NYSDA News October 2023

Dentists Take to the Road to Raise Money for Cancer Research

Kevin Hanley and Amy Bryan choose to do their fundraising from bicycles.

For two Western New York dentists, riding a bike is more than exercise or a mode of transportation, it’s also an act of charity. Kevin J. Hanley, D.D.S., of East Amherst and Amy Bryan, D.D.S., of Williamsville suited up this summer for rides to benefit cancer research and patient care at Roswell Park Comprehensive Cancer Center in Buffalo. Dr. Hanley was recording his 12th appearance as a participant in the Ride for Roswell, held each year on a Saturday in June. Dr. Bryan was making her first appearance in the Empire State Ride, staged over eight days in July. At the end of their rides, Dr. Hanley had raised $3,185 in pledges, while Dr. Bryan and her Team Regan had collected $41,000.

The Ride for Roswell takes place over a 34-mile country route, a somewhat leisurely ride, according to Hanley, an orthodontist, who starts prepping for the event in March and considers it an important part of his summer. It enables him to raise critically needed funds for cutting-edge research and compassionate patient-care programs at Roswell Park, he said. It’s also very personal, as he dedicates his ride to friends and colleagues, those who have died from cancer and those who have survived. Sadly, he notes, the list increases each year, which shows, he said, how pervasive cancer is.

Kevin Hanley flashes victory sign as he crosses finish line in annual Ride for Roswell, held to benefit Buffalo Comprehensive Cancer Care Center.

Amy Bryan celebrates completion of bike ride across New York State to raise funds for cancer research.

Donor Support will Fuel New York State Dental Foundation’s Vision for 2024

The New York State Dental Foundation is poised to create a lasting impact on the oral health and overall well-being of countless individuals and families in 2024, but we can’t do it alone.

Stacy McIlduff, CFRE Executive Director, New York State Dental Foundation

At the heart of giving lies an innate human desire to make a positive difference in the lives of others. This act of selflessness brings with it a profound sense of inner joy and fulfillment. Studies in psychology consistently reveal that acts of kindness and generosity trigger the release of endorphins, the body’s natural feel-good chemicals. When you give, your brain

CONTINUED ON PAGE 12 1

OCTOBER 2023

Volume 36 • Issue 3

EDITOR

Chester J. Gary, D.D.S., J.D.

MANAGING EDITOR

Mary Grates Stoll

ADVERTISING & SPONSORSHIP MANAGER

Jeanne DeGuire

ART DIRECTOR

Ed Stevens

NYSDA OFFICERS

Anthony M. Cuomo, President Prabha Krishnan, President-Elect

Maurice Edwards, Vice President

Paul Leary, Secretary-Treasurer

William Karp, Speaker of the House

Gregory D. Hill, Executive Director

Editorial and advertising offices are at Suite 602, 20 Corporate Woods Boulevard, Albany, NY 12211-2370.

Telephone (518) 465-0044.

Fax (518) 465-3219. Email info@nysdental.org. Website www.nysdental.org.

The NYSDA News (ISSN 1531684X) is published quarterly, in February, May, October and December, by the New York State Dental Association, Suite 602, 20 Corporate Woods Boulevard, Albany, NY 12211-2370. It is available in digital form only and accessible online in the members-only section of the NYSDA website, www.nysdental.org, under publications.

NYU dental students Sam Al Safarjalani and Natalie Ralston, participants in NYSDF Champions for Change program, perform volunteer duties at Special Olympics event.

The Habsburg Jaw

The family members occupying the Spanish Throne for some 200 years were not profiles in beauty.

William J. Maloney, D.D.S.

The Habsburg dynasty was one of the primary dynasties of Europe for hundreds of years, starting with their rule of Austria in 1282. The Habsburgs ruled Spain from the early 1500s until the death of Charles II in 1700. Charles’s death marked the end of this period, during which the Habsburg family controlled kingdoms in Italy, Spain, the Netherlands, Germany and Hungary. The collapse of most dynasties and regimes usually stems from factors such as war, political or religious turmoil, corruption or financial upheaval. The demise of the Habsburgs was due simply to genetics, the ultimate result of their practice of intermarriage, which they ironically thought would ensure their continued place on the thrones of Europe and was best illustrated by a craniofacial anomaly collectively known as “The Habsburg jaw.”

The name Habsburg is derived from the castle that bore that name, built in 1020 by Werner, bishop of Strasbourg and his brother-in-law Count Radbot, overlooking the Aar River in present-day Switzerland.[2] Hapsburg jaw, mandibular prognathism, is a rare, genetic developmental defect characterized by the abnormal forward projection of the mandible beyond the standard relation of the cranial base.[3] In the general population, prognathism affects between 2.0% and 4.0% of adults.[4] In most cases, it is simply an inherited condition and is not indicative of any other underlying medical condition. However, in some instances, prognathism may be a symptom of certain medical conditions, such as acromegaly, Crouzon syndrome, Down syndrome, acrodysostosis and basal cell nevus syndrome.[4]

The familial members of the House of Habsburg exhibited certain physical manifestations and characteristics of the Habsburg jaw throughout the centuries. These include a prominent nose,[5] thickened lower lip,[5] flat molar areas,[5] an oxycephalic head shape due to synostosis of all cranial sutures,[5] and a maxillary deficiency that is a condition whereby the bones that form the upper jaw don’t fully develop.[6]

“Your Majesty, shut your mouth, the flies of this country are very insolent.”

Shouted to the Holy Roman Emperor Charles II of Spain by a Spanish peasant[1]

The unfortunate progeny of married relatives, Charles II displayed family trait known as The Hapsburg jaw.

Meeting is Held at the Jacob K. Javits Convention Center

The Problem with Cyber Insurance

WITH CONCERNS MOUNTING over cybersecurity, HIPAA and dentistry’s increasing exposure as a profession, many doctors have purchased cyber insurance riders to their business and general liability insurance policies. These riders protect holders from losses specifically incurred from damage to their information systems, ransomware and data loss.

Some of these policies also protect from claims made against doctors for HIPAA violations, and for mitigating the financial and reporting burdens a HIPAA claim can bring. Dentists must be very careful, however, when applying for these policies. The applications often ask specific and technical questions about the procedures in the office regarding information technology and cybersecurity. If you answer the questions incorrectly or incompletely, there’s a strong chance this will be uncovered in the event of a claim, resulting in cancellation of the policy or denial of coverage. Just recently, the Travelers Insurance Co. sought to rescind a cyber insurance policy it issued to International Control Services (ICS) because of alleged misrepresentation of its use of multifactor authentication (MFA).

Multifactor authentication, or MFA, is commonly used in everyday life. It is like using two locks instead of one to protect something important. Imagine you have a password to log into your practice management system, but you also need a special key (like a fingerprint or a code sent to your phone) to allow access. This way, even if someone guesses your password, they still can’t open the second lock without the special key. This is familiar to all of us and is standard for any type of secure communication. When logging into your bank account from a new computer, for example, you might be required to enter your password first and then receive a special code to your phone that must be entered as well. MFA adds an extra layer of protection, making it much harder for unauthorized people to access your accounts and personal data.

Travelers alleges that ICS falsely claimed in its application that it used MFA for administrative access, but later discovered that MFA was only applied to its firewall. This is a subtle distinction, and it might be easily missed on an insurance application. Travelers is declaring the insurance contract void, rescinding the policy and denying responsibility for any claims or costs incurred by ICS, including those resulting from the ransomware attack.

This case is relevant to dentistry because multifactor authentication is incredibly important for the secure storage and communication of health information. Any offsite access to your practice management system should be protected by MFA. This case also contains a warning for all of us. It points out some of the risks in answering technical questions without adequate background knowledge. It is highly recommended that before submitting any application for insurance, you run it past someone at your IT company, or anyone else you rely on for advice regarding information technology.

As always, the NYSDA Information Technology Committee is available to provide education and support for dentists struggling with issues surrounding information technology and cybersecurity. To reach the committee contact Jacqueline Donnolly at NYSDA, jdonnolly@nysdental.org.

It’s always a good idea to consult with an expert before signing any document requiring you to divulge technical information about your practice.

Mitchell Rubinstein, D.M.D.

Dr. Rubinstein is chair of the NYSDA Information Technology Committee. He can be reached at Dr.Mitch57@gmail.com.

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Understanding Staff Attrition in Dental Practices

Identifying Causes and Solutions

Ashli Klingaman

Employee turnover is a never-ending challenge faced by dental practices, impacting both patient care and financial stability. Although attrition isn’t exclusive to the dental industry, what is unique are the strategies that a practice can implement to improve the ongoing hamster wheel of recruiting, hiring and training. While some factors contributing to staff attrition are obvious, we’ll take a closer look at the subtler, often unconscious, triggers that lead to employees leaving their positions.

Inadequate Communication and Feedback Channels

In dental practices, the significance of effective communication and accessible feedback channels cannot be overstated. Insufficient communication channels and limited opportunities for staff to voice concerns or offer suggestions can result in adverse consequences.

For instance, imagine a situation where your office manager identifies a recurring issue with cancellations and the receptionist is having a hard time keeping up with confirmation calls of future appointments and filling those canceled appointments. An automated communication tool, like PracticeMojo, can save your receptionist time and is more effective in filling your calendar. However, without a clear avenue for your receptionist to share her challenges and ideas for resolution, her frustration will escalate, and the ongoing cancellation problems will continue.

To counter this, you can cultivate an environment where open dialogue is not only welcomed but actively encouraged. By implementing regular staff meetings, suggestion boxes and systems for anonymous feedback, you can tap into the collective expertise of your team, boost staff morale and, ultimately, improve the quality of patient care you provide.

Insufficient Professional Development Opportunities

In a survey conducted by the American Dental Association, approximately 30% of dental professionals expressed dissatisfaction with the level of professional development opportunities provided by their practices. This discontent doesn’t just influence personal career advancement, it can also have repercussions on the overall patient experience and the competitiveness of your practice.

SMILE SALUTE VETS WITH A

WILL YOU PLEDGE TO PROVIDE DENTAL CARE FOR ONE VETERAN IN 2024?

Through major acts of courage and simple acts of kindness, Veterans have protected Americans' rights and defended our freedoms. Yet millions of U.S. Veterans are going without much-needed, essential oral health care.

The New York State Dental Foundation is organizing a crew of dentists across New York State who will pledge to provide free dental treatment to one or more United States Veterans in 2024.

PLEDGE YOUR SUPPORT TODAY

Fill out the pledge form by using the QR code below. Your name will be added to our internal directory of Dental Heroes.

We will spread the news about New York's Salute Vets with a Smile program and connect Veterans in need with a Dental Hero in their area.

Free toothbrushes and up to $500 in funding for supplies will be provided to any components wishing to organize an additional Veterans event in their district.

"85%, or about 7.8 million veterans enrolled in the Veterans Affairs health care system, are ineligible for VA dental benefits... in order to qualify for dental services, Veterans must either have a dental issue that is service-connected or qualify based on narrow criteria."

NYU College of Dentistry Advances Aesthetic Dentistry Programs with Alumnus Michael Apa

“MAKE THE MOST out of what you worked so hard to obtain.”

This inspirational advice in NYU College of Dentistry’s Class of 2003 yearbook came from Michael Apa, D.D.S., then a newly minted dentist with a passion for aesthetics. In the 20 years since his graduation from NYU, Dr. Apa has helped to transform the evolving field of aesthetic dentistry and distinguished himself as one of its leaders.

Now, Dr. Apa is “making the most” of his achievements by investing in the dentists of tomorrow and enhancing the college’s programs in aesthetic dentistry.

In recognition of Dr. Apa and his contributions to the field, NYU Dentistry will rename its education program in aesthetic dentistry the Apa Advanced Clinical Fellowship in Aesthetics. The college is also establishing the Apa Aesthetic Suite at the college, a state-of-the-art clinical space and the first permanent home for aesthetic dentistry education at NYU. These advances are made possible by a transformational gift from Dr. Apa.

Dr. Apa will collaborate with Anabella Oquendo, D.D.S., director of the renamed Apa Advanced Clinical Fellowship in Aesthetics, to provide input on bringing international and U.S. dentists state-of-the-art training that restores and enhances natural smiles. The renowned, one-year program has attracted practicing dentists from 47 countries to study the latest techniques in aesthetic dentistry.

The new Apa Aesthetic Suite, designed in collaboration with Dr. Apa, will be located on the first floor of NYU Dentistry. Planning for renovations to the existing clinical space will begin this fall, and the suite is scheduled to open in fall 2024.

As one of the world’s most sought-after aesthetic dentists, with practices in New York, Los Angeles and Dubai, Dr. Apa has maintained his connection to NYU Dentistry as a lecturer and mentor to dental students. His passion for aesthetic dentistry blossomed while at NYU, where he founded NYU Dentistry’s Aesthetics Society and was part of the college’s Aesthetics Honors Program.

Head, Neck and Oral Pathology

Dentists Take to the Road

continued from page 1

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The Empire State Ride is a bit more grueling. It’s a 550-mile trek from Staten Island to Niagara Falls, challenging even for the physically fit. Dr. Bryan, who has completed 11 full marathons, multiple half marathons and triathlons and a full ironman competition, admits it was a struggle at times, as the 350-plus riders encountered hills, heat, rainstorms and strong headwinds during their days on the road. “The miracle of this event is that we raised over $2 million to donate to Roswell Park.” It was also life-altering for the oral surgeon:

“I felt this entire journey was life changing in that the people I rode with were so kind and inspirational. Doing this ride was one of the most challenging things I have ever done, and I plan on repeating it again in July 2024!”

Donor

Support

continued from page 2

responds by making you happier. It’s a simple yet potent mechanism that reminds us that giving is not just about the recipient—it’s also about nurturing our own well-being.

As NYSDA members contemplate making a gift to support the New York State Dental Foundation when dues statements arrive this fall, here is a glimpse into the impactful programs and initiatives that donor generosity will fuel in the coming year.

Honoring Veterans Year-Round

A nation’s gratitude knows no bounds, and the Foundation seeks to express it in a tangible way. Our Salute Vets with a Smile program is not just a one-day event; it’s a year-round commitment to providing free dental care to veterans across the state. With your support, we can extend our reach and touch the lives of those who have selflessly served our country.

Oral Health Care is About Empowerment and Access

In 2024, we are pioneering the My Healthy Smile NY pilot program, a visionary initiative to expand access to oral health care. At its core are community dental health coordinators, a dedicated team tasked with promoting dental professions and ensuring that oral health care reaches the heart of our communities.

Don’t Ignore Your Mouth: Early Detection, Lifesaving Impact

Early detection is the key to saving lives, and we are committed to raising awareness about oral cancer. Your support will enable us to conduct screening events and advocate for the HPV vaccination, crucial steps in our mission to protect New Yorkers from this silent threat.

Inspiring the Future of Dentistry

Through the Champions for Change program, we are creating opportunities for dental students and residents to engage in volunteerism and mentorship. Your donation will help nurture the next generation of dental leaders and changemakers.

We are committed to transparency and accountability. If you elect to contribute to the New York State Dental Foundation, we will keep you informed of the outcomes of our initiatives, showcasing the transformative power of your generosity.

Oral health care is not a luxury but a right that should be accessible to all. As the New York State Dental Foundation embarks on an inspiring journey in 2024, a year brimming with promise and potential, please stand with us and make a difference. It’s your support, your belief in our mission, and your generosity that drive our efforts to transform lives and communities through the gift of oral health.

Habsburg Jaw continued from page 4 -

Unfortunate Unions

Many royal families have viewed marriage as a means of making alliances and ensuring continuity of their reign. As a result, the Habsburgs were not the only royal family to be affected by genetic disorders. Queen Victoria’s recessive trait for hemophilia spread throughout the ruling families of Europe, with particularly tragic consequences for the Romanov family of Russia. In the case of the Hapsburgs, the many deleterious genetic effects of intermarriage guaranteed their fall from power. The Spanish Habsburg rulers had 34 children, half of whom died before the age of 10, some even before their first birthday. By contrast, the death rate for the average family of the time was only one in five, even though these nonroyals had significantly fewer resources than the royal Habsburgs.[7]

Modern research has determined the average inbreeding coefficient of the Habsburgs to be .093. This means that over 9% of the genes of each member of the Habsburg family were identical. As a point of reference, the inbreeding coefficient of two first cousins is .0625.[8]

Charles II was the last in the line of Spanish Habsburg kings. The genetic effect of intermarriage manifested itself

CONTINUED ON PAGE 14 1

The death of the childless Charles II sparked the War of Spanish Succession.

Habsburg Jaw continued from page 13

to a terrible degree in Charles. His physical characteristics earned him the nickname El Hechizado, or “The Bewitched.” Charles’s inbreeding coefficient was .25, as his mother and father, already being highly inbred themselves, were niece and uncle.[8] Francesco Niccolini, the Apostolic Nuncio to Portugal, described Charles, at the age of 25, as being “short rather than tall, not badly formed, ugly of face, he has a long neck, a long face that curves inwards; the lower lip typical of the House of Austria … He can’t straighten his body, rather when he walks he curls up against a wall, a table or something else. His body is as weak as his mind.” [9]

Charles II died at the age of 54 with no children. The War of the Spanish Succession (1701-1714) followed his death. His heirs, Philip of Anjou and Charles of Austria, struggled for control of the Spanish Empire amid conflicting claims.

Felled by His Family Tree

The Habsburg jaw illustrates the genetic conditions that led to the downfall of a dynastic family that ruled throughout Europe for centuries. The medical dangers of consanguinity and the severity of the genetic maladies faced by the Habsburgs are evident in the autopsy report of Charles II. The doctor wrote that his body “did not contain a single drop of blood, his heart was the size of a peppercorn, his lungs corroded, his intestines rotten and gangrenous; he had a single testicle, black as coal and his head was full of water.”[10]

Modern researchers feel that Charles suffered from pituitary hormone deficiency, posterior hypospadias, monarchism, an atrophic testicle, a congenital monokidney with stones and infections and an intersexual state.[10] It is no wonder that the genetic condition referred to as The Habsburg jaw led to the collapse of one of the greatest dynastic families in world history.

Dr. Maloney is clinical associate professor, New York University. He holds a postgraduate certificate in healthcare writing from Harvard Medical School, is a fellow of the New York Academy of Medicine and a member of The Explorers Club. Queries about his article can be sent to Dr. Maloney at wjm10@nyu.edu.

REFERENCES

1. Grabb WC, Hodge GP, Dingman RO, O’Neal RM. The Habsburg jaw. Plast Reconstr Surf 1968;420:442-445.

2. Web Gallery of Art. Hapsburg, House of. Accessed on 6/16/23. Available at: https:/www.wga.hu/tours/gothic/history/ habsburg.html.

3. Genetic and Rare Diseases Information Center. Prognathism mandibular. Accessed on: 6/15/23. Available at: https:// rarediseases.info.nih/gov/diseases/10319/prognathism-mandibular.

4. Cleveland Clinic. Prognathism. Accessed on 6/15/23. Available at: https://my.clevelandclinic.org/health/diseases/22872-prognathism.

5. Wolff G, Wienker TF, Sander H. On the genetics of mandibular prognathism: analysis of large European noble families. J Med Genet 1993 Feb; 30 (2):112-116.

6. Saplakoglu Y. Inbreeding caused the distinctive ‘Habsburg Jaw’ of 17th century royals that ruled Europe. 12/2/19. Live Science. Accessed on 6/6/23. Available at: https://livescience.com/habsburg-jaw-inbreeding.html.

7. Yong E. How inbreeding killed off a line of Kings. National Geographic. April 14, 2009.

8. Thulin L. The distinctive ‘Habsburg Jaw’ wasn’t likely the result of the royal family’s inbreeding. Smithsonian Magazine. December 4, 2019.

9. Ansende M. Research confirms that intermarrying caused the ‘Habsburg jaw’ in Spanish royals. El Pais. December 4, 2019.

10. Medium. The autopsy of Charles II of Spain. Accessed on 6/13/23. Available at: https://worldroyals.medium.com/theautopsy-of-charles-ii-of-spain-d659015cb30.

Understanding Staff Attrition continued

from page 8

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Taking a comprehensive approach is key to overcoming the above challenge. Creating tailored development plans, investing in diverse training programs and supporting continuing education courses demonstrates a commitment to staff growth. If budget is a concern, in-practice mentorship programs, cross-training initiatives and regular feedback systems foster skill transfer and address evolving needs. These strategies enhance professional development and ensure that your team is well-equipped to deliver the best patient care possible, ultimately contributing to the longterm success and reputation of your practice.

Unequal Workload Distribution

Ensuring an equitable distribution of responsibilities within your practice is essential for cultivating a motivated team. When tasks are not allocated fairly and transparently, it can lead to feelings of inequality among your staff members. It’s crucial to institute comprehensive systems that prioritize the assignment of tasks according to individual competencies and regularly evaluate workloads, making necessary adjustments when required. You can do this by:

• Assigning tasks based on the specific skills and expertise of each team member. For example, dental hygienists may excel in patient education, while dental assistants may be proficient in chairside assistance. Assigning tasks accordingly ensures that each team member is working in his or her area of strength, which not only improves efficiency but also boosts morale, as team members feel confident and competent in their roles.

• Regularly assessing workloads to make sure that no team member is unfairly burdened or underutilized. This involves tracking the time spent on different tasks, patient appointment volumes and the complexity of procedures. If disparities are identified, adjustments can be made to distribute tasks more evenly, preventing burnout and frustration among team members.

• Being prepared to adapt and redistribute tasks based on changing circumstances. For instance, during a surge in patient appointments, redistributing administrative tasks or extending appointment scheduling hours can alleviate stress on the team. Conversely, during quieter periods, team members may have the opportunity to engage in continuing education or focus on long-term practice improvement initiatives.

These systems act as safeguards for maintaining high team morale and nurturing an environment where every team member feels genuinely valued and enthusiastic about making optimal contributions.

Lack of Recognition and Appreciation

Recognizing and appreciating your team members’ contributions can shape their level of engagement and commitment. When you neglect to acknowledge the efforts and achievements of your staff, it inadvertently creates an environment where team members may feel undervalued.

Implementing a system that acknowledges outstanding performance creates a sense of belonging and, ultimately, strengthens the bond between you and your staff. A few ways to start doing this right away include implementing a monthly “Employee of the Month” award and regular shout-outs on social media or your website, showcasing the staff’s accomplishments or newly acquired credentials.

Inadequate Conflict Resolution

Inadequate conflict resolution can harm team dynamics and patient care. Unresolved conflicts lead to lower morale and reduced productivity. In a Dental Post 2023 Salary Survey, it was reported that “31% of the dental hygienists surveyed are considering a job change and one-in-four said their driving factor was a desire for a more positive work environment.”

To address this, you should encourage open communication, provide conflict-resolution training and establish a structured conflict-resolution process. Promoting empathy and mutual respect

among team members also helps prevent conflicts, creating a positive work environment that benefits both your staff and your patients.

Recognizing and mitigating staff attrition issues in your practice is imperative for maintaining a thriving and successful clinic. Identifying the root causes of attrition and implementing effective solutions can significantly enhance the overall work environment at your practice, leading to greater job satisfaction among your staff and improved patient experiences.

At ProSites, we understand the challenges dental practices face and are committed to supporting your practice’s success. Our comprehensive marketing services, including patient engagement strategies and online visibility optimization, can help attract and retain both patients and talented team members. By partnering with us, you can create a practice that not only provides exceptional dental care but also fosters a positive and sustainable work culture. To learn more and claim exclusive NYSDA member discounts, visit prosites.com/nysda.

Ashli Klingaman is a versatile professional with a rich background in sales, training management, human resources and marketing, and is a regular contributor to ProSites. ProSites is endorsed by NYSDA for members looking to increase patient engagement, add comprehensive marketing strategies, increase practice visibility, and help attract and retain patients and team members. To learn more and claim exclusive NYSDA member discounts, visit prosites.com/nysda.

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