AGD Impact
The Role of Compassion in Healthcare
By Maggie Augustyn, DDS
Knowing more about patients and relating to them on a universal level can open a window into understanding why they get sick and how dentists’ proposed treatments can best be presented. AGD Impact Wellness columnist Maggie Augustyn, DDS, encourages dentists to understand the impact of the human connection they have with each other and their patients.
Self-Instruction article, 1 CE credit
Frenectomies in the General Dental Practice
By William S. Bike
Frena — tissues that connect lips to gums and the tongue to the floor of the mouth — support both the lips and the tongue. But if frena interfere with function and the tongue’s range of motion, is a frenectomy warranted?
Three Firsthand Accounts: Perspectives from AGD2024
This past July, general dentists gathered in Minneapolis, Minnesota, for AGD2024. AGD Impact spoke with three dentists who attended the meeting to hear their most exciting highlights.
Efficiency at Any Cost? A Tale of McDonald’s and Chick-fil-A
Can dentistry learn anything by looking at the fast-food industry?
In dentistry, we can define efficiency as the ability to avoid wasting materials, time and energy. The fast-food industry may have a similar definition of efficiency, but what happens when it is taken too far? I recently visited my local McDonald’s and Chick-fil-A restaurants and gauged their very different approaches to customer service.
The McDonald’s location had recently been torn down and rebuilt from the ground up in just six weeks. The new facility is sleek, modern and clean, and more comfortable than the previous iteration. Next to the counter are self-service kiosks that I used to order and pay. Of course, the option to “upsize” my order popped up my screen, but it sure seems I would have ordered the larger size from the beginning if that was what I wanted. My order was waiting for me when I walked a few feet to the counter. I experienced no human interaction; even the person who put my order on the counter did not speak, and he disappeared as rapidly as he appeared. The brain trust at corporate McDonald’s is to be commended for its goal of achieving ultra efficiency.
In stark contrast, my visit to Chick-fil-A began with a person warmly greeting me at the door and pointing me to the long line of people ahead of me. As he escorted me, he assured me the line would move quickly, and he politely asked if I knew what meal he could begin preparing for me. He entered the information on his tablet, took my name and payment, and estimated my meal would be ready in three minutes. To my surprise, another worker approached me with my meal on a tray and asked, “Bruce, where would you like to sit?” It could have been the worst meal I ever had, but the service completely overwhelmed me, making for a morethan-pleasant experience. Efficiency with a perk of extreme service.
Is efficiency more important than the patient experience? The unintended consequences in your office may show up in your numbers. Back to the fast-food market — the average annual
sales at a standalone Chick-fil-A is $9.4 million, compared to a McDonald’s at $3.7 million — and that’s comparing the six-day work week of Chick-fil-A to the sevenday work week of McDonald’s. Customer service can be a competitive and financial advantage in many industries, including service-oriented healthcare (and dentistry in particular).
As AGD dentists, we are well trained in the technical aspects of providing quality dentistry. You may think that speed of delivery and cost are all that matter to effect efficiency, but consider how the human interactions at your office impact how patients view your practice.
John R. DiJulius III, author of “The Customer Service Revolution: Overthrow Conventional Business, Inspire Employees, and Change the World,” points out that 85% of our human interaction has been replaced by tools such as ATMs, self-serve gas pumps, websites and apps. Patients coming to your practice expect human interaction, which is part of the 15% that remains in our daily lives. And because they’re choosing your practice over all the other dentists in town, you’d better make sure that the interactions they receive — from the first scheduling phone call to the moment they walk out the door — are all top-notch.
Consider this: Efficiency in the business of dentistry is essential to maintain profitability, but taking efficiency to extremes will impact your profitability. There is a happy medium that will explode your profitability, and the answer is creating the ultimate patient experience. How do your patients feel at the end of their encounter?
Disclaimer: I have no financial interest in any fast-food restaurant, although I do have special feelings for Mickey D’s because they provided my supper for three years in undergraduate school, and everybody there knew me by name.
Bruce L. Cassis, DDS, MAGD Associate Editor
Editor
Timothy F. Kosinski, DDS, MAGD
Associate Editor
Bruce L. Cassis, DDS, MAGD
Director, Communications
Kristin S. Gover, CAE
Executive Editor
Tiffany Nicole Slade, MFA
Managing Editor Leland Humbertson, MA
Associate Editor
Caitlin Davis
Manager, Production/Design Tim Henney
Graphic Designers
Robert Ajami Eric Grawe
Academy of General Dentistry 560 W. Lake St., Sixth Floor Chicago, IL 60661-6600
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Letters to the Editor
On “Dental Implant Marketing Is Different, and Here’s How to Do it Right” by Jackie Ulasewich Cullen in AGD Impact, July 2024
I am certain the author has some very well-intentioned advice. The article is well written.
What I find woefully disturbing and disheartening is the lack of encouragement for practitioners to seek the highest levels of continuing education in order to provide the best possible services (surgical and/or restorative) for long-term success. Nondental dental experts hide behind an assumption that all dentists are “qualified,” thus justifying their own “area of expertise.” All too often, enhanced dental education necessity is underemphasized or neglected entirely!
Impact, July 2024
I wanted to express my gratitude for the insightful article addressing the challenges many international dentists face. As someone who has personally navigated these obstacles, I found the piece particularly relatable and impactful.
I am proud to share that my American dream has come true. My son, Dr. Chethan Chetty, has followed in my footsteps and become a successful dentist. I am immensely proud to say he will soon be serving as the incoming president of AGD.
Thank you again for shedding light on this critical topic.
R. K. Chetty, DDS
Long-term comfort, proper oral function and retention success are far and away the most effective marketing tools available to any dental practice.
I am writing as a very longtime clinical practitioner and educator. I truly worry about the future of dental care. The focus on high-tech procedures and stronger materials with a lack of emphasis on interpersonal relationships and a host of other “subjects” at the expense of teaching core fundamental principles is a terrible sacrifice by many, if not most, dental schools’ curricula. Our dental students and their future patients are being severely cheated.
The answers lie in a return to teaching the fundamentals that made American dentistry the best in the world, with less reliance on nondental dental experts, influencers, and research for the sake of research without regard for use or consequence.
Today’s environment begs for a certain level of marketing. However, delivering comfortable, well-functioning dentistry is far and away the best and most rewarding advertisement available to any dental practice.
Joseph F. Perry, DDS
On “Chronicling the Paths of Internationally Educated Dentists” by Carrie Pallardy in AGD
AGD
Dental Practice Advocacy
AGD Files NIH Reform Comment
By Jeanie Kennedy, Manager, AGD Dental Practice and Policy
On Aug. 16, AGD responded to the House Energy and Commerce Committee Proposal on National Institutes of Health (NIH) reform. The proposal is located at energycommerce.house. gov/posts/chair-rodgers-unveils-framework-for-nih-reformrequests-stakeholder-input
In the NIH framework document, the committee proposed to consolidate the National Institute of Dental Craniofacial Research (NIDCR) into a new institute named the National Institute on Neuroscience and Brain Research that would contain NIDCR, the National Eye Institute and the National Institute of Neurological Disorders and Stroke.
AGD opposed streamlining the existing 27 institutes into the proposed 15 institutes. AGD did not support the proposed consolidation due to concerns that the new agency would not provide appropriate attention to research into our nation’s oral healthcare needs.
The Energy and Commerce Committee recommends:
• Ensure grant recipients remain dynamic.
• Require that research is credible, reliable and timely.
• Continue prohibition of risky gain-of-function research.
• Establish independent review entity for the National Institute of Allergy and Infectious Diseases.
• Demand accountability from grantees.
• Support independent community review oversight boards.
• Mandate foreign grant reporting.
• Incorporate a national security review.
• Prevent conflicts of interest.
• Empower agencies to suspend grants.
• Ensure appropriate oversight of animal research.
AGD stated that oversight is needed in medical research following the problematic response to the COVID-19 pandemic.
Constituents
Constituent Recognition Program
The Constituent Recognition Program’s (CRP’s) mission is to enhance the exposure and recognition of constituent successes and efforts throughout the year
Congress can ensure that oversight authority is enforced and appropriations are provided to make funding conditional on adherence of the grant contractual metrics. AGD specifically targeted long COVID-19 and gain-of-function research as areas needing improvement. To access the letter, go to agd.org/ advocacy/agd-priorities/advocacy-center.
Advocacy
AGD Attends Two Important Legislative Meetings
AGD exhibited at both the American Legislative Exchange Council (ALEC) and the National Conference of State Legislatures (NCSL) over the summer. ALEC and NCSL bring together state legislators from around the country to discuss important issues and speak with organizations like AGD.
At ALEC, AGD staff spoke to scores of legislators about AGD’s policy on dental therapy, issues dentists have with insurers and the importance of community water fluoridation. Gordon R. Isbell III, DMD, MAGD, AGD’s representative to the ALEC’s Health and Human Services Task Force, spoke forcefully during the task force meeting against a proposed model policy in favor of dental therapy. The proposal was sponsored by the chair of the task force and unfortunately passed by one vote. AGD will urge the ALEC board to oppose the policy.
Richard A. Huot, DDS, FAGD, chair of AGD’s Legislative & Governmental Affairs Council, attended NCSL and spoke with legislators about how state governments can address the dental workforce issues affecting general dentistry. ABC political commentator Donna Brazille thanked AGD for providing attendees with travel toothbrushes to stress the importance of oral health. AGD’s booth was situated with the booths of the American Academy of Pediatric Dentistry and the American Dental Association in “Dental Row.”
These meetings raise awareness of AGD in the state legislative arena and provide an opportunity for AGD to bring to policymakers’ attention the important issues that are affecting general dentists’ practices in all 50 states.
via AGD meetings, newsletters, local constituent meetings/events and other platforms to highlight the great initiatives of constituents at the grassroots level.
The committee recently recognized two individuals:
Maj. Austin Fluke, DDS, served as the director for the first-ever Region 17 MasterTrack continuing education (CE) program, which was held in San Antonio, Texas, May 13–17. There were 28 participants in attendance across the Army, Navy, Air Force and Public Service divisions, with some members coming from overseas assignments. The course provided up to 39 hours of lecture and participation CE hours and featured 15 different speakers.
Matthew R. Serbousek, DMD, of Region 10 brought a new energy and excitement to the board and focused on the MasterTrack course selection process. He served as president of the Nebraska AGD board and held the board together during the COVID-19 pandemic. He was also active in advocacy and, when asked, stepped up to serve a second term when the president-elect stepped away from the board.
The CRP committee members are: Amar Kosaraju, DMD, FAGD, chair; Thomas St. Germain, DDS, FAGD; Colleen B. DeLacy, DDS, MAGD; Brenden D. Moon, DMD, MAGD; Tyler L. Scott, DDS, FAGD; Raymond J. Johnson, DMD, MAGD, regional director chair-elect; and Narpat S. Jain, DMD, MAGD.
Maj. Austin Fluke, DDS Matthew R. Serbousek, DMD
Meet the Candidates for the 2024–2025 Executive Committee
Candidate for Vice President:
George J. Schmidt, DMD, FAGD
A New Jersey native, George J. Schmidt, DMD, FAGD, has practiced in the Hanover Township, New Jersey, area since 1998. Schmidt attended Fairleigh Dickinson University, where he graduated summa cum laude with a degree in biology. He received his DMD from the University of Medicine and Dentistry of New Jersey.
In graduate school, Schmidt received numerous academic and patient care awards, including induction into the prestigious OKU dental society, of which he later became component president. Schmidt served as class president and was later elected president of the Student Government Association, representing the entire student body, which numbered over 400.
After receiving his dental degree, Schmidt completed a three-year continuum in the surgical placement of dental implants at the New York University (NYU) College of Dentistry and remained on staff as a clinical associate for an additional year. He
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has been awarded Fellowship status in AGD as well as in the International Congress of Oral Implantologists.
In addition to private practice, Schmidt serves as a trustee of the AGD Foundation. He is an adjunct clinical assistant professor and surgical director in the implant continuing dental education department at the NYU College of Dentistry. He serves as an adjunct clinical assistant professor at Rutgers School of Dental Medicine in the department of diagnostic sciences. He is the host of the AGD Podcast Series, is active with AGD and lectures nationally on various topics in dentistry. He and his wife, Robin, split their time between Florida and New Jersey and enjoy traveling, playing golf and spending time with family and their dog, Kobe.
Personal Statement
“AGD has an established reputation for education, advocacy and camaraderie. These tenets are our mission. Today, we face challenges threatening our core beliefs. Membership issues, increased competition in the education space and legislative pressures confront us. It’s my mission to face these threats with leadership, vision and passion. I will ensure these tenets remain vital and durable as we move forward.
“Make no mistake, the education landscape is changing. Courses and content are available at our fingertips. Education that is timely, succinct and well-developed is just a click away. Attention spans are short, and our consumers want on-demand education. We must stay focused and continue to refine our products, messages and modes of delivery. We have taken a
big step toward maintaining our position as the market leader with our recent introduction of microeducation opportunities and the refinement of our educational foundation. These efforts must continue to evolve and expand.
“We must continue advancing our advocacy efforts to expand our representation on behalf of the general dentist. Working at the national level is critical, but, more importantly, we must expand grassroots advocacy efforts at the regional and state levels. I will ensure that AGD increases the guidance, support and training necessary to accomplish advocacy results valuable to practicing dentists.
“We pride ourselves on being a group of like-minded professionals who strive to be the best we can be. This mindset fosters a sense of camaraderie that is woven deeply into the fabric of our culture and organization. We cannot ignore the threatening membership challenges we face. It’s not enough to justify this as a generational dilemma. We need increased engagement. We need to influence, underscore and promote the value of all we do. We need to realize that our younger members want less traditional ways to participate. We need to create and provide the appropriate forums and media outlets that can accomplish this.
“The road ahead is tough and not without challenges. However, our future is bright. Working together, we will change these challenges into opportunities, and we will use these opportunities for the betterment of our profession. In the coming months, I look forward to listening to you as we work to secure our future.”
pride ourselves on being a group of like-minded professionals who strive to be the best we can be. This mindset fosters a sense of camaraderie that is woven deeply into the fabric of our culture and organization. We need to influence, underscore and promote the value of all we do.”
Candidate for Treasurer:
Joseph A. Picone, DMD, MAGD
Joseph A. Picone, DMD, MAGD, current AGD treasurer, has been active in organized dentistry at both local and national levels for more than 36 years. His AGD involvement includes serving as Region 1 regional director from 2019 to 2022 and chairing the Scientific Meeting Council for four years. He has been treasurer of AGD since 2022. He is also active in the American Dental Association, having served as a delegate and alternate delegate at the national level. He also served as Continuing Education Council chair and Finance Committee member of the Connecticut State Dental Association. Additionally, Picone is an AGD Master and has received two AGD Presidential Awards (2017, 2021). He maintains fellowships in the American College of Dentists, the International College of Dentists and the Pierre Fauchard Academy.
Personal Statement
“Without question, membership in AGD has made me a better practitioner, allowed me to grow as a leader, and provided a ‘professional home base’ where I’ve established lifelong personal friendships with colleagues from across the continent. I remain deeply grateful for the many ways AGD has shaped my world both personally and professionally.
“Serving as your treasurer these past two years has been an honor and a privilege. I take pride in the progress we’ve made together, and I hope to continue the positive trajectory we’ve established. One of the major steps we’ve taken during my tenure is to improve our forecasting method used for dues revenue projection. For the AGD delegate, this allows for a clearer, more meaningful financial interpretation when tasked with approving the annual budget at the House of Delegates annual meeting. This is just one example of how a commonsense approach to budget and finance can favorably impact both the fiscal health of AGD and the hard-working volunteers of our organization.
“Looking forward, I remain committed to increasing nondues revenue to ensure our organization’s long-term stability and growth. By diversifying income through sponsorships, partnerships and innovative member services, we reduce our reliance on dues while enhancing member value. This approach strengthens our financial foundation and allows for greater investment in member benefits, education and advocacy efforts.
“A strong, engaged base is essential for
AGD’s continued influence and relevance. Therefore, increasing our membership must always remain a key priority. In my view, this requires improving outreach, offering valuable resources and fostering a welcoming community. As your treasurer, I will continue my efforts to seek, support and help implement initiatives that advance this goal.
“While the mission and direction of AGD are driven solely by its members, the AGD staff are there to execute the plan. Our staff ensures the effective operation of AGD programs and services, and they deliver on the promises we make to our members. I’m proud of our staff and the collaborative environment that exists today. I fully expect that, together, we will continue to deliver the quality service and products our members deserve.
“My experience and background in budgeting and finance, coupled with my deep understanding of our organization’s needs, uniquely position me to continue making a positive impact on the financial health and strategic planning of our organization. I am firm in my belief that AGD can more clearly define its role and become an indispensable factor in the professional life of the successful general dentist. With your support, I hope to build on the successes of these past two years with the same energy and commitment to a responsive, collaborative and creative approach to problem-solving.
“I humbly ask you for the opportunity to serve a second term as your AGD treasurer, and I am excited about the possibilities that lie ahead.”
“A strong, engaged base is essential for AGD’s continued influence and relevance. Therefore, increasing our membership must always remain a key priority. In my view, this requires improving outreach, offering valuable resources and fostering a welcoming community.”
Marketing Revealing Your Practice’s Personality Through Digital Marketing
Adapting to Changing Patient Attitudes Toward Dental Care
By Jackie Ulasewich Cullen
In the modern world, consumers refuse to settle for anything less than the best service. We’re more educated than ever and have copious reliable resources at our fingertips. What’s more, in some practices, you might have noticed patients are not afraid to advocate for themselves, and they feel no obligation to return somewhere they believe provides an unsatisfactory experience. If the doctor refuses to listen to them, the support staff is unfriendly or the atmosphere is cold, they have no problem moving on. Today’s dental patients want more than a dentist who will work on their teeth. They want a dentist with whom they can build a relationship. Consequently, the more traditional, exclusively clinical approach that dentists have historically taken no longer works. With this new consumer attitude toward optimal experiences, dental practices must adapt their clinical approach and foster a different kind of reputation to attract and keep patients.
The Problem
Patients make decisions not based solely on facts and needs, but also feelings. Historically speaking, dental practices have not had to prioritize patients’ feelings to keep growing. As information has become more widely available and patients become more educated about their health, the criteria for choosing a dentist have changed, with nonclinical factors like customer service and overall patient experience becoming increasingly important.
The Solution
Digital marketing offers a unique opportunity to reveal the personal side of dentistry. Your practice’s online presence can play a huge role in making an emotional connection with prospective and existing patients. For example, if your practice’s website is filled with generic images, stock photos, technical descriptions and a list of the doctor’s qualifications, it will seem cold and impersonal. In contrast, a website featuring descriptions that emphasize the benefits of your services, pictures of the doctors and team members, patient beforeand-after photographs, testimonials, and reviews will feel warm and inviting. Having an active blog, social media profiles, a YouTube channel and a complete Google Business Profile presents a more engaging and approachable image than simply having a website that links to third-party resources.
What Kind of Image Do You Want Your Digital Marketing to Project?
When presented with two comparable dental practices offering equivalent services, a patient will choose the one that resonates with them emotionally. By taking advantage of your current digital marketing channels, you can easily tip the scales in your favor by following three key principles:
1. Humanize the doctors at the practice. Patients assume a dentist will be qualified, but that’s not all they need. They want to get a sense of the person behind the expertise. Sharing stories, videos and images that show the dentist engaging with patients and doing
activities other than dental procedures breaks down barriers and builds trust. There is no need to reveal details about anyone’s personal life. It can be as simple as a social media post sharing what you and your team are having for lunch — it may not seem impactful, but, on a sociological level, it reinforces that you are human just like everyone else. Small things like a photo of the doctor shaking hands with a patient make them more relatable. Highlighting community events and charity work, or even sharing facts about the dentist’s professional journey, add value that clinical imagery and research simply cannot.
2. Build relationships outside the practice. You know there’s more to dentistry than performing procedures, but your patients may need a reminder. Making this side of the practice public encourages patients to engage with it on a more personal level. Regularly sending educational emails, creating social media posts and posting videos create a connection that extends beyond the office. Sharing patient success stories, community involvement and lighthearted moments shows the different sides of the dental field. For instance, a blog post featuring a patient’s journey from consultation to smile transformation and linking to their video testimonial is incredibly compelling. The practice can also use social media to celebrate team member anniversaries, feature five-star patient reviews, and share some dental humor to foster a sense of community and keep the practice in patients’ thoughts.
3. Be real and vulnerable. It’s no longer enough to post a picture of the dentist in their crisp, white coat alongside their list of credentials. Today’s patients want a dentist to be empathetic and genuinely interested in their well-being. They appreciate authenticity and transparency. In response, the practice, and especially the dentist, needs to show a sensitive side. Sharing challenges, triumphs and even the occasional silly picture signals that your practice’s doctors and team members are like everyone else. A story about a challenging case and how the entire team worked together to give the patient their dream smile or a humorous anecdote about life as a dental professional gives patients a glimpse into the practice’s reality. Patient testimonials that speak to the compassionate care reinforce the “patient-first” image.
Dental practices are beginning to understand that patients want more than quality dental care from their dentist. They also want familiarity and trust. By using digital marketing to showcase your practice’s personality and humanize the doctor, building relationships outside the practice through engaging content, and being authentic, you create an inviting and relatable image that will resonate with more patients. A personal approach to marketing your practice will not only set it apart from others, but also foster a loyal patient base that feels genuinely connected to your team. ♦
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
Dr. Asthana Hits All the Right Notes to Help Patients
Sam Asthana, DDS, FAGD, is a lot of things. He is president of the Houston AGD; a member of national AGD’s New Dentist, Resident and Student Council; a husband; and a practicing general dentist in the Houston, Texas, area. His commitment to advancing the profession through organized dentistry and continuing education certainly makes him stand out, but there is another major quality that differentiates him from his colleagues — Asthana was trained as a classical musician before entering the field of dental health, and, as a dentist, he takes a special interest in musicians’ oral health issues. He seeks to deepen the conversation between wind musicians and oral health professionals by lecturing on the topic and encouraging discourse. AGD Impact spoke with him about this unique professional interest.
AGD Impact: What inspired you to become a dentist? Why did you switch from music to dentistry?
Asthana: I’m not from a family of dentists, and I really didn’t know much about dentistry before dental school. My childhood dentist (Dr. Isabel Vahedi) actually suggested dentistry to me, and I knew from watching her work that it was a good fit for a people person like me. I studied classical music performance in college, and I found the transition from music to dentistry to be very natural; both fields are essentially craftwork, which is a unique type of job that takes self-analysis skills, the ability to take and process criticism, discipline to practice, and a careful navigation of one’s personal relationship with perfectionism.
On top of that, I really believe that every dentist is a performer, and we all have to put on certain acts or faces with our patients — and even our team members — every day. I am so grateful to have a background in studying the craft of performing to prepare for the constant song-and-dance every dentist has to do.
The actual path from music to dentistry was very smooth. While I studied music, I also took the necessary coursework to apply to dental school. I honestly think that dental
schools look more favorably on applicants who stand out in the pile of applications and who have interesting answers to interview questions. While in dental school, I continued to use my music training and was able to teach private saxophone lessons in San Antonio, Texas, perform with local chamber groups, and work at summer music camps for high school students. It was a great source of extra spending money during school.
What unique dental concerns do wind musicians have? How do you make this population a clinical focus in your practice? Wind musicians are basically fighting a ticking clock leading to myofascial and joint problems. They have to do what we as dentists consider “parafunction” every day, for hours a day. Honestly, dentists and musicians are very similar in that we all tend to prioritize delivering a great product over protecting our own bodies, and, in the same ways that dentists develop chronic pain and dysfunction from poor ergonomics (guilty!), musicians develop orofacial pain pretty regularly. Some even retire from their field because of this.
Helping wind musicians manage this “occupational hazard” is rooted in educating them and helping them to understand their own anatomy. Often, musicians think their dentist will just tell them “play less, wear a guard and eat soft food.” In reality, we can all help the musicians in
our communities by working with them to review their practice habits and timing, getting them to incorporate stretching exercises into their routines, and teaching them better overall postural health. With some patients, I discuss specific performance practice modifications they can make regarding how they position their jaw while they play. Beyond that, all of the things we do for every patient with muscle and joint pain — habit modification, splint therapy, photobiomodulation, etc. — will help musicians as well.
I have felt very honored to speak on musicians’ oral health with groups such as the International Saxophone Academy, chapters of the North American Saxophone Alliance and more. I also love to meet with student musicians, as I was a college music student when I first started experiencing jaw pain. Texas A&M International had me speak with a studio of music students, and I’ll be lecturing at my alma mater, Baylor University, this fall as part of its Musician’s Health Series.
What led you to organized dentistry, and what led you to get involved in leadership roles?
I found my way to organized dentistry within the first few days of dental school through no hard work on my part. The International College of Dentists has a great mentoring program called Great Expectations, which is aimed at dental
A still from one of Dr. Asthana’s videos.
students, and my dental school in San Antonio had us all attend a first session. I was paired up with Dr. Akshay Thusu, who immediately became a good friend and a bit of a role model. Akshay is very involved with AGD and is an AGD Fellow, and, through him, I met a lot of other dentists in San Antonio and across Texas who frankly seemed to enjoy being dentists more than other dentists I met. When I realized that all of the AGD dentists I met seemed to be happier, more excited about their lives and more confident as clinicians than non-AGD dentists, it was very easy to decide to get involved with AGD. I have never once regretted that choice.
I wish I knew what led me to get involved in leadership roles. I just keep finding myself in them by accident! I think when you really see the value in something and appreciate what it does for you, you can’t help but want to take care of it and help it grow. Currently, I’m president of Houston AGD, and my involvement is due to how inspired I have been by all the other doctors involved in the group who constantly push me to be a better version of myself. Plus, I’ve made so many friends in Houston AGD, so the time commitment that comes from serving in leadership positions feels more like friend time rather than work.
When did you begin pursuing your AGD Fellowship, and do you have any other major goals on the horizon?
In my first semester of dental school, I had to interview a professor about his career journey. I interviewed our orofacial pain professor at San Antonio, Dr. Ed Wright (who just retired), and he cited his AGD Fellowship as one of his proudest achievements. He strongly suggested I make it a priority for myself after school. I took his suggestion to heart, and I’m really excited about and proud of having received my FAGD this past summer. I’ve realized that Fellowship itself is just the result; the journey of progressing toward it is what has really made me a better, more trustworthy and more confident dentist. It has also given me lots of cool experiences revolving around continuing education in the last few years, and it has pushed me to make a bunch of new dentist friends as well.
I’ve got two big goals on the horizon. One is earning my AGD Mastership, and I’ve already started attending Texas AGD’s MasterTrack program. The second is working on starting my own dental practice in Houston. My wife and I have been planning a startup for a while. We just signed a lease, so we’re entering the buildout process.
“Each of us has something that makes us special and unique; leaning into those qualities should be prioritized, even if it doesn’t seem immediately practical.”
What advice do you have for other dentists on how to incorporate their own special interests into their practices?
Nothing I do regarding musicians’ health makes any meaningful money for me as a dentist. However, it makes me happy, gives me a little extra purpose and helps me build relationships with my community. Patients who aren’t musicians still get excited when they learn about my background in music and my work with musicians’ health, not because it’s relevant to them but because it’s a chance for them to learn something new and different about me. Each of us has something that makes us special and unique in the eyes of our families, our communities and our patients; leaning into those qualities should be prioritized, even if it doesn’t seem immediately practical. Anything that keeps us fulfilled, sane and at peace will keep us happy practicing dentistry longer!
Do you play music in any groups?
My wife is a flutist and an actual professional (unlike me, someone who is drifting further and further into “has-been” territory). She plays with several orchestras and chamber groups, but she saves some time in her busy schedule to plan some projects with me, too! We’ve been working on some flute and saxophone duos, focusing on works written by living composers, and hopefully we can put on a recital in Houston soon. ♦
Dr. Asthana (second from right) performing a concerto with the San Antonio Saxophone Quartet and the Heart of Texas Concert Band.
The Role of Compassion in Healthcare
By Maggie Augustyn, DDS
Narrative writing is a more humanized form of documentation, wherein the ideas of empathy, active listening and lived experience are viewed equally to scientific expertise.1 In healthcare, it is hypothesized that implementing narrative writing is a way of humanizing the role of a provider. 2 It brings about a capacity to “recognize, absorb and metabolize, interpret and be moved by stories.” 3 In this article, I will take a narrative approach — introducing examples of my own life and my own struggles — to drive home the idea that we must change the way we view the doctor-patient relationship. Instead of an authority figure treating a sick person, we must think of the healthcare relationship as one human being caring for another. Changing our perspective will result not only in better patient care but also better provider mental health.
I hope to inspire dentists to reach out and learn more about the ways patients lead their lives, what drives them, whom they love and why they struggle. Knowing more about our patients and relating to them on a universal level can open a window into understanding why they get sick and how our proposed treatment can best be presented. My ambition is to allow us dentists to understand the impact of the human connection on each other and our patients.
The Parsons Model
Seasoned dentists with decades more experience than I introduced to me a certain model of providership. I was mentored to be the kind of dentist who always presented herself in a white coat, stood up straight, was stoic and showed only a mild amount of emotion. Above all, I was to appear educated. Explanations to patients were to be scientific in nature. This would make the patient aware of the vast knowledge and experience that I, the dentist, had gathered. And this is how I offered myself to many of my patients for more than a decade, a neatly starched white coat always in tow.
Unbeknownst to me, I was following a very outdated model introduced in 1951 by
“The teachings of my senior mentor left me arrogant and unkind in the perception of my patients, and I have the Yelp reviews to prove it. I can’t blame my predecessors for misteaching me or giving me faulty advice. It’s how they’d been trained, and, having made them successful, it wasn’t something worth challenging.”
Talcott Parsons, who talked about the “sick role” of a patient, as well as their obligations, rights and representations.4 As Parsons defined the characteristics of a sick person, he also made a point to outline the rights and obligations of “the doctor.” There was status and reward owed to “the doctor” as a way to encourage future individuals to suffer through the long years of training. Parsons believed that doctors were authority figures — trained experts in the field and gatekeepers between those who were labeled “healthy” or “sick.” He also specified that each provider had an obligation to be not just objective, but also emotionally detached from the patient. Empathy or compassion toward patients was frowned upon, partly because that type of display made the physician less of an authority and not in control of the relationship.
Years after Parsons’ theories, French philosopher Michel Foucault agreed that society continues to elevate the status of a health practitioner above the patient due to an inequality of knowledge, creating a power misperception. 5
A 2021 article on postoperative care in surgery warned that “[physicians] should be aware of the significant potential for knowledge deficits among their patients and should make specific efforts to identify and correct those deficits.”6
The vast space between physician and patient continues to be evident in popular culture. In “Grey’s Anatomy,” a
television show running 20 seasons, the concept of separating provider from patient is used in training fictitious doctors. A seasoned mentor advises young Meredith Grey that “when giving the patient bad news, you have to be polite and detached but not cold. You show that you care without actually allowing yourself to care.” 7 Part of this could be understood to serve as a self-protective measure against the turmoil of watching other humans suffer, but it is still taught. Doctors, then, continue to practice withholding emotions like empathy because they feel less likely to feel blamed for the news — and to prevent themselves from facing their own mortality. 8
The teachings of my senior mentor left me arrogant and unkind in the perception of my patients, and I have the Yelp reviews to prove it. I can’t blame my predecessors for misteaching me or giving me faulty advice. It’s how they’d been trained, and, having made them successful, it wasn’t something worth challenging.
We know that levels of empathy are highest in the first year of dental school and diminish in the years following, being lowest as the level of education increases into specialty programs.9 There is an array of reasons that can potentially explain this phenomenon. The greatest reduction occurs as dental students begin to practice on real patients. Some of the deflection in empathy might have to do with the realization that patients are not always willing to change their behaviors at the advice of the doctor.9 Their noncompliance can drive the provider to feel that, despite their training and years of education, their opinion simply isn’t valued. So why care for someone who doesn’t care back? Further, dental students focus greatly on graduation demands, as opposed to patients, protecting their selfinterests and years of study.9 We also know that education in dental school focuses more on procedures and scientific knowledge as opposed to social science. Patient-(pre)doctor relationships are not encouraged; camaraderie among peers is. With the amount of focus and attention it takes to get through clinical training, the mind often doesn’t have the capacity to focus on anything other than passing boards and gaining a license.10
What disturbs me most is that the imbalance between provider and patient, as I was taught to follow, leaves patients confused and unable to understand their diagnoses.11,12 Patients feel intimidated, unable to ask the appropriate questions. They likely agree to treatment they don’t understand to either please the doctor or end an uncomfortable appointment. They may also altogether dismiss the treatment recommendation, putting their health in jeopardy.
The Parsons model would have definitely fallen out of favor with today’s crowd. The hundreds of thousands of women who have joined the workforce as doctors in the last several decades have had an opportunity to redefine
what truly matters in taking care of patients. We have made space for skills that were previously thought of as “soft skills.” It’s our movement — the Women’s Rights Movement — that might have bridged the gap initially observed and defined in the 1950s. It likely is what has allowed me to step outside of the advice and mentorship I’d been offered upon graduation. Before, it was not uncommon to misconstrue traits such as kindness, compassion, empathy and trust as indicators of vulnerability and weakness. Today, we understand and accept that expressing compassion and thoughtful consideration underscores an individual’s adeptness at navigating complex interpersonal dynamics and fostering a nurturing environment. An empathetic provider, deeply attuned to the emotional currents and well-being of others, is uniquely positioned to discern and dismantle barriers by keenly sensing the internal experiences of those within their care. By cultivating an atmosphere of psychological safety wherein individuals feel empowered to voice their ailments, the “soft” provider not only enhances mutual understanding but also fortifies collective resilience, leading to a more cohesive and harmonious community.
Reevaluating the Provider-Patient Relationship
When power imbalances between patient and dentist are removed, a newly facilitated communication allows the patient to disclose past experiences and preferences in treatment and can also increase compliance with treatment. Though ostracized by mentoring practitioners, I share a lot about myself with my patients. I step out of the role of gatekeeper between healthy and sick (as Parsons believed) and allow myself to become human in their eyes. I humanize myself by talking to them about my daughter and husband, my own health struggles, and even the disproportionally large amount of dental work in my mouth. And, though warned by those same seasoned practitioners that sharing my experiences with depression would have a debilitating effect on my career, it has done just the opposite. Patients are able to visualize me in a different dimension. I can empathize with their fears and insecurities. Often, it’s my own story that puts them at ease. The previously seen gap of status and education disappears in the operatory. What comes to light is one human, who is skilled to do so, taking care of another. An example of this would be my personal disclosure of anxiety as I’m facing a patient with an elevated heartbeat and labored breathing. It is during an onset of that patient’s panic attack that I hold their hand, face them directly and make prolonged eye contact. I gently and slowly repeat as often as I need to: “I get it. I have been here, too.”
That which allowed me to reexamine my own role within the Parsons model didn’t necessarily boil down to a single interaction. But it was a single interaction that sparked the
“In that moment, I was not taking care of the woman sitting in front of me, I was taking care of my grandmother. It was with that particular encounter that my heart fully opened to compassion and empathy, drawing a previously unfelt honor, service and fulfillment from the interaction.”
shedding of the above dynamic. Several years ago, I entered an operatory where an older Polish woman was suffering with a toothache. She was accompanied by her daughter, a woman who seemed to be close to my mother’s age. A transplant to this country myself, I moved to the United States at the age of 14, leaving behind all my family and everything I’d known. I looked at the pained woman and was transported back to my old life. I felt myself back in the presence of my beloved grandmother, the kindest human I had known, someone whom I hadn’t seen in a decade, and, at that time, was nearing her end. In that moment, I was not taking care of the woman sitting in front of me, I was taking care of my grandmother. It was with that particular encounter that my heart fully opened to compassion and empathy, drawing a previously unfelt honor, service and fulfillment from the interaction.
Innate Characteristics of Prosocial Behavior
Most people believe that the presence of empathy and the ability to connect to another human, to offer help and guidance, are prosocial characteristics inherent only to humans. In a 2011 study, researchers found evidence that rats possess characteristics we previously thought were solely
“We are capable of sensing that which another is feeling, but only if we engage with them and make eye contact. And thus, if we only listen to our patients’ concerns and complaints, we miss messages that could be invaluable in treating the patient.”
reserved for humans.13 Rats cohabiting following two weeks of daily interaction were separated, with one of them being placed in a plexiglass cage. Within a week of the disunion, the freed rat learned to open the glass cage, via door, and free the caged mate. The free rat uncaged its companion regardless of reward. Furthermore, when given the choice between freeing a tasty treat or its rat companion, the free rat indiscriminately opened both doors. This study demonstrated that prosocial behavior is a phenomenon that may be present among many living beings. And, as such, it may be innate rather than learned. If we know that empathy and compassion are part of our evolutionary development, perhaps utilizing it in our daily lives and to the advantage of our patients will come easier than previously thought.
A 2012 Journal of the American Medical Association article described a child’s drawing of a doctor seated in front of a laptop while examining a patient, with no stethoscope or tongue depressor in sight.14 Unlike the drawings we saw years ago, this one showed the physician typing on a computer, looking away from a patient, a common occurrence today during our medical evaluations. This drawing also brought front and center the new reality that, as providers of any kind, we listen more to patients and look at them less. While we are multitasking, checking different
screens for images and tests, and scrolling through notes, we miss out on a very important aspect of human relationships or healing; we eliminate what scientists call neuron mirroring.
Neuroscientist Giacomo Rizzolatti, MD, with his colleagues at the University of Parma, were the first to discover neuron mirroring in the early 1990s.15,16 In this experiment, animals were attached to monitoring equipment, allowing scientists to examine which neurons fired and when.
During the course of the experiment, a scientist near one of the monkeys reached for a sandwich. Though the animal had not moved even a fraction of an inch, the computer recognized brain function within the animal. The same neurons fired within the monkey’s brain that would have fired had the monkey actually reached for the sandwich himself. Other studies have come to solidify this concept. For example, in a study of participants watching videos of subjects putting their hands in ice buckets, scientists found that the participants experienced a reduction in their own hand temperatures.17 We are capable of sensing that which another is feeling, but only if we engage with them and make eye contact. And thus, if we only listen to our patients’ concerns and complaints without looking at them, we miss messages that could be invaluable in treating the patient.
How Compassion Can Help the Practitioner
Now, the age-old question, a driving force for creating change: “What’s in it for me?” Burnout among healthcare professionals is very real.18 According to the latest literature, 80% of oral care providers are suffering.19 Burnout presents a hardship that can lead to job desertion, reducing the overall presence of healthcare providers in the field. We have seen and experienced that in dentistry after the COVID-19 pandemic. However, creating deep relationships with patients, though many of us were taught the opposite, can actually be healing not just for the patient, but also for the practitioner. That’s what is in it for you.
Many call it “helper’s high.” This concept first emerged in the 1980s and has been validated by numerous studies over the years, including some recent ones in 2021. 20 Surveys have shown that more than 70% of people experience a helper’s high when giving meaningful aid to those in need. 21 Seth Gillihan, PhD, a professor of psychology at the University of Pennsylvania, says, “Coming together (in compassion) works a sort of alchemy, transforming one person’s pain into a shared feeling of uplift.” 22
Giving meaningful help to others activates reward pathways in the brain, producing a profound sense of positive affect and a myriad of uplifting emotions. 23 One mechanism at play activates the parasympathetic nervous system by stimulating vagus nerve activity. This activation essentially produces a calming effect that counterbalances the fight-or-flight response governed by the sympathetic
nervous system. It allows for a profound engagement with empathy, illustrating how deeply our biological systems are intertwined with our capacity for compassion. 24
Another mechanism involves boosting circulating neuromodulators, such as oxytocin, which not only buffers stress but also evokes feelings of calm and closeness. This potent hormone, often dubbed the “love hormone,” underscores our instinctual drive, weaving a tapestry of emotional warmth and communal harmony that can profoundly impact our overall well-being. 25 Researchers, ergo, concluded that “helper’s high” is linked to better health and increased longevity. 26 Studies also show that practicing compassion reduces depression. 27 The beauty of compassion and empathy is that it truly comes full circle. As we engage deeper into the relationships with our patients, as we listen to them and heal them, as we take those extra few minutes to show concern, we also heal and thrive.
My hope is that, as we move to the next juncture in our evolution of dentistry, we not only focus on the strength of what technological or clinical advancements can bring to patient care, but also on humanizing the experience. A part of this will have to include holding each other accountable in conversations. I would encourage a paradigm shift away from the over-displayed doctor confidence and rushed appointments and transition instead to remembering that the mouth is attached to a human, a human like our mother, brother, best friend or child — a human who ought to be related to and inquired of, not just prescribed to.
I remember, as a young dentist, I was confused as to why my patients didn’t follow through with my proposed treatment. I assumed it was because I looked too young. Today, I know it had everything to do with the arrogance of entering the room as the authority, barking a treatment plan in their direction with little concern for the person in front of me. I might have been skilled in reviewing radiographs, evaluating periodontal conditions, and examining hard and soft tissues, but I was not skilled in showing compassion or prioritizing relationships. We will not be able to move our profession forward until we can unselfishly ask about others and genuinely care for them. And, just as important, we will not be able to recover from the unforgivingly difficult days as providers unless we emotionally connect to the patients in our care. The final prescription on all of this is quite simple. In the words of the Dalai Lama: “If you want others to be happy, practice compassion. If you want to be happy, practice compassion.” ♦
Maggie Augustyn, DDS, is a practicing general dentist, owner of Happy Tooth, faculty member at Productive Dentist Academy, author and inspirational speaker. She is also the AGD Impact Wellness columnist. To comment on this article, email impact@agd.org
References
1. Charon, Rita. “What to Do with Stories: The Sciences of Narrative Medicine.” Canadian Family Physician, vol. 53, no. 8, August 2007, pp. 1265-1267.
2. Quah, Elaine Li Ying, et al. “The Role of Patients’ Stories in Medicine: A Systematic Scoping Review.” BMC Palliative Care, vol. 22, no. 1, 12 Dec. 2023, article no. 199.
3. Vergnes, Jean-Noel, et al. “What About Narrative Dentistry?” Journal of the American Dental Association, vol. 146, no. 6, June 2015, pp. 398-401.
4. Parsons, Talcott. “Illness and the Role of the Physician: A Sociological Perspective.” American Journal of Orthopsychiatry, vol. 21, no. 3, 1951, pp. 452-460.
5. Foucault, Michel. The History of Sexuality Volume 1: An Introduction. New York, Vintage Books, 1978.
6. Jester, Adam, et al. “Do Patients Know Their Post-Operative Plan? A Prospective Cohort Study of Orthopaedic Trauma Patients at a Level I Trauma Center.” Injury, vol. 52, no. 6, June 2021, pp. 1370-1373.
7. “The Heart of the Matter.” Grey’s Anatomy, season 4, episode 4, ABC, 18 Oct. 2007.
8. Meier, Diane E., et al. “The Inner Life of Physicians and Care of the Seriously Ill.” Journal of the American Medical Association, vol. 286, no. 23, 19 Dec. 2001, pp. 3007-3014.
9. Sherman, Jeffrey J., and Adam Cramer. “Measurement of Changes in Empathy During Dental School.” Journal of Dental Education, vol. 69, no. 3, March 2005, pp. 338-345.
10. Narang, Ridhi, et al. “Empathy Among Dental Students: A Systematic Review of Literature.” Journal of Indian Society of Pedodontics and Preventive Dentistry, vol. 37, no. 4, Oct.–Dec. 2019, pp. 316-326.
11. Ley, Philip. Communicating with Patients, Improving Communication, Satisfaction and Compliance. London, Chapman and Hall, 1988.
12. Hadlow, Jan, and Marian Pitts. “The Understanding of Common Health Terms by Doctors, Nurses and Patients.” Social Science & Medicine, vol. 32, no. 2, 1991, pp. 193-196.
13. Bartal, Inbal Ben-Ami, et al. “Empathy and Pro-Social Behavior in Rats.” Science, vol. 334, no. 6061, 9 Dec. 2011, pp. 1427-1430.
14. Toll, Elizabeth. “A Piece of my Mind. The Cost of Technology.” Journal of the American Medical Association, vol. 307, no. 23, 2012, pp. 2497-2498.
15. di Pellegrino, G., et al. “Understanding Motor Events: A Neurophysiological Study.” Experimental Brain Research, vol. 91, no.1, 1992, pp. 176-180.
16. Gallese, V., et al. “Action Recognition in the Premotor Cortex.” Brain, vol. 119, pt. 2, April 1996, pp. 593-609.
17. Cooper, Ella A., et al. “You Turn Me Cold: Evidence for Temperature Contagion.” PLoS One, vol. 31, no. 9, 31 Dec. 2014, p. e116126.
18. Kane, Leslie. “‘I Cry but No One Cares’: Physician Burnout & Depression Report 2023.” Medscape, 27 Jan. 2023, medscape.com/2023-lifestyle-burnout. Accessed 24 July 2024.
19. “Identifying Strategies to Improve Oral Health Workforce Resilience.” Oral Health Workforce Research Center, 26 Sept. 2023, chwsny.org/our-work/reports-briefs/identifying-strategies-toimprove-oral-health-workforce-resilience/. Accessed 24 July 2024.
20. Lu, Caixia, et al. “A Way to Improve Adolescents’ Life Satisfaction: School Altruistic Group Games.” Frontiers in Psychology, vol. 12, 4 March 2021, p. 533603.
21. Luks, Allan. “Helper’s High.” Psychology Today, October 1988.
22. Gillihan, Seth J. “Why Does Compassion Feel So Good? Here Are Five Reasons.” Psychology Today, 1 Feb. 2018, psychologytoday.com/us/blog/think-act-be/201802/why-does-compassionfeel-so-good-here-are-five-reasons. Accessed 24 July 2024.
23. Shamay-Tsoory, Simone, and Claus Lamm. “The Neuroscience of Empathy — From Past to Present and Future.” Neuropsychologia, vol. 116, pt. A, 31 July 2018, pp. 1-4.
24. Stellar, Jennifer E., et al. “Affective and Physiological Responses to the Suffering of Others: Compassion and Vagal Activity.” Journal of Personality and Social Psychology, vol. 108, no. 4, April 2015, pp. 572-585.
25. Brown, Stephanie L., R. Michael Brown. “Connecting Prosocial Behavior to Improved Physical Health: Contributions from the Neurobiology of Parenting.” Neuroscience & Biobehavioral Reviews, vol. 55, Aug. 2015, pp. 1-17.
26. Dossey, Larry. “The Helper’s High.” Explore (NY), vol. 14, no. 6, Nov. 2018, pp. 393-399.
27. Mongrain, Myriam, et al. “Practicing Compassion Increases Happiness and Self-Esteem.” Journal of Happiness Studies: An Interdisciplinary Forum on Subjective Well-Being, vol. 12, no. 6, pp. 963-981.
Self-Instruction
Self-Improvement
(Subject Code: 770)
The 10 questions for this exercise are based on information presented in the article, “The Role of Compassion in Healthcare” by Maggie Augustyn, DDS, on pages 10–15. This exercise was developed by members of the AGD editorial team.
Reading the article and successfully completing the exercise will enable you to:
1. _____ writing is a more humanized form of documentation, wherein the ideas of empathy, active listening and lived experience are viewed equally to scientific expertise.
A. Biographical
B. Anecdotal
C. Narrative
D. Persuasive
2. The Parsons model of providership was introduced in 1951 by _____ Parsons.
A. Charles
B. Terence
C. Frederick
D. Talcott
3. In the Parsons model, Parsons outlined the role and obligation of “the doctor” to be an authority figure and gatekeeper between those who were labeled “healthy” or “sick.” He specified that each provider had an obligation to be not just objective, but also emotionally detached from the patient, because empathy or compassion toward patients made the physician less of an authority and not in control of the relationship.
A. Both statements are true.
B. The first statement is true; the second is false.
C. The first statement is false; the second is true.
D. Both statements are false.
4. Years after Parsons’ theories, French philosopher _____ agreed that society continues to elevate the status of a health practitioner above the patient due to an inequality of knowledge, creating a power misperception.
A. Gaston Bachelard
B. Michel Foucault
C. Albert Camus
D. Jean-Paul Sartre
• understand the history of how compassion between healthcare providers and patients has been regarded;
• recognize how compassion and empathy can be used to provide better, more comprehensive care for patients; and
• understand the biological benefits to healthcare providers of employing compassion.
This exercise can be purchased and answers submitted online at agd.org/self-instruction Answers for this exercise must be received by Sept. 30, 2025.
5. Levels of empathy are highest in the first year of dental school and diminish in the years following, being lowest as the level of education increases into specialty programs. Empathy levels spike in the third year, as dental students begin to practice on real patients, then drop as their education progresses.
A. Both statements are true.
B. The first statement is true; the second is false.
C. The first statement is false; the second is true.
D. Both statements are false.
6. A _____ study found evidence that _____ possess characteristics of empathy that we previously thought were solely reserved for humans, demonstrating that prosocial behavior is a phenomenon that may be present among many living beings and, as such, may be innate rather than learned.
A. 1996; mice
B. 2001; rabbits
C. 2006; pigs
D. 2011; rats
7. A _____ Journal of the American Medical Association article described a child’s drawing of a doctor seated in front of a laptop while examining a patient, with no stethoscope or tongue depressor in sight. This drawing brought front and center the new reality that, as providers of any kind, we listen more to patients and look at them less.
A. 2010
B. 2011
C. 2012
D. 2013
8. Neuroscientist _____, MD, along with his colleagues, were the first to discover neuron mirroring, which is our capability of sensing and feeling that which another is feeling, but only if we engage with them and make eye contact.
A. Giacomo Rizzolatti
B. Rita Levi-Montalcini
C. Maria Grazia Spillantini
D. Emilio Bizzi
9. The concept of “_____” first emerged in the 1980s and has been validated by numerous studies over the years, including some recent ones in 2021. Surveys have shown that more than _____% of people experience this feeling when giving meaningful aid to those in need.
A. companion celebration; 61
B. caregiver’s cheer; 64
C. team thrill; 67
D. helper’s high, 70
10. Giving meaningful help to others activates reward pathways in the brain. One example is when the _____ is stimulated, activating the parasympathetic nervous system. This activation essentially produces a calming effect that counterbalances the fight-or-flight response governed by the sympathetic nervous system, allowing for a profound engagement with empathy and illustrating how deeply our biological systems are intertwined with our capacity for compassion.
A. vagus nerve
B. thoracic splanchnic nerve
C. cardiopulmonary nerve
D. lumbar splanchnic nerve
Frenectomies in the General Dental Practice
By William S. Bike
Frena — tissues that connect lips to gums and the tongue to the floor of the mouth — support both the lips and the tongue.1
But if frena interfere with function and the tongue’s range of motion — a condition known as ankyloglossia, or tongue-tie2 — is a frenectomy warranted?
“Frenectomies get a bad name,” said Justin A. Welke, DDS, a pediatric dentist in private practice in Chicago, who said that some medical professionals “deem them to be unnecessary and unhelpful.”
However, having performed more than 3,000 frenectomies, Welke contends that “the procedure is life-changing.”
Jennifer A. Hathaway, DDS, FAGD, a general dentist in Bryan, Texas, has seen that firsthand.
Medical professionals believed that an 18-year-old patient of hers “was developmentally delayed,” Hathaway recalled. “But there wasn’t anything wrong with her brain. She could not speak because her tongue was tied.”
Top left: An example of a frenectomy performed by Dr. Baxter. Other photos are frenectomies performed by Dr. Hathaway.
“Since identifying and treating tongueand lip-ties are not taught in school, it’s imperative to receive training.”
Richard Baxter, DMD, MS
Sometimes, Hathaway noted, with frena that are “too high, tight or attached, newborn babies can’t nurse because that attachment doesn’t let them form a good seal, either on a bottle or on mom’s breast. If you don’t do the frenectomy, they literally can’t eat.”
Frenal Abnormalities
“When discussing frenal abnormalities, we are generally talking about a frenum that is too tight to allow full function of the tongue,” said Trace Favre, DDS, FAGD, a general dentist at Mississippi Dental Arts in Pass Christian, Mississippi. “When the tongue is not able to move properly, the patient may experience issues with sleeping, feeding, speech or several other related problems.”
Richard Baxter, DMD, MS, pediatric dentist owner of the Alabama Tongue-Tie Center in Pelham, Alabama, noted that “a restricted maxillary labial frenum can lead to a diastema or gap in the teeth as well as trouble brushing the teeth, leading to early childhood caries, and it can affect nasal breathing and B, P, M and W sounds. Restricted buccal frena and the mandibular labial frenum can lead to issues with gingival recession, denture retention and fascial tension.”
The American Academy of Pediatric Dentistry, American Association of Oral and Maxillofacial Surgeons, and American Association of Orthodontists all have guidelines and/or recommendations for their specialists about performing frenectomies.3-5 But Favre noted that general dentists, who sometimes may be wary of the procedure, should not be reluctant to perform frenectomies “with proper training.”
Karl R. Koerner, DDS, FAGD, founder of the Koerner Center for Surgical Instruction in Draper, Utah, calls the idea that pediatric dentists should be exclusively performing frenectomies “ridiculous” because frenal abnormalities “are common in adults and especially a problem with denture cases.”
Favre uses the Kotlow classification system to document the appearance of the frenum in infants and the tongue range of motion ratio (TRMR) in older children and adults. “The most important thing for general dentists is to be able to recognize when a frenum is too tight, and the TRMR is a great place to start.”
“The hardest age group to treat is from around six months to four years old, and that group is probably more manageable for a pediatric dentist to treat because those children are likely to bite down even when assessing,” Baxter said. “If a general dentist does not feel comfortable treating them, referral to a provider who can treat them early is better than leaving them with suboptimal function.”
“A frenectomy procedure on a child requires specialty training on the unique attributes of pediatric health and psychology,” Welke said. “But, for adult patients, general dentists can surely perform frenectomies once they have achieved proper training.”
Training
“Since identifying and treating tongue- and lip-ties are not taught in school, it’s imperative to receive training,” Baxter said, noting he created a course called Tongue-Tied Academy that provides “25 hours of master class–style video lessons and covers history, examination, diagnosis, treatment, research and business aspects.” He also wrote a book about frenectomies called “Tongue-Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding, and More.” Baxter donates the proceeds from the book and courses to local and global nonprofits related to clean water, anti–human trafficking efforts, health centers and poverty alleviation.
Koerner noted that frenectomy training is available “in most surgical extraction courses, any oral surgery training, and in most general practice and advanced education in general dentistry residencies.”
Favre recalled that he started his frenectomy training with a lecture and hands-on course by Baxter at an AGD meeting. He also spent a day with a frenectomy provider in a nearby city.
With no frenectomy training requirements at the state or federal levels, training is nonetheless crucial because “it’s essential so no patients are harmed and the best outcomes can be achieved,” Baxter added.
Frenectomy Modalities
Favre noted that various types of laser surgery are the most common way to perform the procedure among dentists, although some ear, nose and throat physicians (ENTs) “are still performing the procedure with scissors — but it is more than just a simple snip or clip. It takes several small cuts to achieve a proper release with a diamond-shaped wound.”
Koerner believes that frenectomies “can easily be done with a blade,” particularly since “only 15% of general practitioners have a laser.”
Laser advocates note that both diode and carbon dioxide (CO2) lasers are used in frenectomies. Welke prefers the latter because diode lasers “aren’t as precise as CO2 lasers, and they also cause more collateral damage to the tissue.”
The diode laser “is essentially a hot glass tip touched to the tissue to burn and cauterize it; it gets to 700°C–1,000°C,” Baxter said, noting that when he used the diode, “I could tell it was painful.” After switching to a CO 2 laser, “the procedures were faster” — 10–15 seconds per area as opposed to 60–90 seconds — “and I stopped getting phone calls at night about babies who wouldn’t nurse due to the pain. The CO 2 wavelength works better because the laser energy itself comes into contact with the water in the cells of the mucosa, and it vaporizes at 100°C instead of burning at 1,000°C.” He believes a CO 2 laser also offers excellent coagulation, “so it has the best blend of cutting efficiency and hemostasis.”
However, Hathaway noted that, for some practices, the diode laser may still be indicated because, “the CO2 laser is really expensive; that’s the biggest hangup,” she said. “There are pros and cons to both of them. Find whatever you’re comfortable with, but get good training through a certified course.”
Diode lasers cost around $3,000, and CO2 lasers are around $35,000, Welke noted. Before making that purchase, he suggested, “first attend a conference and do some hands-on
“Find whatever you're comfortable with, but get good training through a certified course.”
Jennifer A. Hathaway, DDS, FAGD
training. The American Laser Study Club offers excellent conferences and courses.”
Lebret et al. did a thorough study of frenectomies using lasers vs. conventional surgery in the Journal of Oral Medicine and Oral Surgery 6
“Around 10%–25% of your patients have a restricted tongue or lip and could benefit from the procedure, and, in many cases, have life-changing effects,” Baxter said.
Identifying Patients in Need
How should the general dentist identify patients in need of frenectomies?
“If you’re looking at the airway, you can see the tongue tie,” Hathaway said. “If you’re doing cosmetic dentistry and dentures, you’re already used to listening to people’s speech patterns, so you can identify the need that way. You can tell if it’s an abnormal speech pattern, and you can ask them: ‘Does your speech pattern bother you? Do you have any swallowing issues?’ They usually know if it’s bad, but they have to make the decision to keep living with it or make the change. And, in the case of a denture, if that muscle in the front pulls it up, then we really need to trim the muscle.”
“Assess whether the frenum looks and feels tight,” Welke advised. “Ask if there are symptoms such as feeding and speech issues, head and neck pain, temporomandibular disorders, open-mouth breathing, and poor-quality sleep.”
“Learning the TRMR is a simple way to get started,” Favre said. Baxter has created a Tongue Restriction Questionnaire, “which includes the most common symptoms,” he said.
In July 2024, the American Academy of Pediatrics released news of a report published in the August issue of Pediatrics alleging that frenectomies are overused and are sometimes unnecessary.7 The article states that parents should consult with lactation specialists, and often changing the baby’s feeding position results in successful latching.
Hathaway disagreed, saying, “I would say that frenectomies are underused. I think that, with the current baby formula shortage, more people will try breastfeeding, and if you don’t do a frenectomy on a baby with ties, the baby literally can’t eat.”
“There are many pediatricians who are against tongue-tie releases, but they are the same pediatricians who present no solutions to their patients in term of ways to improve feeding for babies,” Welke added. “Dentists like myself who have performed thousands of these procedures know when to treat and when not to treat.”
The experts took issue not only with the article’s conclusions, but with the research as well.
“The article danced around some issues; it didn’t have any pictures of the different kinds of ties we see,” Hathaway said.
Favre noted that “the last example in the article was a mom who actually improved with a laser release — it just speculates that a snip or clip may have been sufficient. All in all, it is a poorly written
article with a lack of data to back up the claims it makes.”
Baxter says the article “purposefully left out research that supports tongue-tie treatment. They simply did not report it or cite it because it did not fit their narrative.”
A Team Approach
Dentists who perform frenectomies recommend a team approach.
“Working with a functional professional — such as a lactation consultant, speech or feeding therapist, or myofunctional therapist — is essential because all tied patients have compensations and need help to various degrees to overcome these old habits,” Baxter advised.
Hathaway works with a pulmonologist for airway considerations. Favre also noted that “interdisciplinary collaboration is necessary for success.”
Marketing
Collaboration is also part of marketing. Favre noted that, while he lists frenectomies on his website, he mainly gets referrals from other medical professionals.
“The best marketing method is word-of-mouth from previous patients,” Baxter said. “After proper training, announcing that you are open to helping these families on your website and social media often is enough to get started. From there, word will spread, and you will have more patients than you can serve.”
“There are many patients looking for help with frenectomy care,” Welke said. “Marketing should be done by dentists via their practice website or even creating a practice dedicated to only frenectomies.” Welke has done this and calls his practice the Chicago Tongue-Tie Center.
“It’s hard to find another procedure in dentistry that is more rewarding than helping babies nurse or eat better, kids speak better and with more confidence, or patients sleep more soundly,” Baxter said. ♦
William S. Bike is a freelance writer and editor based in Chicago. He is a former director of advancement communications for the University of Illinois Chicago College of Dentistry. To comment on this article, email impact@agd.org.
References
1. “Frenum (Frenulum in Mouth).” Cleveland Clinic, my.clevelandclinic.org/health/body/frenum-mouthfrenulum. Last reviewed 12 Dec. 2023. Accessed 20 July 2024.
2. “Tongue-Tie (Ankyloglossia).” Mayo Clinic, 15 May 2018, mayoclinic.org/diseases-conditions/tongue-tie/ symptoms-causes/syc-20378452.
3. “Policy on Management of the Frenulum in Pediatric Patients.” American Academy of Pediatric Dentistry, aapd.org/globalassets/media/policies_guidelines/p_mgmt_frenulum.pdf. Revised in 2022. Accessed 3 Aug. 2024.
4. “What is a Frenectomy?” American Association of Oral and Maxillofacial Surgeons, myoms.org/what-we-do/ oral-soft-tissue-surgery/what-is-a-frenectomy/. Last updated July 2023. Accessed 3 Aug. 2024.
5. Procedures: Frenectomy, Fiberotomy & Gingivoplasties. American Association of Orthodontists, St. Louis, Missouri. Brochure.
6. Lebret, Clément, et al. “Perioperative Outcomes of Frenectomy Using Laser Versus Conventional Surgery: A Systematic Review.” Journal of Oral Medicine and Oral Surgery, vol. 27, no. 3, 2021, doi: 10.1051/ mbcb/2021010.
7. Thomas, Jennifer, et al. “Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants: Clinical Report.” Pediatrics, vol. 154, no. 2, August 2024, e2024067605.
Three Firsthand Accounts: Perspectives from AGD2024
This past July, general dentists gathered in Minneapolis, Minnesota, for AGD2024, AGD’s scientific session dedicated to networking and continuing education (CE) opportunities specifically tailored to the needs of general dentists. AGD Impact spoke with three dentists who attended the meeting to hear their most exciting highlights and what they’re looking forward to next year at AGD2025 in Montréal, Quebec.
Learn more at AGD2025
July 9–12, 2025, in Montréal, QC
Timothy F. Kosinski, DDS, MAGD, AGD Editor
AGD2024 in Minneapolis provided a myriad of the highest-quality CE. I signed up for lecture courses on Thursday, Friday and Saturday mornings and the all-important unique participation courses on Thursday and Friday afternoons. Continuous learning is a part of my DNA, so I appreciate the opportunity to expand my knowledge in various topics in one contained site. As a member of the AGD Executive Committee and a consultant to the Communications Council, I also had the added opportunity to interview many of the speakers. I found them all to be devoted educators with amazing standards and techniques that could benefit all in attendance.
The Exhibit Hall was full of wonderful contributors, and I had a chance to sit down at some of the shorter, informational
Learning Lab sessions. Most importantly, the ability to network with not only our AGD leaders and team members, but also other colleagues from around the nation, made the entire time enjoyable. There is nothing better than in-person conversations.
One of the most rewarding parts of the entire scientific session was the Convocation Ceremony. Standing on the stage handing out the ribbons representing special achievement in Fellowship, Mastership, and Lifelong Learning and Service Recognition (LLSR) reminded me of years past. It is easy to forget the pride experienced while walking the stage, standing for photos with the president of AGD, and being cheered on by family and friends. The excitement in the eyes of those proud recipients brought me back to my own moments of achievement and reinforced my belief in how important the AGD family is to me and how much our organization elevates not only the profession of dentistry, but also our individual selfworth. Congratulations to all who attended, improved their clinical knowledge and invested in their practices, and a special salutation to all the committed, hard-working awardees.
Looking forward to another spectacular scientific session at AGD2025 in Montréal. See you there!
Bruce L. Cassis, DDS, MAGD, AGD Associate Editor
The Minneapolis venue was well thought-out and efficient.
The convention center was conveniently central to hotel accommodations, restaurants and entertainment. Someone had ordered beautiful weather, and it was delivered!
The Exhibit Hall offered some popular new attractions for members and their families.
The President’s Reception in the Exhibit Hall, which offered good food and drinks, was an event where members could mingle with the exhibitors and meet and greet colleagues from all over.
If you ever wanted to be interviewed on a podcast, this was your chance! AGD Podcast Series host George J. Schmidt, DMD, FAGD, appeared to be enjoying his role, and the lineup of guests was great. Adding to the experience, the interviews were “open-air,” so you could see and hear the podcast interviews as they occurred.
This year, your AGD editors (Tim and I) had the opportunity to conduct unscripted interviews with members, exhibitors and course presenters. There is much to learn from candid interviews. The participants held nothing back, and we got a sense they were eager to speak their minds, professing their love and admiration
for their profession, their colleagues and especially for AGD, which gives them a sense of direction and recognition for their efforts. The instructors in the highly popular, sold-out participation courses were thrilled to be a part of AGD2024. One of the instructors described it as “the pinnacle of his career” to present to like-minded, genuinely motivated participants. This was his second time as an instructor at an AGD scientific session.
As a past president, I know that Convocation is the highlight of any AGD scientific session. The culmination of many hours and years to attain Fellowship, Mastership and LLSR is recognized in a three-hour ceremony by family, friends and colleagues. The pride exhibited by the awardees was matched by all of us who were fortunate to preside over the ceremony. The recipients deserve every honor they earned, and it is an enchanting ceremony. I enjoyed every opportunity I had to congratulate attendees on their hard-earned honors.
Overall, our team at AGD did an outstanding job facilitating the meeting and providing a seamless flow of events for everyone. Conversations with participants were extremely positive, as staff worked swiftly to address any problems that occurred to ensure a positive experience both for course presenters and attendees.
AGD2025 will be in Montréal, Quebec, a destination city with much to offer. Whether you come for great CE, camaraderie, Convocation or to enjoy the venue, there is something for everyone at an AGD scientific session. Get your passport ready, and prepare for the adventure of your lifetime!
On a beautiful Saturday around noon, I took a brief 10-minute walk from the Minnesota Convention Center during AGD’s 2024 scientific session to Peavey Plaza, a below-streetlevel public outdoor space. I was watching a young man and his senior pit bull enjoy a stroll at the plaza’s wading pool. I took in the sounds of splashing water from the various waterfalls. I observed some wonderful architecture that served as a backdrop for an elderly couple on a lunch date. After taking it all in, I sat there on a stone bench looking at photos of the meeting. I was filled with gratitude for what I had experienced so far at AGD2024.
I was excited to have taken an all-day CE course on cosmetic dentistry from Lee Ann Brady, DMD, on Friday and had just wrapped up digesting a knowledge bowl of evidence-based cariology information from Brian B. Novy, DDS. I know my friends share similar sentiments regarding the CE at the meeting. I do wish I could have attended CE from other well-known titans, such as Brett E. Gilbert, DDS, FICD; Amelia Orta, DMD, FACP; and more, but I’ll have that to look forward to next year in Montréal at AGD2025.
My first day of the meeting included visiting the welcoming Exhibit Hall. I was excited to see all the exhibitors that continue to help support AGD’s scientific session. I was impressed by the
New Dentist Lounge and the Learning Lab. The fun zone with photo backdrops and games was a lot of fun. I had the chance to visit with the wonderful AGD team and AGD Foundation colleagues. Another special treat was running into my friends in academia who were taking the Fellowship Review Course. One unique experience I will take away from this scientific session was the keynote address by comedian Jeffrey L. Gurian, DDS. He shared his experiences as a general dentist and comedian. Another fun memory was getting to meet a colleague for a great dinner at Manny’s Steakhouse, located in the W Minneapolis - The Foshay hotel, which also has a really neat observation deck on the 31st floor. In addition to the urban amenities like fine dining and architectural sights, I also know many attendees were able to experience nearby waterfalls, hiking trails and other outdoorsy adventures.
After my moment of reflection, I left Peavey Plaza to make it in time for Saturday’s Convocation Ceremony, where I was honored to serve as a marshal. It was inspiring to see many earn their FAGDs, MAGDs and LLSRs. Watching excited AGD awardees share the honor with each other and their families is something indescribable. I was reminded again of why I continue to be an AGD member. The C amaraderi E is the essence. An AGD scientific session is much like Peavey Plaza’s highlight: the wading pool. This meeting serves as the centerpiece of your AGD journey — you have the opportunity to reflect, reconnect, re-engage, recharge, and, most importantly, celebrate YOU.
See you in Montréal!
Partha Mukherji, DDS, FAGD
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