ADA to pursue the same policy nationally. There will be a great deal of discussion and research on this issue. Massachusetts voters approved a dental loss ratio in a referendum, and many other states are following in their footsteps. As dentists, we lead teams that alleviate pain and restore health and functions to our patients. Our teams create and maintain smiles across the Commonwealth. Education is something we all do every day with our patients. Educating our communities about the limitations of dental insurance plans helps to raise awareness. Some citizens of Virginia, including many of our patients, do not understand how dental insurance plans function. Is it truly Insurance, or is it a discount plan? Preventive services are only covered fully if a dentist is in network with that plan. Many plans have deductibles that have to be met, and then coverage is only a percentage of the cost of treatment provided. Once the yearly maximum is met, then all the cost of treatment falls on the patient. This is vastly different from medical insurance. Will a dental loss ratio solve all of these limitations? No one knows the answer, but with the wave of change occurring across the country, we will see the results. This makes me remember my grandfather, who loved the saying, “Time will tell.”

Medicaid reimbursement rates increased by 30% last year. Now we must show the General Assembly that we are willing to help with this program. There have been close to a million adults added to this program. They now have a comprehensive dental benefit, but there are still a large number of adults who have not been able to see a dentist.

I have been informed by DMAS that many of these adults are working. Some companies throughout the Commonwealth are hiring people to work under 40 hours a week, so they do not have to include benefits. These people need our help. Please, if you are not a Medicaid provider, consider signing up. If you are a provider, consider taking on a few more cases. If we could each “Take 3 in 2023” or, even better, “Strive for Five,” we could make a huge difference. If we all pitch in a little, we can meet a need and help the people in our communities.

I challenge each of you to recruit one non-member to join and give a little extra to your association and your PAC this year. Who wouldn’t want to join and support an association that looks out for its members and their patients? We’re an association that led us through a pandemic, an association with over 150 years in existence, an association that supports third-party payers being fair and accountable to their subscribers, and an association that has been and will be here for you.

Finally, don’t forget to register for the Virginia Dental Showcase in Norfolk. There will be CE, the exhibit hall, social events, a golf tournament, time to spend with friends and colleagues, and don’t forget the President’s party. I look forward to seeing you in Norfolk.

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LIBERTY

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THE STORY IN YOUR EYES

Dr. Richard F. Roadcap

Novelist John Grisham says this about lawyers: “The great ones simply tell the jury a story.”1 Anthropologist Jane Goodall tells us, “I’ve found that stories reach the heart better than any facts or figures.” Since its founding in 1839, our profession has made it a priority to tell its story. After being rebuffed by the medical school in Baltimore, Drs. Chapin Harris and Horace Hayden started the world’s first dental school, and dentistry was set apart from medicine as an independent and unique profession.

Harris and Hayden knew then what was needed to create the new profession: an association (i.e., organized dentistry), education, and a journal. Sometimes referred to as the “triumvirate of dental history”2, this foundation guided the upstart profession throughout the 19th century and into the first two decades of the 20th. Dr. Harris is credited with starting the first dental journal, the American Journal of Dental Science. Publications such as AJDS “provided the greatest impetus to forming dentistry as a profession.”3. However, Harris’s tenure as editor of the first dental journal was wracked by financial difficulties and controversy. It’s alleged that he died in 1860 at age 54 from “overwork,” but by 1883, there were twenty dental journals in the US, over half of all such publications in the world.

Dental journalism grew rapidly after 1840, but it was the norm for independent non-profit journals to wither and die, while manufacturer and trade journals flourished. Prior to 1920 the for-profits dominated dental literature. Editors endured differing levels of independence, with many expected to flog the company’s wares in content presumed to be unbiased. The most widely-read journal, Dental Cosmos, was introduced by

Philadelphia’s S. S. White Company and merged with another publication in the 1930s to create the Journal of the American Dental Association

that represents 100 years of publishing. Nowadays most journals record one year as one volume. However, we’re not certain that was the case years ago, as there was less standardization among journals. Nonetheless, VDA members should be proud that they’ve supported journalism within the state and its localities. At some point in 2018, the National Library of Medicine removed most state and regional dental publications from PubMed, making our content unavailable online and discouraging authors of peer-reviewed research from submitting manuscripts. The barriers to reinstatement proved to be insurmountable for most publications. The ADA House of Delegates came to the rescue in 2022 and approved funding for a digital archive of constituent journals, seeking to make our content and those of similar publications available online.

Dr. William J. Gies, who has been profiled in these pages before, gave a speech in 1916 that marked a turning point in dental journalism. Gies taught at Columbia and has been credited with reforming dental education at a time when the profession threatened to devolve into a trade. Among his comments: “Trade journalism… is a form of vulgar autocracy. Like autocracy, it exploits those who trust it.”4 Although it took years for his comments to change minds, today independent non-proprietary journals dominate the literature of dentistry.

The Virginia Dental Journal celebrates 100 volumes this year. It’s tempting to say

State and regional dental journals are sometimes referred to as “gray” publications, a mix of science, gatherings, and opinion. We have fashioned each of our issues on four pillars: science; membership; outreach; and advocacy. There are a few articles that can’t be assigned to one of these categories. But it’s this composite that distinguishes our literature from medical and scientific publications. Both Dr. Hayden and Dr. Harris feared that dental articles would be consigned to the back pages of medical journals if the new profession did not establish its own literature and its own voice. They knew in 1840 that separation would lead to divorce from the medical establishment, and the nascent profession had to tell the world its own story.

Long before I became involved with editing and publishing, I thought the VDA Journal was all about the VDA. Well, it’s not. Of course, it’s about dentistry. But

“We have fashioned each of our issues on four pillars: science; membership; outreach; and advocacy. There are a few articles that can’t be assigned to one of these categories. But it’s this composite that distinguishes our literature from medical and scientific publications.”

it’s really all about people. And these people have one thing in common: they share a love for this great profession. I’ve heard members will always receive two things from their association: a bill for dues and a copy of the journal. I feel confident that we will continue to receive an invoice for dues. My hope for the future is that members still receive a copy of the Journal, whether it’s in print, digital, or in some format we can’t imagine. We have a story that needs to be told, not only for our contemporaries but also for generations to come.

References

1. Grisham, John. (2022) The Boys from Biloxi. Doubleday/Random House

2. Hook SA. Early Dental Journalism: A Mirror of the Development of Dentistry as a Profession. Bull Med Libr Assoc. 1985; 73(4): 345-351

3. Hook SA.

4. Gies WJ. Indpependent journalism versus trade journalism in dentistry: an irrepressible conflict. J Allied Dent Soc. 1916; 11: 577-623

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A MUCH-NEEDED INCREASE:

REIMBURSEMENT RATES RAISED BY 30% FOR VIRGINIA MEDICAID SMILES FOR CHILDREN PROGRAM

Sarah Koury, DMD and Elizabeth Berry DDS, MSD, MPH

There had not been an increase in Virginia Medicaid Smiles for Children program reimbursement rates in over 16 years. Virginia had one of the lowest participation rates in the country, being number 48 out of 50 states in 2021. Thanks to the many dentists, members of the VDA, and students that fought for an increase in funding and reimbursement rate, a change occurred last year. As of July 1, 2022, the reimbursement rates were finally increased by 30%, with $116 million dollars included in new state and federal funding. There is now hope for children in this program to get the much-needed dental services they need moving forward.

Medicaid was established in 1965 to provide healthcare to low-income individuals in the United States as part of the Social Security Act.1 Medicaid has undergone many changes at a federal level, one being the 1967 legislation that created the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. EPSDT mandated that dental care would be made available to Medicaid-eligible children younger than 21 years of age. Each state has its own Medicaid program with varying stipulations as to who qualifies for benefits, what services are covered, and reimbursement rates for healthcare providers that accept Medicaid.2

In Virginia, with the implementation of the Virginia Smiles for Children Program in 2005 and a 30% increase in dental fees, the number of contracted dentists more than doubled.3 Additionally, the reform led to a single-payer model instead of eight managed care organizations that had been responsible for providing dental benefits. Unfortunately, while reimbursement rates were increased at that time, no additional increases have occurred until 2022.

Many barriers still exist for those reliant on Medicaid for their healthcare coverage. This includes difficulties finding providers who accept Medicaid. For dental care, a lack of providers accepting Medicaid has been attributed to low reimbursement rates for procedures.4 As of 2016, Medicaid fee-for-service reimbursement relative to fees was, on average, 46.4% for pediatric patients in Virginia. Private dental insurance reimbursement relative to fees was, on average, 73.3% for pediatric patients.5

Adjusting Medicaid payment rates closer to “market” levels, along with other reforms, has a significant positive impact on access to dental care.6 In 2015, a study was completed in Connecticut showing that increased dental fees resulted in an increase in dental participation by children with Medicaid by 72%.7 A study in 2015 found that Medicaid reforms increased Medicaid reimbursement rates for pediatric dental care in Connecticut, Maryland, and Texas, which resulted in a positive impact on dental care use among these children.6

The hope for Virginia is to now see an increase in dental care for children with Medicaid benefit. Due to the collaboration of many in our state meeting with legislators, we have achieved a muchneeded increase in our reimbursement rates in Virginia.

References

1. Title XIX of the Social Security Act, USC §1396-1396v, Subchapter XIX, Chapter 7, Title 42 (1965).

2. US Department of Health, Education, and Welfare, Health Care Financing Administration: A Guide to Dental Care for the Early and Periodic Screening,

Diagnosis, and Treatment Program (EPSDT) Under Medicaid, Washington DC, 1980.

3. Virginia Department of Medical Assistance Services. Annual report on “Smiles for Children.” Richmond VA: Virginia Department of Medical Assistance Services; December 2011. https://rga.lis.virginia.gov/ Published/2011/RD372/PDF

4. U.S. Government Accountability Office. GAO/HEHS-00-149: Factors contributing the low use of dental services by low-income populations. September 2000. Available at http://www.gao. gov/assets/240/230602.pdf

Accessed February 13, 2023.

5. Gupta, N, Yarbrough, C, Vujicic, M, Blatz, A, Harrison, B. Medicaid fee-for-service reimbursement rates for child and adult dental care services for all states, 2016. American Dental Association 2017. Available at: https://www.ada.org/-/media/ project/ada-organization/ ada/ada-org/files/resources/ research/hpi/hpibrief_0417_1

Accessed February 13, 2023.

6. Nasseh K, Vujicic M. The impact of Medicaid reform on children’s dental care utilization in Connecticut, Maryland, and Texas. Health Ser Res 2014; 50(4): 1236-1249.

7. Beazoglou T, Douglass J, MyneJoslin V, Baker P, Bailit H. Impact of fee increases on dental utilization rates for children living in Connecticut and enrolled in Medicaid. JADA 2015; 146(1): 52-60.

Dr. Berry Dr. Koury

WHAT IS YOUR “WHY”?

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

If we accept “We Make People Healthy” as an answer to our “Why” question, then dentistry plays a crucial role for people and their optimal health. As the ADA moves through the transformation of its governance structure, the “Why” question will be critical in determining the how strategy and the management of the when, who, where, and what of the ADA.

The ”Why” question is one that forces us to step back and think analytically. Organizations sometimes get so lost in the details that they end up developing a project plan that actually deviates from their initial goal. Strategic forecasting and mission-based budgeting should keep the ADA focused on its mission and vision statements. Councils, committees, and action groups will also be guided by the “We Make People Healthy” statement.

Questions are more important than answers because questions seek to understand situations. The ADA is asking young dentists a lot of questions in hopes of gaining insight as to how the ADA can be reformed and remade as the dental world shifts. That is the purpose of the governance change. Go to where the organization will be, not where it is today.

Young dentists feel they need to be connected to something bigger than themselves. They want to know that their work matters and understand how it impacts other people. Health Equity, Diversity, and Inclusion are important to them. That is why the ADA is preparing answers for their questions about how we are dealing with those issues. The ADA is trying to inspire dentists to join and then together we can improve oral, as well as overall, health care.

The Dental Lifeline Network, known in some states as Donated Dental Services,

is one example of something bigger than the individual. Dentists have contributed over $500 Million in donated dental treatment since it was formed many years ago. This generosity has resulted in health improvements for many people. Give Kids A Smile, Missions of Mercy, and numerous volunteer clinics are examples of efforts that have contributed to the support and wellbeing of our communities.

is, I think, important to keep focused on why we do what we do. As always, I thank you for allowing me to be your trustee and invite you to contact me at any time.

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

Your “Why” statement can serve as a compass. A clear declaration attracts people who believe what you believe, which is vital for projects and resolutions. The current workforce issues, insurance issues, and employment decisions are very real “Why” issues affecting our profession and to which all of us are seeking solutions.

This “Why” question is guiding many organizations and businesses today. The ADA Board of Trustees worked hard at a December meeting to come up with this simple but inclusive statement as to why we exist. As we hear about healthcare providers having mental health issues, it

“Your ‘Why’ statement can serve as a compass. A clear declaration attracts people who believe what you believe, which is vital for projects and resolutions.”

GARY OYSTER, D.D.S., RECEIVES INAUGURAL ADPAC LIFELONG LEGACY AWARD

Jennifer Garvin, ADA News

Reprinted with permission from ADA News

Gary Oyster, D.D.S., wasn’t sure what to think when he was summoned to the podium during the ADA Dentist Student Lobby Day.

His friend and colleague, Hal Fair, D.M.D., had just called him up to the stage to surprise him with the inaugural ADPAC Lifelong Legacy Award. The award was created to recognize those individuals who have contributed at least $20,000 to the American Dental Political Action Committee over their lifetime.

“Dr. Oyster has set himself apart from the rest of us when it comes to advocating for policies that are important to the American Dental Association and to the patients that our member dentists serve,” said Dr. Fair, a past 16th District trustee. “Not only does he advocate tirelessly for our policies but he also, so to speak, puts his money where his mouth is.”

“There is no doubt if you were to look up the definition of passion, commitment and advocacy in the dictionary, the name Gary Oyster would be there next to each one,” Dr. Fair said.

Tributes soon followed from Alec Parker, D.D.S., CEO of the North Carolina Dental Society, and Charles Norman, D.D.S., a past ADA president from North Carolina. There was also a surprise video tribute from the N.C. Dental Society members and a reception held in his honor.

“Wow, that’s all I can say,” said Dr. Oyster, who received two standing ovations from the audience and is the current trustee of the ADA’s 16th District. “I want to say to the students to keep the passion that they feel now as they go through dentistry forever. Never give up. You will not win every battle, but you want to win the war. And the war is to keep dentistry and the

doctor-patient relationship as a model for health care.”

Dr. Oyster has been involved in organized dentistry for more than 50 years and according to the tributes, his tireless efforts in advocating for dentistry at the local, state and national levels are legendary. Most recently he contributed $100,000 to the successful Massachusetts ballot initiative to establish a medical loss ratio in dentistry.

“Gary has taught me by his actions the most important business lesson I ever learned: relationships are everything,” Dr. Parker said. “Thank you, Gary, for your dedication and service to the dentists of our state and our nation as well as the patients they serve.”

“Gary Oyster is the epitome of political activism. He has spent countless hours meeting with legislators, hosting fundraisers, attending fundraisers and contributing untold financial aid to their campaigns,” added Dr. Norman, a friend of Dr. Oyster’s for more than 40 years. “Probably the most inspiring thing about Gary’s many years of service as NC legislative and PAC chair was that he never expected recognition for his efforts. He did what he thought was right for his practice, our profession, and the patients we serve.”

Recognized: Gary Oyster, D.D.S., second from right, received the inaugural ADPAC Lifelong Legacy Award during Lobby Day. From left are Charles Norman, D.D.S., Alec Parker, D.D.S., and Hal Fair, D.M.D., who presented Dr. Oyster with the award. Photo by Max Taylor.

AN ARMY OF ONE = AN ARMY OF NONE

Ryan Dunn, CEO

In January, the VDA made a show of force in the General Assembly during Dental Days at the Capitol, advocating for funding to plan a new VCU School of Dentistry building, for licensure changes that make it easier for dentists and other healthcare professionals to seek help for mental health issues, and for legislation from Senator Todd Pillion that will allow dentists to perform Botox for cosmetic purposes.

We had nearly a hundred dental students join our members from around Virginia at Dental Days and they showed up prepared to discuss these issues with their representatives in the General Assembly. These measures gained legislative support because they are not only good policy that benefits our patients but because when our government affairs team walked in to meet with legislators, they had already heard from member dentists in their districts about why they were important. You called, met in-person, and more than 500 dentists took action through the VDA’s call-to-action platform this year.

Senator Pillion is not only a pediatric dentist in Southwest Virginia, but he is also widely respected by colleagues on both sides of the aisle in the General Assembly, and with the Governor’s signature, his bill directs the Virginia Board of Dentistry to create training and education requirements for dentists to administer botulinum toxin injections for cosmetic purposes. The VDA will be engaged in this regulatory process to ensure the regulations are reasonable and fair for Virginia dentists who wish to incorporate it into their practice. Ensuring there will be clear guidance to protect patients and dentists is of the utmost importance.

During Dental Days at the Capitol, the VDA’s Board of Directors and House of Delegates also met to chart the course forward for the Association. Our President, Dr. Cynthia Southern, will be convening a Virginia Dental Workforce Council throughout the coming year with policymakers and dental educators to ensure that our existing dental training programs have the resources, staff, and clinic space they need to meet workforce needs in their communities, as well as to identify other unmet needs and solutions around the dental workforce in Virginia. Workforce challenges are not unique to dentistry or to Virginia, but we cannot expect anyone else to solve these issues for us. We have already had promising discussions with Governor Youngkin’s administration and legislators and look forward to moving forward together to identify and implement solutions so that every community in Virginia has the workforce available to provide essential dental care.

Our VDA House of Delegates also gave unanimous approval for our Association to move forward in pursuing a dental loss ratio in Virginia, which would require third party payers to spend a certain threshold of premium dollars on patient care. It’s good policy for dentists and their patients, and it’s popular with the public as well, as we saw with the 72 percent voter approval of the ballot initiative in November in Massachusetts.

It would be a heavy lift to achieve this in a normal General Assembly. There will be more newly elected members to the Virginia General Assembly than we have ever seen. Several of the most senior Senators and House of Delegates members have announced their retirement. There will be more than 200 years of legislative experience leaving the Senate alone before they return for the next session. And with all 140 seats in the General Assembly up for election this November, we can expect to work with a lot of fresh faces who do not have experience around oral healthcare issues. The challenges and the opportunities before us are great!

Our members and their team members will need to be engaged in the coming years more than ever. The assaults on dentistry and the business models surrounding practices are constant and many. While we can count on our members, there are many dentists that are not engaged and are not members of the VDA. We need to unify the entire profession. We are asking every member of the VDA to reach out to a nonmember dentist and share with them all that the VDA does for them and directly ask them to join. The future of the VDA, the profession and the positive health outcomes that dentistry provides in the Commonwealth are at stake.

“Our members and their team members will need to be engaged in the coming years more than ever. The assaults on dentistry and the business models surrounding practices are constant and many.”

Please save the date of September 21-24, not only for you, but for your entire team to join us in Norfolk for the Virginia Dental Showcase. New for this year, we will be offering the first session of the Virginia Dental Academy, a credentialing program for dental team members, especially those involved in the management of the office to save your practice time, money and headaches while improving your patients’ and team’s satisfaction.

We have had a great start to 2023 and have a busy year ahead to deliver for our members with powerful advocacy, practice management solutions and opportunities for professional development with dentists who are invested in each other and in the future of our profession.

VDA’S 2023 DENTAL DAYS AT THE CAPITOL HAS RECORD ATTENDANCE

Laura Givens, Director of Legislative and Public Policy

Over 200 VDA member dentists and VCU dental students attended the VDA’s Dental Days at the Capitol on January 2627 in Richmond. Dentists, dental students, and guests gathered with legislators at the Omni in downtown Richmond on the evening of January 26 for our annual legislative reception, where members enjoyed mingling with legislators. The event continued the following morning with participants enjoying breakfast and a program that began with a special guest speaker, Lieutenant Governor Winsome Earle-Sears. Attendees were motivated by Ms. Earle-Sears’s message, in which she expressed the importance of being involved in the association and particularly in advocacy efforts.

The large crowd of dentists and students, many in white coats, walked over to the Pocahontas Building following breakfast to meet with legislators and legislative staff. Their mission included thanking legislators for supporting the increase in dental Medicaid reimbursement rates, asking for their support on a study on dental licensure, and for their support of a budget item that would allow VCU to begin the first steps in planning for a new dental school building.

The significant number of dentists and students who devoted precious time and effort to attend this important event was incredible. We thank everyone who participated. You all can be sure that your involvement was immensely impactful. It

will mean even more at next year’s Dental Days at the Capitol – Please mark your calendars for January 18-20, 2024!

Join us in our efforts to protect dentistry and your patients. How can you help?

• Thank your legislators for their support on our behalf during the 2023 General Assembly session.

• Make a contribution to the VDA Political Action Committee by visiting https://www.vadental.org/vda-pac

• Mark your calendar and attend the 2024 VDA Dental Days at the Capitol, scheduled for January 1820, 2024.

ADVOCACY FOR DENTISTRY IS ALIVE IN VIRGINIA

BUT WE STILL NEED YOUR HELP

Bruce Hutchison, DDS; Chair, VDA Tooth PAC

The 2022 and 2023 General Assembly Sessions in Richmond were eventful and successful for the dental profession. The 2022 Session was highlighted with a 30% increase in Dental Medicaid Reimbursement fees across the board. Though this increase was long overdue (17 years since the last increase), it was substantial. Getting funds into the budget and passing the budget is a big deal in any legislature. The recently adjourned 2023 Session featured the introduction and passage of a bill allowing properly trained dentists in Virginia to use Botox for cosmetic purposes and important legislation to make it easier for dentists and team members to access mental health services without fear of loss of license. These wins come from successful advocacy efforts by dentists across the Commonwealth. Our active dentists who cultivate relationships, our very effective lobbyists, and our VDA Tooth PAC together made this all possible. 2024 will pose new and larger challenges for our profession.

minimum of 83% of collected premiums on actual dental care for their clients and policyholders.

Since the referendum victory in Massachusetts in November 2022, seven other states have taken up this policy in their legislatures. The VDA House of Delegates voted this year to pursue a dental loss ratio in Virginia. This would force insurance companies to be more transparent, allocate more money to patient care or return premium dollars to their policyholders. The VDA has been successful with the General Assembly because we advocate for policies that are good for our patients. Spending premium dollars on patient care benefits our patients.

WHAT CAN YOU DO?

1. Join me in contributing generously to your VDA Tooth PAC. Our PAC collects contributions from Virginia dentists and spends them to support candidates we believe will listen to our story and support us when we show the benefits for their constituents – our patients. We have a compelling story to tell. The PAC gives us a seat at the table to tell it.

3. I choose to make a difference and help guide the future of our profession. I hope you see the urgency and importance of getting involved NOW! Otherwise- you’ll get the handouts THEY feel like giving you.

MAKE A DIFFERENCE.

1. Give to VDA Tooth PAC- give generously- your future depends on it! https://www.vadental.org/ vda-pac

2. Get involved with your local State Senator and Delegate

3. Let’s keep winning these fights. Our patients deserve that.

You’ve heard and read of the successful Question #2 Referendum in Massachusetts this past November. This ballot referendum, which called for an 83% medical (dental) loss ratio for dental insurance companies in Massachusetts, was approved. Over 72% of the voters agreed that it was a good idea for dental insurance companies to pay a

2. Meet your local legislators, spend time getting to know them, support their campaigns by working with them or financially assisting them, and attend local town hall meetings. Make yourself a resource on dental issues. Make sure they understand that you are the one to call should they have any questions regarding dental health.

4. New district lines were drawn and approved by the Virginia Supreme Court. Of the 100 Delegate districts, 23 new districts have no incumbent (current delegate), while 42 of the 100 have two or three sitting delegates now in the same district, facing off for a single delegate position. Eleven (11) of the 40 State Senate districts have no incumbent, while 18 of the 40 have two or more competing Senators. The 2023 elections will create a huge turnover in our General Assembly, and now is the time to get involved, donate time and money, and contribute to our professional PAC- Your VDA Tooth PAC. This election will be huge, and we simply must get and stay involved. Otherwise, we leave the future of our profession, of our offices, and of patient care in Virginia up for grabs. >> CONTINUED ON PAGE

The chart on the following page outlines the turnover in the legislature.

HOUSE OF DELEGATES

Retiring

Dawn Adams

Tim Anderson

John Avoli

Rob Bell

Jeff Bourne

Kathy Byron

Glenn Davis

James Edmunds

Eileen Filler-Corn

Wendy Gooditis

Mike Mullin

Kathleen Murphy

Ken Plum

Margaret Ransone

Roxann Robinson

SENATE OF VIRGINIA

Lamont Bagby

Emily Brewer

Tara Durant

Elizabeth Guzman

Chris Head

Sally Hudson

Clint Jenkins

Dave LaRock

John McGuire

Danica Roem

Suhas Subramanyan

Schuyler Van Valkenberg

Angelia Williams-Graves

Kaye Kory/Marcus Simon

Marie March/Wren Williams

Israel O’Quinn/William Wampler

John

Janet Howell

Lynwood Lewis

Tommy Norment

Dick Saslaw

Jill Vogel

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

TOTAL CONTRIBUTIONS: $211,942 MUST RAISE $163,058 TO REACH GOAL

2023 GOAL: $375,000

VIRGINIA 2023 GENERAL ASSEMBLY SESSION REPORT

Charles Duvall, Tripp Perrin, and Missy Wesolowski; VDA Lobbyists

The 2023 session officially adjourned Sine Die on Saturday, February 25. During the “short session,” 2,863 bills and resolutions were introduced by members of the General Assembly. Eight hundred nineteen bills have passed both the House and the Senate and will be heading to the Governor for his amendments, signature, or veto in the coming days. The General Assembly will return to Richmond on April 12 for the annual one-day reconvene session to consider actions proposed by Governor Youngkin. As of February 26, no bills have yet been communicated to the Governor.

The General Assembly did not complete its work on amendments to the biennial budget. Instead, they adjourned with only a “skinny budget,” which included a handful of amendments, including adjustments related to the average daily members changes for K-12 education, appropriating over $400 million to the Rainy-Day Fund and investments to the Virginia Retirement System and the Capital Supplement Fund. It is rumored that the budget conferees will continue to meet to finalize additional budget amendments, and the General Assembly will return to Richmond for a Special Session by the end of the month.

In Virginia, a budget must be presented to the General Assembly 48 hours before a vote can take place. After the final budget passage, the Governor has the right to make line-item amendments to the budget. The Governor can add or remove funding as well as add budget language; however, a Governor cannot veto budget language that does not have funding attached to the line item unless he does a veto of every line in the entire section. If a budget is finalized in late March/early April, the General Assembly will likely return to Richmond for a second veto session.

This session brought many new faces, as Holly Siebold (D) and Ellen Campbell (R) were sworn into the House of Delegates on the first day of the session. In addition, Senator Aaron Rouse (D) was elected to fill Senate District 7 in Virginia Beach after Jen Kiggans was elected to Congress in November 2022. The entire General Assembly is up for re-election in November. Due to redistricting, numerous incumbents have been drawn into the same district and faced primaries. This led to a higher-than-normal number of Delegates and Senators announcing retirements, including Senators Saslaw, Edwards, Norment, and Delegates Bell, Byron, Plum, Avoli, Edmunds, Robinson, Ransone, and Murphy. There are rumors of more retirements that will be announced by April 6 (the last day to file paperwork for the 2023 Election). In addition, Jennifer McClellan was elected to Congress in a Special Election on February 21, and Delegate Lamont Bagby won the primary to fill her seat in the March Special Election.

Additional updates from the 2023 Session

Legislation: If signed into law, the legislation below will become effective July 1.

• HB 2251 Dentists and dental hygienists; DHP shall convene a workgroup to analyze licensure requirements. The legislation passed both chambers unanimously and is heading to Governor Youngkin!

• SB 1539 Dentistry; botulinum toxin injections for cosmetic purposes. The legislation passed the Senate 39-0 and the House of Delegates 87-9.

Other bills of note that passed this legislative session:

• HB 1426 - Tata - Human trafficking; continuing education required for the biennial renewal of licensure.

HB 1452 - Orrock - Medicaid Fraud Control Unit; appointment of sworn unit investigators to Unit, powers, and duties.

• HB 2158 - Fariss - DMAS; Department shall evaluate its ability to comply with certain federal regulations.

• HB 2190 - Rasoul - Managed care organizations; data collection and reporting requirements, report.

• HB 2262 - Hodges - Health insurance; online credentialing system, processing of new applications.

• SB 1060 - Favola - DPOR, et al.; disclosure of certain information.

• SB 1261 - Dunnavant - Health insurance; electronic prior authorization and disclosure of certain prescription drug information.

LOOKING GLASS THROUGH THE

WITH DR. SARAH GLASS

Explore the Fantastical World of Oral Pathology

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

A 35-year-old female patient comes to the dental clinic. Upon intraoral examination, you note a single, ovoid-shaped swelling measuring 1 cm x 1 cm in the right posterolateral surface of the hard palate. The mucosa overlying the swelling appears healthy and smooth with some bluish hue. On palpation, the lesion is firm, nontender with well-defined margins. What is your suspected diagnosis?

Presented by: Saleh Smadi, a dental student at the VCU School of Dentistry

A 70-year-old male on bisphosphonates due to multiple myeloma presents for a recall. During the oral cancer screening, you notice areas of exposed yellow-white bone. A panoramic radiograph shows mixed radiolucent/ radiopaque lesions in the anterior mandible. What is your suspected diagnosis?

A 50-year-old male presents to clinic with oral pain, burning, and inflamed gingiva. He indicates using a new toothpaste with cinnamon. What is your suspected diagnosis?

THE LOOKING GLASS ANSWERS CONTINUED FROM PAGE 17

1. Pleomorphic adenoma: Histologic examination shows a benign salivary gland tumor composed of epithelial cells, myoepithelial cells, and chrondromyxoid stroma. Pleomorphic adenoma is the most common neoplasm of salivary gland origin and mostly occurs in the parotid gland. Intraorally, they can be found on the palate.

2. MRONJ: Medication-related osteonecrosis of the jaw (MRONJ) causes progressive bone destruction in the maxillofacial region. It is seen in patients who currently take or have prior treatment with antiresorptive or antiangiogenic agents. The exposed bone must persist for greater than 8 weeks with no history of radiation therapy to the jaws or obvious metastatic disease to qualify as the diagnosis.

3. Plasma cell gingivitis: Microscopic examination shows diffuse polycolonal plasma cells in the gingival tissue consistent with plasma cell gingivitis. The condition will not resolve with improved oral hygiene. Treatment is aimed at determining the product or medication causing the reaction.

TRICALCIUM SILICATE CEMENT SEALERS: DO THE POTENTIAL BENEFITS OF BIOACTIVITY JUSTIFY THE DRAWBACKS?

Aminoshariae A, Primus C, Kulild J. | JADA. 2022; 153(8): 750-760

Bioceramic (BC) sealers have become very popular and this review paper highlights the pros and cons of utilizing a tricalcium silicate-based sealer during endodontic therapy.

Endodontic sealers have progressed from zinc oxide-eugenol to silicone, resin, and more recently to tricalcium silicate cements. Mineral trioxide aggregate (MTA) was the original form of tricalcium silicate that was introduced to the market for use in perforation repair and endodontic surgery. The advantages of MTA include better biocompatibility, bioactivity, improved sealing and hydrophilicity. Other names commonly seen for this new class of materials include: calcium silicate cement, bioactive bioceramics, and hydraulic silicates.

In 1940 Grossman highlighted the ideal properties of an endodontic sealer. As dental materials have progressed, these ideal properties have been used as a baseline to measure each new material. We will investigate several of these properties related to tricalcium silicate cements. Ease of placement: While somewhat vague and subjective, single paste and resin BC sealers

had satisfactory flow requirements recommended to properly seal dentin tubules. Shrinkage and Expansion: Amount of shrinkage and expansion vary slightly by the brand of BC sealer but generally are within acceptable limits. Antimicrobial: BC sealers are antibacterial to some bacteria and yeast due to their high pH. Discoloration: Discoloration was noted early with MTA due to the presence of bismuth oxide. While amount of discoloration from BC sealers has decreased, caution should be exercised to not leave sealer or other endodontic materials in the coronal aspect of teeth. Sealing: Studies indicate superior sealing abilities with BC compared to resin based sealers. It was also observed that a high flow BC sealer used with continuous wave condensation was able to fill more lateral canals when compared to a single cone technique. Radiopacity: The radiopacity for all BC sealers exceeded the minimum recommendation. Retreatability: After BC sealers set they become insoluble in organic solvents commonly used in endodontics. And as discussed earlier they penetrate deeper into dentin tubules and in lateral canals which may result in inability to remove during re-treatment. Bioactiviy: BC sealers facilitate the

formation of apatite crystallite formation. They also show biomineralization and osteoblastic differentiation. They also induce angiogenic osteogenic growth factors as well as PDL proliferation.

Generally, the BC sealers perform well clinically and meet many of the ideal sealer properties as outlined by Grossman. They allow adequate placement, working and setting times. They are dimensionally stable with minor expansion and shrinkage. They have some anti-microbial properties that may reduce bacterial growth. The weaknesses of BC sealers include their cost and lack of solubility during retreatment. If re-treatment is not indicated and surgery is the next step this may warrant their usage. The unique capability for bioactivity and biomineralization supports their usage in endodontic therapy.

James DeGracie, DDS; Resident in Endodontics, Virginia Commonwealth University

A RETROSPECTIVE COMPARISON OF OUTCOME IN PATIENTS WHO RECEIVED BOTH NONSURGICAL ROOT CANAL TREATMENT AND SINGLE-TOOTH IMPLANTS

Vahdati SA, Torabinejad M, Handysides R, Lozada J. | J Endod. 2019;45(2):99-103

Current trends in dentistry seem to indicate a more favorable preference for placing implants as the standard treatment for compromised teeth instead of treating them endodontically. Arguments are often made that one treatment is more predictable than the other; however, making an objective comparison is challenging. Outcomes of non-surgical root canal treatment (NSRCT) are usually assessed using more strict criteria, including function, clinical signs, or symptoms as well as judging radiographic healing of periapical lesions. This differs from outcome criteria for implants, for which the term ‘success’ primarily has been used interchangeably with ‘survival’ of the implant. The purpose of this study was to determine if the survival outcome of NSRCT is different from single-tooth implants (STI) in the same patient.

In this study, the dental records of 3671 patients with at least one STI and one NSRCT were reviewed. Included for evaluation were 170 patients with at least a 5-year follow-up. The survival outcome of NSRCT and STI and related

factors were evaluated. Both treatments had a 95% survival rate with a mean 7.5-year follow-up. Most preoperative and postoperative factors involved in both procedures had no significant effect on the treatment outcomes. However, the number of adjunct and additional treatments, the total number of appointments, the elapsed time before the final restoration was placed, the number of prescribed medications, and the cost of the treatment were all significantly higher for STI in comparison with NSRCT.

To the author’s knowledge, this is the first study comparing the success of root canal therapy and a single tooth implant within the same patient. The high success rate of both modalities is consistent with previous endodontic research. One of the most significant findings was the difference between NSRCT and STI in terms of adjunct and additional procedures. An adjunct procedure would be one done at the same time as the primary treatment, such as a bone graft at the time of implant placement or crown lengthening at the time of root canal therapy. An additional procedure would

be one that is done at a later time, such as an endodontic retreatment or replacing an implant screw. In the present study, STIs had a significantly higher number of adjunct and additional procedures compared with NSRCT. Patients also experienced three times more appointments (13.6 vs. 3.9 appointments) and more than twice as much time (13.5 vs. 4.8 months) waiting for implants to become functional compared with their nonsurgical root canal–treated teeth.

Based on the conclusion of this study, both NSRCT and STI are highly successful treatments. However, it appears that STI tend to require more adjunct and additional therapies as well as more appointments spread out over longer periods of time. When we encounter patients with compromised teeth that could otherwise be saved by NSRCT and deemed restorable, these teeth should not routinely be treatment planned for an implant.

Joe Vaughn, DMD; Resident in Endodontics, Virginia Commonwealth University

SUCCESS AND SURVIVAL OF ENDODONTICALLY TREATED CRACKED TEETH WITH RADICULAR EXTENSIONS: A TWO TO FOUR YEAR PROSPECTIVE COHORT

Davis M, Shariff S. | J Endod. 2019; 45(7):848-855

Cracked teeth are defined by the American Association of Endodontists as a tooth with one or more incomplete, longitudinal fractures originating in the coronal tooth structure and extending apically. Most frequently, cracks involve the marginal ridges and are oriented in a mesiodistal direction. In cases of reversible pulpitis, cracked teeth can be effectively managed with cuspal coverage restorations without the need for endodontic treatment. For cracked teeth presenting with a pulpal diagnosis of symptomatic irreversible pulpitis or pulpal necrosis, endodontic treatment is required prior to completion of a coronal restoration. This study is the first to prospectively look at the success and survival of endodontically treated cracked teeth in which the crack extends beyond the level of the canal orifice internally.

This study included 70 posterior teeth requiring endodontic treatment with visible internal fractures at the level of the canal orifice or extending up to 5mm into the canal. All teeth had to be functional, and in occlusion with an opposing tooth. Exclusion criteria included split teeth, teeth with cracks extending all the way across the pulpal floor, and teeth with cracks limited to coronal dentin. Of the 70 teeth treated, 21.4% had an isolated pretreatment pocket depth greater than 4mm (ranging from 5-7mm) corresponding with the location of the radicular crack. Forty percent of these teeth had a preoperative diagnosis of irreversible pulpitis, 51.4% had a preoperative diagnosis of pulpal necrosis, and 8.6% were previously initiated or fully

treated teeth. A periapical radiolucency was present in 42.9%, 72.9% had a diagnosis of periapical periodontitis (AAP, SAP, acute apical abscess or chronic apical abscess), and 42.9% were terminal teeth in the arch.

All cases were completed under rubber dam isolation with the use of a dental operating microscope. Both primary root canal treatment and retreatment procedures were performed using nickeltitanium rotary files, in addition to 2.6% sodium hypochlorite with sonic activation, and final irrigation was completed with 17% EDTA and 2% chlorhexidine. In cases with a periradicular radiolucency, Calcium hydroxide was placed as an intracanal medicament for 2 to 3 weeks. Canals were obturated using Roth 801 sealer and gutta percha. Obturation materials were then removed 2-3mm apical to the deepest extent of the radicular crack, where a fluoride-releasing resin was placed as an extended orifice barrier. The tooth was temporized, and patients were urged to complete the final restoration as soon as possible. Patients were seen at 6-weeks to verify that the final restoration was completed. Occlusal contacts were adjusted 78.7% of the time at this initial recall.

All patients included in the analysis had to be present for follow-up at a minimum of 2 years after endodontic treatment. Overall, the recall rate of enrolled patients was 81.5%. A tooth was considered “survived” if it was present, asymptomatic, and functional. At the 2-year mark, 100% of teeth had survived; by the 4-year

period 96.6% of teeth were categorized as “survived”. The category of “success” was given to a tooth if strict radiographic and clinical criteria were met. Strict radiographic criteria included no noted increases in alveolar bone loss, and normal-appearing periradicular structures (periapical index ≤2). Strict clinical criteria included no sensitivity to percussion, palpation, or biting pressure on a cotton roll. In the 2- to 4-year term 90.6%of the teeth were deemed as a “success”.

This study reported data on endodontically treated cracked teeth with radicular extensions of the crack with success rates comparable to outcomes of endodontically treated teeth without cracks. Cracked teeth have historically been deemed “hopeless” or “nonrestorable” and are oftentimes referred for extraction. By following specific treatment and posttreatment protocols, survival and success following endodontic treatment may be higher than previously thought. Microscope-assisted intra-orifice barriers placed apical to the level of the crack, complete occlusal reduction of the tooth post-endodontically, and expeditious placement of a fullcoverage restoration with appropriate occlusal equilibration may lead to improvements in success and survival of cracked teeth.

Ryan N. Hediger, DMD; Resident in Endodontics, Virginia Commonwealth University

12-MONTH SUCCESS OF CRACKED TEETH TREATED WITH ORTHOGRADE ROOT CANAL TREATMENT

Krell KV, Caplan DJ. | J Endod. 2018; 44(4): 543–548

Cracks in enamel and extending into dentin have been formally recognized as a diagnostic problem since the 1950s. In 2008, the American Association of Endodontists published ‘‘Cracking the Cracked Tooth Code: Detection and Treatment of Various Longitudinal Tooth Fractures.” Five types of cracks or fractures were defined: craze lines, fractured cusps, cracked tooth, split tooth, and vertical root fracture. Cracked teeth had a history of cold sensitivity and acute pain upon chewing. Clinically, the cracks were in a mesial-to-distal plane. There would be no radiographic changes unless there had been pulpal necrosis caused by bacterial ingress through the crack. Periodontal probing depths would vary depending on the apical extension of the crack.

Long-term studies examining the treatment outcomes of cracked teeth receiving orthograde root canal treatment in the United States do not exist. The purpose of this study was to examine the distribution and 1-year treatment outcomes of cracked teeth receiving orthograde root canal treatment in a

private endodontic practice over a 25-year period.

Pulpal and periapical diagnoses, year of treatment, tooth type, restorative material, number of restored surfaces, and periodontal probing depths were all recorded at the time of examination for 2086 cracked teeth. The patients’ age and sex were added retrospectively for all patients whose data were available. Univariate frequency distributions for all collected variables were evaluated. Bivariate associations were analyzed between explanatory variables and the success of the root canal therapy.

Of the 2086 cracked teeth, the most common were mandibular second molars (36%) followed by mandibular first molars (27%) and maxillary first molars (18%). Of teeth with cracks that were treated with nonsurgical root canal therapy, 82% were deemed successful after one year. There were no statistically significant differences in success based on pulpal diagnosis (irreversible pulpitis, 85%; necrosis, 80%; previously treated, 74%), patients’

age, sex, year of treatment, tooth type, restorative material, or number of restored surfaces at the time of examination. The three most significant factors for longterm outcomes were pocket depth, distal marginal ridge crack, and periapical diagnosis, which were used to generate a prognostic index for the success of orthograde root canal therapy in cracked teeth called the Iowa Staging Index. When endodontic treatment is deemed necessary, the Iowa Staging Index could potentially help with treatment decisionmaking and the informed consent process.

The results of this study suggest that cracked teeth that received root canal treatment can have prognoses at higher success rates than previously reported. The Iowa Staging Index may prove to be useful in clinical treatment decisionmaking.

Colton Fischer, DDS; Resident in Endodontics, Virginia Commonwealth University

OUTCOME OF DIRECT PULP CAPPING USING CALCIUM HYDROXIDE: A LONG-TERM RETROSPECTIVE STUDY

Ricucci D, Roças I, Alves F, Cabello P, Siqueira J. | J Endod. 2023;49(1):45-54

The outcome of performing direct pulp caps on teeth with advanced carious lesions has been a controversial topic because of the variety in outcome success rates.

This study aimed to evaluate the longterm outcome of Direct Pulp Capping (DPC) on mature teeth with advanced caries. The study was conducted over a period of 35 years and included 225 teeth from 148 patients. The teeth were diagnosed with reversible pulpitis,

treated with direct pulp cap using calcium hydroxide by a single operator under microscopic magnification, and had the caries completely removed. The exposed pulp was examined and capped with either pure calcium hydroxide or a calcium hydroxide-based cement. The cavity was restored and the outcome was evaluated over five follow-up periods (one year, five years, ten years, 20 years, and 35 years). Teeth that were asymptomatic with a normal response to the cold test

and no pathology radiographically were categorized as success, while teeth with no response to the pulp test and radiographic pathology were categorized as failure. The study also evaluated independent variables such as sex, age, symptoms, number and size of pulp exposure, bleeding time, capping material, and final restoration on the outcome.

The study reports that out of a total of 225 teeth from 148 patients, all teeth were >

OUTCOME OF PULPOTOMY IN PERMANENT TEETH WITH IRREVERSIBLE PULPITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Ather A, Patel B, Gelfond JAL, Ruparel NB. | Sci Rep. 2022; 12(1): 19664. doi: 10.1038/s41598-022-20918-w

The concept of “vital pulp therapy” (VPT) has been a predictable and successful biological intervention to manage teeth with carious pulp exposures and reversible pulpitis. Clinical outcomes for VPT in permanent teeth with reversible pulpitis have been reported to be about 82-100%. However, when a tooth was diagnosed with “irreversible pulpitis,” the consensus has often declared the pulp to be irreversibly damaged beyond repair. Root canal treatment was thus the preferred treatment option in these cases. However, with the emergence of newer biocompatible, anti-inflammatory, and osteo-inductive biomaterials, VPT has re-emerged as a minimally invasive treatment option, even for teeth with irreversible pulpitis.

This meta-analysis was conducted to determine the overall success rate of pulpotomies in permanent teeth diagnosed with irreversible pulpitis because of a carious pulp exposure. Secondarily, the meta-analysis aimed to investigate the effect of predictors such as symptoms, root apex development

(closed vs. open), and type of pulp capping material used on the success of the pulpotomy. An electronic database search retrieved 1,116 records. Eleven studies published between 1960 and 2021 met the criteria used for this study.

The pooled success rate of pulpotomies in carious teeth with irreversible pulpitis was 86%. When divided specifically into predictor factors, the success rates were found to have significant differences in teeth with an open apex (96%) versus those with a closed apex (83%). This may be attributed to the increased vascularity and cellularity of pulps in immature teeth. Aging of the dental pulp complex also is associated with reduced regenerative potential of dental stem cells. Another significant predictor is the choice of the pulp capping agent used. Biodentine was shown to have higher success rates compared to MTA or calcium hydroxide. In addition, Biodentine has a shorter setting time, less potential to discolor teeth, and releases more calcium ions and bioactive growth factors. One insignificant predictor of success was the classification of

symptomatic (84%) versus asymptomatic irreversible pulpitis (91%). This favorable outcome in symptomatic irreversible pulpitis may be due to the fact that irreversible pulpitis is often confined to the coronal portion of the pulp. The antiinflammatory effects of tricalcium silicate capping materials, which promote the reversal of residual inflammation, allow healthy pulp tissue to be maintained.

Given that this is the first meta-analysis study of pulpotomy outcomes for carious teeth with irreversible pulpitis, there is a need for further studies on how predictable this minimally invasive and biological procedure may be in preserving healthy pulps in teeth with irreversible pulpitis.

Jing Ye, DMD; Resident in Endodontics, Virginia Commonwealth University

available for follow-up at one year, with a success rate of 100%. At five years, ten years, and 15 years follow-up, the success rate remained at 95%, while at 35 years, it dropped to 89%. Quality/presence of an adequate coronal restoration was found to be the variable that significantly affected the treatment outcome in all follow-up periods. Additionally, the size and number of pulp exposures at 20 years follow-up, and exposure size, capping material, and restoration type at the 35 years followup were found to be isolated variables associated with the outcome.

This study evaluated the long-term outcome of direct pulp caps on mature vital teeth with advanced caries. The factors that may affect the treatment outcome were

evaluated, and the study found that when pulp capping procedures were completed under controlled conditions, the outcome revealed a very high success rate, with a 100% success rate at one year and 89% at 35 years. The study found that the success rate was higher than many previous studies, which have reported lower success rates. The authors of the study suggest that the difference in outcome is most likely due to proper case selection, treating teeth diagnosed with reversible pulpitis, use of magnification, and complete removal of all softened and infected dentin. This suggests that proper case selection, treatment of reversible pulpitis, use of magnification, and complete removal of infected dentin are crucial for successful direct pulp capping.

This retrospective study evaluated the long-term success rate of direct pulp capping procedure of mature teeth with reversible pulpitis using calcium hydroxide as a base. The main variable that was found to affect the outcome of the direct pulp capping procedure was the quality of the coronal restoration. The authors of the study suggest that the high success rate is likely due to proper case selection. This suggests that proper case selection is crucial for achieving a high success rate in direct pulp capping procedures using calcium hydroxide.

Abdulaziz Mallik, DDS; Resident in Endodontics, Virginia Commonwealth University

PROGNOSTIC FACTORS AND PRIMARY HEALING ON ROOT PERFORATIONS REPAIRED WITH MTA: A 14-YEAR LONGITUDINAL STUDY

Gorni FG, Ionescu AC, Ambrogi F, Brambilla E, Gagliani MM. | J Endod. 2022;48(9):1092-1099

Root canal perforations are a common complication in endodontic treatment, with an incidence of 2%-12%. They can be caused by iatrogenic events or be pathological in nature, and if left untreated, can lead to loss of integrity in the root and damage to the surrounding periodontal tissues. The success of perforation repairs depends on several factors, including the location, size, and nature of the perforation, the materials used for repair, and the practitioner’s expertise. Mineral trioxide aggregate (MTA) has been shown to be effective in repairing root perforations due to its biocompatible and sealing properties. However, there is limited data on the longterm prognosis of MTA use for perforation repair, with only a few clinical studies examining this issue. The present study aimed to assess the long-term prognosis of MTA use for perforation repair by adding a 14-year follow-up to a previous study and also to determine patient and clinical characteristics that may impact the long-term prognosis.

This study was a prospective cohort study conducted in Italy to evaluate the long-term outcomes of mineral trioxide aggregate (MTA) treatment for root canal perforations. The study enrolled 124 patients with a single root canal perforation who were treated with MTA between 1999 and 2009 and followed up

for a maximum of 17 years. The median age of the study population was 36.5 years, and 53.2% were male. Clinical and radiographic evaluations were conducted using standardized protocols, and the outcomes were dichotomized as healed or non-healing. The study found that 115 patients were healed at the first or second annual post-treatment checkup, while nine subjects (7%) did not heal. Factors significantly associated with non-healing were gender, positive probing, size, and perforation site. Perforations that were initially successfully reversed in 48 teeth during the follow-up period, with the estimated probability of reversal at five, ten, and 14 years being 6%, 30%, and 62%, respectively. Positive probing and perforations larger than 3 mm were more likely to result in reversal.

One key issue highlighted by this study was the long-term stability of the seal provided by MTA. When used clinically, this material may be exposed to an inflammatory environment with a pH as low as 5.0, especially when there is a pre-existing periodontal pocket or in the case of large perforations, that can lead to increased inflammation. Research has shown that low pH can delay the setting process, affect adhesion, and increase the solubility of MTA. The dissolution of MTA over time when exposed to an acidic pH, potentially due to microbial

colonization, can create gaps and voids in the sealing material that allow the penetration of microorganisms or their byproducts into the periapical tissues. Further research is needed to understand these mechanisms and the interactions between MTA and colonizing biofilms in order to improve its long-term performance.

The findings of this study indicate that the risk of recurrent issues in healed root canal perforations treated with MTA increases over time. While the reversal probability was low at five years (6%), it rose to 62% after 14 years. This finding highlights the need to further study and improve the long-term behavior of the material, particularly in regards to its performance under acidic conditions and in the presence of microbial colonization, in order to increase the longevity of perforation treatments. Additionally, these results suggest that the current criteria for predicting the prognosis of perforated teeth may need to be revised in light of this evidence.

Banks Lee, DMD; Resident in Endodontics, Virginia Commonwealth University

COMBINATION OF NONSURGICAL ENDODONTIC AND VITAL PULP THERAPY FOR MANAGEMENT OF MATURE PERMANENT MANDIBULAR MOLAR TEETH WITH SYMPTOMATIC IRREVERSIBLE PULPITIS AND APICAL PERIODONTITIS

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

Diagnosis of pulpal and periapical status plays a crucial role in the appropriate treatment planning of endodontic treatment; the presence of pulpal inflammation and whether said inflammation is reversible determines the extent of intervention. When it is reversible, a coronal pulpotomy is considered a definitive treatment option with high reported success rates. On the other hand, when the inflammation is irreversible, it is typically managed with a complete pulpectomy and standard nonsurgical root canal treatment. Clinically, this delineation is difficult to diagnose, and histological studies show us that various degrees of inflammation may exist at various levels within the pulp.

An alternative solution has been suggested, namely that combined vital pulp therapy (VPT) and nonsurgical endodontic treatment (NSET) may be a viable treatment modality in cases of partially irreversible pulpitis and apical periodontitis (AP). For example, a mandibular molar may present with symptoms of irreversible pulpitis and a lesion consistent with AP on the distal root, but the pulp of the mesial roots remains vital with no evidence of AP. The present study, then, aimed to assess the outcome of a combination of NSET and VPT in permanent mandibular molar teeth with symptomatic irreversible pulpitis (SIP) and apical periodontitis.

This study recruited patients ages 18-35 who had been referred to the clinic of conservative dentistry and endodontics at the All India Institute of Medical Sciences in New Delhi, India. They exhibited permanent mandibular molar teeth with a diagnosis of symptomatic irreversible pulpitis (positive response to a pulp sensitivity test) and apical periodontitis (periapical index [PAI] score  3). Two study groups were determined with block randomization based on the procedure: the NSET group (n = 30) and the NSETVPT group (n = 30). Intraoperatively in the NSET-VPT group, bleeding at each orifice was assessed, and hemostasis was achieved with a 2-minute application of a cotton pellet soaked in 2.5% NaOCl. If hemostasis had not been achieved after 8 minutes total, the tooth was excluded from the study. Placed in the orifice was 2-3 mm of MTA, followed by a light-cured RMGI. Subsequently, NSET was completed on the remaining root with periapical involvement. An 11-point numeric rating scale was used to record pain intensity before and after treatment at 24, 48, and 72 hours. The patients were then followed-up both clinically and radiographically at 12 months.

Preoperative pain scores showed no significant differences, and postoperative pain was significantly different only at the 48-hour interval (NSET: 46.7%, NSETVPT: 13.3%, p < 0.5). At the 12-month

recall stage, 27 teeth (90%) of the NSET group and 28 teeth (93.3%) of the NSET-VPT group were categorized as completely healed and asymptomatic. In addition, there was no significant difference noted between the two groups regarding the proportion of healed and non-healed teeth (p > 0.5).

The results of this study suggest an alternative treatment option for the irreversibly inflamed pulp with apical periodontitis. When bleeding can be controlled, it is often an indicator of a mild to moderately inflamed pulp whose vitality may be maintained with the appropriate use of materials like MTA. Current literature supports the use of MTA in vital pulp therapy due to its ability to induce growth factors that stimulate new osteoblast-like cells to form dentin bridges. Case selection is crucial when considering the combination of NSET and VPT, and accurate diagnosis plays perhaps the largest role in the decision. With this study’s high success rates and future research potential, the clinician may consider NSET-VPT as a viable alternative to the standard NSET in treating SIP and AP while still preserving the vitality of the uninvolved tissue.

Will Rudnicki, DDS; Resident in Endodontics, Virginia Commonwealth University

Regulations KNOWING IS HALF THE BATTLE

DID YOU KNOW?

A SERIES FROM THE VIRGINIA BOARD OF DENTISTRY

Current Hard Copy Licenses and Expiration Dates

• Beginning in 2023, the Board of Dentistry has ceased mailing hard-copy licenses, certifications, permits, and registrations on a yearly basis for our regulated professions. A final hard-copy license was issued in 2022. The hard-copy license does not list an expiration date.

• Only those who are initially licensed will receive a hard-copy license. Any licensee renewing their license will no longer receive a hard-copy license. A replacement or duplicate of a final hard-copy license, certification, or registration, with the applicable fee, may be requested through an individual online account.

• The final hard-copy license received in 2022 should be maintained, carried, or posted in accordance with relevant applicable laws and regulations.

• State health regulatory boards, employers, insurance providers, and citizens seeking verification of current licensure status in the Commonwealth of Virginia may obtain this information via License Lookup (available on the DHP website).

License Posting Requirements

• A dentist who is practicing under a firm name or who is practicing as an employee of another dentist is required by § 54.1-2720 of the Code to conspicuously display his name at the entrance of the office. The employing dentist, firm, or company must enable compliance by designating a space at the entrance of the office for the name to be displayed.

(See 18VAC60-21-30. A.)

• In accordance with § 54.1-2721 of the Code, a dentist shall display his dental license where it is conspicuous and readable by patients in each dental practice setting. If a licensee practices in more than one office, a duplicate license obtained from the board may be displayed.

(See 18VAC60-21-30. B.)

• For Sedation permit and DEA posting requirements please see regulations 18VAC60-21-30.C and D.

VIRGINIA BOARD OF DENTISTRY NOTES

MARCH 3, 2023

Ursula Klostermyer, DDS, PhD

Dr. Nathaniel Bryant, Board President, called the meeting to order at 9:00 a.m. No public comments were presented in person. Dr. Mitchell Levine, with the American Academy of Sleep Medicine, had submitted a written comment regarding standards for oral appliance therapy for the treatment of sleep apnea. The BOD did discuss this briefly later in this meeting but did not take any action as they unanimously agreed that this topic had been discussed extensively previously. There was no interest to revisit this topic.

Two new board staff were briefly introduced.

The minutes of the meetings on December 2, 2022 and February 16, 2023 were approved unanimously.

Following his first five months as a deputy chief DHP director, Arne Owens briefly reported that he is thankful that he has a great team. He stated that the General Assembly meetings are public events and he encouraged anyone interested to partake in the meetings. He was excited to report that they would soon move to their new building. He stated that a study is being performed to assess the shortages in the workforce. The first phase of this study is a 76 page report and is available online for interested parties.

Ms. Jamie Sacksteder, Executive Director of the Board of Dentistry, reported about the CDCA/WREB/CITA meeting she attended in January 2023. More than 1000 people were able to express their views about the challenges other groups were having with examinations. She felt it was very helpful to meet the representatives of other states.

Ms. Yetty Shobo, PhD and Ms. Barbara Hodgdon, PhD presented a very thorough report about workforce data for Dentists and Dental Hygienists:

debt of $25,000. The amount of student debt has dropped. The unemployment rate of dental hygienists is slightly lower than pre-pandemic levels. The retirement numbers are reported to be relatively stable in the most recent years.

Ms. Erin Barrett talked about the legislative and regulatory actions for dentists and dental hygienists. These direct the Department of Health Professions to convene a work group to analyze licensure requirements for dentists and dental hygienists and to examine the viability of licensure by the endorsement pathway. The work group shall report its findings to the House Committee of Health, Welfare and Institutions and the Senate Committee on Education and Health by October 1, 2023. Legislation creating the licensure work group passed the Senate in February 2023.

The 2022 survey which dentists in Virginia had filled out was consolidated in that report. There is a 2% drop in valid dental licenses. The demographics of dental workforce dropped in average age and included more females in each age category. The diversity in the demographics increased. There was a slight increase of the median income of dentists to $155,000, but at the same time the education debt increased to $145,000. Student loan debt is carried by almost half of dentists, 42%. Still the highest concentration of dentists is in Northern Virginia. Southwest and Southern Virginia have the lowest concentration of dentists. The report states that there is a 5% increase of licensees for dental hygienists. The number of hygienists is stable and the workforce is 98% female. The median age is 44 and has been stable. Diversity has increased. Median income increased to $65,000 and 29% of the dental hygienists carry an average

Regarding Botulinum Toxin injections for cosmetic purposes: a dentist may possess and administer botulinum toxin injections for cosmetic purposes, provided that the dentist has completed the required training and CE in the administration of it. The bill requires the BOD to amend its regulations to remove Botulinum toxin injections from the list of procedures requiring an additional certification. This bill passed the Virginia House of Delegates on February 21, 2023.

The bill for the training on infection control still hasn’t completed the process to become effective, nor has the digital scan technicians training.

Ms. Barrett also shared several bills that were introduced during the 2023 session.

The Williams Petition for rulemakingto amend 18VAC60-21-250(C)(8), the

“A dentist may possess and administer botulinum toxin injections for cosmetic purposes, provided that dentist has completed the required training and CE in the administration of it.”

proposed removal of Guidance Document 60-15 and to combine Guidance Documents 60-27 and 60-3 was unanimously agreed on.

Ms. Sacksteder updated the BOD on CE Broker, a third-party CE tracking agency. With CE Broker licensees can currently track their CEs now voluntarily. This service currently offers the best choice and is free of charge.

Mr. Rutkowski, Deputy Attorney General, briefly reported on a case where a dentist had abused his prescription rights and the case is in court now.

Ms. Weaver introduced a short Disciplinary report: from November 2022 through February 2023, 135 cases were received. One hundred fifty-two (152) cases were closed (some from the backlog) with no violation, and four (4) cases were closed with a violation. Those violations included instances in which the diagnosis/treatment was improper, delayed, or unsatisfactory. Also included were failure to diagnose/treat and other diagnosis/treatment issues.

Ms. Sacksteder recognized the Virginia State Loan Repayment Program. Part or full time health care professionals are eligible. For those interested, the website is: https://vdh.myoneflow.com/oneflow/ weblogin.aspx

For more information visit the VDH Virginia State Loan Repayment Program website: https://www.vdh.virginia.gov/ health-equity/virginia-loan-repaymentprograms-2/ or contact: Olivette Burroughs, Health Workforce Specialist, Virginia Department of Health, 804-864-7431 or olivette.burroughs@ vdh.virginia.gov

Some interesting facts shared at the meeting. As of February 13, 2023 there are 7,428 dentists in Virginia (and 259 of them are Oral/Maxillofacial surgeons), 5,812 Dental Hygienists, 48 Dental Assistants II. There were 379 moderate Sedation permits, and 67 Deep Sedation permits registered. There were 616 Sedation Permit holder locations. Thirty eight Cosmetic Procedure Certifications are registered.

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

CORRECTION:

Virginia Board of Dentistry Notes, December 2, 2022

Ursula Klostermyer, DDS, PhD

Virginia Dental Journal 2023, Volume 100 Number 1, Page 23, Column 3

This article stated that “the Board increased the hours for dentists and dental hygienists from two to three hours of the 15 required hours for the annual renewal that may be satisfied through the delivery of dental services without compensation, to low-income individuals receiving health services through a local health department or a free clinic...” Currently, a licensee can only earn two hours of CE credit for volunteer work. On December 2, 2022, the Board discussed adding an additional hour, but nothing was decided at that time.

Dr. Pond marks the stop point - 1973

Crew Chief Dr. Pond (far right) communicates with driver

Dr. A. Wright Pond knew in the third grade he wanted to be a dentist. A local doctor relieved his toothache, and the die was cast. In the 10th grade, a local orthodontist gave him a tour of his office, and Dr. Pond knew then he not only wanted to be a dentist, but an orthodontist as well. After he completed his studies at William & Mary, and entered VCU School of Dentistry, he was headed toward fulfilling his personal and academic goals.

In 1970, while a senior in dental school, Dr. Pond became actively involved in auto racing. Brother Lennie, four years older, had been piloting race cars since age 17, and had achieved success in the Sportsman, modified and Late Model Sportsman (LMS) series in NASCAR. Up to that time Dr. Pond had been a spectator at Lennie’s races. While living in Ettrick and finishing dental school, he helped build a LMS car in a one-bay garage in the backyard. He recalled, “The first race car Lennie built at home was the same year I started as a general practitioner.”

“I was never a mechanic”, he said. He designed and built spoilers, splitters, dashboards, and roll cages. “I built the roll cage for most of Lennie’s early cars.” As his brother’s career progressed, Dr. Pond took on many job titles in the organization: crew chief, treasurer, publicist, and travel agent. He started and ran the Lennie Pond Fan Club, with members throughout the US and in foreign countries. The Club’s sophisticated newsletters and memorabilia set the standard for other racing teams in the years to come. Dr. Pond issued press releases and developed relationships with the news media to keep Lennie’s achievements on the sports page. Randy Hallman of the Richmond News-Leader and Harry Marsh of Petersburg’s Progress-Index tracked the number 54 car in their columns.

DR. POND’S CAREER IN AUTOS AND ORTHODONTICS

Dr. Richard F. Roadcap, Editor

Brothers in childhood L/R: A. Wright Pond, Lennie Pond.

Above: Dr. Pond marks stop pointBristol 1976

By 1972 a second car had been built in the same backyard garage, and Lennie’s racing career took off. “He was extremely successful that year (in LMS)” his brother recalled. In 1971, between the first and second cars, Dr. Pond started his orthodontic residency at VCU and became even busier. “I was trying to study.” In November ’72 car owner Ronnie Elder and Lennie approached Richard Petty, to buy some Chrysler springs for their LMS Chevrolet. “The Chrysler springs just seemed to work better for us” said said Dr. Pond. Petty suggested that Lennie should try racing in the Winston Cup series, NASCAR’s highest level of competition. Owner and driver took the bait, and 1973 was Lennie’s first full year as a Cup driver.

Lennie’s career accelerated in ’73, when Dr. Pond was finishing his orthodontic residency at VCU. Lennie not only was competitive at the Cup level, he landed a number of top ten finishes, earning him the Rookie-of-the-Year Award (ahead of Darrell Waltrip). Dr. Pond celebrated his brother’s success with a banquet at the Hopewell Moose Lodge at the end of the racing season. The team flourished in the mid-1970s, landing a major sponsor, Pepsi, and finishing fifth in Cup Points at the end of the 1976 season. Despite 88 top-ten finishes, Lennie had to wait until ’78 for a first-place finish, the Talladega 500. He set what was then a record speed for a 500 mile race, over 174 miles per hour. Also, by 1977 Harry Ranier had become a part-owner of the race team, and became full owner in ’78.

Throughout Lennie’s career, Dr. Pond applied his scientific background and attention to detail to race operations. He measured the circumference of every tire in an era before steel belted radials. He knew on flat tracks the left rear tires had to be 1 ¾” smaller than the right rear to get the best traction. He also measured tire sizes during and after the race to create a database on tire wear. Other teams were puzzled when they saw him taking. measurements, but soon the competitors were doing

Left: Brothers in 1975 (L/R) Lennie Pond, Dr. A. Wright Pond

the same. Tires were a major expense for a small, family-run racing outfit.

Meanwhile in the 1970s, NASCAR was shedding its regional image and scheduling events in the Midwest, MidAtlantic, and California. New Hampshire, Illinois, and Kansas races were added to the calendar. Multi-car teams landed corporate sponsors, and prize money finished second to sponsorships. Soon there would be no place for a single-car team, manned by family and friends, that built cars in a backyard garage. The character of stock car racing had changed, leaving some owners, teams, and drivers behind.

Dr. Pond said he never considered racing as a full-time endeavor. “It was too political.” Some drivers received preferential treatment, with inspectors looking the other way at violations. He remembered a top team’s car looked “too narrow,” and it was, but someone else reported it. Asked if he had any regrets, he said, “We finished second six times.” The best memories were family members traveling and working together. Someone once asked him how he managed a busy practice and being the “CEO” of a race team, and he replied “Well, I was 29 then.” Now retired from clinical practice, his advice for new dentists is “Do the best dentistry you can do and success will follow.” As a reminder of his racing involvement, and in memory of his brother’s early race car (Lennie died in 2016), Dr. Pond has in his garage a red ’36 Chevrolet coupe street rod.

Top: Dr. Pond clocks lap times and communicates with Lennie, 1974

Bottom: Dr. Pond doing a consultation at his office with his lab tech, 2011

EXPLORING SPECIALTIES AS A THIRD-YEAR DENTAL STUDENT

Jack Madigan; Class of 2024, VCU School of Dentistry

At VCU, we are fortunate to gain experience in seven of the dental specialties during our third year. We have rotations through each, which help us expand upon the knowledge we gained in our didactic and lab courses. This also helps us treatment plan during new patient exams for those that require it. The specialties include Oral and Maxillofacial Surgery, Oral and Maxillofacial Radiology, Orthodontics, Pediatric Dentistry, Periodontics, Prosthodontics, and Endodontics.

ORAL SURGERY

In our third year, we have two separate oral surgery rotations. The first being one week in the first semester, followed by a two-week endeavor during our second semester. The first rotation is definitely nerve-wracking. Extracting teeth is one of the few things we do in clinic that we don’t get to practice in our pre-doc labs. We are paired up with a fourth-year student who walks us through the steps as we assist them with the first patient of the day, and the roles are reversed for the second patient, which was very helpful. This rotation takes place in our emergency clinic, where patients who are not active patients at the school go when they are in pain and need a tooth extracted. This is a great way to get proficient at extractions while also giving patients the immediate care they need. These circumstances are also great for learning to do quick limited exams, working through extensive health and dental histories efficiently to check for contraindications to dental treatment, learning different anesthesia

techniques, and learning suturing techniques. This clinic is filled with great surgeons and residents that help us approach each case and help give us advice on more difficult cases.

RADIOLOGY

During our Radiology rotation, we are fortunate to be taught by two great radiologists, Dr. Aniket Jadhav, and Dr. Anusha Vaddi. This is a rotation that you learn to appreciate after it is over. We go over different pathologies that you may see in panoramic, bitewing,

periapical, or CBCT images. Dr. Jadhav and Dr. Vaddi do a great job teaching us efficient ways to look through these images and how to quickly recognize and come up with differential diagnoses for abnormalities. These skills really help us when we do our radiographic exams of patients, so we can efficiently make diagnoses and make proper referrals.

ORTHODONTIC

The Orthodontic rotation is a unique rotation at VCU. The rotation takes

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L-R: Jack Madigan, Dr. Charles Janus, and Dan McQuillan

place once per week for eight weeks. It consists of weekly lectures where we review cases the residents are treating or have finished. While there is less hands-on work in this rotation, I found this helpful for knowing when to refer patients for orthodontic care and to give the patients an idea of what to expect regarding the timeline of and outcomes of care.

PEDIATRIC

Our Pediatric rotation is a tiring but rewarding rotation in our third year. The extent of our care includes exams, radiographs, prophies, and sealants. What makes this tiring is that we see five patients a day, one every hour, as apposed to the two we usually see a day in our general practice clinics. This helps improve our efficiency and keeps us moving. What makes this rewarding is we set kids up with a healthy dentition that they can maintain as they grow. We teach each one and their parents proper oral hygiene habits so they can continue for life while giving them a good experience at the dentist, so they are willing to come back as they grow up.

PERIODONTICS

Our Periodontics rotation is different from others but is applicable to our day-to-day work in our general practice clinics. In this rotation, we assist the periodontics residents in the treatment they are doing that day. This is great for us because while we do our own periodontal exams, initial

therapy (scaling and root planing), and periodontal maintenance, sometimes patients need more aggressive treatment. Assisting the residents in these procedures helps us give patients with periodontitis an idea of what the next steps would be for treatment if they were to require further treatment beyond initial therapy.

PROSTHODONTIC

The Prosthodontic rotation is known as our denture rotation. Students are paired with another third-year student and a prosthodontic faculty member to fabricate the student’s first denture. I had the opportunity to work with Dan McQuillan, who sat next to me every day in pre-doc labs for our first two years. We worked under Dr. Charles Janus, who has helped generations of dentists in the Prosthodontic Clinic at VCU. This is one of the most rewarding rotations we have. There are a lot of hours in the lab fabricating the denture. This is a tedious process, as is the case with lab work you are doing for the first time. It seems like you’re making no progress when you get steps checked by your attending faculty and told you have to redo them. The blood, sweat, and tears are worth it when you see the transformation of your patient as you deliver the final denture.

ENDODONTIC

Finally, there is the Endodontic rotation. This rotation begins similarly to our predoc labs, doing root canal therapy on extracted and plastic teeth. But we also

get to take turns using the endodontic microscope. The microscope takes a few minutes to get used to, but after using it for a while, you learn why all endodontists use it. The magnification and lighting are unparalleled, and it is a great adjunct to your skills if you are considering endodontic therapy in your practice. During the second part of this rotation, we perform endodontic screenings. These patients are referred to the VCU Grad Endo clinic from outside offices. This is a helpful part of this rotation as it gives us insight and experience in making diagnoses, recommending treatment, and making referrals.

VCU does an excellent job giving us a taste of these specialties during our third year. We get enough information so that we can apply it to each patient that sits in our chair, but not so much that we are overwhelmed. These rotations also give us a great foundation to learn more about each specialty throughout our time at school.

PERFECT PRACTICE MAKES PERFECT

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

Throughout the spring semester, D4 students gradually start planning and practicing for their clinical boards that are scheduled to start midFebruary. The first round involved fixed prosthodontics and endodontics performed on mannequins. The procedures involve root canal treatment of tooth #8, endo access preparation on #14, a crown prep on #9, and a fixed partial denture preparation on #3-#5. To prepare for these steps in their professional careers, students eagerly practiced on the weekends and in their free time. “Coming in on the weekends and staying after hours to practice was crucial for success on clinical boards” said Justin Conduff (D4 student). The senior dental students’ hard work and long hours of practicing did not go unnoticed by other students. “It is wonderful to see my colleagues wrap up their journey in dental school with mock boards. It is such a thrilling experience to see so many showcase their hand skills one last time before they are officially DDS!” said Bahar Boroumand Rad (D3 student).

VCU School of Dentistry also prepared students with a mock boards experience. Faculty dedicated their Saturday to grading and providing feedback on the students’ FPD preps and endodontic treatments. “The VCU SOD mock boards is pivotal to prepare for the actual boards, and it truly is a team effort from staff to students to faculty. We are one of the only schools to implement this in the country and I am proud to be a part of it.” said Dr. Shahrzad Orenduff (VCU faculty and Clinical Board Director).

Other dental students, staff, and administration volunteer their time to help with this event, allowing the upperclassmen a realistic experience. “Support and dedication are what makes the VCU School of Dentistry a special place, and I am in awe of the tremendous teamwork and professionalism of faculty, staff,

residents, and dental students, working together to provide our D4s this valuable experience.” said Dr. Richard Archer (Senior Associate Dean of Clinical Affairs). The entire day was a huge success and over 50 people volunteered their time to create a meaningful learning experience for soon-to-be dentists.

VCU School of Dentistry Class of 2023

WHAT’S CHANGING IN VIRGINIA’S DENTAL WORKFORCE?

Paul Logan, Director of Strategic Initiatives/Innovation

On March 3, representatives from the Virginia Healthcare Workforce Data Center presented new data from 2022 licensure surveys of Virginia dentists and dental hygienists. The complete reports are available at the Virginia Healthcare Workforce Data Center and provide valuable insights into trends in the licensed dental workforce. It’s important to note that the reports don’t contain workforce data on dental team members who aren’t licensed by the Virginia Board of Dentistry.

State-level Trends

After a decade of consistent year-overyear growth faster than the Virginia population as a whole, 2022 saw two percent fewer dentists in the workforce in Virginia than the previous year. The presenters suggested that the change in the licensure process could be a factor but that the data doesn’t provide a clear answer as to why the growth paused, with accelerated retirements being another potential factor.

Virginia added 220 more dental hygienists to the workforce in 2022, which brings Virginia, for the first time, beyond prepandemic levels of full-time equivalent dental hygienists (3,426 in 2022 vs. 3,403 in 2019) in the workforce.

Seventy-four percent of dentists worked between 30-49 hours a week in 2022. Sixty-eight percent of dental hygienists worked between 20-39 hours a week. Most new dental hygienists obtain their initial professional degree in Virginia, while a small percentage of new dentists practicing in the Commonwealth get their initial degree here.

Among Virginia dentists who obtained their initial license in the past five years, 16 percent received their dental degree in Virginia. The next most common dental schools are located outside the United States, in Pennsylvania, New York, Maryland, Massachusetts, and Washington, D.C.

Fifty-nine percent of Virginia hygienists who obtained their initial license in the last five years received their initial professional degree in Virginia, with the next most common states being Maryland, North Carolina, Florida, New York, and West Virginia.

The presentation highlighted demographic changes, including that dentists ages 44 and younger are now more likely to be female than male and that dentistry now has a higher diversity index than Virginia’s population as a whole.

Regional Data

There are wide disparities in different regions of the state in the concentration of dentists and hygienists and in the ratio of dentists to hygienists. For example, Northern Virginia has 421 more dentists than hygienists in the workforce, while there are 322 more hygienists than dentists in the Hampton Roads workforce. There are more than twice as many dentists per 1,000 residents in Northern Virginia as there are in Southwest, West Central, Southside, and Central Virginia. Breaking down the data at a county level shows a further urban and suburban vs. rural divide in the dentist-to-population ratio within those regions.

More to Come

The American Dental Association’s Health Policy Institute (HPI) will soon be releasing a 2022 update to their stateby-state report on the dental workforce, which will provide additional national context to the trends we see in Virginia. In HPI’s most recent report, Virginia’s dentist to overall population was above the national average. However, Virginia faces similar challenges to other states in terms of aligning our dental workforce with communities of need.

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WHAT’S THE VDA DOING TO ADDRESS THE VIRGINIA DENTAL WORKFORCE ISSUE?

Shannon Jacobs, VDA Director of Communications

“Declining Workforce” or “Labor Shortage” are some of the buzzwords we hear in almost all job sectors. And the dental sector is no exception. In the previous article, Paul Logan analyzed. the most current workforce data available from the Virginia Healthcare Data Center. Overall trends show fewer dentists in the workforce in 2022 and more overall dental hygienists providing fewer hours of work on an individual basis. However, regional data indicates acute needs for dentists and dental hygienists. Impacts are being felt throughout Virginia, as practices report that difficulty in filling open positions with qualified candidates prevents them from seeing a full patient load.

Addressing the state’s dental workforce shortage is a top priority for the VDA. To begin moving the needle on improving the Virginia dental workforce, we have convened the Virginia Dental Workforce Council. The group comprises organizations that understand the importance of qualified, highly trained dental teams in the Commonwealth to deliver oral health care, including representatives from the state government, dentistry, allied professions,

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Dig into the Data

dental education, and other associations. Our President, Dr. Cynthia Southern, will chair the council with the following goal in mind.

THE GOAL:

To develop recommendations to ensure all communities in Virginia have the dental workforce needed to serve their oral healthcare needs.

THE OBJECTIVES:

• Develop a shared understanding of the scope and magnitude of Virginia’s short-term and long-term regional dental workforce needs.

• Identify and evaluate possible causes and solutions to regional shortages and unmet needs within our existing dental programs.

• Develop strategies, partnerships, and policy recommendations to create sustainable pathways for trained dental professionals to serve and thrive in the dental offices and communities that need them.

The first Virginia Dental Workforce Council meeting will be held this Spring. We are confident that together the workforce group can significantly impact the dental health of communities in Virginia. Stay tuned for updates on the group’s progress in future VDA communications.

Have you experienced a specific workforce challenge in your practice? Let the VDA know by emailing your experience to Paul Logan at logan@vadental.org.

At the Virginia Healthcare Workforce Data Center, you can find regional breakdowns for dentists and hygienists of median salary, years to expected retirement, practice modality, and much more. This data will help inform the efforts of the Virginia Workforce Council in the coming months, and we welcome any insights our members would like to share from the data.

MANAGING RISK AS YOU PREPARE FOR RETIREMENT

Dylan Mills; Marketing Specialist, ACG Worldwide

Most investors understand that they should take less risk with their investments as they approach retirement, but reducing risk isn’t simply a matter of swapping out your stocks for bonds and walking away. Your unique goals, risk comfort, and other factors should lead to creating an individualized portfolio that is right for you. This article will cover oftoverlooked considerations of building an asset allocation for retirement.

How Much Stock Should You Keep in Your Portfolio?

There is a quick calculation often suggested as a handy way to determine what percentage of your portfolio should be invested in stock: subtract your age from 100. For example, this guideline would suggest a 60-year-old hold 40% in stock while a 70-year-old would hold 30%. Unfortunately, this is a one-sizefits-all approach to a question that is personal and unique. Rather than asking how much stock your portfolio should have, a better question is to ask how much return you need and how much risk can you afford. The best way to answer this is by creating a financial plan that includes a cash flow analysis. This way, your portfolio can be tailored to the unique circumstances that are driving your retirement.

Are Your Attempts at Reducing Risk Doing What You Think?

Many investors think they can sell stocks and buy bonds, and just like that, the risk is reduced! Unfortunately, it is not that simple. Not all bonds are created equally, and just like stocks, some bonds are riskier than others.

Bonds come with a wide variety of credit quality. There are those ultra-high-quality bonds that are issued by stable countries like the U.S. and blue-chip companies

that have strong balance sheets, and then there are those low credit quality bonds, commonly referred to as high yield or junk bonds, issued by countries and companies that have a higher risk of default. These high-yield bonds have the benefit of paying a higher interest rate, and including a small percentage of them in a portfolio can enhance return and diversification. But investors should be careful not to add too much exposure to high-yield bonds in their portfolio if their intention is to reduce risk in preparation for retirement.

long-duration bonds in your retirement portfolio, but exposure should be limited to match your specific risk objectives.

Hedged Equity: Stocks without the Shocks

One way to reduce a stock portfolio’s risk without dealing with the problems posed by bonds is hedged equity. Hedged equity is a broad umbrella of investment strategies that have different approaches and objectives. We’ll get into a couple of examples here, but the unifying characteristic of the hedged equity category of investments is that it seeks to provide investors returns based on the stock market while dampening the degree of losses that can occasionally happen when stocks decline. It’s important to distinguish the hedged equity category from the term “Hedge Fund.” Hedge funds are typically secretive, expensive, and many often do not even attempt to hedge risks. Hedged equity has nothing to do with hedge funds.

Similarly, another risk that comes with bond investing is interest rate risk. Bond prices move inversely with interest rates, and the degree to which this happens is not the same for all bonds. Shorterterm bonds are much less sensitive to interest rates than longer-term bonds. This measure of interest rate sensitivity is called duration. Having a bond portfolio with a high average duration can lead to greater than expected declines in a rising interest rate environment. As with high-yield bonds, it is okay to have some

One example of a hedged equity strategy combines traditional stock investing with an option-based strategy overlaid on top. Options are commonly associated with more risk, not less, but this characterization misses the full picture. Options can be used to substantially reduce risk in a portfolio. In one example, the investor gets exposure to the S&P 500 index of stocks, and they participate in 4-6% of the upside of that index in any given quarter—an annual return as high as 16-24%. In return for capping the investor’s quarterly upside, the investor gets significant downside protection in the event of a negative quarter. The investor participates one-for-one on the downside through the first 5% of the decline in a quarter. After that, the investor does not lose anything else until the index has lost more than 20%. Here is a table that

“Ultimately the right mix of stocks, bonds, hedged equity, interval funds, and other alternatives for your retirement portfolio will depend on your unique circumstances.”

outlines some different return scenarios for the index and the corresponding investor experience:

another. However, creating a sleeve of one’s retirement portfolio for hedged equity is a great way to achieve return while reducing risk.

Other Alternatives

Another type of hedged equity involves convertible bond arbitrage. Convertible bonds are issued by companies that agree that the bond can be converted into stock if the stock price rises above a certain level. Convertible arbitrage is the process of buying a convertible bond and simultaneously shorting the same issuing company’s stock. This hedges out the volatility of the underlying stock and isolates the yield created by the bond’s payments.

These are a couple of examples within the varied investment category of hedged equity. As with every investment category, not every strategy is right for you. It is important to understand how they work individually and how one complements

There are many other alternatives that can diversify and reduce the risk of a portfolio. The key is to find alternatives that aren’t dead weight during periods of strong stock and bond performance. Private real estate and real assets like infrastructure, farmland and timberland are alternatives that have been shown to produce attractive returns throughout a stock market cycle without a strong correlation to the stock market. Such investments used to be more difficult to access but are now available to a broader set of investors through vehicles like interval funds. Interval funds look and feel a lot like mutual funds, the key distinction being that you can typically only sell shares of an interval fund on a quarterly basis, rather than daily. While such investments should be limited to a smaller part of one’s portfolio to match their liquidity needs, they nonetheless offer yet another great option for reducing risk without relying on bonds.

What’s the Right Mix for You?

Ultimately the right mix of stocks, bonds, hedged equity, interval funds, and other alternatives for your retirement portfolio will depend on your unique circumstances. By first identifying your risk and return objectives through a cash flow analysis, you can then build a robust retirement portfolio for today’s challenging market with the tools discussed above.

The information in this article applies to every investor approaching retirement, but how it impacts you specifically is unique. Rather than considering this article as individual investment advice,

treat it as a guide through which you can identify key areas that require your attention for retirement success. Working with a professional can help you sort out the complexity in your portfolio to guide you toward the most efficient system for living off your investments in retirement.

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

USING EMAIL MARKETING TO STAY CONNECTED WITH PATIENTS

Michaela Mishoe, Account Executive at The Hodges Partnership

You may use your email as a tool for communicating with colleagues, friends, and family or as a virtual mailbox to receive local news, credit card statements, and coupons from your favorite retailers. But your inbox also can serve as a hub with the latest resources to keep you healthy and engaged with health professionals.

Your practice may already use email to book and confirm appointments with patients, but with 99% of email users1 checking their email at least once daily, it may be time to get creative with your strategy and use this statistic to your advantage.

Here are a few ways to use email marketing to stay connected with your patients and ensure they return for regular checkups.

Share Healthy Tips and Fun Facts

Even though patients hear about healthy tips while receiving their exam, there’s not always enough time to cover every topic and answer every question when it comes to keeping a healthy smile. Consider sending out helpful tips about fighting bad breath and remembering to floss, or share a dental fact that might surprise people, such as that tooth enamel is the hardest part of the entire body. Even outside of the dental chair, you can keep your patients engaged and connected through email.

Feature New Products, Procedures, and Promotions

If you’ve started offering a new cosmetic procedure, share the news through email. Patients may even reach out and ask specifically about your new products or procedures if they see that you offer them without feeling like they’re being upsold

while getting their teeth cleaned. If you run promotions throughout the year, such as half-off cleanings, give your patients plenty of notice so they can make an appointment before they fill up.

While social media is a great place to post about your volunteerism in the community, don’t forget to send the news right to your patients’ inboxes. Promoting your charitable efforts can improve employee retention, raise awareness about nonprofits in your community and introduce a new cause for your patients to support.

Reengage Patients and Find New Ones

Using email, text messages and phone calls is a great way to remind patients about upcoming appointments, but what about the patients who you haven’t heard about in a while? Following the pandemic, many people fell out of regular checkup routines. Check in on those patients to see if they’re ready to get back in for a checkup, or if they’ve changed dentists.

Use email communication to ask current patients about others in their lives. Has their partner been to the dentist in the last year? What about their friends and family? While paying for referrals is against the ethics code of the profession, you can thank patients for referrals with a note, but gift cards, coupons, or anything of monetary value would not be advised.

Share News About Your Staff, History and Charitable Activities

Does your practice have an interesting history in your local community, or has it been passed down through generations? Highlight what makes your practice unique while showing that you and your staff genuinely care about the health and well-being of your patients. Showcase members of your staff that patients interact with during their appointments. When they come in for checkups, they’ll feel more comfortable and connected, whether with the person who checks them in or the hygienist who cleans their teeth.

Things You Should Think About

Before executing your new email marketing strategies, there are a few things to consider. Make sure you have an option for people to unsubscribe from any emails they’ve signed up to receive. The United States CAN-SPAM legislation, enforced by the Federal Trade Commission, states that you must include a clear and obvious way for subscribers to opt out of your commercial messages. If you’d like to use photos of patients in email or social media posts, get permission from the patient or a parent or guardian. The ADA provides

“Your practice may already use email to book and confirm appointments with patients, but with 99% of email users checking their email at least once daily, it may be time to get creative with your strategy and use this statistic to your advantage.”

a sample photo release available for members to adapt to use in their practices. The release can be found on its website under Resources for Managing Patients.

And finally, make sure that your emails are visually appealing, legible, free of typos, and reflective of you and your practice.

Works Cited

1. Santora, J. (2020, August 14). Is Email Marketing Dead? Statistics Say: Not a Chance. Retrieved March 2023, from Optinmonster. com: https://optinmonster.com/ is-email-marketing-dead-hereswhat-the-statistics-show/

FINDING AND HIRING THE RIGHT CANDIDATE FOR YOUR DENTAL PRACTICE

Sydney Andersen, Content Team Marketing Manager at ProSites

Growing your dental practice team is both an exciting and stressful time. Finding someone with the skills you need and who will mesh with your team may seem like finding a four-leaf clover. But it doesn’t have to be.

Having a clear idea of the type of person and skills you want your next team member to have is key to making the hiring process flow as smoothly as possible. It’s good to have a full list of both hard and soft skills your ideal candidate should have and then prioritize that list with what’s most important to your team. Here are some examples to get you started:

• Hard Skills – Technical skills (how to do x-rays, prepare supplies, disinfect rooms, etc.), computer knowledge, hand-eye coordination, motor skills

• Soft Skills – Team player, attention to detail, compassion, dependability

Once you have a clearer picture of the type of person you’d like to add to your team, it’s time to start actively recruiting. According to The National Association of Colleges and Employers, it costs businesses on average $7,645 to hire a new employee. Making sure you find the right team member the first time will not only save you time, but it will save you money too. Here are some things to consider when posting a job opening:

• Create a compelling job title and description. LinkedIn reports job seekers lose interest after 14 seconds, so you want to make sure your first impression is the best.

• Make sure your posting isn’t too long (or too short). Between 300700 words is ideal.

• Post on multiple sites. You never know where the right candidate will come from, so it’s best to post your job openings in more than one place. Aside from large national sites like LinkedIn and Indeed, also consider posting on local job boards, Facebook groups, the new VDA Career Center (careers.vadental. org), and your website. If you don’t have a website, or if you need help with your website, ProSites can help!

A few open-ended introductory questions:

• Why do you want to work here?

• What made you choose a career in the dental field?

• What do you find most rewarding about your work?

Tell me how…

Asking candidates technical interview questions such as how they prepare for patients or how they perform specific procedures provides dental assistants and hygienists with the opportunity to share their knowledge of processes that would be part of their daily duties and demonstrate that they have learned and performed them correctly.

Some sample questions that lead to “tell me how”:

• Do you have experience assisting with fillings, crowns, or extractions?

• Do you have experience making dental impressions?

• How do you help keep patients calm during procedures?

When it comes time to interview candidates, asking the right interview questions will ensure you find the best team member for your practice. Here are a few examples:

Tell me why…

An open-ended introductory question requires a candidate to go beyond sharing facts and stock answers and think deeper to share some of their motivations and personality. This will help you gauge how a candidate will gel with your team and how they align with how your practice serves patients.

How do you explain the need for a dental procedure to a patient who doesn’t understand the importance of the treatment?

This question can tell you a lot about the candidate. It gives them the chance to share both their technical knowledge of procedures as well as their communication and compassion for patients.

What experience do you have with practice efficiency?

Your practice may be like others. Where practices are commonly understaffed and busy with appointments, dental teams

“Having a clear idea of the type of person and skills you want your next team member to have is key to making the hiring process flow as smoothly as possible.”

with a collective knowledge of important tools and systems to save time and improve practice efficiency can navigate towards a better tomorrow that so many practices now seek.

Asking candidates what they bring to the table beyond traditional dental skills invites them to share what they have to offer that other candidates don’t. In doing so, you have the chance to identify a potential team member whose experience can benefit many or all aspects of your practice, including operational efficiency, time-savings, patient relations, profitability, and team well-being. Make sure candidates know practice efficiency experience is not a prerequisite for the job (unless it is). You’re simply letting them know that you value the whole of their experience and you’re inviting them to share it.

Example questions:

• Do you have experience with practice management software?

• Do you have experience with automated patient communication systems?

If a candidate doesn’t have direct experience with a particular system, ask them how they think a particular system might improve practice efficiency. This tells candidates that you’re a forwardthinking practice (which may differentiate your practice if a candidate is shopping around for such a practice) and informs them that you value their input, which is a retention factor.

What kinds of challenges are you seeking in this position?

With this question, candidates can share what they hope to gain from being hired, and you gain further insight into

retaining them if you hire them. It could be something missing from a prior position that a practice didn’t offer (for example, a more active role in leadership or decisionmaking) or something you provide in your practice, which becomes a retention factor for a candidate.

What are your interests outside of work?

In addition to shedding additional light on a candidate’s personality, this question shows that you care about work-life balance, and you’re interested in what they do to help maintain it.

What do you see as some of the biggest challenges that are facing our industry?

It can be difficult for dentists and management to hear how dental assistants, hygienists, and office staff really feel about the state of the dental industry. Some of these candidates believe practices are unaware of (or choose to ignore) workplace issues that can cause team members to quit, either their job or the profession entirely. Asking what they see as some of the biggest challenges facing the dental industry informs candidates that you care about a healthy workplace, that you value their voice, and that you can see the big picture.

Best of luck!

We hope these tools help make the hiring process for your dental practice less daunting. At ProSites we have over 20 years of experience serving the dental community. We offer a complete range of affordable, proven website and marketing solutions that deliver results. Trusted by over 7,500 dental and medical professionals, ProSites’ solutions provide a seamless patient experience tailored to practice needs. Visit www.prosites.com/ VDA to learn more.

Editor’s Note: Sydney Andersen has been helping both large and small businesses create their content and social media strategies since 2012. She studied sales and marketing at BYU-Idaho and currently lives in Phoenix where she is the Content Team Marketing Manager at ProSites. When she’s not helping businesses grow she enjoys playing basketball with her kids and crafting.

Prac�ces for Sale

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

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

expansion. Office is paperless with digital x-ray. Seller is re�ring.

Loudoun County The prac�ce generates over $500K per year in revenue. The cash flow is strong and pa�ent base is 100% FFS. There are 4 ops, digital x-ray, and a strong staff in place. Real estate is for sale.

under contract

refers out all oral surgery, ortho, endo, and perio. Located in the Blue Ridge Mountain, perfect for someone who loves outdoors!

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

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

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

under contract under contract

Norfolk Collec�ng over $800K per year. Currently has 7 operatories with room for

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

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

SW Virginia Well established prac�ce for sale on a busy road with great visibility. Collects over $750K working only 10 months out of the year. Seller is looking to re�re but is flexible in staying on. Sellers

Dr. Geovanny Balderas has joined the prac�ce of Dr. Joe McIntyre Bridgewater, Virginia

Dr. Priya Gupta has acquired the prac�ce of Dr. Stephen St. Louis Fairfax, Virginia

DDS:DentalDetectiveSeries

DENTAL DETECTIVE SERIES

WORD SEARCH

Dr. Zaneta Hamlin

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GENIOGLOSSUS

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OPEN VDA LEADERSHIP POSITIONS

Are you interested in getting involved with the VDA in a leadership position? Then you’re in luck! We offer many opportunities for you to get involved in a way that aligns with your skills and interests.

PRESIDENT-ELECT

2024, THEN PRESIDENT 2025

Job Description (President-Elect):

The President-Elect is a convener within the organization. Their focus is on understanding the organizational workings of the VDA (by reading its bylaws) and developing relationships with state and component leadership and staff, as well as committee (or council) chairs so that they can effectively carry out the responsibilities of the President during the subsequent year.

Job Description (President):

The president is the members’ voice and the link between the ADA, the state organization, board members, component leadership, and student networks. The president is the spokesperson for statewide initiatives during his or her term and works closely with component leadership, as well as committee chairs, to make sure program details and expectations are communicated and understood by those executing them. The president is also the state’s eyes and ears, collecting programmatic cues from the ADA and other state associations.

ADA DELEGATE (2024

Four positions available

– 2026)

Job Description: Attend all the regular sessions of the House of Delegates, the District caucuses, and other meetings as the chair of the Delegation shall designate. Serves a three-year term.

ADA ALTERNATE DELEGATE (2024 – 2025)

Five positions available

Job Description: Attend all the regular sessions of the House of Delegates, the District caucuses, and other meetings as the chair of the Delegation shall designate. Serves a two-year term.

Deadline for Nominations: May 1, 2023

AWARD NOMINATIONS – NOW OPEN

DENTAL TEAM MEMBER AWARD

The nominee must be a dental team member of a VDA member dentist. This award may be presented to multiple recipients only when worthy candidates are recognized. The nominee(s) should demonstrate that he/she holds the profession of dentistry in the highest regard, promotes the interest and betterment of the profession through the team concept of dentistry, and has five or more years of experience in the dental field.

SPECIAL SERVICE AWARD

This award is presented to a non-dentist who has demonstrated outstanding service, support, and dedication to the profession of dentistry. This award is presented when a worthy candidate is recognized.

VDA FELLOW

NEW DENTIST AWARD

This award is presented yearly to a VDA member who has been in practice ten years or less. This award is only presented when a worthy candidate is recognized. The nominee must have demonstrated leadership qualities through service to dentistry.

NOMINATE YOUR COLLEAGUE:

vadental.org/award-nomination

A Fellow nominee must be an active, life, or retired member of the Virginia Dental Association for at least seven years. Nominees shall have given freely of their time and energies to their local component society, as well as the Virginia Dental Association and the profession of dentistry. Military and or federal service personnel having served a minimum of two years active duty and maintaining active membership in the ADA may be considered for VDA Fellowship after five years of VDA service.

Deadline for Nominations: May 1, 2023

WELCOME NEW MEMBERS THROUGH MARCH 1, 2023

Dr. Paul Thomas – Richmond – Medical University of South Carolina James B Edwards College of Dental Medicine 2021

Dr. Tandra Atkins – Virginia Beach –Meharry Medical College School of Dentistry 1997

Dr. Frederick Rumford – Virginia Beach –University of Pennsylvania School of Dental Medicine 2007

Dr. Anusha Vaddi – Richmond - University of Connecticut School of Dental Medicine 2022

Dr. Liara Vinson – Richmond – Virginia Commonwealth University School of Dentistry 2020

Dr. Virginia Atencio Orozco – FairfaxColumbia University College of Dental Medicine 2022

Dr. Maha Elzubair – Fairfax – Howard University College of Dentistry 2021

Dr. Kelsey Freeman – Loudoun – Virginia Commonwealth University School of Dentistry 2022

Dr. Ricardo Gaitan – Fairfax – Howard University College of Dentistry 2022

Dr. Anshu Khanna – Hampton – Howard University College of Dentistry 2021

Dr. Chinwendu Nnagbo – Hampton – Loma Linda University School of Dentistry 2022

Dr. Jessaca Charite – Roanoke – Tufts University School of Dental Medicine 2019

Dr. Adam Holt – Roanoke – University of Alabama School of Dentistry at UAB 2010

Dr. Priyen Patel – Bedford – New York University College of Dentistry 2018

Dr. Aisha Qazi – Pittsylvania – Howard University College of Dentistry 2021

Dr. Bradley Hagen – Alexandria – University of Florida College of Dentistry 2018

Dr. Hemani Kaur – Fairfax – Boston University Goldman School of Dental Medicine 2001

Dr. Rahul Kumar – Fairfax – New York University College of Dentistry 2012

Dr. Brian Bins – Richmond – University of Louisville School of Dentistry 2016

Dr. Adrianne Castro – Richmond – Howard University College of Dentistry 2017

Dr. Jasmine Chopra – Richmond –University of Minnesota School of Dentistry 2020

Dr. Alexandra Glickman – Henrico – New York University College of Dentistry 2011

Dr. Madeleine Maas – Henrico – Touro College of Dental Medicine at New York Medical Center 2021

Dr. Kristen Reitano – Richmond – Virginia Commonwealth University School of Dentistry 2020

Dr. Leonicia Blue – Montgomery – Case Western Reserve University School of Dental Medicine 2007

Dr. Abdul Majeed – Prince William –University of Colorado Denver School of Dentistry 2022

Dr. Dayne Patterson – Fairfax – Virginia Commonwealth University School of Dentistry 2011

Dr. Marianne Saade – Arlington – Boston University Goldman School of Dental Medicine 2022

Dr. Archana Srinivasan – Fairfax –University of Rochester Eastman Department of Dentistry 2009

IN MEMORY OF:

AWARDS & RECOGNITION

2023 Trailblazer

Award

VCU School of Dentistry

Named in Honor

Danville Redevelopment and Housing Authority

L-R: Drs. David Stafford, Tadasha Culbreath, Melanie Love, Zaneta Hamlin, Garry Myers, Jitendra Jethwani, and Anh Pham. At right is Dr. Mark Crabtree, 16th District Regent, ICD-USA. Drs. Erika Anderson and George Jacobs were inducted virtually.

INTERNATIONAL COLLEGE OF DENTISTS, USA SECTION

Dentists from Virginia were inducted in Houston, October 14, 2022.

L-R: Drs. David Stafford, Dani Howell, and Zaneta Hamlin. Drs. Daniel Stockburger, Thomas Glazier, Holly Lewis, Gloria Ward, Evan Garrison, and Jeena Devasia were also named VDA Fellows.

VDA FELLOWS

Virginia Dental Association

DR. RANDY ADAMS

DR. ZACHARY HAIRSTON Scholarship

>> CROSSWORD ANSWERS CONTINUED FROM PAGE 49

DDS:DentalDetectiveSeries

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

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

YOUR SUPPORT MATTERS MORE THAN EVER

The VDA works hard to advocate for your profession and patients at the local, state and federal levels.

To control the future of your profession and your practice, political action is the only way to get the job done and political contributions are an important part of this activity. Don’t assume your colleagues’ contributions are enough. Your contribution WILL make a difference. Please support the VDA Political Action Committee (Tooth PAC) today!

HOW IS ORAL HEALTH IN VIRGINIA?

ROOM FOR IMPROVEMENT, SAYS THE 2022 VIRGINIA ORAL HEALTH REPORT CARD

Sarah Bedard Holland; CEO, Virginia Health Catalyst

The 2022 Virginia Oral Health Report Card (Report Card) is a tool driven by state and community stakeholders to evaluate our efforts to improve oral health in the Commonwealth. It compares Virginia’s performance in nine key oral health indicators to national benchmarks, and assigns an overall grade as an average of all the indicators. Virginia earned an overall grade of C+; we can do better, and dentists are an important part of the solution!

This is the second edition of the Report Card, the first of which was published in 2016, so we can track our progress over time. The latest Report Card compares rates for each indicator with the 2016 rates, where applicable, to show improvements or no change. The overall grade (C+) did not change since 2016, but the VDA, its members, and community partners helped improve the public oral health system in Virginia since then, including expanding Medicaid eligibility and adding a comprehensive adult dental benefit to Medicaid. These and other factors led to progress in the rates of several Report Card indicators.

However, there are significant opportunities for collective action. Dental disease is preventable, and dentists play a pivotal role by focusing on prevention and forging meaningful relationships with their patients.

The 2022 Report Card allows us to refocus on the areas where Virginia needs improvement, especially for communities that carry a greater burden from oral health inequities than others. The Report Card highlights data showing differing health outcomes by race/ ethnicity, income, education, geography and more. We need an approach that centers health equity and the voices of

these communities in order to improve the health of Virginians.

Throughout 2022, Virginia Health Catalyst will host learning opportunities across Virginia centered around how to use the Report Card in grant writing, clinical and community care, advocacy, and more. Look out for these events virtually or inperson near you!

We made it easy to share the 2022 Virginia Oral Health Report Card –find the one-page report card here: https://bit.ly/2022OHRC

Read the full Report Card, including methodology, health equity concerns for each indicator, and more, on the Virginia Health Catalyst website: www.vahealthcatalyst.org

Editor’s Note: Virginia Health Catalyst is a statewide public health nonprofit whose mission is to ensure that all Virginians have access to comprehensive health care that includes oral health. Through advocacy, education, and partnership, Catalyst elevates oral health as a vital component of overall health in Virginia.

Figure 1 2022 Virginia Oral Health Report Card indicators, rates, and grades.

* No national benchmark exists; therefore, Virginia receives an “I” for incomplete. ** Data collection delayed due to COVID-19 restrictions in schools.

Where’s my Referral Book?

The 2023 VDA Referral Book will be mailed separately from the Journal and directly to your office address. Please share this book with your office manager and staff.

Remember to use this resource to be sure you are referring your patients to other VDA member specialists whenever possible.

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EMPLOYERS:

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