NYSDJ August/September 2024 by New York State Dental Association

The Patient has HIV Is He a Candidate for Dental

Implants?

Cover: Dental providers may be needlessly worried about placing implants in patients with HIV. The development of medications that control the disease has extended patients’ lives and made them candidates for long-term dental care.

Success of Implant Placement in Patients with Human Immunodeficiency Virus

Osman Khan; Kathryn Gauch; Alison Newgard, D.D.S.; Ezzard Rolle, D.D.S.

Now that patients with HIV are living longer, they are looking for longterm solutions to dental care, including implants. Dental providers need to be aware of research that has shown that in patients whose HIV is well-controlled, dental implant success is the same as with healthy non-infected patients.

29 Effects of Mandatory COVID-19 Testing Policy on No-Show Rates for Aerosol-Generating Procedures

Ramin Kashani, D.D.S.; Natesha Kumar, D.D.S.; Sheena Nandi, D.D.S., M.P.H.; Courtney H. Cehinn, D.D.S., M.P.H.

Authors conducted a retrospective chart review at pediatric dental clinic to determine the impact of mandatory COVID-19 testing policy on visit no-show rates. The policy not only didn’t increase rates, it resulted in more treatment being completed in a shorter time frame.

33 Heterotopic Bone Formation after TMJ Surgery

Sumir Gandhi, D.D.S., M.D.S.; Robert S. Glickman, D.M.D.

Heterotopic ossification, the formation of lamellar bone in soft tissues where normally bone does not exist, is most frequently diagnosed in patients who undergo total hip and knee replacement surgery. While associated with any joint in body, it receives little attention relative to the TMJ. An overview is presented to prepare providers for the prevention and management of patients at high risk for development of HO. Literature review

Rural Oral Health Access

in New York State

Renae Williams Atkinson, D.M.D., M.S.; Stacy McIlduff, CFRE; Hayward Derrick Horton, Ph.D.

New York State Dental Foundation is hopeful that its newly created interactive map will help connect patients with private dentists who accept Medicaid to overcome potentially deadly disparities in their access to dental care.

60 Addendum

Pierre Fauchard Academy honorees

A Sorry Situation

Doing the right thing and apologizing to a patient for an adverse treatment outcome can, but shouldn’t, increase a dentist’s liability.

Dr. Doright’s heart pounded. He felt a sickening, empty feeling in the pit of his stomach as he read the oral surgeon’s recent treatment report regarding his next scheduled patient. He suddenly realized he had mistakenly ordered, and the surgeon had completed, extraction of the wrong teeth. The loss of two critical abutment teeth in a partially edentulous arch now created a more complicated, expensive and compromised treatment plan. He swallowed hard, collected himself, entered the operatory, clinically confirmed the situation and apologetically said, “I’m genuinely sorry.”

He went on to explain what had happened, admitted his error, and advised the patient to file suit against him to have the dentist’s malpractice insurance carrier compensate the patient for the injury and added expenses. After careful consideration, the patient responded, “But, Doctor, I don’t want to sue you because then you couldn’t continue to be my dentist.”

All dentist apologies and admissions of fault to patients, regretfully, do not result in as fortunate an ending as in the above, actual case summary. The decision to apologize and admit fault remains controversial with many risk managers and attorneys. Typically, they

advise dentists to “deny and defend” when things go wrong to avoid making a verbal mistake which the patient’s attorney could use against the dentist in court. Nevertheless, candid, open disclosure can reduce the risk of liability claims when a dentist knows when and how to say “I’m sorry” and practices in a state with apology law legislation that makes such statements inadmissible as evidence.

The Hardest Word

Elton John’s song “Sorry Seems to be the Hardest Word” aptly describes the quandary dentists face when we seek to explain and show sympathy for adverse treatment events to our patients. Ethics dictate transparency and honest disclosure. Risk management principles warn that apologies can backfire and create increased liability. It places dentists in a Catch-22 situation, where the apology we ethically want to deliver could increase our risk of a lawsuit. Dr. Doright offered his apology and admission of fault, as the facts attest, into a strong, mutually trusting dentist-patient relationship, an essential element to achieve an apology that both strengthens the therapeutic relationship and deters legal action. Here, the patient so valued their ongoing relationship over the

prospect of a financial settlement that the patient declined the dentist’s invitation to file a slam-dunk lawsuit. Since the patient had no intent to sue Dr. Doright in the first place, it rendered moot whether the dentist simply apologized without admitting fault, or apologized and admitted fault, or whether state law would allow any of the statements to be used against Dr. Doright at a malpractice trial.

In the case of a weaker dentist-patient relationship, with minimal trust, and certainly after an angry patient has requested transfer of their records to another dentist or contacted an attorney or the State Board, apologies and admissions become ineffective, since the relationship is already beyond salvage. And it’s inadvisable in most states since they may alert the patient to an otherwise unknown event and prompt a lawsuit in which the statements will be admissible as evidence against the dentist.

Since most patients will not respond like Dr. Doright’s patient, dentists involved in a trusting dentist-patient relationship facing the task of disclosing to the patient the circumstances of an unexpected or adverse treatment outcome should understand the underlying reasons patients sue dentists, dentists’ ethical and legal duties of disclosure, and the state’s apology law to determine what to say and when to say it.

What to Do When Lightning Strikes

Patients sue dentists for four main reasons. First, to get information or answers regarding what happened and why. Second, to get back at the dentist out of anger for a violation of their trust and perceived lack of empathy. Third, to hold the dentist accountable and prevent future patient injuries and, finally, to get money—not usually the prime reason.[1]

A disclosure and explanation of an adverse event, an apology and plan to correct the problem can respond to these patient concerns and diffuse the patient’s desire to strike back legally. A timely acknowledgment of the circumstances opens a candid dialogue, enhances trust, and reduces patient anxiety and confusion. An apology expressing genuine remorse, regret and empathy will quell patient anger. A detailed explanation of what went wrong answers patient questions and provides evidence the dentist holds himself accountable and will prevent similar reoccurrences. Finally, a plan to correct and commit to ongoing care, possibly without additional fees, as a form of reparation allows space for problem solving.

In the event of an adverse patient outcome, dentists have four options. First, hide the error, avoid the patient and their questions, bill as usual and hope it goes away. Second, disclose only the legally minimum information to inform them of their current condition. Third, disclose the minimum, but with an apology, expressing regret and re-

EDITOR

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

ASSOCIATE EDITOR

Stuart L. Segelnick, D.D.S., M.S.

MANAGING EDITOR

Mary Grates Stoll

ADVERTISING/SPONSORSHIP MANAGER

Jeanne DeGuire

ART DIRECTOR

Ed Stevens

EDITORIAL REVIEW BOARD

Frank C. Barnashuk, DDS. Past Clinical Assistant Professor, Department of Restorative Dentistry, University at Buffalo School of Dental Medicine, Buffalo, NY.

David A. Behrman, DMD. Chief, Division Dentistry/OMS, Associate Professor of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY.

Michael R. Breault, DDS. Periodontic/Implantology. Private Practice. Schenectady, NY.

David Croglio, DDS. Clinical Assistant Professor, University at Buffalo School of Dental Medicine, Buffalo, NY. Private Practice (retired), Amherst, NY.

Jennifer Frustino, DDS, PhD. Director, Oral Cancer Screening and Diagnostics, Division Oral Oncology and Maxillofacial Prosthetics, Department of Dentistry, Erie County Medical Center, Buffalo, NY.

Michael F. Gengo, DDS. Board-certified Endodontist, Clinical Assistant Professor, Department of Endodontics, University at Buffalo School of Dental Medicine, Buffalo, NY. Private Practice, Hamburg, NY.

G. Kirk Gleason, DDS. General Dental Practice (retired), Clifton Park, NY.

Kevin Hanley, DDS. Orthodontic Private Practice, Buffalo, NY.

Violet Haraszthy, DMD, DDS, MS, PhD. Professor, Chair, Department of Restorative Dentistry, University at Buffalo School of Dental Medicine, Buffalo, NY.

Stanley M. Kerpel, DDS. Diplomate, American Board Oral and Maxillofacial Pathology, Associate Director, Oral Pathology Laboratory, Inc. Attending, Section of Oral Pathology, New York-Presbyterian, Queens, NY.

Robert M. Peskin, DDS. Dental Anesthesiology Private Practice, Garden City, NY.

Joseph Rumfola, DDS. Clinical Assistant Professor, AEGD Program Director, University at Buffalo School of Dental Medicine, Buffalo, NY. Private Practice, Springville, NY.

Jay Skolnick, DMD. Board-certified Pediatric Dentist. Attending dentist, Rochester General Hospital. Private Practice, Webster, NY.

Lisa Marie Yerke, DDS, MS. Diplomate, American Board Peiodontology, Clinical Associate Professor, Director Advanced Education Program in Periodontics, University at Buffalo School of Dental Medicine Department Periodontics & Endodontics, Buffalo, NY. Private Practice, East Amherst, NY.

PRINTER

Fort Orange Press, Albany

NYSDJ (ISSN 0028-7571) appears two times a year in print: January and June/July. The March, April, August/September and November issues are available online only at www.nysdental.org. The Journal is a publication of the New York State Dental Association, 20 Corporate Woods Boulevard, Suite 602, Albany, NY 12211. In February, May, October and December, members have online access to the NYSDA News. Subscription rates for nonmembers: $75 per year or $12 per issue, U.S. and Canada; $135 per year foreign or $22 per issue. Editorial and advertising offices are at Suite 602, 20 Corporate Woods Boulevard, Albany, NY 12211. Telephone (518) 465-0044. Fax (518) 465-3219. Email info@nysdental.org. Website www.nysdental.org. Microform and article copies are available through National Archive Publishing Co., 300 N. Zeebe Rd., Ann Arbor, MI 48106-1346.

morse, and no admission of fault. Fourth, disclose, apologize and admit fault, possibly with a financially acceptable corrective plan, such as a redo at no additional fee.

Can’t We Talk It Over?

The choice to hide our error and avoid the patient out of fear of being found out and punished violates our legal and ethical duties and could increase the risk of a suit and its settlement value. This coverup strategy violates our legal duty to inform the patient of the progress of treatment and their current condition. It also violates our ethical duties to communicate truthfully and without deception, autonomously involve the patient in treatment decisions in a meaningful way and refrain from harming the patient by correcting errors immediately to avoid further injury to the patient.

If and when the patient discovers the error and injury from a subsequent treating doctor, it increases patient anger, feelings of betrayal of trust, and the desire to file a claim to get all the information and hold their former dentist accountable. It will also increase the potential verdict or settlement value due to the judge or jury’s disapproval of the dentist’s failure to do the right thing. No doubt the coverup overshadows the deed.

The choice to apologize and/or to admit fault after informing the patient of their condition in a mutually trusting dentist-patient relationship depends on the state in which the dentist practices and, most importantly, the dentist’s training on how and when to apologize. Approximately 18 states, including Colorado and Arizona, offer a practitioner full protection for both an apology and admission of fault. The Colorado statute states, in part, “…in any civil action… all statements…expressing apology, fault, sympathy… made by a healthcare provider… which relates to the … pain, suffering, injury or death of the alleged victim… shall be inadmissible as evidence of an admission of liability.”[2]

Approximately 16 states, including Michigan, Pennsylvania and Maryland, offer a practitioner partial protection only for an apology, but not an admission. Approximately six states, including Florida, Texas and California, have general apology laws applicable in all “accidents” that, although there is limited case law on the topic, would probably offer dentists limited protection only for apologies. All remaining states, including New York, New Jersey and Illinois, currently have no apology statutes, thereby making all apologies or admissions of liability admissible as evidence.[3]

Apology laws can only reduce malpractice lawsuits against dentists if dentists receive risk management training in when and how to apologize. The training must include how to honestly appraise trust in the dentist-patient relationship, why patients sue dentists, the minimum legal

disclosure requirement, the existence or type of state apology law and how apologies must differ in each jurisdiction. If no state apology law exists, the dentist should probably avoid all statements of regret, remorse or apology and, certainly, of admission.

If state law protects apologies, but not admissions, then dentists must take great care in their choice of words because, often, no bright line exists between saying you are sorry and admitting you are wrong or at fault. In these partial apology law states, dentists must learn to say “I am sorry” for the patient’s inconvenience or dissatisfaction, but never admit, state or imply regret for the delivery of substandard care. Forcing dentists to walk this tightrope without knowing their state apology law and how to navigate it, puts these dentists at risk for sounding evasive and insincere and could enable a lawsuit against them rather than prevent it.

Finally, if state law protects both apologies and admissions, and the dentist understands how and when to deliver them within the protection of the law, then the statements can both strengthen the dentist-patient relationship and reduce the risk of a malpractice lawsuit.

A Sad Sad Situation

It’s sad and, thankfully, rare in our legal system that following ethical principles and doing the right thing can increase your liability. Dental societies in states without protections for apologies and admissions need to lobby for full-protection apology laws. Dental education, along with malpractice insurance carriers and organized dentistry, must work together to train practitioners how and when to say we are sorry to our patients in light of our individual state law. Importantly, dentists must consult with our malpractice carrier and attorney on a case-by-case basis before apologizing or admitting fault. Together, we need to protect, not punish, doing the right thing.

D.D.S., J.D.

This editorial is intended to provide general risk management information only. Legal advice should be obtained from qualified counsel to address specific facts and circumstances, to ensure compliance with applicable laws and standards of care.

REFERENCES

1. Hicks J, McCray C. When and Where to Say “I’m Sorry.” Claims and Litigation Management Website February 16, 2021. https://www.theclm.org/Magazine/articles/apology-laws-medical-malpractice/2172.

2. C.R.S.A. #13-25-135.

3. Hicks J, McCray C. When and Where to Say “I’m Sorry.” Claims and Litigation Management Website February 16, 2021. https://www.theclm.org/Magazine/articles/apology-laws-medical-malpractice/2172.

Managing Medicaid Managed Care

There is a system in place to ensure Medicaid managed care organizations operate properly. Be prepared for a lot of paperwork.

MLance Plunkett, J.D., LL.M.

embers often question what, if any, controls there are on Medicaid managed care organizations. They may be surprised to learn there is an extensive system requiring these programs to deal with fraudulent behaviors that waste Medicaid dollars and divert them from patient care. How effective these controls are is a different issue, but the controls are supposed to work as outlined below.

All Medicaid managed care organizations (MMCOs) are required to adopt and implement programs to detect and prevent fraud, waste and abuse in the Medicaid program. Regulations in Sections 521-2.1 through 521-2.4 of Title 18 of the Official Compilation of Codes, Rules and Regulations of the State of New York (18 NYCRR) set forth the standards for managed care fraud, waste and abuse prevention programs. It should be noted that Title 18 contains the regulations of the old New York State Department of Social Services, but now these regulations are maintained by the New York State Department of Health. New York eliminated the Department of Social Services and made the Department of Health the single state agency running the Medicaid program. The definitions of

fraud and abuse are defined in each Medicaid Managed Care Contract. The definition of waste is the overutilization of services or other practices that directly or indirectly result in unnecessary cost to the Medicaid program.

The Title 18 regulations require that MMCOs adopt and implement policies and procedures designed to detect and prevent fraud, waste and abuse. The MMCO’s fraud, waste and abuse prevention program may be a component of a more comprehensive effort by the organization but must meet the requirements outlined in Section 521-2.4 of Title 18, which requires that the Medicaid fraud, waste and abuse prevention program be incorporated into the Medicaid Compliance Program.

In addition to general MMCO recordretention requirements in the regulations, Section 521-2.3 specifically requires any MMCO and its subcontractors to provide the New York State Office of the Medicaid Inspector General (OMIG), the Department of Health, or any of their authorized representatives, and the New York State Medicaid Fraud Control Unit (MFCU) of the New York State Attorney General’s Office all records and information requested, in the form re-

quested, and to allow access to their facilities at any time. The MMCO and its subcontractor must permit private interviews of MMCO personnel, its subcontractors and their personnel, as requested.

OMIG is the entity that will issue written requests for records or other information needed. The requests will be delivered via email to the MMCO Government Liaison, Compliance Officer, Special Investigative Unit (SIU) Director and/or other designee. The requests will include submission instructions and identify a due date.

Full Disclosure

MMCOs must specify within their contracts with contractors, agents, subcontractors, independent contractors and participating providers that they are subject to audit, investigation or review under the MMCO’s fraud, waste and abuse prevention program. OMIG may request the MMCO to provide a copy of its contract to demonstrate compliance with this requirement. The MMCO is responsible for ensuring that the requirements of its fraud, waste and abuse prevention program are incorporated into its overall Medicaid compliance program. If the MMCO has an enrolled population of 1,000 or more persons in the aggregate in any given year, the MMCO must establish a full-time Special Investigation Unit (SIU) to identify risk and to detect and investigate cases of potential fraud, waste and abuse. If the total enrollment during any month of the calendar year is 1,000 or more, the requirement to establish a full-time SIU is prompted and remains in effect for the duration of that calendar year.

To assist MMCOs in determining the number of enrollees, plans may reference the New York State Department of Health (DOH) Medicaid Managed Care Enrollment Reports. The reports can be found at: https://www.health.ny.gov/ health_care/managed_care/reports/enrollment/monthly/. MMCOs must monitor their enrollment levels to determine when the SIU staffing requirements may be triggered. MMCOs may consider the Medicaid Managed Care Enrollment Reports to assist them with monitoring enrollment. SIU staffing will only be prompted when the enrollment thresholds are met and not at intermediate points.

The MMCO is required to explain how the MMCO determined the SIU staff and resources dedicated to the SIU were sufficient. OMIG recommends that the MMCO consider how it determines sufficient staffing levels for commercial lines on business and take an equitable approach to dedicating staffing and resources to the Medicaid line of business. One full-time lead investigator and one SIU director are required to be based in New York State and be responsible for communicating and coordinating with OMIG or MFCU on reports of fraud, waste and abuse. An in-state

presence is designed to enhance the efficiency of the SIU to conduct any necessary fieldwork and more readily obtain/access records needed for the MMCO to determine if an allegation is potentially fraudulent, wasteful or abusive, thereby requiring referral to OMIG.

Exceptions to the Rule

In recognition of the different business models and activities conducted by the SIUs, OMIG allows the MMCOs flexibility to determine any proposed alternate staffing levels that are as effective as the regulatorily defined staffing requirements. It is the responsibility of the MMCO to demonstrate and communicate this determination. Requests for exceptions to the regulatorily defined requirement must be submitted to: bmfa.mco@omig.ny.gov. SIU investigators must have:

1. A minimum of five years in the healthcare field working in fraud, waste and abuse investigations and audits; or five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies; or seven years of professional investigation experience involving economic or insurance-related matters.

2. An associate’s or bachelor’s degree in criminal justice or a related field; or employment as an investigator in the MMCO’s SIU on or before the effective date of the regulations. The MMCO will need to make available, upon request, employment information, including the date of employment and assignment date to SIU, for any investigator who cannot demonstrate in a resume or other documentation that they meet the credentials required of investigators to be in compliance with the regulations.

Annual Plan

The SIU must prepare a work plan no less frequently than annually. In developing this plan, the SIU must consider the MMCO’s risk areas, as well as current trends related to fraud, waste and abuse. Consideration of risk areas and fraud, waste and abuse trends is designed to help ensure that the MMCO is conducting audits and investigations appropriate to preventing and detecting fraud, waste and abusive practices. The work plan, at a minimum, must identify provider name and/or provider types to be audited or investigated and include the intended scope and review period of the planned audit or investigation, along with the rationale for conducting the planned audit or investigation. The MMCO may delegate all or part of the functions of the SIU. If the MMCO decides to delegate management authority, such contract shall be subject to review and approval by the Department of Health. If the MMCO delegates all

or part of its SIU function, the contract shall be submitted to OMIG for informational purposes only. The submission to OMIG does not constitute approval of the contract. SIU contract submissions made to OMIG must be submitted via e-mail to: bmfa.mco@omig.ny.gov or via OMIG’s MCO Reporting Unit shared mailbox on the New York State Health Commerce System (HCS) at https://commerce.health.state. ny.us. All electronic files must be submitted in a file format that is searchable.

The MMCO must audit, investigate or review cases of fraud, waste or abuse specific to its participation in the Medicaid program, and the risk areas identified by the SIU in its Work Plan. These audits, investigations and reviews shall be conducted in accordance with the regulatory requirements and contracts between the MMCO and Department of Health. If applicable, the SIU will be primarily responsible for performing this work or collaborating and overseeing the individuals performing these activities. The SIU will also coordinate with the MMCO’s overall compliance officer. Section 521-2.4(c)(2) of Title 18 requires the audits, investigations and reviews involve at least one percent or more of the aggregate of Medicaid claims. “Aggregate” means total number of Medicaid claims paid.

Audits, investigations and/or reviews must include pre/ post-payment review of Medicaid claims, patient records, orders and any other supporting documentation to substantiate claim submissions. Examples of audits, investigations and/or reviews that are acceptable include, but are not limited to: 1) SIU investigations into allegations of fraud, waste or abuse identified through data analysis or referrals received; 2) vendor investigations into fraud, waste or abuse, including Pharmacy Benefit Managers, dental benefits, mental health or substance abuse services; and 3) either the MMCO or subcontractor audits of Medicaid claims through data analysis typically to capture issues like duplicate claims, third-party liability, retroactive disenrollment, modifier misuse, or Diagnostic Related Grouping (DRG) overpayments. Questions on these items may be directed to mmcoreporting@omig.ny.gov.

The MMCO and its subcontractors shall report all cases of potential fraud, waste and abuse to OMIG. “Potential” means having or showing the capacity to become or develop into fraud, waste or abuse in the future. The MMCO must take reasonable steps to establish the potential for fraud, waste or abuse prior to reporting. This may be done by reviewing data and/or patient records or conducting other investigative activities to determine the allegation or complaint is potentially substantiated. OMIG has its own referral form that an MMCO must use. If an MMCO has its own investigative summary report that it would like to at-

NYSDA Directory

OFFICERS

Prabha Krishnan, President 11045 Queens Blvd., Ste 108, Forest Hills, NY 11375

Maurice Edwards, President-Elect 30 East 60th St., #1401, New York, NY 10022

Amarilis Jacobo, Vice President 824 East 181st St., Bronx, NY 10460

Paul Leary, Secretary-Treasurer 80 Maple Ave., Ste 206, Smithtown, NY 11787

William Karp, Speaker of the House 4500 Pewter Ln., Bldg 6, Manlius, NY 13104

BOARD OF TRUSTEES

Anthony M. Cuomo, Immediate Past President 19 Cannon Dr., Newtown, CT 06470

Brendan Dowd, ADA Trustee 1119 Deleware Ave., #6, Buffalo, NY 14209

NY – Lois Jackson 505 Laguardia Pl., Apt L4, New York, NY 10012

2 – John P. Demas 8814 Fort Hamilton Pkwy, Brooklyn, NY 11209

3 – Geoffrey Gamache 24 Eastview Rd., Averill Park, NY 12018

4 – Adrienne L. Korkosz 1309 Union St., Schenectady, NY 12308

5 – Lynn A. Stacy 7504 E State St., Lowville, NY 13367

6 – Louis Giordano 864 Hooper Rd., Endwell, NY 13760

7 – Theresa A. Casper-Klock 33 William St., Ste 1, Auburn, NY 13021

8 – Raymond G. Miller 122 Covington Rd., Buffalo, NY 14216

9 – Gary M. Scharoff 1255 North Ave., Ste A1H, New Rochelle, NY 10804

N – Donald R. Hills 136 Woodbury Rd., Ste L3, Woodbury, NY 11797

Q – Mitchell S. Greenberg 11966 80th Rd., #1A, Kew Gardens, NY 11415

S – Guenter J. Jonke 2500 Nesconset Hwy., Bldg 24A, Stony Brook, NY 11790

B – Jacqueline J. Samuels 120 Alcott Place, Bronx, NY 10475

New Dentist – Kathryn Rothas 920 Lark Dr., Albany, NY 12207

COUNCIL CHAIRPERSONS

Council on Awards Brendan P. Dowd 1119 Delaware Ave., #6, Buffalo, NY 14209

Dental Benefit Programs

Dental Education & Licensure

Joseph A. Craddock 3325 East Main St., Attica, NY 14011

Robert M. Peskin

601 Frankline Ave., #225, Garden City, NY 11530

Dental Health Planning & Raquel Rozdolski

Hospital Dentistry

Dental Practice

Ethics

Governmental Affairs

Membership & Communications

Nominations

Peer Review & Quality Assurance

52 Shingle House Rd., Millwood, NY 10546

Mario Silvestri 501 Plaza Dr., Vestal, NY 13850

Paul W. Teplitsky 1 Hanson Pl., # 705, Brooklyn, NY 11243

Radha Sachdeva-Munk 203 Smithtown Blvd., Nesconset, NY 11767

Kendra J. Zappia 1 Pine West Plaza, #106, Albany, NY 12205

Anthony M. Cuomo 19 Cannon Dr., Newtown, CT 06470

Lawrence J. Lehman 7303 197th St., Fresh Meadows, NY 11366

Professional Liability Insurance Roland C. Emmanuele 4 Hinchcliffe Dr., Newburgh, NY 12550

OFFICE

Suite 602, 20 Corporate Woods Blvd., Albany, NY 12211 (518) 465-0044 | (800) 255-2100

Greg D. Hill

Lance R. Plunkett

Michael J. Herrmann

Grazia A. Yaeger

Mary Grates Stoll

Jenna Bell

Briana McNamee

Jacquie Donnelly

Stacy McIlduff

Executive Director

General Counsel

Assistant Executive Director Finance and Administration

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Executive Director NYS Dental Foundation

tach to OMIG’s referral form, the MMCO may submit a written request and sample report to bmfa.mco@omig.ny.gov seeking OMIG’s review and approval. The request should clearly describe or identify how the MMCO’s investigative report form includes all the information outlined in OMIG’s Investigative Summary Report.

MMCO investigative summary reports shall not be considered acceptable unless and until written approval from OMIG is received. Any filing must report the specific Medicaid program statutes, rules, regulations and/or policies violated. If the report alleges violation of an MMCO policy, a copy of the policy must be included with the referral. Copies of the investigation file and related material must be submitted as part of all referrals. The investigative file means any and all information maintained in the MMCO SIU’s records relative to the matter reported. The reports must be reviewed and signed by an executive officer of the MMCO responsible for the operations of the SIU. A report is considered “signed” by a unique signature either by hand or electronic means. All reports must be submitted via email to: bmfa.mco@omig.ny.gov or via the HCS through the Secure File Transfer to OMIG’s MCO Reporting Unit shared mailbox or the upload link on the MCO Reports to DOH/ OMIG Uploads Application at https://commerce.health. state.ny.us. All electronic files attached to the report must be submitted in a file format that is searchable.

Reporting criminal activity relates to the commission of a crime, which is different from the standard reporting obligations related to potential fraud, waste and abuse. Therefore, in reporting suspected criminal activity, OMIG’s Medicaid Managed Care, Potential Fraud, Waste and Abuse Referral form should not be utilized. A description of the suspected criminal activity with all relevant information must be reported to OMIG at bmfa.mco@omig.ny.gov and MFCU at MFCUReferrals@ag.ny.gov.

Identifying and Disclosing Overpayments

OMIG’s Self-Disclosure Guidance serves as the primary guidance to report, return and explain Medicaid overpayments that have been identified. To comply with Section 521-2.4(f) of Title 18, the MMCO must develop a process for healthcare providers to report, return and explain any identified overpayments within 60 days of identification. In accordance with Section 521-2(h) of Title 18, the procedure for healthcare providers to self-disclose must be published on the MMCO website. Any reported self-disclosures an MMCO receives from a healthcare provider must be reported on the MMCO’s Medicaid Managed Care Operating Report and monthly Provider Investigative Report, conforming with the requirements for each report.

An MMCO must develop a fraud, waste and abuse detection procedures manual for use by officers, directors, managers, personnel and subcontractors performing claims underwriting, member services, utilization management, complaint, investigative and/or SIU services. The fraud, waste and abuse detection procedures manual is incorporated into the MMCO’s Medicaid compliance program, and the manual must be reviewed and updated at least annually. Training on the fraud, waste and abuse detection procedures manual may also be incorporated into the general MMCO training and education requirements set forth in Section 521-1.4(d)(1)(ii) of Title 18.

The MMCO must also develop a fraud, waste and abuse public awareness program focused on the cost and frequency of Medicaid program fraud, and the methods by which the MMCO’s enrollees, providers and other contractors, agents, subcontractors or independent contractors can prevent it. The MMCO must make information regarding the public awareness program available on the MMCO website.

A summary of the MMCOs fraud and abuse prevention activities for the past year, including their public awareness campaign, is required to be included in the “Annual SIU Report for Managed Care Organizations” pursuant to the Department of Health Guidance and Instructions, accessible through the HCS MCO Reports to DOH/OMIG Uploads Application.

The MMCO must also develop a fraud, waste, and abuse prevention plan. The MMCO shall be responsible for ensuring that the requirements of its fraud, waste and abuse prevention program are incorporated into its overall Medicaid compliance program. MMCOs must submit the fraud, waste and abuse prevention plan to OMIG within 90 calendar days of the effective date of the regulations and within 90 calendar days of signing a new MMCO contract with the Department of Health. The MMCO must review and update such plan no less frequently than annually. All such plans must be submitted via email to: bmfa.mco@omig.ny.gov or via the HCS through the Secure File Transfer to OMIG’s MCO Reporting Unit shared mailbox or the upload link on the MCO Reports to DOH/OMIG Uploads Application at https://commerce.health.state.ny.us. All electronic files attached to the report must be submitted in a file format that is searchable.

OMIG has developed a Managed Care Plan Annual Report form, accessible through the HCS MCO Reports to DOH/OMIG Uploads Application, which includes fields for all information required to be reported. Managed Care Plan Annual Reports must be submitted between Feb. 1-28 each year via e-mail to: bmfa.mco@omig.ny.gov or via the HCS through the Secure File Transfer to OMIG’s MCO Reporting

Unit shared mailbox or the upload link on the MCO Reports to DOH/OMIG Uploads Application at https://commerce. health.state.ny.us. All electronic files attached to the report must be submitted in a file format that is searchable. The first annual report was required to be submitted in February 2024.

Bottom Line

The bottom line is that MMCOs must adopt and implement policies and procedures designed to detect and prevent fraud, waste and abuse and these requirements include but are not limited to the establishment of special investigation units (SIU), minimum staffing requirements, the obligation to prepare an SIU work plan, requirements related to delegation of the MMCO’s SIU function, and minimum standards for conducting audits and investigations.

Does any of this work to control bad behaviors of MMCOs? It is all designed to provide data and access to OMIG, the Department of Health and MFCUs to help them combat misspending Medicaid managed care monies and benefit patients. Or it’s a massive amount of paperwork that sounds comprehensive but is paperwork only. It isn’t clear that any of it has improved Medicaid managed care interactions with healthcare providers.

A lot of thought went into the Title 18 regulations governing Medicaid managed care, but it may be that a lot of paperwork is what has come out of it.p

The material contained in this column is informational only and does not constitute legal advice. For specific questions, dentists should contact their own attorney.

Eating Disorders and Oral Health A Dental Professional’s Role

Author speaks from experience when she encourages dentists to be cognizant of signs their patients may be engaged in harmful eating behavior and be prepared to intervene.

Bree Zhang

Iam a dental student who has struggled with an eating disorder.

A reason why I chose to enter dentistry was because dentists can play a huge role in working with patients with eating disorders. Eating disorders are more common than we think, affecting 9% of the world’s population and increasing in prevalence each year. They are not just a “phase” and, in fact, they can cause irreversible and even life-threatening health problems, such as heart failure, permanent bone loss, stunted growth, infertility, kidney damage and more.[1] In fact, eating disorders have one of the highest mortality rates of all psychiatric illnesses, second only to opioid overdoses. About 26% of people with eating disorders attempt suicide.[2]

Research shows early intervention provides a greater chance of recovery. As dental professionals, we often see patients every six months, and we sit in a space where conversations easily flow to topics about food, diet, nutrition and more. Furthermore, the mouth is a window to the health of the body and the first place to reflect signs of nutritional deficiencies and imbalances.[3] It is also a place that hides signs of purging that are not easily visible to other medical providers—but in plain sight for dental providers. [4]

We can serve as a point of early detection if we notice habits, mindsets or oral health manifestations that point towards eating disorders. In fact, approximately 28% of patients suffering from bulimia are first diagnosed during a dental exam, according to the National Institute of Dental and Craniofacial Research.[5]

Be Proactive and Prepared

Currently, while dental professionals are often the first healthcare providers to examine and recognize patients with eating disorders, most dentists do not take action out of fear of losing the patient, insufficient confidence in their suspicion, failure to initiate conversation due to uncertainty about how to broach the issue, and lack of office protocol and practice policy.[6]

Familiarize Yourself with Risk Factors

There are many biological, psychological and social risk factors at play. Biologically, having a history of dieting or negative energy balance can predispose one to an eating disorder. People with food allergies, gastrointestinal conditions (IBS, celiac disease, etc.) or diabetes are more predisposed to eating disorders due to the reality in which they

are required to focus on food, labels, numbers (weight, blood glucose, A1c) and control.[7] In fact, one-fourth of people with diabetes develop an eating disorder.[8]

Additionally, psychological risk factors of perfectionism, body image dissatisfaction, behavioral inflexibility and co-occurring psychological conditions like anxiety, depression, substance use, obsessive-compulsive disorder and PTSD, can predispose one to an eating disorder. In fact, two-thirds of those with anorexia showed signs of an anxiety disorder, including generalized anxiety, social phobia and obsessive-compulsive disorder, before the onset of their eating disorder.[7,10]

Societal expectations and popular media also contribute to development of eating disorders, leading to weight stigma, teasing or bullying, appearance ideal, internalization, limited social networks, historical trauma/intergenerational trauma, and acculturation. In particular, people from racial and ethnic minority groups, especially those who are undergoing rapid Westernization, may be at increased risk for developing an eating disorder due to complex interactions between stress, acculturation and body image.[7]

Establish a Protocol and Plan

How do we become prepared? As a dental team, we can establish in-office protocol for our dental team so that we are prepared to know:[6]

1. What to look for.

2. What to do/say when encountering a patient with an eating disorder.

3. How to approach treatment planning. We can publicize familiarity with eating disorders on our website and office so that patients know our office is a safe space and helpful resource for them. We can also improve early detection by adding eating disorder screening questionnaires with medical history to offer patients more options for disclosure if they do not feel comfortable with an upfront conversation.[6]

Know What to Look For Physical Signs

When appraising a patient, we should be observant of any recent changes in their general demeanor, gait and facial symmetry.[5]

Physically, patients with anorexia may present with:[9]

1. Fluctuations in weight.

2. Hair thinning/hair loss.

3. Lanugo, a layer of soft, downy hair over their body.

4. Edema—swelling in legs/ankles.

5. Brittle nails and nail clubbing, jaundice—yellowish skin and eyes.

Patients with bulimia may look like they have a more normal weight, but they might present with:[9]

1. Acute sialadenosis—“Chipmunk cheeks,” that is, puffy, swollen cheeks.

2. Parotid gland swelling.

3. Russell’s sign—abrasion on knuckles from self-induced vomiting.

Conversational Signs[9]

Warning signs in conversation can include:

1. If the patient talks about frequent dieting or engagement with fad diets (keto, no carbs, no dairy, vegetarianism/veganism).

2. If they show a preoccupation with weight, dieting, food, calories.

3. If they mention their refusal to eat certain food categories.

4. If they have obsessive compulsive tendencies towards oral hygiene routine.

5. If they complain about being cold all the time.

6. If they make any mention of loss of period (for female patients).

Oral Signs

There are many dental complications for both eating disorders, often resulting from nutritional deficiencies or acid regurgitation. Patients with anorexia can develop:[4-6,15]

• Canker sores.

• Chronic dry mouth.

• Angular cheilitis.

• Candidiasis.

• Glossitis.

• Enamel erosion.

• Dry, cracked lips.

• Tooth decay from dry mouth and impaired saliva buffering. Patients with bulimia may develop:[4-6,15,22]

• Dental erosion on the palatal surfaces of maxillary anterior teeth.

• Parotid gland swelling.

• Cuts/ulcerations on the soft palate and oropharynx— from insertion of objects to induce vomiting.

• Globus sensation.

• Incisal fractures and chipping.

• Peri-mylolysis in posterior teeth.

• Hypersensitivity + temperature sensitivity.

• Loss of bone density, increasing the risk of jaw fracture during extractions.

In addition to these complications, patients with eating disorders may also develop degenerative arthritis within the temporomandibular joint, creating pain in the joint area, chronic headaches and problems chewing and opening/closing the mouth.[17]

Establishing a Safe, Nonjudgemental Space

When you talk to patients, try to ask questions using general terminology.

• Instead of “Do you purge?” you can ask, “Do you ever feel guilty after you eat?”[12]

• Instead of “do you have an eating disorder,” you can ask, “do you struggle with issues around food, eating and exercise?”[12]

You can also ask patients about their current challenges, either healthwise or in general, to get to the root cause of any disordered eating patterns. If you suspect your patient does have an eating disorder, don’t let your hesitation of being wrong stop you from potentially helping a patient with an eating disorder. Always approach the conversation in a nonthreatening, nonjudgemental manner: [11,12,13]

1. Discuss the problem privately, without others around.[11]

2. Use “I” statements (“I have noticed”) rather than “you” statements (“you may have XYZ”). [13]

3. Focus your language on your observations, rather than the diagnosis. For instance, if there is dental erosion, we can mention some probable causes (acid reflux or frequent vomiting) and give patients an opportunity for disclosure. “There are several problems with your teeth, including x, y, z. These problems can be associated with vomiting or a lack of nutrients in your diet.”[11]

4. Give your patient dignity but stand firm with what you observe and what you know.

5. Reassure the patient that they are not alone and that eating problems are common.[14]

6. Commend the patient if they are willing to talk about their problem (e.g., “I understand how difficult this is” or “I’m really glad you are talking to me”).[11] Reference the facts. Patients may not realize the severity of the health problems that can arise from their eating disorders. As a dental provider, you are in a unique position to educate your patients about the potential dental complications of eating disorders and nutri-

tional deficiencies (mouth sores, bad breath, cracked lips, swollen gums, receding gums) and complications of frequent vomiting/purging (erosion, brittle teeth, discoloration). Make sure your patients are informed about their oral health.[11]

7. Be prepared for resistance and denial. You should speak the truth about what you see and the facts you know. However, if your patient does not want to hear them, do not push them.[11]

8. Avoid being critical, suggesting quick fixes or commenting on the patient’s weight, appearance or health in general.[11-13]

9. If the patient denies they have an eating issue, accept their answer and focus on maintaining or restoring their oral health.[11]

10. Provide the patient with information on how to improve or maintain their dental health overall.[12]

Managing Dental Care

ED patients need regular dental visits for continuing care and support; they should also be regarded as medically compromised due to the risk of dangerous medical complications, which can include cardiac arrhythmias and cardiac arrest from electrolyte imbalances, risk for osteoporosis and jaw fracture during extractions, and gastric bleeding. Blood pressure should be monitored. A comprehensive medical history should be taken and reconfirmed at every visit, and a thorough intraoral and extraoral exam should be performed.[5]

In-office Dental Care

They should be reminded to clean interproximally daily, and also clean their tongue, to remove biofilm and acid residue. To remineralize enamel, patients can use self-applied neutral fluoride and calcium + phosphate products. To relieve dry mouth, patients can take saliva substitutes during the day. Xylitol products (toothpaste, gum, candies) are beneficial for salivary flow, reducing caries and acidity. [5]

Throughout this process, you should keep in close communication with other medical providers, as patients may be prescribed new medications (antidepressants) that could affect their oral health (xerostomia) and dental treatment plan.

It’s important to remember that patients may still be purging throughout their recovery process. The patients can wear a mouthguard to protect teeth during purging episodes. Due to the high acidic content in the stomach, the patient should not brush directly after vomiting because it can scrub acids deeper into the tooth enamel and may cause more loss in tooth structure. After purging, patients can first neutralize their oral pH by adding a spoon of baking soda to a cup of water and rinsing their mouth or rinsing with a product with calcium and phosphate ions. They should wait at least one hour before brushing.[5]

Working with a Support Team

You can also remind your patient that they are not alone, and that there are many people who can be on their support team, including:[18,19]

• Primary care physician (PCP).

• Psychiatrists for medication prescription and management.

• Nutritionists/registered dieticians to provide education on nutrition and meal planning.

• Psychologists/counselors for psychological therapy.

To remineralize enamel and reduce tooth sensitivity, you can introduce in-office fluoride varnish applications and fluoride mouthrinses. Essential restorative work should be done to limit tooth damage and relieve pain, but more permanent dental restorations, such as crowns, should not be completed while a patient is purging regularly (acid erosion will shorten the life of the restorations).[5]

Home Care + Oral Hygiene Routine

The patient should be encouraged to brush three times a day with a soft brush and fluoridated toothpaste.

• Partner, parents, other family members, friends.

• School nurse/counselor (if attending school).

• Medical and dental specialists to treat other underlying health issues.

• Eating disorder support group.

Throughout this process, you should keep in close communication with other medical providers, as patients may be prescribed new medications (antidepressants) that could affect their oral health (xerostomia) and dental treatment plan. Patients may also undergo refeeding syndrome that should be monitored carefully, and they may need to

see other specialists to address additional health complications, especially as eating disorders often lead to multi-organ damage. Elective dental procedures should get medical clearance before you perform them.[3,5,20]

If patients are looking for an eating disorder support group, you can encourage them to ask their doctor or therapist for a referral, call local hospitals and universities, call local eating disorder centers and clinics, or visit their school’s counseling center.

Continuous Learning

While for this article, I mostly covered symptoms of anorexia and bulimia nervosa, it is important to note that there are various dimensions of eating disorders, such as Binge Eating Disorder (uncontrolled, binge eating and no purging), Avoidant/Restrictive Food Intake Disorder (restrictive food intake, but lacking the psychological consequences of AN), Rumination Disorder (regurgitation of ingested food), and more.[21]

Your job is not to diagnose but to help support your patient and get them the proper help for recovery. Let us work

together as a profession to support our patients through this journey. p

REFERENCES

1. Mehler PS, Brown C. Anorexia nervosa - medical complications. J Eat Disord 2015;3:11. Published 2015 Mar 31. doi:10.1186/s40337-015-0040-8.

2. Smith AR, Zuromski KL, Dodd DR. Eating disorders and suicidality: what we know, what we don’t know, and suggestions for future research. Curr Opin Psychol 2018;22:63-67. doi:10.1016/j.copsyc.2017.08.023.

3. Sheetal A, Hiremath VK, Patil AG, Sajjansetty S, Kumar SR. Malnutrition and its oral outcome—a review. J Clin Diagn Res 2013;7(1):178-180. doi:10.7860/JCDR/2012/5104.2702.

4. Hasan S, Ahmed S, Panigrahi R, Chaudhary P, Vyas V, Saeed S. Oral cavity and eating disorders: an insight to holistic health. J Family Med Prim Care 2020;9(8):3890-3897. Published 2020 Aug 25. doi:10.4103/jfmpc.jfmpc_608_20.

5. Douglas L. Caring for dental patients with eating disorders. BDJ Team 1, 15009 (2015). https:// doi.org/10.1038/bdjteam.2015.9.

6. Antonelli JR, Seltzer R. Oral and physical manifestations of anorexia and bulimia nervosa. Tex Dent J 2016;133(9):528-535.

7. Eating Disorder Risk Factors.

8. Coleman SE, Caswell N. Diabetes and eating disorders: an exploration of ‘Diabulimia.’ BMC Psychol 2020;8(1):101. Published 2020 Sep 23. doi:10.1186/s40359-020-00468-4.

9. Pritts SD, Susman J. Diagnosis of eating disorders in primary care. Am Fam Physician 2003;67(2):297-304.

10. Swinbourne J, Hunt C, Abbott M, Russell J, St Clare T, Touyz S . The comorbidity between eating disorders and anxiety disorders: prevalence in an eating disorder sample and anxiety disorder sample. Aust N Z J Psychiatry 2012;46:118–131.

11. National Eating Disorders Collaboration. Dentistry and Eating Disorders. A professional resource developed by the National Eating Disorders Collaboration. Available online at: https://nedc.com.au/assets/NEDC-Resources/NEDC-Resource-Dentistry-and-EDs.pdf (Accessed September 2021).

12. Inspira Health. (2022b, February 21). Talking to your patients about eating disorders. https:// www.inspirahealthnetwork.org/news/talking-your-patients-about-eating-disorders.

13. Eating disorders—support for families—Better Health Channel.

14. Think Your Friend May Have an Eating Disorder? Here’s What You Can Do—Center for Change.

15. Westgarth D. What should the role of the dentist be in managing patients with eating disorders? BDJ In Practice 2021;34(10):12-15. doi:10.1038/s41404-021-0916-z.

16. Angela Grover M. (2022, September 26). Treating patients with eating disorders: What you need to know. Registered Dental Hygienists https://www.rdhmag.com/patient-care/article/14280352/treating-dental-patients-with-eating-disorders-what-you-need-to-know.

17. Johansson AK, Johansson A, Unell L, Norring C, Carlsson GE. Eating disorders and signs and symptoms of temporomandibular disorders: a matched case-control study. Swed Dent J 2010;34(3):139-147.

18. Mayo Foundation for Medical Education and Research. (2017, July 14). Eating disorder treatment: Know your options. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/ eating-disorders/in-depth/eating-disorder-treatment/art-20046234.

19. A. P. J. S. J. (n.d.). School counselors’ knowledge of eating disorders. Adolescence https:// pubmed.ncbi.nlm.nih.gov/2275448/.

20. Persaud-Sharma D, Saha S, Trippensee AW. Refeeding Syndrome. [Updated 2022 Nov 7]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564513/.

21. Types of eating disorders. Types of Eating Disorders | Anxiety and Depression Association of America, ADAA. (n.d.). https://adaa.org/eating-disorders/types-of-eating-disorders .

22. Rosten A, Newton T. The impact of bulimia nervosa on oral health: a review of the literature. Br Dent J 2017;223(7):533-539. doi:10.1038/sj.bdj.2017.837.

23. Patterson-Norrie T, Ramjan L, Sousa MS, et al. Eating disorders and oral health: a scoping review on the role of dietitians. J Eat Disord 8, 49 (2020).

24. Dental complications of eating disorders. National Eating Disorders Association. (2018, February 22). https://www.nationaleatingdisorders.org/dental-complications-eating-disorders .

25. Statistics & amp; research on eating disorders. National Eating Disorders Association (2021, July 14). https://www.nationaleatingdisorders.org/statistics-research-eating-disorders.

Ms. Zhang is a third-year student at Columbia University College of Dental Medicine and ASDA representative on the NYSDA Committee on Substance Abuse and Well-Being. Queries about her article can be sent to her at bz2450@cumc.columbia.edu.

Dental Foundation Celebrates Vets

A much-sought-after ticket at NYSDA’s House of Delegates Annual Meeting is admission to the New York State Dental Foundation Annual Brunch. This is the foundation’s major fundraiser and an opportunity to learn more about the oral healthcare programs and initiatives donors are supporting. This year’s brunch on June 1 at Turning Stone Resort and Casino in Verona was a celebration of the foundation’s newest program, Salute Vets With A Smile. Vets who have benefitted from free oral healthcare were on hand to describe their experience. Appropriately, the program began with a presentation by the TR Proctor High School Naval Junior Reserve Officer Training Corps from Utica.

New York State Dental Foundation Board is joined by Foundation Executive Director Stacy McIlduff, second from left.

Veteran Tom Hinton, 90, from Stephentown, displays his appreciation for the Salute Vets With A Smile program.

Foundation boosters include contingent from Second District Dental Society.

Association Activities

Awarding Moments from 2024 NYSDA House of Delegates Annual Meeting

May 31 / Turning Stone Resort and Casino, Verona, NY

Scott Firestone, D.D.S., right, of Smithtown, Suffolk County, recipient of JarvieBurkhart Award, accepts his award from NYSDA 2023-2024 President Anthony Cuomo. The Jarvie-Burkhart Award is the highest honor bestowed by NYSDA. Dr. Firestone, who has made a career of volunteering his time and professional services, instructing dental students and residents, providing free care to patients without resources and persons with disabilities, and participating in outreach missions, was lauded for “outstanding service rendered to humankind through dentistry.”

Frank Barnashuk, D.D.S., of Buffalo, accepts Dr. Mark J. Feldman Distinguished Service Award from President Cuomo. Dr. Barnashuk was cited for having provided “outstanding service and commitment to the New York State Dental Association.” While serving as program director and clinical assistant professor at the University at Buffalo, Dr. Barnashuk helped mold future dentists, encouraging students to be part of the Eighth District, NYSDA and the ADA. He himself was an active participant in organized dentistry, holding the posts of president of the Eighth District Dental Society and NYSDA Secretary-Treasurer. He was especially effective in the latter position, helping to keep the Association afloat financially during the crushing COVID pandemic. He volunteered as well to serve on multiple NYSDA councils and committees.

The Hallmarks of Excellence Award, presented by the NYSDA Council on Membership and Communications, went this year to the Ninth District Dental Association for community outreach to underserved children through its Give Kids A Smile program. Accepting the award on behalf of the Ninth District is Renuka Bijoor, left. Kendra Zappia, chair of Membership Council, makes the presentation.

Photos by Bill Mueller

Association Activities

In Memoriam

SECOND DISTRICT

Mark Debock

New York University ‘87

123 99th St, Brooklyn, NY 11209

May 8, 2024

THIRD DISTRICT

Marianne Gable

Columbia University ‘90

101 Great Oaks Blvd. Albany, NY 12203

June 29, 2024

John Lonnstrom

University at Buffalo ‘56

10 Overlook Dr.

Voorheesville, NY 12186

April 13, 2023

NASSAU COUNTY

Alvin Horing

New York University ‘64

505 Southern Blvd. East Marion, NY 11939

September 26, 2023

Stanley Kaye

New York University ‘65

111 Cherry Valley Ave., #M25 Garden City, NY 11530

July 1, 2024

Alvin Weinberg

Temple University ‘63

194 Alta Terrace Jericho, NY 11753

March 4, 2023

QUEENS COUNTY

Lawrence Mass

New York University ‘60 103 Emerald Key Lane Palm Beach Gardens, FL 33418

May 19, 2024

A Fond and Fun Farewell

It was a fitting tribute to Dr. Anthony Cuomo on the final night of his term in office as NYSDA’s 142nd President. The President’s Dinner Gala, June 1, staged at the conclusion of the business portion of the 2024 meeting of the Association’s House of Delegates, was festive and celebratory, but it was also a serious occasion for presenting awards and saying “thank you” to Dr. Cuomo and to the other officers who served alongside him in 2023-2024.

This year’s gala took place on a perfect summer evening in the Shenandoah Club House on the grounds of

Turning Stone Resort and Casino in Verona. It will long be remembered for its offerings of food, music, dancing and a spectacular drone show that paid homage to New York State, NYSDA and the Ninth District Dental Association, host of this year’s meeting.

Taking a bow, along with Dr. Cuomo were his fellow officers: Prabha Krishnan, president-elect; Maurice Edwards, vice president; Paul Leary, secretary-treasurer; William Karp, speaker; and James Galati, immediate past president.

A gallery of photos of celebrants is presented here.

Photos by Bill Mueller

Nominees Sought for NYSDA Honors

The NYSDA Council on Awards is seeking nominations for the Association’s two merit awards—the William Jarvie and Harvey J. Burkhart Award and the New York State Dental Association Dr. Mark J. Feldman Distinguished Service Award.

The council will consider nominees according to its criteria and guidelines for selecting recipients. The guidelines are printed here. The council expects to make its selection at its teleconference at noon, Wednesday, Dec. 11, although it reserves the right to withhold either of the awards if it feels no nominee meets the criteria.

The 2025 Jarvie-Burkhart Award and Distinguished Service Award will be presented in June at the NYSDA Annual Session. Nomination forms appear on the following page. Nominations must be submitted no later than Friday, Nov. 22.

Awards Criteria and Guidelines

The William Jarvie and Harvey J. Burkhart Award

The William Jarvie and Harvey J. Burkhart Award (also referred to as the Jarvie-Burkhart Award) is the highest honor bestowed by the New York State Dental Association and is presented in recognition of great service rendered mankind in the field of dentistry. It may be awarded to an individual dentist, a nondentist or an organization. To be considered for the Jarvie-Burkhart Award, nominees must have demonstrated advancement in at least one of the following areas:

• promotion of continuing dental education;

• advancement of dental research;

• philanthropic endeavors in the field of dentistry; or

• original contributions to the science and application of dentistry.

Nomination Procedure: Annually, notice shall be published in an official publication of the New York State Dental Association in the month of September, requesting nominations for the Jarvie-Burkhart Award. The notice shall include the eligibility criteria, as well as the guidelines and instructions for submitting a nomination. The nomination form for the Jarvie-Burkhart Award shall be available from the New York State Dental Association’s Headquarters Office or from the Association’s website (www.nysdental.org). The completed form must include pertinent information detailing the accomplishments of the nominee in the field of dentistry. In addition, the nomination must include corroborative endorsements and testimony from as many sources as possible substantiating the great service that has resulted from these accomplishments.

an eligible nominee is to receive the award in accordance with Chapter V, Section 100 of the Bylaws, the Jarvie-Burkhart Award shall be presented at the Annual Session of the New York State Dental Association.

Inasmuch as the Jarvie-Burkhart Award is the highest award that NYSDA can bestow, it must not be seen as synonymous with the Distinguished Service Award, which was established to recognize an individual’s contributions to organized dentistry. Therefore, the Jarvie-Burkhart Award is not necessarily given every year. The Council on Awards shall only recommend presentation of the Jarvie-Burkhart Award if the council is of the opinion that the above criteria and guidelines have been met.

Nominations of members serving on the Council on Awards must be deferred until completion of their service on the council.

The New York State Dental Association Dr. Mark J. Feldman Distinguished Service Award

The New York State Dental Association Dr. Mark J. Feldman Distinguished Service Award is presented to an individual in recognition of numerous years of meritorious service and commitment to the Association. The criteria to be considered in determining eligibility for the Distinguished Service Award include:

• contributions to the New York State Dental Association;

• contributions to organized dentistry as a whole;

• the offices and positions held; and/or

• the tenure of the individual’s service

Nomination Procedure: Annually, notice shall be published in an official publication of the New York State Dental Association in the month of September requesting nominations for the Distinguished Service Award. The notice shall include the eligibility criteria, as well as the guidelines and instructions for submitting a nomination. The nomination form for the Distinguished Service Award shall be available from the New York State Dental Association’s Headquarters Office or from the Association’s website (www. nysdental.org). The completed form must include pertinent information substantiating why the individual being nominated should be considered.

The deadline for submitting applications shall be Nov. 22 after notice has been published. The Council on Awards shall meet to consider all eligible nominees and make its recommendations and report to the Board of Trustees before the first meeting of the Board of Trustees in the year following the Nov. 22 deadline for submission of nominations. Should the Board determine that an eligible nominee is to receive the award in accordance with Chapter V, Section 100 of the Bylaws, the Distinguished Service Award shall be presented at the Annual Session of the New York State Dental Association.

Nominations of members serving on the Council on Awards must be deferred until completion of their service on the council.

2025 William Jarvie and Harvey J. Burkhart Award NOMINATION FORM

(Deadline for Submission – November 22, 2024)

Name of Nominee:

Submitted by:

• promotion of continuing dental education;

• advancement of dental research;

• philanthropic endeavors in the field of dentistr y; or

• original contributions to the science and application of dentistr y.

Please specify how the nominee has accomplished advancement in the areas noted above.

2025 Dr. Mark J. Feldman

Distinguished Service Award

NOMINATION FORM

(Deadline for Submission – November 22, 2024)

Name of Nominee:

Submitted by:

• contributions to the New York State Dental Association;

• contributions to organized dentistr y as a whole;

• the offices and positions held; and/or

• the tenure of the individual’s service.

Please specify how the nominee has contributed to the New York State Dental Association, or organized dentistry as a whole.

m Please fill in circle if continued on attached pages.

Please list any other reasons you believe the nominee is deserving of this award.

m Please fill in circle if continued on attached pages.

Please list any other reasons you believe the nominee is deserving of this award.

m Please fill in circle if continued on attached pages.

Please attach curriculum vitae or other appropriate documents detailing the background and general information regarding the nominee. Remit to:

New York State Dental Association

20 Corporate Woods Blvd., Ste. 602

Albany, New York 12211

ATTN: Dr. Brendan Dowd, Council on Awards Chair

m Please fill in circle if continued on attached pages.

Please attach curriculum vitae or other appropriate documents detailing the background and general information regarding the nominee. Include the offices and/or positions held in organized dentistry. Remit to:

New York State Dental Association

20 Corporate Woods Blvd., Ste. 602

Albany, New York 12211

ATTN: Dr. Brendan Dowd, Council on Awards Chair

Transforming Dental Operations

The Role of AI in Streamlining Back-Office Functions

Artificial intelligence has the potential to deliver greater efficiencies to the dental office. Just keep in mind, it’s not always a perfect solution and requires human oversight.

Robert McDermott

Artificial Intelligence (AI) is revolutionizing industries, including dentistry, well beyond its initial clinical applications, such as diagnostics and treatment planning. AI’s integration into dental practices is significantly enhancing operational workflows, particularly in back-office operations, which are essential for smooth functioning and directly affect patient experience.

Swift Automated Insurance Verifications Reduce Errors

AI helps reduce administrative burdens and enhance accuracy. Advanced AI algorithms can swiftly analyze patient data, cross-reference it with insurance policies and verify coverage in real time, minimizing delays and errors commonly associated with manual verification. This auto-

mation not only speeds up patient intake and billing processes, it also ensures that dental practices can focus more on patient care rather than on paperwork.

Streamlining Billing and Claims Processing

Through AI algorithms, dental practices can automate coding and billing processes, significantly reducing human error. Real-time analysis and auditing of billing statements and insurance claims ensure accuracy and transparency, speeding up reimbursements and reducing claim denials.

Predictive Analytics for Increased Revenue

Beyond billing and claims processing, AI engages in predictive analysis, helping practices manage aspects like

As AI technologies evolve, ongoing training and adaptation are necessary, requiring a commitment to continuous learning by dental professionals. It’s crucial to maintain a balance between automation and human oversight, ensuring AI enhances rather than replaces the professional judgment and personal interaction that are critical to quality care.

Considerations and Challenges in AI Adoption

Despite AI’s benefits, dentists must consider certain challenges. The accuracy of AI systems heavily depends on the quality of the data they are trained on; poor data can lead to inaccurate outcomes. There are also ethical and privacy concerns, especially with handling sensitive patient data, requiring compliance with privacy regulations like HIPAA. Additionally, as AI technologies evolve, ongoing training and adaptation are necessary, requiring a commitment to continuous learning by dental professionals. It’s crucial to maintain a balance between automation and human oversight, ensuring AI enhances rather than replaces the professional judgment and personal interaction that are critical to quality care.

The Future of AI in Dental Operations

cash flow and resource allocation. Predictive analytics in AI systems can forecast future appointment bookings, patient cancellations, and even predict seasonal variations in patient flow. Furthermore, predictive analysis extends to financial operations, where AI tools analyze accounts receivable information from patient charts.

Improving

Patient Data Management

AI excels in managing large volumes of data, organizing, storing and retrieving patient records securely and in compliance with regulations like HIPAA. It also provides insights from patient data, enabling personalized care and better service tailoring.

Revolutionizing ICD-10 and CPT Coding

AI automates the assignment of ICD-10 and CPT codes, crucial for dental practices that cross-code with medical insurance. This ensures precision, leading to fewer claim rejections and a streamlined billing process, allowing practices to focus more on patient care.

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The integration of AI into dental operations is proving transformative, automating routine tasks, enhancing accuracy and improving efficiency. This allows dental professionals to focus more on patient care and less on administrative tasks. As AI technology advances, its role in dental practice operations will continue to grow, promising more innovative and efficient healthcare solutions. p

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Success of Implant Placement in Patients with Human Immunodeficiency Virus

Osman Khan; Kathryn Gauch; Alison Newgard, D.D.S.; Ezzard Rolle, D.D.S.

ABSTRACT

With the development of effective antiviral medication, patients with human immunodeficiency virus (HIV) are living longer, with fewer comorbidities. Because HIV is a chronic disease, patients are looking for long-term solutions to dental care. As dental providers, it is important that we treat patients to the standard of care. Currently, implants are the standard of care for treating edentulous areas. Dental providers may be hesitant to recommend implants in patients with complex medical conditions like HIV. However, research has shown that if a patient with HIV is well-controlled, dental implant success is the same as with a healthy non-HIV infected patient.

The human immunodeficiency virus (HIV) infection is a condition that has become more prevalent in the population due to the development of medications that control the disease. As the disease has progressed from acute to a more chronic condition, there has been an increased need for long-term dental care for patients living with HIV. The HIV crisis in the United States began as a bicoastal epidemic, primarily in large cities.[1] Over the past four decades, the epidemiology of HIV has changed (Table 1). According to the CDC, over one million Americans were living with HIV at the end of 2019.

HIV infects specific CD4 helper (CD4) lymphocyte cells in the immune system. This makes affected individuals more susceptible to opportunistic infections, some of which are observed in the oral cavity (Table 2). In many cases, untreated HIV infection leads to acquired immunodeficiency syndrome (AIDS).[3] AIDS is defined by a CD4 cell count below 200 cells/mm^3.[3]

Clinically, HIV is well-controlled if the CD4 cell count is above 500 cells/mm^3 and the viral load is undetectable.[3] Uncontrolled HIV can increase the risk of cardiovascular, metabolic, neurological and renal comorbidities.[4] Antiretroviral therapies have been shown to be extremely effective in preventing the progression of the disease.[5]

Current research has indicated that the most effective therapy is highly active antiretroviral therapy (HAART). HAART prevents the virus from duplicating itself.[3,4] HAART therapy is a combination of three drugs—two drugs of the nucleoside/nucleotide reverse transcriptase inhibitors (NRTI) class plus one drug that is either an integrase strand transfer inhibitor (INSTI), non-nucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (PI).[4]

Due to the initiation of HAART, the HIV+ population has seen a decrease in comorbidities and mortality. The transition of the disease from acute, life-threatening to long term has led more HIV+ individuals to seek extended dental care.[6] Therefore, more dental practitioners are treating patients with HIV and are turning to research to identify safe and effective means for treating these patients with various dental needs.

In recent years, implants have become a popular and effective treatment choice for patients presenting with missing teeth. From 1999 to 2016, dental implant placement increased by 5.7% and is projected to increase by an additional 20% by 2026.[7] This is due to the stability and os-

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seointegration into the bone that, when successful, allows for a reliable treatment choice for patients.

While implants are becoming the standard of care for edentulous patients who present with no significant medical conditions, practitioners may be hesitant to place implants in patients with more complex medical conditions and etiologies because of potential complications to suc-

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cess and perceived lack of evidence. This report will look at the success rate of and approach to implants as a treatment option for edentulous areas in patients living with HIV.

Success Rate of Implant Placement in HIV+ Patients

Implants have increased prosthetic options and are becoming a standard procedure for treating edentulous areas. As with any surgical procedure, case selection and review are important for success. Common reasons for implant failure are peri-implantitis, osseointegration failure, primary infections and prosthesis failure.[4]

Research has found implant placement to be a suitable treatment option for patients living with HIV that is controlled, especially if these patients are undergoing HAART treatment.[3] The overall survival rate of implants placed in HIV+ patients is above 90%, which was comparable to the survival rate in healthy patients without HIV.[3] In cases that did fail, there was no evidence to suggest that the cause of implant failure was from antiretroviral therapy or the disease itself.[5]

The most important factor associated with implant success in HIV+ patients was an undetectable or low viral load and elevated CD4 count.[3] If the CD4 count is greater than 200 cells/mm^3 and the HIV status is controlled and stable, literature indicates there is no significant difference in the success of implant placement between HIV+ and HIV- patients.[8]

While HAART is an effective means to control the disease, there are side effects to consider with implant placement. The HAART regimen has been associated with osteoporosis and osteopenia.[4] Since implant placement success is dependent on osseointegration into the bone, these bone metabolic issues may cause concerns for longterm success.[4]

Some surgeons choose to prescribe prophylactic antibiotics prior to implant placement, although there is no clear evidence supporting or contradicting its use. Some studies suggest that antibody prophylaxis prior to placement of implants may lower the risk of implant failure in HIV+ patients due to the immunocompromising nature of the disease.[9-11] However, other trials demonstrate that antibiotic prophylaxis prior to implant placement may not be clinically relevant, as it is not shown to reduce postoperative infection or failure.[11] The growing concern for antibiotic resistance should also be considered when prescribing prophylactic antibiotics in the dental practice.[12] Antibiotic resistance is a global problem and antibiotics should be prescribed based on clear guidelines, guided by clinical evidence.

Conclusion

Current literature shows that dental implant placement for HIV+ patients has a favorable prognosis, similar to that of HIV- patients. Controlling viral load plays a significant role in the success of implant placement for HIV+ patients. Therefore, it is important to assess the immune competence of the patient before attempting implant therapy. However, certain medications in the HAART therapy may affect osseointegration. Further studies are necessary. p

Queries about this article can be sent to Dr. Newgard at an2621@cumc.columbia.edu.

REFERENCES

1. Sullivan PS, et al. Epidemiology of HIV in the USA: epidemic burden, inequities, contexts, and responses. Lancet 2021;397(10279):1095-1106.

2. Braunstein SL, et al. Epidemiology of reported HIV and other sexually transmitted infections during the COVID-19 pandemic, New York City. J Infect Dis 2021;224(5):798-803.

3. Sivakumar I, et al. Does HIV infection affect the survival of dental implants? A systematic review and meta-analysis. J Prosthet Dent 2021;125(6):862-869.

4. Sivakumar I, et al. Do highly active antiretroviral therapy drugs in the management of HIV patients influence success of dental implants? AIDS Rev 2020;22(1):3-8.

5. Rubinstein NC, et al. Retrospective study of the success of dental implants placed in HIVpositive patients. Int J Implant Dent 2019;5(1):30.

6. Sabbah A, et al. A retrospective analysis of dental implant survival in HIV patients. J Clin Periodontol 2019;46(3):363-372.

7. Elani HW, et al. Trends in dental implant use in the U.S., 1999-2016, and projections to 2026. J Dent Res 2018; 97(13):1424-1430.

8. Gherlone EF, et al. A prospective longitudinal study on implant prosthetic rehabilitation in controlled HIV-positive patients with 1-year follow-up: the role of CD4+ level, smoking habits, and oral hygiene. Clin Implant Dent Relat Res 2016;18(5): 955-964.

9. Vidal F, et al. Dental implants and bone augmentation in HIV-infected patients under HAART: case report and review of the literature. Spec Care Dentist 2017; 37(3):150-155.

10. Laskin DM, et al. The influence of preoperative antibiotics on success of endosseous implants at 36 months. Ann Periodontol 2000;5(1):166-74.

11. Momand P, et al. Effect of antibiotic prophylaxis in dental implant surgery: a multicenter placebo-controlled double-blinded randomized clinical trial. Clin Implant Dent Relat Res 2022;24(1):116-124.

12. Chrcanovic BR, Albrektsson T, Wennerberg A. Prophylactic antibiotic regimen and dental implant failure: a meta-analysis. J Oral Rehabil 2014;41(12):941-56.

Osman Khan is a dental student, Columbia University College of Dental Medicine, New York, NY.

Kathryn Gauch is a dental student, Columbia University College of Dental Medicine, New York, NY.

Alison Newgard, D.D.S., is assistant professor, Columbia University College of Dental Medicine, Section of Cariology and Restorative Sciences, Division of Operative Dentistry, New York, NY.

Ezzard Rolle, D.D.S., is assistant professor, Columbia University College of Dental Medicine, Section of Cariology and Restorative Sciences, Division of Operative Dentistry, New York, NY.

Effects of a Mandatory COVID-19 Testing Policy on No-Show Rates for Aerosol-Generating Procedures

Ramin Kashani, D.D.S.; Natesha Kumar, D.D.S.; Sheena Nandi, D.D.S., M.P.H.;

Courtney H. Chinn, D.D.S., M.P.H.

ABSTRACT

Purpose. To determine the impact of a mandatory COVID-19 testing policy on visit no-show rates.

Methods. We conducted a retrospective chart review at NYC H+H/Bellevue’s Pediatric Dental Clinic, comparing no-show rates and dental work completed before and during this policy.

Results. We assessed a total of 812 scheduled appointments. After the policy, we found no statistical difference between no-show rates, more quadrants of dental work completed per visit (P<0.001) and shorter interval times between appointments (P<0.001).

Conclusion. The policy did not increase visit noshow rates. We also found more treatment completed in a shorter time frame.

In 2020, the COVID-19 pandemic began to affect all aspects of life in the United States. The primary transmission pathway for COVID-19 was found to be airborne or via respiratory droplets. Many professions were deemed high risk for transmission of COVID-19, which included dentists who perform aerosol-generating procedures (AGPs).[1] AGPs are defined by the use of dental equipment, such as ultrasonic scalers and high-speed handpieces, which result in the

production of airborne droplets. In dental settings, these particles can remain suspended, increasing the risk for developing disease.[2]

In March of 2020, the CDC recommended dental practitioners avoid all elective treatment and only provide emergency treatment. Across the globe, practitioners detected increasingly more caries in children because families feared going to the dentist and contracting COVID-19.[3,4] Many pediatric dental practitioners resorted more to noninvasive, non-aerosol procedures to stabilize dental decay, such as atraumatic restorative techniques, interim restorative techniques, Hall crowns and silver diamine fluoride.[2]

As COVID cases from the first wave began to decline and restrictions were loosened, dental facilities adopted new safety protocols to reduce the risk of transmission during dental visits. Examples of new protocols included limiting the number of individuals present at an appointment, televisits, telescreening, in-office pre-screening, temperature checks, greater levels of protective personal equipment (PPE), high-efficiency particular air (HEPA) filtration, hand hygiene protocols and surface disinfection.[1,3,5,6]

In July 2020, a policy was implemented in the pediatric dental clinic (PDC) at New York City Health + Hospitals / Bellevue (Bellevue). The protocol required proof of a negative COVID-19 test within five days of the patient’s first scheduled AGP appointment, which was scanned into their electronic health record (EHR). The test was then valid for up to 10 days after the test date, to accommodate for

a possible necessary second AGP appointment. For patient convenience, the administrative staff scheduled COVID-19 tests for patients at either Bellevue or a convenient New York City Health + Hospitals (NYCH+H) location close to the patient’s home.

Also, for patient convenience, this policy accepted PCR antigen tests and rapid antigen tests from non-NYCH+H sites. If a patient’s COVID-19 test was positive, the policy permitted rescheduling the AGP appointment after a minimum 14-day quarantine, with allowance to return, so long as the patient was asymptomatic and all symptoms resolved. Additionally, patients with a positive test were exempt from retesting for 90 days from the date of their positive test result.

The purpose of this study was to determine whether the required COVID-19 testing policy had any impact on no-show rates, number of quadrants completed per visit and number of days between a patient’s AGP appointments in Bellevue’s PDC. The study hypothesized that for children and adolescents diagnosed with dental caries, a mandatory COVID-19 test for AGPs at Bellevue’s PDC would increase the appointment no-show rate as compared to a time prior to COVID-19. We also hypothesized that there would be no difference in number of quadrants completed per visit or length of time between AGP appointments.

Materials and Methods

This retrospective chart review was approved by the New York University (NYU) Langone Institutional Review Board (i21-00877) and the NYCH+H’s System to Track and Approve Research (STAR) (00003347). Study subjects were patients attending Bellevue’s PDC who met the inclusion and exclusion criteria. Sample size was calculated using power analysis estimates with a confidence level of 95%, margin of error of 5%, standard deviation of 0.5 and z-score of 1.96. The estimated effective sample size obtained was 218. Subjects were selected with the following inclusion criteria: age 4-17, diagnosed with dental caries, and scheduled for an AGP during the two time periods: October 1, 2019, through February 29, 2020, for the pre-COVID-19 policy (control group), and October 1, 2020, through March 31, 2021, for the COVID-19 policy (case group). There were an equal number of patients in each group (250 each). Appointments were excluded from the study if treatment only included use of a slow-speed handpiece or ultrasonic scaler. All hygiene appointments were excluded from the study, as it was not clear when ultrasonic scaling was used versus hand scaling in the control group.

Data was collected from Bellevue’s dental EHR system (Dentrix Enterprise v 11.0, 2021). Study data were collected and

managed using REDCap electronic data capture tools. Data collected for each subject included age, gender, month and year of dental visit, appointment status, number of quadrants completed per appointment, and number of days between each scheduled visit. All information was deidentified, using a separate key to identify medical record number and subject ID number. The appointment status (show/no-show), number of quadrants completed per visit and number of days between a patient’s AGP appointments were compared for both the control and the case group using chi-square and student t-tests through JASP Team (2022). JASP (Version 0.16.3) [Computer software]. (CI=95, P<0.05).

Results

The study included 500 patients with a total of 812 visits from Bellevue’s PDC who met the inclusion criteria. The control group and case group each consisted of 250 subjects. Overall, appointment status data revealed a 75% (610 visits) show rate and 25% (202 visits) no-show rate. Table 1 demonstrates the distribution of patient visits in the two groups.

Table 2 contains the data of each visit collected, including appointment status (show versus no-show), number of quadrants completed per visit (1 versus 2 or more), and

number of days between each visit (10 days or less versus 11 days or more). When comparing the control and case groups, results showed no statistical difference between no-show rates, even when stratified by age and gender.

The number of quadrants completed per visit showed a statistically significant difference (P<0.001), with more quadrants completed per visit during the COVID-19 policy case group as compared to the control group (Figure 1). Furthermore, with statistical significance, the case group showed patients returned for subsequent AGP visits in shorter intervals as compared to the control group (P<0.001) (Figure 2).

Discussion

We hypothesized that requiring a COVID-19 test prior to AGPs would create an additional barrier to dental treatment, thereby increasing no-show rates for scheduled appointments. Many barriers to care existed before the pandemic, particularly in the communities at high risk for pediatric dental caries. One systematic review explored and identified facilitators and barriers to pediatric patient compliance for attending dental visits. One common finding among studies in this review was reduced dental attendance due to conflicts with school schedules, examinations, travel distance and time required to attend appointments.[7]

In this study, authors perceived these same reasons as potential barriers to compliance with a COVID-19 test requiring an additional appointment. However, on the contrary, this study revealed no change in patient attendance to dental appointments after adopting a COVID-19 testing policy. Possible reasons for this finding may include school and work being remote during COVID-19, which may have alleviated conflicting schedules and time constraints for both parents and children.

Two studies discovered more compliance with dental visits in younger children compared to older children, owing to more dependency on parental decisions and willingness.[7] Furthermore, another study found the highest rate of missed dental appointments occurring between the ages of 7 to 12.[8] On the contrary, this study showed no difference when comparing younger and older children or any age groups in both the control and case groups. Moreover, 12 studies concluded no implication between gender and dental visit adherence, analogous to the results found in this study,[7] whereas another study noted more failed appointments in males.[8]

With respect to COVID-19 transmission, many patients feared going to the dentist due to high risk of transmission. A questionnaire conducted in Brazil consisting of 1,003 parent respondents of children ages 0-12 years old revealed that 86% of respondents did not seek dental care due to fear level and current number of COVID-19 cases, even though 56% reported dental trauma or pain.[4] Avoidance of healthcare during the pandemic was a common experience.[9] However, this study rejects these findings, which may be due to mandatory COVID-19 testing prior to an AGP visit; the policy may alleviate concerns for patients and their caregivers regarding their own safety and risk of contracting COVID-19.

Many studies encourage and insist dental practitioners employ pre-procedural COVID-19 testing, including chairside rapid testing.[10] One study conducted in a hospital dental clinic for adult patients required COVID-19 testing within 48 hours of AGP procedures if use of a rubber dam was not feasible. Results of this study showed an increase in patient attendance and compliance with testing and receiving treatment (108 patients to 162) from May 2020 to July 2020.[11] Investigators noted patients felt safer, PPE was conserved, infection rate was minimized (19.2% to 3.5%) and more elective treatment could be performed safely.[11] These findings coincide with results from this study, showing no change in no-show rates, and the ability of practitioners to complete more elective dental treatment needs rather than be limited to primarily urgent or temporary noninvasive dental needs. Additional potential reasons for

completing more quadrants per visit may include practitioner motivation to reduce patient exposure, reduce advancing decay and prevent urgent dental needs.

Regarding the COVID-19 test, several perceived barriers may exist. Probable barriers might include fear of test, discomfort from test and positive test result. Inability of pediatric patients to comply with taking the COVID-19 test itself could lead to a reduction in show rates. Although this study did not evaluate the results of COVID-19 tests, testing positive may be a reason for not showing to an appointment. As mentioned in another study, being sick accounted for 45% of missed appointments for children, which was second highest to missing an appointment due to school exams or parents forgetting the appointment.[8]

On the other hand, if parents were able to successfully obtain a COVID-19 test prior to the child’s AGP appointment, and the test was negative, they may have been more motivated to come in for their appointment. Additionally, they may have been keener to schedule any additional AGP appointments within the 10-day testing window, to avoid multiple COVID-19 tests for their child.

This study had several strengths, weaknesses and limitations. A strength is only one examiner reviewed charts and recorded data, eliminating the need for calibration. Additionally, the study contained a large sample size, with variation in demographics, which was equally distributed between the two groups, and provided a sample size representative of the general population of interest. This retrospective chart review also excluded any loss to follow-up, recall bias of subjects and did not pose any ethical considerations.

A weakness authors acknowledge is this study does not include qualitative data, including COVID-19 test results, indicating reasons for no-show appointments. Additionally, practitioner or patient beliefs or opinions regarding the COVID-19 testing policy were not assessed. Therefore, future research is recommended to better understand potential reasons for the increased amount of dental work per visit and shorter intervals between appointments during the COVID-19 time period.

This study evaluated the effects of a new pandemic, which was the biggest limitation to this study, because existing research is minimal and there are no replicative findings in a pediatric setting to compare results.

Conclusion

The COVID-19 testing policy did not result in increased noshow rates for AGP appointments. During this policy, practitioners actually completed more quadrants of treatment in each appointment, and patients scheduled consecutive ap-

pointments in shorter intervals. Further research is needed to investigate possible reasons for these outcomes. p

The authors state they have no financial, economic or professional interests that would influence positions presented in the article. Their research was supported by New York University and New York City Health + Hospitals / Bellevue. No funding was received for this study. The authors thank Liz Best, M.P.H., for her guidance. Queries about this article can be sent to Dr. Kashani at rk282@nyu.edu.

Ramin Kashani, D.D.S., is a board-certified pediatric dentist; attending, New York City Health + Hospitals/Bellevue, New York, NY; and adjunct assistant professor, New York University College of Dentistry, New York, NY.

Natesha Kumar, D.D.S., is a board-certified pediatric dentist; 2022 graduate, New York University College of Dentistry New York, NY; and currently in private practice in Chicago, IL.

Sheena Nandi, D.D.S., M.P.H., is a board-certified pediatric dentist; attending, New York City Health + Hospitals/Bellevue, New York, NY; and adjunct assistant professor, New York University College of Dentistry, New York, NY.

Courtney H. Chinn, D.D.S., M.P.H., is a board-certified pediatric dentist; associate chair, Department of Pediatric Dentistry, and clinical associate professor, New York University College of Dentistry, New York, NY.

REFERENCES

1. Occupational Safety and Health Administration. Healthcare Workers and Employers. Nov. 21, 2021. Accessed Dec. 15, 2021. https://www.osha.gov/coronavirus/control-prevention/ healthcare-workers.

2. Sharma A, Jain M. Pediatric dentistry during Coronavirus Disease-2019 pandemic: a paradigm shift in treatment options. International Journal of Clinical Pediatric Dentistry 2020;13(4):412-415.

3. Kochhar AS, Bhasin R, Kochhar GK, Dadlani H, Thakkar B, Singh, G. Dentistry during and after COVID-19 pandemic: pediatric considerations. The International Journal of Clinical Pediatric Dentistry 2020;13(4):399-406.

4. Campagnaro R, et al. COVID-19 pandemic and pediatric dentistry: fear, eating habits and parent’s oral health perceptions. Children and Youth Services Review 2020;118 105469.

5. Villani FA, Aiuto R, Paglia L, Re D. COVID-19 and dentistry: prevention in dental practice, a literature review. International Journal of Environmental Research and Public Health 2020;17(12):4609.

6. Sales SC, Meyfarth S, Scarparo A. The clinical practice of pediatric dentistry post-COVID-19: the current evidence. Pediatric Dental Journal 2021;31(1):25-32.

7. Badri P, Saltaji H, Flores-Mir C, Amin M. Factors affecting children’s adherence to regular dental attendance: a systematic review. The Journal of the American Dental Association 2014;145(8):817-828.

8. Bhatia R, Vora EC, Panda A. Pediatric dental appointments no-show: rates and reasons. International Journal of Clinical Pediatric Dentistry 2018;11(3):171-176.

9. Soares P, Leite A, Esteves S, Gama A, Laires PA, Moniz M, Pedro AR, Santos CM, Goes AR, Nunes C. Factors associated with the patient’s decision to avoid healthcare during the COVID-19 pandemic. International Journal of Environmental Research and Public Health 2021 Dec 15;18(24):13239.

10. Shirazi S, Stanford CM, Cooper LF. Testing for COVID-19 in dental offices: mechanism of action, application, and interpretation of laboratory and point-of-care screening tests. Journal of American Dental Association 2021;152(7):514-525.

11. Umer F, Arif A. Preprocedural pool testing strategy for dentistry during the COVID-19 pandemic. International & American Associations for Dental Research 2021;6(2):139-144.

Dr. KashaniDr. NandiDr. Chinn

Heterotopic Bone Formation after TMJ Surgery A Literature Review

Sumir Gandhi, D.D.S., M.D.S.; Robert S. Glickman, D.M.D.

ABSTRACT

Background. Heterotopic ossification (HO) is defined as the formation of lamellar bone in soft tissues where normally bone does not exist. It is a rehabilitative disease that can be associated with any joint in the body; however, its pathogenesis and management in the temporomandibular joint (TMJ) is infrequently mentioned in the literature.

Types of studies reviewed. The authors searched various articles, including systematic reviews, meta-analyses, randomized clinical trials, Cohort studies, case reports and literature review on heterotopic bone formation and treatment in PubMed, Google Scholar and Scopus.

Results. Identification of patients who are classified as high risk for the development of HO is vital for its prevention and management. Postoperative range of motion exercises, prophylactic medication with indomethacin and etidronate could reduce the incidence of HO. Similarly, the role of external beam radiation in the prevention of HO is well-documented. Additionally, several studies mentioned the inhibitory role of novel medication, such as rapamycin (RAPA), palovarotene and imatinib mesylate.

Furthermore, clinical trials are underway to test the efficacy of saracainib, Garetosmab and IPN60130. Practical implications. HO is most frequently diagnosed in patients who undergo total hip and knee replacement surgeries; its mention in the temporomandibular joint is rarely found in literature. The risk factors for HO in TMJ include trauma, infections, ankylosis, recurrent ankylosis, intra-articular corticosteroid injections, recurrent inflammatory conditions and total TMJ replacement with alloplastic or autogenous grafts. Its formation is unpredictable and, hence, patients with identifiable risk factors should be told about the risks and benefits of surgery and encouraged to strictly follow the prescribed postoperative regimen. Surgery is the final treatment of choice; however, placement of a fat graft in the surgical site has shown promising results to prevent HO at the surgical site.

HO is defined as the formation of lamellar bone inside soft-tissue structures where bone normally does not exist.[1] It has also been defined as the presence of bone in nonosseous tissues or, more accurately, formation of ectopic lamellar bone in muscles or joint apparatus.[2] The first

description of the condition (HO) dates to 1692, by Patin, in children with myositis ossificans progressive. Eileen M. Shore and Frederick S. Kaplan have categorized this disorder as pathological.[3]

Synonyms of this condition are heterotopic bone, ankylosis and myositis ossificans, as well as fibrodysplasia ossificans progressive, which is a hereditary autosomal dominant variant.[4] Similarly, myositis ossificans is a variant of HO and refers to a condition in which ectopic bone is formed within muscles and other soft tissues.

While HO and ectopic bone formation may seem to be similar entities, histologically, ectopic bone formation is merely a calcium deposition in soft tissues, while HO is new lamellar bone. However, there is as yet no agreement on the definition of this condition.

Incidence and Demographics

This condition is seen in rehabilitative patients, and any joint in the body can be affected; however, it is most frequently seen in people who have undergone total hip and knee replacement surgeries. The incidence ranges between 16% and 53% after total hip arthroplasty.[1] L. G. Mercuri and B. M. Saltzman state that the incidence of acquired HO after total knee and hip replacement is as high as 23% to 30% after primary surgery, and 56% after revision surgery.[4]

The incidence of HO is twice as frequent in males than in females; however, females older than 65 years have an increased risk of developing HO.[5] A recent systematic review conducted by Schoenmaker et al. stated that HO is slightly more common in females as compared to males and trauma-induced HO occurred at a younger age than spontaneous HO.

Although rare, FOP of the temporomandibular joint (TMJ) has been described in the literature by Heba Saleem, Herford and Chicahreon et al.[6,7] Many causative factors are listed for HO in the TMJ; nevertheless, infection and alloplastic TMJ replacement (TMJR) account for 2.7% and 1.2%, respectively.

Etiology and Risk Factors

The etiology of HO can broadly be classified as hereditary or acquired. Fibrodysplasia ossificans progressive (FOP) is the genetic variant of the hereditary variant of HO. The hallmark sign of this is the malformation of big toes at birth. This is caused by a mutation of the bone morphogenic protein (BMP) receptor called activin receptor type –1 (ACVR1) receptor, also known as activin receptor-like kinase –2 (ALK-2), which results in arginine to histidine substitution at position 206. This substitution renders the receptor hyperactive to BMP ligands.[8]

Acquired causes include traumatic (fracture, arthroplasty, muscular trauma, joint dislocation, burns) and neurogenic (stroke, spinal cord injury, traumatic brain injury and brain tumors).[5] Additionally, HO has also been reported in patients with a gamut of crystal deposition diseases secondary to systemic illnesses, such as hyperparathyroidism and tumors.[9]

Risk factors for developing HO include the following: spasticity, older age, pressure ulcer and the presence of deep vein thrombosis (DVT); long bone fractures, prior injury to the same area; and edema. Nonambulatory patients, such as those in a long-term coma and severe injury (trauma, traumatic brain injury, spinal cord injury, stroke), can also be contributing factors.

Similarly, risk factors for the development of HO in TMJ are: trauma, infections, ankylosis, recurrent ankylosis and previous surgery to the same area; recurrent inflammatory conditions and total temporomandibular joint replacement with alloplastic or autogenous grafts; and patients uncooperative with post-implantation physical therapy.[10] It is postulated that the blood clot that forms after extensive joint debridement or total joint replacement promotes the migration of pluripotent cells and differentiation into osteoblasts. So, the more fibrotic the joint, the greater the loss of vascularity and, subsequently, a hypoxic environment is created.

Another study stated that intra-articular corticosteroid injections for inflammatory conditions of the TMJ lead to a 20% incidence of HO of the TMJ.[9,11,12] Also, individuals diagnosed with juvenile idiopathic arthritis (JIA) are more prone to develop HO. It is stated that a 38% increase in risk is associated with each passing year after the diagnosis is established.[9,10]

Classification

The various grades of heterotopic ossification of the temporomandibular joint were described by Turlington and Durr in 1993. Depending on the radiographic presentation, four grades were described. They are:

• Grade 0: no bone islands visible

• Grade 1: islands of bone visible within the soft tissue around the joint

• Grade 2: periarticular bone formation

• Grade 3: apparent bony ankylosis

Grades 1,2 and 3 are further classified as symptomatic (s) and asymptomatic (a). The symptomatic ossification includes severe pain, decreased interincisal opening, closed locking of the jaw, or decreased lateral or protrusive movement.[13]

Pathophysiology

The exact mechanism in the formation of HO is still being ascertained; however, research into the molecular struc-

ture of this condition is showing promising results. The pathogenesis for hereditary and acquired variants of HO is almost similar, albeit it differs at a few stages. However, regardless of the variant of HO, most authors agree that the initial inciting factor is the development of an inflammatory state leading to hypoxic environment[14] (Figure 1).

Hypoxia can be localized or generalized; nevertheless, it triggers the formation of hypoxia-inducible factor-1α (HIF-1α). HIF-1α further activates the release of cytokines, vascular endothelial growth factor (VEGF), bone morphogenic protein (BMP) and promotes mesenchymal cell differentiation. Furthermore, HIF-1α promotes chondrocyte differentiation, proliferation and survival.

BMPs are a part of the transforming growth factor-β (TGF- β) family of cytokines. BMP ligands transduce signal through the ACVR-1/ALK transmembrane receptors. Inside the cell, the signal is transported to the cell nucleus via the SMAD pathway. Additionally, BMP ligands can also transport signal to the nucleus via the Smad-independent pathways, such as TGF-β-associated kinase 1 (TAK1), mitogen-activated protein kinase (p38MAPK) and c-Jun N-terminal kinase (cJNK). Once the signal reaches the nucleus, transcription leads to transformation of pluripotent cells and deposition of osteoid, which eventually results in HO.

However, in patients with FOP due to a genetic mutation in the ACVR-1/ALK transmembrane receptor, the response to the BMP/activin A ligands is exaggerated through the Smad pathways.[15,16]

Another signaling pathway which has gained popularity in the recent past is the mammalian/mechanistic target of rapamycin (mTOR). This kinase is present in two forms, mTOR complex 1 (mTORC1) and mTOR complex 2 (mTORC2). mTORC1 is involved in various physiological processes in the body, such as responding to growth factors, stress, hypoxia, and it regulates several anabolic processes. It has also been stated that mTOR signaling pathway plays a vital role in the osteoblast differentiation and bone formation.[17]

Laboratory Investigations

Alkaline phosphatase is the most frequently requested lab parameter; unfortunately, it may not be elevated in the early phases of HO development. Nevertheless, serum alkaline phosphatase greater than 250 has been shown to correspond with HO. It should be borne in mind that alkaline phosphatase is also elevated in long-bone injuries; hence, it is not a specific marker for HO. Another lab parameter which could signal HO formation is erythrocyte sedimentation rate (ESR). Similarly, C-reactive protein is another such parameter that foretells the development of HO5. However, these are nonspecific markers that could foreshadow the formation of HO.

Management

The primary step in the management of this condition is to identify high-risk patients for developing HO. History is vital because intramuscular injection of lignocaine should be avoided in those previously diagnosed with FOP18. Current literature states that gentle range-of-motion (ROM) exercises should be implemented immediately or within five days from the day of replacement surgery. Aggressive physiotherapy after a period of immobilization has been shown to favor the formation of HO; therefore, gentle ROM should be instituted.[1] Other measures to prevent HO include prophylactic medication with indomethacin and etidronate and external beam radiation (Figure 2).

Indomethacin is the most commonly used NSAID for prophylaxis, although meloxicam, celecoxib, rofecoxib and ibuprofen have also been used.[5] Its action is twofold: first, it inhibits the differentiation of mesenchymal cells into osteogenic cells; and second, it prevents post-traumatic bone remodeling by suppression of the prostaglandin-mediated response.[1] Moreover, these drugs reduce pain and, consequently, patients can carry out gentle ROM exercises.

Figure 1. Formation of HO in TMJ. (a): Normal anatomy of TMJ. (b): Inflammatory condition of TMJ. (c): Formation of HO subsequent to chronic inflammation.

The recommended dose of indomethacin is 75 mg to 100 mg per day for 7 to 14 days postoperatively.[5] Complications of this regimen include risk of bleeding and gastrointestinal ulcers. To overcome such untoward occurrences, supplementation therapy with misoprostol 200mg/day can be instituted, or a selective cox-2 inhibitor can be substituted for indomethacin.[1] A recent study that compared the efficacy of celecoxib and indomethacin in the prevention of HO stated that there was no significant difference between the outcomes of the two drugs; however, patients who were on celecoxib had fewer side effects.[19]

Sodium etidronate, a bisphosphonate, is routinely used for prevention of heterotopic ossification in spinal cord injuries and complications of total hip arthroplasty. Its action is threefold: inhibition of calcium phosphate precipitation; slowing of hydroxyapatite crystal aggregation; and, finally, inhibition of the transformation of calcium phosphate to hydroxyapatite.[1] Thus, it is clear from the above description that this drug prevents bone formation by its effect on the crystallization process only and bears no effect on the

bone matrix formation. Hence, after cessation of treatment a phenomenon called “rebound effect” can precipitate where the matrix undergoes mineralization. Consequently, it is essential to start treatment as soon as possible and continue it for a sufficiently long period of time, i.e., at least six months.[1]

Another modality gaining popularity in prevention of HO is irradiation therapy. Its prophylactic effect after hip surgery is well-known. Radiation therapy is most effective when given early in the postoperative period, that is, within five days.[20] Ionizing radiation interferes with the processing of nuclear DNA formation during cell division and may, thus, interfere with the differentiation of osteoprogenitor cells.[21]

This therapy was first described in hip joint surgery and later was utilized in other locations. The recommended radiation dose to prevent HO in TMJ is 10 Gy in five fractions, scheduled over a median range of five days. It is advised that the radiation be delivered to the surgical field within 72 hours postoperatively.[20]

Jensen et al., conducted a study to test the long-term results of radiation prophylaxis to prevent HO in TMJ and stated that postoperative RT prevented reformation of TMJ HO in 50% of treated patients, and late toxicities from RT were mild and infrequent.[22] The question of radiation-induced cancer is of great concern; however, the likelihood of cancer induction is very low with doses less than 30 Gy in three weeks. No patient had developed a radiation-induced malignancy in doses less than 30 Gy in three weeks over a 50-year study period at Memorial-Sloan Kettering.[23] Although some patients are prone to radiation-induced parotitis and xerostomia, this condition is transient. While much literature is available on the effectiveness of RT and NSAIDS in the prevention of HO, it states there is no statistical difference between the effectiveness of the two modalities.[24]

A recent study demonstrated the effectiveness of rapamycin (RAPA) as a prophylactic measure to prevent HO. RAPA is an effective immunosuppressant and an anti-fungal agent. It prevents the formation of HO through the inhibition of mTOR signaling pathway. Consequently, it prevents angiogenesis and vascular permeability in experimental mice; reduces the total leuco-

Figure 2. Flow chart showing HO formation and action of various medications at different steps.

cyte count (TLC); and prevents hypoxic and oxidative stress in the injured tissue, which influences the development of HO.[16,17]

Similarly, palovarotene is a selective retinoic acid receptor (RAR)γ which is under phase trials for the prevention of HO, particularly in patients suffering from FOP. By virtue of its agonist (RAR)γ action, it inhibits BMP and SMAD 1/5/8 signaling. Interfering with these pathways prevents chondrogenesis and, ultimately, HO.[8,16]

Another novel drug used for the prevention of HO in FOP patients is imatinib mesylate, a tyrosine kinase inhibitor, which is used for chronic myeloid leukemia (CML). It works by means of preventing the hypoxic environment that is created in the inflamed tissues. This medication has anti-proliferative and immunomodulatory actions in WBCs. Remarkably, imatinib is also used in the management of systemic mast cell diseases and inhibits pro-inflammatory cytokines, which are also involved in the pathogenesis of HO.[25]

In addition to the above-mentioned, saracainib, Garetosmab and IPN60130 are under clinical trials for prevention of HO in FOP patients. Saracainib functions by blocking the mutated ALK receptor, to prevent the exaggerated response to BMP, and Garetosmab is an antibody to Activin A which triggers Smad pathway when it binds to ACVR1 receptor.

Surgical Management

The classic treatment for HO of the TMJ is surgical management.[21] Various treatment options are available, including resection of the heterotopic tissue, temporary spacer and removal of the prosthesis with replacement at a secondary procedure. This technique is more tiresome and would require two admissions and a second surgery at a later date. However, a novel technique is replacement of the prosthesis, followed by packing fat around the articular surfaces simultaneously.[26] This technique precludes the need for two admissions and, consequently, overall treatment costs are reduced.

Also, packing fat around the articular surface promotes neoadipogensis, which inhibits growth of new bone and cartilage.[27]Similarly, Larry M. Wolford used abdominal fat graft and stated that it is a useful adjunct to prosthetic TMJ reconstruction. The occurrence of excessive joint fibrosis and heterotopic calcification are minimized and, therefore, the range of motion is improved.[28,29] Dimitroulis interposed dermis fat graft harvested from the groin in the TMJ and reported favorable outcomes.[27] However, harvesting fat from other sites causes a second surgical site morbidity. Hence, Rattan V. described a simple technique where buc-

cal pad of fat was interposed between the articular surfaces of TMJ. This precluded the need for a second surgical site and patient comfort was enhanced.[30]

Since patients with heterotopic bone formation who undergo TMJ replacement may continue to have the tendency to reform heterotopic bone, further surgery may be required, which adds to morbidity, scarring and the risk of dysesthesia. Therefore, any solution to reduce the number of procedures should be considered.

Conclusion

HO is a rehabilitation complication after joint arthroplasty. The implication of this review article is to reinforce the preventive aspect of heterotopic ossification of TMJ. Its formation is unpredictable and, hence, patients with identifiable risk factors should receive special consideration.

Prevention with ROM, control of spasticity, NSAIDs (indomethacin, COX-2 inhibitors), bisphosphonates (etidronate) and external beam radiation after joint replacement should be considered. Absolute management involves surgery; however, as an adjunct to surgery, fat graft should be packed in the surgical site to prevent recurrence of heterotopic ossification. p

The authors have declared no conflict of interest. Queries about this article can be addressed to Dr. Gandhi at sg7245@nyu.edu.

REFERENCES

1. Vanden Bossche L, Vanderstraeten G. Heterotopic ossification: a review. J Rehabil Med 2005 May;37(3):129–36.

2. Salman NJ, Trento GD, Carvalho PH, Gabrielli MA, Gabrielli MF, Ana ES. Heterotopic ossification around temporomandibular joint prosthesis: case report and a scoping review. J Bone Res 2021;9:106.

3. Shore EM, Kaplan FS. Inherited human diseases of heterotopic bone formation. Nat Rev Rheumatol 2010 Sep;6(9):518–27.

4. Mercuri LG, Saltzman BM. Acquired heterotopic ossification of the temporomandibular joint. Int J Oral Maxillofac Surg 2017 Dec;46(12):1562–8.

5. Sun E, Hanyu-Deutmeyer AA. Heterotopic ossification. InStatPearls [Internet] 2021 Aug 7. StatPearls Publishing.

6. Herford AS, Boyne PJ. Ankylosis of the jaw in a patient with fibrodysplasia ossificans progressiva. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 2003Dec1;96(6):680-4.

7. Saleem HA. Fibrodysplasia ossificans progressiva: TMJ involvement and feeding dilemma. Oral Health Dental Sci 2019;3(2):1-3.

8. Lees-Shepard JB, Nicholas SA, Stoessel SJ, Devarakonda PM, Schneider MJ, Yamamoto M, Goldhamer DJ. Palovarotene reduces heterotopic ossification in juvenile FOP mice but exhibits pronounced skeletal toxicity. Elife 2018Sep18;7:e40814.

9. Ringold S, Thapa M, Shaw EA, Wallace CA. Heterotopic ossification of the temporomandibular joint in juvenile idiopathic arthritis. J Rheumatol 2011 Jul;38(7):1423–8.

10. Stoll ML, Amin D, Powell KK, Poholek CH, Strait RH, Aban I, Beukelman T, Young DW, Cron RQ, Waite PD. Risk factors for intraarticular heterotopic bone formation in the temporomandibular joint in juvenile idiopathic arthritis. The Journal of Rheumatology 2018 Sep 1;45(9):1301-7.

11. Lochbühler N, Saurenmann RK, Müller L, Kellenberger CJ. Magnetic resonance imaging assessment of temporomandibular joint involvement and mandibular growth following corticosteroid injection in juvenile idiopathic arthritis. The Journal of Rheumatology 2015Aug 1;42(8):1514-22.

12. Patel K, Gerber B, Bailey K, Saeed NR. Juvenile idiopathic arthritis of the temporomandibular joint–no longer the forgotten joint. British Journal of Oral and Maxillofacial Surgery 2021 Mar 31.

13. Ding R, Lu C, Zhao J, He D. Heterotopic ossification after alloplastic temporomandibular joint replacement: a case cohort study. BMC Musculoskeletal Disorders 2022 Dec;23(1):1-8.

14. Huang Y, Wang X, Lin H. The hypoxic microenvironment: a driving force for heterotopic ossification progression. Cell Communication and Signaling 2020Dec;18(1):1-0.

15. Wu J, Ren B, Shi F, Hua P, Lin H. BMP and mTOR signaling in heterotopic ossification: does their crosstalk provide therapeutic opportunities? Journal of Cellular Biochemistry 2019 Aug;120(8):12108-22.

16. Wentworth KL, Masharani U, Hsiao EC. Therapeutic advances for blocking heterotopic ossification in fibrodysplasia ossificans progressiva. British Journal of Clinical Pharmacology 2019 Jun;85(6):1180-7.

17. Hu Y, Wang Z. Rapamycin prevents heterotopic ossification by inhibiting the mTOR pathway and oxidative stress. Biochemical and Biophysical Research Communications 2021 Oct 8;573:171-8.

18. Ibourk A, Bouzoubaa SM, Yahya IB. Characteristics of the odontological management of patients with progressive ossifying fibrodyplasia. Journal of Oral Medicine and Oral Surgery 2019;25(4):33.

19. Romanò CL, Duci D, Romanò D, Mazza M, Meani E. Celecoxib versus indomethacin in the prevention of heterotopic ossification after total hip arthroplasty. J Arthroplasty 2004 Jan;19(1):14–8.

20. Durr ED, Turlington EG, Foote RL. Radiation treatment of heterotopic bone formation in the temporomandibular joint articulation. Int J Radiat Oncol Biol Phys 1993 Nov 15;27(4):863–9.

21. Reid R, Cooke H. Postoperative ionizing radiation in the management of heterotopic bone formation in the temporomandibular joint. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg 1999 Aug;57(8):900–5; discussion 905-906.

22. Jensen AW, Viozzi CF, Foote RL. Long-term results of radiation prophylaxis for heterotopic ossification in the temporomandibular joint. J Oral Maxillofac Surg 2010May 1;68(5):1100–5.

23. Kim JH, Chu FC, Woodard HQ, Melamed MR, Huvos A, Cantin J. Radiation-induced softtissue and bone sarcoma. Radiology 1978 Nov;129(2):501–8.

24. Vavken P, Castellani L, Sculco TP. Prophylaxis of heterotopic ossification of the hip: systematic review and meta-analysis. Clinical Orthopaedics and Related Research® 2009 Dec;467(12):3283-9.

25. Kaplan FS, Andolina JR, Adamson PC, Teachey DT, Finklestein JZ, Ebb DH, Whitehead B, Jacobs B, Siegel DM, Keen R, Hsiao E. Early clinical observations on the use of imatinib mesylate in FOP: a report of seven cases. Bone 2018Apr 1;109:276-80.

26. Selbong U, Rashidi R, Sidebottom A. Management of recurrent heterotopic ossification around total alloplastic temporomandibular joint replacement. Int J Oral Maxillofac Surg 2016 Oct;45(10):1234–6.

27. Dimitroulis G, Slavin J, Morrison W. Histological fate of abdominal dermis–fat grafts implanted in the temporomandibular joint of the rabbit following condylectomy. Int J Oral Maxillofac Surg 2011 Feb 1;40(2):177–83.

28. Wolford LM, Karras SC. Autologous fat transplantation around temporomandibular joint total joint prostheses: preliminary treatment outcomes. J Oral Maxillofac Surg 1997 Mar 1;55(3):245–51.

29. Çakarer S, Isler SC, Yalcin BK, Diracoglu D, Uzun A, Sitilci T. Autogenous dermis-fat graft in temporomandibular joint ankylosis surgery. Annals of Maxillofacial Surgery 2018 Jan;8(1):162.

30. Rattan V, Rai S, Vaiphei K. Use of buccal pad of fat to prevent heterotopic bone formation after excision of myositis ossificans of medial pterygoid muscle. J Oral Maxillofac Surg 2008 Jul;66(7):1518-22.

Grove, CA.

S. Glickman, D.M.D., is associate dean, professor and chair, oral and maxillofacial surgery, New York College of Dentistry, New York, NY.

Sumir Gandhi, D.D.S., M.D.S., is associate dentist at Ora Dentistry, Elk

Robert

Dr. GandhiDr. Glickman

Rural Oral Health Access Disparities in New York State

Renae Williams Atkinson, D.M.D., M.S.; Stacy McIlduff, CFRE; Hayward Derrick Horton, Ph.D.

ABSTRACT

Disparities in access to dental care for those whose primary/only dental insurance is Medicaid is a known issue. The infamous case of 12-year-old Deamonte Driver from Maryland brought this great need for access to private dental care through Medicaid to the fore. Yet, to this date, there has been no resource to address this great need.

Dentists accepting Medicaid fall into two categories: those who practice in federally qualified health centers (FQHC), and those who practice privately. FQHCs are known anecdotally to have long waitlists, delaying access to needed care (as in the case of Driver). This is compounded by the inability to identify private dentists who will accept Medicaid. To solve this problem in New York State, we made an interactive map where users of the My Healthy Smiles Mobile Application, created by the New York State Dental Foundation, will be able to find private dentists accepting Medicaid in their locale.

Using two publicly available datasets, we generated a new database of private dentists accepting Medicaid in New York State using R, a software environment for statistical computing and analysis. We

also analyzed the rate of private dentists/100,000 of the county population to rank the counties with the highest need. This resource has been useful from its generation to help connect patients with providers and to help lobbyists communicate the need that exists to politicians and policymakers interested in improving oral health disparities in New York State.

Access to dental care in New York State is not equal across all demographics. New York adopted the Affordable Care Act (ACA) Expansion of Medicaid in 2010.[1] The purpose of the dental benefit of Medicaid is to provide access to dental care to people who would not otherwise be able to afford it. Medicaid is offered to persons whose annual income is below the 138% federal poverty level (about $20,000 in 2024).

Insurance plays a major role in access to dental care in the United States. Private dentists accepting Medicaid are a valuable resource for those seeking timely dental care and in some cases, specialty services. In fact, New Yorkers since 2023, have the option of accessing specialty oral healthcare, like oral surgery treatments, endodontic care, crown lengthening and restorative care like implants and dental crowns.[2] Our work seeks to make finding dentists for these and other services just a few taps of the finger away. Organizations seeking to coordinate dental care, like the New York State Dental Foundation, have found it very difficult because of the volume of need that exists, particu-

larly in upstate New York. Identifying the areas of greatest need allows for better planning by all stakeholders.

The challenges associated with Medicaid among African Americans have been documented.[3] One such challenge in the city demography that was studied was the inability to find dentists accepting their dental insurance. In 2011, when this paper was published, research subjects reported having to travel long distances to reach dentists accepting their form of insurance (ibid. 2011). This added to the cost of access to care and for some even presented a barrier. Given that the bill for the ACA took effect in 2014, Medicaid services could have seen significant changes since that report. Our data, however, show that traveling long distances is the norm in rural areas and that access challenges span across racial and ethnic lines.

The closure of health centers accepting this kind of insurance continues to be a problem because the low reimbursement rates by Medicaid are exceeded by the cost of operating.[4] FQHCs bear the brunt of the responsibility in caring for the underserved in both urban and rural areas but are plagued with their own challenges. Private dental offices might be a possible solution to help with the burden of care; the first task is to locate them.

Significance

Many people postpone dental care because they are uninsured, underinsured or are unable to find a dentist who will take their insurance. Deamonte Driver died from a brain infection arising from an abscessed tooth.[5] Driver, who was covered by Medicaid, was unable to find a dentist who would accept his insurance to do the extraction. Our soonto-be-launched interactive map will connect patients seeking treatment with private dentists who accept Medicaid and, it is hoped, prevent anything like this from happening in New York State.

Methods

We generated a new dataset of private dentists in New York State who accept Medicaid using two publicly available datasets: the Medicaid Enrolled Provider Dataset[6] and the Human Resources and Services Administration (HRSA).[7] For the Medicaid data, after filtering for New York State, we selected “Dentists” as the “Profession or Service.” For dentists who practice in federally qualified health care (FQHC) centers (HRSA dataset), we filtered for New York State and added the following columns: Telephone Number; Address; City; ZIP; Longitude; Latitude. The Medicaid Provider list

Figure 1. Snapshot of Interactive Map of New York State showing Distribution of Private Dentists Accepting Medicaid. Each dot represents private dentist accepting Medicaid, but there might be multiple dentists accepting Medicaid at private facility. In such cases, dots overlap. Map displays total number of dentists in our new dataset:14,694 (this number may have repeats if dentist works at multiple private facilities).

Medicaid Acceptance by NY Dentists/Providers (not FQHCs)

Number of Non-FQHC Dentists per 100,000 Residents

Figure 2. Map of population distribution of private dentists accepting Medicaid/100,000 population. Highest distribution of dentists is in green, transitioning to lesser distributions, which are increasingly orange.

had 16,106 entries, with Medicaid providers having numerous entries by virtue of working in numerous facilities. Of these entries, 1,412, or 9%, were identified as FQHC entries and were excluded from the dataset. Our new dataset consisted of the difference between these two datasets.

We wanted to filter out the FQHCs, but there were no common columns across the two datasets. We therefore had to use the telephone number and address with the county information to cross-reference the two datasets in R.[8] Matching on telephone number accounted for the majority of matches and then additionally matching with the first line of the address with county increased the number of matches by approximately 50%. These results give a high degree of confidence; however, they possess any inherent weaknesses from their parent datasets. All attempts to ascertain the exact number of private dentists accepting

Counties with Fewest Dentists/100,000 Population

Counties with Most Dentists/100,000 Population

Medicaid, like corroborating our data with possible data from any other state agency, proved futile. We then used this data to generate the Interactive Map of Private Dentists accepting Medicaid that will be published on the My Healthy Smiles NY app when relaunched this year.

We were interested in how this related to the population of the counties and so we determined the number of private dentists accepting Medicaid /100,000 of county population using the 2024 New York county population data.[9] We then created a Map of the Distribution of Dentists by 100,000 of the county population and generated tables showing the counties with the greatest need and the highest supply of private dentists accepting Medicaid (Figures 1,2; Tables 1,2).

Discussion

Your private dentist accepting Medicaid is perhaps one of the best kept secrets in town. Many people, including those in the dental community, have resigned themselves to thinking that most private dentists do not accept Medicaid. We set out to find just how many private dentists do accept Medicaid in New York in 2024. In 2023, 92% of rural counties in New York State were designated as health professional shortage areas (HPSA).[10] We see this in the maps we generated (Figure 2). Also, the top 10 counties with the fewest dentists/100,000 county population were the most rural counties (Table 1). The top two counties with the smallest number of dentists were in the Adirondack Mountain Region. This means that people who live in these regions who are poor and relying on Medicaid are forced to rely on the FQHC for services.

Contrarily, the top two counties with the largest number of dentists per 100,000 of the county population were located in and around the second largest city in the state— Buffalo (Figure 2) (Table 2). The importance of having a dental home cannot be understated. For instance, routine care is often how early signs of oral and pharyngeal cancer are caught and chronic diseases that can contribute to systemic illnesses like periodontal disease and caries are managed. Numerous vulnerable populations exist in remote areas of New York, including pregnant women, children, the chronically ill, disabled and the aged. Routine care is just as important for them as it is for the able-bodied, if not more so. If able-bodied individuals find it difficult to travel considerable distances for dental care, imagine how much more difficult it is for those who are limited physically.[3] More work therefore needs to be done to ensure that the benefits of Medicaid are more equitably accessed between rural and urban areas.

One way of accomplishing this is by providing more avenues for licensure of dentists from other states and other

TABLE 2

TABLE 1

countries to practice in New York.[10] It has been shown that increasing the ethnic and racial diversity of the dental workforce increases the likelihood that underrepresented groups are able to serve in these areas, as they are more likely to do so.[11] Increasing the number and distribution of dental schools across the state that accept international dentists might be a viable option as well. It is noteworthy that the areas in the state where dental schools are located, like Rochester, Buffalo and New York City, are the areas with the highest number of dentists accepting Medicaid (Figure 1). Indeed, the University of Rochester Eastman Dental Institute and the University at Buffalo are known for their high acceptance rates of internationally trained dentists.

Numerous vulnerable populations exist in remote areas of New York, including pregnant women, children, the chronically ill, disabled and the aged.

Another way in which dentists have been addressing this is by employing teledentistry. Its use has been on the rise since the 2020 pandemic. The process employs oral cameras and telecommunication devices to connect remote clinics with providers, who are often located in more urban

areas. This has been useful in limiting long trips for consultations and allows for clinicians and patients to focus on procedures for in-person visits. This approach has even been adopted by FQHCs and is covered by Medicaid for triage, consultation, diagnosis, referral, follow-up and health education.[12]

Taking dental care to these underserved neighborhoods using mobile dentistry is a viable option that is covered by Medicaid. There are currently a limited number of mobile dental care providers in New York State. This represents an area of relatively untapped potential. It also may be less expensive than establishing a brick-and-mortar establishment, which usually requires that the providers live in the area or nearby. This highlights one factor that affects the establishment of private dental offices—how desirable a location is to live in. People tend to gravitate to areas where there are greater amenities and, therefore, supplying these amenities to remote areas might serve to attract dentists to the area. One limitation to mo-

• Automated Insurance Verifications—Fast.

bile dentistry is that this type of service is usually standalone and does not lend itself to follow-up procedures when necessary. Nevertheless, it might serve as a springboard for establishing a dental facility.

This study does not address the general limitations of health insurance in New York State. As seen in the introduction, reimbursement rates affect the bottom line of businesses and, thus, lead to closures. For this reason, many private dental facilities, although they may be accepting Medicaid, might not be accepting new patients. In the best interest of their practice, they may have to favor other insurance types with higher reimbursement rates. Therefore, the presence of a dot on the map in an area might not translate as access in real time (Figure 1).[13] The study does not consider racial and ethnic disparities or socioeconomic status. As a quantitative study, we hope our results have provided the basis for exploring geographical challenges to accessing dental care.

Conclusion

Most private dentists accepting Medicaid are located in urban areas of New York State. Ours is the first visual representation of the demographic oral health disparities focused on the provision of dental care to the underserved by the private dentist population. It is our hope to prevent anything like what happened in the state of Maryland from ever happening in New York. This interactive map, when launched, will aid in accomplishing that objective when kept up-to-date year after year.p

The authors thank Dr. Travis Atkinson for his technical expertise and support. And they acknowledge the support of the Presidential Doctoral Fellowship for Research Training in Health Disparities with funding from the National Institute on Minority Health and Health Disparities (#MD003373) through the Center for the Elimination of Minority Health Disparities (CEMHD) at the University at Albany, State University of New York (SUNY). Queries about this article can be sent to Dr. Atkinson at renae173@hotmail.com.

REFERENCES

1. Summary of the Affordable Care Act, KFF. Accessed: Jul. 23, 2024. [Online]. Available: https://www.kff.org/affordable-care-act/fact-sheet/summary-of-the-affordable-care-act/.

2. Mulder J. New York must cover root canal dental treatments for Medicaid patients under legal settlement, Syracuse. Accessed: Jul. 24, 2024. [Online]. Available: https://www.syracuse.com/health/2023/05/new-york-must-cover-root-canal-dental-treatments-for-medicaidpatients-under-legal-settlement.html.

3. Schrimshaw EW, Siegel K, Wolfson NH, Mitchell DA, C Kunzel C. Insurance-related barriers to accessing dental care among African American adults with oral health symptoms in Harlem, New York City. Am J Public Health 2011;101(8):1420–1428. doi: 10.2105/ AJPH.2010.300076.

4. Patients scramble as St. Peter’s closes dental center, and a doctor’s practice. The Altamont Enterprise. Accessed: Jul. 23, 2024. [Online]. Available: https://altamontenterprise. com/05312023/patients-scramble-st-peters-closes-dental-center-and-doctors-practice.

5. Deamonte Driver Dental Project. Maryland.gov Enterprise Agency Template. Accessed: Jul. 24, 2024. [Online]. Available: https://health.maryland.gov/phpa/oralhealth/pages/driver_ project.aspx.

6. Medicaid Enrolled Provider Lookup. Accessed: Jul. 24, 2024. [Online]. Available: https:// health.data.ny.gov/stories/s/Medicaid-Enrolled-Provider-Lookup/ru78-uxr9/.

7. Data Explorer. Health Resources and Services Administration. Accessed: Jul. 24, 2024. [Online]. Available: https://data.hrsa.gov/tools/data-explorer.

8. R: The R Project for Statistical Computing. Accessed: Jul. 01, 2024. [Online]. Available: https://www.r-project.org/.

9. Annual Population Estimates for New York State and Counties: Beginning 1970 | State of New York. New York State. Accessed: Jul. 24, 2024. [Online]. Available: https://data.ny.gov/ Government-Finance/Annual-Population-Estimates-for-New-York-State-and/krt9-ym2k/ about_data.

10. Kerry. Combating an Oral Health Crisis #TransformRuralHealth. Health Foundation for Western & Central New York. Accessed: Apr. 05, 2024. [Online]. Available: https://hfwcny. org/combating-an-oral-health-crisis-transformruralhealth/.

11. Mitchell DA, Lassiter SL. Addressing health care disparities and increasing workforce diversity: the next step for the dental, medical, and public health professions. Am J Public Health 2006;96(12): 2093–2097. doi: 10.2105/AJPH.2005.082818.

12. Is Teledentistry Here to Stay? University at Albany. Accessed: Jul. 23, 2024. [Online]. Available: https://www.albany.edu/news-center/news/2023-study-teledentistry-here-stay.

13. Medicaid Reimbursement Is Not Keeping Pace With Medicare. Accessed: Jul. 24, 2024. [Online]. Available: https://www.acr.org/Practice-Management-Quality-Informatics/ACR-Bulletin/Articles/June-2023/Medicaid-Reimbursement-Is-Not-Keeping-Pace-With-Medicare.

Renae Williams Atkinson, D.M.D., M.S., is a Jamaican-trained dentist with a Master’s Degree in Biomedical Sciences. She is a Health Disparities Fellow at the University at Albany, SUNY, Albany, NY, completing her experiential learning placement with the New York State Dental Foundation.

Stacy McIlduff, CFRE, certified fund-raising executive, is executive director of the New York State Dental Foundation.

Hayward Derrick Horton, Ph.D., is professor sociology, School of Public Health, University at Albany, SUNY, Albany, NY.

Dr. AtkinsonMs. McIlduffDr. Horton

UB School of Dental Medicine Receives Inspiring Programs in STEM Award

FOR THE THIRD YEAR IN A ROW, the University at Buffalo School of Dental Medicine’s Destination Dental School (DDS) has received the Inspiring Programs in STEM Award from Insight Into Diversity magazine, the largest and oldest diversity-focused publication in higher education.

As a recipient of the annual award—a national honor recognizing colleges and universities that encourage and assist students from underrepresented groups to enter the fields of science, technology, engineering and mathematics (STEM)—UB will be featured in the September 2024 issue of Insight Into Diversity magazine, along with 82 other recipients.

The Inspiring Programs in STEM Award winners were selected based on their efforts to inspire and encourage a new generation of young people to consider careers in STEM through mentoring, teaching, research and successful programs and initiatives.

UB’s hybrid online and in-person summer pathway program is free and open to undergraduate students and bachelor degree recipients interested in a career in dentistry. It

provides participants with an understanding of the day-today life of a dentist and dental student, helps strengthen their dental school applications and develops their skills as researchers. This year’s program wrapped up with in-person programming June 23-27 on the South Campus.

“Faculty, staff and students put extensive effort into providing this unique opportunity for underrepresented students interested in the dental profession,” says Simone Duarte, D.D.S., M.S., Ph.D., associate dean for faculty affairs, equity, diversity and inclusion. “Destination Dental School fellows not only engage in activities that make the dental profession come alive, but they also learn about the intricacies of the field and how best to prepare their applications for dental school.”

UB dental alumna Arian Johnson, D.D.S., ’21, founded Destination Dental School in 2021 after recognizing a lack of resources for students like herself when she applied to dental school. In 2022, the DDS program partnered with the Native American Pre-Dental Student Gateway to Dentistry program to combine virtual and in-person events.

NYU College of Dentistry Names Implant Dentistry Fellowship in Recognition of Major Gift from Alumni Noel Liu and Nazish Jafri

NYU College of Dentistry has received a multimillion gift from alumni Noel Liu, D.D.S. (’07), and Nazish Jafri, D.D.S. (’11), to enhance the college’s programs in implant dentistry and improve access to dental education and care.

In recognition of the gift, the college’s advanced training program in implant dentistry will be renamed the Liu Advanced Clinical Fellowship in Implant Dentistry. A portion of the gift—$1 million—will be dedicated to scholarships for dentists enrolling in the fellowship, creating the Liu Scholars. Having already made the decision to support the NYU Dentistry Oral Health Center for People with Disabilities, where one of the treatment rooms will be named for them, their gift will expand their support to the NYU Dentistry Ashman Department of Periodontology and Implant Dentistry and the Veterans Oral Care Access Resource (VOCARE), among other areas of the college.

Dr. Liu and Dr. Jafri are the cofounders and owners of Secure Dental, a dental service organization with more than 10 dental

practices in Illinois, Indiana and Iowa, with plans to expand to Tennessee. The husband-and-wife team began their careers after graduating from NYU College of Dentistry.

The Liu Advanced Clinical Fellowship in Implant Dentistry at NYU Dentistry is a two-year, full-time program designed for U.S. and foreign-trained dentists seeking to enhance their clinical skills and knowledge in implant dentistry.

The fellowship involves clinical experience, didactics and research to equip dentists to excel in the field, balancing restorative and surgical experience.

Drs. Liu and Jafri have maintained a connection to NYU Dentistry through invited guest lectures to first-year dental students; they will continue to impart their expertise to students through mentorship and regular guest lectures.

REGISTRY IS NOW

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Elevate Your Membership Experience with CE Navigator

Continuing Education (CE) is key to staying ahead of the curve and advancing your knowledge as a practitioner. It is also crucial to maintaining your New YorkState license. The New York State Dental Association (NYSDA) has restructured the NYSDA CE Registry for its members, making it more accessible. ► Set Your Own Email & Password ► Download the App

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Second District cont.

BRONX COUNTY

Welcome, Residents

Don Safferstein, D.D.S.

On Aug. 15, the Bronx County Dental Society and NYSDA cosponsored a gettogether with the new residents of our

BRONX COUNTY

five area hospitals. It was an evening of drinks, appetizers and great conversation. Mostly, it was great to welcome so many young dentists to the Bronx and talk to them about the importance of organized dentistry.

Thank you to the event sponsors, MLMIC and Bank of America.

Dinner and Learning

The Bronx has a full schedule of fall dinner lectures. They include the following:

• September 10: Dr. Jefferey Hoos. “If You Can Do Composites Correctly, You Can Do Full-Mouth Reconstruction.” Sponsored by Kuraray Dental.

• October 15: Michele Gabriel of DDS Match. “Important Steps to a Seamless Transition.”

• November 12: Dr. Dennis Bohlin. “Making a Difference-Substance Misuse and Your Patients “

BRONX COUNTY

EIGHTH DISTRICT

Gaining Members

Kevin J. Hanley, D.D.S.

The Steer Restaurant was the venue for Senior Sign-up Day in April. Fourth-year dental students in attendance heard about membership in the American Dental Association and its importance in their professional lives. Current members of the Eighth District’s Executive Council were on hand to give personal testimony about this importance and to encourage the students to join. At the end of the evening, 105 students became members, a banner day for the Eighth District!

Guild Meets for Brunch

The Guild of St. Apollonia held its annual appreciation brunch on April 28 at St. Leo the Great Church in Amherst. Members and their families attended Mass in the morning, followed by a catered lunch in the parish hall. Sister Mary Johnice from Response to Love Center shared the story of the inspirational mission work she performs daily at the Center. Fourth-year dental student Ramses Tamara Guerra received the Guild’s annual student service award.

The Guild of Apollonia is a group of Western New York dentists who provide needed care to those who don’t have the financial resources to afford it.

Members Recognized for Service

Three members of the Eighth District were honored by various organizations for their contributions to dentistry and their communities.

The Pierre Fauchard Academy presented Dr. Joseph Gambacorta with its Distinguished Service Award at its luncheon during the recent NYSDA House of Delegates meeting. Dr. Gambacorta was recognized for his work in RAM outreach both nationally and internationally and for his academic support at the University at Buffalo School of Dental Medicine. This is well-deserved recognition of Dr. Gambacorta, who

Residents based at hospitals in the Bronx were treated to a night out to socialize and learn more about organized dentistry. BCDS Executive Director Stephen Harrison, standing at left, was among leaders on hand to greet them.

Bronx County will be ably led in the coming year by a slate of female leaders. They are, clockwise, from left: Jacqueline Samuels, NYSDA Trustee; Amarilis Jacobo, NYSDA Vice President; Kirti Tewari, BCDS Secretary; Jerica Cook, BCDS President; Jemima Louis, BCDS President-Elect.

served as a driving force behind such missions at the dental school.

Another outstanding member of the Eighth District, Dr. Frank Barnashuk, received the prestigious Dr. Mark Feldman Distinguished Service Award during the NYSDA House of Delegates meeting for his significant contributions to NYSDA and organized dentistry. The district congratulates both Dr. Gambacorta and Dr. Barnashuk and thanks them for their work on our behalf.

Buffalo Business First honored Dr. Elizabeth Kapral on June 13 with its Excellence in Healthcare Award, presented at the organization’s awards luncheon at Salvatore’s Italian Gardens in Depew. Dr. Kapral is director of Special Needs Dentistry at Erie County Medical Center in Buffalo. She has received multiple HRSA grants, totaling over $3 million to address workforce challenges in dental care for vulnerable patients.

In 2023, Dr. Kapral and her dental team opened the ECMC Center for Dental Care at 800 Hertel Ave., Buffalo. This center operates within a multidisciplinary facility focused on meeting the needs of patients with disabilities, significantly expanding ECMC’s impact on the community. Dr. Kapral also chairs the New York State Special Needs Task Force. Congratulations to Dr. Kapral for this well-deserved recognition.

Golf Outing

On Monday, June 17, the 2024 William C. Knauf Jr. Memorial Golf Tournament was held at Diamond Hawk Golf Course in Cheektowaga. The morning began with a CE lecture by Dr. Sebastiano Andreana titled “Implant Therapy and the Edentulous Patient.” Following the lecture and lunch, 98 golfers teed up for the tournament.

Like most of the summer, the weather was hot and humid, but everyone appeared to be having a wonderful time playing the challenging course. Following golf, dinner and prizes finished off the great day of camaraderie. The team of Drs. Chris Kacalski, Rob Kacalski, Mike Piazza and Mr. Joe Piazza were the Men’s overall champions in

the scramble competition. The Senior’s overall champion was the team of Drs. Robert Reszel, Ron Chmiel, Scott Seier and Gregory George. Triumphant in the Super Seniors Division were Drs. Timothy Seel, Joseph Rutecki, Richard Lynch and David Stasiak. The Women’s overall champion was the team of Drs. Catherine Grogan, Patricia Starring, Frances DePlato and Alyssa Tzetzo. The Mixed team of Drs. Chester Gary, Rick Redmin, Frank Sindoni and Ms. Julia Gengo won that division.

It was another very successful day and tournament. Next year’s tournament will take place in June at Fox Valley Country Club in Lancaster.

Safe Behind the Wheel

The Eighth District will hold another safe driving course on Sept. 4 at the district office. This course is not your grandparents’ boring driving course; it is a serio-comic exploration of what it means to be a safe driver. Ray Ammerman, with the Safe Driver Academy, will present the course. Having taken the course two years ago, I can personally vouch for its value. Mr. Ammerman presents the information in a format guaranteed to keep all participants involved and entertained.

Attendees will receive a certificate entitling them to a 10% discount on their auto insurance for the next three years. I heartily recommend you attend this course.

FOURTH DISTRICT

Salute to Graduates

Crystal Arpei-McHugh, D.D.S., M.S.

The Fourth District Dental Society congratulates the 2024 graduates of Hudson Valley Community College School of Dental Hygiene, particularly Shane White, recipient of the Gerard A. Ripp Memorial Award, and Isabella Sypek, winner of the Dr. Mark A. Bauman Scholarship.

The Gerard A. Ripp Award, presented by the Hudson-Mohawk Section of the American College of Dentists, was

created in 2000 to honor local oral surgeon and HVCC instructor Dr. Gerard Ripp. It is presented to the students who demonstrate leadership, scholastic performance and great potential to contribute to the dental hygiene profession.

The winner of the Bauman Scholarship, presented by the Fourth District, is chosen for exhibiting traits that mirror those displayed by the late Dr. Bauman, including leadership, interest in and high standards for the profession, and compassion and care.

FOURTH DISTRICT

Dr. Wayne Harrison presents Gerard A. Ripp Memorial Award to HVCC graduate Shane White.

Dental hygiene graduate Isabelle Sypek, left, accepts Mark A. Bauman Scholarship from Dr. Jennifer Kluth.

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Fourth District cont.

In the House

The Fourth District was well-represented at the annual meeting of the NYSDA House of Delegates May 31-June 2 at Turning Stone Resort and Casino. Tak-

ing part in proceedings were delegates Drs. Christina Cocozzo, Fred Wetzel, John Milza and Jennifer Kluth and alternate delegates Dr. Rachel Hargraves and Diana Sandu. Also attending from the Fourth were NYSDA Trustee Dr. Adrienne Korkosz, NYSDA Immediate Past President James Galati and Executive Director Lisa Hicks.

Vets Program Making Difference

The New York State Dental Foundation’s annual Brunch and fundraiser,

FOURTH DISTRICT

held June 1 during the NYSDA House of Delegates meeting, celebrated the early successes of Salute Vets With a Smile, a new program to connect veterans with free dental care. At the brunch, the foundation recognized the dozens of volunteer dental heroes who are already providing free care to veterans in need of treatment.

The Fourth District acknowledges and thanks all its members who are helping to promote this program. Their participation has resulted in close to 100 connections being made.

SUFFOLK COUNTY Seminar Engages

Natalia Elson, D.D.S.

On May 15, we hosted Seminar Series Event #2 with Dr. Amanda Seay, presenter of “A Journey Through Esthetic Dentistry.” We had 60 people in attendance in our fully refurbished venue. Feedback was outstanding, and we thank Dr. Seay for sharing her knowledge and expertise in such a kind and engaging way. We’ll do our best to have her back.

SUFFOLK COUNTY

Dr. Amanda Seay leads members on “Journey through Esthetic Dentistry.”

Dr. Loren Baim, member of NYSDF Board and speaker at foundation’s annual brunch fundraiser. This year’s brunch was devoted to promoting foundation’s Salute Vets With A Smile program.

Fourth District’s delegation to NYSDA House seen on floor of House during break in proceedings.

Great Day for Golf

We had a beautiful day and a great time at our 24th annual golf outing on June 12 at Willow Creek Golf and Country Club. More than 70 golfers and volunteers enjoyed the day that included a barbeque lunch and dinner banquet.

A huge thank you to all our sponsors, including Tangredi Endo, Damianos Realty Group, Henry Schein Dental, MLMIC, Premier Endo, Rivkin Radler, Straumann, Fuoco Group, Joe Schwan CPA, Nappi’s Nook, Dr. Peter Pruden, TD Bank Healthcare Practice Solutions and Spot Pal. And, of course, thank you to our golf committee, its chair Tony Maresca, and the volunteers who put in a huge effort to deliver a great outing. They are Carol Deerwester, Patricia Hanlon, Fran McHugh, Terry Sanders, Chris Vazquez, Claudia Mahon-Vazquez, Ivan Vazquez, Vincent Verderosa and Nick Vittoria.

We’ll do it again next year. You won’t want to miss it.

Residents Invited to Lunch

Later in the month, on June 25, a busy day unfolded for new dental residents. And, as always, we were there to support them. We were honored to host a luncheon at the Stony Brook School of Dental Medicine for 36 of the 38 new dental residents. Our leadership team was there, too, including Drs. Jimmy Kilimitzoglou, Matt Hanna, Jeff Seiver and Patricia Swanson, as well as longtime faculty and SCDS member Dr. John Foti.

The residents hailed from communities across the United States. Some said they wanted to stay on Long Island or elsewhere in New York State, while some said they were looking to return to their home states.

At the same time as the event at Stony Brook, other SCDS leaders—Drs. Claudia Mahon-Vazquez, Ivan Vazquez, Patria Hanlon, Keri Logan, John Damaskos and Scott Goldstein—were meeting with five of the six dental residents at St. Charles.

Both groups of residents were provided with an overview of organized dentistry and the value of ADA mem-

SUFFOLK COUNTY

Annual golf outing benefited from good weather and turnout of number of enthusiAstic players and volunteers.

Dress was casual for a summer fun social hosted by SCDS for new dentists.

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Suffolk County cont.

bership. We appreciate the support of the American Dental Association and the New York State Dental Association in helping us provide the lunches and create a positive experience.

A big shoutout to Carol Deerwester (SCDS), Lynda Reynolds (SBSDM) and Daniella Zajac (SBSDM) and all our volunteer dentist leaders for their help in making these events possible.

Summer Social

We had a great time July 31 at Top Golf. More than 30 new dentists were joined by several SCDS leaders for a fun summer social event, sponsored by TargetRock Wealth Management, Bank of America Practice Solutions, Straumann and MLMIC. SCDS President Dr. Steven Feigelson, President-Elect Dr. Bill Bast, NYSDA Trustee Dr. Guenter Jonke and NYSDA Secretary-Treasurer Dr. Paul Leary were all on hand, as were our New Dentist Chair Dr. Devin Klein and Membership Chair Dr. Hailey Taylor.

Make it a Day of Learning Compliance Day is Dec. 4, a chance to get your mandated courses taken care of in one day! Check it out at SuffolkDental.Org/Calendar.

SECOND DISTRICT

Summer Means FUN at SDDS

Alyson Buchalter, D.M.D.

This summer has been packed with member-oriented, fun-filled events. In July, we learned shuffleboard is not just for senior citizens. That was when our New Dentist Committee hosted a “Summer Fun Night,” a social event at the Royal Palms Shuffleboard Club to encourage camaraderie and networking

among our newest members. Known for its food trucks, DJs, markets, concerts and, of course, shuffleboard, it was inevitable that Royal Palms would be the venue for a fun time.

Invitees included new dentists and residents from across Brooklyn and Staten Island. Over 30 dentists attended. We want to thank Henry Schein for its generous sponsorship. Thank you also to our New Dentist Committee Chair Theressa

Eliscar-Hewett and Dr. Stephanie Sagar, a member of the SDDS BOT, for organizing the event. Of the evening Dr. Sagar said, “It was a great summer night to bring new dentists and residents together while experiencing a new game.”

Who knew shuffleboard was so much fun?! Events like this show how much the SDDS values its new dentists. The summer fun will continue with a Pizza Day and Family Fun Day. Pizza

SECOND DISTRICT

New dentists gather on summer evening to bond over shuffleboard.

Party planners, from left, New Dentist Committee Chair Theressa Eliscar-Hewett and committee members Aia Shalan and Stephanie Sagar.

SECOND DISTRICT

Day is being organized by Dr. Sager for new dentists, who will be invited to take part in a master class in pizza making. Attendees will learn new recipes while networking with new friends. Watch your email for the invite.

Family Fun Day will cap off the summer. It will bring together members and their families for a day of excitement, laughter and bonding. The venue, Urban Air Adventure Park, promises a “safe place for the whole family to jump, soar, race, climb and play.” How can it be anything but fun!

Dr. Segelnick Published in JADA

The SDDS is proud of our own Dr. Stuart Segelnick. Not only was his article “Orally Dissolving Buprenorphine for Opioid Use Disorder Linked to Caries” published in the July 2024 issue of the Journal of the American Dental Association, but it was also the cover story. We at SDDS have always known how special Dr. Segelnick is, but now he has gained national attention. As he completes his term as the SDDS Bulletin’s award-winning editor and moves onto his new role as editor of the NYSDA Journal, we at the SDDS are delighted to call him one of our own!

NINTH DISTRICT

A Swell Event

Monica Barrera, D.D.S.

Congratulations to Dr. Anthony Cuomo, past president of the Ninth District, who completed his term as NYSDA

NINTH DISTRICT

Members were up and moving at summer Health is Wealth wellness event in park overlooking Hudson River.

Ninth District delegation to NYSDA House gather for group photo on House floor.

Ninth District, host of this year’s House of Delegates meeting, wowed attendees with a colorful, musical drone show, staged during President’s Dinner Gala.

Stuart Segelnick

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Ninth District cont.

President at the conclusion of the Association’s House of Delegates meeting in June.

The 9th District hosted events at this year’s meeting, held at the Turning Stone Resort and Casino in Verona. We are grateful to our delegates, alternate delegates, executives, our executive director and his executive assistant for their hard work in making the event a tremendous success. Not only did the 9th District collect a generous donation for EDPAC, our Golf Outing, Dinner and the highly praised drone exhibition were celebrated by attendees as some of the best events ever. We also want to thank our sponsoring vendors and the NYSDA staff, whose assistance and direction were paramount to the week’s success.

We want to take a moment to remember another past president, Dr. Stuart Coleton, who also was an important NYSDA leader, serving on the Association’s Board of Governors, numerous councils and as our first trustee. His leadership and mentoring will be missed.

Occasions for Learning

Our next full-day General Meeting will take place on Wednesday, Sept. 18, at the Crowne Plaza in Suffern. Christopher Salierno, D.D.S., will present “Think Like a CEO”; attendees will receive 7 MCE credits.

Our first two General Meetings of 2024 were well-attended, and the speakers were highly praised by attendees. The March meeting featured “Opportunities and Challenges for the GP in Periodontally Challenged Patients,” by Salomon Amar, D.D.S., Ph.D. The May meeting had Dr. Yongkun Kim discussing “Minimally Invasive Reconstructive

Dentistry in an Era of All-on-X: PatientCentered and Occlusion-Driven,” which members found incredibly powerful and useful for their practices.

Proper Disposal

The 9th District continued its new Shredding Day tradition, providing a HIPAA-compliant method for discarding patient records. It was held again in the parking lot of District headquarters in Hawthorne. Members are already asking when and where the next one will be. This sought-after benefit is well-appreciated by our members.

Answers, Please

In keeping with our focus on strengthening the association and organized dentistry, the 9th is planning a new dentist “Ask Me Anything” event for Oct. 10 at the Sleepy Hollow Hotel. The evening will feature a panel of new and established dentists, as well as company representatives, all prepared to provide insights into career paths and life after dental school and answer questions from attendees.

Additionally, we held a summer “Health is Wealth” wellness event on July 31 at the Hudson RiverFront Park in Tarrytown. This event was for all members, new dentists, residents and Touro Dental students, along with their spouses, partners and children. The evening included fun activities, picnic food, standing yoga, a clown and music at the beautiful scenic Hudson River Park.

Special thanks to our cosponsors, Feldman Kieffer, M&T Bank, Torch Dental and Westchester Myofunctional Specialties.

Plans are underway for a winter new dentist event. Stay tuned!

Finishing out the Year

Among our members’ favorite events each year are the Give Kids A Smile programs taking place around the 9th District. The years of the pandemic, 2020 to 2022, were difficult for all of us, especially underserved children in need of oral healthcare. So far, this year, we have held three events; a fourth, which

will include screenings for the children at B’Above in Peekskill, is planned for Oct. 16.

To finish our calendar year, our Annual Meeting will take place on Wednesday, Nov. 20, at the Westchester Country Club in Rye. Dr. Randy Huffines will present “Autoimmune Disease and Dentistry.”

Count on Us

As always, our executives, committees and headquarters’ staff are ready, willing, and able to help. We welcome your advice, thoughts and concerns, to ensure that all our members’ needs are met and voices are heard.

Remember, coming together is the beginning; keeping together is progress; working together is success!

SEVENTH DISTRICT EDPAC Reception

Becky Herman, Executive Director

Drs. Aaron and Abigail Rosen hosted an EDPAC-sponsored reception in their home on June 20 to introduce Seventh District members to Democratic State Senator Jeremy Cooney of Rochester. Attendees spoke with Sen. Cooney about challenges and opportunities impacting patients and dental teams in the Rochester community.

Take Me Out to the Ballgame

Seventh District members enjoyed a fun and relaxing night at Innovation Field cheering on the Rochester Red Wings when they took on the Lehigh Valley IronPigs on July 24. The event was sponsored by M&T Bank.

A Night of Country Music

New dentists and residents came out to listen to the Jack Thomas Band, network, and mingle with friends and colleagues Aug. 15 at the Blue Barn Cidery in Hilton. Thanks to event sponsors BMG-CPA, DDSmatch, GRB, Vision Financial Group and Walsh Duffield, attendees enjoyed great food and specialty ciders while learning about im-

portant office services available in the region.

SMS Text Services Now Available

In August, we will begin offering text services to members who opt-in to receive messages about events and upcoming activities. This is one more tool

to engage with members in the hopes of increasing event participation and enhancing member communication. Sign-up today.

Volunteers Aid Vets

Thank you to Seventh District members who have volunteered to provide free

SEVENTH DISTRICT

dental treatment to one or more veterans in need of essential oral healthcare through the New York State Dental Foundation’s Salute Vets With A Smile program. Members who have volunteered in 2024 include: Drs. Vincent Badali, Lindsey Cody, Michael DeLucia, Alaina Doiron, Geoffry Hallstead, William Hurtt (USN veteran), Lynne Meriwether, Anthony R. Mesolella, Nicholas Nicosia, Xiomara Restrepo, Mark Roman, Steven Spoto, John Pier Sullivan (USN veteran), as well as one person who prefers to remain anonymous.

NEW YORK COUNTY Equinox Experience Enjoyed

Andrew S. Deutch, D.D.S.

New dentists enjoyed a private cycling class at the luxury, members-only fitness club Equinox on June 11. After the intense workout, they recovered with post-workout refreshments at nearby Cask Bar & Kitchen. It was a great way to do something healthy and connect!

Rooftop Outing for a Cause

Do good while having fun? That’s exactly what took place on July 18 at a rooftop fundraiser for Camp Bronx, an organization that helps underprivileged children in the Bronx enjoy the many valuable experiences of sleepaway camp. New dentists and others enjoyed a beautiful night featuring hibachi chefs, drinks and music, all in support of making a difference in the lives of low-income Bronx children.

Marketing Influencer Wows Members

Members had a special opportunity to hear from best-selling author, marketing strategist, social media coach and registered dental hygienist Minal Sampat on Aug. 7. Ms. Sampat, the founder of Marketologist, an online marketing training program and a hugely popular marketing expert, with a heavy focus on dental marketing, delivered her lecture via Zoom. Her marketing strategies have been featured in the industry press and on Forbes.com seven times in

Members await arrival of Sen. Jeremy Cooney at EDPAC reception in home of Drs. Aaron and Abigail Rosen.

New dentists and residents enjoy night of country music, cider, chance to connect with colleagues and learn from sponsors about office services available in the area.

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New York County cont.

the last three years. NYCDS was thrilled to have Ms. Samat share her marketing insights with members.

A Slice of Fun and Connection

New dentists turned out in large numbers on Aug. 19 to sample a variety of delicious pizzas and refreshments at a local “old school” pizza restaurant. This al fresco event in late summer is a great way for members to reconnect with colleagues and recap summer vacations and more. We were glad to welcome many new members too! Much appreciation to MLMIC Insurance for

its sponsorship of this event, which has become a beloved tradition.

Mark Your Calendars

New York County & Second District Dental Societies

Meeting Dates: November 29th – December 4th

Exhibit Dates: December 1st – December 4th

JACOB K. JAVITS CONVENTION CENTER 11th AVE BETWEEN 34th & 39th STREET

For 2024, the Greater New York Dental Meeting is proud to offer a greatly expanded World Implant Expo, Annual Global Orthodontic Conference, 3D Printing Conference, Oral Health Symposium, Pediatric Summit, Women’s Program, Public Health Program, Special Needs programs and Dental Laboratory Education. Your staff can also take advantage of the many educational opportunities available. With over six hours of free CE daily, the education program at the GNYDM is an experience not to be missed! Register today to attend and sign up for courses and programs at www.gnydm.com.

Continuing Education

Our fall and winter schedule has a mix of new courses and returning favorites, including several required courses. Plan your schedule now.

Please Note: The ADA is transitioning to a new system from Sept. 3-9. We anticipate opening registration for fall courses and events by Sept. 10. To learn more about the transition, click this link: ADA Transition.

Check out the offerings on our upcoming schedule below. 9/18 ACD Lecture

9/19 New Dentist CE Program

9/25 Mandatory Prescriber DEA Education Renewal

9/26 Special Ethics Program

9/30 Effective Management of TMJ Disorders

10/9 Infection Control for the Dental Practice

10/9 Preparing for Retirement Well In Advance

10/16 ACD Lecture

10/16 Basic Life Support/ CPR Certification Course

10/18 Lecture 1: Workflows for Conservative Cosmetic Dentistry

10/18 Lecture 2: Smile Design Simplified

10/23 OSHA-Mandated Update for Dentists and Staff

10/30 Speed Learning: 6 Speakers, 6 Hours, 6 Credits 11/1 Innovations in Aesthetic Dentistry

11/20 ACD Lecture

12/11 Basic Life Support/ CPR Certification Course 12/18 ACD Lecture

Visit www.nycdentalsociety.org for the latest courses and registration information.

NEW YORK COUNTY

New dentists flex their muscles at fitness club Equinox.

New Dentist Committee member Haemin Chin, Treasurer Jaskaren Randhawa, President Suchie Chawla, New Dentist Committee Chair Greg Shank, left to right, enjoy rooftop fundraiser for Camp Bronx.

Read, Learn and Earn

Readers of The New York State Dental Journal are invited to earn three (3) home study credits, approved by the New York State Dental Foundation, by properly answering 30 True or False questions, all of which are based on articles that appear in this issue.

To complete the questionnaire, log onto the site provided below. All of those who achieve a passing grade of at least 70% will receive verification of completion. Credits will automatically be added to the CE Registry for NYSDA members.

For a complete listing of online lectures and home study CE courses sponsored by the New York State Dental Foundation, visit www.nysdentalfoundation.org.

Success of Implant Placement in Patients with Human Immunodeficiency Virus—Page 26-28

1. Human immunodeficiency virus (HIV) has progressed from acute to a more chronic condition.

o T or o F

Effects of a Mandatory COVID-19 Testing Policy on No-Show Rates for Aerosol-Generating Procedures

Page 29-32

1. Dentists were not considered “high risk” for the transmission of COVID-19.

o T or o F

Visit our online portal for more.... Visit our online portal for more....

ONLINE CE QUIZ

Heterotopic Bone Formation after TMJ Surgery

Page 33-38

1. Heterotropic ossification (HO) is defined as the formation of lamellar bone in soft tissue where bone does not normally exist. o T or o F

FOR SALE

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SYRACUSE SUBURBS: General dental practice for sale. Exceptional opportunity to own your own practice. Located in standalone 6-operatory facility with plenty of off-street parking on main road in Fayetteville/Manlius area. Real estate, equipment and established patient practice available for sale. Retiring Dentist willing to stay part time to ensure successful transition and assist buyer to further develop practice. Owner open to exploring all transition options. For details, contact: richardmaestri44@gmail.com.

BINGHAMTON AREA: Must see. Profitable general practice near Binghamton. Practice grossing over $600K on 4-day workweek. Hygiene booked out till February 2025. Low overhead. 4 operatories with room for 5th. Over 1,000 square feet. FFS/PPO. Digital modern office with efficient systems in place. No marketing. Attractive commercial building with rentable apartment available for sale or lease. All endo, oral/perio surgery; most ortho and implants referred. Great opportunity and investment for new graduates and established dentists. Inquiries to: mail005@aol.com.

ALBANY COUNTY: Exceptional opportunity to acquire flourishing practice in heart of revitalized downtown area. Turnkey. Private parking lot, modern setup, 6 fully equipped chairs, room for expansion. Fully networked with computers, digital X-rays and TVs with cable and internet apps in all operatories. Currently experiencing impressive 25% growth trajectory; significant untapped potential with specialty procedures referred out. Averaging over 20 new patients / month. Owner committed to seamless transition and willing to stay on to ensure continuity of care and staff retention. Seller owns property and open to leasing to buyer, including first right of refusal for future purchase, making excellent long-term investment opportunity. Practice on pace for $760K revenue; asking price: $505K. Investment structured to offer immediate operational stability and substantial growth potential in thriving community. Ideal for dentists looking to expand their footprint or for new entrant into dental practice. Don’t miss out on this perfectly positioned practice ready for its next phase of growth. Reach out to: jkoski@rosendentaltransitions.com.

Online Rates for 60-day posting of 150 words or less — can include photos/images online: Members: $200. Non-Members: $300. Corporate/Business Ads: $400. Classifieds will also appear in print during months when Journal is mailed: Jan and July.

SOUTHERN TIER: Dental practice for sale. Well-established general dental practice has served community for over 30 years. 7 operatories (6 equipped, 1 plumbed) and remodeled facility. Practice has 3,350 active patients and adds 20-25 new patients monthly. 100% fee-for-service, generating $1.78M collections and nearly $200K EBITDA. Current owner open to various transition options and willing to stay on for smooth handover. Operating four days/week, there is significant growth potential by extending hours or services. Location offers easy access to Rochester, Syracuse, Philadelphia, with minimal local competition. Real estate available. Highlights: 7 operatories ; Collections: $1.78M; EBITDA: nearly $200K; Real estate available; FFS practice. Contact Bailey at Professional Transition Strategies by email: bailey@professionaltransition.com; or call (719) 694-8320. Ref #NY21424.

BRONX: Very well set-up and well-maintained full-time dental office for sale in Co-op City. Three operatories, lab, sterilization room, storage room. Equipment 5-years old and in excellent condition. Please call to discuss: (347) 831-3742.

STATEN ISLAND: Well-established solo general practice for sale by owner. Family-oriented practice grossing over $500K+ on 4.5-day week. Four rooms, 3 full operatories. FFS/PPO with Softdent/Visix. Full staff, part-time hygienist, strong recall system. Attractive, freestanding medical building on high visibility road within established residential neighborhood. Present owner will stay on as PT associate for smooth transition. Asking $350K, with offers considered. Email Jack at: jfpjrdds27@gmail.com.

BROOKLYN: Boro Park dental condo for sale. Stop paying rent. 4-op dental condo with or without PT general practice. Good for specialists, as very few in area. Great location; very busy area. Good for dentist starting out; be busy right away. Or as second office with many potential patients in area. Purchase includes half ownership of entire building with rent-paying tenants. Very few properties available in area making great future investment. Owner flexible. Can stay on, or not, as needed or desired. Contact to discuss: dds7723@gmail.com.

NEW YORK METRO AREA: Well-established practice in prime NYC area. Beautiful office and great lease available in Woodside, Queens. Very negotiable. Current dentist unwell and looking to retire. Will stay on for short transition period if needed. Please contact to discuss. Email: hjameradds@gmail.com; or call (347) 453-9581.

UPSTATE/NORTHERN NY: Turnkey practice for sale in beautiful upstate/Northern NY. Established dental practice since 1988. Gross revenue exceeds $1M annually. Located approximately 1 hour north of Syracuse and close proximity

to beautiful Thousand Islands area. Surrounding communities with great school districts include gorgeous Clayton (22 miles), Sackets Harbor (10 miles), Dexter (8 miles), Fort Drum (13 miles), along with Canadian border approximately 30 miles away. Practice has 9 operatories with digital X-ray, CBCT, 3D printing and Cerec. Practice can support 1–2 dentists with established patient caseload. Real estate also available. For more information, please contact Sean Hudson by phone: (585) 690-6858; or email: sean@hudsontransitions.com.

TOMPKINS COUNTY: Well-established, high-quality general practice available to transition to new owner, or seller can stay as part of team. Located in Ithaca suburb, this beautiful standalone, 15-year-old building of 2,544 square feet has five ops, digital X-rays, utilizes Eaglesoft software and completely paperless. Revenue over $700K. One FT and one PT Hygienist. Real estate also. Growing patient base, practice draws increasing number of new patients, with strong mixture of FFS. Great opportunity with doctor willing to stay on as part-time associate. For details contact Dental Practice Transitions Consultant Michael Damon by email: mike.damon@henryschein.com; or call (315) 430-9224. #NY3071.

ORANGE COUNTY: Family-oriented practice in desirable location experiencing explosive retail and residential growth, with completion and early success of Legoland. Well-established practice has served dental needs of area for past 30 years. Housed in 1,500-square-foot building with mixed tenants. Four fully equipped treatment rooms featuring contemporary up-to-date equipment, including intraoral camera, imaging scanner, Picasso laser unit and utilizes Dentrix and Dexis. Diagnostic, preventive and restorative-driven practice, with strong hygiene program. For details contact Dental Practice Transitions Consultant Chris Regnier at (631)766-4501; or email: chris.regnier@ henryschein.com. #NY3257.

ERIE COUNTY: Located on busy road, surrounded by established residential population and beautiful town. 3-operatory digital practice well-positioned for future growth with $307K gross revenue. Crown & bridge, restorative and preventative focus. Some specialties referred out. Strong patient base and mixed PPO. Real estate next to practice owned by seller and for sale with practice. Contact Dental Practice Transitions Consultant Brian Whalen at (716) 913-2632; or email: brian. whalen@henryschein.com. #NY1648.

EASTERN LONG ISLAND: Well-established PPO/FFS dental practice/charts for sale. In practice for 17 years, with over 779 active patients and averages 10-15 new patients monthly. For details contact Transition Sales Consultant Chris Regnier at (631) 766-4501; or email: chris.regnier@henryschein.com. #NY3437.

SUFFOLK COUNTY: Well-established general practice located in professional building that overlooks beautiful park and plenty of parking. Three fully equipped treatment rooms and open 4.5 days/week. Highly profitable, with collections over $570K. Collections based on 50% FFS and 50% PPO insurance. Seller open to transition options. For details contact Transition Sales Consultant Chris Regnier at (631) 766-4501; or email: chris.regnier@henryschein.com. #NY3470.

JEFFERSON COUNTY: Great opportunity. Longestablished, profitable practice is must-see. Located minutes from downtown Watertown. Well-equipped 4-operatory practice sits on busy road, with great curbside appeal. Large private parking lot. Practice fully digital with pano X-ray and utilizes Eaglesoft. Revenue $730K with one FT Hygienist. Doctor only works 3 days/week (20 hours max). Seller refers out all endo, ortho and oral surgery. Practice positioned for growth. Primarily FFS, with 2,000 active patients. 2-story building also for sale with vacant apartments upstairs. Contact Dental Practice Transitions Consultant Michael Damon at (315) 430-9224; or email: mike.damon@henryschein.com. #NY3385.

ONTARIO COUNTY: Long-established, highly productive practice with 2022 revenue of $1.4M. Nestled in backdrop of beautiful Finger Lakes wine-making country. Fully computerized, fully digital office with 7 well-equipped treatment rooms. Utilizes Dentrix Ascend PMS; Planmeca CBCT and digital impression systems added in recent years. 3,500 active patients and combination of insurance and FFS. Strong hygiene program. Well-trained team available for transition. Contact Dental Practice Transitions Consultant Michael Damon at (315) 430-9224; or email: mike. damon@henryschein.com. #NY3395.

UPSTATE NY: Long-established practice in diverse community halfway between Binghamton and Syracuse; situated just minutes from area hospital and college on busy 2-lane road with excellent street visibility. Three operatories in 3,000 square feet and room to expand. Real estate also available. Building includes 2,000-square-foot rental apartment upstairs for great passive income. Three full-time employees, including one full-time Hygienist. 75% FFS and 25% PPO. Refers out all endo, ortho and oral surgery, offering great upside for new owner. 2022 gross collections $358K. Highly motivated seller. Contact Transition Sales Consultant Mike Damon at (315) 430-9224; or email: mike.damon@henryschein.com. #NY3488.

ONEIDA COUNTY: Bright, immaculate, all-digital, 100% FFS practice, with great curb appeal. Highly desirable location, with convenient access to highways. $900K+ revenue on 4-day workweek. Seller in practice for 30 years and committed to aiding in very successful transition. Four well-equipped operatories and Dentrix, all in efficiently designed 1,100-squarefoot space. Thriving general practice averages 30+ new patients per month. Excellent turnkey opportunity. Contact Transitions Sales Consultant Mike Damon at (315) 430-9224 or email: mike.damon@henryschein.com. #NY3513.

SENECA COUNTY: Charming practice in heart of Finger Lakes region; 45-minute drive to both Rochester and Syracuse city centers. Digital practice offering 3 equipped ops, with 2022 revenue of $653K on 3 clinical days/week. Softdent, 2D pano and diode laser. 1,700-square-foot practice offers comprehensive dental care in welcoming environment. Full-time Hygienist and full administrative staff, all with excellent systems and training in place. 50% FFS. Refers out specialties. Real estate also available. Schedule to see this wonderful opportunity today. Contact Transition Sales Consultant Michael Damon at (315) 430-9224; or email: mike.damon@henryschein.com. #NY3572.

MANHATTAN: Great opportunity to own private, wellestablished practice in elegant boutique residential apart-

ment building with commercial street-front-level entrance in desirable area, close to Lexington Ave. 2 treatment rooms in 600 square feet, including intraoral camera, scanner, laser and digital X-ray in nicely renovated modern office. Collections in 2022 were $409K, driven by 60% PPO, 40% FFS and active patient base, with strong new patients per month. Great startup for younger doctor looking for successful Manhattan focal point. Contact Transition Sales Consultant Rikesh Patel by phone: (845) 551-0731; or email: rikesh.patel@henryschein.com. #NY3596.

ST. LAWRENCE COUNTY: Highly profitable, $550K+ revenue, all digital practice on just 3 day/week schedule. Located in scenic St. Lawrence County, along Canadian border. 5 well-equipped treatment rooms. Approximately 2,500-square-foot practice space with building available for sale. Large property with ability to expand footprint. Eaglesoft PM and iCat 3D. Refers out all Endo and Ortho. 1,200 active patients, with strong new patient flow. FFS practice with 1 in-network insurance. Doctor willing to stay on for 12 months to assist with transition. Priced to move. For more information, contact Transition Sales Consultant Michael Damon at (315) 430-9224; or email: mike.damon@henryschein.com. #NY3632

WESTCHESTER: Holistic general dental practice for sale. 4 ops in spacious 1,800-square-foot suite in medical building. FFS office on pace to gross over $1.7M in 2023. Cone beam CT, Dentrix software, Trios scanner, as well as digital X-rays, computers, TVs in every operatory. Open only 4 days/week. Amazing opportunity to purchase profitable practice with huge growth potential in wonderful community. For details contact Transitions Sales Consultant Chris Regnier at (631) 766-4501; or email: chris.regnier@ henryschein.com. #NY3641.

SOUTHERN ERIE COUNTY: Fantastic opportunity to grow in 3-op digital practice treating 1,100 active patients 3.5 days/week. Well-established patient base of mixed PPO and FFS. Real estate with apartment also available. Plenty of off-street parking. Low overhead and skilled team make great opportunity for profit and lifestyle. Contact Transition Sales Consultant Brian Whalen at (716) 913-2632; or email: Brian.Whalen@henryschein.com. #NY3661.

WESTERN NEW YORK: 5-op practice with 4,700 active patients and averaging 40 new patients per month. Wellestablished growing practice with loyal patient base. 86% insurance and 14% FFS. Fully digital pan, sensors, intraoral cameras and paperless charting, all integrated with Eaglesoft software. Building with off-street parking and additional rental units also for sale or lease. Outstanding staff and established patient base make this wonderful opportunity. Contact Transition Sales Consultant Brian Whalen at (716) 913-2632; or email: Brian.Whalen@henryschein.com. #NY3665.

SOUTHERN TIER: Long-established, stable, 8-op FFS practice. No in-network insurance. Located on main road, this standalone building offers great visibility and curb appeal. 2,620-square-foot, 100% digital practice utilizes computers throughout with Softdent, Carestream sensors and CS8100 panoramic X-ray. Well-trained, experienced team of professionals, including 4 full-time hygienists expected to transition with practice. Open 5 days per week with 4,100 active patients and healthy new patient flow. Doctor willing to stay on for up to 12 months to assist

with transition. Priced to move. Contact Transition Sales Consultant Michael Damon at (315) 430-9224; or email: mike.damon@henryschein.com. #NY3679

NASSAU COUNTY: 4-treatment-room practice based on 60% PPO insurance and 40% FFS. 1,100-square-foot office available for rent or purchase. Tremendous room for growth as doctor refers out endo, ortho, implants and oral surgery cases. Contact Transition Sales Consultant Chris Regnier at (631) 766-4501; or email: chris.regnier@henryschein. com. #NY3698.

CAPITAL REGION: Attractive 2,100-square-foot practice in professional building on busy main road. 5 well-equipped treatment rooms and 6th plumbed in long-established practice. Located in desirable, affluent community, with one of area’s top school districts. Affordable rent with assignable lease. 100% digital, paperless and utilizes Eaglesoft. Doctor refers out all endo, implants, perio, ortho, and some extractions. Primarily PPO. Schedule showing today, as seller looking to sell and transition quickly. Contact Transition Sales Consultant Michael Damon at (315) 430-9224; or email: mike.damon@henryschein.com. #NY3691.

WESTERN NEW YORK: Fantastic opportunity to own well-established, thriving general practice in beautiful area. 5-ops, fully digital, paperless, supported by Eaglesoft software, with room to expand if desired. Strong hygiene team treats patients with care and has excellent recall. Sensors, scanner, laser, air, electric handpieces, CAD/CAM technology, Carivue detection and more. 60% PPO, 40% FFS, with 2,300 active patients. Real estate available. Turnkey opportunity. Contact Transition Sales Consultant Brian Whalen at (716) 913-2632; or email: Brian.Whalen@henryschein.com. #NY3695.

JEFFERSON COUNTY: Well-established, spacious, 3,500-square-foot practice in beautiful, historic building housing 7 equipped treatment rooms, with 8th plumbed. Practice utilizes Dentrix PM software. FFS/PPO; only in-network with 2 insurances. Strong hygiene program, with dedicated team ready to stay on. All specialties referred out. Revenue $837K and positioned for continued growth. Stunning property also for sale includes 4 fully occupied residential apartment units. Doctor looking to stay on for extended period. Contact Transition Sales Consultant Michael Damon at (315) 430-9224; or email: mike.damon@henryschein.com. #NY3719.

NEW YORK CITY: High-tech dental practice with CBCT, two scanners, two lasers and A-Dec dental chairs. Three equipped treatment rooms and 4th plumbed. Located in co-op that is also available for purchase. Collections consistently over $1.1M. Open 5 days/week. Contact Transition Sales Consultant Chris Regnier at (631) 766-4501; or email: chris.regnier@henryschein.com. #NY3722.

SUFFOLK COUNTY: Well-established, 1,500-squarefoot practice averaging 45 new patients monthly. Three ops with one additional plumbed needing only dental chair/ unit. Dentrix, Dexis, and digital Pan. On heavily trafficked main road, with great visibility in standalone building shared with medical urgent care. Medicaid/PPO and FFS patients. Nicely appointed and excellent opportunity for growth. A must-see opportunity. Contact Transition Sales Consultant Chris Regnier at (631) 766-4501; or email: chris.regnier@henryschein.com. #NY3746.

NEW YORK CITY: State-of-the-art dental practice nestled in Upper East Side, one of NYC’s most desirable neighborhoods, a stone’s throw from iconic Central Park. Grossing $1.8M with seven meticulously designed operatories. Cuttingedge technology includes 3D imaging and Dentrix. Mostly FFS with some PPO insurance accepted. Open 4 days/week. 3,920 square feet located in professional building with plenty of room for growth. Contact Rikesh Patel: 845-551-0731 | rikesh.patel@henryschein.com. #NY3759

CAPITAL REGION: Turnkey opportunity for well-established dental practice located in growing and desirable area conveniently located to downtown Albany, Saratoga and Schenectady, with revenue of $800K. Attractive, efficient 2,505-square-foot space with 5 fully equipped treatment rooms. Standalone building offers excellent visibility on busy two-lane main road and also available for purchase. Digital office using Dentrix with pano X-ray upgradable to 3D. Four dedicated full-time employees and three part-timers willing to stay after transition. Doctor refers out most specialties on 39-hour week. Must-see opportunity for any interested buyer looking to acquire successful, primarily FFS dental practice. Contact Transition Sales Consultant Michael Damon: 315-4309224 | mike.damon@henryschein.com. #NY3942

ORANGE COUNTY: Attractive, boutique practice in efficiently designed 1,800-square-foot space located in well-maintained professional building. Offers great curbside appeal and visibility. Area voted one of best cities to live in US and located about 60 miles from NYC. Affordable lease. Long-established family practice offers 4 well-equipped treatment rooms. Digital, paperless practice utilizes PracticeWorks. Excellent opportunity to grow as doctor refers out all specialties on short, 3-day workweek. 100% FFS. Schedule showing today as seller looking to sell/transition quickly. Contact Transition Sales Consultant Michael Damon at (315) 430-9224; or email: mike.damon@ henryschein.com. #NY3925

CAPITAL REGION: Attractive, 1,400-square-foot facility located in professional building complex on high-traffic main road with great visibility. Affordable lease for renovated space. Long-established family practice offers four (4) well-equipped treatment rooms with bright and airy surroundings. Located in desirable community with one of area’s top school districts. Softdent PM with digital sensors. Excellent opportunity to grow as doctor refers out molar endo, implants, perio and some extractions. Room for expanded clinic to grow to 6 ops. Practice open 3.5 days/week with 5.5 hygiene days. 60% PPO and 40% FFS. Schedule showing today as seller looking to sell/transition quickly. Contact Transition Sales Consultant Michael Damon at (315) 430-9224; or email: mike.damon@henryschein. com. #NY3921

NORTHERN NEW YORK: High-grossing, high-tech 7-op general dentistry practice located in standalone building. Located near Canadian border. Beautiful practice offers great visibility and curb appeal. 3,000 square feet, 100% digital practice utilizes Eaglesoft with CBCT and CEREC. Highly trained, experienced team of professionals awaits including 3 full-time hygienists expected to transition with practice. Open 4 days/week with 3,300 active patients and healthy new patient flow. Doctor willing to stay to assist with transition. Great turnkey opportunity. Contact Transition Sales Consultant Michael Damon at (315) 430-9224; or email: mike.damon@ henryschein.com. #NY3673

MANHATTAN: Unique opportunity to acquire state-ofthe-art 3-op general practice strategically located near iconic Central Park. Established insurance-based practice, providing accessibility in high-traffic area, boasts strong financials and solid foundation for immediate growth. Collections in 2023 were $946k with over 900 patients. Practice fully operational, allowing smooth transition for new owner to step in and continue success. Contact Rikesh Patel at (845) 551-0731; or email: rikesh.patel@henryschein.com. #NY3889

HOWARD BEACH: Lucrative opportunity awaits in heart of Howard Beach. Well-established dental practice for sale featuring four fully equipped operatories and proven track record of success. With 2023 collections over $430K, practice poised for growth and presents excellent opportunity for new owner to step in and build upon its solid foundation. Office currently 50% PPO, 40% FFS and 10% Medicaid. Contact Transition Consultant Rikesh Patel at (845) 551-0731; or email: rikesh.patel@henryschein. com. #NY3792

ST. LAWRENCE COUNTY: Explore unique opportunity with well-established practice nestled in scenic St. Lawrence

County. Spacious 2,756-square-foot office offers outstanding work-life balance in area known for family friendly environment and access to great outdoors. $1M annual revenue and exclusively FFS. Affordable, leased space with 6 ops is well equipped with updated A-dec equipment and cabinetry. 100% digital, paperless office utilizing Eaglesoft, Schick sensors and Schick pano X-ray. Dedicated and well-trained team ready to support your professional vision. Seller highly motivated to facilitate smooth transition. Rare opportunity to acquire successful practice with solid foundation, committed team and potential for growth. Schedule visit today. Contact Transition Sales Consultant Michael Damon at (315) 430-9224; or email: mike.damon@henryschein. com. #NY3546

ONONDAGA COUNTY: Seize the opportunity to own well-established GP practice with rich 40-year history. 5-ops, spacious 2,751-square-foot office located in hightraffic area with ample parking lot. Advanced technologies including imaging system, i/o camera, digital X-ray, digital pan and Softdent. Well-balanced revenue mix with 60% FFS and 40% PPO. Dedicated team willing to stay on with 7 hygiene days and 4-day week. Located 7 miles from Micron Technologies, future site of largest semiconductor plant in NYS. Excellent growth opportunity. Don’t miss out on incredible chance to own your own practice and real estate. Schedule viewing today. Contact Transition Sales Consultant Michael Damon at (315) 430-9224; or email: mike.damon@henryschein.com. #NY3786

SOUTHERN TIER: General dental practice for sale. Located in picturesque Southern Tier region of New York State, well-established general dental practice boasting over 30 years of exceptional patient care and community service. 100% FFS. Excellent investment opportunity, featuring 7 operatories (one plumbed but unequipped), allowing for immediate expansion and customization. Strong patient base of 3,350 active individuals, with 20-25 new patients monthly. Four-day workweek presenting significant growth potential by extending hours or services. Strategically positioned near major cities like Rochester, Syracuse and Scranton, benefiting from low competition and proximity to vibrant community known for cultural richness and outdoor activities. Recent remodeling enhances real estate value, making an attractive purchase. Collections $1.6M and EBITDA nearly $300K. Prosperous venture for those aiming to continue legacy of success. For further details, contact Professional Transition Strategies by emailing Bailey Jones email: bailey@professionaltransition.com; or calling (719) 694-8320, referencing #NY21424. Unique chance to invest in thriving dental practice within community that offers affordable, quality lifestyle.

OSWEGO: General practice for sale. High-visibility, established practice with convenient access to I-81. Growing community located less than 10 miles from future Micron SemiConductor plant, which will be one of country’s largest. $1.1M revenue on just 28-hour week. 5 well-equipped operatories with recent addition of new hygiene room. 100% digital practice with newly added Pano X-ray and iTero scanner. Refers out all specialties. Mix of FFS/PPO. Don’t miss out on this growing practice with seller committed to very successful transition. Schedule visit today. Contact Transition Sales Consultant Michael Damon at (315) 430-9224; or email: mike.damon@henryschein.com #NY4023.

ST. LAWRENCE COUNTY: Well-established, highly profitable, 100% FFS general practice with just 52% overhead. Turnkey. Annual revenue $750K+ on 4-day week. Standalone building with large parking lot located right on main road with excellent visibility. Building also available for sale with approximately 3,000 square feet of dedicated dental space. Room to double practice size based on recent clinic vacancy on other half of building. 4 fully equipped treatment rooms in 100% digital practice with Sirona Pan/Ceph imaging. Refers out some endo and oral surgery. Doctor willing to stay for extended period of time. Contact Transition Sales Consultant Michael Damon at (315) 430-9224; or email: mike.damon@henryschein. com #NY4019.

MONROE COUNTY: Looking for well-established, standalone GP practice with wonderful curb appeal? Here it is. Conveniently located in front of Wegmans Plaza, 1,400-square-foot dental space with commercial renters downstairs available for sale or lease. Located in one of Rochester’s fastest growing suburbs. Digital practice offers four fully equipped treatment rooms and 4-day week with 6 days of hygiene. Primarily PPO with FFS. Motivated seller refers out all specialties. Don’t miss out. Contact Transition Sales Consultant Michael Damon at (315) 430-9224; or email: mike.damon@henryschein.com. #NY4035

SYRACUSE: Long-established, highly visible general practice in desirable neighborhood. $725K+ revenue practice with great curb appeal and ample parking. 2,100-squarefoot leased space just 10 minutes from downtown. Offers 4 well-equipped treatment rooms with ability to add 5th. 100% digital practice and CAD/CAM. Well-trained, experienced team awaits with strong full-time hygiene program. Mix of FFS/PPO. Refers out most specialties. Very motivated seller seeking retirement. To schedule visit or for more information, please contact Mike Damon at (315) 430-9224; or email: mike.damon@henryschein. com. #NY4142

BROOME COUNTY: Amazing opportunity to purchase well-established, highly profitable general practice in desirable city. Housed in attractive standalone building with ample parking conveniently located less than one mile from shopping, restaurants and entertainment district. Spacious, 4,000 square feet, updated and well-designed for efficient workflow. Eight (8) fully equipped treatment rooms with plumbed nitrous. 100% digital practice with modern technologies throughout. Fee-for-service with 3,425 active patients and steady new patient flow. Experienced, highly engaged team of 9 staff members awaits with robust hygiene program in place. Building available to buy or lease. Don’t let this opportunity slip away! Contact Transition Sales Consultant Michael Damon at (315) 430-9224; or email: mike.damon@henryschein. com. #NY4097

FOR RENT

MIDTOWN MANHATTAN: Beautiful, brand new, stateof-the-art office with 1-2 spacious operatories for rent. Brand new A-Dec chairs and A-Dec cabinets. Office has new CBCT and very conveniently located in Midtown at

53rd Street and Madison Ave. Available Monday through Saturday; rent as few or as many days as needed. All ops have large windows and lots of sunlight. Perfect for GP or specialist. Please contact if you’re interested in learning more: jpastagia@gmail.com.

MIDTOWN MANHATTAN: Newly decorated office with windowed operatory for rent FT/PT. Pelton Crane equipment, massage chair, front desk space available; shared private office, concierge; congenial environment. Best location on 46th Street, between Madison Avenue and 5th Avenue. Please call or email: (212) 371-1999; karenjtj@aol.com.

MIDTOWN MANHATTAN: Space for rent in great location. 1-2 operatories available full time or part time. Renovated, sunny, windows, with private office in 24-hour doorman building. Reasonable. Call or email for details: (212) 581-5360; or email: kghalili@gmail.com.

MANHATTAN: Dental operatories/chairs available for rent in multiple locations on Central Park South in Manhattan and in Tribeca. Ready to use, state-of-the-art facility. Flexible lease terms (per hour, per day, etc.). We can provide dental assistants, billing services, and insurance assistance, etc. if needed. Great street access with lots of foot traffic. Easy to commute to and from with public transport. Please call/text (917) 605-9496; or email: doc@ centralparkdentalservices.com.

MANHATTAN: Upper East Side. Looking for pediatric dentist to rent chair or two in brand-new, gut-renovated dental office on ground floor at street level on Upper East Side. Office shared with orthodontist, providing excellent opportunity for collaboration and cross referrals. Residential neighborhood surrounded by families and children ideal for pediatric dentist. Available Wednesdays. Modern, wellequipped office offers prime location to grow your practice. For more details or to arrange visit, please email hello@ linedental.com.

SERVICES

INTRAORAL X-RAY SENSOR REPAIR/SALES: American Sensor Tech. We repair broken sensors. Save thousands in replacement costs. Specializing in Kodak/ Carestream, and major brands. We also buy/sell sensors. American SensorTech (919) 229-0483. Online at: www.repairsensor.com.

OPPORTUNITIES AVAILABLE

HUDSON: Seeking full-time dentist to join caring, warm, friendly and busy multi-discipline practice. Seeking motivated, personable general dentist for full-time position. MondayThursday 8:30 - 5:00; Friday 8:00 - 4:00. Daily minimum vs. draw 35% of collections less lab fees. Experience preferable. Candidates must be positive, motivated team players. Position available for immediate start. Call/email for more information or forward resume for consideration. Phone: (518) 671-6002; or email: drbarry@aol.com.

BAY RIDGE, BROOKLYN: Seeking part-time general dentist associate with experience. Must possess excellent clinical and communication skills. Proficiency in all aspects of general dentistry. Must be team player and self-starter. State-of-the-art facility. Must be able to work Saturdays and Thursdays. Please call (347) 487-4888; or email: Studiodntl@gmail.com.

NASSAU COUNTY: Seeking Perio associate. We are searching for periodontal associate for 1-2.5 days in our established, 30-year periodontal practice with 2 locations in Nassau County Long Island. Great long term opportunities. New grads ok. Must be proficient in all perio procedures and implants. Salary based on production. Inquiries and/or resumes to: drb@jbperiodontics.com. dr.backer.sgdc@gmail.com.

CAPITAL DISTRICT: Associate sought for modern, friendly, well established dental practice. Pleasant working conditions. Great, helpful staff. Everything digital. We do not participate with dental insurance nor Medicaid. I am here to ensure your success. Contact to discuss: Dr. Jeffrey Backer, Scotia Glenville Dental Center (518) 526-0177 or email: dr.backer.sgdc@gmail.com.

Fauchard Academy Honors Joseph Gambacorta

Inducts Seven New Members

Joseph Gambacorta, D.D.S., M.P.H., former clinical associate professor, oral and maxillofacial surgery, and associate dean for public health dentistry and global initiatives at the University at Buffalo School of Dental Medicine, is the 2024 recipient of the Pierre Fauchard Distinguished Service Award, presented by the New York Section of the academy.

Dr. Gambacorta, who received his award May 31 at a meeting of the New York Section that took place during the annual session of the NYSDA House of Delegates, was cited for “his sustained, high-level caring service to both the dental and academic communities.”

At its May gathering, held at Turning Stone Resort and Conference Center in Verona, the academy also inducted seven new fellows.

At UB, Dr. Gambacorta was a member of an interprofessional leadership team that offered collaborative practice experiences to students and faculty. In that same vein, he was involved in research projects evaluating the impact of interprofessional forums on dental medicine.

A 1993 graduate of the UB School of Dental Medicine, Dr. Gambacorta also received a Master of Public Health De-

gree from UB in 2022. He completed his general practice residency at Millard Fillmore Hospital in 1994. Since 2006, he has led several outreach missions to a number of international and domestic destinations and currently serves on the Remote Area Medical (RAM) Board of Directors.

Dr. Gambacorta is a past president of the Eighth District Dental Society and past chair of the NYSDA Council of Dental Education and Licensure.

New Members Inducted

The Pierre Fauchard Academy seeks to educate dental professionals about the latest techniques in dentistry and to foster a sharing of ideas to improve the profession. Dr. Amarilis Jacobo of Bronx County and Dr. Jay Skolnick of the Seventh District are cochairs of the New York Section. This year’s inductees include the following:

Suchie Chawla, New York County; Eli Eliav, Seventh District; Joseph Gambacorta, Eighth District; Patrick M. Lloyd, Suffolk County; John Milza, Fourth District; Aaron M. Soeprono, Second District; James Wanamaker, Fifth District. p

2024 Pierre Fauchard Academy inductees include, from left, Patrick Lloyd, Suchie Chawla, Eli Eliav, Joseph Gambacorta, John Milza, James Wanamaker.

Jay Skolnick and Amarilis Jacobo, PFA New York Section cochairs, with Joseph Gambacorta, this year’s recipient of PFA Distinguished Service Award.

Jeffrey Eastman, chief executive officer, Remote Area Medical, guest speaker at PFA meeting, receives certificate of appreciation from Dr. Skolnick.

Photos by William Mueller