AGD Impact June 2025

Regenerative Dentistry

By Carrie Pallardy

What if you could grow entirely new teeth for patients instead of relying on fillings, root canals and implants? That is one of the dazzling possibilities within the multidisciplinary field of regenerative dentistry. Regenerative therapies focus on the repair and restoration of soft and hard tissues like dental pulp, enamel, dentin, gums, bone and other supporting tissues. Where is the field of regenerative dentistry today? And what advances could it bring in the future?

Competing Dental and Dental Hygienist Compacts: What Dental Professionals Need to Know

By Jake Kathleen Marcus, JD, PGDip

The issue of dental and dental hygienist license portability — the ability to transfer dental and dental hygienist licensure from state to state — has long been an issue in the dental community. Currently, two dental compacts are at different stages of development.

Self-Instruction article, 1 CE credit

Frustrated in Life, in Practice; What Can Be Done?

I

just read a quote of the day: “Don’t cling to a mistake just because you spent a lot of time making it.” Feeling frustrated with circumstances, individuals or just your lot in life is something that none of us wants to experience. It is not pleasant and can easily overwhelm emotions and actions.

Frustration can arise when we’re in situations we feel powerless to change or when we are unable to reach goals or ambitions. As dentists, we are constantly shifting between dealing with micro and macro issues. One moment, we’re examining a tiny carious lesion. The next, we’re concerned about the finances of our entire practice. Frustrations can come from any number of angles.

Some might experience anger and annoyance, while others retreat into shells and cut off the rest of the world. Others will indulge in a knee-jerk reaction and do whatever first comes to mind.

If not dealt with properly, these feelings of frustration can lead to detrimental mental and physical effects. If we fixate on the cause of our frustration, we can put blinders up. Our decisionmaking skills can be impaired, and we can become unfocused. This can lead to decreased productivity, which can affect the entirety of the practice.

How can we deal with these feelings of frustration?

I always recommend first taking a break. Walk away from what’s causing your frustration. Take a deep breath and realize that we all go home at the end of the day. Calm down, contemplate, and realize that emotions will adapt to circumstances over time.

I like to write things down or create voice memos. I try to turn the mistake into a learning experience. Writing it down helps to organize my thoughts and prioritize which problems to tackle

first. What steps led to this feeling of frustration? What could I have done better? What can I do differently next time? Reviewing where frustration comes from is important to alleviate the strong negative feelings.

Expectations can be high in so many parts of life, and learning to manage them is hard. Reducing expectations is one approach. We can also learn to rely on others. There are many responsibilities each of us address daily. We can delegate some duties to our staff to take them off our plate. We can also talk about the sources of frustration with family, friends and mental healthcare workers. A strong family surely helps. Good friends and an awesome team are critical. You are not helpless, and a support structure elevates one through dark days. So, work hard to reduce stress through activities and support mechanisms, and pursue goals that are achievable in small increments. This is a solution to perceived problems and will increase confidence. Restructure your professional lifestyle to create alternative plans. Realize that some things just can’t be changed, and we must accept what is set before us. Where you are today is not necessarily where you will end up. You have the power and control to achieve whatever you want. It may require taking some risks, but internal happiness and professional contentment is always the target.

Timothy F. Kosinski, DDS, MAGD Editor

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AGD Corporate Sponsors

Advocacy

AGD Government Relations Manager Presents at AAO Professional Advocacy Conference

On March 12, Jay Fisher, AGD manager, government relations, spoke to the American Association of Orthodontists (AAO) Professional Advocacy Conference in Washington, D.C., prior to the attendees visiting members of Congress.

Fisher spoke about the advocacy areas where AGD and the AAO can work together to enhance advocacy campaigns. Last year, AGD assisted the AAO in its petition campaign to the Food and Drug Administration, raising patient care concerns with mail-order orthodontic models that don’t require a dental visit.

AAO has expressed willingness to assist AGD’s efforts on Capitol Hill to enact the Oral Health Literacy Act that will fund the Health Resources and Services Administration’s oral literacy campaign, “A Healthy Mouth for Every Body.”

The invitation to speak to AAO and the focus on the two organizations working together on advocacy arose from a meeting between the two organizations’ presidential lines in 2024. AGD strives to work with other dental associations to advance general dentistry.

Dental Practice Advocacy

AGD Responds to Two DQA Requests for Comment

AGD recently responded to two requests for feedback from the Dental Quality Alliance (DQA). On March 11, AGD responded to the DQA’s request for input on the annual review of its 18 Pediatric Dental Quality Measures, seven Adult Dental Quality Measures and two Pregnancy Dental Quality Measures. Members of AGD’s Dental Practice Council (DPC) conducted the review after considering recommendations from Ralph A. Cooley, DDS, FAGD, AGD’s representative to the DQA. Cooley provided the DPC with background information and assessments for the 27 measures under review.

On March 28, AGD, at the recommendation of the DPC and in consultation with Cooley, communicated its support of the DQA’s Interim Report 6: Topical Fluoride for Children. The report presented the results of testing at the practice and clinician levels and included a recommendation for the inclusion of this measure in a starter set of DQA measures.

Information on the DQA is available at ada.org/dqa

AGD Conducts Stakeholder Review of AAPD’s Clinical Guidelines on Vital Pulp Therapy in Permanent Teeth

On Feb. 28, 2025, AGD’s Dental Practice Council (DPC) submitted stakeholder comments on the American Academy of Pediatric Dentistry’s (AAPD’s) clinical practice guidelines on vital pulp therapy in permanent teeth. DPC member John V. Gammichia, DMD, FAGD, reviewed AAPD’s information and provided recommendations to the DPC. Following an internal review and comment period, AGD’s final response was developed and provided to AAPD.

“It was an honor to represent general dentists and AGD in this capacity,” said Gammichia. “The process required a thorough review of AAPD’s cutting-edge research that was in the 11th hour of the submission process. AGD’s efforts were very collaborative; following my review, members of the DPC considered my feedback and provided their input. Together, we raised some questions and recommended content changes that would be significant to the general dentist. Intraprofessional efforts like this demonstrate AGD’s position as the leading advocate for general dentists.”

Fisher addressing the AAO Professional Advocacy Conference. Fisher (right) with Nathan Mick, AAO vice president of advocacy.

Upcoming

2025 Dr. Thaddeus V. Weclew Award Winner

AGD’s Dr. Thaddeus V. Weclew Award is given to an individual who has made outstanding contributions to the art and science of dentistry or who has enhanced the principles and goals of AGD and has made exceptional efforts in promoting these ideals. Named for the founding father of AGD, the award is presented annually to a dedicated educator who embodies the spirit of comprehensive dental care. This recipient is a professional role model whose activities exemplify a commitment to the profession of dentistry and to AGD.

This year’s recipient, Jane F. Martone, DDS, MAGD, is an educator, practicing dentist, pioneer of dental implant placement and a lifelong learner. The first in her family to go to college, she credits her parents for instilling the value of education in her at an early age. After completing her undergraduate biology degree and Doctor of Dental Surgery at Marquette University, she entered an oral medicine and oral surgery residency at Western Massachusetts Hospital. This specialized training allowed her to treat medically compromised patients with advanced restorative and surgical problems. Never one to stop learning, she completed implant training at the Medical College of Georgia and earned certification in intravenous sedation. Martone studied implant surgery under an implant pioneer, Hilt Tatum Jr., DDS, and cites him as her greatest professional mentor.

For nearly three decades, Martone has spent three weeks a month in private practice and one week a month teaching general practice residents at the Augusta University Dental College of Georgia. As a practicing dentist, she guides patients to achieve health through reconstructing their smiles; as an educator, she passes on what she has learned to another generation. She cites both her students and her patients as her inspiration, especially when supervising residents in the operating room and performing full-mouth rehabilitations for physically and mentally compromised patients. Seeing others overcome hardships inspires her to contribute wherever she can.

Martone is an emeritus member of AGD and has earned Fellowship, Mastership, and multiple Lifelong Learning and Service Recognitions. She has also served on both the national and local PACE councils for 20 years. She has reached diplomate status in both the International Congress of Oral Implantologists and the American Board of Oral Implantology/Implant Dentistry, and she is a fellow in the International College of Dentists, Pierre Fauchard Academy, American Academy of Implant Dentistry and American College of Dentists. She was elected to prestigious dental honor society Omicron Kappa Upsilon through the Dental College of Georgia. She also maintains membership in the Hinman Dental Society and is a Life member of the American Dental Association, the Massachusetts Dental Society and the Georgia Dental Association.

In the July issue of AGD Impact :

• Guide to Compensation

• ‘Invisible’ Dental Services Organizations

In the following articles in the May/June issue of AGD’s peer-reviewed journal, General Dentistry :

• Complementary examinations in the diagnosis of Sjögren syndrome: a report of 2 cases

• A clinical guide to oral manifestations and diagnosis of limited systemic sclerosis: a case report

• Comparison of the antimicrobial effects of 0.2% curcumin mouthwash and chlorhexidine mouthwash on Streptococcus mutans in orthodontic patients: a randomized clinical trial

Read these articles and more at agd.org/generaldentistry.

Dr. Tian Works to Improve Pathway to Legal Status for Dentists on H-1B Visas

Originally from Jinan, China, Geng Tian, DMD, FAGD, came to the United States in 2011. He received his undergraduate degree from the University of Minnesota and his DMD from the University of Pittsburgh School of Dental Medicine. He currently practices in Leesville, South Carolina, and has pursued both a Fellowship in AGD as well as national leadership roles. As a member of AGD’s national Dental Practice Council (DPC), he chairs a new subcommittee created to identify and monitor issues that affect associate dentists in the United States on H-1B visa status. Below, he shares his personal story, as well as information about the subcommittee and its goals.

As many of you know, being a dentist is no easy feat. Not only do we spend our days fixing things in the dark, cramped and often damp environment of the oral cavity, but we also may juggle the demands of running a business. Now, imagine doing all of that while also dealing with the uncertainty of your legal status in the country. That’s the reality of practicing dentistry on an H-1B visa — it adds a whole new layer of complexity.

Geng Tian, DMD, FAGD

“It’s a pleasure for me to share my story and let you know that AGD recognizes the struggles dentists on H-1B visas face.”

The H-1B visa allows U.S. employers to hire professionals of other nationalities in specialized fields, and I’m incredibly grateful for it. Without this program, my four years of dental school would have been nothing more than an expensive lesson in student debt and a collection of dental textbooks. Employment-based immigration is my only option for staying in the United States, but the process is long and exhausting.

After graduating, I had just one year of temporary work authorization to gain experience working in different locations via optional practical training (OPT) — unlike STEM [science, technology, engineering and mathematics] graduates, who get three years of OPT. Following my mentor’s advice, I chose to refine my skills through a general practice residency (GPR).

Unfortunately, a small mistake during the visa application process — whether by an attorney, an applicant or even a school official — can cause a denial, doubling the processing time. I learned this the hard way. Instead of diving straight into my GPR, I ended up on an unplanned five-month “vacation” in New York City while waiting for my OPT issues to be resolved. To make matters worse, Pennsylvania refused to renew my driver’s license because my immigration status was still pending, and New York wouldn’t

issue me a new one. Let’s just say I became way more familiar with the subway system than I ever intended. I was finally able to start my program after my OPT approval in late October, but the OPT was only valid for 9 months. I worked every Saturday and with no vacation leaves in order to complete the program successfully.

Then, in January, way before my OPT ended and in order to continue practicing after residency, I scrambled to find a dental office willing to sponsor my H-1B visa because the visa is awarded through a lottery process every March (unless the employer is a cap-exempt organization like a university, hospital or federally qualified health center). For context on how competitive the application process is, in 2024, the selection rate was a mere 16.6%. Waiting for the lottery results was incredibly nerve-wracking; missing out would have meant losing my job offer and desperately searching for a cap-exempt employer, or, worse, having to leave the country with my family.

Licensing was another hurdle. Because of my immigration status, the process had extra steps. Many states link the expiration date of professional licenses to the length of the applicant’s legal status. When I applied for my South Carolina dental license in March, it was initially valid for just six months — until September. Luckily, once my visa was approved, my license was extended to its full term.

Once granted, an H-1B visa is valid for three years and can be extended up to six years total. If you’re in the process of obtaining a green card (permanent residency), the H-1B can be extended beyond the six-year limit until the green card is granted. However, since the visa is employer-specific, changing jobs means finding a new employer willing to sponsor both the visa and the green card. The silver lining? Transferring an H-1B to a new employer doesn’t require going through the lottery again — just filing a petition for transfer.

Since graduating in 2018, I’ve only traveled abroad once to visit my parents. To return to the United States, I had to apply for a visa stamp through an interview at a U.S. embassy abroad. Although this process usually takes about a week, the interview may need to be scheduled way ahead of time, and administrative checks can lead to lengthy delays, making it nearly impossible to squeeze into a short vacation. If the stamp isn’t issued in time, my

employer might have to find another associate. Sorry, I won’t be able to join you all in Montreal for AGD2025 this July, which is really disappointing.

As you can imagine, this journey has been physically, mentally and emotionally draining. With just one year of OPT, I had to make a tough decision: use it for advanced training or focus on securing a job with an employer willing to sponsor my H-1B. I also considered applying for specialty training, but many residency programs only accept U.S. citizens or permanent residents, narrowing my options. Ultimately, I chose to prioritize my place in the H-1B lottery and green card waitlist, putting specialty training on hold. To add to the challenge, the lottery aspect of the H-1B process deters many private dental practices from sponsoring noncitizen dentists, because there is a strong chance the associates they hire may not receive an H-1B visa, and they will have to start the hiring process over again. In my area, only a handful of offices within a 30-mile radius are open to sponsorship — and many of them just aren’t the right fit.

It’s a pleasure for me to share my story and let you know that AGD recognizes the struggles dentists on H-1B visas face. AGD’s DPC, of which I am a member, has formed a subcommittee to address these issues. We have reached out to the Department of Homeland Security to gain a deeper understanding of the situation, and we have already gathered some valuable insights. Moving forward, the subcommittee hopes to identify opportunities for easing some of the restrictions around H-1B visas for dentists and for educating AGD members about the process of integrating a dentist on an H-1B visa into their practices. We’ll also explore potential pathways for dentists — and possibly even physicians — on H-1B status to secure green cards more easily.

While the road is tough, I’m hopeful that, with continued advocacy and support, it will become a little less rocky for future dentists like me.

If you have comments or a personal story you would like to share with the DPC subcommittee regarding dentistry and the H-1B visa program, please contact practice@agd.org. ♦

Financial Management

Steer Clear of Abusive Tax Shelters to Stay Off the IRS Radar

By Wesley W. Lyon II, CPA, CFP®

The IRS recently released its annual “dirty dozen,” an annual list comprised of some of the most common tax scams and fraudulent schemes. Based on this list, I want to turn my attention to the four most common abusive tax shelters that target dentists.

Syndicated Conservation Easements

A conservation easement is simply a deed or legal agreement between a landowner and a nonprofit organization or government agency that restricts the use of the land. In return, a landowner is allowed to take a charitable contribution deduction equal to the difference in value of land before and after the easement, so long as certain requirements are met.

The key to this strategy is to ensure there is a difference in the value of the land, which causes many conservation easements to not be worthwhile. For example, if you purchase hunting land worth $800 per acre, but the land is still worth $800 per acre with a conservation easement in place since the land’s highest and best use is hunting, no charitable deduction will be granted. On the other hand, if a dentist purchases a lake home with 10 acres and decides they do not want neighbors, placing an easement on nine acres of the land could substantially reduce the value of the land since lake homes can no longer be developed.

As with any good abusive tax shelter, the strategy is based on something that is perfectly legal and achievable. However, syndicated conservation easements use a few tricks to inflate valuations. In a syndicated easement, a partnership purchases land with the intent of maximizing charitable contributions for the partners. Once purchased, valuations are obtained in the form of greatly inflated appraisals that claim the land could be used for developmental purposes such as ski resorts, neighborhoods, etc., that would dramatically increase the value. The charitable deduction is then applied to the higher valuation, not the purchase price. However, these transactions lack economic substance and are a target of the IRS. Additionally, the IRS now limits the deduction to no more than 2.5 times the investors’ actual cash outlay.

Micro-Captive Insurance Companies

A captive insurance company is a licensed insurance company formed by a business to provide risk mitigation services for its parent company or related entities. For example, some large companies decline going to market for health insurance and instead “self-insure” against their risk. This can be achieved by creating a captive insurance company that is typically administered by a larger insurance company.

Many promoters of using a micro-captive insurance company sell dentists on the tremendous tax benefits that can be achieved by deducting insurance payments against practice income, since insurance companies do not need to claim premium payments as

taxable income. The money can then be invested at favorable tax rates or loaned out to the doctor to avoid taxes. However, most of these captives formed to save tax money instead of providing insurance benefits aren’t following the rules. Often, they are found to have excessive premiums in relation to the risks being insured against, and very few — if any — claims are ever paid out.

These abusive captive insurance arrangements have been successfully targeted by the IRS previously, making their resurgence a bit surprising. Do yourself a favor, and avoid the excessive startup and management fees associated with tax deductions that will not stick if audited.

Research and Development Tax Credits

Research and development (R&D) tax credits are paid to companies that meet certain requirements in order to stimulate R&D in the United States. The credit can be taken if four tests are passed to prove that the expenses relate to the elimination of uncertainty, are technological in nature, involve a process of experimentation, and have a qualified purpose to design a new process or improve a current process. Under these rules, some dental practices do qualify to take the R&D tax credit.

However, as with the first two scams, the devil is in the details. While some practices have real research to improve a process or product, most do not. Furthermore, the tax credit is only

calculated on the additional expenses related to the research. Many promoters try to convince dentists that everything they do is experimental and technological in nature, allowing them to qualify for inflated R&D tax credits. These promotors are most often misleading dentists that they qualify based on the four tests, while also miscalculating the attributed expenses, leading to inflated tax credits sometimes exceeding $200,000.

Abusive Trust Tax Shelter

Over the past few years, client questions regarding setting up trusts to hide income have increased substantially. I suspect this has been driven by a craze of social media influencers claiming they use multiple trusts to avoid paying income taxes. This is about as far-fetched as thinking income taxes are voluntary. Promoters of the trust scheme encourage dentists to place their assets into irrevocable trusts that then pay out expenses such as home mortgages, car payments, sporting event tickets, etc.

See a problem? Just because an asset is in a trust doesn’t mean a personal expense is now a business expense and can be deducted. To make matters worse, the trustee is supposed to take control over the assets in these situations. However, in almost every case, it is found that the original owner still maintains complete control. Just because an expense is incurred in a trust does not mean that it is a legitimate tax deduction.

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What Should You Do?

Dentists should seek to eliminate any illegal strategies from their tax plan. However, this does not mean dentists should fear trying to lower their tax bill. As a tax professional, I rely on two basic principles to guide my advice. The first is that no taxpayer shall be required to pay more than legally necessary. In the 1935 case Gregory v. Helvering, Supreme Court Justice George Sutherland wrote, “The legal right of a taxpayer to decrease the amount of what otherwise would be his taxes, or altogether avoid them, by means which the law permits, cannot be doubted.”

The second principle is that all expenses that are ordinary and necessary in conducting a trade or business shall be permitted as a deduction against income.

In short, maximizing legal tax deductions should be your goal. In my next column, I’ll review the top strategies to maximize your legitimate business tax deductions. ♦

Wesley W. Lyon II, CPA, CFP, is president and CEO of McGill and Lyon Dental Advisors. For more information on his firm’s comprehensive tax and business planning services for dentists and specialists, contact Danielle Fitzgerald at 877.306.9780, or email consulting@mcgillhillgroup.com. To comment on this article, email impact@agd.org

Practice-Based Dental Research: Historical and Ethical Considerations

By J. Terrell Hoffeld, DDS, PhD, FADI, FWAS, FACD, FICD

This column is a collaboration between AGD and the American College of Dentists.

About 55 years ago, when I had just completed my second year of dental school, I openly declared my interest in a research career by joining the International Association for Dental Research as a student member, the only one in the College of Dentistry. Some faculty members were very supportive, most did not care, and a few questioned my sanity. One of the operative dentistry faculty expressed his disdain by saying, “You do not need to make that a separate career. As a practicing dentist, you can do research every day by trying to improve the procedures you use and adopting new techniques.” I used appropriate restraint and did not argue about what I wanted to learn and do. Instead, I pointed out that, although the dictionary could denote a definition of the word “research,” there was a wide range of connotations among individuals.

Historical Considerations

One important role of research for dentistry is to systematically validate “community standards of practice.” When all the healthcare disciplines were apprenticeship-trained careers, these standards were pragmatic — did they work?1 As a result, disparate varieties of procedures became locally accepted throughout the world. When healthcare training became academically based, the standards of the faculty became the standards for the students, followed quickly by licensing boards, whereby regional standards were required.2 In recognition of the need to validate standards, dental school faculty performed clinical trials under specific, ideal experimental designs to show that rigorously repeated procedures produced desired outcomes; these were then reported in the academic literature.3-5 Concomitantly, community dentists accrued experience with large numbers of patients under whatever varied conditions they were presented. If the desired outcomes were achieved, that information was reported in study groups, continuing education courses and as case studies in clinical publications.6 Using economic terminology, some would call the first model a “trickle-down” mode of validation, whereas the second model would be a “trickle-up” means to validate. Each model has provided valuable information and has reciprocally seeded studies by the other in support of the goal of validating community standards of practice. From either direction, adoption into practice followed the precepts of the diffusion of innovations theory.7 The theory posits that the acceptance of new ideas follows a normal distribution over time. The progressive temporal segments of that curve are designated by the familiar phrases: innovators, early adopters, early majority, late majority and laggards.

Beginning in the late 1970s, for a decade, the National Institutes of Health (NIH) acknowledged not only both these parallel directions of study, but also discrepancies in agreement nationwide on certain clinical procedures, thereby inhibiting the development of uniform, nationwide community standards of practice. The NIH Consensus Development Program was formulated and operated for a decade with the stated purpose: “To evaluate in a public forum the use of biomedical technologies, to publish a consensus statement relevant to the public at large that provides guidelines for practitioners on the use of the technology, and to disseminate this information to the intended audience.”8 Any NIH institute or other public health service agency could request a conference. “Most often the program focuses on new information. This information can pertain to existing technologies, making them obsolete, or to emerging technologies.”8 Of the 63 conferences convened, seven had a principal focus in dentistry: Management of Pain, Anaesthesia and Sedation in the Dental Office, Dental Sealants, Biomaterials, Pain Discomfort and Humanitarian Care, Removal of Third Molars, and Dental Implants.8 One outcome throughout the series was the recognition of the differences between academic studies under ideal, controlled conditions, and real-world, practice-based studies. Health services researchers coined the outcomes of academic studies as healthcare “efficacy,” whereas the real-world results were termed healthcare “effectiveness.”9 Thus began the era of healthcare effectiveness research in support of community standards of practice.

In 1991, a new public health service organization was established, the Agency for Health Care Policy and Research (AHCPR). This agency was charged with responsibilities for many things that NIH did not do, but the jewel in its crown was the authority to convene panels to develop clinical practice guidelines based on both academic clinical trials and practice-based effectiveness research. In support of those goals, practice-based research networks (PBRNs) were established as “… groups of primary care clinicians and practices working together to answer community-based health care questions and translate research findings into practice. PBRNs engage clinicians in quality improvement activities and an evidence-based culture in primary care practice to improve the health of all Americans. The PBRN Web site enables PBRNs to share research, connect with colleagues, find funding opportunities, and access resources.”10,11 In 1999, AHCPR was renamed the Agency for Healthcare Research and Quality (AHRQ), and its mission to develop clinical practice guidelines was relegated to the appropriate private sector clinical professional societies.12 The PBRN program was retained, and the value of evidence-based practices as community standards thrives, as evidenced by the Cochrane Center in the United Kingdom (cochrane.org), which compiles evidence-based practices worldwide on a huge variety of healthcare services, and the Clinical Practice Guidelines and Dental Evidence website maintained by the American Dental Association (ada.org/

resources/research/science/evidence-based-dental-research), to which dentists can refer for current community standards.

The model of the PBRN was also adopted by several of the NIH institutes, including the National Institute of Dental and Craniofacial Research (NIDCR). Following a preliminary study at the University of Florida, beginning in 1998, the project was expanded by a grant to the University of Alabama at Birmingham. In 2005, that grant was extended to include dental practices in Norway, Sweden and Denmark, with expansion to dental practices in six U.S. regions: Western, Midwest, Southwest, South Central, Mid-Atlantic and Northeast.13

The NIDCR website states: “There are over 8,400 practitioner members of the National Dental PBRN across the United States representing different types of practice settings, with ~475 practitioners currently active in clinical studies that collect research data on their consenting patients. The ~5,675 practitioners who have participated in research studies have contributed to conducting 58 studies, enrolling over 75,000 patients, and analyzing health records from more than 790,000 patients. Many studies involve complex clinical data collection and analyses.”14 These studies can be prospective, retrospective or both. See the list for some completed National Dental PBRN studies that have contributed to community practice standards.

Ethical Considerations

Although all general dentists are familiar with the ethical tenets of patient autonomy, non-maleficence, beneficence, justice and veracity,15 participation in a clinical trial requires further ethical considerations: value, validity, fair subject selection, favorable risk-benefit ratio, independent review, informed consent and respect for enrolled participants.16 Although many of these additional considerations are the responsibility of the principal investigator of a project, in order to ensure these features are practiced uniformly, participating dentists in PBRNs are required to have additional training (usually online). The PBRN has standardized forms and practices throughout any particular study to ensure complete ethical and practical compliance.17 To become a participating dentist in the National Dental PBRN, visit nationaldentalpbrn.org/become-a-member, view the introductory clip, read the information, and submit your application.

References

1. Ring, Malvin E. Dentistry: An Illustrated History. Harry N. Abrams, Inc., 1985.

2. Spielman, Andrew I. “Dental Education and Practice: Past, Present, and Future Trends.” Frontiers in Oral Health, 17 April 2024, pmc.ncbi.nlm.nih.gov/articles/PMC11061397/pdf/froh-05-1368121.pdf.

3. “History of Dental Schools.” Encyclopedia of the History of Dentistry, edited by J. Forrai and Andrew I. Spielman, 2023, kaleidoscopehistory.hu/index.php?subpage=cikk&cikkid=974.

4. Research Methodology in Dentistry. Edited by Pragati Kaurani and Nikhil Marwah. Bluerose Publishers, 2020.

5. Tabatabaei, Fahimeh, and Lobat Tayebi. Research Methods in Dentistry. Springer Nature Switzerland AG, 2022.

6. “History of the Dental Practitioner,” Encyclopedia of the History of Dentistry, edited by J. Forrai and Andrew I. Spielman, 2023, kaleidoscopehistory.hu/index.php?subpage=cikk&cikkid=916.

7. Fennell, Mary L., and Richard B. Warnecke. The Diffusion of Medical Innovations: An Applied Network Analysis. Plenum Press, 2013.

8. Institute of Medicine Council on Health Care Technology. “National Institutes of Health Consensus Development Program.” Medical Technology Assessment Directory: A Pilot Reference to Organizations, Assessments, and Institute of Medicine. Edited by C. Goodman. National Academies Press, 1988, ncbi.nlm.nih.gov/books/NBK218375/

9. Cochrane, A.L. “Effectiveness and Efficiency: Random Reflections on Health Services.” The Nuffield Provincial Hospitals Trust, 1972, nuffieldtrust.org.uk/research/effectiveness-and-efficiency-random-reflections-on-health-services.

10. “History and Funding of PBRNs.” Agency for Healthcare Research and Quality, November 2024, ahrq.gov/ ncepcr/communities/pbrn/history/index.html#:~:text=Between%202000%20and%202005%2C%20 AHRQ,and%20a%20dedicated%20community%20extranet.

Select List of Studies Conducted by the National Dental Practice-Based Research Network14

• Anterior Openbite Malocclusions in Adults: Recommendations, Treatment, and Stability

• Assessment of Caries Diagnosis and Caries Treatment

• Cracked Tooth Registry

• Decision Aids for the Management of Suspicious Occlusal Caries Lesions

• Dental Management of Patients with Special Healthcare Needs

• Diagnoses for Persistent Dentoalveolar Pain Following Root Canal Therapy

• Leveraging Electronic Dental Record Data for Clinical Research

• Longitudinal Study of Repaired or Replaced Restorations

• Management of Dentin Hypersensitivity

• Management of Painful Temporomandibular Disorders

• Mental Health Screening and Referral in Dental Practices

• Predicting Outcomes of Root Canal Treatment

• Primary Care Management for TMJD Pain

• Reasons for Replacement or Repair of Dental Restorations

• Retrospective Cohort Study of Osteonecrosis of the Jaws

• Risk for Oral Cancer Study

• Selective Versus Non-Selective Caries Removal in Permanent Teeth

I am pleased now that I did not argue with that operative dentistry faculty member 55 years ago. I acknowledge that, given the structure of the National Dental PBRN and the breadth of evidence-based dentistry, he has been proven correct: the general dentist can now actively participate in research without the additional years of training. ♦

J. Terrell Hoffeld, DDS, PhD, FADI, FWAS, FACD, FICD, retired after 30 years of active duty as a dental officer in the U.S. Public Health Service. At the National Institutes of Health, he was a senior investigator and a scientific review officer. At the Agency for Health Care Policy and Research, he was the director of the Office of Scientific Review and the agency research integrity liaison officer. In retirement, he served as the secretary general of the International College of Dentists and is currently both a member-at-large on the board of directors of the American Society for Dental Ethics and a retired officer member of the board of directors of the Commissioned Officers Association of the U.S. Public Health Service. To comment on this article, email impact@agd.org

11. Green, Larry A., and John Hickner. “A Short History of Primary Care Practice-based Research Networks: From Concept to Essential Research Laboratories.” Journal of the American Board of Family Medicine, vol. 19, no. 1, 2006, pp.1-10.

12. “Healthcare Research and Quality Act of 1999.” Title IX of the Public Health Service Act (42 U.S.C. 299 et seq.), ahrq.gov/policymakers/hrqa99a.html. Accessed 26 March 2025.

13. “Map and Regions.” National Dental Practice-Based Research Network, 2025, nationaldentalpbrn.org/mapregions/.

14. “Dental Primary Care Practice-Based Research Network to Support Research in Clinical Practices.” National Institute of Dental and Craniofacial Research, nidcr.nih.gov/grants-funding/funding-priorities/futureresearch-initiatives-concept-clearances/dental-primary-care-practicebased-research-network-supportresearch-clinical. Accessed 26 March 2025.

15. “Principles of Ethics and Code of Professional Conduct: With Official Advisory Opinions Revised to October 2024.” American Dental Association, ada.org/-/media/project/ada-organization/ada/ada-org/files/ about/2025_code_of_ethics_full.pdf.

16. Macrina, Francis L. Scientific Integrity: Text and Cases in Responsible Conduct of Research (ed. 4). American Society for Microbiology Press, 2014.

17. “Mission, Vision, & Goals,” National Dental Practice-Based Research Network, 2025, nationaldentalpbrn.org/about/mission-vision-goals/.

Light a FIRE to Manage Your Own Finances

By Clayton Sorrells, DDS

Irecently decided to part ways with my financial adviser and start managing my money and investments myself. If you are in dental school, you might be thinking, “Wait, I have negative money to manage. This doesn’t apply to me!” Au contraire! The sooner you can learn to manage any money, whether it is $180,000 in debt or $1.8 million in profit, the better off you will be.

The first step in managing money is learning how to budget. My favorite way to do this is to automate. If I can automate something in my life, I am going to do it. There are several apps that connect all your bank, credit card, investment and loan accounts. Some popular ones are Copilot, Monarch Money and YNAB. My advice: Pick one. They all work and will show you where your money is going. You’ll probably be disappointed when you see how much you spend in certain categories. While in dental school and early in your career, budgeting is crucial. Less spending in school means fewer loans, and less spending after school means faster debt repayment. Set monthly goals for groceries, gas, student loans, fun and all your other expenses.

The next step is saving money. My recommendation: Include your savings goal in your budget. If you don’t allocate it, you’ll spend it. But where should savings go? This is when people get scared and think they need a financial adviser. The answer depends. But one category is non-negotiable: You need an emergency fund. You never know when things will go wrong. You may lose your job, your car may break down, or your dog may need emergency surgery. You need at least three months of essential expenses saved. Since you’ve been budgeting, you know this number. Rather than letting it sit in a checking account where it earns little or no interest, consider putting it in a money market account that offers better returns while still keeping it accessible for emergencies.

Financial Independence

Once your emergency fund is set, the fun begins. You get to decide where your money goes. I had a financial adviser because I thought investing was complicated and didn’t want to lose my hard-earned money. What I didn’t realize was how much my adviser was making off my investments. That led me to read everything I could about finance. I got deep into the Financial Independence, Retire Early (FIRE) movement, which led me to the concept of financial independence (FI). As I learned more, I started thinking differently about my financial future. I realized that FI isn’t just about retiring early — it’s about having the freedom to make choices based on what I want to do, not what I have to do. My goal is to reach FI in 15 years, by age 45, so that

I have the flexibility to continue practicing dentistry because I enjoy it, not because I need the paycheck.

Now, you might be thinking: “Wait, is he crazy? What will he do for 50 years if he isn’t working?” My answer: whatever I want. People hesitate to pursue FI because they don’t fully understand it. A general rule for determining your FI number is 25 times your expected annual expenses. If you need $60,000 per year to maintain your lifestyle, you need $1.5 million to reach FI. If you need $40,000, you need $1 million. FI isn’t as complicated as some financial advisers make it seem. And if your financial adviser says it’s too complex, ask them to do a molar root canal on No. 31 in a patient with an 8-millimeter opening and a tongue the size of Manhattan. Then they’ll know complicated. Managing money is far simpler than many things we do every day in dentistry.

How to Take Ownership of Your Investments

When I decided to take control of my finances, I knew I needed to educate myself first. I wasn’t looking for a complicated system or some secret formula — I just wanted a straightforward approach that made sense. I read Mr. Money Mustache’s article, “The Shockingly Simple Math Behind Early Retirement,” and thought, “No way, it’s harder than that!” Then I read “The Simple Path to Wealth” by J.L. Collins; “White Coat Investor” by James Dahle, MD; and “Rich Dad Poor Dad” by Robert Kiyosaki and Sharon Lechter. I also listened to “The Financial Independence Podcast” and “Mad Fientist.” The more I read, the more I realized that managing my own money was not as intimidating as I had thought. Within a month, I had absorbed enough knowledge to feel confident in making my own financial decisions, and I knew it was time to take full ownership of my investments.

So, where do you put your savings? After reading those books and listening to the podcasts, you’ll have a solid understanding.

But, here’s a spoiler: Investing is boring and simple. The best approach? Low-cost index funds. Any major institution like Vanguard or Fidelity offers them. You can research further, but a total stock market index fund is a common recommendation for beginners. At this point, the key is to take action. You don’t need to have everything figured out right away, but, the sooner you start, the more time your money has to grow.

While I felt comfortable taking control of my finances and parting ways with my financial adviser, that doesn’t mean financial advisers are bad. There are plenty of great ones who can provide value, especially for those who don’t have the time or interest to manage their investments. I just wanted to take control of my money and future. I encourage you to do your own research and, if needed, consult with a financial professional to determine the best path for you.

Taking control of your finances doesn’t mean making drastic changes overnight. Start with small steps. Track your spending, set a savings goal, and learn the basics of investing. You don’t need to be a financial expert to build wealth. You just need a plan, some discipline and the willingness to take the first step. Mastering your finances is a lot like mastering dentistry. At first, it feels overwhelming. There’s a learning curve, some trial and error, and a lot of people telling you what you should and shouldn’t do. But, just like perfecting a crown prep or nailing the art of patient communication, the more you practice, the more confident you become. Money is simply another tool — learn to use it well, and it can give you the freedom to design the life you want. ♦

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Clayton Sorrells, DDS, is a new dentist and previous AGD chapter president at Louisiana State University School of Dentistry. To comment on this article, email impact@agd.org

Wellness

A Struggle for Perfection: Embracing Our Human Side

By Maggie Augustyn, DDS

Dentistry stands out as a unique discipline where our creations manifest tangibly. It allows us to contrast our own handiwork against the crisp images of textbooks or those presented in lectures. Yet, we often overlook the myriad human factors that prove ever-challenging. Striving to achieve the legendary exactness of dental restorations, we encounter patients riddled by fear, ones with unreasonably strong and curious tongues. We come faceto-face with patients tangled with financial constraints. And we still aim for perfection in a setting far from ideal. Amid the pursuit of flawless work within the limited timeframe of appointments, interrupted by routine tasks and unforeseen equipment issues, we subject ourselves to physical strain and emotional turmoil.

This impossible quest for perfection has been cultivated through our education and practice, and recognizing our inability to achieve it could lead us to a more contented professional life and a healthier self-acceptance. We could actually be freer to celebrate our ability to be “perfectly imperfect.”

Take Your Mark

The pursuit of perfection begins in our high school years, when our fixation with numerical achievements begins. During this period, the allure of attaining high scores becomes a significant driving force. It’s during these formative stages that many of us, especially those inclined toward higher education, start to measure our worth through these numerical benchmarks. Success, measured through high grades, earns us the respect and sometimes even the admiration of teachers, parents and peers. This validation feels rewarding and turns into an addictive affirmation that encourages us to continue. Concurrently, a sense of rivalry begins to take root, transforming our peers into competitors in the race to secure the top position.

The simplicity of achieving high grades becomes increasingly elusive in college, where we find ourselves immersed in a broader sea of intellectually driven individuals, all striving for that same exemplary grade. This pursuit intensifies as our aspirations toward graduate school crystallize, necessitating not just superior grades but also outstanding entrance exam scores and class rankings. The cycle of pursuit and reward continues. The habit of competition and achievement burrows deeper into our psyche. Upon graduating from college and then dental school, years of being measured and defined by grades ingrained a deep-seated belief in our minds, intertwining our self-worth with our academic or professional accomplishments. This conditioning leads us to equate high scores with personal satisfaction and selfesteem, while low scores provoke self-doubt and dissatisfaction.

Making the Grade in Dentistry

This fixation with being graded evolved into a new phase where the quality of our dental work — our preparations and endodontic procedures — is the new metric for self-assessment. We can visually assess the angle of a preparation, the uniformity of margins or the precision of a filling, often critiquing our work with a harshness that surpasses our most stringent evaluators. A complication such as a dry socket can lead us to harshly judge ourselves as failures or, worse, be perceived as such by our patients. Yet, this perspective is fundamentally flawed. We inadvertently shift from one system of evaluation to another, substituting numerical grades with a subjective and often overly critical self-assessment of our work’s quality.

Thus, the question arises: How do we reconcile this? How do we find equilibrium in our self-assessment and professional mindset? It compels us to reflect: Is there room for improvement in our practice? Can we aspire to greater heights in our dental work, enhancing the positives and mitigating the negatives? Should we strive even harder toward perfection? The straightforward response to these inquiries is “no.” In essence, each of us is already doing our utmost, utilizing the skills, tools, procedural knowledge and unique practice dynamics at our disposal. Our commitment to our patients and our professional integrity is paramount. The notion that simply becoming better dentists would erase our failures is not only unrealistic, but also fundamentally flawed and unattainable. Achieving perfection consistently is a fallacy.

The Treatment for Perfectionism

The strategy to surmount this challenge is to acknowledge and embrace our imperfections. We must shift our perspective on how we gauge our self-worth, moving away from equating it with

“Dentistry, like life, is an art shaped by hands that will never be flawless, and yet those same hands bring comfort, healing and care to others.”

dental imperfections such as short crown margins or underfilled endodontic treatments. So, how do we achieve this? It might sound simplistic, but it’s essential to start by forgiving ourselves for not being perfect. This doesn’t mean we ignore our shortcomings; rather, we acknowledge them, forgive ourselves, and learn from them. Our best effort might not always result in the perfect endodontic fill, but that’s OK. We need to give ourselves the grace to accept imperfection.

Imperfection does not equate to negligence or subpar care; it simply means that not every outcome will be flawless. With this mindset, we understand that there’s always room for growth and improvement, whether it means retaking a procedure, consulting a specialist or pursuing further education to enhance our skills. However, striving for perfection in every case is unrealistic and can lead us to lose touch with the reality of clinical practice. Recognizing and accepting imperfection will keep us humble and grounded, reminding us that expecting every treatment to be flawless is not only unrealistic but may also border on arrogance.

Implementing a practice of consistent self-celebration is crucial. Make it a habit to acknowledge your accomplishments, however small, on a daily basis. If it helps, dedicate a moment each day to jot down victories. When you receive a compliment, don’t just brush it off; instead, fully immerse yourself in the moment for about 90 seconds. Allow the positive words to penetrate deeply, absorb them completely, and carry that uplifting feeling with you throughout the day. Should you find yourself struggling with feelings of guilt, shame or any form of negative emotion, write a self-apology note to address and soothe these feelings. Furthermore, if you notice that a critical and harsh mindset is hindering your ability to live mindfully and love yourself, seeking professional support is a necessary step.

Ultimately, to celebrate being “perfectly imperfect” is to honor the humanity within ourselves — a humanity that strives, stumbles, learns and grows. Dentistry, like life, is an art shaped by hands that will never be flawless, and yet those same hands bring comfort, healing and care to others. The pursuit of perfection is not what defines us; it is our resilience in the face of imperfection, our compassion for ourselves and others, and our ability to adapt and improve that truly matter. By giving ourselves permission to be imperfect, we allow space for joy, balance and fulfillment — not despite our flaws, but because of them.

♦

Maggie Augustyn, DDS, is a practicing general dentist, owner of Happy Tooth, faculty member at Productive Dentist Academy, author and inspirational speaker. To comment on this article, email impact@agd.org

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Corporate Sponsor Electric vs. Manual Brushing: Settling the Debate

By Melissa Seibert, DMD, MS, ABGD

This column is sponsored by Crest + Oral-B, an AGD Corporate Sponsor.

As oral healthcare practitioners, we should not only seek to restore what has been lost due to disease, but also to help our patients achieve and maintain optimal health. In fact, enabling our patients to be healthy through robust preventive self-care treatment-planning practices should be our chief aim. One of the aims of these practices is to prevent biofilmmediated diseases such as periodontal disease and caries, and it will come as no surprise that a critical variable in preventing these diseases is toothbrushing.

This begs the question: Are powered toothbrushes more efficacious than manual brushes? A question this critical and foundational must be answered by high-quality evidence. In evidence-based medicine, it is extremely rare to have such substantial, high-quality data to draw conclusions from. Clinicians often must default to limited laboratory data or even expert opinion to infer conclusions. However, in this instance, a deluge of evidence has been synthesized by a gold-standard meta-analysis and systematic review. A 2014 Cochrane systematic review and meta-analysis found that powered toothbrushes remove significantly more plaque and reduce gingivitis more effectively than manual brushes.1 In addition, since 2020, there have been five other independent systematic reviews and meta-analyses consistently demonstrating greater plaque removal and gingivitis-reduction efficacy (e.g., reductions in bleeding sites), for round, oscillating-rotating brushes relative to manual and sonic brushes.2–6 The newest round oscillatingrotating model (Oral-B iO) showed the greatest benefits, as well as faster improvement to gingival health, compared to traditional oscillating-rotating, sonic and manual toothbrush models in a recent meta-analysis.7

Clinicians can therefore be confident in the assertion that powered toothbrushes, in particular

References

1. Yaacob, Munirah, et al. “Powered Versus Manual Toothbrushing for Oral Health.” The Cochrane Database of Systematic Reviews, vol. 2014, no. 6, p. CD002281.

2. Thomassen, Tim MJA, et al. “The Efficacy of Powered Toothbrushes: A Systematic Review and Network Meta-Analysis.” International Journal of Dental Hygiene, vol. 20, no. 1, 2022, pp. 3-17.

3. Elkerbout, Therese A., et al. “How Effective Is a Powered Toothbrush as Compared to a Manual Toothbrush? A Systematic Review and Meta-Analysis of Single Brushing Exercises.” International Journal of Dental Hygiene, vol. 18, no. 1, 2020, pp. 17-26.

4. Clark-Perry, Danielle, and Liran Levin. “Systematic Review and Meta-Analysis of Randomized Controlled Studies Comparing Oscillating-Rotating and Other Powered Toothbrushes.” Journal of the American Dental Association (1939), vol. 151, no. 4, 2020, pp. 265-275.e6.

5. van der Sluijs, Eveline, et al. “Dental Plaque Score Reduction with an Oscillating-Rotating Power Toothbrush and a High-Frequency Sonic Power Toothbrush: A Systematic Review and Meta-Analysis of SingleBrushing Exercises.” International Journal of Dental Hygiene, vol. 19, no. 1, 2021, pp. 78-92.

6. van der Sluijs, Eveline, et al. “The Efficacy of an Oscillating-Rotating Power Toothbrush Compared to a HighFrequency Sonic Power Toothbrush on Parameters of Dental Plaque and Gingival Inflammation: A Systematic Review and Meta-Analysis.” International Journal of Dental Hygiene, vol. 21, no. 1, 2023, pp. 77-94.

oscillating-rotating brushes, achieved superior clinical outcomes for patients and should be considered a gold standard of homecare. When advising our patients on how to select a power brush, it may be beneficial to consider periodontal stability. With a manual toothbrush, in addition to consistently higher plaque scores, data suggests patients use greater force than they do with an electric toothbrush.8 Some modern brushes now use haptic and/or visual feedback to alert the patient if they are using excessive force.

Two separate three-year studies demonstrated that an oscillating-rotating brush is gentle and promotes periodontal stability; the most recent of these confirmed this even among patients with preexisting gingival recession and for a diverse range of gingival phenotypes.9,10 Additionally, some electric brushes, particularly those that leverage smartphone applications, provide detailed feedback at each brushing session. This personalized coaching can transform patients’ brushing habits. Studies have also shown that including an oscillating-rotating power brush as an intervention yields greater reductions in plaque and gingivitis in pediatric patients,11 increases plaque removal efficacy for orthodontic patients,12 and helps to maintain health on peri-implant soft tissue.13

Ultimately, patients may be reticent to purchase a power toothbrush. They may be unaware of the oral health advantages power toothbrushes provide, feel they are too complex or have questions about cost. Sharing the evidence with patients can help them see it’s an investment in their long-term oral health. ♦

Melissa Seibert, DMD, MS, FAGD, ABGD, is the creator and host of “Dental Digest,” a top 1% global podcast and two-time winner of the Most Educational Podcast in Dentistry Award. Recognized as one of the “Top 40 Under 40 Dentists in America” by Incisal Edge, she completed the U.S. Air Force’s comprehensive dentistry residency and an advanced education in general dentistry. As a faculty member at Creighton University School of Dentistry, she lectures internationally.

Disclaimer: This article and the views presented are the author’s and do not represent those of any federal agency.

7. Zou, Yuanshu, et al. “A Meta-Analysis Comparing Toothbrush Technologies on Gingivitis and Plaque.” International Dental Journal, vol. 74, no. 1, 2024, pp. 146-156.

8. van der Weijden, GA, et al. “Toothbrushing Force in Relation to Plaque Removal.” Journal of Clinical Periodontology, vol. 23, no. 8, 1996, pp. 724-729.

9. Sutor, Simone, et al. “Effect of a Powered and a Manual Toothbrush in Subjects Susceptible to Gingival Recession: A 36-Month Randomized Controlled Clinical Study.” International Journal of Dental Hygiene, vol. 23, no. 1, 2025, pp. 26-36.

10. Dörfer, Christof E., et al. “Three-Year Randomized Study of Manual and Power Toothbrush Effects on Pre-Existing Gingival Recession.” Journal of Clinical Periodontology, vol. 43, no. 6, 2016, pp. 512-519.

11. Davidovich, Esti, et al. “A 4-Week Randomized Controlled Trial Evaluating Plaque and Gingivitis Effects of an Electric Toothbrush in a Paediatric Population.” International Journal of Paediatric Dentistry, vol. 34, no. 3, 2024, pp. 246-255.

12. Erbe, Christina, et al. “A Comparative Assessment of Plaque Removal and Toothbrushing Compliance Between a Manual and an Interactive Power Toothbrush Among Adolescents: A Single-Center, Single-Blind Randomized Controlled Trial.” BMC Oral Health, vol. 18, no. 1, 2018, p. 130.

13. Allocca, Giuseppe, et al. “Effectiveness and Compliance of an Oscillating-Rotating Toothbrush in Patients with Dental Implants: A Randomized Clinical Trial.” International Journal of Implant Dentistry, vol. 4, no.1, 2018, p. 38.

Regenerative Dentistry

Current Research and Upcoming Advances

By Carrie Pallardy

What if you could grow entirely new teeth for patients instead of relying on fillings, root canals and implants? That is just one of the possibilities within the multidisciplinary field of regenerative dentistry. Regenerative therapies focus on the repair and restoration of soft and hard tissues like dental pulp, enamel, dentin, gingiva, bone and other supporting tissues.

Researchers specializing in tissue engineering, biomaterials, genetics and nanotechnology are making progress in their labs that could translate into myriad clinical applications in general dentistry, endodontics, periodontics and oral surgery.1

Where is the field of regenerative dentistry today? And what advances could it bring in the future?

Stem Cells and Regenerative Dentistry

Stem cells, along with bioactive molecules and bioactive scaffolds, are an essential part of regenerative medicine.2 These cells have the ability to self-renew and differentiate. Dental pulp stem cells (DPSCs) and periodontal ligament stem cells, for example, can play a role in regenerating dental, bone and periodontal tissues.3 In the past, research involving stem cells has

been clouded by controversy, particularly relating to embryonic stem cell research.4

“Now, we can isolate stem cells from many different tissues in adults. They are in dental pulp, for example,” said Luisa A. DiPietro, DDS, PhD, professor and director of the University of Illinois Chicago (UIC) Center for Wound Healing & Tissue Regeneration.

Researchers can also take cell-free approaches. Rather than implanting stem cells, they can use in situ tissue regeneration, which involves using biomaterials to direct stem cells already in the body to promote the repair and replacement of diseased or damaged tissue.5

How are some researchers using stem cells in their labs to push the field of regenerative dentistry forward?

Sriram Ravindran, PhD, an associate professor of oral biology at UIC, is currently conducting research that makes use of mesenchymal stem cells found in dental pulp, bone marrow and adipose tissue. His lab aims to develop a biomimetic approach to stem cell differentiation using cell type-specific extracellular matrices and exosomes. Ultimately, his lab is focused on regenerating dental pulp, cartilage and bone.

On the second visit, the endodontist may irrigate the canal with ethylenediaminetetraacetic acid. “Once we disinfect the canal, we intentionally try to induce bleeding at the apex, and that creates a blood clot within the canal,” said Lai. “That blood clot acts as a natural scaffold for the tooth to attract stem cells and growth factors to induce hard tissue formation, and increased root length and thickness. Then the ideal goal is, eventually, to regenerate the nerve cells as well.”

Endodontists leverage bioceramic materials to seal the pulp canal space, with the intention of inducing a hard tissue barrier and revascularization. Regenerative endodontics — also referred to as revascularization endodontics — is not yet at the point of regenerating the whole pulp-dentin complex and restoring sensitivity in teeth, but there are exciting developments in the

Biomaterial scaffolds serve as the framework that facilitates tissue regeneration. A study published in the Journal of last year found promise in antimicrobial silk scaffolds.9 Other researchers are 3D-printing scaffolds.10 Platelet-rich plasma and platelet-rich fibrin are also useful tools in creating scaffolds and promoting tissue regeneration in endodontic procedures.

“How can we engineer certain stem cells for direct insertion into the root canal? Or how might we incorporate them into a 3D-printed bioscaffold? These are some of the exciting innovations that are emerging right now in this field,” said Lai.

Lai also sees some challenges in the field of regenerative endodontics. One is the issue of standardization. Treatment protocols, such as those published by the American Association of Endodontists, serve as guides for endodontists.11 But there are still plenty of variations to consider.

“For example, when we’re disinfecting the root canal during the first visit, what concentration of sodium hypochlorite should we use? We have to use sodium hypochlorite to eliminate the bacteria, but, at the same time, if we use too strong of a concentration, we might be simultaneously killing the stem cells we want to recruit inside the root canal,” said Lai.

“We’re focused on understanding the difference between these two tissues and trying to determine if we can really improve skin healing and model it after the oral cavity.”

— Luisa A. DiPietro, DDS, PhD

Lai also sees the need for more long-term research. “What we’re missing right now is those long-term studies, 10 or 15 years out. Are these regenerative endo procedures still successful at that time — or are they failing?” he said.

Regenerative techniques can also be applied to preserve and restore tissue, like periodontal ligaments and bone, that can fall prey to periodontal disease.12

Guided bone regeneration (GBR) and guided tissue regeneration (GTR) are two of the primary therapies in regenerative periodontics. 13 Periodontists leverage GBR to regenerate alveolar bone around areas affected by disease. GTR, on the other hand, is used to regenerate periodontal ligaments, cementum and bone. Both procedures involve the use of a barrier membrane to promote regeneration while inhibiting the growth of undesirable tissue.

Researchers are also studying how DPSCs can be put to work in the regeneration of periodontal tissues and the dentin-pulp complex.3 They have leveraged different strategies, such as biochemical interventions and small-molecule therapies, to amplify the therapeutic value of DPSCs.3

Regenerative dentistry research can have applications that go beyond the mouth. In her lab at UIC, DiPietro, also a professor of periodontics, is studying wound healing in the oral mucosa and skin.14 “We’re focused on understanding the difference between these two tissues and trying to determine if we can really improve skin healing and model it after the oral cavity,” DiPietro explained.

Challenges in Regenerative Research

Regenerative research is an exciting field, but it is not without its scientific and logistical obstacles. The prospect of regrowing complex biological structures — like an entire tooth — is a major goal in the field. Scientists can look to examples of that capability elsewhere in the natural world. Take axolotls. These amphibians can regrow entire limbs.15 Understanding and replicating that regenerative capability is of obvious interest. “Many scientists have asked if we can find a way to get humans to adopt that regenerative phenotype and mechanism,” said DiPietro.

We don’t yet fully understand axolotls’ natural regenerative capabilities. Even if we reach the point of translating that capability to humans, how long would it take for us to regrow natural tissue?

In all likelihood, it would take a significant amount of time. There is a possibility that restorative materials will outpace the clinical applications of regenerative dentistry. “Robotic and material replacements for tissues are getting better and better. These advances may leapfrog regeneration strategies,” DiPietro said.

Bioinspired materials, for example, mimic the structure and function of naturally-occurring tissue material.

Ana Bedran-Russo, DDS, MS, PhD, associate dean for research and head of the Department of Oral Biology at UIC, is leveraging natural compounds to create these kinds of materials to improve tooth restoration and strengthen tooth structure.

Researchers exploring bioengineering tissue must grapple with the sheer complexity of the human body.

“What we’re learning is that the human body is a lot more complicated than just putting stuff together and engineering it. It’s not just regenerating and engineering the tissue; it’s making it last,” said Embree. “It’s really hard to build a house on sand, so to speak. You really have to have a clear foundation of how tissues work and how they’re maintained.”

That’s why, in recent years, Embree has observed a greater push for a multidisciplinary approach to regenerative research in dentistry. Engineers, researchers who specialize in the microbiome, immune system specialists — many different experts are needed to push the field forward. “It really takes a lot of different teams to understand how to not only prepare the tissue, but also how to maintain it. Because we also have to make sure it lasts,” she said.

For all of the exciting possibilities unfolding in the lab, there is a major external difficulty to be managed: funding. Every researcher knows how competitive, and often demoralizing, securing grants for their work can be.

Peer reviewers can be harsh. And work that researchers pour countless hours into may not secure a necessary grant. DiPietro shared her perspective on the process, acknowledging both the difficulty and opportunity that can come from it.

“It can be very difficult at times. Reviewer comments can be hard to read because people are harshly criticizing your work, but, a lot of times, you can read those reviews and get good ideas out of them,” she said. “Most of us, as scientists, demand the very best of ourselves: our very best ideas, our very best effort, and that’s how I approach every grant that I write.”

Today, funding challenges are further complicated by significant cuts to the National Institutes of Health (NIH), which funds billions of dollars of medical research.16 While industry can be a source of funding, the private sector tends to focus on work that can be commercialized on a shorter timeline.

“We need public support and public funds — namely NIH support — to really see a lot of these advances through to fruition,” said Embree. “A lot of industry doesn’t

do foundational, basic science because it takes way too long. Sometimes, the science takes 15 years before it gets to the point where it can be translated to patients.”

When researchers do reach the point where their work can be prepared for clinical use, there are then many regulatory hurdles to clear.

“There are so many nuances in commercializing and translating your drug or technology to patients,” Embree noted.

NIH support can play a role here as well. Embree co-founded biotechnology company WNT Scientific to help bring StemJEL to patients.6 That company secured support from the NIH’s National Institute of Dental and Craniofacial Research and NIH’s Commercialization Readiness Pilot program.17

“They partnered us with a team of regulatory consultants, which was phenomenal because I had no idea how to do this,” said Embree. “There must have been 15 people on the call helping prepare us for our Food and Drug Administration meeting.”

The Future of Regenerative Dentistry

Dentists have access to many aspects of regenerative dentistry in clinical practice today: bioactive materials, endodontic revascularization, GBR and GTR. Research continues, and, with it, the hope of more clinical applications.

New generations of researchers and clinicians have opportunities to learn about regenerative dentistry and figure out how they can incorporate that work into their labs and practices. The University of Michigan, for example, has a 12-month postgraduate program dedicated to regenerative dentistry.18

The competitive, intensive program accepts three or four students per intake. Students can come from a variety of backgrounds. “Dentistry, medicine and veterinary medicine, as well as physicists and engineers — we are all are trying to bridge engineering with biology and clinical applications of these biomaterials for regenerative applications,” Marco Bottino, DDS, MSc, PhD, FADM, the program director, told AGD Impact

Approximately a quarter of the program is dedicated to coursework in foundational areas of regenerative medicine, like stem cell biology and biomaterials science. Another quarter gives students the opportunity to participate in clinical shadowing based on their particular interests. The other half of the program is focused on hands-on research.

Many students join Bottino in his lab. “My lab focuses on the development of biomaterials and drug delivery therapies for reconstructing damaged dental and craniofacial tissues,” he said.

A number of different projects are underway in the lab. For example, Bottino and his team are exploring ways to 3D-print antimicrobial dental implants and to 3D-print tissue-specific grafts and scaffolds for the reconstruction of bone and periodontal ligaments. They are also examining ways to reconstruct alveolar

ways as well. At the end of 2024, researchers with the Tufts University School of Dental Medicine published a study in Stem Cells Translational Medicine. They successfully bioengineered tooth buds with human cells and implanted them in minipigs. Toothlike tissue grew over the course of two or four months.19 While that end product doesn’t yet look like a natural human tooth, the research appears to be an exciting step toward living tooth replacements.20

Of course, that is just one study. Plenty of other researchers are hard at work exploring possibilities in regenerative dentistry. And one area that could open a lot of doors for them? Vast, complex sets of information from a variety of sources — big data.

Machine learning models, often referred to as artificial intelligence, could be applied to data sets to drive more efficient “… analysis of factors that define cells’ differentiation, creating an optimal scaffold for cell growth, and predicting the effectiveness of the treatment.”21

“What’s often called ‘big data’ is really advancing the field very rapidly,” said DiPietro. “Because of the advancement of genomic and transcriptomic analysis, we’re able to learn so much about what genes are being turned on and utilized in different circumstances.”

“I’m very excited about the possibility of people doing more computational modeling. That approach will help us make

predictions about things that we can’t easily test in the lab,” DiPietro added. “It really could be helpful in any regenerative field — not just in the oral cavity or the craniofacial complex, but the whole body.” ♦

Carrie Pallardy is a freelance writer and editor based in Chicago. To comment on this article, email impact@agd.org.

References

1. Jamal, Hasan, and Mustafa Elhussein. “Integration of Regenerative Dentistry into the Dental Undergraduate Curriculum.” Frontiers in Dental Medicine, vol. 1, 2020, doi.org/10.3389/fdmed.2020.596189.

2. Thalakiriyawa, Dineshi Sewvandi, and Waruna Lakmal Dissanayaka. “Advances in Regenerative Dentistry Approaches: An Update.” International Dental Journal , vol. 74, no. 1, 2024, pp. 25-34.

3. Inchingolo, Angelo Michele, et al. “Stem Cells: Present Understanding and Prospects for Regenerative Dentistry.” Journal of Functional Biomaterials, vol. 15, no. 10, 2024, p. 308.

4. “Examining the Ethics of Embryonic Stem Cell Research.” Harvard Stem Cell Institute, 2007, hsci.harvard.edu/examining-ethicsembryonic-stem-cell-research. Accessed 31 March 2025.

5. Safina, Ingrid, and Mildred C. Embree. “Biomaterials for Recruiting and Activating Endogenous Stem Cells In Situ Tissue Regeneration.” Acta Biomaterialia, vol. 143, 2022, pp. 26-38.

6. “New Drug Shows Promise in Preventing Cartilage Loss from Osteoarthritis.” Columbia College of Dental Medicine, 31 Aug. 2023, dental.columbia.edu/news/new-drug-shows-promisepreventing-cartilage-loss-osteoarthritis.

7. “Regenerative Endodontics.” American Association of Endodontists, aae.org/specialty/clinical-resources/regenerative-endodontics/. Accessed 9 April 2025.

8. Bowers, Anna, et al. “Current Trends in Regenerative Endodontics: A Web-Based Survey.” Journal of Endodontics, vol. 50, no. 2, 2024, pp. 181-188.

9. Narayanam, Ramyasaketha, et al. “Antimicrobial Silk Fibroin Methacrylated Scaffolds for Regenerative Endodontics.” Journal of Endodontics, vol. 50, no. 12, 2024, pp. 1752-1760.

10. Zhao, Fengxiao, et al. “The 3-Dimensional Printing for Dental Tissue Regeneration: The State of the Art and Future Challenges.” Frontiers in Bioengineering and Biotechnology, vol. 12, 22 Feb. 2024, p. 1356580, doi:10.3389/fbioe.2024.1356580.

11. “Guide to Clinical Endodontics.” American Association of Endodontists, 3 June 2019, aae.org/specialty/clinical-resources/guideclinical-endodontics/.

12. Jepsen, Karin, et al. “Complications and Treatment Errors Related to Regenerative Periodontal Surgery.” Periodontology 2000, vol. 92, no. 1, 2023, pp. 120-134.

13. Alqahtani, Ali M. “Guided Tissue and Bone Regeneration Membranes: A Review of Biomaterials and Techniques for Periodontal Treatments.” Polymers, vol. 15, no. 16, 10 Aug. 2023, p. 3355, doi:10.3390/polym15163355.

14. UIC College of Dentistry. “Perfect Wound Healing: Lessons from the Mouth.” YouTube, uploaded by UIC Dentistry, 24 May 2024, youtube.com/watch?v=clyt_0I2ieY.

15. McCusker, Catherine, et al. “The Axolotl Limb Blastema: Cellular and Molecular Mechanisms Driving Blastema Formation and Limb Regeneration in Tetrapods.” Regeneration (Oxford, England), vol. 2, no. 2, 11 May 2015, pp. 54-71.

16. Gaind, Nisha. “How the NIH Dominates the World’s Health Research — in Charts.” News, Nature, 10 Mar. 2025, nature.com/ articles/d41586-025-00754-4.

17. “Commercialization Readiness Pilot (CRP) Program.” National Institutes of Health, U.S. Department of Health and Human Services, seed.nih.gov/small-business-funding/find-funding/crp. Accessed 31 March 2025.

18. “Regenerative Dentistry Graduate Program (Non-Degree).” University of Michigan School of Dentistry, dent.umich.edu/education/ regenerative-dentistry-graduate-program-non-degree. Accessed 31 March 2025.

19. Zhang, Weibo, and Pamela C. Yelick. “In Vivo Bioengineered Tooth Formation Using Decellularized Tooth Bud Extracellular Matrix Scaffolds.” Stem Cells Translational Medicine, vol. 14, no. 2, Feb. 2025, doi.org/10.1093/stcltm/szae076.

20. Gordemer, Barry, and Obed Manuel. “Scientists Grew Human-like Teeth in Pigs. Could It Lead to Living Tooth Replacements?” NPR, 10 Feb. 2025, npr.org/2025/02/10/nx-s1-5290022/scientistsgrow-human-like-teeth-in-pigs.

21. Saberian, Elham, et al. “Applications of Artificial Intelligence in Regenerative Dentistry: Promoting Stem Cell Therapy and the Scaffold Development.” Frontiers in Cell and Developmental Biology, vol. 12, 5 Dec. 2024.

Self-Instruction

Exercise No. IM159, 1 CE Credit Basic Science

(Subject Code: 010)

The 10 questions for this exercise are based on information presented in the article, “Regenerative Dentistry: Current Research and Upcoming Advances,” by Carrie Pallardy on pages 18–23. This exercise was developed by members of the AGD editorial team.

Reading the article and successfully completing the exercise will enable you to:

• understand the current state of regenerative dentistry research and materials;

• recognize clinical applications for regenerative techniques; and

• learn about pathways for future research and developments.

This exercise can be purchased and answers submitted online at agd.org/self-instruction

Answers for this exercise must be received by May 31, 2028.

1. Stem cells, along with bioactive _____ and bioactive _____, are an essential part of regenerative medicine.

A. platelets; collagen

B. cytokines; nanofibers

C. nanotubes; matrices

D. molecules; scaffolds

2. The acronym DPSCs stands for dental _____ stem cells.

A. pluripotent

B. plasma

C. platelet

D. pulp

3. Sriram Ravindran, PhD, is currently conducting research that makes use of _____ stem cells found in dental pulp, bone marrow and adipose tissue.

A. hematopoietic

B. mesenchymal

C. neural

D. pluripotent

4. Mildred Embree, DMD, PhD, MS, principal investigator at Embree Lab, and her team have shown that _____®, a drug developed in Embree Lab, can be used as a therapy for osteoarthritis.

A. StemJEL

B. BonePaste

C. OsteoSTEM

D. JawJel

5. In a survey published in the Journal of Endodontics in 2024, _____% of respondents reported performing regenerative endodontic procedures in their practice.

A. 70.4

B. 75.4

C. 80.4

D. 85.4

6. Regenerative endodontics — also referred to as _____ endodontics — is not yet at the point of regenerating the whole pulp-dentin complex and restoring sensitivity in teeth, but there are exciting developments in the field.

A. revascularization

B. rehabilitative

C. revitalization

D. rejuvenative

7. A study published in the Journal of Endodontics last year found promise in antimicrobial _____ scaffolds.

A. polymer

B. ceramic

C. titanium

D. silk

8. Platelet-rich _____ and plateletrich _____ are also useful tools in creating scaffolds and promoting tissue regeneration in endodontic procedures.

A. tissue grafts; stem cells

B. plasma; fibrin

C. glycoproteins; liposomes

D. exosomes; globulins

9. Researchers have leveraged different strategies to amplify the therapeutic value of DPSCs, such as biochemical interventions and _____ therapies.

A. albumin

B. small-molecule

C. proteoglycan

D. dense-myosin

10. At the end of 2024, researchers with the Tufts University School of Dental Medicine published a study in Stem Cells Translational Medicine after they successfully bioengineered tooth buds with human cells and implanted them in _____.

A. beagles

B. axolotls

C. minipigs

D. chimpanzees

Competing Dental and Dental Hygienist Compacts

What Dental Professionals Need to Know

By Jake Kathleen Marcus, JD, PGDip

The issue of dental and dental hygienist license portability — the ability to transfer dental and dental hygienist licensure from state to state — has long been an issue in the dental community. While license portability is critical for any dental professional who wishes to practice in more than one state — either because they have practices in multiple or border states or because they have relocated to another state — the issue is of particular concern to members of the military and their spouses, whose service may require they move frequently between states. Additionally, since the COVID-19 shutdown, the shortage of dental hygienists and other dental staff has been crippling, leading dental boards to explore ways to increase the available population of dental auxiliaries.

While state dental boards have worked to address license portability, particularly for members of the military and their families, more recently two organizations have created proposals for “compacts” that facilitate license portability across states. The Council of State Governments (CSG) Dentist and Dental Hygienist Compact (DDHC)1 and the American Association of Dental Boards (AADB) Interstate Dental & Dental Hygiene Licensure Compact (AADB Compact)2 are both initiatives designed to streamline the process for dentists and dental hygienists to

be able to practice, though these compacts differ in terms of governance, scope and implementation. But how these compacts work and the difference between the two has been confusing for the dental community.

This article will examine both the DDHC and the AADB Compact. Critical to the dental professional today is whether there is

some action you need to take and whether either compact has changed the way you can practice in multiple states. To begin, there are two things you should know: first, whether the state in which you are currently licensed has adopted the DDHC (no state has adopted the AADB Compact yet), and second, if it has, that the DDHC will not be available for at least 18 months. If you are licensed in a state that has not yet adopted the DDHC or that is considering adopting the DDHC, you should be informed about both compacts and how they could affect you.

What Are the Key Differences Between the DDHC and AADB Compact?

The DDHC is managed by a broader, statefocused organization, the CSG, that works to facilitate multistate practice for many professions. The AADB is an organization comprised solely of state dental boards that

focuses on dental board coordination and standardizing licensure practices across states.

Another critical distinction is that the AADB Compact creates uniform standards among states for licensure, while the DDHC creates a pathway for dentists to practice in multiple states via privilege to practice. Under the DDHC, dentists do not receive licenses in multiple states.

Another difference between the DDHC and the AADB Compact is the mode of funding. Under the DDHC, each state will pay a fee to the DDHC Commission, while the AADB Compact Commission would charge fees for using the compact process directly to the dental professionals seeking licensure.

Most significantly, and an object of criticism by some including the North Carolina State Board of Dental Examiners,3 is the difference in skills requirements under each compact. Most notably, the DDHC does not

require hand skills testing for dentists. To this criticism, the American Dental Association (ADA), which has partnered with the CSG, responds that extensive hands skills training takes place in dental schools followed by “14 states requir[ing] a single-encounter hand-skills clinical assessment in statute or state dental board rules, while 10 states accept alternative clinical assessments, either DLOSCE, PGY-1 or both.”4 It is a matter of dispute whether the possibility exists that dentists would seek primary licensure in a state without such a requirement and then seek practice privilege under the DDHC in a state that does require this testing.

In addition to the difference in skills testing, a dental professional who receives practice privilege through the DDHC will be required to complete continuing education only in the state in which they are licensed. This distinction too has raised the possibility that practitioners will maintain a license only in a compact state with a lower number of continuing education hours required. By contrast, once a dentist or dental hygienist has received a license

via the AADB Compact, they must meet all ongoing licensure requirements in all states in which they are licensed, as is currently the case for professionals holding licenses in multiple states.

What You Need to Know About the DDHC

While its name may lead some to believe the CSG is a governmental organization or agency, it is an independent organization that works with state government officials and other organizations on a variety of issues, one of which is occupational licensure. For example, through its National Center for Interstate Compacts (NCIC)5 in partnership with the U.S. Department of Labor, the NCIC “works with state government officials to strengthen the portability of occupational licenses and remove duplicative and overly burdensome requirements.”6 In the case of the DDHC, the CSG partnered with the U.S. Department of Defense (DOD) as part of a broader initiative to support interstate licensure compacts for military families. Other occupation interstate compacts that are part of the collaboration between the CSG and DOD include interstate compacts for teachers,7 social workers8 and school psychologists.9

In 2021 the CSG and DOD entered a partnership with the ADA, and the American Dental Hygienists’ Association to draft a model compact legislation, which was completed and made available to stakeholders for public comment in 2022. In 2023, the DDHC was then available for introduction as legislation in individual states. The precise language of the DDHC is available here: ddhcompact.org/wp-content/ uploads/sites/31/2024/06/Dentist_DentalHygienist-Compact-Model-Language_Final. pdf. The DDHC facilitates the process for dentists to practice in multiple states without having to obtain separate licenses in each state, provided they meet the requirements set forth in the compact. However, under the DDHC, professionals licensed in one compact state are not entitled to a license in another compact state. Under the

DDHC, a professional meeting the compact requirements can receive the privilege to practice in another compact state. To be eligible for a compact privilege under the DDHC, a dentist or dental hygienist must show the following:

• A license with no disciplinary action in a state that has joined the compact.

• Graduation from a predoctoral dental education program accredited by the National Board Examination of the Joint Commission on National Dental Examinations; or a dental hygiene education program accredited by the Commission on Dental Accreditation (CODA).

• Having not been convicted or found guilty, or entered into an agreed disposition, of a felony offense under applicable state or federal criminal law within five years prior to the date of their application.

• Passage of the National Board Examination.

• Completion of a “clinical assessment” (defined as “examination or process, required for licensure as a dentist or dental hygienist as applicable, that provides evidence of clinical competence in dentistry or dental hygiene for licensure”).

• Completion of a background check prior to obtaining their qualifying license.

• Completion of any jurisprudence requirements established by the license state.

• Payment of all required fees.

• Report to the commission of any adverse action taken by any nonparticipating (noncompact) state.10

Under CSG rules, “activation” of the DDHC could not begin until the model legislation had been adopted in seven states, which occurred April 22, 2024, with the passage of DDHC by the state of Maine. As of this writing, the DDHC has become law in:

• Colorado • Washington

• Kansas • Minnesota

• Iowa • Wisconsin

• Maine • Ohio

• Virginia • Tennessee

• Arkansas

The following states are considering passage of the DDHC:

• Oregon • Nevada

• Arizona • Nebraska

• Oklahoma • Texas

• Missouri • Indiana

• Pennsylvania • New Jersey

• Vermont • New Hampshire

• Massachusetts

The DDHC is now ready for “activation,” but there are still significant steps on the implementation timeline (see “What’s Next” section below).

What You Need to Know About the AADB Compact

The AADB is a national organization representing state dental boards. Unlike the DDHC, the AADB Compact draft legislation creates a centralized mechanism for dentists and dental hygienists to obtain and maintain licensure in multiple states. The full text of the AADB Compact can be found here: aadbcompact.org/wp-content/ uploads/2024/11/IDDHL-CompactOfficial-Final-version2-11-13-2024.pdf.

In order for a dentist licensed in an AADB Compact state to receive a license in another AADB Compact state, they must:

• Graduate from a CODA-approved dental school.

• Pass the ADEX dental licensure exam; or have been in practice five years or more and passed a regional board examination or equivalent state-administered psychomotor licensure examination prior to Jan. 1, 2024.

• Pass the written National Dental Board Exam administered by the Joint Commission on National Dental Examinations.

• Possess a “full and unrestricted dental license” issued by an AADB Compact State Dental Board.

• Never have been “convicted or received adjudication, deferred adjudication, community supervision, or deferred disposition for any offense (other than traffic offenses) by a court of appropriate jurisdiction.”

AGD’s Stance on Dental Compacts

The AGD Legislative and Governmental Affairs and Dental Practice councils are monitoring the two dental compacts in the various state legislatures, and AGD has not taken a position in support or opposition of either compact. AGD Policy 92:33-H-7 supports licensure by credentials for licensed dentists who: 1) have passed national boards; 2) have passed a state or regional licensure exam; 3) have passed a jurisprudence exam if required by a state; and 4) have not violated any law or ethical duty in their home state.

• Never have been “a subject of discipline by a licensing agency through any adverse action, order, or other restriction of the licensee by a licensing agency, with the exception of failure to pay fees or failure to complete continuing education.”

• Never had “a state or federal drug registration, permit, or license restricted, suspended, or revoked by the U.S. Drug Enforcement Administration or any licensing agency that oversees scheduled drug registrations.”

• Not “currently be under active investigation by a licensing agency or law enforcement authority in any state, federal or foreign jurisdiction.”

• Meet any jurisprudence requirement in the AADB Compact state in which they are seeking a license.11

While the AADB will issue a “compact privilege” to a successful applicant through this process, the license itself is issued directly by the dental board of the compact state in which the dental professional seeks a new license.

As of this writing, no state has passed AADB Compact legislation, though the AADB Compact website cites pending legislation in Texas, Oklahoma, Missouri, Kentucky, Mississippi, Pennsylvania, Massachusetts and Maryland. Notably, several of these states also have pending legislation that would adopt the DDHC, which means the state in which you as a dental professional are currently licensed may be considering legislative adoption of both compacts, only one of which is likely to succeed.

Can States Have Both Compacts?

While there is no necessity for a state to adopt either compact, a state could theoretically

adopt both, since there is a difference between the privilege to practice and actually receiving a license. However, each compact requires the passage of a different state legislation and is governed by a different commission, with each commission requiring significant participation from the compact state dental board. The DDHC Compact Commission, already in development, requires a commissioner to be appointed from the dental board of each compact state. The AADB Compact Commission would require two representatives from each compact state dental board. The pathways to practice created by each compact are not exclusive, and individual state dental boards may be supporting one draft legislation and opposing another. This creates the opportunity for dental professionals to become involved in whatever debate is happening at their state boards.

What’s Next?

With the DDHC Commission now in place and having recently approved its bylaws, the commission has begun the process of creating the data system to support application record collection and maintenance. This process is expected to continue into 2026, at which point compact states will onboard, followed by the opening of the privilege application process to dentists and dental hygienists.

As no state has yet passed legislation allowing it to join the AADB Compact, no AADB Compact Commission is in place. However, the AADB already maintains a licensure depository containing disciplinary actions for dentists in all states. Unlike the DDHC, which could not move forward until legislation was adopted in seven states, the AADB Compact process does not require a minimum number of compact states in order to begin functioning. If pending AADB Compact legislature

passes in two or more states, creation of a commission could follow, but the AADB has not published any timeline.

Whether or not states adopt one of the compacts, license portability for military members is an important issue for dental boards. Fees are waived for military dental professionals and their spouses under both compacts, and states such as North Carolina are independently streamlining the process for obtaining dental professional licenses by military endorsement and at an accelerated pace.12 If you are a dentist or dental hygienist in a military family or practice in multiple states for another reason, rest assured that license portability will continue to be the subject of state action in the years to come. ♦

Jake Kathleen Marcus, JD, PGDip, has been a regulatory lawyer primarily in the healthcare space for over 35 years. A graduate of Temple University School of Law, where they served as research editor of the Temple Law Review, they recently earned a postgraduate diploma in technology, media and telecommunications law from Queen Mary University of London School of Law. To comment on this article, email impact@agd.org

References

1. National Center for Interstate Compacts. “Dentist and Dental Hygienist Compact.” The Council of State Governments, ddhcompact.org. Accessed 4 April 2025.

2. “Interstate Dental & Dental Hygiene Licensure Compact.” American Association of Dental Boards, aadbcompact.org. Accessed 4 April 2025.

3. “Position Statement on Selection of a Dentist and Dental Hygienist Compact.” The North Carolina State Board of Dental Examiners, March 2024, ncdentalboard.org/PDF/Compact%20Position%20 Statement%20%20Mar%2024.pdf.

4. American Dental Association. “Myths vs. Truth About Dental Education, Testing, and the DDH Compact.” DDH Compact. ddhcompact. org/wp-content/uploads/sites/31/2024/03/Myths-and-Truths-inTesting-and-Examination.pdf. Accessed 4 April, 2025.

5. The Council of State Governments. National Center for Interstate Compacts, compacts.csg.org/. Accessed 4 April 2025.

6. The Council of State Governments. “Occupational Licensing Policy.” National Center for Interstate Compacts, compacts.csg.org/ourwork/licensing/. Accessed 4 April 2025.

7. The Council of State Governments. Interstate Teacher Mobility Compact, National Center for Interstate Compacts, teachercompact.org/. Accessed 4 April 2025.

8. The Council of State Governments. Social Work Licensure Compact, National Center for Interstate Compacts, swcompact.org/. Accessed 4 April 2025.

9. The Council of State Governments. Interstate Compact for School Psychologists, National Center for Interstate Compacts, schoolpsychcompact.org/. Accessed 4 April 2025.

10. “Frequently Asked Questions.” Dentist and Dental Hygienist Compact, ddhcompact.org/faq/. Accessed 4 April 2025.

11. Interstate Dental and Dental Hygiene Licensure Compact, 13 Nov. 2024, aadbcompact.org/wp-content/uploads/2024/11/IDDHLCompact-Official-Final-version2-11-13-2024.pdf.

12. North Carolina General Statutes. Chapter 93B, Occupational Licensing Boards, § 93B-15.1. Licensure for individuals with military training and experience; proficiency examination; licensure by endorsement for military spouses; temporary license. ncleg.gov/ EnactedLegislation/Statutes/PDF/BySection/Chapter_93B/ GS_93B-15.1.pdf. Accessed 4 April 2025.

Self-Instruction

Practice Management and Human Relations

(Subject Code: 550)

The 10 questions for this exercise are based on information presented in the article, “Competing Dental and Dental Hygienist Compacts: What Dental Professionals Need to Know,” by Jake Kathleen Marcus, JD, PGDip, on pages 26–29. This exercise was developed by members of the AGD editorial team.

1. In the context of this article, which of the following best represents the definition for dental and dental hygienist license portability?

A. the ability to transfer dental and dental hygienist licensure between the United States and Canada

B. a legal infrastructure that allows dentists and dental hygienists to take regional licensing exams that grants licensure in several states simultaneously

C. the ability to transfer dental and dental hygienist licensure from state to state

D. a legal infrastructure that allows states to “borrow out” a certain number of dentists and dental hygienists to other states on an annual basis

2. The Dental Hygienist Compact (DDHC) is managed by the _____ (CSG).

A. Council of State Governments

B. Constituent Subcommittee on Governance

C. Congressional Superintendent of Governments

D. Commission for Strategic Governing

3. The full name of the AADB Compact is the American Association of Dental Boards _____ Compact.

A. Dentist and Dental Hygienist Portability

B. Dental Professionals Licensure Portability

C. Interstate Dental Professionals

D. Interstate Dental & Dental Hygiene Licensure

Reading the article and successfully completing the exercise will enable you to:

• contextualize the need for cross-state licensing options for dental professionals;

• understand what options are currently coming on the legislative horizon; and

• recognize what steps should be taken to leverage these options once they are available.

This exercise can be purchased and answers submitted online at agd.org/self-instruction

Answers for this exercise must be received by May 31, 2028.

4. The AADB Compact creates a pathway for dentists to practice in multiple states via privilege to practice. The DDHC creates uniform standards among states for licensure.

A. Both statements are true.

B. The first statement is true; the second statement is false.

C. The first statement is false; the second is true.

D. Both statements are false.

5. Under the DDHC, each state will pay a fee to the DDHC Commission, and dental professionals will also pay a fee to the Commission. The AADB Compact Commission would only charge fees for using the compact process directly to the dental professionals.

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. At the time of this article’s publication, all of the following are other occupation interstate compacts that are part of the collaboration between the CSG and Department of Defense except for one. Which is the exception?

A. school psychologists

B. principals

C. social workers

D. teachers

7. All of the following are required by the DDHC for each participating dentist or dental hygienist except one. Which is the exception?

A. completion of a “clinical assessment”

B. a background check prior to obtaining their qualifying license

C. a license with no disciplinary action in a state that has joined the compact

D. passage of the National DDHC Examination

8. Which was the seventh state to adopt the DDHC?

A. Arkansas

B. Colorado

C. Iowa

D. Maine

9. All of the following are required by the AADB Compact for each participating dentist and dental hygienist except one. Which is the exception?

A. graduate from a CODA-approved dental school

B. have been in practice for seven or more years

C. possess a “full and unrestricted dental license” issued by an AADB Compact State Dental Board

D. not “currently be under active investigation by a licensing agency or law enforcement authority in any state, federal or foreign jurisdiction”

10. At the time of the article’s publication, no state had passed AADB Compact legislation, though legislation was pending in all of the following states except one. Which is the exception?

A. Connecticut

B. Texas

C. Oklahoma

D. Pennsylvania

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