ACD-OS 2024 Newsletter

2024 Annual Newsletter

American College of Dentist
 Ontario Section

Our mission is to advance excellence, ethics, professionalism, and leadership in dentistry.

The Executive Committee Members

Dr. Sunita Joshi

Chair of the ACD Ontario Section

Dr. Sonia

Slawuta-Shulakewych

FACD, ACD-Ontario Chair 2023

Dr. Karin Van Ryswyk Treasurer

Dr. Tamara Sosath

SPEA Liason – U of T

Dr. Anwar Dean

SPEA Liason – Western Schulich

Dr. Abbas Jessani Member at Large

Dr. Louann Visconti

Vice Chair and Editor
 ACD-OS Newsletter 24

Dr. XueEr Hong Secretary

Dr. Shawn Steele Editor; Constitution and By-Laws Chair

Dr. Jawad Tawil

SPEA Liason – U of T

Dr. Nancy Baldan Member at Large

Dr. Brenda Thomson Regent

It has been said that; “Ethics is knowing the difference between what you have a right to do and what is right to do.” Over the past 35 years since my graduation from the Faculty of Dentistry at the University of Toronto, I have seen the many challenges that the profession and individual practitioners face; increasing government intrusion into professional regulatory colleges and the professions; increasingly stringent practice guidelines; an erosion of trust of the public in the dental profession leading to a rise in dental tourism and creative business models promoting other treatment modalities; and the aftermath of the COVID-19 pandemic. This initiative, while politically driven, should cause us to pause and look inward at our social responsibilities to society, to those in need and to our patients every day.

The dichotomy of the practice of dentistry is that we deliver these health care services in a small business setting. With an increasingly complex practice environment comes an increase in the cost to deliver this care. Coupled with that is the economic downturn resulting from the global 2020 pandemic resulting in rising inflation and recession. As the average household discretionary dollar amount continues to decrease, dentistry is competing with other lifestyle options for these dollars.

As dental students, we took an Oath of Commitment and in that oath we; “Solemnly acknowledge that (my) paramount responsibility is to the health and well-being of (my) patients.” But how do we uphold this commitment facing the economic pressures of practice? What is dentistry’s social contract to the public? The federal government is reminding us of this contract as it moves toward the creation of the Canada Dental Care Plan to improve access to dental care for all Canadians, with a focus on those that do not currently have access either through third-party dental plans or through their own personal finances.

We must ask ourselves do we make treatment decisions based on our economic needs or do we make decisions based on the best interests of those under our care? Do the economic pressures of practice dictate who is treated? There are many marginalized segments of society, such as those with special needs, seniors and our First nations peoples that experience obstacles in accessing regular dental care with the dental team of their choice. What are our social and moral responsibilities to these groups when it comes to making clinical decisions?

In this edition of the ACD Ontario Section newsletter, we explore these questions through different lenses attempting to provide differing perspectives on this overall issue. We hope that you find these articles thoughtprovoking and that you enjoy this edition of the ACD-OS.

Incoming Chair’s Report

It is an honour to be the Chair of the American College of Dentists Ontario Section. I hope to uphold the strong traditions of the ACD that all past presidents maintained. The Ontario section has grown to 182 fellows including Active Retired Fellows and 61 Life Fellows. Our Regency 4 has new excellent leadership with Dr. Brenda Thomson at the helm. I would like to thank Dr. Sonia Slawuta for her leadership last year. We had a very successful year with the Dr. E.J. Rajczak Ethics and Professionalism Continuing Education Series. Dr Paul Romanson has retired from the ACD-ON executive and moved onto a new venture, we wish him success.

Looking to the year ahead as your Chair I am so excited to work with the new and in igorated executi e. We ha e a great team

Dr. Sonia Slawuta is Past Chai

Dr. LouAnn Visconti is the Vice Chai

Dr. XueEr ong is the Secretar

Dr. Karin Van Ryswyk is the Treasure

Dr. Sunita Joshi Chair of the ACD Ontario Section

“The theme for the year is to continue with the great education programme with an emphasis on Ethics, Professionalism, Inclusion and Diversity.”

Dr. Shawn Steele is the Edito

Dr. Tamara Sosath and Dr Jawd Tawil are the SPEA Liaisons for University of Toront

Dr. Anwar Dean is the SPEA Liaison for Western Schulich School of Medicine and Dentistr

Dr. Nancy Balden is a member at larg

Dr. Abbas Ali Jessani is a member at large

The theme for the year is to continue with the great education programme with an emphasis on Ethics, Professionalism , Inclusion and Diversity. We are also looking to engage more of the newly graduated dentists into the profession and get ethics and

professionalism to be an important part of their continuing education.

The Ontario Section is a well-respected component of the American College of Dentists. Being Accepted as a fellow is a great honour. Please consider nominating one or two of your colleagues for fellowship. I look forward to hearing from you and seeing you in the coming year either virtually or inperson at the ACD meeting in New Orleans from October 15-18, 2024.

Respectfully submitted,

Sunita Joshi

“Every Accomplishment starts with the decision to try.” – JFK

This year, 2023, has been marked with new directions and enhanced benefits to all members. I would like to thank the hardworking Ontario Section executive for their great ideas and their dedication of time and effort in keeping our section strong and encouraging our initiatives to blossom. The introduction of the Dr. Emo Rajczak Ethics and Professionalism CE Series has been a wonderful success, with a fantastic roster of excellent speakers, almost all ACD fellows, speaking on various aspects of ethics and professionalism. In addition to providing a great benefit to section fellows, the online format enabled the outreach to SPEA students as well as the teaching staff at both dental schools.

As in previous years, we were invited to participate in the White Coat Ceremonies and were pleased to bring our message regarding the importance of ethics and professionalism in dentistry to students of both UofT and Schulich faculties of dentistry. We also carried this message into our meetings with the RCDSO leadership last October, successfully lobbying to have Ethics courses considered as category 2 rather than category 3, as they had been in the past.

Recently, the leadership of the ACD Ontario Section met with the RCDSO presenting compelling support for the need for mandatory ethics courses as a stipulation for license renewal.

The result of our discussions is for the two organizations to continue the dialogue on this point and to continue to work together to ensure that that all dentists are knowledgeable and proficient in dealing with ethical dilemmas when faced with them, and that ethics are fully appreciated as the cornerstone of daily clinical practice.

In addition to our award-winning annual Newsletter, we also introduced a quarterly Bulletin to celebrate current accomplishments and news and to keep you apprised of upcoming events and deadlines. To celebrate Ontario fellows, we also introduced a birthday card outreach to honor your special day and a holiday card program to celebrate these times of joy and reflection with you. Reflecting on the many planned initiatives introduced at our Strategic Planning Meeting and programs initiated this year, I would like to invite you to join us in making the Ontario Section even better by sharing your ideas, participating in our committees or by nominating your worthy colleagues for ACD Fellowship.

the new Regent for Regency 4 within the American College of Dentists (ACD).

As background, Officers and Regents of the ACD provide guidance for the organization. The College is divided into eight Regencies, and Regencies are further divided into Sections. There are 51 Sections overall.

Our Regency 4 covers Indiana, Michigan, West Virginia, Kentucky, Ohio, and Ontario. Regents provide a lot of the direct contact and cohesion between each of their sections and ACD headquarters. This is done by attending AGMs in each section, and providing advice and support as needed. Clearly a lot of travel is involved, and I know my car’s odometer will be spinning over the next four years.

Our immediate past Regent, Dr. Terry Norris, initiated a very useful newsletter for all Fellows in Regency 4, and I will be continuing that. As well, Terry Norris and I co-hosted a virtual Regency 4 Breakout Session with section leaders in December, and I plan to continue this.

This past spring and summer I had the opportunity to attend several Section meetings, while job shadowing Terry Norris as he prepared to pass the torch to me.

Dr. Brenda Thomson Regent

This was a great introduction that is helping me get up to speed as quickly as possible. I am truly thankful to Terry for all his guidance. Other former Regents have been very helpful in supporting me in this new endeavournotably Dr. Richard Jones and Dr. Lance Rucker. Dick Jones was our Regent immediately prior to Terry, and has just completed his term as ACD/ACDF President. Also Vancouver-based Lance Rucker, was the past Regent of Regency 8, and he was able to offer invaluable information from a Canadian perspective.

In addition to their important liaison support role with individual Sections, Regents participate directly in governance for the organization via membership on the ACD Board, and by serving on selected board committees. I am delighted to serve on both the Finance and the Sections Committees.

In my short time in the Regency world, I have been very proud to see what a strong player and contributor our Ontario Section is within the overall organization. Ontario has shown real leadership by repeatedly having an award-winning newsletter, model section status, active SPEA chapters, and an exceptionally robust CE Program.

future, and I expect that the ACD will do more and more in coming years to help younger dentists successfully build highly Ethical and Professional practices.

I am very confident that ACD is becoming a stronger force within organized dentistry. So please keep nominating worthy colleagues, with a focus on their leadership skills in dentistry and/or in their community.

Respectfully submitted,

Brenda Thomson Regent, Regency 4

A Perspective on the Future

Dr. Teresa Dolan President, American College of Dentists
 Chief Dental Officer, Overjet

Dentistry, as a noble profession, has a unique professional contract with society. This essay explores the delicate balance between economic considerations and the ethical responsibilities dentists bear towards their patients, particularly those in marginalized segments of society. As oral health practitioners, we are entrusted with the wellbeing of our patients, yet we typically operate within a small business framework facing economic challenges. The dichotomy of delivering healthcare services within a business setting raises questions about whether treatment decisions are influenced by economic needs and how to best meet the oral health needs of segments of society facing obstacles in accessing routine preventive and restorative dental care.

The economic pressures of running a dental practice are undeniable. And these pressures exist independent of whether the care is provided by an independent private practitioner, a group practice, a dental school clinic or a publicly funded program. The cost of delivering quality care continues to increase, exacerbated by the economic downturn following the global pandemic. Dentistry often competes for a decreasing share of the average household's discretionary income, forcing patients and practitioners to confront difficult decisions regarding care. Despite these challenges, dentists are bound by a professional commitment to prioritize the health and wellbeing of their patients. Ethical principles guiding the dental profession emphasize the paramount responsibility to patients' health.

In fact, ethical behavior is a foundational tenant of professionalism and the basis for the public trust granted to professionals. Striking a balance between economic viability and ethical imperatives becomes a critical aspect of navigating the professional landscape.

Health inequities and access to care. Several segments of society, including people with special needs, seniors, and First Nations peoples, encounter barriers in accessing regular dental care. Economic disparities can exacerbate these challenges, limiting individuals' ability to seek timely and comprehensive oral healthcare. Dentists must confront the question of whether economic pressures contribute to inequities in treatment accessibility, particularly for marginalized groups.

Dentists hold both social and moral responsibilities to ensure equitable access to dental care for all segments of society. This includes addressing the unique needs of special needs individuals, providing appropriate care for seniors, and acknowledging the historical and systemic barriers faced by First Nations peoples. The ethical commitment to prioritize patients' well-being extends beyond individual treatment rooms to encompass broader societal implications.

To fulfill these responsibilities, dentists may need to advocate for policies that promote inclusivity and accessibility in oral healthcare. Collaborating with public health initiatives, community organizations, and policymakers becomes essential to address systemic issues contributing to disparities in dental care access. Dentists can advocate for health policies that align with the profession's

ACD International President: A Perspective on the Future

ethical standards. Moreover, engaging in continuing education to enhance cultural competency and sensitivity is vital for providing patient-centered care that respects the diverse needs of the population. Health professionals, business leaders and policy makers should consider alternative practice models that balance economic viability with the provision of quality care.

Implementing preventive care measures, adopting efficient practice management strategies, and exploring innovative approaches to service delivery can contribute to maintaining high standards of care while navigating economic challenges.

The role of professional organizations. The American College of Dentists (ACD), the American Dental Association (ADA) and Canadian Dental Association (CDA) provide guidance and support for dental professionals navigating the complex interplay between economic pressures and ethical responsibilities.

Through its educational programs, conferences, and resources, the ACD can facilitate a deeper understanding of the challenges faced by dental practitioners. The ACD organizes continuing education that specifically addresses the ethical considerations in dentistry, emphasizing the importance of upholding the dentist’s code of professional conduct, even in economically challenging times.

By fostering a community of like-minded professionals, the ACD creates a platform for dentists to share insights, strategies, and best practices in maintaining the delicate balance between economic viability and patient-centered care. Additionally, the ACD can advocate for policies that promote inclusivity and address systemic barriers, ensuring that its members are equipped to fulfill their social and moral responsibilities to

all segments of society. Through these initiatives, the ACD can contribute to a more ethically conscious and socially responsible dental community. The ACD, with its commitment to fostering excellence and integrity in dentistry, can provide dentists with access to ethical frameworks, case studies, and mentorship opportunities that deepen their understanding of ethical decisionmaking. Please visit the ACD website at ACD.org and take advantage of these educational opportunities, and plan to attend our next annual meeting and Convocation in New Orleans in October of 2024.

Impact of technology. Recent technological advances, including the integration of artificial and augmented intelligence (AI), have the potential to significantly impact the challenge of balancing economic pressures with ethical responsibilities in dentistry. Augmented intelligence, with its capacity to enhance decision-making processes, can assist dentists and dental team members in optimizing patient care.

Advanced diagnostic tools powered by AI can contribute to more efficient and accurate treatment planning, allowing practitioners to prioritize preventive measures and costeffective interventions. Additionally, AI-driven practice management systems can streamline administrative tasks, freeing up resources for personalized patient care.

However, it is essential for the dental community to approach these technological advancements ethically, ensuring that the integration of AI aligns with the profession's commitment to patient well-being. Continuing education on the ethical use of technology, coupled with guidelines from organizations like the ACD and the ADA, can empower dentists to leverage technological advances responsibly, maintaining the delicate equilibrium between economic viability and ethical imperatives.

ACD International President: A Perspective on the Future

Embracing these technological tools with ethical considerations in mind can potentially enhance the quality of care and contribute to a more sustainable and patient-centered dental practice. I invite you to read the most recent eJACD focused on “The Ethics of Integrating AI into Dentistry: Past, Present & Future Considerations” for additional information on this topic (see: https:// www.acd.org/communications/jacd/).

Conclusion. Dentistry's professional contract to society necessitates a delicate balance between economic realities and ethical responsibilities. The dichotomy of operating as a healthcare provider within a small business setting underscores the challenges practitioners face in meeting the diverse needs of their patients. While economic pressures may exist, dentists are bound by a solemn commitment to prioritize the health and well-being of those under their care.

Addressing the disparities in dental care access for marginalized segments of society requires a proactive approach. Dentists must actively engage in advocacy, collaboration, and continuous education to ensure that their practices align with social and moral responsibilities.

As members of the ACD, thank you for your steadfast commitment to promoting ethical conduct and professionalism in dentistry, advancing dialogue on ethical issues, and stimulating reflection on commonly encountered ethical problems in dental practice. You continue to do this work, even in the face of economic uncertainties, reinforcing the enduring bond between the dental profession and the well-being of society.

Where Do We Go from Here?

Dr. Terry Norris Vice President of the ACD

Was it not Martin Luther King, Jr. who said;
 “Now, in order to answer the question, “Where do we go from here, we must first honestly recognize where we are now.”

I am reminded of a story about a group of sailors on shore leave who had more than one too many at the local watering hole. As they stumbled out the door they bumped unknowingly into the Admiral whom they asked “Do you know where we are? His simple reply was “Do you know who I am?” to which their reply was “Boy are we in trouble, we don’t know where we are and he doesn’t know who he is.”

Having been a Fellow for 13 years now, having been in Kentucky leadership for 12 years, having been a Regent for four years and now entering the officer corps of the American College of Dentists it should seem reasonable that I know where we are. As age sets upon me I tend to be a reductionist or in mathematical terms reducing things to their lowest common denominator. Are we focused on the finish line of the ACD’s four pillars; Excellence, Ethics, Professionalism and Leadership? Or, do we allow ourselves to be side tracked by the peripherals in carrying out our Mission? The College is blest to have an active, growing Foundation that is of the same mindset as the College and at the same time independent. This allows the Foundation to assist in funding the initiatives of the College such as lending support to Sections

with projects they could not do on their own, new Fellow leadership training and my favorite, Ethics in a Box. This last one is a
 no cost set of Ethics Courses that cover all four years of dental training plus the first year of post graduate training. By investing in new Fellow training for Leadership and ethics education for the dental colleges the Mission of the College rings loud and clear.

The ACD is an exciting organization and watching the growth not only of the “mother ship”, but that of the Regency and the Sections is exciting. This tri-partite works well in that Sections have direct contact with the Regency which in turn has direct contact with the National. I see my position, in the officer corps, as one working directly with the geographic Regents to assist in anyway I can to help their Sections grow. The Mission of the ACD is not a top-down approach but an approach that begins at the bottom and works its way up. Fellowship is not a means to an end, but a new beginning. As I reflect on my Convocation, my induction was not one of you have hit the finish line and now time to rest. My induction opened my eyes to what the College has to offer and gave me a broader insight on how I might affect others knowing there is a broad group of Fellows

Where Do We Go from Here?

ready to assist in ways I would be unable to do on my own. Specifically the biggest blessing from this is the inception of SPEA at Louisville. With the help of other Kentucky Fellows we have made a difference at Louisville. This initiative will have an impact
 on students for years to come. Ethics need to be at the forefront as treatment is discussed with patients and as patients are referred for specialty treatment. It comes down to this; is the treatment I am providing what I would want performed on me, my wife or my children?

The limiting factor of the future of the ACD is our time. A series of questions would be
 appropriate to ask:

1. When was the last time I attended a SPEA Meeting?

2. When was the last time I mentored a student?

3. When was the last time I took that new dentist to lunch?

4. When was the last time I sent a note of encouragement to the Dean of my dental
 school acknowledging the good work that is being done and offer assistance?

5. When was the last time I sent a note to my Section chair in support of the work he/she
 is doing?

When making contact with students and young graduates it can only show a concern and an offer to help which will create an excellence in practice, an ethical environment for patient treatment, and a congeniality among fellow dentists to be as professional as we can. All of this will provide a catapult into leadership.

One on one contact is the key to sustained growth and carrying out the Mission of the ACD. A short story is in order. Our four- and six-year-old grandsons were visiting alone with Ginger and me for a week. After work, a trip to the huge park playground was planned

if they took naps. You have to understand the four-year-old is as hard headed as a mule.

When I arrived home, I was informed he had not taken a nap and was staying home with me while Ginger and the six-year-old went to the park. I expected a major tantrum, however it never happened. I fixed his dinner and asked what he wanted to do, and he said “let’s go upstairs and play Legos”. Word got back to me when he returned home that the favorite part of his trip was “playing Legos with T-Daddy”. You may never know the one-on-one impact you will have on that student or young dentist, but you will make a difference.

Ontario is blest and is one of the most unique Sections in the ACD. Your Executive is close,
 focused on growth and thinks outside of the box. Not only have you found new ways to use the wheel, you have reinvented it. This message is not to gain favor with Ontario, it is a statement of fact and encouragement to keep doing what you are doing and to do even more.

I am blest to be a part of Ontario and I look forward to working with Brenda Thomson for the next four years. In closing I am reminded of the words of Baroness Caroline Cox; “You cannot do everything; however, you cannot just do nothing.”

Blessings to you,
 Terry L. Norris, Vice President of the ACD

A Perspective on Professional Education

Dr. Carlos Quiñonez DMD, MSc, PhD, FRCD(C)

Like any other health care profession, dentistry has a social contract with society. The social contract is unwritten, constantly being negotiated, and results in a set of mutual commitments and reciprocal obligations between both parties.

Two things are important here. First, that there is in indeed a contract. My experience suggests that some dentists deny this to be the case. The fact remains, denying the presence of the social contract does not mean it does not exist or that its implications do not come to bear on one’s daily practice. Simply put, it’s like denying the effects of gravity. Second, while the social contract plays out with individual patients and through the actions of individual dentists, the contract itself is generated through the interactions of institutions—the profession of dentistry and the society that supports and maintains it.

From my perspective – or that of a leader in dental education who is responsible for setting and communicating the normative standards of professionalism, as well as imbuing those standards in dental students through the process of professional identity and character formation – the above two issues must be addressed throughout the four years of dental school.

The point of departure for addressing these issues is to set a professional tone from the outset. From day one, students, staff, and faculty must see and hear a particular decorum. They must see and hear about the principles and expectations of professionalism. They must understand that at its most basic, professionalism means

acquiring a high degree of proficiency in a technical skill, solely in the service of others. This must constantly be communicated, and, in turn, role modelled.

To me, this is how one prepares dental students to keep and maintain professionalism at the forefront of every clinical and other decision, especially in the face of contextual challenges, whether economic, social, or personal. Setting normative standards like being present, showing up on a time, being thoughtful, respectful, and caring, understanding that there is indeed a way of being – from dress to language – in clinical and other professional interactions, is one way in which professional identity and character formation are created in dental students.

Another important aspect is to hold each other accountable. Faculty, staff, and students cannot ignore lapses in professionalism. People learn better from their mistakes than from their victories. The point here is that in 99.9% of cases, nothing ever needs to be truly punitive. In all cases, we must be caring and encouraging of each other’s self-development as dental professionals.

From the point of view of the curriculum, it has become vogue to position professionalism as a learning outcome, largely through efforts at “community outreach”. The fact remains, though, there is scant evidence that, as currently conceived, these activities result in any long-term change in behaviour post-graduation. These activities can change knowledge, yes, but the point is to change behaviour and facilitate professionalism over a career trajectory.

A Perspective on Professional Education

From my perspective, the answer to modelling and setting professional behaviour is straightforward. In fact, it is my contention that dental education had this in spades in the past, and unfortunately, it has arguably lost what it once had. That is, a deep focus on professional standards through the setting of culture. No matter the latitudes that are now granted to dental students, the fact remains that dental education is expected to create professionals—to create in trainees the virtues, or the dispositions of character, that society expects of all health care practitioners. These dispositions of character are not created through a set of lectures or specific clinical experiences. They are created through culture, and culture is set through an ethos that pervades an institution and its outcomes at all levels.

In the end, if we are to facilitate professionalism, it must start from day one and continue throughout every aspect of dental education. Our culture must point to what is right, not what is easy, and it must constantly be role modelled. The trials and tribulations of dental school will only matter if the dental student can reflect on why such hardships exist. They exist, of course, to increase knowledge and technical proficiency. But they also exist to test how one behaves at the margin, when things are not so easy, as in daily clinical practice. Most importantly, these hardships exist to teach us how to be in the service of others—namely our patients and the society we are tasked to serve.

Carlos Quiñonez is the Vice Dean and Director of Dentistry at the Schulich School of Medicine & Dentistry, Western University.

Dentistry's Social Contract with Society

Dr. Clive Friedman

To claim membership in the dental profession is a privilege. Our restrictive professional licensure bestows rewards aplenty. What do we owe to society in return? What do we owe to the patients we treat and the families who not only trust us with their care?

I believe our primary obligation is that we must be fully present for every patient we work with. To be fully present is to listen to the needs of each person, and to let our patients' voices guide us, irrespective of ability, disability, race, gender, or economic status. This is the social contract: in return for the elevated status bestowed by our profession, we must be fair, competent, knowledgeable, compassionate, and practice with the goal of addressing society’s needs. When we uphold this social contract, patient need, and not professional economic need will determine every treatment decision and result in safe care.

What does it mean to be fully present for patient populations, particularly those with special health care needs? It begins with assessing our attitudes, belief systems, levels of expertise, the professional environments we practice in, and the ways we conduct ourselves outside of work, which influence the way we engage with patients and make decisions about their treatment. Instead of listening to the patient and allowing their needs and goals to drive our decision making, we will be distracted by internal chatter; “I haven’t been trained to treat this individual.” “I don’t have time to treat this individual.” “I won’t be able to bill enough to cover the full cost of this treatment.”

Prioritizing our own fears at the expense of safe care is a failure to uphold this social contract. This has contributed to the marginalization of groups, including individuals with special needs, who experience obstacles in accessing regular dental care with the dental teams of their choice.

As you consider what might be preventing you from providing care to all patient populations, I invite you to consider how you might draw on creativity to overcome these barriers. How can you maximize what you do have to offer rather than fixate on what you can’t (or won’t) do? Creativity can help us progress beyond these often-self-imposed constraints.

Let’s apply a creative lens to a scenario many of us have encountered that highlights several of these constraints. A family with three children wants to begin receiving care in your practice. They do not have insurance and one of the children, aged fifteen, has severe Autism Spectrum Disorder (ASD). How can you draw on your creative self to welcome this family and help your practice grow?

Has the child with ASD been seen before, and if so, have the transition documents on the CDA website been completed? If not, print the documents for the family and request that the family have the previous provider complete the documents. This will give you extensive information about what approaches and interventions have been successful and will provide education for your staff on how to meet the specific needs of this child. Download the special needs form again from the CDA website to enhance your knowledge base on the requirements and peculiarities specific to this child, and then have a staff meeting to discuss how

Dentistry's Social Contract with Society

your team might creatively approach their care. Is there a person in your office who could be her champion?

To address financial remuneration, find out if the family has access to the new Government Dental Plan. Can your front desk team help them access it? Is your office willing to create and build a membership plan for the family?

These are all ways you can be present for this family, upholding the social contract and catapulting your office into a new way of being able to provide sustainable and affordable care to marginalized patient populations.

Let’s return to the question of economic vs patient need. The charge that we make treatment decisions based on our economic needs rather than the needs has been supported by recent research (Quinonez et al). During my 40 plus years as a practitioner, both in Canada and previously in England under the National Health System, I have witnessed a shift where increased economic pressures have transformed our treatment decisions radically. For some dentists this is further amplified by cultural expectations around wealth and status. The result is that too often we fail to uphold our obligation to be present for our patients and allow economic need to guide our decisions about their care.

I have always made clinical decisions by treating the patient as if they were my child or my parent, prioritizing the environmental and personal context of the presenting person rather than my own. Have I erred? Absolutely. Most of these mistakes were made when I failed to pause and truly think and listen to the person in front of me. Treatment decisions are never black or white. I can have two people with the exact same clinical and radiographic findings and suggest a radically different treatment approach based on the

functional, participatory, personal, and environmental factors of the person being treated.

We must ask ourselves; Do I believe I have a social and moral responsibility to provide safe care to all patient populations? Are my clinical decisions wholly driven by the expressed needs and desires of my patients, or are they driven by fear, prejudice, or financial limitations?

These are not comfortable questions to ask ourselves, and each of us will respond based on our unique core values and belief systems. My intent is not to shame my colleagues or dismiss the very real constraints, financial or otherwise, that impact our approach to care. All I can do is encourage self-reflection, and perhaps help motivate a shift in our professional community’s shared core values so that we are better equipped to uphold our social contract, and in doing so provide all patients with the good and safe care they deserve.

Ethical and Legal Issues Arising from Trans-Border Treatments

Dr. Barry Schwartz

DDS, MHSc (bioethics), FACD, FPFA

Treating travelling patients can raise a number of ethical and legal considerations with wideranging and potentially serious results for the dentist. I am going to describe two different scenarios and discuss the options, potential outcomes and best practices for future occurrences. Scenario 1 is about a patient from outside of Ontario who attends a dentist in Ontario. The other, Scenario 2, deals with a dentist who performs treatment on a staff member outside of Ontario. The issue of waivers will also be discussed.

You are a dentist in Windsor and advertise your cosmetic services in publications on both sides of the border. An American from Detroit attends your office for 8 veneers and bleaching of his teeth. The patient has signed a consent form which outlines the costs, potential benefits and the risks involved including temporary sensitivity of the teeth. The patient has the treatment performed but develops extreme sensitivity and is not at all happy with the appearance and sues you for malpractice asking $ 3 million for general damages plus $1 million for punitive and exemplary damages. The suit is filed in the US. You have $2 million coverage from your license fee through the RCDSO.

What Should You Do?

At this point, it is imperative to contact PLP (the Professional Liability Program in Ontario) right away. The PLP will try to have the case moved to Ontario Courts since the treatment was performed in Ontario. The Plaintiff (the patient) would prefer to have the case heard in their own jurisdiction because it would be more convenient for the patient to retain a lawyer in Michigan than to travel to Ontario, but more importantly, damage awards are much higher in the United States than in Canada and Canadian courts rarely award punitive and exemplary damages. Dentists who are licensed in Ontario have $2 million of malpractice insurance in Canadian dollars that covers damages and legal costs. Any award in the USA would be subject to currency exchange which would reduce the indemnification accordingly (by 38% at the time of this writing). There are a number of factors that courts can consider when there are jurisdiction disputes. The domicile of the patient is an important consideration for the courts. More importantly, the issue of enticement becomes quite germane in this case. If an American resident is enticed by an advertisement in a US media, as is what has occurred in this case, there would be a greater likelihood that the US court in Michigan will conclude that it should accept jurisdiction.

Scenario 1: The Trans-Border Patient

Ethical and Legal Issues Arising from Trans-Border Treatments

Just to remind you of the type of extreme awards reached in American courts, there was a case of a woman in Albuquerque N.M. in 1992, who went to a McDonalds drive through for a cup of coffee. Her grandson was driving, and he pulled into the parking lot so Mrs. Liebeck could add cream and sugar. In the absence of a cup holder, Mrs. Liebeck steadied the cup between her knees, but she spilled the coffee, suffered third degree burns and was later awarded $200,000 for general damages and $2.7 million for punitive damages. The jury found her to be 20% at fault which reduced the general damages to $160,000. After appeals from both parties, the lawsuit was ultimately settled for $600,000. At issue was the fact that McDonalds kept their coffee 30 degrees F hotter than most restaurants and coffee shops.

What Should You Have Done?

Before proceeding with treatment on non-residents of Ontario, it would be wise to have the non- resident patient sign, as part of the consent process, a statement that would ensure that any disputes between the dentist and patient follow all laws in the Province of Ontario and be adjudicated by an Ontario court. Both of the sentences of “governing law” and “jurisdiction” should be initialed by the patient. There is a sample patient agreement on page 96 of Staying Safe that can be used as a guide. Keep in mind that this statement outlining the jurisdiction of the relationship of the dentist and patient, is not a waiver of the patient’s right to sue you but only a mutual acknowledgement of where disputes can be adjudicated.

Scenario

A dentist licensed in Ontario registers for a hands-on one appointment implant course in Florida. The dentist must supply their own patient for the course. The dentist has a dental assistant who is missing a maxillary first molar and offers to replace the missing tooth for free if she accompanies her to Florida. The dentist offers to pay for all of her expenses, such as airfare, meals and to pay her regular salary for the time away. The dentist has her sign a detailed consent form outlining all of the potential risks as well as a malpractice waiver since it is the first time the dentist will be doing the procedure. The procedure went uneventfully however upon returning home, the patient experienced headaches, facial pain, nasal pain and a thick green nasal mucous discharge from her nose along with a reduced sense of smell. The dentist referred her to a maxillofacial surgeon where a sinus perforation from the implant placement was diagnosed. The implant had to be removed and a bone graft placed. The dental assistant was very upset, quit her job and sued her dentist for malpractice.

What Should You Do?

As in the other case, you should contact PLP, however this case is very different. Dentists in Ontario only have malpractice insurance for treatments that are performed in Ontario. There would be no coverage for any treatments performed outside of Ontario. It would be wise for you to retain a lawyer to negotiate a reasonable settlement with your former dental assistant with you taking financial responsibility to replace the implant or replace the missing tooth with a fixed bridge.

2: The Trans-Border Treatment

Ethical and Legal Issues Arising from Trans-Border Treatments

What Should You Have Done?

Having a patient sign a waiver for liability and or malpractice is not a good idea. Legally, patients cannot be asked to waive their right to sue you for malpractice as it would be unlikely to stand up in a court of law.

“Dentists should comply with the licensing requirements in the jurisdiction where they provide treatment. An Ontario licence may not be valid in other jurisdictions. Checking first protects you against allegations of illegally practising dentistry.

Obtaining a licence or permission to practice in another province or country does not mean malpractice protection applies. Most jurisdictions require dentists to obtain malpractice protection for that jurisdiction separately. PLP protection does not apply to jurisdictions other than Ontario. PLP protection applies to treatment performed in Ontario by RCDSO licenced dentists. It does not matter that you are volunteering, completing treatment on a pro bono basis, or taking a course. It does not matter where the patient resides – Ontario, in Canada, or elsewhere. The treatment provided must have been rendered in Ontario for the PLP malpractice protection to apply.” A dentist would need to determine what they would need to do to get temporary licensure in Florida and to contact an insurance company that would be willing to insure you. The College/PLP affiliated broker, Jones DesLauriers Insurance Management Inc. (JDIMI), is also available to arrange such coverage, if required.

Conclusions

Many dentists treat patients who might be on holiday, travelling on business, or simply taking advantage of the current exchange rates between Canada and other countries. It is important for dentists to review the patient’s personal history, including where they live and what the purpose of their visit to you is. In this way you can evaluate what extra material might be included in your consent for treatment forms and/or decide if it is wise to perform treatments on this patient.

I personally know many dentists who routinely travel abroad for courses and/or to provide probono treatments in other countries around the world. Make sure that you are completely aware of the licensure regulations for where you are going and that you are properly protected with liability/malpractice insurance. Hopefully these two cases will help you be mindful of your legal and ethical responsibilities in treating foreign patients and when providing pro-bono treatment abroad so that both you and your patients are always kept safe.

i RCDSO Staying Safe. November 2006. Reprinted from Dispatch Summer 2006.

ii CBC news: https://www.cbc.ca/news/canada/british-columbia/mcdonalds-hot-coffee-lawsuit-burnaby-bc-1.6719467

iii Enjuris. The Real Story Behind McDonalds Infamous Hot Coffee Case. Available at: https://www.enjuris.com/blog/resources/mcdonalds-hot-coffee-lawsuit/

iv Where Malpractice Insurance Applies. PLP. Available at: https://plp.rcdso.org/risk-management/where-malpractice-protection-applies

v Ibid PLP

Dentistry’s Obligation to Senior Care

Dr. Michael Wiseman

Associate Professor, Faculty of Dentistry, McGill University

The senior population is growing in North America; the current population of the aged 65 and older within Canada is almost 7,350. What is striking is that this senior group represents 18.8% of the population whereas those aged from 0-14 is 15.6% . There are more people over 65 than under 14! This clearly indicates that the population of Canada is becoming older. This shift in demographics can be explained by the “baby boomers” aging and the birth rate dropping. Yet the oral health care of this growing demographic is often neglected, leaving many to experience the pain, suffering and debilitation of advanced dental disease.

In the USA, the prevalence of having a history of dental caries in the population over 65 is 96%, with 1 in 6 seniors having untreated decay . Periodontal disease has a frequency of 68% in patients 65 and over. Edentulism amongst those over 65 is highest in individuals who are poor and lack insurance. It is also higher in the disabled, homebound, or institutionalized. It is well known that the senior patient may have multiple comorbidities such as arthritis, hypertension, diabetes, cardiovascular disease, and vision loss. Many comorbidities require medications which have a xerogenic effect upon the saliva. This decreased salivary function with decreased mobility and manual dexterity can affect the oral hygiene ability of the patient and leads to increased rates of caries and periodontitis.

Why is the rate of dental disease and dental debilitation so high among our seniors? There exist many obstacles that the senior patient must surmount prior to receiving treatment. The first obstacle may be physical in nature.

The dental office may have too many steps which may prevent the patient from entering due to an inability to walk up steps or may have a wheelchair. There may be financial obstacles that prevent the patient from receiving care. It is hope that within Canada, there will be a future socialized system in which the senior can receive free care paid by the provinces. A final obstacle would be agism by the professional. We must not alter our treatment plans based upon the patient’s age. For example, a healthy 80- year-old patient may want cosmetic treatments such as bleaching, or veneers. If the patient meets the criteria as outlined previously, they have fully consented, possess the ability to provide good oral hygiene, then the dentist can fulfil their treatment requests.

It is strongly presumed that dentists are ethical. Ethical guidelines as outlined by the Royal College of Dental Surgeons of Ontario, state that the dentist must provide an unbiased explanation of options with associated risks and costs and obtain consent before proceeding with investigations or treatment.

When seeing a senior for dental care, it is imperative that the dental team always evaluate the whole patient. This evaluation should encompass both a dental, medical, and social evaluation. Of course, the dental evaluation should include caries, periodontal status, saliva quality/quantity, broken or poor fitting prosthesis, and any chief complaints. The medical evaluation should begin with the review of the patient’s medical status, and list of prescribed medications, over the counter medications, and herbal supplements. The social evaluation should begin with determining if the patient can consent for care and if not, who is responsible not only for consent of care but who bears the financial responsibility for this care. The dentist must determine what

Dentistry’s Obligation to Senior Care

resources are available to the patient for oral care maintenance. As part of the overall evaluation, the dentist should determine whether or not the patient can be responsible for their own oral care or must they rely on others to assist them.

The treatment plan must be explained in a simple manner. When dealing with senior patients, the explanation should begin with the verification that if they require eyeglasses to see or have their hearing aids turned on to hear the explanation. One must never forget or omit the obvious.

The dentist upon presentation of the treatment plan must always try to be prognostic to the patient’s lifespan. For example, treating a cancer patient with a poor prognosis, the dentist must try to improve the patient’s quality of life. If for example the simple relining of a denture would provide a suitable outcome versus making a new denture, or in the extreme case, suggesting an implant supported denture, then it is our professional obligation to provide adequate care at the lowest cost possible. The dentist must resist the temptation to suggest the treatment of the greatest monetary reward. In this regard, if the patient in the previous example wants the implant supported denture, I believe that it is the moral obligation of the dentist to refuse the provision of such care if the prognosis is questionable.

It is important when making a treatment plan for the senior patient to make treatment choices based on prognostic outcomes, capability of the patient or caregiver to maintain their oral hygiene, and comprehension of the patient to provide consent to care.

There exists a full spectrum of senior patients coming for care to the dental office. This includes the healthy, cognitive patient who may opt for advanced, dental care; versus

the elderly patient who is infirmed by either a physical or cognitive disorder, then the treatment should be provided with a moral obligation to provide without financial reward. In this way, we as a profession will fulfill our social contract to those under our care and honor the Oath of Commitment taken by us as professionals to put the needs of our patients first and foremost above our own .

References

1. https://www.statcan.gc.ca/en/subjects-start/ older_adults_and_population_aging

2. https://www.cdc.gov/oralhealth/publications/OHSR-2019dental-carriesadults.html#:~:text=The%20prevalence%20of%20dental%2 0caries%20among%20adults%20aged%2065%20years,3 %20to%205%20percentage%20points

3. Eke PI, Dye BA, Wei L, et al. Update on prevalence of periodontitis in adults in the United States: NHANES 2009 to 2012. J of Periodontology. 2015;86(5):611-622.

4. https://www.rcdso.org/en-ca/standards-guidelinesresources/professionalism-with-patients/code-of-ethics

5. http://216.19.69.74/pdfs/OathofCommitment.pdf

As she heads to Petawawa in preparation for her new career as a Dental Officer in the Canadian Armed Forces, Dr. Eunice Park, winner of the ACD 2023 Outstanding Student Leader Award, took time to speak with Newsletter Editor, Dr. LouAnn Visconti, to reflect on the journey that led her to where she is today.

Grade 4 after my parents asked me if this was something I would like to do. Naturally, as most 9-year-olds, I said yes... it sounded fun and it sounded like an adventure.”

This was not without great sacrifice; “When we first landed in Canada, our family structure changed drastically.” Mr. Park returned to Korea to continue to work and Mrs. Shin remained in Toronto with Eunice, taking on different jobs herself. What saw both of her parents through this change was the support that they received from finding their own community of friends, something that they encouraged their daughter to do. Initially, Eunice felt “like my world was flipped upside down,” but she quickly recognized what her parents had left behind to provide this life. “Somehow in this odd family situation, 14-hour time difference and an ocean separating us, they made it work.”

Eunice Sangeun Park was born in Seoul, Korea to Taekweon Park and Howon Shin. Eunice’s parents hoped to provide her with new opportunities that would allow her to learn and grow. “I immigrated to Canada in

Through her parents’ example, Eunice learned the importance of finding her place within the community; of the “immense joy of being part of something bigger than myself.” She learned through their example, the importance of being open to change and to meeting this change with a positive attitude; an asset which she would need living in a new country. To Eunice, “learning English was one of the hardest aspects of adjusting

to Canada. I desperately wanted nothing more than to fit in but everyday felt like a reminder of how out of place I was. It was slow and gradual, but it gave me a sense of excitement each time I felt that I was starting to improve.”

A love of healthcare and the idea of being able to use the skills and knowledge acquired to help someone else, drew Eunice to the dental profession. As well, the provision of continuity of care as part of an overall team approach while developing longterm relationships with those under her care were all things that drew her to the profession.

During her 4-year program at Schulich School of Medicine and Dentistry, Eunice became involved in SPEA and was Regent of Canada and Chapter President from 2021-22. To Eunice, her involvement in SPEA was “an opportunity to be surrounded by colleagues and mentors who strived to improve the profession and better the care of patients.” SPEA was a place where she felt that she could “learn leadership and professionalism, which were qualities that I hope I would one day embody as a clinician.”

Sponsored in part by the Ontario Section of the ACD, Eunice, along with SPEA members from both Ontario faculties of dentistry, had the opportunity to attend the 2022 ACD International meeting in Houston, Texas. This was one of the highlights of her years as a dental student; “Being surrounded by colleagues who were eager to learn about professionalism and ethics in dentistry inspired me and renewed my motivation to strive for the same. It gave me a sense of empowerment to see the culmination of what the SPEA chapters and board members worked on during the past year, and it was humbling to meet colleagues and mentors who inspired me in different ways through their unique experiences.”

Drawing on the life lesson imparted by her parents of being part of a larger community, Eunice joined the Canadian Armed Forces. Mentorship and support provided by the CAF as a Dental Officer were also main factors in the decision to serve Canada in this way.

Where does Eunice see herself in the future? “I hope that I grow as a clinician and that I would have had a chance to serve in different parts of Canada (and maybe even abroad). I hope that my passion for dentistry has become even bigger, that my relationships with family and friends has strengthened, that I have travelled more, and that my cooking skills and the ability to keep plants alive have improved (she laughs).”

Eunice’s story tells of love, sacrifice, courage and determination. The ACD Ontario Section would like to thank Eunice for taking time to share her incredible journey with all of us and as well for her service to her country. We wish you all the best in your future endeavours and look forward to seeing you in leadership roles in the future.

Dr. Larry Levin

ODA Barnabas Day Award

Dr. Peter Fendrich

Dr. Flavio Turchet

Dr. Chandan Advani

Dr. Larry J. Tenaschuk

ODA Honourary Membership Award ODA Service Award ODA Award of Merit ODA Award of Merit

ODA Barnabas Day Award

Dr. Naveen Verma

Awards 2023-2024

Dr. William Karl Hettenhausen CDA Distinguished Service

Dr Lynn Tomkins Alumni of Influence Award

Awards 2023-2024

Dr. John O'Keefe

Dr. Karin Van Ryswyk

Dr. Roch St-Aubin

CDA Medal of Honour ODA Service Award Schulich Alumni of Influence Award

Ontario Section at ACD Convocation

Orlando, Florida on October 4th and 5th, 2023

Disney and the American College meet in Orlando

At sunrise on Monday, we found our reserved parking and walked the ramp over to Pearson Airport. Air Canada took it from there and whisked us down to Florida in time for a second breakfast.

The day was spent decompressing and exploring the huge Hyatt Regency Orlando. We discovered the 24 hour “Market”, between the towers. We started each morning with their coffee.

Our comfy room enjoyed a 17th floor view of the vast array of landscaped patios and network of swimming pools complete with a water slide. I did that slide all by myself! Tuesday morning, we were up bright and early and headed off to Epcot Centre in a Mears cab to beat the lineups. A taxi was the best way to travel about. All of the hotels, shopping malls and attractions are sequestered in a maze of highways and access ramps. Taxis added to the sheer pleasure of going places to be a kid again.

Karen and I spent 6 hours walking all the attractions in the park and we took in the Canadian, American and Chinese shows. The positive vibes and atmosphere throughout Epcot are exciting to young and us more mature folks.

Back at the Hyatt we had an amazing swordfish dinner at “Descend 21”. We repeated that supper there again before we flew home. That same night an impromptu Ontario Section breakfast was organized for Wednesday morning at Fiorenzo’s. Breakfast was a hit, and everyone had a chance to reconnect and chat up the new fellows and their plus ones.

Wednesday everyone was off to register and pick up their cap and gowns for the Convocation. From 1 to 4pm the ASDE Ethics course and the AADEJ Communications course were offered. The Business Meeting and Orientation went from 4 to 5. With hardly time to catch our breath it was off to the Regency Breakout Sessions. The Regency 4 breakout session was proudly populated with the biggest turnout from Ontario. Need I say more. It was such a pleasure to be there when Brenda Thomson was introduced as our New Regent. Having a Regent from Ontario is historic, and it is now in the books. Bravo Brenda!

We learned a great deal from the breakout discussions and met so many terrific people in our Regency from Michigan, Kentucky, Indiana, Ohio and West Virginia.

Next, this fluid agenda took us right into the ACD Meet and Greet where all the attendees amassed for a chance to shake hands with board members fellows and new fellows alike.

Ontario Section fellows and their guests regrouped at Café TuTu Tango. It was a fabulous party atmosphere and we had fantastic selection of tapis style food. Terry and Ginger Norris, Former Regent of Regency 4 and Incoming Vice President of ACD International Wayne Pulver, past Chair of the ACD Ontario Section and his lovely wife, Marlene Pulver, new fellow Chantal Czerednikow from Montreal, and Dennis and Joan Rush from Vancouver happily shared the evening with us. Joan as you may know, was inducted into Honorary Membership at the Convocation.

A professional belly dancer arrived and delighted the restaurant crowd with her

dancing skill. The dancer was thrilled when Brenda Thomson joined her in the fun. Thursday was the big day with the 8:30am President-elect’s address followed by the Fellows Forum on “The Ethics of Interprofessionalism,” which was exceedingly well received. The Convocation Luncheon was excellent, and we enjoyed music from a talented local country group.

The procession of ACD dignitaries and new fellows, was the time honoured, colourful show of pomp and circumstance that we have always come to expect. The convocation of about 300 new fellows unfolded quite efficiently and the evening moved seamlessly into the Palm Trees and Pearls Gala. The Gala featured delicious food

stations and a DJ for entertainment. It was here that Brenda was formally recognized as Regent, of Regency 4.

Friday it was back to being a kid again and Karen and I took in Animal Kingdom. We saw the whole park and took in the live indoor Lion King show. The park quickly filled up with families and it became very busy, and fun people watching.

Saturday became our pool day. The weather was warm and breezy. The two of us kept moving to shade as the sun patrolled the sky.

That evening we enjoyed being part of the Pierre Fauchard Academy Gala celebrations held in the same Hyatt venue. Many colleagues share memberships in ACD and PFA and other organizations. This allowed us the opportunity to see familiar faces but to also meet and talk with fellows from around the globe. The evening with PFA was extremely well done and enjoyable. A double header I would say.

Sunday home.

“To market, to market, the AGM was fun, Home again, home again, Orlando is done.”

Respectfully submitted,

Paul Romanson

Ontario Section at ACD Convocation

2023 Ontario ACD Convocants

Jawad Tawil

Raffy Chouljian

Girish Deshpande

Michael  Ian Gossack

Abbas Ali Jessani

Michael Vrbensky

Jason Gopaul

William Keven Hockley

Stephen K. Chung Ho

Nancy  Baldan

Peter T. McDermott

Elliott A. Schwartz

ACD Meet and Greet at Cafe TuTu

ACD Ontario Section hosted a Meet and Greet and Cafe TuTu in Orlando for all Ontario fellows, both existing and new fellows who made the journey to Orlando for their convocation.

Model Section Award 2023

Model Section Designation

The purpose of the Model Section program is to encourage Section improvement by recognizing Sections that meet quality performance standards in four areas: Membership, Section Projects, ACD Foundation Support, and Commitment and Communication. In 2023 the Atlantic Provinces, Illinois, Kentucky, Maryland, Virginia, Wisconsin, and Ontario Sections earned the Model Section designation.

ACD Ontario Section AGM

November 2023- Toronto and London

London Hunt Club Venue with Virtual Link to Boulevard Club Venue

Yesterday’s snow had melted in Southwestern Ontario and we were blessed with the last of daylight saving’s evening glow.

Karen and I arrived at 4:30pm for the AV technical dry-run, to put the London Hunt Club venue in one accord with the Toronto venue. And that’s exactly what it took: the Toronto Boulevard Club needed “one cord”, to finalize the wireless hook-up.

Connections were made and as we gathered for dinner and the evening’s program, the big screen brought us together in real time allowing those in attendance to follow what was happening at both venues.

We were honored by the presence of Dr. Carol Hanes, Treasurer of the ACD International, who provided the ACD-OS fellows information on the financial health of the organization and on how the dues revenue is utilized to support the various ACD sections and forward the mandate of the College. The keynote speaker for the evening was Dr. Daniel Haas, former Dean of the Faculty of Dentistry at University of Toronto, who spoke about the delivery of ethics and professionalism in dental education.

It was also wonderful to have the SPEA students from both faculties in attendance; representing Schulich were Co-Presidents Stella Feng and Sanaya Engineer, as well as Tanesha Goel, SPEA regent, regency 2; representing University of Toronto were CoPresidents, Sharon Yoon and Athena Zhang.

We are a very tight and unique group of dental colleagues at this combined AGM. Everyone

shares bonds with American College, Ontario Section, their ODA Component Societies and have strong connections to Toronto’s Faculty of Dentistry and Western’s Schulich Dentistry. It was apparent from watching our big screen tv that the same collegial atmosphere and energy was enjoyed simultaneously at the Boulevard Club and Hunt Club with lots of laughter, hugs and warm camaraderie.

It was great to have XueEr Hong, our new Ontario Section Secretary be with us. She fit right in as a recent Western graduate and past SPEA President. A heartfelt thank you goes out to Karin Van Ryswyk for emceeing and meticulously running the show at our end. And thank you Sonia Slawuta for the great job you did leading and hosting the overall agenda from Toronto. It all synced very nicely.

The evening’s programming flowed quite well with awards, recognizing Brenda Thomson as our new Regent, Regency 4, and seeing the gavel of the Chair passed to Sunita Joshi from Sonia Slawuta. It was also a very real pleasure for all of us to hear from the SPEA students, both from U of T and Western U. The students all spoke well and they brought their fresh and vibrant outlook to the proceedings.

Congratulations Lionel Lenkinski and Olaf Plotzke for receiving the Meritorious Service Awards for all of your outstanding work and achievements. We are very proud of Olaf for being a founding member and immediate past President of the Canadian Society for Disability and Oral Health.

Hoediono received his 15-year pin, with Dr. Cary Letkemann receiving his 25-year pin. Rounding out the recognition of service were the certificates of appreciation presented to myself and Dr. Brenda Thomson. For all her hard work and dedication to the ACD-OS, Dr. Sonia Slawuta was awarded the Crystal Award.

I would like to thank Chef Michael for the excellent dinner, Michael Hearse for his IT skills and the Hunt Club staff for looking after us with professional and gracious service. The Executive members that attended the Boulevard Club would also like to extend their gratitude to the staff there for a delicious meal and exemplary service helping to make the ACD-OS’ AGM a wonderful experience for all.

The second annual, combined venue AGM has proved itself a great success once again. This format opens the AGM to a greater number of fellows by eliminating weather, time and travel cost concerns for those not in or near the GTA.

A heartfelt thank you goes out to Sonia Slawuta for her exemplary leadership this past year and to the Ontario Section Executive team for making this amazing evening possible.

Special Appointments

Dr. Paul Romanson appointed Chair of the Canadian Society for Disability and Oral Health (CSDH)

The Canadian Society for Disability and Oral Health (CSDH) is a Canadian not-for-profit totally inclusive organization focused on achieving highest quality oral healthcare for all people living with disabilities in Canada. Our mission is clearly stated as C.A.R.E. that one of the mandates of the CSDH, in the wake of the Canadian Dental Care Plan, has been to actively advocate at the Federal government level for a "fair and equitable national dental plan to meet the unique needs of these people."

Dr. Shawn Steele

We are pleased to announce that Dr. Shawn Steele has been appointed as Assistant Dean, Learner Experience (Dentistry), at the Schulich School of Medicine & Dentistry, Western University effective August 1, 2023, to July 31, 2028. In this role, Dr. Steele will engage with, assist and support the wellbeing of Dentistry learners through the development of a comprehensive wellness curriculum and maintaining a close working relationship with the Learner Experience office and relevant committees.

In Memory of Our Fellows Who Have Passed

In memory of

“We make a living by what we get, but we make a life by what we give.”

Winston Churchill

Thank you for all the lives that you have touched and for the care that you have given, which is the greatest gift that one person can give to another.

Dr. Sidney Goldman

Dr. Barry Chapnick

ACD-OS events- a Year at a Glance

ACD-OS

Strategic planning session at the London Hunt and Country Club

White Coat Ceremony -University of Toronto

ACD-OS events- a Year at a Glance

White Coat Ceremony -University of Toronto- IDAP

White Coat Ceremony- Schulich School of Medicine and Dentistry

Treasurer’s Report

Greetings Ontario Section Fellows

I would like to say that the Ontario Section had a very busy and productive 2023 thanks to the executive, Dr. Sonia Slawuta as our chair, Dr. Sunita Joshi as our vice chair and Dr. Lou Ann Visconti as our secretary, as well as the large team that supports them.

As you are aware, the Ontario Section is a non-incorporated not-for-profit organization. Our active fellows pay dues to the ACD with $120 USD coming back to the Ontario Section (OS) to help us run our programs. Active Retired Fellows pay $50 USD that comes back to the OS. Lifelong Fellows are not required to pay any dues.

The executive has worked very hard at being fiscally responsible. Revenue to Expenses is getting much harder to balance in these difficult financial times.

December 1, 2022, the OS had $ 32,095.88 in the bank. December 1, 2023, we had $35,954.54.

We received $12,000 USD for active members (100) and $550 USD for active retired (11).

From ACD HQ we received a one-time grant of $ 6,000 USD to support the continuing education program that Dr. Slawuta initiated. We also received $ 2,000 USD to support our SPEA students in travel to Orlando and the Outstanding Student Leadership Awards, of which we matched.

Thank you to BMO for their sponsorship of 
 $ 3,000 to support our programming and Patterson Dental, London Ontario for their sponsorship of $ 1,300 to support our inperson student event in London Feb 2, 2023.

Dr. Karin Van Ryswyk Treasurer

The Emo Rajczak continuing education series was a very big success providing many Core 1 webinars to our fellows as well as the faculty and Students at both Schulich and U of T. Our costs for running this program include honorarium of $ 2,500 and IT (see below).

We support our SPEA students at both faculties by providing some financial help to run their programs and to travel to their national meeting. We budgeted $7,000 this year and paid $ 6,022.40 between the schools.

Our newsletter is now digital, saving us on printing and mailing expenses. We again won the best Newsletter Award from the ACD last year! Congratulation Ontario Section! Our expenses this year were 
 $ 1,531.77.

This is our second year of holding a one day in-person strategic planning session, which takes place in June. This meeting is critical in that it allows us to plan for the future of the Ontario Section, including resource allocation to the various projects designed to support our members and the students at both faculties. The costs for the meeting in London this year were $944.99.

We held a “Meet and Greet” social at the Café TuTu in Orlando at the National ACD AGM for our current and new Ontario fellows. Our expenses for this event after registration fees were $653.

And lastly, we had our Ontario Section AGM on November 2, 2023, at 2 venues: 1 in Toronto and 1 in London. Dr. Dan Haas spoke to us about “Ethics & Professionalism in Dental Education: A Former Deans Perspective.” The evening was well received

and enjoyed by all. Our expenses after registration fees were $3,437.

Our IT expenses were $ 3813.04 this year. Some of this year’s IT costs were billed and paid for in 2022, This has been corrected for the year 2024. Our IT expenditures include our Website, our ZOOM platform for our executive meetings and webinars, Mailchimp for our mailings, and the services of FutureProof to manage our webinars, CE and our AGM. I anticipate that our IT costs will increase for next year.

Under Dr. Sunita Joshis’ leadership, next year looks to be very exciting! The ACD-OS will continue to be fiscally responsible as we continue to provide offerings to support our members and to advance the mandate of the College within our profession.

Respectfully submitted,

Karin Van Ryswyk Treasurer.

University of Toronto SPEA Report

Dr. Tamara Sosath

SPEA Liason – U of T

Our University of Toronto SPEA co-presidents, Sharon Yoon and Athena Zhong, started the 2023 fall term off with an exceptional and well received presentation by Dr. Plotzke entitled “How to fit ethics, professionalism, compassion and social responsibility into your busy work schedule after graduation”. It was well attended and in Athena’s words, “...we received immense positive feedback from students. Dr. Plotzke’s presentation made us reflect on how we define ourselves through the choices we make in our personal and professional lives and our commitment to service in our profession”. To be addressed by such a renown and ethically admirable speaker as Dr. Plotzke was an invaluable experience for all the attendees. It enforced the fact that we, as dentists, have much to offer all members of the community.

In October, both Sharon and Athena attended the ACD Annual General Meeting in Orlando, Florida. For the SPEA representatives it is always an exciting event. They get to share ideas and experiences with their cohorts from other North American Universities and they return home with fresh enthusiasm and new perspectives.

Early November brought the Ontario Chapter AGM. Athena and Sharon were able to meet and mingle with some of the ethically committed and outstanding members of the Ontario Chapter. Their energy and enthusiasm complimented the affair which along wth the Schulich SPEA Chapter co-presidents, Sanaya Engineer and Stella Peng, impressed all attendees with their presentations.

There are some exciting events being planned for the upcoming months. Athena, Sharon and their executive team are formulating ideas for social media engagements, increasing awareness of SPEA in the school, and organizing speakers for topics such as: AI Use in Dentistry, Ethical Decision Making, The Transition to Private Practice, Forensic Dentistry, and Disputing Complaints.

It is this enthusiasm and commitment of our SPEA students to ethics, excellence, professionalism and leadership which helps build the great dentists of the future.

U of T SPEA Meet and Greet

On September 28, 2023, Dr. Olaf Plotzke presented to SPEA at the University of Toronto (U of T) on the topic of “How will you fit ethics, professionalism, compassion, and social responsibility into your busy work schedule after graduation?” Dr. Plotzke is the co- founder, director, and past president of the Canadian Society for Disability and Oral Health and has a wealth of knowledge to share. As the first event of the year for U of T’s SPEA chapter, it was a great success and was well-received by all 50 students that attended.

Throughout his presentation, Dr. Plotzke touched on fundamental topics of ethics and professionalism in dentistry. He emphasized the importance of embodying honesty, sincerity, and integrity in our actions, and made us reflect on how the choices we make in our personal and professional lives can define who we are. Despite there being challenges that young dentists may encounter including a lack of knowledge, the incentive for reimbursement of services, and the nature of dental corporatization, we are reminded that the choices we make should be guided by our commitment to service in our profession.

Overall, Dr. Plotzke instilled within students the desire to keep ethics and professionalism at the forefront of our decision-making as dentists, and shed light on a crucial topic that young dentists may find themselves challenged with especially while balancing the demands of a busy work schedule.

The event was organized by Athena Zhong and Sharon Yoon, co-presidents of SPEA at U of T, with the guidance of Dr. Tamara Sosath, the SPEA liaison at U of T, and support of Dr. Paul Romanson, both of whom were in attendance.

We would like to express our immense gratitude for the ACD Ontario Section in sponsoring our event and continually funding opportunities for ethics and professionalism discussion for students early on in our professions.

Thank you,

Athena Zhong

Schulich SPEA Report

Lecture and Networking Event

On February 2, 2023, the London Ontario Section Fellows, along with Schulich SPEA and Patterson Dental London Branch hosted an evening for Schulich students at the London Hunt and Country Club.

Dr. Paul Romanson welcomed everyone to the event including our sponsors from Patterson Dental and introduced the ACD Ontario Section to the students. Dr. Anwar Dean spoke about his work as SPEA Liaison to Schulich SPEA. Ms. Tanisha Goel, the Schulich SPEA President introduced SPEA to the Ontario Section Fellows and spoke of the work they are doing with the students at the school.

Dr. Olaf Plotzke led a 1-hour informal discussion about “Breaking the Barriers” for treatment of disabled patients, many of whom are children. His discussion included the need for us as practitioners to see the patient as an individual, and not as a person with a disability.

Approximately 22% of Canadians are living with one or more disabilities. That makes 8.8 million Canadians. 35% of Indigenous Canadians live with a disability as do over 38% of our seniors. Most individuals with disabilities live in lower income or poverty levels and have huge access to care barriers. Physical, monetary, poor government dental plans and mental health are examples of the barriers that exist.

Dr. Plotzke very clearly showed us that as practitioners we need to work harder and better in order to overcome these barriers and provide dental care to all individuals. The education for all dental personnel on how we provide care to these individuals must improve.

Dr. Plotzke then invited Dr. Clive Friedman to speak on Special Olympics. Dr Friedman has a long history of supporting special needs patients and has a major involvement with the Special Olympics. Dr. Friedman invited any of the students who wish to learn more and possibly volunteer to speak with him at any time during the evening or in the future.

After the formal part of the evening had concluded, we had a light dinner and lots of social time for our students to mingle with the Fellows and Sponsors to ask questions and network. It was amazing to have 50 students from first, second, third and fourth years all together showing such keen interest in our profession.

The evening was a grand success thanks to ACD Head Quarters and Patterson Dental sponsorships. We hope to hold such events for the students yearly to provide continued support and guidance.

Respectfully submitted, Karin Van Ryswyk

Schulich SPEA Liaison Report

Dr. Anwar Dean

SPEA Liason – Western Schulich

The Student Professionalism and Ethics Association (SPEA) at Schulich Dentistry, WU, remains vibrant with an active Executive Committee structured as follows

Sanaya Engineer, Co-President

St lla ng, Co- r sid n

Sh lly L , Continuing V Financ

Ar j Idr s, Incoming V Ev nt

anisha Go l, ast r sid nt and R g nt for R g ncy #2, Canad Sahil Khanna, I D R pr s ntative

Dr. Karin Van Ryswyk, ACD OS r asur r, and Dr. aul Romanson, ACD OS ast r sid nt, continu to provid invaluabl r f r nc and guidanc .

h changing d mographics is r fl ct d within th Schulich d ntal stud nt body. his y ar witn ss d th inaugural Eid C l bration and Diwali C l bration, both w ll-att nd d and support d by faculty m mb rs and stud nt body. anisha was th co mc at this first Schulich Diwali C l bration. S EA m mb rs and ACD Liaison activ ly participat d in th s v nts, mphasizing th importanc of such ngag m nts for th succ ss of ACD OS outr ach programs.

With pati nts r turning post-COVID, Schulich stud nts hav b n notably occupi d in th clinic, impacting th sch dul of S EA activiti s. D spit this, th Ex cutiv Committ has maintain d r gular m tings. lans ar und rway for a Schulich S EA Liaison m t-and-gr t with all S EA m mb rs in th N w Y ar. Additionally, th postpon d program on NOMA from Octob r is r sch dul d for th coming y ar.

h Schulich D ntistry Whit Coat C r mony (WCC) on Aug 31, 2023, witn ss d consid rabl faculty att ndanc , primarily ACD F llows, including th activ participation of curr nt and ast Schulich S EA Liaisons. h ACD's st m d r putation r mains int gral to th Schulich WCC.

h annual Schulich S EA v ning program "Surviving th First Y ar," r c iv d positiv

f dback from stud nts, s rving as an id al platform for incoming stud nts to s k guidanc from s niors.

Fiv Schulich S EA m mb rs att nd d th ACD AGM in Orlando and xpr ss d gratitud for th g n rous trav l allowanc provid d by ACD and ACD OS. h ir shar d xp ri nc s and nthusiasm about th ACD AGM hav spark d discussions r garding att nding n xt y ar's v nt in N w Orl ans.

Sanaya Engin r, St lla ng, and anisha Go l from Schulich S EA w r invit d to th ACD OS AGM at th London Hunt Club. his opportunity allow d th m to gain insight into th functioning of ACD OS at a local l v l and r conn ct with Dr. Xu Hr Hong, a form r Schulich S EA Ex cutiv and curr nt ACD OS Ex cutiv .

Schulich S EA r mains activ across various social m dia platforms, with a pr f r nc for Instagram. Mor ov r, plans ar in plac to c l brat National D ntist Day on Monday, March 6, 2023.

Schulich S EA is consid ring participation in U of S EA programs this y ar, including vi wing a r cording of Dr. Olaf lotzk 's “Sp cial Car D ntistry” program and collaborating on an AI-focus d program. h s initiativ s might pav th way for a joint S EA R g ncy #2 program in th futur .

Lastly, th Outstanding Stud nt L ad rship award is plann d for Jun 2023.

Anwar D an

ACD – Schulich Liaison

Membership, Nominations & Awards Committee Report with focus on Membership Value

Dr. Brenda Thomson

Membership Nominations Awards Chair 2023

ACD Ontario is quite passionate about ensuring that we are doing everything we can to make this Fellowship meaningful for our members, and more broadly to have a positive impact on dental students and the younger dentists who are coming along behind us.

In 2022 and 2023, the Ontario executive participated in strategic planning sessions to better prioritize projects, with a focus on how best to add value to our membership. Among other initiatives, these brainstorming sessions led to the existing Nominations & Awards Committee being broadened to focus on membership needs and as well to recognize member service contribution to the advancement of ethics and professionalism within our profession. The committee has thus been renamed and is now the Membership, Nominations & Awards Committee (MNAC). This change was made to reflect on how the ACD Ontario Section (OS) can add value for all our fellows, and how members can better access the value of membership that has always been part of ACD.

Most significant in the past year has been the creation of a world class CE program focusing on ethics. Dr. Sonia Slawuta initiated this program with 10 live webinars, working in collaboration with the RCDSO to ensure that these important ethics courses were appropriately categorized. This well- received ethics continuing education program was named in honour of Dr. Emo Rajczak, our first Ontario chair.

The Ontario section was awarded Model Section 2023 in Orlando. Ontario has received this nod on 4 occasions since our inception in 1991. Our Newsletter truly is an exceptional production, a labour of love for those who invest many hours each year making this just right! The proof is in the pudding – the Ontario section has received the ACD Newsletter Award 5 times, most recently in 2022. This annual newsletter is being released early in 2024. Again, the newsletter is in digital format only – with the significant amount of money saved on mailing and printing, going a long way to funding our expanded CE program.

Also, to make our newsletter messaging timelier, a quarterly Bulletin was launched in 2022, to provide current insights and updates into Ontario projects, programs, and events. The MNAC worked together with the full executive to host a dual location AGM (Toronto & London) in November 2023. Our new executive and updated by-laws were ratified at this AGM.

ACD Ontario is continuing its active endorsement of the White Coat Ceremony at both Ontario dental faculties. ACD-OS also provides financial support for SPEA. MNAC and the entire executive recognize the importance of mentoring emerging young dentists. One newly graduated former SPEA leader, Dr. XueEr Hong is managing Ontario’s newest project, creating the special occasion ecards you received this year. She also joined the executive line in 2023 as secretary. This is a wonderful leadership opportunity and the ACD-OS Executive encourage other new fellows to consider becoming involved.

Continuing Education Report

Dr. Sunita Joshi

Chair of the ACD Ontario Section

Following a very successful first year of the Dr. E. J. Rajczak Ethics and Professionalism Continuing Education series, we were excited to keep up the momentum in our CE offerings to our membership.

The theme of this year’s Education series is Changing Times and Changing Needs with special emphasis on Equality, Diversity, and Inclusion.

There are six webinars planned:

November 30/2023

“Ethics and Professionalism: A Faculty of Dentistry Perspective”

presented by Dr. Greg Anderson – (Core 1)

January 18/2024

“Changing Times...Changing Needs”

presented by Dr. Peter Hong and Ms. Lisa Bruni –(Core 1)

February 8/2024

“The study of Ethics and social Justice go hand in Hand”

presented by Dr. Bryan Walls.

April 11/2024

“What is Ethics?”

presented by Dr. Dave Chambers

May 30/ 2024

Maintaining Ethical Boundaries in the Dentist Patient Relationship”

presented by Dr. Shawn Steele – (Core 1)

September 12/2024

“Ethical Considerations in Adult Orthodontics”

presented by Dr. Richard Schmidt – (pending Core 1 status)

Three of the six in this series have already been approved for Category 1 status and there is still application pending for another one.

Respectfully Submitted,

Dr Sunita Joshi FACD and Chair of CE and Sponsorship Committee

The ACD International AGM/Convocation in New Orleans, Louisiana

The ACD-OS Meet and Greet on Wednesday October 16, 2024 at the Plates restaurant