toWatch TEN
By Kelly Rehan
In the face of challenges, young dentists are doing incredible things like starting their own practices, improving dental care access to the underserved and reimagining the patient experience. With less than a decade of experience, these 10 dentists have fueled the future of dentistry with their enthusiasm and leadership. AGD Impact proudly shares their stories.
Dentistry on the Inside: Exploring the Prison Dental System
By Michal Christine Escobar
While many aspiring dentists may not immediately think about working at a correctional institution upon graduation, correctional dentistry can provide a very fulfilling and stable career path. Like any dental field, it has pros and cons, but many correctional dentists find deep satisfaction in their work.
What Makes a Master?
How long does it take to become an expert at anything? Interviews with experts say it takes anywhere from 10 to 18 years to become worldclass competent. In his book, “Outliers: The Story of Success,” Malcolm Gladwell introduced “the 10,000-hour rule,” which suggests that becoming an expert may take 10,000 hours of dedication to a particular task. While there is no instant recipe for success or competence, there is always practice, practice, practice. With competency comes confidence, and with confidence comes an innate ability to communicate effectively and provide outstanding care.
If you follow the 10,000-hour rule, setting yourself apart and becoming a master means providing a specific service for up to 20 hours a week for 10 years. This will take much self-discipline, investment in oneself and dedication to something loved. Finding a mentor or a group of mentors is an effective means to this end. Growth occurs through accumulated education and experience. Sharing knowledge is a recipe for success and professional satisfaction.
Being just good at your chosen profession is OK to get through any day, but that does not mean you’ve mastered your job. There is a significant difference between being successful at something and truly mastering it. This has lots to do with your particular goals and ambitions. Doing something once can be considered a success, but doing it correctly over and over and over creates mastery.
To achieve mastery requires an investment in higher education. Getting credentialed, engaging with other dentists, reading scientific journals (our General Dentistry is an ideal resource), associating with social media forums, contributing to organized dentistry (such as your AGD) and being engaged with online platforms all keep us up to date on
current trends and allow us to work toward mastery. Indeed, becoming an AGD Master allows you to earn the label of one — and follow a map for how to get there.
Attending conferences, especially our AGD scientific session, is one of the best means of clinical and business growth. A nominal investment pays incredible dividends — learning practical innovations from awesome speakers and networking with like-minded colleagues. Maybe even presenting your own cases or ideas might help someone else achieve success. Improving your skills to advance personally and professionally is imperative. Never stop learning. Your thirst for knowledge should be immeasurable. Becoming a “super GP” is a goal that is achievable for every AGD member who wants to reach those heights.
Commitment to education helps realize a support system that will stay throughout your professional career. Mentorship is one of the strongest and most important components in dentistry. A mentor can elevate your experiences, help you visualize what you want to achieve and challenge you to excel.
My advice is to plan proactively with a positive attitude; keep an open mind about novel techniques, materials and technology; and invest in your practice and yourself to improve patient satisfaction. Stagnation is a detriment. Forward momentum is the key to becoming a master.
Timothy F. Kosinski, DDS, MAGD Editor
Editorial Staff
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Dental Practice Advocacy
AGD Responds to Dental Quality Alliance Request for Comments on Two Interim Reports
By Cindy Kluck-Nygren, AGD manager, Dental Practice
In September 2024, AGD provided feedback in response to two requests for comment from the Dental Quality Alliance (DQA). On Sept. 20, 2024, AGD’s then-president Merlin P. Ohmer, DDS, MAGD, sent a letter to the DQA advising that AGD endorsed “Interim Report 4: Claims-Based Starter Set Measure Care Continuity for Children” and “Interim Report 5: Claims-Based Starter Set Measure Periodontal Maintenance for Adults with Periodontitis.”
AGD’s Dental Practice Council reviewed both reports in consultation with Ralph A. Cooley, DDS, FAGD, AGD’s representative to the DQA. Ohmer’s letter to the DQA conveyed two concerns. The first is the potential application of practice- and/ or clinician-level measures, which may be developed by external entities for inappropriate purposes, such as influencing treatment plans and/or limiting provider reimbursements. The second is the possibility that external entities, including third-party payers, may attempt to use invalid practice- and/or clinician-level measures to evaluate dentists’ performance. The letter stressed that, in order to be valid, quality measures should meet standards of feasibility, reliability, validity and usability.
Ohmer’s response noted that the measure detailed in “Interim Report 4: Claims-Based Starter Set Measure Care Continuity for Children” was feasible, reliable, valid and appropriate for use for both practice-level reporting and to identify performance gaps and guide improvement efforts. It also advised that the measure detailed in “Interim Report 5: Claims-Based Starter Set Measure Periodontal Maintenance for Adults with Periodontitis” was a suitable resource to guide improvement through identifying performance gaps in a practice setting. The response also referenced AGD policy supporting the concept of a patient-centered dental home led by the general dentist who determines when referral of care is warranted and who coordinates specialty services when indicated and appropriate.
Information on the Dental Quality Alliance is available at ada.org/dqa
Dental Practice Council Representative Attends National Meeting on Dental Plans
By Cindy Kluck-Nygren, AGD manager, Dental Practice
AGD Dental Practice Council (DPC) member Laura Sharbash, DDS, FAGD, DABDSM, recently attended the National Association of Dental Plans’ (NADP’s) CONVERGE conference, Sept. 23–26, 2024, in Minneapolis, Minnesota. This meeting is the premier professional event in the dental benefits industry, with most attendees representing dental insurance industry companies and affiliated vendors and suppliers.
“AGD members frequently report that issues relating to thirdparty payers are among their most significant pain points,” said Sharbash, who has attended the CONVERGE conference for
two consecutive years. “AGD demonstrates its commitment to advocacy in this area by attending this meeting and by engaging in dialogue with NADP staff throughout the year.”
DPC chair Darren S. Greenwell, DMD, MAGD, concurred.
“While AGD and NADP may have differing perspectives on many issues, our presence at this meeting reaffirms AGD’s position as the leading advocate for general dentists and the patients we serve,” he said.
Both AGD and NADP maintain voting member status on the American Dental Association’s (ADA’s) Code Maintenance Committee and the Dental Quality Alliance.
Background: Medical and Dental Loss Ratios
Dental loss ratios (DLRs) remain a key topic for NADP, and it plans to conduct a study to assess consumer feedback on whether and how dentists think their states’ DLR legislation has impacted their dental benefits. NADP and the ADA developed proposed model legislation for states to consider when developing DLR legislation; that proposed language was endorsed by the National Conference of Insurance Legislators. The suggested legislation advances reporting and mediation actions instead of immediately establishing and implementing medical loss ratio and DLR thresholds of a specific percentage. That suggested legislation is available here: ncoil.org/wp-content/uploads/2024/01/ NCOIL-DLR-Model-Health-Cmte-Adopted-1-26-24.pdf.
In 2023, AGD’s House of Delegates adopted a policy, recommended by the DPC, that supports legislation requiring DLR minimums of no less than 85% of dental insurance premiums spent on all claims in all relevant jurisdictions and transparency in the reporting of dental insurance companies’ expenditures as they relate to direct patient care. The policy also includes a clause allowing AGD to support a DLR less than 85% in states where the 85% figure is not politically feasible. In January 2024, a member of NADP’s government relations staff delivered a presentation on the status of DLR state legislation to AGD’s DPC.
Research and New Initiatives
Research and strategic initiatives highlighted during the CONVERGE meeting included:
• An assessment of payers’ and providers’ perspectives on, and experience with, transitioning from the traditional reimbursement model of fee-for-service dentistry to a value-based care model. The goal of value-based dental care is to improve patient outcomes through a focus on prevention, treating disease and long-term dental health benefits. It was reported that at least one state Medicaid program has started implementing this type of reimbursement system. Research on evolving market dynamics was conducted by HealthScape Advisors in collaboration with NADP and the CareQuest Institute for Oral Health. Research protocols involved a market survey with follow-up qualitative interviews of dental payers and multisite dental providers.
• At the time this recap was developed, a survey to assess pain points relating to dental practice communications with
dental insurance companies regarding patients’ benefits was being developed. NADP will partner with the American Association of Dental Office Management to field the survey to dental practice office managers.
• NADP and the Dental Trade Alliance are planning a patientcentric strategic initiative designed to yield insights on how to achieve behavioral change among patients.
• Representatives of SKYGEN, a provider of benefits management and administration services, presented highlights from their research opportunities for payer-provider collaboration.
Other Topics
“This year’s meeting also included sessions on the integration of dental and medical care, as well as applications of artificial intelligence in dentistry and within the third-party payer community,” said Sharbash. “Attending this meeting gives AGD the chance to learn about new products and innovations in the dental benefits space. Having that knowledge informs the DPC about which trends, new products and services should be monitored and, when appropriate, communicated to members.”
This year’s CONVERGE event will be held Sept. 15–18, 2025, in Indian Wells, California.
Governance
The Impact of the 2024 Election on the Year’s Dental Legislation
By Jay Fisher, JD, AGD manager, Government Relations
The effect of the 2024 election on oral healthcare policy will be unclear for a while. Former President Trump was elected with 312 electoral votes, sweeping all seven swing states. The Republicans regained control of the Senate, picking up four seats and giving them a total of 53, enough to approve most nominees, but nowhere near the 60 votes needed to end a filibuster and pass most bills without Democratic support.
In the House of Representatives, the Republicans will retain their very narrow majority, meaning that just a few holdouts can prevent the passage of legislation. In the last Congress, the Freedom Caucus was not shy about derailing Republicansponsored legislation that its members felt wasn’t conservative enough. It is unclear whether President Trump will be able to keep the Freedom Caucus on board for bills that do not meet their purity test. Additionally, more moderate Republican members may feel pressure to buck the party and vote in line with their district.
With a Republican “trifecta,” we should see slightly more legislation enacted than in the last Congress. Prior to the December lame duck session, only 106 bills had
passed in 2023 and 2024. This was a record low number. Without 60 votes in the Senate, expect to see the Republicans try and pass as much as possible in a reconciliation bill that cannot be filibustered.
What policy positions can we see in a Trump administration that affect oral healthcare? The most obvious area of concern is around community water fluoridation. At the time of writing this article, Robert F. Kennedy Jr. has been mentioned as Secretary of the Department of Health and Human Services (HHS). Prior to election day, Kennedy stated that, on its first day, the Trump administration would “advise all U.S. water systems to remove fluoride from public water.” President-elect Trump stated, that “sounds OK to me.”
Water fluoridation is a local matter, but the proper amount of fluoridation is governed by the Environmental Protection Agency, not HHS. However, Kennedy can change policy at the Centers for Disease Control and Prevention, which provides support and funding for local fluoridation programs.
Regarding federal healthcare programs, do not expect to see an inclusion of dental benefits in Medicare in a Trump administration. The current financial
strain on the system makes it unlikely that new benefits will be added. Current projections show that Part A will run out of funds in 2036.
President Trump promised not to touch Medicare. However, Project 2025, which Trump disavowed, advocates that Medicare Advantage be the default option for new enrollees. If enacted, this could increase the number of seniors with a dental benefit who are looking for innetwork providers.
During his first term, President Trump attempted to undo the Affordable Care Act (ACA), commonly known as Obamacare. It is unlikely that Congress would expand the ACA to include dental benefits. Kennedy has spoken out against the medical loss ratio (MLR) mandates in the ACA. If Congress removes the MLR mandates from the ACA, that could disincentivize state legislatures from passing MLR legislation that applies to dental insurers (similar to Massachusetts Ballot Question 2).
Another possible area of reform the Republicans may try to pass is to increase the utility and utilization of health savings accounts. If enacted, this may allow more people to afford oral healthcare services.
Inside General Dentistry
Look for the following article in the January/ February 2025 issue of AGD’s peer-reviewed journal, General Dentistry.
Validation of oblique line contrast (W-index) for osteoporosis risk screening in panoramic radiographs using peripheral dualenergy X-ray absorptiometry
The objective of this study was to validate the usefulness of the W-index (WI) for screening patients at risk of osteoporosis by correlating the WI results with those obtained from peripheral dual-energy X-ray absorptiometry (pDXA). The WI is based on oblique line contrast on panoramic radiographs, in which the pixel intensity of the oblique line is compared with the pixel intensity of adjacent structures at the mandibular ramus. A total of 333 patients with panoramic radiographs and pDXA results were evaluated according to T-score results and WI measurements. A Spearman correlation test was executed to assess the correlation between measures. Patients were divided into 3 groups: normal bone mineral density (BMD), osteopenia, or osteoporosis. The WI values were compared with the Kruskal-Wallis test. A significant but negligible correlation was found between the pDXA and WI results for all peripheral sites assessed. Statistically significant differences in the WI results emerged between patients with normal BMD and osteoporosis (P = 0.007) as well as between those with osteopenia and osteoporosis (P = 0.010). There were no significant differences in WI between patients with normal BMD and osteopenia (P = 0.598). The results of the study indicate that WI values can differentiate patients with normal BMD or osteopenia from patients with osteoporosis, suggesting that the WI is an easy, convenient tool to screen patients for low BMD using panoramic radiographs.
Read this article and more at agd.org/generaldentistry.
AGD Fact Sheet
Talking to Patients About Nutrition
AGD fact sheets provide your patients with all of the information they need to maintain their oral health. Fact sheets on more than 25 oral health topics are available for downloading online and can be customized to include your name and practice information. Download the fact sheet “What to Know About Oral Health and Nutrition” at agd.org/factsheets.
Governance
2024 Annual Meeting Recap: Bylaws Amendments
AGD’s House of Delegates (HOD) accomplished a great deal of housekeeping, rescinding or amending old policies. It updated its position on healthcare reform and also updated a policy recommending dentists closely monitor possible adverse effects of biologics, devices and pharmaceuticals. Another revised policy called on third-party payers to respect the sanctity of the doctorpatient relationship, without interference. A new policy was adopted focusing on the general practitioner’s scope of practice based on their training and experience.
The HOD renamed the AGD’s Advocacy Fund after Myron “Mike” Bromberg, DDS, who passed away last year. Bromberg served as chair of AGD’s Legislative & Governmental Affairs and Dental Practice councils several times and was also AGD’s representative to the American Dental Political Action Committee and the driving force behind the creation of the Advocacy Fund.
In other business, the HOD amended the organization’s Election Guidelines by adding the members of the Scientific Meetings Council to the list of groups that are prohibited from being involved in election campaigns. It adopted a new policy of supporting general dentists supervising medical esthetic professionals. Additionally, the Bylaws were amended to clarify that the Commission on Dental Accreditation accredits dental programs, and not dental schools.
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10 Things I’ve Learned About Dental Marketing in the Last 10 Years
By Jackie Ulasewich Cullen
Anew year is always a good time for reflection. This year, my dental-focused marketing agency, My Dental Agency, is celebrating a big milestone: our 10th anniversary. Just as your dental practice has likely experienced significant shifts over the past decade, so has our agency — and our approach to marketing has evolved dramatically.
Rewind even further, and the changes become even more noticeable. Twenty years ago, digital marketing was still in its infancy, and social media marketing wasn’t even on the radar. Today, consumer behavior is evolving rapidly, and it’s shaping how we develop strategies for our clients.
The good news? What we’ve learned through these years of trial and error can offer valuable insight into how you should be marketing your practice today. Every lesson we’ve gathered isn’t just about how we’ve grown — it’s about what’s working for dental practices now and how these strategies can help you attract more quality patients, build loyalty and grow your business.
1. Testing Is Your Best Friend
Marketing is always evolving, and testing is essential to staying ahead. Whether it’s images, landing page copy or headlines in your ad campaigns, continuous testing ensures your efforts are aligned
with what works. Assumptions can be misleading, and what seems like a winning idea might not deliver.
For example, we once tested a sleek, newly designed landing page against an older version, expecting the new design to outperform it. Surprisingly, the original page delivered better results (more new patients requesting an appointment). This experience was a powerful reminder that marketing is driven by data, not assumptions. The key takeaway? Testing and tracking aren’t just optional — they’re the only way to uncover what truly works for your practice.
2. Call and Form Tracking Is Key
Without tracking phone calls or online form submissions, it’s difficult to understand how well your marketing is performing. Tracking these interactions gives your practice valuable insights — not only into the number of new patient inquiries, but also into how effectively those inquiries convert into appointments and treatment plans. This data is essential for identifying which marketing strategies are driving the best results, so you can focus your efforts where they matter most.
At My Dental Agency, we prioritize closing this loop with our clients. While we can track the volume of inquiries, it requires coordination with each practice’s office team to determine how
many appointment requests turn into scheduled appointments or accepted treatments. Having this complete picture allows us to align our strategies more effectively with our clients’ goals to ensure long-term marketing success.
3. Always Make Data-Driven Decisions
Data is the backbone of any successful marketing strategy. Tracking performance metrics allows your practice to move beyond guesswork and make informed decisions that are rooted in reality. Whether you’re testing ad copy, tracking calls or analyzing form fills, every insight helps refine your campaigns for stronger results.
A data-driven approach ensures that your marketing efforts are both targeted and measurable. By focusing on what works, your practice can attract more patients, improve retention and ultimately generate more revenue — giving you a clear path to sustainable growth.
4. What Works Today May Not Work Tomorrow
A marketing strategy that worked well in the past may lose its impact over time — but that doesn’t mean it’s gone for good. Take Facebook ads, for example. They performed exceptionally well for our clients eight to 10 years ago, declined for a few years, and now they’re delivering strong results again.
This shift highlights the importance of ongoing testing and adaptation. Just because a tactic isn’t working today doesn’t mean it won’t become a powerful tool for your practice in the future. Staying flexible and open to revisiting past strategies ensures that you’re always prepared to leverage what works when the time is right.
5. Consumers Change
Patients today expect more than just dental care — they’re looking for a genuine connection with the practice they choose. In the past, trust played a smaller role in decision-making, but now prospective patients are more intentional. They research thoroughly to find a practice that aligns with their values.
To attract these patients and earn their loyalty, your marketing needs to reflect authenticity, build trust and provide social proof. Doing this successfully helps you establish stronger patient relationships and encourages long-term commitment.
6. Embrace New Technologies
Just as patient expectations have evolved, so have the tools available to dental practices. Video marketing, once uncommon, has become a powerful way to engage patients and showcase your services. Embracing new technologies allows your practice to stay ahead and can help you build stronger connections with your community.
7. Education Is Critical
Have you ever questioned whether your practice needs a social media presence or if a Google Ad campaign is worth the investment? Without a marketing professional on your team, it can be difficult to understand the value of every strategy or channel. But understanding why these tools matter — and how they can benefit your practice — can make all the difference.
When you and your team stay open to learning, you’re better equipped to align your efforts and achieve long-term success.
A shared understanding of the “why” behind marketing ensures everyone is on the same page and working toward the same goals.
8. Authenticity Matters
The most successful practices embrace who they are and let that shine through in their marketing. When your marketing reflects your core values, mission and brand personality, it resonates with the right audience and draws in patients who align with your practice’s vision.
Authenticity isn’t just a buzzword; it builds trust and fosters lasting relationships with your patients. When patients feel they truly know your practice, they’re more likely to stay loyal and recommend your services to others.
9. A Comprehensive Approach Is Essential
In our early years, we sometimes limited marketing efforts to what clients initially requested — like just a website or social media presence. However, we soon realized that this piecemeal approach wasn’t sustainable. To achieve long-term success, a marketing strategy needs to integrate multiple channels — such as paid ads, social media, blogging, reviews, search engine optimization and email campaigns — into a cohesive plan.
A comprehensive approach ensures all your marketing efforts work together, amplifying your message across platforms and maximizing your results. When each channel supports the others, your practice can build momentum, attract more patients and foster deeper connections with your community.
10. Don’t Ignore Your Existing Patients
One of the most important lessons we’ve learned is the value of prioritizing your existing patients. It’s easy to become so focused on attracting new patients that you overlook the potential within your current patient base. However, nurturing these relationships builds loyalty and creates advocates for your practice.
When your existing patients feel valued and cared for, they’re more likely to stay with you — and refer friends and family. This not only strengthens patient retention but also drives sustainable growth for your practice over time.
Keep Learning, Keep Growing
If there’s one takeaway from the past decade, it’s that marketing is an ongoing journey. Success comes from staying curious, testing ideas and being open to change. What works today may shift tomorrow, but, with continual learning and adaptation, your practice will be ready to thrive — no matter what the future brings.
We have an exclusive offer for AGD members: You can request a free copy of my brand-new book, “Elite Dentistry: A Guide to Attracting Premium Patients,” which covers how to attract premium patients, build your brand and create an exceptional patient experience. It also offers insights on measuring success and driving sustainable growth.
Visit EliteDentistryBook.com/AGDMember to request your copy and keep your marketing moving in the right direction. ♦
Jackie Ulasewich Cullen is co-founder of My Dental Agency, a marketing company specializing in dental practice. To comment on this article, email impact@agd.org
Dentists toWatch TEN
A new generation of dentists is stepping forward to shape the future of oral health.
By Kelly Rehan
The years after dental school graduation can be isolating. Recent graduates may struggle to find their footing and navigate a field that is rapidly changing.
But in the face of these challenges, young dentists are doing incredible things like starting their own practices, improving dental care access to the underserved and reimagining the patient experience. They’re involved in organized dentistry and making their voices heard at the national level.
With less than a decade of experience, these 10 dentists have fueled the future of dentistry with their enthusiasm and leadership. AGD Impact proudly shares their stories.
SAM ASTHANA, DDS, FAGD
Fig Tree Dental Studio, Houston, Texas (opening Spring 2025)
Sam Asthana, DDS, FAGD, took an unconventional path to dentistry, initially pursuing a music career. As a saxophonist, Asthana experienced jaw pain that eventually led him to dentistry.
“I discovered that the world of dentistry was much broader and more interesting than I knew, and I quickly made the commitment to dive into the field,” he said.
Asthana counts earning his AGD Fellowship as his most meaningful accomplishment so far.
“My Fellowship represents hours of study and learning how to be a better dentist, but it’s also the result of setting a goal and achieving it,” he said.
Texas AGD leader Partha Mukherji, DDS, FAGD, nominated Asthana to this year’s 10 Dentists to Watch list. “Sam asks the questions and seeks guidance on how to succeed, not just professionally but also personally,” Mukherji said. “He’s already made his mark as president of the Houston AGD component, and he’s recently joined the Texas AGD board of directors.”
This year looks to be Asthana’s biggest year yet, as he plans to open his dental practice, Fig Tree Dental Studio, in the spring.
“I discovered that the world of dentistry was so much broader and more interesting than I knew, and I quickly made the commitment to dive into the field.”
Asthana carefully considers the patient experience. Instead of telling patients what they need, he engages them in their own treatment process.
“I prefer to begin sitting side by side and reviewing data — such as a clear intraoral scan — along with my patient,” he said. “I ask my patients to show me what they notice and what they are concerned about. It has really changed the dynamic of my relationship with my patients.”
Asthana also enjoys showing his patients a bit of his personality, too.
“I’m naming the office after my dog, Fig,” Asthana said. “You better believe I’m going to send emails of my dog in a white coat saying, ‘Dr. Fig wants you to schedule your six-month checkup.’”
BLAKE EDWARD BANDEFF, DMD
Summit Family & Cosmetic Dentistry, Summit, New Jersey
Blake Edward Bandeff, DMD, knew he wanted a career where he could deliver a visible difference in people’s lives.
“Dentistry felt like the perfect blend of science, art and personal connection,” Bandeff said. “What truly inspired me was witnessing how restoring a smile could transform a person’s confidence and overall well-being.”
His proudest achievement is building a practice that embraces both cosmetic and implant technologies. His practice focuses not only on restoring function but also on creating natural, esthetic results tailored to each individual.
“I’ve successfully handled complex full-mouth rehabilitation cases that brought life-changing results to patients,” Bandeff said.
Bandeff’s commitment to continued learning, which includes advanced training in implantology and esthetics, has allowed him to bring the latest treatments to his practice. His approach to practice extends beyond clinical skills to fostering an enjoyable work environment, striking a balance between professionalism and warmth.
“The success of a practice is a direct reflection of the entire team, and I ensure everyone feels valued,” he said.
Teresa Cupo, a member of Bandeff’s front office staff, nominated him to this year’s 10 Dentists to Watch.
“What truly inspired me was witnessing how restoring a smile could transform a person’s confidence and overall well-being.”
“Many patients who fear dentist visits leave our office feeling relieved, relaxed and happy to have found him,” Cupo said. “The many reviews — from over 150 patients — are reflective of the caring, professional and knowledgeable doctor that he is.”
Bandeff’s goals this year include integrating more advanced technology into his services. He also plans to grow the implant side of the practice, focusing on advanced full-mouth rehabilitation procedures.
“The fast-evolving nature of dental technology keeps me excited,” Bandeff said. “I’m constantly learning new techniques that make treatments more efficient and comfortable for my patients. This continuous innovation fuels my enthusiasm for dentistry.”
JOSHUA D. BUSSARD, DDS, FACD, FPFA
Private Practitioner, Indianapolis, Indiana
As a child, Joshua D. Bussard, DDS, FACD, FPFA, had what he calls “somewhere teeth.”
“Some were here, some were there,” he said. “Prior to orthodontic treatment, I shied away from group activities and often felt excluded.”
His life changed after his orthodontic transformation, inspiring him to pursue a career in dentistry to help others achieve similar improvements in their health and well-being.
Thinking back on his time as a patient serves him as a provider. Bussard emphasizes patient education and transparency in his practice.
“I strive to be a relatable and transparent provider while taking quality care of people,” Bussard said. “My team and I inform patients of all their appropriate options and spend time educating them about their oral health. Through education, patients are able to make an informed decision on their dental care.”
Bussard also prioritizes empowering his staff in their careers. He fosters a positive work environment by leading by example and encouraging team-bonding activities, like holiday decorating contests.
In addition to his clinical practice, Bussard has been actively involved in organized dentistry since dental school. Notably, he served as the national executive chair for the Student Professionalism and Ethics Association and is currently the National Regent Intern for the American College of Dentists.
“I strive to be a relatable and transparent provider while taking quality care of people.”
This involvement inspired Col. Peter H. Guevara, DMD, MAGD, ABGD, and Gary M. Berman, DDS, FAGD, DABFO, to nominate Bussard as one of the 10 Dentists to Watch.
“He serves as a role model to our younger generation of dentists,” Guevara said.
Looking ahead, Bussard’s professional goals include remaining actively involved in organized dentistry and creating opportunities for young dentists to develop professionalism, leadership and business skills that aren’t extensively covered in dental school. He is committed to providing educational resources and support to help recent graduates succeed in their careers and contribute positively to the dental profession.
“I pride myself in having a laughter-filled office, with team members and patients laughing together in the hallways to help alleviate the anxiety that patients often feel.”
GRACE V. EICHLER, DMD
Dental Care of Fairfield, Hamilton, Ohio
A pacifier attachment is a common cause of childhood dental problems, but, for Grace V. Eichler, DMD, it sparked her dentistry career.
“I had a major dental transformation at a young age — thanks, pacifiers! — and spent plenty of time with my general dentist, orthodontist and oral surgeon,” she said.
Eichler observed how her childhood dentist volunteered in the community and mentored young dentists, and that inspired her to pursue a dentistry career.
Eichler was nominated to this year’s 10 Dentists to Watch list by her colleague Matthew J. Kirlough, DDS, FAGD, who highlighted her involvement in organized dentistry. Eichler is the chair of the Subcouncil on New Dentists and serves on the Council on Membership Services for the Ohio Dental Association.
Additionally, Eichler speaks at continuing education (CE) courses for new dentists, focusing on mental health challenges in the profession.
“Helping new dentists feel seen and not alone in their struggles has been a huge motivator for me,” she said, emphasizing the importance of breaking the stigma surrounding mental health in dentistry.
Eichler has not only played a role in helping dentists feel more comfortable in their profession, but she’s also created a practice environment that eases patients’ fears.
“We’ve pivoted to making our office not feel like a dental office. We have plants all over, candles burning and plenty of sunlight,” she said. “I pride myself in having a laughter-filled office, with team members and patients laughing together in the hallways to help alleviate the anxiety that patients often feel.”
Looking ahead, Eichler continues to set ambitious goals. In 2025, she is set to receive her FAGD and is expanding her clinical skills to include implant placement, driven by patient demand to stay in-office for more procedures.
ALEXANDRA J. FUSHI, DMD, MPH
Mint To Be Family Dentistry, Willoughby Hills, Ohio
Alexandra J. Fushi, DMD, MPH, was drawn to dentistry before she lost her first tooth.
“My childhood dental office was adorned with colorful drawings, and its warm atmosphere transformed what could have been a scary experience into something fun and engaging,” Fushi said.
Fushi’s early dental experiences laid the foundation for her career journey, which has included involvement in organized dentistry, dental missions and practice ownership.
Fushi’s practice, Mint To Be Family Dentistry, focuses on a personalized approach to patient care. She emphasizes a bidirectional relationship with patients.
“I always hope to provide care that is a partnership where the patient is accompanied on their oral health journey.”
Her team prioritizes education and dental literacy, enabling patients to be active participants in their care decisions.
As a practice owner, fostering a positive work environment is crucial. In her early ownership days, she got a firsthand look at what it takes to operate a practice.
“I wore every hat, and it was exhausting,” Fushi said. “But it made me appreciate every role in the office.”
When not in her office, Fushi also works at Cleveland Children’s Surgery Center treating pediatric and special needs patients in the operating room under general anesthesia — performing everything from cleanings to full-mouth rehabilitations.
In 2025, Fushi is excited about adding new technology, including laser dentistry, and hopes to expand her impact by lecturing on topics including special needs dentistry and care for pregnant patients. Her sights are also set on achieving her FAGD.
Although she has many professional goals, Fushi’s dentistry career has taught her the importance of her own physical and mental well-being.
“Dentistry and practice ownership can be a wild ride with unexpected twists and turns,” Fushi said. “I have learned that when a situation is not benefiting you or affecting your well-being, it is OK to protect yourself and set boundaries. Learning these boundaries and practicing gratitude has allowed me to maintain my enthusiasm for dentistry.”
“I always hope to provide care that is a partnership where the patient is accompanied on their oral health journey.”
BRANDI R. HAIR, DMD
Community Health, Columbia, South Carolina
Brandi R. Hair, DMD, was inspired to pursue dentistry after witnessing her family’s struggles with accessing affordable dental care.
“The lack of access to affordable, comprehensive dental treatment resulted in many of my family members experiencing negative oral health outcomes,” she said.
This motivated her to become the dentist her family needed, focusing on mobile community health to bring comprehensive care directly to underserved populations.
“Each day is an opportunity to build a legacy of developing healthier communities.”
“I aspire to see all communities have access to the dental care that they need,” Hair said. “And I am committed to doing my part in making this dream become a reality.”
What makes Hair’s practice unique is its commitment to “meeting patients where they are,” both geographically and in terms of oral health literacy. Through mobile dentistry and clear communication, her practice breaks down barriers, helping patients better understand and engage with their oral health.
“Each day is an opportunity to build a legacy of developing healthier communities,” Hair said.
Outside of her clinical work, Hair has made an even broader impact through organized dentistry. She currently volunteers as editor for the South Carolina AGD, where she launched the constituent’s inaugural member-exclusive bulletin and revitalized its social media presence. She oversees all communications on the state level, encouraging South Carolina dental students and dentists to pursue lifelong learning with AGD.
At the national level, Hair serves as an AGD national spokesperson and was appointed director of membership and chapters for the American Association of Women Dentists (AAWD). She also volunteers her time to help plan the 2025 AAWD Conference and looks forward to broadening the organization’s impact through predental initiatives.
Hair is committed to increasing oral health literacy, and her 2025 goal is to collaborate with organizations like AGD and use social media to make dentistry more relatable and engaging for patients.
DENNIS NGUYEN, DDS, FAGD
Cape Girardeau Dentistry, Cape Girardeau, Missouri
Shortly after the world shut down due to the COVID-19 pandemic, Dennis Nguyen, DDS, FAGD, made a bold move: He purchased a dental practice.
Keeping staff employed and patients safe while the world grappled with the pandemic were huge tests for Nguyen.
“I went through this tough challenge with so much uncertainty,” he said. “But my practice survived that adversity and has thrived. It’s rewarding to see how the practice, staff and myself have grown over the last several years.”
Inspired by relatives who were also dentists, Nguyen recognized early on dentistry’s potential to make a meaningful impact in patients’ lives.
“Dentistry is a great profession as it allows me to bring positive changes to people by either creating new smiles or getting them out of pain,” he said.
One of Nguyen’s proudest achievements is earning his FAGD.
“I always wanted to achieve this award and be the first of my family of dentists to do so,” he said.
Another point of pride is his active involvement in organized dentistry, including serving as past president of the Missouri AGD. Nguyen credits organized dentistry with providing him an outlet to share his knowledge and gain new perspectives on the dental field.
“Dentistry is a great profession as it allows me to bring positive changes to people by either creating new smiles or getting them out of pain.”
Nguyen was nominated as one of the 10 Dentists to Watch by his friend and colleague Brett T. Durbin, DDS.
“Dennis practiced in public health for several years before moving to a rural, underserved area and purchasing a practice that he has revitalized and is now flourishing,” Durbin said. “He embodies what AGD stands for and is an excellent representative of our profession.”
Nguyen is eager to continue advancing his practice in the year ahead by adding new techniques and technologies, including digital dentures and laser therapy. His dedication to professional development — having already earned over 1,100 CE credits — ensures that he remains at the forefront of dental innovation.
JUILI SUBODH SHIVDE, DMD
Community Health Systems, Beloit, Wisconsin
Juili Subodh Shivde, DMD, was exposed to healthcare from a young age, inspired by her physician parents. This background ignited a passion for blending artistic creativity with science, ultimately guiding her to a career in dentistry.
“The field’s commitment to lifelong learning, precision and patient-centered care resonates deeply with me,” Shivde said.
Less than three years after graduating from the Advanced Standing Program for International Dentists at the Temple University Kornberg School of Dentistry, Shivde has already racked up several professional achievements, including earning the Temple Alumni Humanitarian Award and receiving the Scientific e-Poster Award at AGD2024.
“We’ve established strong partnerships with local organizations to connect our patients with food banks and housing assistance programs.”
Her practice, located in a dental workforce shortage area, focuses not only on dental care, but also on addressing the social determinants of health.
“We’ve established strong partnerships with local organizations to connect our patients with food banks and housing assistance programs,” Shivde said, underscoring her commitment to holistic care.
Her dedication extends to mentoring dental students, which is one of the reasons Soham Vivek Apte, DMD, nominated Shivde to this year’s 10 Dentists to Watch list.
“Through her experience observing students rotate at the clinic, she identified that, while most dental students are proficient in restorative dentistry, they lack experience in raising flaps and attempting surgical extraction cases,” Apte said. “So, she encourages the scheduling of patients in a way that allows students to undertake as many extraction cases as possible and hopes to mentor them to prepare them for real-world dentistry, which will significantly boost their clinical skills.”
Shivde is eager to shape the future of dental education through her new role as adjunct faculty at the University of Illinois Chicago College of Dentistry. She also plans to contribute to organized dentistry and continue her research, aiming to make a lasting impact on both her profession and underserved populations.
AMBIKA RANI SRIVASTAVA, DMD, MPH
Tuscaloosa, Alabama; Juneau, Alaska; Skagway, Alaska
Ambika Rani Srivastava, DMD, MPH, has a unique work environment, operating her practice bicoastally in Alabama and Alaska.
“My journey in dentistry has been shaped by a commitment to community health and a desire to make a meaningful impact on the lives of those I serve, regardless of geographic boundaries,” she said.
Srivastava is an associate dentist in pediatric offices in Tuscaloosa, Alabama, and Juneau, Alaska, as well as a federally qualified health center in Skagway, Alaska. Despite the many miles separating the states, Srivastava observed a similarity in how adolescents in the areas were not able to get the dental services they needed.
“As a general dentist, I provide essential dental care to adolescents in a familiar and supportive environment, ensuring they receive the comfort and quality of care they deserve,” Srivastava said.
As an educator and a clinician, Srivastava also finds immense fulfillment in mentoring the next generation of dental professionals. She serves as an adjunct assistant professor at the University of Alabama at Birmingham and is involved in organized dentistry through roles in the American Dental Association’s Institute for Diversity in Leadership and the AAWD.
Orthodontist Susan E. Whitt, DMD, regularly collaborates with Srivastava and nominated her as one of this year’s 10 Dentists to Watch. “Dr. Srivastava’s contributions and commitment to underserved communities are making a lasting impact not only on her patients, but also on the broader field of dentistry through her teaching, leadership and community service,” Whitt said.
“My journey in dentistry has been shaped by a commitment to community health and a desire to make a meaningful impact on the lives of those I serve, regardless of geographic boundaries.”
Srivastava’s future aspirations remain rooted in serving rural communities in Alaska and Alabama. She plans to engage in community outreach initiatives that promote dental health awareness and access to care.
“By fostering partnerships with local organizations and advocating for public health resources, I aspire to make a meaningful impact on both dentistry and patient care, ensuring that underserved populations receive the attention and services they deserve,” she said.
“It’s incredibly rewarding to see patients who arrive with fear, pain or low self-esteem leave my dental chair with a renewed sense of confidence and a smile.”
DIVYA UPADHYAY, BDS, DMD, CCI Alliance Dental, Quincy, Massachusetts
Divya Upadhyay, BDS, DMD, CCI, has amassed several achievements in her young career — serving as president of Massachusetts AGD and earning the prestigious “10 Under Ten” award in 2022 by the Massachusetts Dental Society, just to name a few. But her proudest moment came when a young patient from an immigrant family revealed that she had been inspired by Upadhyay to become a dentist.
“That moment holds deep meaning for me, as it represents my impact not only as a dentist but as a mentor,” she said.
This connection with her patients, along with a commitment to individualized care, is a hallmark of her practice.
“When patients walk through my clinic doors, I make sure they are heard without judgment,” Upadhyay said. “It’s incredibly rewarding to see patients who arrive with fear, pain or low self-esteem leave my dental chair with a renewed sense of confidence and a smile.”
Upadhyay’s dental career also includes a strong organized dentistry component. She was recruited to the executive board of the Massachusetts AGD, where she served in different roles over the years and volunteered alongside Ofelia V. Villanueva, DMD, who nominated Upadhyay to this year’s 10 Dentists to Watch list.
“[Upadhyay] has a great blend of energy and intensity coupled with an easygoing personality and pleasant demeanor, allowing her to integrate seamlessly with and inspire everyone around her,” Villanueva said.
This year, Upadhyay is focused on integrating oral health with other medical disciplines to enhance overall healthcare outcomes, especially for underserved populations.
“I look forward to contributing to improved patient care through this collaborative effort, fostering healthcare solutions that are not only comprehensive and holistic but also equitable and accessible to all.”
Kelly Rehan is a freelance journalist based in Omaha, Nebraska. To comment on this article, email impact@agd.org.
Dentistry on the Inside
Exploring the Prison Dental System
Uncover the unique challenges and rewards faced by correctional dentists as they provide essential care amid a backdrop of limitations and risks.
By Michal Christine Escobar
While many aspiring dentists may not immediately think about working at a correctional institution upon graduation, correctional dentistry can provide a very fulfilling and stable career path. Like any dental field, it has pros and cons, but many correctional dentists find deep satisfaction in their work. This type of dentistry provides a unique opportunity to serve a population in need, with the added benefits of a reliable work-life balance and strong job security, as well as the chance to make a meaningful impact on patients who are often extremely grateful for the care they receive.
Reliable, Not Glamorous:
Correctional Dentistry’s Scope
According to Rhay Street, DDS, dentist with the Cook County, Illinois, Department of Corrections, correctional dentistry can most aptly be described as a “meat-andpotatoes” kind of dental practice. This is due in large part to the limitations that the state or federal government places on the care correctional dentists can provide to incarcerated individuals.
For example, in California, correctional dentists are not allowed to offer implants, crowns, bridges, cosmetic dentistry or orthodontics to incarcerated individuals, explained Eric Wong, DDS, MAGD, supervising dentist with the California Department of Corrections and Rehabilitation. Instead, dentists tend to do a lot of routine extractions, restorations,
“Private practice isn’t immune to rude, poorly behaved or even dangerous patients. At least in prison, I have a custody officer with me if things get out of hand.”
Michael W. Lew, DMD, MAGD
dentures and treatments for infection because periodontal disease, dental caries, grossly decayed teeth, abscesses and fractured mandibles (from altercations) tend to be the most common dental maladies among prison inmates.
Since patients aren’t receiving complicated treatment, correctional dental clinics rarely, if ever, have access to the newest dental equipment available. Instead, dentists have access to “solid equipment that gets the job done,” Street said.
This doesn’t mean that correctional facilities are using ancient equipment. For example, California will replace dental operatory systems every 10 years, panoramic radiography machines every 15 years, autoclaves every five years, and compressors and vacuums every 5–7 years, said William Kushner III, DDS, FAGD, regional director of AGD Region 13 and director of the California AGD’s Pathway to Fellowship program. Kushner is also a supervising dentist for the California Department of Corrections and Rehabilitation. These replacement lifecycles are deliberately in place to ensure that correctional dentists have access to the equipment needed to provide the legally required care for their patients.
When it comes to ordering materials, correctional dentists must adhere to a budget. In some cases, they may also be given a list of preapproved materials (determined to be high quality and top grade) from which they can order.
This is the case in California, Kushner explained. “When new materials become available to the market, it can take a long time for them to be added to the preapproved supplies list. Thus, dentists in the correctional system are often using tried-and-true products and rarely get to use new, cutting-edge materials.”
Other correctional facilities, such as Cook County Jail in Chicago, do not provide their dentists with a preapproved supply list. Instead, dentists are allowed to order any brand of material as long as they stick to their budget, Street said.
“I always ordered the best materials available at the time,” said Ronald Townsend, DDS, a retired dentist from the Cook County Department of Corrections. “We never cut corners by using cheap materials because we need our work to last as long as possible.”
Treatment Planning in Correctional Dentistry
Before correctional dentists create a treatment plan for their patients, they must first ask: How long will this person be a ward of the state?
“Some individuals who are in jail might only be incarcerated for a year or less,” said Michael W. Lew, DMD, MAGD, chief dentist with the California Department of State Hospitals. “They might refuse our treatment plan because they believe they’ll be able to visit a private practice within a reasonable amount of time and then have access to treatment options that the state doesn’t provide.”
“Private practice patients can be very demanding and thankless. But incarcerated individuals will almost always treat you with kindness and respect because they recognize that you’re doing your best to help them out, and they’re grateful for it.”
Eric Wong, DDS, MAGD
On the other hand, some patients are wards of the state for a very long time, whether they’re currently in jail or in prison. In those instances, these individuals are much more willing to
Veterans of Correctional Dentistry: Meet the Experts
William Kushner III, DDS, FAGD, supervising dentist for the California Department of Corrections and Rehabilitation, director of AGD Region 13, and director of the California AGD Pathway to Fellowship program
• Opened a private practice in 1994.
• Joined the police academy and became a reserve deputy in 1999.
• Sold his private practice and became a correctional dentist in 2005.
• Promoted to supervising dentist in 2007.
Michael W. Lew, DMD, MAGD, chief dentist, California Department of State Hospitals
• Operated a private practice for 25 years before becoming a correctional dentist in 2007.
Rhay Street, DDS, Cook County Department of Corrections
• Opened a private practice.
• Began working part time for the Cook County Department of Corrections, eventually transitioned to full time.
• Left in 1999 to work for a community health center that served underserved populations in Chicago.
• Returned to the Cook County Department of Corrections in 2017.
Ronald Townsend, DDS, private practitioner
• Began his own private practice in 1988.
• Began working for the Cook County Department of Corrections in 1991.
• Promoted to chief of dental services in 2010.
• Retired from the Cook County Department of Corrections in 2017.
• Continues to operate his private practice.
Eric Wong, DDS, MAGD, supervising dentist, California Department of Corrections and Rehabilitation
• Operated a private practice for 20 years before becoming a correctional dentist in 2007.
accept the treatment plan suggested by a correctional dentist, Street added.
However, correctional facilities didn’t always offer comprehensive care. For example, in the past, the sole treatment model for incarcerated individuals in California was urgent care.
“Now, we have a much more comprehensive care model where we offer annual
checkups to our patients and provide a treatment plan that encourages better oral hygiene,” Wong said.
The Realities of Correctional Dentistry
Working as a correctional dentist isn’t for everyone, but many have found the work to be rewarding and satisfying. However,
there are some key differences from private practice.
First, when working in a correctional facility, “you lose the autonomy to practice as you see fit,” Wong said. “It’s a very litigious environment, and we’re governed by strict policies and procedures to ensure that each individual is treated with the same amount of fairness.”
Second, the correctional environment can be depressing, which makes it easy for dentists to bring negativity home, Kushner said. In fact, the suicide rate among staff members within the correctional system is high, and dentists are no exception.1,2
Third, while some incarcerated individuals made mistakes but still are good people, many more are hardened
“It’s a very litigious environment, and we’re governed by strict policies and procedures to ensure that each individual is treated with the same amount of fairness.”
Eric Wong, DDS, MAGD
criminals or con men looking to take advantage of anyone they interact with, Kushner said. Dentists must be constantly on guard for concerning behaviors to keep themselves and their patients safe.
On the other hand, working for the government comes with many perks. Besides standard benefits — health insurance, vacation time, personal time off — government employees can take advantage of a lucrative pension plan and typically have a better work-life balance than private practitioners, allowing them to spend more time with family compared with owning a private practice, Lew said.
Correctional dentistry is also an option for dentists looking for help with student loans, as they could qualify for loan forgiveness through state and federal programs that encourage dentists to work in underserved areas, Lew said.
But perhaps the biggest advantage is the joy and gratification that comes with working with patients who are truly appreciative of the treatment they receive.
“Private practice patients can be very demanding and thankless,” Wong said. “But incarcerated individuals will almost always treat you with kindness and respect because they recognize that you’re doing your best to help them out, and they’re grateful for it.”
Maintaining Safety in High-Stakes Environments
The safety of correctional dentists is of paramount importance. Typical safety measures include having a custody officer within sight of patients during their appointments and cameras within the clinic, Wong said.
In some cases, patients will be handcuffed during their appointments, Street
said. These individuals typically come from the highest-security divisions of a prison or jail, whereas inmates from lower security divisions will not be handcuffed.
Patients are usually civil and grateful for the treatment they receive, Townsend said. But there are times when inmates can become belligerent.
“One time, I had a patient who was in a lot of pain,” Townsend recounted. “At the time, we were seeing patients on a firstcome, first-served basis. He tried to cut the line, and when I told him he had to wait his turn, he began yelling, swearing and even spat on me. But the security guards stepped in and removed him from the clinic. The next day, I asked the guards to bring him to me when I had a break in patients so that I could examine him, and he was very grateful that I was willing to see him after his outburst.”
In the event of a severe security breach, correctional dentists in California are told that, while the state will do everything it can to ensure their safety, it will not negotiate with a prisoner over a hostage, Kushner says.
“We’re trying to remove any value a hostage might have, which ensures an employee’s safety. While it’s very rare that a hostage situation occurs, we need our employees to know how it will be handled,” Kushner added.
With that said, Wong, Lew and Street all agreed that they’ve always felt safe in their roles as correctional dentists.
“Private practice isn’t immune to rude, poorly behaved or even dangerous patients,” Lew said. “At least in prison, I have a custody officer with me if things get out of hand.”
Street echoed that sentiment, noting he’s had “more problems working in private practice than at the jail.” ♦
Michal Christine Escobar is a freelance writer based in Chicago. To comment on this article, email impact@agd.org
References
1. Frost, Natasha A. “Understanding the Impacts of Corrections Officer Suicide.” National Institute of Justice, 30 April 2020, nij.ojp.gov/ topics/articles/understanding-impacts-corrections-officersuicide#1-0.
2. Weichselbaum, Simone. “For Corrections Officers and Cops, a New Emphasis on Mental Health.” The Marshall Project, 14 June 2017, themarshallproject.org/2017/06/14/for-corrections-officers-andcops-a-new-emphasis-on-mental-health.
Must-Attend Event for General Dentists
Dive into a dynamic learning experience with a variety of hands-on CE courses led by industry experts, where you can practice and refine your skills in real-time. Connect with dental professionals from across the world, exchange valuable insights, and stay up to date on the latest advancements in oral health.
Join us in Montréal and see why AGD2025 is the premier meeting for...
Deepening Your Knowledge
Experience a comprehensive selection of lecture courses designed to elevate your dental expertise. Encompassing a wide range of topics across various dental disciplines, attendees are presented with the opportunity to learn from industry-leading experts.
Enhancing Your Career
Students and new dentists can take advantage of a range of resources designed to support their early career growth. Explore the New Dentist Lounge for free courses and guidance to help you transition from education to practice.
Montréal, QC / July 9–12, 2025
Sharpening Your Skills
Explore hands-on participation courses that provide practical experience to refine your techniques. Guided by expert instructors, you'll engage in case studies, demonstrations and live practice, directly applying new skills to enhance your clinical practice.
Expanding Your Network
Take advantage of multiple networking opportunities to connect with peers, mentors and industry experts. These valuable interactions will enhance your knowledge and skills, while building relationships that support your career growth and practice development.
Registration for AGD2025 and courses opens on Jan. 29, 2025 agd2025.org
Find Inspiration in the Paris of North America
Montréal is a vibrant, multicultural city that offers something for everyone, making it a must-visit destination. Known for its unique blend of European charm and North American energy, Montréal boasts stunning architecture, lively neighborhoods and a rich cultural scene. Visitors can explore historic Old Montreal, enjoy world-class museums and galleries, and experience a thriving culinary scene that spans from gourmet restaurants to diverse street food. The city is also home to beautiful parks, festivals throughout the year and exciting nightlife. Whether you’re a history buff, foodie, art lover or outdoor enthusiast, Montréal’s dynamic atmosphere and welcoming vibe make it a memorable place to visit.
“l attend AGD's scientific session for quality education from world-class experts. I always return inspired by the passionate and dedicated dentists who attend. To me, it's a worthwhile investment of time and money.”
Chethan Chetty, DDS, MAGD President, Academy of General Dentistry
Testing the Tools
By Ross Isbell, DMD, MBA
In my practice, my usual plan is to extract a tooth as atraumatically as possible and allow the site to heal. This is the least expensive treatment, and we know the body will heal in time. However, I am not always fortunate enough to have patients or sites that heal perfectly — luckily, there are a variety of ways to help heal them. While postoperative management of surgical sites is a commonly encountered situation in practices that extract teeth, past solutions haven’t always been as predictable and easy to deliver.
Fill the Void in Your Arsenal with This Matrix
3M™ Filtek™ Matrix
Solventum solventum.com
Freehand sculpting of composite veneering will always be a highly critical skill for the wet-fingered general dentist. However, in cases where we are planning to significantly alter the appearance of a smile with at least a four-tooth area, a wax-up can be a helpful guide in presenting the case as well as giving us a great model. A wax-up nowadays can be done totally digitally instead of using manual wax placement and sculpting, and we can use 3D-modeling software to design and showcase what the result could look like. After it is 3D-printed or sculpted, our model can then be used as a delivery method if we use a clear suck-down matrix or guide to place the composite with injection molding or load-and-press instead of layering. The downside to this process is that it has always been challenging to clean up between adjacent teeth. 3M™ created a unique solution to placement of composite veneers with the Filtek™ Matrix system. Now sold through Solventum, this injection-molding frame uses precision windows to allow access to individual teeth for direct composite veneer placement. The first step is scanning the existing dentition and submitting through the company’s online portal. Then, its team will design a plan based on desired shade changes, contours and amount of tooth planned to prep for rotation reasons. The proposed treatment design will be available in the portal for viewing with a 3D-rendered model, and you and your patient can critique and request revisions until you are satisfied. Then, Solventum will send you the matrix and a printed model. The Filtek Matrix comes with buccal and lingual components that snap together and lock onto the unaltered lingual surface of the teeth. Isolation with a rubber dam is possible, but difficult. Use of a full labial retractor such as an OptraGate® (Ivoclar) allows for pretty good isolation with easier access for the matrix, especially if you are doing more than four teeth. Prior to attachment of the
matrix, you should complete your etch-and-bonding protocol so that the matrix will not be cemented in place and will easily detach from your restorative material. Attach the lingual side first, then the buccal. You can either load material directly onto the tooth surface and press the window closed, which will cause extrusion of material through the access hole, or you can inject flowable composite through the access hole to complete an injection-molding process. Personally, I prefer the flowable injection route because it seems to adapt more perfectly to the matrix and leaves fewer wrinkles, but make sure to insert the tip all the way to the gingival zenith since the access hole is at the incisal edge. If you don’t have a tip long enough to reach, it’s worth ordering some because it will reduce the number of voids in the final fill. To make cleanup simpler, each tooth is separated by a wing that reaches into the contact point and requires minimal effort to break through the contact after matrix removal. While the matrix is clear, and light-curing can penetrate, I always like to make sure and cure again after removal. To finish, I break contacts with the ContacEZ system (Directa) and polish with a disc system like the Shofu Super Snap. If you’re worried about learning a complex new process, don’t be — the product requires minimal onboarding training. If you would like to add a well-planned and straightforward system for ideally designed direct composite veneers, I definitely recommend the Filtek Matrix system.
Ross Isbell, DMD, MBA, currently practices in Gadsden, Alabama, with his father, Gordon Isbell, DMD, MAGD. He attended the University of Alabama at Birmingham (UAB) School of Dentistry and completed a general practice residency at UAB Hospital. Isbell has confirmed to AGD that he has not received any remuneration from the manufacturers of the products reviewed or their affiliates for the past three years. All reviews are the opinions of the author and are not shared or endorsed by AGD Impact or AGD. To comment on this article, email impact@agd.org
Hit White Spot Lesions with a Smooth Criminal Material
Icon Smooth Surface
DMG
dmg-america.com
If I was going to pick a phrase that was the most important philosophy to modern dentistry, it would be “conserve tooth structure whenever possible.” DMG created a product with exactly that philosophy in mind with its Icon Smooth Surface infiltration system. Instead of using the traditional approach of excavation and physical removal, these two kits instead utilize a chemical-based approach for removal of minor carious lesions or scars, such as white spot lesions or fluorosis. This system uses a 15% hydrochloric acid etch (instead of the 30%–50% phosphoric acid used in standard composite bonding or 5%–10% hydrofluoric acid used in ceramic bonding) to treat the tooth surface. Icon Smooth Surface is indicated for non-cavitated lesions on smooth surfaces that are enamel only or less than one-third of the way into the dentin. The interproximal kit is indicated for Class II “boards” lesions that are enamel only radiographically. Due to the strength of the etch and need for great isolation for an extended amount of time, a rubber dam is required and should not be considered optional. After placement of the etch on affected regions for two minutes, rinse with water for 30 seconds and dry for 30 seconds. Then apply the Icon Dry agent, an ethanol-derived chemical that further dehydrates the tooth, and inspect the appearance of the lesion. If needed, this process can be carried out two more times prior to placement of the infiltrant. The infiltrant resin should be allowed to sit for three minutes prior to air dispersion and light-curing for 40 seconds. The resin is highly fluid, so it accomplishes the goal of filling all micro gaps on the etched surfaces after enough time has passed. In some situations, it may be possible to do this process without anesthesia, but with rubber dam–clamping and the amount of acid exposure, I recommend anesthesia just to make sure the patient is comfortable. Sensitivity is possible after this procedure but typically only lasts for a few days or a week, like any other etch-and-bonding process. From a cosmetic standpoint, the goal of this procedure is to restore the natural preexisting and surrounding enamel but not dramatically alter the shade. The translucent resin has a similar refractive index to enamel and will match the base or stump shade of the tooth, so there is no shade selection involved. Though there will be some brightening due to elimination of stains through the etching and new resin placement, you should make sure to set expectations that this is not a traditional composite veneer. That being said, bonding additional layers of composite to this newly- and strongly-bonded surface is a simple transition to veneers. Each box treats three to five teeth, and they are packaged with two boxes in a mini kit and seven boxes in a standard kit. This review just discussed the clinical process of treating smooth accessible anterior tooth surfaces, but the interproximal kit is similar in style, other than utilizing barriers between the teeth. If you are searching for a way to reduce color discrepancy and restore teeth closer to their natural appearance in the most conservative fashion available, check out the Icon infiltration systems from DMG.
A Majestic New Flowable
Clearfil Majesty™ ES Flow Universal Kuraray kuraraydental.com
There are many flowable composites on the market, and it is worth knowing which ones work best in your hands. With continuous advances in chemistry that are allowing for simpler and more impressive optical transmission results, I think it’s worth continuing to try new materials. One such new material is the Clearfil Majesty™ ES Flow Universal from Kuraray. Using a filler particle that promises significant light-diffusion properties, this material accomplishes a range of approximately 16 Vita shades using only two shades: Universal (U) and Universal Dark (UD). If you want more shade range than that, Clearfil Majesty ES-2 is the company’s packable composite, and it adds the shades Universal Light (UL) and Universal White (UW). Clearfil Majesty ES Flow Universal is a highviscosity composite with a consistency slightly runnier than honey, which is the density I personally look for in a flowable. It has a high filler-particle concentration of 78%, so it has fantastic wear properties. This is not meant to be a bulk-fill material, and the fillers limit the depth of cure to two millimeters, so incremental layering is important for more reasons than just reducing configuration factor forces. As with most composites, the wavelength for curing is between 400 and 515 nanometers, with peak curing around 450 nm. The filler concentration also results in a slow self-leveling process, which makes building anatomical details like cusps a simple process. It has a high gloss immediately after curing, so it is nice to be able to just build it and leave it; however, if you do need to adjust it or remove the oxygen-inhibited layer, you can achieve an even higher level of shine with a composite polishing kit. I was impressed with Clearfil Majesty, and I think that you will be, too.
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