NYSDJ March 2022

Improving the Safety of Opioid Prescribing the new york state dental journal

Volume88 Number 2

March 2022

Advantage Employees

The Patients’ View

Inside:

Orthognathic Surgery: Was it Worth it?

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the new york state dental journal

Volume88 Number 2

March 2022 12 Orthognathic Surgery and Quality-of-Life Outcomes Findings from a Hospital-Based Patient Satisfaction Survey Parth D. Shah, D.D.S., M.P.H.; Victor M. Badner, D.M.D., M.P.H.; Benn Lieberman, D.M.D. Study examined patient satisfaction and changes in quality of life following orthognathic surgery, performed to treat severe dentofacial deformities. The majority of respondents reported a beneficial outcome to their surgery.

18 Recommendations for Co-Prescription of Opioids and Naloxone in the Dental Office

Cover: In preparing patients for orthognathic surgery, it is important that surgeons emphasize the substantial postsurgical improvement in overall quality of life to be achieved.

Madeleine Maas, D.D.S.; Raquel Rozdolski, D.M.D. A new law about to take effect in New York State requires that medical professionals co-prescribe naloxone with an opioid prescription to at-risk patients. Authors provide dentists with recommendations for putting law into practice in their offices.

24 Papillon-LeFevre Syndrome A Case Study of Two Siblings 2

Editorial Preserving dentistry’s contract with society

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Attorney on Law Employees gain upper hand

10 Association Activities 38 Component News 49 Read, Learn, Earn

Babak Bina, D.M.D.; Boris Zats, D.D.S.; Tom Rubinstein, D.M.D. A rare autosomal recessive disease, Papillon-LeFevre syndrome challenges treatment skills of medical and dental professionals. Authors present case report of brother and sister of Chinese origin with PLS who they followed for a decade.

30 Treatment of Peri-implant Soft-tissue Deficiency around a Narrow Diameter Implant with Subepithelial Connective-tissue Graft Jaewon Kim, D.D.S., M.S., Ph.D.; Abhiram Maddi, D.D.S., M.Sc., Ph.D. Narrow diameter and mini-implants are preferred for restoration of missing teeth on narrow ridges, but they are associated with long-term complications. Case report describes novel approach using connectivetissue graft to resolve peri-implant mucositis.

51 Classifieds 55 Index to Advertisers 56 Addendum In Memoriam

The New York State Dental Journal is a peer reviewed publication. Opinions expressed by the authors of material included in The New York State Dental Journal do not necessarily represent the policies of the New York State Dental Association or The New York State Dental Journal.

EZ-Flip version of The NYSDJ is available at www. nysdental.org and can be downloaded to mobile devices.

34 Simple Lipoma Mimicking Oral Infiltrating Lipoma Moacyr Tadeu Vincente Rodrigues, D.D.S., Ms.C.; Judson Nascimento Brasil, D.D.S.; Gabriel Albuquerque Guillen, D.D.S., Ms.C.; Cláudio Ferrerira Nóia, D.D.S., Ph.D. Lipomas, while commonly seen on trunk and extremities, are rarely visible in the mouth. Authors report case of 51-year-old patient affected by intra- extraoral swelling for eight months, which after careful examination was diagnosed as simple oral lipoma. Conservative surgical treatment resolved it. (Case report)

editorial

If Dentistry’s Social Contract with America Could Talk Dentistry must make running the business of dental practices compatible with professional responsibility.

A

s a contract, I demand my parties comply with my terms. After all, an agreement between an entire society, along with its governing bodies and the dental profession, impacts the oral health of all prospective patients. My unwritten terms delineate society’s and the dental profession’s rights, responsibilities and expectations regarding the practice of dentistry in our country. My parties’ duties to respond to the changing demands of oral healthcare delivery and societal needs constitute their prime directives.

Over the past few decades, dental management organizations (DSOs), many nondentist-owned, have met practices’ growing need for more efficient business and administrative skills and systems. Regretfully, the dentists affiliated with these groups too often allow corporate financial imperatives to interfere with, and control, clinical processes. Lay interference in professional decision-making violates my terms. Society has a right to expect, and dentistry a duty, to rescue professionalism from the slippery slope of commercialism. The dental profession must incorporate the business and financial expertise of DSOs into dental practices to make available cost-effective care that meets dentists’ ethical duty to place patients’ best interests above personal and corporate interests.

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Intent of my Parties America and the dental profession must remember why they brought me into existence. The public wanted to trust that their doctors knew what they were doing and would meet the oral health needs of individual patients, and society as a whole. To achieve these goals, society granted the privilege of a virtual monopoly on the practice of dentistry to those able to successfully obtain a degree from an accredited program and meet state licensure requirements.

In return, dentistry agreed to provide the public with access to quality dental care in each patient’s best interest at an affordable cost. The parties agreed that only the dental profession qualified to implement these initiatives. As a key piece to the deal, society demanded that dentists adopt and comply with a code of ethics, self-regulate and address society’s changing oral health needs.

It concerns me that both parties now continually breach my terms. The dental profession fails to successfully address inadequate access and the everincreasing cost of care and now struggles to control quality in an increasingly commercialized delivery process. On the other side, states grant nondentists the right to own dental practices and bleach teeth and empower midlevel providers to perform duties

THE NEW YORK STATE DENTAL JOUR­NAL

previously reserved for licensed dentists. My parties act as if I no longer apply. I cannot believe they think the advantages of these violations outweigh the long-term benefit of compliance. I worry they will rescind me.

Accept Dentistry as Both Profession and Business Dental practices, from their inception, exhibited characteristics of both a profession and a business. They simultaneously offered a healthcare decision-making service and required a profit from that service to exist. The inherent tension in this duality exponentially expanded after the Federal Trade Commission and US Supreme Court ruled in the 1970s that the ethical prohibition of professional advertising effectively operated as a restraint of trade.[1] In addition, potential conflicts between business goals and professional responsibility increased over time as the administrative complexities of the delivery of oral healthcare and operating a business exploded.

DSOs met the demand with critical management skills provided in a manner organizationally distinct from clinical practice. Their services included: office management; non-licensed personnel staffing; IT support; regulatory compliance; billing; payroll; and accounting. In today’s model, the DSO corporate entity typically owns the equipment, while a separate entity owns the practice and employs licensed dentists and auxiliaries. Problems arose as DSOs directly interfered with clinical decision-making to meet financial goals. Legal and ethical violations included DSOs splitting fees with nondentists, controlling practice accounts and, ultimately, clinical treatment plans.

The fact that my terms required dentists to act in the best interests of patients stands as the best evidence that all agreed the business demands of dental practice present inherent conflicts of interest with professional conduct. Dentistry must not pretend its business component does not exist, because society’s current problems with inadequate access and inflated costs stem directly from a failure of dentistry to successfully deal with this stark reality. Abdicating control to nondentist business experts threatens the quality of care and only exacerbates the situation.

Eliminate Nondentist Practice Ownership and Control Currently, approximately six states, including Arizona, Mississippi, North Dakota, New Mexico, Ohio, and Utah,[2] permit nondentist or unlicensed ownership of dental practices. The supporting legislation in these states reveals the threats nondentist practice ownership presents to the public. The New Mexico state board’s rules regarding the responsibility of nondentist-owners provide: “No person other than a New Mexico licensed dentist shall direct, control or interfere with the dentist’s or dental hygienist’s clinical judgment.”3 The Utah Statutes state: “Directing or interfering with a licensed dentist’s judgment and competent practice of dentistry…” is a felony.[4] In the remaining 44 states that require dentist practice ownership, DSOs attempt to control dentists’ clinical decision-making through onerous management agreements. Texas, in addition to lim-

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

MANAGING EDITOR Mary Grates Stoll

ADVERTISING MANAGER Jeanne DeGuire

ART DIRECTOR Ed Stevens

EDITORIAL REVIEW BOARD Frank C. Barnashuk, DDS. Clinical Assistant Professor, Department of Restorative Dentistry, School of Dental Medicine, University at Buffalo, The State University of New York, 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. Alexander J. Corsair, DMD. Periodontic/Implantology Private Practice. Rockville Centre, NY. Joel M. Friedman, DDS. Associate Clinical Professor Dental Medicine. Columbia University College of Dental Medicine, New York, 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, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY. G. Kirk Gleason, DDS. General Dental Practice, Clifton Park, NY. Kevin Hanley, DDS. Orthodontic Private Practice, Buffalo, NY. Violet Haraszthy, DMD, DDS, MS, PhD, Professor, Chair, Department of Restorative Dentistry, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY. Stanley M. Kerpel, DDS. Diplomate, American Board of Oral and Maxillofacial Pathology, Associate director, Oral Pathology Laboratory, Inc. Attending, section of Oral Pathology, New York Presbyterian, Queens, NY. Elliott M. Moskowitz, DDS, MSD. Diplomate American Board Orthodontics; Clinical Professor.

Department Orthodontics, NYU College Dentistry; Orthodontic Private Practice, New York, NY. Eugene A. Pantera Jr., DDS. Past Director, Division of Endodontics, Department of Periodontics and Endodontics, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY. Robert M. Peskin, DDS. Dental Anesthesiology Private Practice. Garden City, NY. Robert E. Schifferle, DDS, MMSc, PhD. Professor Periodontics, Endodontics and Oral Biology.

School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY. Jay Skolnick, DMD. Board-certified pediatric dentist. Attending dentist, Rochester General Hospital. Private practice, Webster, NY.

PRINTER Fort Orange Press, Albany NYSDJ (ISSN 0028-7571) appears three times a year in print: January, March and June/ July. The 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. Periodicals postage paid at Albany, NY. Subscription rates $25 per year to the members of the New York State Dental Association; rates for nonmembers: $75 per year or $12 per issue, U.S. and Canada; $135 per year foreign or $22 per issue. Postmaster: Please send change of address to the New York State Dental Association, Suite 602, 20 Corporate Woods Boulevard, Albany, NY 12211. Editorial and advertising offices are at Suite 602, 20 Corporate Woods Boulevard, Albany, NY 12211. Telephone (518) 465-0044. Fax (518) 465-3219. E-mail 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.

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iting practice ownership to dentists, makes it a violation of the Texas Dental Practice Act for management contracts to dictate, among others, any of the following improper influences on professional judgment: • “… imposing requirements concerning the type or scope of dental treatment…”

• “… controlling, owning or setting conditions for access to … dental records…”

• “… imposing requirements concerning the supplies, instruments or equipment deemed reasonably necessary…”[5] Owners earn decision-making authority regarding their assets primarily based upon their legal position. Owners’ financial risk of loss on their investment and liability for debt obligations makes owners solely accountable for the ultimate viability of a practice or business. In addition, continued ownership requires commitment to the entity’s future and ultimate success. This liability and mindset ensure that owners have the authority and motive to implement and enforce policies.

One could ask why, then, would states allow nondentists to own dental practices in the first place. It appears counterintuitive when such arrangements risk direct violation of the very licensing laws states created to protect the public as part of my terms. I can only construe these states’ decision to breach my terms and allow nondentist practice ownership as society’s vote of no confidence in dentistry’s ability and willingness to successfully provide necessary access to care at an affordable cost. These so-called “corporate states” turn back the clock to the days prior to licensing laws and the promise of ethical practitioners, which leaves the expectation of quality care in the hands of the market. Society must require that only licensed dentists own practices because only dentists have promised to place patients’ interests above dentists’ interests, and only owners can ensure this happens.

Contract at Crossroads America and the dental profession formed me to establish the general parameters for the ideal relationships between the dental profession and society as a whole and the individual dentist and patient. As dentistry failed to meet its obligations to provide adequate access to care and control costs, DSOs filled the void with nondentist-controlled commercialization. In response, society diluted dentistry’s virtual monopoly with midlevel providers. As dentistry then failed to place patients’ interests in quality above the profit motives of DSO owners and managers, society allowed nondentist practice ownership. Society, in effect, utilized DSOs as a form of external control to let the market balance cost and access with less regulated quality. Regretfully, society mistakenly has given privileges to control the delivery of oral healthcare to those who made no promise to elevate patients’ and society’s interests above their own.

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I stand at the crossroads of my implied contract life. If my parties continue to breach more than comply with my terms, then they will abrogate me and return to their course of dealing prior to my formation. A tragic but preventable scenario.

Dentistry’s Duties Dentistry must recognize it alone can save me and itself as a profession. In order to do so, dentistry must continue to earn society’s trust on three fronts. First and foremost, define its professional purpose as an ethics-based calling, not a profit-driven financial strategy. Society will only reciprocate on its promises if dentistry meets its obligations to prioritize the oral health of all above its own financial remuneration. Do the right thing and the money will come.

Second, dentists must undertake the financial risk and responsibility of ownership interest in their practices. Only practice owners earn the authority to incorporate ethical principles into their business plans. In addition, join organized dentistry’s advocacy efforts to fight against nondentist practice ownership.

Third, learn the necessary practice administration skills to either directly manage or delegate, and never abdicate authority to implement ethical decision-making in any clinical situations.

I conclude that my terms apply now more than ever. During these challenging times, neither party wants me to terminate. As I see it, only the dental profession, with its expertise, can spearhead the appropriate response to today’s crisis. Entrusting oral healthcare decisions to individuals who accept no ethical responsibilities merely re-establishes the risks I sought to eliminate. Dentistry must embrace and integrate DSOs’ business expertise into dental practice as a tool to control costs, increase access and, simultaneously, serve patients’ best interests. I trust dentistry to comply.

D.D.S., J.D.

REFERENCES 1.

2.

3.

4.

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American Dental Association. From the Federal Trade Commission: the final order on ethical restriction against advertising by dentists. JADA 99(5), 927-930 (1979).

Cutler E. Although a Non-Dentist May be Prohibited from Owning a Dental Practice, There is a Way for Financial Participation. https://www.eisneramper.com/dental-practice-management-0421.

NM Code R, Sec N, 16.5.9.8(c).

Utah Code Ann 58-69, Sections 501(3), 503(1).

Texas Administrative Code, Title 22, Part 5, Ch. 108(F), Rule§108.70.

ATTORNEY ON LAW

New York Continues Employment Law Rampage Newly enacted laws continue trend favoring employee rights.

Dental practices on notice.

I

Lance Plunkett, J.D., LL.M.

n 2022, the trend in New York State to enact laws favoring employees over employers has continued unabated. Two new laws have taken effect or will take effect this year statewide. Those two major laws are discussed below. Note that New York City has also adopted new employment laws applicable only within New York City; those will be addressed in a future article.

The New York State Whistleblower Law (Section 740 of the New York State Labor Law) took effect on Jan. 26. The law applies to all employers in New York State. It prohibits an employer from taking retaliatory action against an employee because the employee does any of the following: • Discloses or threatens to disclose to a supervisor or to a public body an activity, policy or practice of the employer that the employee reasonably believes is in violation of law, rule or regulation or that the employee reasonably believes poses a substantial and specific danger to the public health or safety.

• Provides information to, or testifies before, any public body conducting an investigation, hearing or inquiry into any such activity, policy or practice by such employer.

• Objects to or refuses to participate in any such activity, policy or practice.

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The law does not define what constitutes a reasonable belief by an employee, but courts are likely to interpret this as they have for government employees—some good faith, reasonably factual basis for believing a violation has occurred. Because the New York State Legislature has broadened the law, it is likely that the benefit of any doubt will be construed in the employee’s favor.

The new whistleblower law requires that employers post a notice for employees of their rights under the new law. The notice must be posted conspicuously, in easily accessible and well-lighted places customarily frequented by employees and applicants for employment. The New York State Department of Labor has issued the required notice (Figure 1) that dental offices should post immediately (and it is largely a restatement of the major provisions of the law, so it also serves as a very good explanation of the new law).

It should be noted that Section 741 of the Labor Law expressly deals with added whistleblowing protections for healthcare employees working in facility settings, but private dental practices are covered only by Section 740.

Putting an End to Electronic Snooping The other new statewide law is Section 52-c of the New York State Civil Rights Law, which will take effect on May 7. The law will require that all

NYSDA employers give notice of electronic monitoring of employees.

Any employer who monitors or otherwise intercepts telephone conversations or transmissions, electronic mail or transmissions, or Internet access or usage of or by an employee by any electronic device or system, including but not limited to the use of a computer, telephone, wire, radio, or electromagnetic, photoelectronic or photo-optical systems, must give prior written notice upon hiring to all employees who are subject to electronic monitoring. The notice required must be in writing, in an electronic record, or in another electronic form and acknowledged by the employee either in writing or electronically.

Each employer must also post the notice of electronic monitoring in a conspicuous place that is readily available for viewing by employees who are subject to electronic monitoring.

Unlike the new whistleblower law that creates a private right for employees to sue to enforce the law, only the New York State Attorney General can enforce the provisions of the employee electronic monitoring law. Any employer found to be in violation of Section 52-c of the Civil Rights Law is subject to a maximum civil penalty of $500 for the first offense, $1,000 for the second offense and $3,000 for the third and each subsequent offense.

It should be noted that the provisions of the new employee electronic monitoring law do not apply to processes that are designed to manage the type or volume of incoming or outgoing electronic mail or telephone voice mail or Internet usage that are not targeted to monitor or intercept the electronic mail or telephone voice mail or Internet usage of a particular individual, and that are performed solely for the purpose of computer system maintenance and/or protection.

There are some dental practices that engage in electronic monitoring of employees (NYSDA has gotten questions about this over the years), but of the two new statewide laws that apply to all employers, the whistleblower law is more likely to affect more dental practices. With all of the infection-control issues surrounding the novel coronavirus (COVID-19) pandemic and the already existing protections of the Occupational Safety and Health Administration (OSHA), employees may now be encouraged to file complaints and feel empowered to threaten lawsuits.

And it will not be so easy to know if the employee has called OSHA or the Office of Professional Discipline (OPD) anymore, thanks to the new employee electronic monitoring law.

New York State may well continue the trend of employee-friendly legislation in this 2022 legislative session if it decides to follow the rapid pace New York City has been setting in this area. More on that in my next column. 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.

Directory

OFFICERS Kevin A. Henner, President

163 Half Hollow Rd., Ste 1, Deer Park, NY 117297

James E. Galati, President-Elect

1758 Route 9, Halfmoon, NY 120659

Anthony M. Cuomo, Vice President

667 Stoneleigh Ave., Ste 301, Carmel, NY 10512

Frank C. Barnashuk, Secretary-Treasurer

3435 Main St., UB School of Dental Medicine, Buffalo, NY 14214

Steven Gounardes, Speaker of the House

351 87th St., Brooklyn, NY 11209

BOARD OF TRUSTEES Craig S. Ratner, Immediate Past President

7030 Hylan Blvd., Staten Island, NY 10307

Paul R. Leary, ADA Trustee

80 Maple Ave., Ste 206, Smithtown, NY 11787

NY – Maurice L. Edwards

30 East 60th St., Ste 401, New York, NY 10022

2 – Mitchell D. Mindlin

30 West End Ave., Ste 8, Brooklyn, NY 11235

3 – Steven L. Essig

Emblem Health, 1873 Western Ave., Albany, NY 12203

4 – Wayne S. Harrison

8 Medical Arts Ln., Saratoga Springs, NY 12866

5 – Margaret Madonian

600 Oswego St., Ste B., Liverpool, NY 13088

6 – Luis T. Mauleon

501 N. Cayuga St., Ithaca, NY 14850

7 – Theresa Casper-Klock

33 William St., Ste 1, Auburn, NY 13021

8 – Kevin J. Hanley

959 Kenmore Ave., Buffalo, NY 14223

9 – Christopher M. Tota

34 Frankford St., Hawthorne, NY 10532

N – Frank J. Palmaccio

875 Old Country Rd., Ste 101, Plainview, NY 11803

Q – Viren L. Jhaveri

14031 Cherry Ave., Apt. 18, Flushing, NY 11355

S – Guenter J. Jonke

2500 Nesconset Hwy Bldg 24A, Stony Brook, NY 11790

B – Amarilis Jacobo

824 E. 181st St., Bronx, NY 10460

New Dentist Liaison James A. Wanamaker

1579 US Rte20, Skaneateles, NY 13152

COUNCIL CHAIRPERSONS Council on Awards

John Liang 2813 Genesee St., Utica, NY 13501

Dental Benefit Programs

Alyson K. Buchalter 388 Avenue X, Ste 1J, Brooklyn, NY 11223

Dental Education & Licensure

Keith S. Margulis 3424 Kossuth Ave., Ste 2A, Bronx, NY 10467

Dental Health Planning & Hospital Dentistry

Sean McLaren 522 E Moreno Dr., Rochester, NY 14626

Dental Practice

John P. Demas 8814 Fort Hamilton Pkwy, Brooklyn, NY 1120

Ethics

Nick J. Vittoria 859 Connetquot Ave., Ste 1, Islip Terrace, NY 1175

Governmental Affairs

Richard L. Rubin 6605 Pittsford Palmyra Rd., Ste W3, Fairport, NY 14450

Membership & Communications

Claudia Mahon-Vazquez 18 Biltmore Dr., Shoreham, NY 11786

Nominations

Craig S. Ratner 7030 Hylan Blvd., Staten Island, NY 10307

Peer Review & Quality Assurance

Christian E. Mathiesen 154 West Ave., Saratoga Springs, NY 12866

Professional Liability Insurance

David J. Reed 1998 Empire Blvd., Webster, NY 14580

OFFICE Suite 602, 20 Corporate Woods Blvd., Albany, NY 12211 (518) 465-0044 | (800) 255-2100 Michael J. Herrmann Lance R. Plunkett Grazia A. Yaeger Laura C. Stedman Mary Grates Stoll Jenna Bell Betsy Bray

Interim Executive Director General Counsel Assistant Executive Director Marketing and Communications Assistant Executive Director Managing Editor Director of Meeting Planning Director of Health Affairs

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FIGURE 1 Notice of Employee Rights, Protections, and Obligations Under Labor Law Section 740 Prohibited Retaliatory Personnel Action by Employers Effective January 26, 2022 § 740.

Retaliatory action by employers; prohibition.

1. Definitions. For purposes of this section, unless the context specifically indicates otherwise: (a) “Employee” means an individual who performs services for and under the control and direction of an employer for wages or other remuneration, including former employees, or natural persons employed as independent contractors to carry out work in furtherance of an employer’s business enterprise who are not themselves employers. (b) “Employer” means any person, firm, partnership, institution, corporation, or association that employs one or more employees. (c) “Law, rule or regulation” includes: (i) any duly enacted federal, state or local statute or ordinance or executive order; (ii) any rule or regulation promulgated pursuant to such statute or ordinance or executive order; or (iii) any judicial or administrative decision, ruling or order. (d) “Public body” includes the following: (i) the United States Congress, any state legislature, or any elected local governmental body, or any member or employee thereof; (ii) any federal, state, or local court, or any member or employee thereof, or any grand or petit jury; (iii) any federal, state, or local regulatory, administrative, or public agency or authority, or instrumentality thereof; (iv) any federal, state, or local law enforcement agency, prosecutorial office, or police or peace officer; (v) any federal, state or local department of an executive branch of government; or (vi) any division, board, bureau, office, committee, or commission of any of the public bodies described in subparagraphs (i) through (v) of this paragraph. (e) “Retaliatory action” means an adverse action taken by an employer or his or her agent to discharge, threaten, penalize, or in any other manner discriminate against any employee or former employee exercising his or her rights under this section, including (i) adverse employment actions or threats to take such adverse employment actions against an employee in the terms of conditions of employment including but not limited to discharge, suspension, or demotion; (ii) actions or threats to take such actions that would adversely impact a former employee’s current or future employment; or (iii) threatening to contact or contacting United States immigration authorities or otherwise reporting or threatening to report an employee’s suspected citizenship or immigration status or the suspected citizenship or immigration status of an employee’s family or household member, as defined in subdivision two of section four hundred fifty-nine-a of the social services law, to a federal, state, or local agency. (f) “Supervisor” means any individual within an employer’s organization who has the authority to direct and control the work performance of the affected employee; or who has managerial authority to take corrective action regarding the violation of the law, rule or regulation of which the employee complains.

2. Prohibitions. An employer shall not take any retaliatory action against an employee, whether or not within the scope of the employee’s job duties, because such employee does any of the following: (a) discloses, or threatens to disclose to a supervisor or to a public body an activity, policy or practice of the employer that the employee reasonably believes is in violation of law, rule or regulation or that the employee reasonably believes poses a substantial and specific danger to the public health or safety; (b) provides information to, or testifies before, any public body conducting an investigation, hearing or inquiry into any such activity, policy or practice by such employer; or (c) objects to, or refuses to participate in any such activity, policy or practice.

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3. Application. The protection against retaliatory action provided by paragraph (a) of subdivision two of this section pertaining to disclosure to a public body shall not apply to an employee who makes such disclosure to a public body unless the employee has made a good faith effort to notify his or her employer by bringing the activity, policy or practice to the attention of a supervisor of the employer and has afforded such employer a reasonable opportunity to correct such activity, policy or practice. Such employer notification shall not be required where: (a) there is an imminent and serious danger to the public health or safety; (b) the employee reasonably believes that reporting to the supervisor would result in a destruction of evidence or other concealment of the activity, policy or practice; (c) such activity, policy or practice could reasonably be expected to lead to endangering the welfare of a minor; (d) the employee reasonably believes that reporting to the supervisor would result in physical harm to the employee or any other person; or (e) the employee reasonably believes that the supervisor is already aware of the activity, policy or practice and will not correct such activity, policy or practice.

4. Violation; remedy. (a) An employee who has been the subject of a retaliatory action in violation of this section may institute a civil action in a court of competent jurisdiction for relief as set forth in subdivision five of this section within two years after the alleged retaliatory action was taken. (b) Any action authorized by this section may be brought in the county in which the alleged retaliatory action occurred, in the county in which the complainant resides, or in the county in which the employer has its principal place of business. In any such action, the parties shall be entitled to a jury trial. (c) It shall be a defense to any action brought pursuant to this section that the retaliatory action was predicated upon grounds other than the employee’s exercise of any rights protected by this section.

5. Relief. In any action brought pursuant to subdivision four of this section, the court may order relief as follows: (a) an injunction to restrain continued violation of this section; (b) the reinstatement of the employee to the same position held before the retaliatory action, or to an equivalent position, or front pay in lieu thereof; (c) the reinstatement of full fringe benefits and seniority rights; (d) the compensation for lost wages, benefits and other remuneration; (e) the payment by the employer of reasonable costs, disbursements, and attorney’s fees; (f) a civil penalty of an amount not to exceed ten thousand dollars; and/or (g) the payment by the employer of punitive damages, if the violation was willful, malicious or wanton.

6. Employer relief. A court, in its discretion, may also order that reasonable attorneys’ fees and court costs and disbursements be awarded to an employer if the court determines that an action brought by an employee under this section was without basis in law or in fact.

7. Existing rights. Nothing in this section shall be deemed to diminish the rights, privileges, or remedies of any employee under any other law or regulation or under any collective bargaining agreement or employment contract.

8. Publication. Every employer shall inform employees of their protections, rights and obligations under this section, by posting a notice thereof. Such notices shall be posted conspicuously in easily accessible and well-lighted places customarily frequented by employees and applicants for employment.

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Buying or Selling a Practice?

EXPERIENCE MATTERS

Association Activities EDPAC Leaders Named THE EMPIRE DENTAL POLITICAL ACTION COMMITTEE (EDPAC) has chosen its Board of Directors for the coming year. They are as follows: Officers: Michael R. Breault, chair; Richard Andolina, vice chair; Raymond Flagiello, secretary; Joseph R. Caruso, treasurer.

Component Chairs: Lois Jackson, New York County; Valerie Venterina, Second District; Geoffrey Gamache, Third District; G. Kirk Gleason, Fourth District; James Wanamaker, Fifth District; Betsey Clark-Fortier, Sixth District; and James Soltys, Seventh District.

Also: John Tibbetts, Eighth District; Duraid Sahawneh, Ninth District; Michael Shreck, Nassau County; Prabha Krishnan, Queens County; Dimitrios Kilimitzoglou, Suffolk County; Joel Friedman, Bronx County.

At-Large Board Members: Robert Doherty, Ninth District; Chad Gehani, Queens County; Steven Gounardes, Second District; Maria Maranga, Suffolk County; Edward Miller Jr., Ninth District; John Nasca, Eighth District; and Lawrence Volland, Eighth District.

NSS Names Ten Board Members NYSDA SUPPORT SERVICES (NSS) will be led in 2022 by the following Board: Joseph Caruso, chairman; Michael Herrmann, president; Mark E S TA B L I S H E D I N 1 9 8 8

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Weinberger, treasurer; Robert Doherty; Lawrence Volland; Minerva Patel; Roxene Gascoigne; Dimitrios Kilimitzoglou; Tricia Quartey; and Frank Barnashuk.

Council Takes Disciplinary Action On Dec. 15, 2021, the NYSDA Council on Ethics issued an order to suspend Dr. Babak Robert Ghalili (License No. 043014) from membership for two (2) years, with said suspension completely stayed; a two (2) year probation with fourteen (14) hours of continuing education to include coursework in recordkeeping by the end of the probationary period.

After a full hearing on Dec. 8, 2021, the council found that Dr. Ghalili had been disciplined for professional misconduct by the New York State Education Department Board of Regents and, as such, was in violation of Paragraph B of Section 20 Chapter X of the NYSDA Bylaws.

Dr. Ghalili did not appeal the council’s decision within the requisite 30-day timeframe to the American Dental Association (ADA). The decision of the NYSDA Council on Ethics thereby became final and effective as of Jan. 14, 2022.

postoperative assessment

Orthognathic Surgery and Quality-of-Life Outcomes Findings from a Hospital-Based Patient Satisfaction Survey Parth D. Shah, D.D.S., M.P.H.; Victor M. Badner, D.M.D., M.P.H.; Benn Lieberman, D.M.D.

ABSTRACT This study examined patient satisfaction and changes in quality of life (QoL) following orthognathic surgery performed to treat severe dentofacial deformities. The short form of the oral health impact profile (OHIP-14) instrument was utilized to measure the negative impact related to severe dentofacial deformities on QoL. Ninety-five patients participated in this survey. Respondents reported significant reduction in the overall OHIP-14 score following orthognathic surgery (p-value<0.0001). Approximately 92% of patients reported postoperative resolution of their chief concerns. In conclusion, orthognathic surgery was found to be beneficial, as it significantly reduced the negative impact of severe skeletal malocclusion on QoL of the patients we surveyed.

Severe dentofacial deformities may adversely affect patients’ mental well-being and, consequentially, their quality of life.

Orthognathic surgery is a well-recognized treatment, routinely

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performed for the correction of facial disharmony and skeletal malocclusion resulting from severe dentofacial deformities.[1] The primary goal of this surgery is to improve mastication, phonation, and dentofacial profile by harmonizing the facial skeletal structure and dental occlusion.[2] In doing so, orthognathic surgery may contribute to enhancing the QoL of those affected individuals who receive the surgical intervention. Therefore, in addition to the objective measures of occlusion and motor function, it is important to include the QoL appraisal in examining the outcomes of orthognathic surgery.

The QoL can be measured using generic or disease-specific tools. However, the generic instruments may not be sensitive to changes related to oral health on QoL and may exhibit limited construct validity. Although the concept of QoL is subjective, a sizeable range of questionnaires has been developed to examine this outcome.[3] Furthermore, these are proven tools for the evaluation of patients’ perceptions.[3,4] One such commonly used questionnaire is the Oral Health Impact Profile (OHIP), which measures individuals’ perceptions of the negative impact from oral disorders on their well-being and QoL.[3,5] The OHIP was originally developed in Australia by Slade et al. to assess individual’s perception regarding discomfort and dysfunction caused by oral conditions.[5] While the OHIP is quite comprehensive in nature regarding the perceptions of impact on

Figure 1: Patient Satisfaction Survey well-being, it is not always possible to use this lengthy instrument of 49 questions, especially in health services research, which requires a more succinct instrument.[6] Therefore, subsequently, its short version, known as OHIP-14, was developed. It consists of 14 questions that examine the same seven dimensions as the original OHIP, and has been determined to be a valid and reliable instrument.[6] In recent years, there has been growing interest in patient satisfaction and changes in QoL following dental treatment and orthognathic surgery.[7-10] Numerous studies have examined the postoperative changes in QoL of patients who had undergone orthognathic surgery for the correction of severe dentofacial deformities and reported improved self-confidence and overall QoL.[7,10-20] Patients’ perceptions and expectations have become increasingly important in justifying health services delivery and ensuring overall healthcare quality.[12,13] The use of QoL measures is a valuable metric for determining the outcome of care.[21-23] At Jacobi Medical Center (JMC), one of the safety-net hospitals of the largest municipal healthcare system in the United States, located in the Bronx, NY, orthognathic surgery is routinely performed on patients who present or are referred to this hospital for the treatment of facial disharmony and severe skeletal malocclusion. This study was undertaken to assess our hospital’s effort in providing this surgical treatment. Its aim was to investigate patient satisfaction and postoperative changes in QoL using OHIP-14 questionnaire in a sample of patients diagnosed with severe forms of facial disharmony and skeletal malocclusion who received orthognathic surgery between January 2015 and December 2017 in the Department of Dentistry and Oral & Maxillofacial Surgery at JMC.

deformities who presented for treatment from January 2015 to December 2017 was recruited to participate in the patient satisfaction survey in 2018. All patients were otherwise systemically healthy and had established diagnosis of severe Class II or Class III skeletal malocclusion, necessitating surgical orthodontics. Informed consent procedure was executed, and participants were assured of the confidentiality of the survey data.

Methods The study protocol was reviewed and approved by the Institutional Review Board of the Albert Einstein College of Medicine. A convenience sample of patients diagnosed with severe dentofacial

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A structured telephone survey was conducted. Multiple attempts were made to contact the patients to obtain their responses to our survey. Our attempts included calling multiple times on different days and at different times of the day, leaving voice messages, accommodating responders’ request to call on a specific day at specific times per their convenience, etc. Technology such as answering machines and caller ID increased the amount of time and effort required to acquire patients’ responses to the telephone surveys.

Patients who participated in this project responded to preoperative and postoperative questionnaires via telephone survey.

The 14-item Oral Health Impact Profile (OHIP-14) instrument was utilized to measure the impact of orofacial conditions on QoL before and after orthognathic surgery.

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OHIP-14 included 14 questions divided into seven evaluation domains (two questions per domain): functional limitation (questions 1 and 2); physical pain (questions 3 and 4); psychological discomfort (questions 5 and 6); physical disability (questions 7 and 8); psychological disability (questions 9 and 10); social disability (questions 11 and 12); and handicap (questions 13 and 14).

[6] Each question evaluated a frequency with five possible answers, ranging from “never” (score zero) to “very often” (score 4).[6]These scores were multiplied by the weight assigned to each question in the original OHIP-14 instrument to compute standardized scores comparable to the results obtained with the standardized OHIP-49.

[6] Accordingly, the total OHIP-14 score ranged from 0 to 28, with higher scores indicating a worse impact on QoL.

In addition to the questions of the OHIP-14, participants responded to a separate questionnaire, developed by the investigators to evaluate postsurgical patient satisfaction (Figure 1).

The non-parametric Kolmogorov–Smirnov test was used to inspect the normality of data. Fisher’s exact test was used to examine the associations of gender and age with the type of deformity and the type of surgery. The Wilcoxon matched-pairs test was used to evaluate significant changes in OHIP-14 scores between S0 (preoperative) and S1 (postoperative) in each domain and overall for all patients. An effect size was also calculated to indicate the impact of orthognathic surgery.

A p-value < 0.05 was considered statistically significant. SAS software (SAS Institute, Cary, NC) version 9.4 was utilized to conduct all data management procedures and statistical analyses.

Results The total number of patients who underwent orthognathic surgery at JMC between January 2015 and December 2017 was 108.

In order to receive the maximum response rate possible, we attempted to contact each patient from three to five times on a different day at a different time of the day. Non-response was made up of refusal to respond and lack of current contact information. Common comments included “Call back,” “Busy,” “Bad time” and “Not interested,” with a hang-up even before complete introduction.

Our survey response rate was 87.96% (n = 95). Descriptive statistical analyses revealed the demographic characteristics of the patients who participated in this survey (Table 1). The gender distribution was almost equal in our study sample. The average age of the patient at the time of surgery was 20.86 years, ranging from 14 to 48 years old. Nearly 75% of total study participants received surgery in both the maxilla and mandible. Fisher’s exact test revealed that variables such as gender and age had no significant association with the type of deformity or type of surgery performed.

Descriptive statistics further revealed the frequency of obtained answers to preoperative and postoperative OHIP-14 questionnaire (Table 2). At S0 (prior to surgery), there was variable distribution of the answers, showing that the evaluated items frequently worried patients (“very often,” “often,” “occasionally,” etc.). At S1 (postsurgery), most of the evaluated items were no longer a problem for these patients, as they did not frequently worry them (“hardly ever” or “never”).

A statistically significant reduction (p-value<.0001) in the overall score of the OHIP-14 (n = 95) was observed between the preoperative and postoperative assessments (Table 3). In addition, there were significant decreases in scores in all seven domains examined through OHIP-14 (p-value<.0001). The significant reduction that we observed in overall OHIP-14 and in the individual domain scores after orthognathic surgery was similar for

the two sexes, among age groups and among the types of surgery performed. Although the negative impact score was reduced in all seven domains of the QoL, maximum effect size was observed in psychological discomfort, followed by psychological disability.

Out of 95 patients who participated in this survey, 96.8% felt that they were actually in need of corrective jaw surgery. Overall, 91.58% of the patients responded that their chief concerns were resolved after orthognathic surgery. From the total sample we surveyed, 80% of the respondents stated (from what they know now) they would consider having this surgery done all over again here at JMC, and 84.21% would recommend it to others who have the similar condition.

Discussion Findings from this study revealed significant decrease in the negative impact resulting from severe dentofacial deformities on overall QoL, as well as in each individual domain assessed by the OHIP-14 in our study sample following the orthognathic surgery.

This reduction was almost similar for both genders, across age groups and between the type of surgery performed.

While analyzing the distribution of answers to each question (Table 2), it became apparent that a few patients still gave scores of 3 or 4 after surgery. However, those higher scores were mainly related to the characteristics of feeding and chewing, which might have been skewed because those patients were still in recovery and adapting to the new occlusion. Previously conducted research has shown that in the initial postoperative period, approximately up to six months, there may be a transient and significant deterioration in OHIP-14 scores, especially in the fields of appearance and functional limitation.[21] It is linked to immediate postoperative morbidity, when the presence of pain, edema, neurosensory disorders, limited mouth opening and decreased masticatory efficiency are common.[21,24] However, eventual continuous improvement in QOL and decreasing OHIP-14 scores over time in-

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dicate gain in the health outcomes and support the hypothesis that orthognathic surgery improves the QoL.[16,19] A few patients who participated in our survey in 2018 received orthognathic surgery in the second half of 2017. Therefore, they were still within the postoperative period of six months.

Data analysis by the OHIP-14 domains revealed that although significant improvement was achieved in all domains of QoL following the orthognathic surgery, the highest improvement was noticed in psychological domains. The effect size was greatest in psychological discomfort and psychological disability, whereas the effect size in each remaining domain of the QoL was comparatively smaller. However, considering the effect size in overall OHIP-14 score for the patients we studied, it is possible that the benefits of this surgical treatment in oral health-related QoL could have been identified clinically. Our findings are supported by the number of studies that reported similar changes in psychological domains and overall improvement in quality of life following the surgical intervention of skeletal malocclusion. [7,10-20,25] Moderate-to-severe dentofacial deformities may physically, psychologically and socially affect those who are afflicted. Such patients may demonstrate and report benefits from orthognathic surgery in all these dimensions of the QoL. However, surgical correction of the severe dentofacial deformity may lead to an extreme change in appearance and a radical alteration in facial profile.[11,19] This may contribute to a significant delay in becoming accustomed to the new appearance,[26] but that was not reported by any of the patients in our study.

Participants’ responses to the patient satisfaction survey revealed that patients, for the most part, were quite satisfied and felt that orthognathic surgery was worth the effort. Unfortunately, 20% of respondents said that they would have not gone through this treatment if they had prior knowledge of how their recovery would be, and 15% would also not recommend this treatment to others who have similar condition.

While this represents a small number, it is not insignificant and indicates that preparation and management of expectations prior to surgery are necessary parts of this protocol and should be provided to all patients.

This was a cross-sectional study, in which both pre- and postintervention data were collected at the same time from our survey respondents. Our phone survey was very challenging to conduct for a number of reasons. In today’s world, people are extremely busy, and it seems that a phone survey may interrupt the personal time of the respondents. Therefore, they may avoid responding to a survey questionnaire. Furthermore, with the availability of caller ID feature, many people tend to use call screening to accept only calls they are expecting and avoid answering any other calls. On the other hand, one big advantage of telephone surveys is the ability to reach a large number of individuals due to the widespread utilization of cell phones.

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Although OHIP-14 is a valid and reliable questionnaire to measure the QoL,[6] it is a subjective evaluation and may have deviation in answers. Furthermore, the format of the answers in OHIP-14 questionnaire is based on frequency, which may often lead the survey respondents to the biased evaluation because it is not always possible to know whether the patients think in terms of absolute numbers or an average number of the events occurring in a given period. Depending upon the respondents’ answers, it may either underestimate or overestimate the true level of impact, especially in cases when the respondents have forgotten the experienced impacts, leading them to underestimate the true levels. Therefore, these findings must be interpreted carefully.

The use of a valid standardized questionnaire for measuring the impact of severe dentofacial deformities and their treatments on QOL is necessary because it allows researchers to study the actual benefit of a clinical procedure to patients’ lives. [4,21-23,27] The major strength of this study was the high response rate to our survey. However, this design is prone to major risk of recall bias.

Therefore, no claim can be made regarding the cause-and-effect relationship. A prospective longitudinal study may help in measuring change over time, eliminating recall bias.

Conclusion By reducing the negative impact related to severe dentofacial deformities, orthognathic surgery was associated with substantial postsurgical improvement in the overall quality of life within our study population. This benefit should be highlighted when discussing the surgical treatment with patients suffering from skeletal malocclusion resulting from moderate-to-severe dentofacial deformities. p Queries about this article can be sent to Dr. Badner at victor.badner@nychhc.org

REFERENCES 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Soh CL, Narayanan V. Quality of life assessment in patients with dentofacial deformity undergoing orthognathic surgery--a systematic review. Int J Oral Maxillofac Surg 2013;42(8):974-980.

Khechoyan DY. Orthognathic surgery: general considerations. Semin Plast Surg 2013;27(3):133-136.

Slade GD, ed. Measuring Oral Health and Quality of Life. Chapel Hill: University of North Carolina, Dental Ecology 1997.

Miguel JA, Palomares NB, Feu D. Life-quality of orthognathic surgery patients: the search for an integral diagnosis. Dental Press J Orthod 2014;19(1):123-137.

Slade GD, Spencer AJ. Development and evaluation of the oral health impact profile. Community Dent Health 1994;11(1):3-11.

Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997; 25: 284-90.

Kurabe K, Kojima T, Kato Y, Saito I, Kobayashi T. Impact of orthognathic surgery on oral health-related quality of life in patients with jaw deformities. Int J Oral Maxillofac Surg 2016;45(12):1513-1519.

Hatch JP, Rugh JD, Clark GM, Keeling SD, Tiner BD, Bays RA. Health-related quality of life following orthognathic surgery. Int J Adult Orthodon Orthognath Surg 1998;13(1):67-77.

Motegi E, Hatch JP, Rugh JD, Yamaguchi H. Health-related quality of life and psychosocial function 5 years after orthognathic surgery. Am J Orthod Dentofacial Orthop 2003;124(2):138-143.

Al-Asfour A, Waheedi M, Koshy S. Survey of patient experiences of orthognathic surgery: health-related quality of life and satisfaction. Int J Oral Maxillofac Surg 2018;47(6):726731.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

Göelzer JG, Becker OE, Haas Junior OL, et al. Assessing change in quality of life using the Oral Health Impact Profile (OHIP) in patients with different dentofacial deformities undergoing orthognathic surgery: a before and after comparison. Int J Oral Maxillofac Surg 2014;43(11):1352-1359.

Stirling J, Latchford G, Morris DO, Kindelan J, Spencer RJ, Bekker HL. Elective orthognathic treatment decision making: a survey of patient reasons and experiences. J Orthod.

2007;34(2):113-27.

Kiyak AH, Bell R. Psychosocial considerations in surgery and orthodontics. In: Proffit WR, White RP, editors. Surgical-orthodontic Treatment. St. Louis: Mosby; 1991. p. 421-37.

Elmouden L, Ousehal L. Assessment of the quality of life in Moroccan patients undergoing orthognathic surgery. Turk J Orthod 2018;31(3):79-85.

Emadian Razvadi ES, Soheilifar S, Esmaeelinejad M, Naghdi N. Evaluation of the changes in the quality of life in patients undergoing orthognathic surgery: a multicenter study. J Craniofac Surg 2017;28(8):e739-e743.

Schilbred Eriksen E, Moen K, Wisth PJ, Løes S, Klock KS. Patient satisfaction and oral health-related quality of life 10-15 years after orthodontic-surgical treatment of mandibular prognathism. Int J Oral Maxillofac Surg 2018;47(8):1015-1021.

Murphy C, Kearns G, Sleeman D, Cronin M, Allen PF. The clinical relevance of orthognathic surgery on quality of life. Int J Oral Maxillofac Surg 2011;40:926–930.

Sun H, Shang HT, He LS, Ding MC, Su ZP, Shi YL. Assessing the quality of life in patients with dentofacial deformities before and after orthognathic surgery. J Oral Maxillofac Surg 2018;76(10):2192-2201.

Ghorbani F, Gheibollahi H, Tavanafar S, Eftekharian HR. Improvement of esthetic, functional, and social well-being after orthognathic surgical intervention: a sampling of postsurgical patients over a 10-year period from 2007 to 2017. J Oral Maxillofac Surg 2018;76(11):2398-2403.

Silva I, Cardemil C, Kashani H, et al. Quality of life in patients undergoing orthognathic surgery - A two-centered Swedish study. J Craniomaxillofac Surg 2016;44(8):973-978.

Lee S, Mcgrath C, Samman N. Impact of orthognathic surgery on quality of life. J Oral Maxillofac Surg 2008;66(6):1194-9.

Patrick DL, Erickson P. Health status and health policy. Quality of life in healthcare evaluation and resource allocation. New York: Oxford University Press;1993.

Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. JAMA 1995; 273:59-65.

24.

25.

26.

27.

Choi WS, Lee S, McGrath C, Samman N. Change in quality of life after combined orthodontic-surgical treatment of dentofacial deformities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109(1):46-51.

Rustemeyer J, Gregersen J. Quality of life in orthognathic surgery patients: post-surgical improvements in aesthetics and self-confidence. J Craniomaxillofac Surg 2012;40:400–4.

Rustemeyer J, Martin A, Gregersen J. Changes in quality of life and their relation to cephalometric changes in orthognathic surgery patients. Angle Orthod 2012;82: 235–41.

Esperão PT, de Oliveira BH, de Oliveira Almeida MA, Kiyak HA, Miguel JA. Oral healthrelated quality of life in orthognathic surgery patients. Am J Orthod Dentofacial Orthop 2010;137(6):790-795.

Dr. Shah

Dr. Badner

Dr. Lieberman

Parth D. Shah, D.D.S., M.P.H., is a former postdoctoral fellow, Division of Population Health & Community Dentistry, Department of Dentistry and Oral & Maxillofacial Surgery, Jacobi Medical Center in affiliation with the Albert Einstein College of Medicine, Bronx, NY. Victor M. Badner, D.M.D., M.P.H., is chairman, Department of Dentistry and Oral & Maxillofacial Surgery, Jacobi Medical Center in affiliation with the Albert Einstein College of Medicine, Bronx, NY. Benn Lieberman, D.M.D., is director, Oral & Maxillofacial Surgery Department, Jacobi Medical Center, Bronx, NY.

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drug abuse

Recommendations for Co-Prescription of Opioids and Naloxone in the Dental Office Madeleine Maas, D.D.S.; Raquel Rozdolski, D.M.D.

On Dec. 29, 2021, Gov. Kathy Hochul signed a bill into law in New York State, with bipartisan support, that will require medical professionals to co-prescribe naloxone (an opioid antagonist) along with an opioid prescription when certain patient risk factors are present. This law will require practitioners to have important conversations with their patients when they consider the prescription of an opioid to determine if the patient has a history of substance-use disorder.

Additionally, practitioners must prescribe naloxone when patients are prescribed high-dose or cumulative prescriptions that equate to 90 morphine milligram equivalents or higher per day or who are also taking concurrent opioids, benzodiazepines or nonbenzodiazepine sedative hypnotics.

This law takes effect 180 days from the date it was signed into law. As authors of the article “Recommendations for the Co-Prescription Opioids and Naloxone in the Dental Office,” which first appeared in 2020 in ADSA Pulse, the newsletter of the American Dental Society of Anesthesiology, both Dr. Madeleine Maas and I applaud the strides New York State is taking in the opioid epidemic.

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IN THE PAST, opioid analgesics were prescribed frequently as the first line of pain management after dental procedures and though nonsteroidal anti-inflammatory drugs have risen to the top, opioids are still commonly prescribed.

Historically, opioid analgesics, while an important tool in pain management, are associated with high rates of abuse, misuse and addiction. In the United States, drug overdose deaths continue to rise and this trend is largely driven by prescription opioid analgesics.[10] In fact, 5 percent to 23 percent of all prescription opioid doses dispensed are used for non-medical purposes.[5] Though primary care physicians prescribe the bulk of opioids, certain specialties, such as dentistry, prescribe opioids at a higher rate.[10] All prescribers have a responsibility to minimize the potential for drug abuse, misuse, addiction and overdose while still prescribing necessary opioids for patients in need of such opioid analgesia.[5] Some physicians have already begun co-prescribing naloxone, along with opioids, to minimize that risk.

However, this practice is not currently common within the dental profession.

Providing overdose prevention in the form of naloxone and opioid overdose response education, including assessment and stimulation of the victim, administration of naloxone, basic life support and aftercare to drug users, their friends and family can save lives. It is the dental provider’s responsibility to respond to this call and stay informed on alternative forms of pain management and to know when and how to prescribe opioids safely to their patients.

This paper will list and discuss several factors related to the decision concerning prescription of opioids and the co-prescription of naloxone. It will also attempt to provide a guideline for such prescriptions.

Reprinted with permission from March 2020 ADSA Pulse, newsletter of the American Dental Society of Anesthesiology.

Naloxone 11.

Göelzer JG, Becker OE, Haas Junior OL, et al. Assessing change in quality of life using the Oral Naloxone is aProfile potent antagonist used clinically Health Impact (OHIP)opioid in patients receptor with different dentofacial deformities undergoing orthognathic surgery: a before and after comparison. Int J Oral Maxillofac 2014;43(11):1352-1359. to counter the effects of opiate analgesia.[19] ItSurg can and should be 12.

Stirling J, Latchford G, Morris DO, Kindelan J, Spencer RJ, Bekker HL. Elective orthognausedthic in treatment opioid decision overdose situations to counteract the life-threatmaking: a survey of patient reasons and experiences.

J Orthod. ening2007;34(2):113-27. depression of the central nervous system and the respira13.

Kiyak AH, Bell R. Psychosocial considerations in surgery and orthodontics. In: Proffit WR, [20] tory White system.

What makes naloxone is that though RP, editors.

Surgical-orthodontic Treatment. unique St. Louis: Mosby; 1991. p. 421-37.it is 14.

Elmouden L, Ousehal L. Assessment the quality of life in Moroccan patients undergoing traditionally administered byofhealthcare professionals, laypeople orthognathic surgery. Turk J Orthod 2018;31(3):79-85. can be minimally trained to safely administer it intranasally or 15.

Emadian Razvadi ES, Soheilifar S, Esmaeelinejad M, Naghdi N. Evaluation of the changes in the quality of life in patientsitundergoing orthognathic a multicenter study. J intramuscularly, making ideal for treatingsurgery: overdose wherever Craniofac Surg 2017;28(8):e739-e743. and in whomever the overdose is identified.

16.

Schilbred Eriksen E, Moen K, Wisth PJ, Løes S, Klock KS. Patient satisfaction and oral Naloxone is available inyears several formulations,treatment including intrahealth-related quality of life 10-15 after orthodontic-surgical of mandibular prognathism. Int J Oral Maxillofac Surg 2018;47(8):1015-1021. venous, intranasal and intramuscular auto-injectors. While intrave17.

Murphy C, Kearns G, Sleeman D, Cronin M, Allen PF. The clinical relevance of orthognanousthic administration islife. reserved trained surgery on quality of Int J Oralfor Maxillofac Surgprofessionals, 2011;40:926–930. intranasal 18.

Sun H, Shang HT, He LS, Ding MC, Su ZP, Shi YL. Assessing the quality of life in and intramuscular delivery methods are simple and safe forpatients the with dentofacial deformities before and after orthognathic surgery. J Oral Maxillofac Surg layperson to administer. Administration of naloxone intranasally 2018;76(10):2192-2201.

19. intramuscularly Ghorbani F, Gheibollahi H, Tavanafareffects S, Eftekharian HR. Improvement of esthetic, functional, or produces within two to five minutes of and social well-being after orthognathic surgical intervention: a sampling of postsurgical paadministration that last between 30 and 120 minutes, with a Tmax tients over a 10-year period from 2007 to 2017. J Oral Maxillofac Surg 2018;76(11):2398-2403.

20. approximately Silva I, Cardemil C, H, et intranasally al. Quality of lifeand in patients undergoingintramusorthognathic of 19Kashani minutes 15 minutes surgery - A two-centered Swedish study. J Craniomaxillofac Surg 2016;44(8):973-978.

[4,6,12,14] cularly.

Once administered, the patient’s breathing should 21.

Lee S, Mcgrath C, Samman N. Impact of orthognathic surgery on quality of life. J Oral be monitored and if respirations do not return within two to three Maxillofac Surg 2008;66(6):1194-9.

22.

Patrick DL, Erickson P. Health status and health policy. Quality of life in healthcare evaluminutes, or the patient relapses, both laypeople and trained healthation and resource allocation. New York: Oxford University Press;1993. care should anwith additional dose of naloxone 23. professionals Wilson IB, Cleary PD. Linkingadminister clinical variables health-related quality of life. JAMA 273:59-65. with 1995; a new auto-injector until emergency assistance arrives.

In order to prevent overdose, two important steps must be taken: 24.

Choi WS, Lee S, McGrath C, Samman N. Change in quality of life after combined orthnaloxone must treatment be co-prescribed with the andOralnaloxone odontic-surgical of dentofacial deformities.

Oralopioid; Surg Oral Med Pathol Oral Radiol Endod 2010;109(1):46-51. education must occur at the time of prescription writing and again 25.

Rustemeyer J, Gregersen J. Quality of life in orthognathic surgery patients: post-surgical at the time of inthe pharmacist dispensing the medication.

When improvements aesthetics and self-confidence.

J Craniomaxillofac Surg 2012;40:400–4.

26.

Rustemeyer J,correctly, Martin A, Gregersen J. Changes in quality of life and their relation to cephaadministered naloxone successfully reverses overdose in lometric changes in orthognathic surgery patients. Angle Orthod 2012;82: 235–41.

[9] 82% of patients.

With a high and ease ofhealthuse, 27.

Esperão PT, de Oliveira BH, desuch Oliveira Almeidasuccess MA, Kiyakrate HA, Miguel JA. Oral related quality of life in orthognathic patients.

Am J Orthod Dentofacial Orthop it is perplexing why naloxone issurgery not more commonly co-prescribed 2010;137(6):790-795. with opioid prescriptions among dental professionals.

Why Practitioners Don’t Co-Prescribe There is no question that the opioid epidemic has continued to rise, with 2.1 million people suffering from an opioid use disorder andDr.47,600 people Dr. dying opioid-related drug overdose Shah Badnerfrom an Dr. Lieberman in 2017.[11] While one of the largest percentage drops in opioidprescribing rates occurred in dentistry, the fact remains that opiParth D. Shah, D.D.S., M.P.H., is a former postdoctoral fellow, Division of Population Health & oid prescriptions are still common, more than million Community Dentistry, Department of Dentistry and Oral & with Maxillofacial Surgery, Jacobi13Medical Center [9,11] prescriptions dispensed per month in the United States. in affiliation with the Albert Einstein College of Medicine, Bronx, NY. In April 2018, the US Surgeon General called for heightened Victor M. Badner, M.P.H., chairman, Department of Dentistry Oral &of Maxillofaawareness and D.M.D., availability ofisnaloxone to reverse the and effects opicial Surgery, Jacobi Medical Center in affiliation with the Albert Einstein College of Medicine, Bronx, NY. oid overdose. Yet, still less than 1% of patients actually receive a [1] naloxone co-prescription. al. found thatJacobi prescribBenn Lieberman, D.M.D., is director, Binswanger, Oral & MaxillofacialetSurgery Department, Medical ers were hesitant to prescribe naloxone with a patient’s prescripCenter, Bronx, NY. tion opioid because of concerns about the patient engaging in risky

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behavior and fears of offending the patient.[2] In fact, prescribers said they were more comfortable prescribing and more often prescribed to patients who were not necessarily those who could benefit most from naloxone.[2] Contrary to popular belief, there is no evidence that patients who are prescribed opioids and naloxone will increase their risky behavior and their dosage of the drug.[3] Additionally, the fear of insulting a patient should be inconsequential compared to the fear of the patient using the opioids irresponsibly or incorrectly and needing an antidote they were never given an opportunity to obtain. Similar to how dentists discuss the risks and benefits of a procedure with a patient, they should also discuss the risks and benefits of taking opioids and the benefits of filling a prescription of naloxone as well to help reduce those risks. A conversation framed in a professional manner will not insult the patient and will make the patient feel comfortable and grateful that he or she have an opportunity to help themselves, a family member or a friend should an overdose occur.

Legal ramifications of prescribing naloxone to a patient who experiences an overdose is another commonly mentioned concern.[2] This belief goes hand in hand with the fear that prescribing naloxone will result in increased risky behavior that would not have occurred had the dentist not prescribed it in the first place. Burris, et al. found that there are no likely legal risks to providers from prescribing prescription naloxone.[3] Given the plethora of information regarding the benefits of co-prescription, there is no legitimate reason to not co-prescribe naloxone with opioids. The practice of co-prescription is becoming more common among physicians, and it should become common practice within the dental community.

Screening for Risk in Office Dentists are in a unique position as healthcare providers to screen for substance misuse and abuse, due to the long-term relationship they are able to build with a patient. Screening is a quick and easy way to identify, prevent and reduce problematic use and abuse of opioid prescriptions. One of the ways dentists can implement this is to use the Screening, Brief Intervention and Referral to Treatment toolkit.[11] By starting a conversation with every patient saying, “This is a screening process we now use for every patient,” the dentist opens up the opportunity to openly discuss potential or real substance abuse problems in a safe and non-judgmental way, with no fear of insulting the patient. Besides the welfare of the patient, several billing codes have now been approved that allow the prescriber to be reimbursed for providing screening and brief intervention services.[16] When to Consider Co-Prescription The Centers for Disease Control and Prevention now recommends that prescribers of opioids consider a naloxone co-prescription if a patient’s opioid dosage exceeds 50 morphine milligram equivalents per day.[9] This should not be the only time that a dentist considers co-prescription of naloxone, since there are many pa-

tients who are at risk of opioid misuse or abuse and can be identified through screening. Additionally, naloxone co-prescription is recommended for individuals with a history of opioid overdose or substance abuse disorder, those taking benzodiazepines with opioids, those with respiratory conditions, those with mental health disorders and those who are at risk for using high-dose opioids when they are no longer tolerant.[11] Ideally, the co-prescription of naloxone should be considered for every patient. Even if the patient is safely taking the opioids prescribed, the main sources for obtaining prescription drugs that are used for non-medical reasons are through family and friends. Patients have a right to be able to help save someone from an overdose.[5] Overdose Education and Naloxone Distribution Patient education is extremely important. Many patients fear that if they are prescribed naloxone and go to fill it, people will assume they are an opioid drug abuser. Through education, dentists can mitigate patients’ fears of being stigmatized and can provide them with potentially lifesaving information. In addition to how to dispense naloxone, drug overdose prevention, recognition and response should be taught. In fact, one study found that implementation of overdose education and naloxone distribution (OEND) in communities was associated with lower rates of opioid-related deaths from overdose.[4]

Dentists should consider educating patients about the benefits and uses of naloxone and prescribing naloxone to the patient of record.[19] Additionally, education of patients should include what to do with prescribed opioids after they are no longer needed for pain management. In one study, 72 percent of participants who were prescribed an opioid had leftover medication, and 71 percent of those with leftover medication kept it, creating potential for drug misuse in the future.[5] It behooves the dental professional to educate not only their patient on the proper use and disposal of opioids and naloxone, but also the patient’s friends and family if they are present with the patient. As an alternative, encourage the patient to inform them themselves.

Part of the education process for family members and friends should include encouragement to obtain naloxone from their pharmacist or through insurance in order to be prepared should someone misuse the prescription.[7] In fact, any person concerned for a loved one can obtain naloxone from their local pharmacy in every state without a prescription.[7] It is also beneficial to remind the patient that he or she can call with questions about the opioid or naloxone and its administration; a prescriber can also offer this service to friends and family. After all, the person who has overdosed is incapable of using naloxone to save themselves.

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Support Insurance Coverage of Naloxone Beyond what can be accomplished in an office setting, it is important that dentists support insurance coverage of naloxone.

Though naloxone may be co-prescribed with opioids, it is still up to the patient to fill the prescription. Without proper education about the benefits of naloxone, many patients may forego filling the naloxone prescription due to added expense of a drug they may not view as beneficial or necessary.

In 2018, patients with commercial insurance had the largest percentage of dispensed naloxone because they did not incur out-of-pocket costs to fill the prescription.[7] Unfortunately, only 42.3 percent of prescriptions for naloxone did not require out-ofpocket costs.[8] That results in a large number of patients who, potentially, will not get naloxone even if it is prescribed due to cost.

Quality Improvement Network for New York State, and Eric A. Wachs, D.M.D., director of oral and maxillofacial surgery, clinical associate professor of dental medicine at Touro College of Dental Medicine, Hawthorne, NY. Queries about this article can be sent to Dr. Rozdolski at doctors@sweetdreamsnewyork.com.

REFERENCES 1.

2.

3.

4.

5.

6.

Support Mandating Co-prescription of Naloxone with Opioids Dentists have a duty to act for the benefit of others according to the Professional Code of Conduct from the American Dental Association and an obligation to use their knowledge for the improvement of dental health and well-being of the public.[18] One way that dentists can act beneficently is to raise awareness of and support laws mandating the co-prescription of naloxone with opioids. A study conducted by Minji Sohn, et al. found that the rate of naloxone dispensing per 100,000 patients increased significantly upon the implementation of legal requirements for naloxone prescription.[17] That is almost 7.75-times more dispensed naloxone compared with not having legal requirements.[17] In fact, states with naloxone access laws had an average of 15% lower incidence of opioid overdose compared with states without those laws.[17] Summary Opioid analgesics play an important role in pain management in the dental profession. Due to the deleterious effects of opioid abuse and misuse, naloxone should be commonly co-prescribed along with the opioid prescriptions. Dentist’s first line of defense for pain management should be nonscheduled pain medications, as well as other forms of non-pharmacologic pain-control management prior to prescribing opioids. However, it is understood that in some circumstances, a patient may require opioid analgesia for proper pain control. If opioid analgesics become necessary, dentists should make it a part of their common practice to write two prescriptions—one for the opioid and one for naloxone. Not only can naloxone help save the life of the patient, but through extension of opioid education and proper naloxone administration, potentially their friends and family as well.

Naloxone is a unique drug in that it provides potentially lifesaving pharmacological benefits, and also provides an opportunity for important conversations with patients regarding education on substance misuse and abuse. p The authors acknowledge contributions to their manuscript made by Anne Myrka, senior director of health care quality improvement and drug safety at IPRO, the Centers for Medicare & Medicaid Services designated Quality Innovation Network-

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7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

Baker JA, Avorn J, Levin R, Bateman BT. Opioid prescribing after surgical extraction of teeth in Medicaid patients, 2000-2010. Journal of the American Medical Association. April 2016;315(15):1653–1654. doi:10.1001/jama.2015.19058.

Binswanger IA, et al. Overdose education and naloxone for patients prescribed opioids in primary care: a qualitative study of primary care staff. Journal of General Internal Medicine 2015;30(12):1837–1844., doi:10.1007/s11606-015-3394-3.

Burris SC, et al. Stopping an invisible epidemic: legal issues in the provision of naloxone to prevent opioid overdose. Drexel Law Review 2009;1:273–340., doi:10.2139/ssrn.1434381.

Coffin PO. Preliminary evidence of health care provider support for naloxone prescription as overdose fatality prevention strategy in New York City. Journal of Urban Health: Bulletin of the New York Academy of Medicine 2003;80(2):288–290., doi:10.1093/jurban/jtg031.

Denisco RC, et al. Prevention of prescription opioid abuse. The Journal of the American Dental Association 2011;142(7):800–810., doi:10.14219/jada.archive.2011.0268.

Evzio (naloxone hydrochloride injection) auto-injector [Package insert]. Richmond, VA: Kaleo, Inc.; October, 2016.

Getting Narcan is Simple. (2020, June). Narcan.Com. https://www.narcan.com/patients/how-to-get-narcan/ Guy GP, Haegerich TM. Evans ME, Losby JL, Young R, Jones CM. (2019, August 6). Vital Signs: PharmacyBased Naloxone Dispensing – United States, 2012 – 2018. Retrieved from https://www.cdc.gov/mmwr.

Kerr D, Kelly A, Dietze P, Jolley D, Barger B. Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose. Addiction 2009; 104: 2067-2074. doi:10.1111/j.1360-0443.2009.02724.x Levy B, Paulozzi L, Mack KA, Jones CM. (September 2015). Trends in opioid analgesicprescribing rates by specialty, U.S., 2007-2012. American Journal of Preventive Medicine September 2015;49(3):409 – 413. https://doi.org/10.1016/j.amepre.2015.02.020.

Massachusetts Department of Public Health: Screening, Brief Intervention and Referral to Treatment Screening Toolkit June 2012.

Naloxone: Drug information. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA. (Accessed on August 31, 2020).

Naloxone: The Opioid Reversal Drug That Saves Lives. U.S. Department of Health and Human Services, 2019, www.hhs.gov/opioids/sites/default/files/2018-12/naloxone-coprescribing-guidance.pdf.

Narcan (naloxone hydrochloride) nasal spray [Package insert]. Plymouth Meeting, PA: Adapt Pharma, Inc. March 2020.

Paulozzi LJ, et al. A national epidemic of unintentional prescription opioid overdose deaths: how physicians can help control it. The Journal of Clinical Psychiatry 2011;72(05):589– 592., doi:10.4088/jcp.10com06560.

SBIRT Financing. SAMHSA-HRSA Center for Integrated Health Solutions, Substance Abuse and Mental Health Service Administration, 2019, https://www.integration.samhsa.gov/ clinical-practice/sbirt/financing.

Sohn M, et al. Association of Naloxone Coprescription Laws with Naloxone Prescription Dispensing in the United States. JAMA Network Open, vol. 2, no. 6, 2019, doi:10.1001/ jamanetworkopen.2019.6215.

ADA Principles of Ethics and Code of Professional Conduct, American Dental Association, 2019, https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conduct.

Understanding Naloxone. Harm Reduction Coalition, 2019, harmreduction.org/issues/ overdose-prevention/overview/overdose-basics/understanding-naloxone/.

Volkow ND, McLellan TA, Cotto JH. Characteristics of opioid prescriptions in 2009. Journal of the American Medical Association April 2011;305 (13): 1299–1301. doi:10.1001/jama.2011.401.

Walley AY, et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. Bmj 2013;346(30):5. doi:10.1136/bmj.f174.

Dr. Maas

Dr. Rozdolski

Madeleine Maas, D.D.S., is a general practice resident at Jersey Shore University Medical Center, Neptune City, NJ. Raquel M. Rozdolski, D.M.D., is director of anesthesia and pain control, Touro College of Dental Medicine, Hawthorne, NY. She is a diplomate of the American Dental Board of Anesthesiology.

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oral surgery

Papillon-LeFevre Syndrome A Case Study of Two Siblings Babak Bina, D.M.D.; Boris Zats, D.D.S.; Tom Rubinstein, D.M.D.

ABSTRACT Papillon-LeFevre syndrome (PLS) is a rare, autosomal recessive disease associated with palmar-plantar hyperkeratosis and premature loss of both deciduous and permanent teeth. Treatment of this disease continues to be a challenge to the medical and dental professions. The following is a case report of two siblings of Chinese origin diagnosed with Papillon-LeFevre syndrome who were followed for 10 subsequent years.

In 1924, Papillon and LeFevre described a syndrome that was associated with diffuse hyperkeratosis of the palms of the hands and soles of the feet and destruction of periodontium, with premature loss of the primary and permanent dentition.[1] Papillon-LeFevre syndrome (PLS) is an autosomal, recessive disease with a prevalence of one to three per million and no apparent racial or gender preference.[2] More cases are being reported every year around the world, as physicians and dentists increase their knowledge of this disease.

PLS periodontal involvement manifests itself with the eruption of primary teeth and their subsequent early exfoliation by the age of 4 or 5. Gingival inflammation and breakdown reappear with eruption of the permanent teeth.[3,4]

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Mutation of Cathepsin C in the chromosomal region 11q14 has been associated with PLS disease presentation,[5,6] and pathogenesis of the disease has been related to Cathepsin C’s capacity to activate neutrophil elastase (NE), Cathepsin G (CG), Proteinase 3 (PR3) and neutrophil serine proteinase 4 (NSP4).[1,7] The treatment of this disease has remained unsuccessful for decades. Usually, all of the erupted permanent teeth are lost, with patients having full upper and lower dentures by age 13 or 14. A few case presentations have been published regarding the use of dental implants; however, information regarding long-term prognosis is limited.[8-10] In this paper, we present the cases of two siblings diagnosed with PLS, describe their comprehensive medical and dental care, and discuss possible treatment options based on their clinical and microbiological situation.

Case History Two siblings of Chinese origin—a 13-year-old boy (Patient B) and a 12-year-old girl (Patient G)—were referred to NYU Langone Health, Brooklyn, NY, by a private general dentist with the diagnosis of localized aggressive periodontitis (AgP), a condition characterized by alveolar bone loss and pocket formation affecting first molars and incisors.[11] Due to limited evidence and lack of pathophysiological uniqueness, AgP is not considered a sepa-

Figure 1. Plantar hyperkeratosis in Patient G.

Figure 2. Hyperkeratosis of elbow in Patient B.

rate disease from chronic periodontitis but, rather, an aggressive manifestation in susceptible individuals. Thus, with the publication of the 2017 periodontal classification,[12] the phenotypical presentation of AgP falls under the Grade C modifier.

As for the medical status of the remaining members of the immediate family, out of the four children in the family, the two remaining older siblings exhibit no signs of this syndrome. The parents are not related, and they deny any family history of such a condition.

Upon careful clinical examination, plantar and palmar hyperkeratosis was observed in both siblings, with additional hyper-

DDS match.com

Figure 3. Gingival hyperplasia in Patient G.

keratosis on their knees and elbows. (Figures 1, 2). According to their parents, the hyperkeratosis was noted soon after birth and has continued throughout their lives. They said the eruption of the primary teeth was normal; however, soon after eruption, the gingiva became inflamed and exfoliation of teeth began.

Histological analysis of punch biopsies taken from the dorsum of the wrist showed marked hyperkeratosis, with acanthosis of epidermis and hyperplasia of the granular layer. These findings are consistent with palmoplantar keratoderma (PPK) Group. Papillon-LeFevre syndrome is a type of PPK known to be associated with severe periodontal disease.

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Further examination revealed hyperkeratosis on the skin in the gluteal region in Patient B. Sonogram of testicles showed that the right testis was localized in the right groin rather than in the scrotal sac and was smaller in size than on the left side. Left testis was in scrotal sac. Both testes were normal in echogenicity.

Cytogenic findings with G-banding showed an apparently normal 46, xx karyotype in Patient G and normal 46, xy karyotype in Patient B. Skull series in both patients were normal, with no signs of abnormal intracranial calcification or fracture.

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Hematologic analysis revealed a high level of alkaline phosphatase (pt. B=331 u/l and pt. G=366 u/l) when compared to normal range, which is still considered to be compatible with the patients’ age.

IgG, IgM, IgA immunoglobins were in normal range in both patients.

Oral examination and radiographic evaluation of Patient G revealed 80% to 90% bone loss around incisors and first molars, with mandibular central incisors exfoliated on their own. Although premolars and canines were not fully erupted, radiographic bone loss (between 20% and 30%) was apparent. Severe gingival hyperplasia of both buccal and lingual surfaces, with the exception of the mandibular incisor area, was noted; the mandibular-incisor region presented with clinically normal gingival tissue (Figure 3). Suppuration was present around the incisors and maxillary molars.

Oral examination and radiographic evaluation of Patient B revealed more than 90% bone loss around the incisors and molars, with mandibular central incisors exfoliated on their own. Premolars and canines were erupted, presenting 30% to 40% bone loss. Generalized, severe gingival hyperplasia was noted on both buccal and lingual aspects of the dentition, with bleeding upon palpation and probing noted. Gingiva appeared clinically healthy around lower central incisors where teeth were lost. Suppuration was present around incisors and maxillary molars.

An oral microbiological sample was taken from both patients and sent to University of Pennsylvania School of Dental Medicine for microbiological assessment by culture and indirect immunofluorescent.

In Patient G, intraoral plaque sampling was conducted from the mesial palatal surface of the maxillary left second premolar (tooth #13). Microbial analysis revealed elevated levels of Aggregatibacter actinomycetemcomitans (A.a.), which

showed resistance to tetracycline-HCl, penicillin G and metronidazole. Elevated levels of P. intermedia, C. rectus, P. gingivalis (P.g.) and T. forsythia were also noted (Table 1).

In Patient B, intraoral plaque sampling was acquired from the buccal aspect of the maxillary right central incisor (tooth #8). Microbial analysis revealed high levels of A.a that was resistant to tetracycline-Hcl and metronidazole.

The sample from patient B also showed high levels of Peptostreptococcus micros, T. forsythia and Gram-negative rods species. (Table 2).

High levels of A.a, P. intermedia, C. rectus, T. forsythia, P.g., and Gram-negative rods species are indicative of severe periodontal disease. Furthermore, antibiotic sensitivity testing revealed lower antibiotic efficacy, suggesting that conventional antibiotic therapy might not be successful in these patients (Tables 1,2).

Figure 4. Normal XX karyotype in patient G.

Treatment Right orchiectomy was performed on Patient B under general anesthesia to address the undescended right testicle. Both patients initially received full-mouth scaling and root planing, and they continued to receive periodontal maintenance approximately every other month.

Initially, hopeless teeth in both upper and lower arch (incisors and first molars) were extracted in both patients, with fabrication of upper and lower transitional partial dentures replacing missing teeth.

After two years, all of the remaining teeth were extracted due to severe bone loss, and upper and lower complete dentures were fabricated.

Both patients were placed on isotretinoin, which produced significant improvement in palmar and plantar hyperkeratosis.

All risks and benefits were explained to the patients prior to oral retinoid treatment (Figure 6).

Discussion Papillon-LeFevre syndrome is known to be associated with premature loss of both deciduous and premature teeth. Other diseases in children that are involved in early alveolar bone loss are: agranulocytosis; cyclic neutropenia; juvenile diabetes; leukemia; actalasia; hypophosphatasia; histocytosis x; and Haim-Munk syndrome.[13] From all of the above conditions, the only other disorder that is associated with diffuse palmoplantar hyperkeratosis in addition to Papillon-LeFevre syndrome is Haim-Munk syndrome. In contrast to Papillon-LeFevre syndrome, in patients with Haim-Munk disorder, the periodontium is less affected and hyperkeratosis is accompanied by arachnodactyly and deformity of the terminal phalanges.[14] Although the palmoplantar keratosis and destruction of periodontal disease are always present in Papillon-LeFevre syndrome,

Figure 5. Normal XY karyotype in patient B.

Figure 6. Resolution after treatment on Isotretinoin.

some of these patients have a variety of other conditions, such as susceptibility to infections,[15] intracranial calcifications[16] and retardation of somatic development.[10,17] The PLS locus has been mapped to chromosome 11q14, where the gene (CTSC) encoding for lysosomal protease cathepsin C lies.

[4,18] A dysfunctional CTSC message will yield a deficiency in Cathepsin C, an important proteinase responsible for intracellular degradation of proteins and activation of serine proteases in inflammatory cells.[19] NE, CG, PR3, NSP4 are granular-associated serine proteinases of neutrophils that are activated by Cathepsin C via N-terminal trimming during biosynthesis. Very small quantities or absence of these serine proteinases has been reported in patients with PLS.[1,7] Without these serine proteinases, the host’s ability to kill periodontal bacteria is diminished.[20] It is important to note that the total number of neutrophils in individuals with PLS are not elevated, but these neutrophils are considered hyperactive, releasing increased amounts of pro-inflammatory cytokines.

Thus, neutrophils in PLS will arrive to answer a bacterial challenge but they are unable to kill the periodontal bacteria effectively therefore exacerbating local inflammation even further by signaling for the recruitment of more, equally deficient neutrophils to the site.[21] Previous studies have reported an increased presence of gram-negative anaerobic pathogens, such as P.g, Capnocytoph-

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aga, Spirochetes, and A.a in individuals with PLS.[22,23] Microbiome assessment of the two patients presented in this report is consistent with previously published data. While these are common periodontal pathogens, their increased presence in PLS patients can be compared to that microbiome previously described in individuals historically diagnosed with AgP. Furthermore, comparisons can be made due to the similar neutrophil dysfunction[24,25] found in both conditions and a possible AgP-specific microbiome profile.[26,27]

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It is important to note, however, that periodontitis found in individuals with PLS is thought to be a systemic manifestation of the disease, as described by Albandar,[13] where individuals diagnosed with Grade C periodontitis (or an AgP phenotype) often respond positively to periodontal therapy, which aims to eliminate or reduce the amount of periodontal pathogens positively; individuals with PLS do not.

Treatment of PLS is a challenge to the medical and dental profession. Multiple therapeutic approaches have been proposed over the years; none has been consistently successful. Cases have been reported in which stringent plaque control and recall periods as frequent as two weeks were enacted, yet periodontal degradation often continued.[23] Complete extraction of deciduous teeth has also been attempted, in hopes that a complete edentulous period before eruption of permanent teeth would decrease the rate of periodontal breakdown, but that, too, has yielded inconsistent results.[28] Patients are often left with complete maxillary and mandibular dentures by their late teens; however, severely atrophic and thin alveolar ridges make the stability of complete upper and lower dentures very difficult in these patients.

Advancements in implants in the past 20 years have opened another treatment option for these patients. Implant osseointegration does not seem to be affected by the deficiency of cathepsin C in PLS,[8-10] yet information is limited regarding the complication rate in these individuals. Clinicians should proceed with caution. Even with different etiology, individuals with AgP and LPS appear to share a defective immunological response and retarded ability to answer to a bacterial challenge. AgP has been shown to increase risk of future peri-implantitis by 14-times[29] and a four-fold increased risk for implant failure.[30] It would be prudent to believe that implants in LPS patients would see a similar if not higher risk.

For the treatment of skin lesions, limited success has been achieved with oral retinoids with etretinate, a second-generation retinoid commonly used to treat severe psoriasis. Typically, clearance of skin lesions starts within 8 to 10 weeks of onset of etretinate course, with complete clearance of palmoplantar keratoderma after 10 to 12 weeks.[4] Oral retinoids only suppress and do not revert the keratinization. They should be given in long-term, full doses until complete resolution of the lesions has been obtained. Less than half a dose should be given for maintenance for periods up to three years.[4,11] Prior to start of therapy, it is important to ensure the patient is not pregnant, as exposure to retinoids during pregnancy can result in fetal retinoid syndrome. Patient G completed a pregnancy test before onset of her retinoid therapy.

In this study, though intracranial classification and increased susceptibility to infection were not present, somatic retardation was noticed in Patient B. Also, due to the resistance of some bacteria to tetracycline-Hcl, metronidazole and penicillin G, antibiotic therapy was not used. Therefore, the treatment approach was extraction of hopeless teeth, professional scaling, fabrication of dentures and use of oral retinoids. Significant improvement in palmar and plantar hyperkeratosis was noticed after use of isotretinoin (Figure 8). Both patients eventually lost all of their teeth and had maxillary and mandibular complete dentures fabricated. Although the option of implants at no cost was given, both patients refused. p

13.

Queries about this article can be sent to Dr. Bina at Babak.Bina@NYULangone.org.

29.

REFERENCES

30.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

Papillon M, Lefevre P. Two cases of symmetrically familial palmar and plantar hyperkeratosis (Meleda disease) within brother and sister combined with severe dental alterations in both cases. Bull Soc Fr Dermatol Syphiligr 1924;31(2): 82-87.

Haneke E. The Papillon-Lefèvre syndrome: keratosis palmoplantaris with peiodontopathy.

Report of a case and review of the cases in the literature. Hum Genet 1979;51(1):1-35.

Fischer J, et al. Mapping of Papillon-Lefevre syndrome to the chromosome 11q14 region.

Eur J Hum Genet 1997;5(3):156-60.

Hart TC, et al. Mutations of the cathepsin C gene are responsible for Papillon-Lefèvre syndrome. J Med Genet 1999;36(12):881-7..

Rao NV, Rao GV, Hoidal JR. Human dipeptidyl-peptidase I. Gene characterization, localization, and expression. J Biol Chem 1997; 272(15):10260-5.

Gelmetti C, et al. Long-term preservation of permanent teeth in a patient with PapillonLefèvre syndrome treated with etretinate. Pediatr Dermatol 1989;6(3):222-5. el Darouti MA, Al Raubaie SM,, Eiada MA. Papillon-Lefèvre syndrome. Successful treatment with oral retinoids in three patients. Int J Dermatol 1988;27(1):63-6.

Etöz OA, Ulu M, Kesim B. Treatment of patient with Papillon-Lefevre syndrome with short dental implants: a case report. Implant Dent 2010;19(5):394-9.

Quirynen M, Van Assche N. Microbial changes after full-mouth tooth extraction, followed by 2-stage implant placement. J Clin Periodontol 2011;38(6) 581-9.

Senel FC, et al. A 3-year follow-up of the rehabilitation of Papillon-Lefèvre syndrome by dental implants. J Oral Maxillofac Surg 2012;. 70(1):163-7.

Adbulwassie H, Dhanrajani PJ, Jiffry A. Papillon-Lefèvre syndrome. Reappraisal of etiology, clinical features and treatment. II. Oral rehabilitation using osseointegrated implants. Indian J Dent Res 1996; 7(2):63-70.

Papapanou PN, et al. Periodontitis:consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

J Clin Periodontol 2018;45 Suppl 20:S162-S170.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

Jepsen S, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol 2018;89 Suppl 1:S237-S248.

Ullbro C, et al. Osseointegrated implants in a patient with Papillon-Lefèvre syndrome: a 4½-year follow-up. Journal of Clinical Periodontology: Case Report 2000;27(12):951-954.

Woo I, et al. Dental implants in a young patient with Papillon-Lefevre syndrome: a case report. Implant Dent 2003;12(2):140-4.

Global Burden of Disease (GBD) 2015 Mortality and Causes of Death Collaborators, Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388(10053):1459-1544.

Bergman R, Friedman-Birnbaum R. Papillon-Lefèvre syndrome: a study of the long-term clinical course of recurrent pyogenic infections and the effects of etretinate treatment. Br J Dermatol 1988;119(6): 731-6.

Toomes C, et al. Loss-of-function mutations in the cathepsin C gene result in periodontal disease and palmoplantar keratosis. Nat Genet 1999; 23(4):421-4.

Bullon P, et al. Late onset Papillon-Lefèvre syndrome? A chromosomic, neutrophil function and microbiological study. J Clin Periodontol 1993;20(9):662-7.

Eick S, et al. Lack of cathelicidin processing in Papillon-Lefevre syndrome patients reveals essential role of LL-37 in periodontal homeostasis. Orphanet J Rare Dis 2014;9:148.

Roberts H, et al. Characterization of neutrophil function in Papillon-Lefevre syndrome. J Leukoc Biol 2016;100(2):433-44.

Van Dyke TE. Neutrophil receptor modulation in the pathogenesis of periodontal diseases.

J Dent Res 1984;63(3): 452-4.

De Vree H, Steenackers K, De Boever JA. Periodontal treatment of rapid progressive periodontitis in 2 siblings with Papillon-Lefèvre syndrome: 15-year follow-up. J Clin Periodontol 2000;27(5):354-60.

Van Dyke TE, et al. Neutrophil chemotaxis in families with localized juvenile periodontitis.

J Periodont Res 1985;20(5):503-14.

Gronert K, et al. A molecular defect in intracellular lipid signaling in human neutrophils in localized aggressive periodontal tissue damage. J Immunol 2004;172(3):1856-61.

Haubek D, et al. Risk of aggressive periodontitis in adolescent carriers of the JP2 clone of Aggregatibacter (Actinobacillus) actinomycetemcomitans in Morocco: a prospective longitudinal cohort study. Lancet 2008;371(9608):237-42.

Chahboun H, et al. Bacterial profile of aggressive periodontitis in Morocco: a cross-sectional study. BMC Oral Health 2015;15:25.

Glenwright HD, Rock WP. Papillon-Lefevre syndrome. A discussion of aetiology and a case report. British Dental Journal 1990;168(1):. 27-29.

Swierkot K, et al. Mucositis, peri-implantitis, implant success, and survival of implants in patients with treated generalized aggressive periodontitis: 3- to 16-year results of a prospective long-term cohort study. J Periodontol 2012; 83(10):1213-25.

Monje A, et al. Generalized aggressive periodontitis as a risk factor for dental implant failure: a systematic review and meta-analysis. J Periodontol 2014. 85(10):1398-407.

Dr. Bina

Dr. Zats

Dr. Rubinstein

Babak Bina, D.M.D., is director of the GPR program at NYU Langone Health, Brooklyn, NY. Boris Zats, D.D.S., is cochair of oral maxillofacial surgery at NYU Langone Health, Brooklyn, NY. Tom Rubinstein, D.M.D., is a periodontics resident at Columbia University College of Dental Medicine, New York, NY.

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periodontics

Treatment of Peri-implant Soft-tissue Deficiency around a Narrow Diameter Implant with Subepithelial Connective-tissue Graft A Case Report Jaewon Kim, D.D.S., M.S., Ph.D.; Abhiram Maddi, D.D.S., M.Sc., Ph.D.

ABSTRACT Narrow diameter implants and mini-implants are preferred by dentists for restoration of missing teeth on narrow ridges. However, such implants are associated with long-term complications, including softtissue deficiencies. This case report describes a novel approach using a connective-tissue graft to resolve peri-implant mucositis. A 66-year-old male patient presented with inflammation and abscess in relation to a mini-implant at the upper left incisor on the facial aspect. Deficiencies of keratinized tissue and width of attached gingiva were observed. Surgical management was performed using subepithelial connective tissue.

An 18-month follow-up showed increased width of attached gingiva at the surgical site.

Narrow-diameter implants with diameters of less than 3 mm have been a popular treatment modality.[1] Currently, strong, longterm data on survival of narrow diameter implants is lacking.[2] Connective-tissue grafts for esthetic improvement around both teeth and peri-implant tissue are widely known.[3-5] However, us-

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ing this technique for the direct treatment of pathologic reaction around narrow-diameter implants has never been reported.

The purpose of this case report is to show that the inflammation associated with a mini-implant can be effectively managed with an autogeneous connective-tissue graft without removing the implant.

Case Report Clinical Presentation A 66-year-old retired Caucasian male patient was referred to the Department of Periodontics, School of Dental Medicine, University at Buffalo, for evaluation of #7 implant. Patient was a nonsmoker, and his medical history was significant for Type II diabetes, hypertension, bilateral orthopedic knee joint replacement, kidney stone removal surgery and bowel section surgery, due to blockage in the colon. The patient’s BMI was 29.8. The patient’s list of medications is presented in Table 1.

The patient’s previous history revealed that in 2015, #7 had a horizontal fracture and was extracted (Figures 1a, 1b). However, the patient decided to get a narrow diameter implant from a private practice; the implant was in service for three years. An Xray revealed that there was slight bone loss extending to the first thread of the implant, along with poor crown gingival contour (Figures 1c, 1d). Periodontal examination revealed generalized

plaque deposition; most of the teeth exhibited 2 mm to 3 mm probing depth (PD), with mild bleeding on probing (BOP), with the exception of PD 4 mm and heavy BOP at mesial and distal of labial #7 implant.

Underneath the saddle type of the implant crown, heavy plaque accumulation was noted, along with redness, slight swelling and suppuration. Soft-tissue dehiscence and draining abscess in the mid-facial aspect were observed, creating an esthetic problem. The width of the keratinized tissue was observed to be 1 mm to 2 mm. However, the peri-implant inflammation extended to the mucogingival junction, indicating a lack of attached gingiva.

This information was pertinent for a diagnosis of peri-implant mucositis and soft-tissue deficiency according to the 2018 classification by the American Academy of Periodontology.[6,7] The patient was given the option of replacing the implant and restoration but he declined. Initial therapy included oral hygiene instruction and scaling and root planing. At re-evaluation after four weeks, suppuration and inflammation had resolved mildly, but persistent dehiscence was noticed. Hence, surgical treatment using subepithelial connective-tissue (CT) grafting was considered.

Case Management Local anesthesia was administered using infiltration (Figure 2a).

Sulcular incision below the crown margin was made from mesial of #6 to distal of #8, labial side only (Figure 2b). A full-thickness labial flap was reflected using a periosteal elevator (Figure 2c).

Granulation tissue was removed using surgical curettes. An exposed implant thread was seen after thorough debridement and saline irrigation, and bone loss was rather horizontal, with no possibility for regenerative procedure (Figure 2d).

A 7 mm x 10 mm connective-tissue graft with thickness of 3 mm was harvested, using the patient’s palate as a donor site (Figure 2e). The donor site was closed with resorbable sutures (Vicryl, Ethicon Inc., Somerville, NJ) and hemostasis was achieved. The graft was de-epithelialized and adipose tissue was removed. The graft was wrapped around a mini-implant and secured to the labial flap with suture (Polypropylene Surgical Sutures, Unify, Denver, CO) using two simple interrupted sutures (Figure 2f). The flap was coronally advanced using resorbable sutures (Vicryl, Ethicon Inc., Somerville, NJ) (Figure 2g). The patient was instructed to take a non-steroidal anti-inflammatory drug (ibuprofen, USP, 600 mg, Dr. Reddy’s Laboratories LA LLC, Shreveport, LA) for three days. He was advised not to brush or floss at the surgical site for six weeks.

Clinical Outcomes After one week, postoperative evaluation was performed. It was observed that the connective-tissue graft was exposed facially and appeared necrotic (Figure 3a). However, in three weeks, the pa-

Figure 1. Preoperative radiographic analysis. 1a: Horizontal crown fracture of #7 was identified. 1b: Dental extraction was done. 1c & 1d: Three years later, patient appeared with narrow-diameter implant on previously extracted site.

Figure 2. Surgical procedure. 2a: Patient appeared with fistula tract and inflammation around #7 peri-implant gingiva. 2b: Using #15c blade and Orban interdental knife, intrasulcular incision was done. 2c: Full thickness flap was reflected, exposing granulation tissue underneath implant crown. 2d: After curettage with Gracey curette, implant thread was exposed. 2e: Connective tissue from palate was harvested, 7 mm x 10 mm in size. 2f: Connective tissue covered entire implant to augment lost volume of tissue. 2g: After graft was secured to labial tissue with simple interrupted suture, coronal sling suture was done.

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tient showed almost complete healing, with a slight defect in the mesial papilla of #7 (Figure 3b). Sutures were removed and oral hygiene instructions were reinforced.

At six weeks after surgery, slight inflammation was observed in the peri-implant tissue at the implant crown margin (Figure 3c). Following initial evaluation, the patient was placed on a supervised six-month recall schedule with a hygienist. At six months, complete healing was observed, with a slight defect on mesial papilla (Figure 3d). The patient was instructed to brush using a periodontal proxabrush.

After 11 months, gradual filling of the mesial defect of the papilla was observed at the site (Figure 3e). After 18 months, the

Figure 3. Postoperative wound healing. 3a: One week postop. 3b: Three weeks postop. 3c: Six weeks postop. 3d: Five months postop; defect on mesial papilla is seen. 3e: 11 months postop; gradual filling of mesial papilla. 3f & 3g: 17 months postop; mesial papilla defect was almost filled and palatal tissue looked healthy. 3h: Healing of palatal donor site after 3 weeks (left) and 17 months (right).

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regained volume of tissue on the labial side of #7 implant was almost close to the original dimension (Figures 3f, 3g). The tissue not only looked healthy, but the increase in keratinized tissue and width of the attached gingiva were obvious, indicating a successful outcome. In addition, the patient’s palatal tissue also healed completely (Figure 3h). The patient was using floss and a smallsize interproximal brush to clean underneath the implant crown, and reinforced oral hygiene instruction was given.

Discussion and Conclusions There are many proposed factors for initiation of peri-implant mucositis and peri-implantitis, such as a patient’s systemic condition and habits, including obesity, diabetes and smoking.[8-10] The effect of lack of keratinized gingiva around dental implants on peri-implant inflammation is a controversial topic.[11-13] Narrow-diameter implants can be exposed to more stress due to lower fracture resistance.[14] Another disadvantage could be the over-contouring of the implant crown, making the abrupt volume transition from alveolar crest to crown margin of the gingival area, which opposes the favorable biologic tissue contour.

This may lead to plaque accumulation, resulting in abscess and chronic inflammation.

In this report, the patient had poor oral hygiene and plaque accumulation. The retention of plaque underneath the saddletype crown, which was fabricated for esthetic purpose, eventually led to inflammation of the peri-implant tissues and abscess formation. There is strong evidence that poor plaque-control skills are related to initiation of peri-implant mucositis and peri-implantitis.[15]

13.

14.

15.

16.

17.

Figure 4. Preoperative and postoperative comparison of treatment site. 4a: baseline 4b: 17 months later, patient gained 3 mm of attached gingiva.

A connective-tissue graft around peri-implant lesions is a wellevidenced approach.[16-18] The placement of connective tissue around an implant is usually utilized for esthetic and functional purposes and is not considered a main intervention method to resolve inflammation. This case report shows that simultaneous resolution of inflammation, in association with the connectivetissue graft, allows treatment of peri-implant inflammation confined to narrow-diameter implant. p The authors declare they have no conflicts of interest and that no author received any monetary compensation for this manuscript. Queries about this article can be sent to Dr. Maddi at maddi@musc.edu.

REFERENCES 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

Al-Johany SS, Al Amri MD, Alsaeed S, Alalola B. Dental implant length and diameter: a proposed classification scheme. J Prosthodont 2017;26(3):252-260.

Schiegnitz E, Al-Nawas B. Narrow-diameter implants: a systematic review and meta-analysis. Clin Oral Implants Res 2018;29 Suppl 16:21-40.

Zucchelli G, Tavelli L, McGuire MK, Rasperini G, Feinberg SE, Wang HL, Giannobile WV. Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction. J Periodontol 2020;91(1): 9-16.

Chambrone L, Salinas Ortega MA. Sukekava F. Rotundo R, Kalemaj Z, Buti J, Pini Prato GP. Root coverage procedures for treating localised and multiple recession-type defects.

Cochrane Database Syst Rev 2018Oct 2;10(10):CD007161.

Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol 2015;86(2 Suppl):S8-51.

Cairo F, Barbato, L, Selvaggi, F, Baielli, MG, Piattelli A., Chambrone L. Surgical procedures for soft tissue augmentation at implant sites. A systematic review and meta-analysis of randomized controlled trials. Clin Implant Dent Relat Res 2019;21(6):1262-1270.

Caton JG, Armitage G, Berglundh T, Chapple I.LC, Jepsen S, Kornman, KS, Mealey BL, Papapanou PN, Sanz M, Tonetti, MS. A new classification scheme for periodontal and periimplant diseases and conditions - Introduction and key changes from the 1999 classification. J Periodontol 2018;89 Suppl 1:S1-S8.

Renvert S, Persson GR, Pirih, FQ, Camargo PM. Peri-implant health, peri-implant mucositis, and peri-implantitis: Case definitions and diagnostic considerations. J Periodontol 2018; 89 Suppl 1: S304-S312.

Al-Shibani N, Al-Aali KA, Al-Hamdan RS. Comparison of clinical peri-implant indices and crestal bone levels around narrow and regular diameter implants placed in diabetic and nondiabetic patients: a 3-year follow-up study. Clin Implant Dent Relat Res 2019;21(2):247-252.

Alshiddi IF, Alsahhaf A, Alshagroud, RS, Al-Aali KA, Vohra F, Abduljabbar T. Clinical, radiographic, and restorative peri-implant measurements of narrow and standard diameter implants in obese and nonobese patients: a 3-year retrospective follow-up study. Clin Implant Dent Relat Res 2019;21(4): 656-661.

Alghamdi O, Alrabiah M, Al-Hamoudi N, AlKindi M. Peri-implant soft tissue status and crestal bone loss around immediately-loaded narrow-diameter implants placed in cigarettesmokers: 6-year follow-up results. Clin Implant Dent Relat Res 2020;22(2):220-225.

Frisch E, Ziebolz D, Vach K, Ratka-Krüger P. The effect of keratinized mucosa width on peri-implant outcome under supportive postimplant therapy. Clin Implant Dent Relat Res 2015;17 Suppl 1:e236-44.

18.

Rosen PS. The merit to phenotypic modification treatment for dental implants: two case reports. Clin Adv Periodontics 2020.

Santoro M, Awosika T, Snodderly K, Hurley-Novatny A, Laerman M, Fisher J. Endothelial/mesenchymal stem cell crosstalk within bioprinted cocultures. Tissue Eng Part A 2020;26(5-6):339-349.

Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Periodontol 2018;89 Suppl 1:S267-S290.

Schwarz F, Sahm N, Becker J. Combined surgical therapy of advanced peri-implantitis lesions with concomitant soft tissue volume augmentation. A case series. Clin Oral Implants Res 2014;25(1):132-6.

Thoma DS, Naenni N, Figuero E, Hämmerle CHF, Schwarz F, Jung RE, Sanz-Sánchez I. Effects of soft tissue augmentation procedures on peri-implant health or disease: a systematic review and meta-analysis. Clin Oral Implants Res 2018;29 Suppl 15:32-49.

Tomasi C, Regidor E, Ortiz-Vigón A, Derks J. Efficacy of reconstructive surgical therapy at peri-implantitis-related bone defects. A systematic review and meta-analysis. J Clin Periodontol 2019;46 Suppl 21:340-356.

Dr. Kim

Dr. Maddi

Jaewon Kim, D.D.S., M.S., Ph.D., is in the Department of Periodontics and Endodontics, School of Dental Medicine, University at Buffalo, Buffalo, NY. Abhiram Maddi, D.D.S., M.Sc., Ph.D., is associate professor, Division of Periodontics, Department of Stomatology, Medical University of South Carolina (MUSC), Charleston, SC.

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oral surgery

Simple Lipoma Mimicking Oral Infiltrating Lipoma Case Report Moacyr Tadeu Vincente Rodrigues, D.D.S., Ms.C.; Judson Nascimento Brasil, D.D.S.; Gabriel Albuquerque Guillen, D.D.S., Ms.C.; Cláudio Ferreira Nóia, D.D.S., Ph.D.

ABSTRACT Lipomas are common soft-tissue neoplasms, usually present on the trunk and proximal portions of the extremities and less frequently in the mouth. We report the case of a 51-year-old patient affected by an intra- extraoral swelling for eight months. Aspiration, surgical excision and histopathological examination confirmed that it was a simple oral lipoma, although clinically and surgically, it mimicked an infiltrating lipoma. Conservative surgical treatment, preferably using an intraoral approach, results in less morbidity and less sequelae for patients.

Physical examinations can greatly assist in the differential diagnosis of oral and maxillofacial swellings. When properly indicated, they avoid misdiagnoses and future iatrogenic procedures.

Lipomas are the most common soft-tissue neoplasms. They are of mesenchymal origin, benign and with no gender predilection, but carry a poorly established etiology.[1-4] They are slow-growing, encapsulated and usually asymptomatic, with an evolution ranging from 15 days to 30 years. [1,5,6] Maxillofacial

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lipomas represent about 15% to 20%, and oral lipomas only 1% to 4% of all cases.[4,6] Microscopically, lipomas are classified as simple lipomas, fibrolipomas, spindle cell lipomas, intramuscular or infiltrating lipomas, angiolipomas, salivary gland lipomas, chondroid lipomas, pleomorphic lipomas and myxoid lipomas. The most common is simple lipoma.[2-4] On histology, the simple lipoma is composed of mature adipocytes, subdivided into lobules by fibrous connective-tissue septa.

Infiltrating oral lipomas are extremely rare and appear to be larger and more deeply located than simple lipomas. In the oral and maxillofacial region, they can cause swelling and deformities due to their greater proximity to the skin and/or mucosa.[5,7,8] The aim of this study is to report a case of simple lipoma with the clinical and surgical features of an infiltrating lipoma, excised by intraoral access under local anesthesia.

Case Report A 51-year-old female patient sought treatment with a complaint of a normal-colored, slow-growing, non-tender, soft and mobile mass present in the left genial region for eight months. She reported rare dysesthetic episodes (“shocks”). Medical and dental histories were insignificant (Figures 1, 2).

Figure 1. Clinical inferior view of swelling in left genial region.

A 51-year-old female patient sought treatment with a complaint of a normalcolored, slow-growing, non-tender, soft and mobile mass present in the left genial region for eight months. She reported rare dysesthetic episodes (“shocks”).

Figure 2. Intraoral aspect of swelling in left lower vestibule.

Cone beam computed tomography showed a 4.15 cm x 2.25 cm hypodense, circular image without any bone or tooth erosion (Figure 3).

A needle aspiration was performed with negative result for liquid or semi-solid material, suggestive of a solid lesion. After physical and imaging examination, a surgical exploration under local anesthesia by intraoral approach was performed.

After mucosal incision in the inferior left buccal sulcus, a yellowish lesion, suggestive of a lipomatous lesion, closely related to the mental neurovascular bundle, was observed. An excisional biopsy was carried out based on all of the collected data. The whole lesion was carefully dissected to preserve the mental bundle as best as possible and sent for histopathological examination (Figure 4). The result, interestingly, was identified as a simple lipoma, composed of bundles of mature adipocytes (Figure 5). After six months, the patient returned without any signs of recurrence or mental nerve disturbance (Figure 6).

Discussion In order to preserve anatomical structures and aesthetic features, orofacial lesions should be investigated as soon as possible through physical examination for differential diagnosis.

Large orofacial infiltrating lipomas are not well-encapsulated and can sometimes cause muscle dysfunction or neural symptoms due to the infiltration. This also led surgeons to consider

Figure 3. CBCT showing well-defined, hypodense, oval-shaped image.

Figure 4. Lipomatous lesion fully dissected, preserving mental bundle.

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Figure 5. Histology showing mature adipose tissue.

Figure 6. Clinical inferior view after six months of treatment.

alternative aesthetic surgical approaches, such as intraoral, as shown in this case.[2] A complete histopathological scan of the whole surgical specimen is essential to confirm the diagnosis and rule out an atypical lipomatous tumor/well-differentiated liposarcoma, previously referred to by many as an atypical lipoma.[9] A higher rate of recurrence has been reported in infiltrating lipomas, perhaps attributable to the difficulty of surgical excision.[7-10] Four of the 46 cases studied by Fregnani et al. (2003) diagnosed as infiltrating lipomas did not show recurrence after surgical treatment, and they also presented proliferative characteristics similar to simple lipomas. Interestingly, there is no consensus in the literature as to whether infiltrating lipomas really exist, or whether they are merely lipomas with retained muscle and/or neural fibers. Another point to note is that the reasons for higher rates of recurrence presented by some authors and low rates presented by others are not well-established.[2,6] Considering the lack of consensus regarding the existence of an “infiltrating lipoma,” some cases that have the clinical and surgical aspects of an infiltrating lipoma, histologically would be simple lipomas and vice versa. Further studies are needed to establish better parameters for an accurate diagnosis and to distinguish the biological behavior of different types of lipomas.

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Conclusions Conservative treatment by intraoral surgical excision seems to be a Accounting for Dentistry is all we do. We don’t broker 8. safe and less invasive alternative for the treatment of oral lipomas. practices, sell investments, provide insurance services 9.

The surgery must be planned based on imaging exams to precisely or broker financing. We forgo these commission-based 10. locate the lesion, and during surgical dissection, blunt instruments services in order that our clients have completely are preferable in order to preserve associated anatomical structures. unbiased advice and analysislesions, for allthe aspects their Even in cases of not well-encapsulated clinicalofaspect personal andsurgical business finances. provides a complete removal with a good prognosis. p

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•

Set up and maintain accounting and payroll systems

Pelissier A, Sawaf MH, Shabana AH. Infiltrating (intramuscular) benign lipoma of the head and neck. J Oral Maxillofac Surg 1991;49:1231-6.

Choi HJ, Byeon JY. Symptomatic intraoral submuscular lipoma located nearby mental foramen. J Craniofac Surg 2016;27:e457-9.

Chrisinger JSA. Update on lipomatous tumors with emphasis on emerging entities, unusual anatomic sites, and variant histologic patterns. Surg Pathol Clin 2019;12:21-33.

Kacker A, Taskin M. Atypical intramuscular lipoma of the tongue. J Laryngol Otol 1996;110:189-91.

We understand the business of dentistry.

Providing services throughout New York and New England. www.doctorscpa.com drothstein@doctorscpa.com (518) 851-9016

3.

Dr. Brasil Dr. Guillen Dr. Nóia Rothstein, D.D.S., M.B.A., C.P.A. Member ADA, NYSDA, NYSSCPA and AICPA 2013, https://doi.org/10.1136/bcr-2012-007889.

Moacyr Tadeu Vicente Rodrigues, D.D.S., Ms.C., is oral surgery and oral diagnosis profes• RCP, Analyze prospective contracts, projects, Coelho Oliveira EM, Silva GCC, et al.

Intraoral excision of a huge acquisitions, cheek lipoma. J sor, São Lucas University, Porto Velho-Rondônia, Brazil, and a Ph.D. student in oral and maxillofacial Craniofac Surg 2018;29:e96-e7. partnerships and/or sales surgery, Piracicaba Dental School-UNICAMP, Piracicaba-Sao Paulo, Brazil.

Studart-Soares EC, Costa FW, Sousa FB, et al. Oral lipomas in a Brazilian population: a

4.

Judson Nascimento Brasil, D.D.S., is affiliated with Sao Lucas University, Porto Velho-Rondônia, Brazil.

• Provide comprehensive ongoing analysis of the REFERENCES 1.

Agarwal R, Kumar V, Kaushal A, et al. Intraoral lipoma: a rare clinical entity. BMJ Case Rep financial health of your practice 2.

5.

6.

Studart-Soares EC, Costa FW, Sousa FB, et al. Oral lipomas in a Brazilian population: a 10-year and analysis 450 cases reportedand in the tax literature.

Med Oral Patol Oral Cir • study Provide tax ofpreparation planning services Bucal 2010;15:e691-6.

• MA, Advise new dentists, new practices, start-ups Furlong Fanburg-Smith JC, Childers EL. Lipoma of the oral and maxillofacial region: site and subclassification of 125 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod or successions 2004;98:441-50.

• A, Provide practicelipoma valuation services Piattelli Fioroni M,certified Rubini C. Intramuscular of the cheek: a case report. J Oral Maxillofac Surg 2000;58:817-9.

Fregnani ER, Pires FR, Falzoni R, et al. Lipomas of the oral cavity: clinical findings, histological classification and proliferative activity of 46 cases. Int J Oral Maxillofac Surg 2003;32:49-53.

Dr. Rodrigues Dan

Gabriel Albuquerque Guillen, D.D.S., Ms.C., is a Ph.D. student in oral and maxillofacial surgery, Piracicaba Dental School-UNICAMP, Piracicaba-São Paulo, Brazil.

Cláudio Ferreira Nóia, D.D.S., Ph.D., is oral and maxillofacial surgery professor, Piracicaba Dental School-UNICAMP, Piracicaba-São Paulo, Brazil.

Accounting for Dentistry, C.P.A., P.C. ACCO U NT I NG, AU DI T, CO NS ULTING AND TAX S E RVICE S FO R TH E DE NTAL PROFESSI ON

Accounting for Dentistry, C.P.A., P.C. is a CPA firm created by a dentist for dentists.

b.

Purchasing a practice is one of the most consequential events of your professional career.

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www.doctorscpa.com drothstein@doctorscpa.com (518) 851-9016 Dan Rothstein, D.D.S., M.B.A., C.P.A. Member ADA, NYSDA, NYSSCPA and AICPA

Contact Dr. Rothstein directly and confidentially to discuss any aspect of the due diligence analysis, multi-year projection of results, financing issues, closing process and/or accounting, payroll, tax, compliance and managerial issues relating to the initiation of operations as a new owner.

The New York State Dental Journal

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President Craig E. Smith, D.M.D.

SUFFOLK COUNTY New Leadership William Bast, D.M.D. On January 8, our 2022 leaders were installed. They are: Dr. Craig E Smith, president; Dr. Radha Sachdeva-Munk, president-elect; Dr. Steven Feigelson, vice president; Dr. William G. Bast, secretary; and Dr. John Guariglia, treasurer.

Congratulations to all of the new officers! Come celebrate with us at our Gala on April 9 at the Hamlet Golf and Country Club in Commack.

Stony Brook Four-Week Ethics Course Each Wednesday from 8-10 a.m., starting Feb. 2, Kevin Henner led a team of volunteer members in delivering a dental ethics course at the Stony Brook School of Dental Medicine. Coordinated and supported by Stony Brook faculty Dr. Steven London and Dr. Robert Iovino, the four-week course attracted 40-plus fourth-year students.

This year’s volunteer dentists included Drs. Ivan Vazquez, Dimitrous Kilimitzoglou, John Lagner, Anthony Maresca, Martin Dominger, Paul Markowitz, Guenter

Jonke, Patricia Hanlon, Kerry Lane, John Guariglia, Claudia Mahon-Vazquez, Nick Vittoria, Peter Pruden, Paul Leary, Scott Firestone, Lauren Heisinger, Craig Smith, Steven Snyder and Robert Peskin.

It’s wonderful to see their practical knowledge being shared with up-and-coming professionals.

Whole New Everything On Feb. 16, our newness was unveiled: our new, branded website, our new logo, Facebook, Twitter and Instagram accounts. Be sure to check them out! But wait, there’s more. The building housing our headquarters office was purchased by Damianos Realty Group, who are upgrading the site, and we’ve a new address—well, a new suite number. We are still at 150 Motor Parkway in Hauppauge, but our suite has been renumbered to 123.

President-Elect Radha SachdevaMunk, D.D.S.

Vice President Steven Feigelson, D.D.S.

Don’t Miss a Thing We continue to make a significant push to better communicate and connect with our members in methods that more easily integrate with their lifestyle. You can find us on Facebook, Twitter, Instagram, LinkedIn and, even, Spotify, in addition to our traditional www.SuffolkDental.Org presence.

Secretary William G. Bast, D.M.D.

SUFFOLK COUNTY Fourth-year students, Stony Brook School of Dental Medicine, receive instruction in ethical principles during four-week course presented by SCDS volunteers.

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Treasurer John L. Guariglia, D.D.S.

SUFFOLK COUNTY

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Take Control of Your Practice Transition With the largest network of dentists in the country, ADA Practice Transitions supports independent dentistry by helping dentists buy or sell a practice, hire an associate, or find a job.

Create your online profile at ADAPracticeTransitions.com

“The ADAPT process was much smoother, much more transparent, much more on top of communication and feedback. They are doing dentistry a big favor by allowing a better mechanism for people to move to a new practice.”

– Joe Thibodeau, D.M.D.

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SECOND DISTRICT

SDDS Members Honored for Journalistic Excellence Alyson Buchalter, D.M.D.

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Three SDDS members were honored in February by the International College of Dentists for excellence in dental-related journalism.

They are: Stuart Segelnick, Shalom Benzaquen and Jeffrey Galler.

NASSAU COUNTY

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Dr. Stuart Segelnick The SDDS is proud to congratulate our past president and current editor of the Second District Dental Society Bulletin, Dr. Stuart Segelnick, for his multiple recent achievements and honors. This past October, Dr. Segelnick was installed as president of the American Association of Dental Editors and Journalists (AADEJ). The AADEJ is a national organization dedicated to improving communication within the dental profession and elevating the standards of dental journalism.

In February, the International College of Dentists (ICD) presented him with its 2021 Newsletter Award, given to the editor of an English language newsletter that demonstrates overall quality of graphics, design and content. The SDDS congratulates Dr. Segelnick and The Bulletin for winning this award for the second time!

Dr. Segelnick, a Brooklyn periodontist, takes his editing duties very seriously. He has been the editor of the SDDS Bulletin since 2015 and is also editor of the Northeastern Society of Periodontists Bulletin.

He has coedited five books on dentistry. In addition to this year’s awards, he was the recipient of the ICD Journalism Silver Scroll Award in 2016 and the ICD Journalism Newsletter Award in 2019.

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Sunday May 7: 50 Shades of Dentistry. (Free courses for dental students, residents and new dentists.)

“The Use of CT Scans in Implant Placement,” presented by David L. Jurman, D.D.S., M.D.; “20 Ways to Make Sure Your Practice is OSHA and HIPAA Compliant,” presented by Andrew P. Nitkewicz, Esq. Check-in 10:30am; breakfast. Course 11 a.m.-2 p.m. Carlyle on the Green, 99 Quaker Meeting House Rd., Farmingdale. (1.5 CE credits) Friday May 12: “Do We Save or Do We Extract?” (3 CE Credits). Checkin 8:30 a.m. Course 9 a.m.-12 p.m.

Dr. Shalom Benzaquen Dr. Segelnick and the SDDS Bulletin also won the ICD Dental Journalism 2021 Humanitarian Service Award. The award was given for publishing an article that exempli-

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Instructor: Alex Pappas, D.D.S. NCDS Headquarters, Lower Conference Level, 377 Oak St., Garden City.

Wednesday May 24: “IT Security” (3 CE Credits). Check-in 8:30 a.m.

Course 9 a.m.-12 p.m. Instructor: Bijan Anvar, D.D.S. NCDS Headquarters, Lower Conference Level, 377 Oak St., Garden City.

Wednesday June 14: “Management of Genetically Missing Premolars” (3 CE Credits). Check-in 8:30 a.m.

Course 9 a.m.-12 p.m. Instructor: Jay Cho, D.M.D. NCDS Headquarters, Lower Conference Level, 377 Oak St., Garden City.

Friday Sept. 8: “CPR for Dentist & Medical Emergencies in the Dental Office” (3 CE Credits). Check-in 8:30 a.m.

Course 9 a.m.-1 p.m. Instructor: James Dolin, D.D.S.; Robert Pollack. NCDS Headquarters, Lower Conference Level, 377 Oak St., Garden City.

Monday Oct. 2: “Oral Mucosal Disease/ Ulcerative Conditions” (2 CE Credits). General Membership and Nominations Meeting. Check-in 6:30 p.m.; dinner. Course 7-9 p.m. Instructor: Robert Kelsch, D.M.D. Jericho Terrace, 249 Jericho Turnpike, Mineola.

Wednesday Oct. 11: “Scrubs & Stilettos Women’s Dental Conference.” 8 a.m. breakfast & introductions. 9 a.m.-12 p.m. round table.

Joint event with Suffolk County Dental Society. Carlyle at the Palace, 1600 Round Swamp Rd., Plainview.

Wednesday Oct. 18: “Evolution of Laser Regenerative Therapies in Periodontics: LANAP, LAR & LAPIP” (3 CE Credits). Check-in 8:30 a.m.

Course 9 a.m.-12 p. m. Instructor: Edwin Ginsberg, D.M.D. NCDS Headquarters, Lower Conference Level, 377 Oak St., Garden City.

Friday Oct. 27: “Infection Control” (4 CE Credits). Check-in 8:30 a.m.

Course 9 a.m.-1 p.m. Instructor: Peter A. Mychajliw, D.D.S. NCDS Headquarters, Lower Conference Level, 377 Oak St.,

fies “serving others” in the August-September 2020 Bulletin. That article was written by then-Kingsbrook Jewish Medical Center Dental Resident Dr. Shalom Benzaquen.

In it, he described his experiences during a two-week mission to Uganda with the Build Your Smile Dental Foundation.

With support from the SDDS, Dr. Benzaquen traveled to Kabale Uganda, where he and his colleagues treated over 2,000 patients. It is quite the honor for an international organization to single out Dr. Benzaquen and his article for recognition.

We enjoyed seeing Dr. Benzaquen at the Zoom awards ceremony from his current home in Rochester, NY. He is enrolled in the Eastman Institute for Oral Health, Prosthodontic Residency Program and is now a member of the Seventh District Dental Society. We at SDDS wish him every continued success.

Dr. Jeffrey Galler The ICD presented Dr. Jeffrey Galler with its 2021 Outstanding Cover Award. Dr. Galler, who practices in Brooklyn, is editor of the Journal of the American Academy of Clear Aligners. The winning cover appeared on the Summer 2020 issue—“The Summer of Success (in Dentistry).” The cover has four hand-drawn caricatures depicting the state of dentistry in March, April, May and June 2020, respectively. They depict the shock of the pending pandemic, being downcast with fear for our practices during the months we had to remain closed, dentistry rising to the occasion when preparing to reopen and, finally, dentistry bouncing back, once again caring for our patients.

SECOND DISTRICT Dr. Shalom Benzaquen treats patient in village school site in Kabale region of Uganda.

Congratulations to all of these winners. You remind us, once again, of why the SDDS has reason to be proud of its members!

NINTH DISTRICT

Webinars Continue in Spring

more comfort with in-person events, we’re looking forward to our first, in-person event of 2022—our March General Meeting. It’s set to take place in Dutchess County, at the Villa Borghese, a venue that has quickly become a member favorite. With the number of registrations coming in daily, we anticipate a terrific turnout.

Olga Lombo-Sguerra, D.D.S.

Women’s Conference Back On The Ninth District will present its spring CE courses as webinars on Zoom. This format has been well-received by members, based on the number of registrants we’re seeing for each course. Evidently, at the end of a long workday, members are happy to head home for dinner and still get their MCE credits toward relicensure.

CPR Take Two Our CPR courses are again being offered by the American Heart Association in two stages—an online module, followed by an in-person skills assessment at the Blythedale Children’s Hospital in Valhalla, rather than at headquarters. The ability of the hospital to host more registrants while keeping them socially distant made it a logical venue.

Taking it Live With new protocols in place in the state, due to the decline in Omicron cases and seemingly

Our executives and committees have continued to meet virtually to ensure our association’s business moves forward. Dr. Renuka Bijoor has been instrumental in planning our “Frills and Drills” event, which was postponed last fall and is now taking place April 6 at The Manor in Pleasantville. If you haven’t registered yet, you may do so on the Ninth’s website (www.ninthdistrict.org).

We are all looking forward to this celebration of women in dentistry. Keep an eye on your inbox, as we will be sending more details as the event draws closer.

Study Groups Back in Business Our study groups are resuming lectures. The Dutchess County Dental Society, the Southern Westchester Dental Forum and the Yonkers Dental Society have all scheduled Zoom lectures this first quarter of 2022. Dutchess County has, however, decided to postpone its April 27th all-day, in-person event. It will

NINTH DISTRICT

On hand to greet students at Signing Day March 1 at Touro College of Dental Medicine, Hawthorne, are, from left: Renuka Bijoor, Ninth District Secretary-Treasurer and member, NYSDA and ADA councils Membership and Communications; Heather Relation, NYSDA Membership Concierge; Chelsea Jankow, NYSDA Marketing Manager.

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Care Providers” Feb. 7 at the Eighth District office. The course fulfilled the state requirement for CPR re-training. Participants completed both a skills test and written test for certification, good for two years. They also earned four MCE hours.

Ski and Learn announce and post updates to their website (www.dcdsny.com) as they become available.

Get in Touch As always, please feel free to reach out to your Ninth District staff for help, advice or to share your thoughts and concerns so we can be sure all of our members’ needs are met and voices heard.

Here’s to a healthy and productive 2022!

Forty members of the Erie County Dental Society attended the society’s annual Ski Day at Holimont Ski Club in Ellicottville. Dr. Joshua Grant presented “Immediate Implant Provisionalization” to those in attendance.

The lecture was divided into two parts—the first following breakfast and the second during lunch. Attendees enjoyed time on the slopes between parts one and two and following lunch. Two MCE units were earned by those in attendance.

Dine and Learn

EIGHTH DISTRICT

Lifesaving Instruction Kevin J. Hanley, D.D.S. The Erie County Dental Society presented the course “Basic Life Support for Health

Over 60 dentists attended the Erie County Dental Society’s evening meeting on Feb. 23 at Santora’s Italian Garden Restaurant in Williamsville. Dr. Vladimir Frias presented “Endosseous Implants for Head and Neck Cancer Patients.” Attendees earned two MCE units for participating.

District Hosts NYSDA Officer

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PROPERTY FEATURES Large window in every op Modern-style chair/unit Dexis digital X-ray system Cavitron Ultrasonic Wireless intraoral camera 5 Computers – networked

Inquiries to: sndastoria@gmail.com

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NYSDA President-elect James Galati visited the Eighth District during the district’s Executive Council meeting Feb. 8 to introduce himself and discuss important issues facing NYSDA in the coming year. The members present gave Dr. Galati a warm Eighth District welcome.

As the first order of business, Dr. Galati installed our officers for 2022. They are: Dr. Joseph Gambacorta, president; Dr. Joshua Hutter, president-elect; Dr. Robert Bocchiecho, vice president; Dr. Joseph Rumfola, secretary; and Dr. Joseph

Modica, treasurer. During his presentation which followed, Dr. Galati shared his plans for his presidential term and fielded questions from the audience.

President-elect visits are always appreciated by members, as they help give a face to a name and allow for interactions with NYSDA officers in a comfortable environment. The Eighth District joins in wishing Dr. Galati good luck in the coming years.

Officers Installed Over Brunch The Erie County Dental Society held its previously postponed Installation Brunch on March 13 at The Mansion on Delaware. Dr. Mary Beth Dunn, a past president of the Eighth District, was master of ceremonies and installed the following new officers: Dr. Kathleen McMahon-Wahler, president; Dr. Matthew Walla, vice president; Dr. Amanda Cryan, secretary; Dr. Martin Gorkiewicz, assistant secretary; and Dr. Darren Forcier, treasurer. Dr. Peter D’Arrigo was presented with the 2022 Frank J. Stone Award.

District Celebrates its Presidents 500 Pearl was the venue for the Eighth District Dental Society’s 2022 President’s Reception on March 26. Dr. Brendan Dowd, a past president of NYSDA and currently the ADA Trustee-Elect, was master of ceremonies for the reception. Music was provided by Central Groove, a band comprising members of the Eighth District.

It was a fun evening, as district members and guests celebrated past presidents and the new incoming officers.

NEW YORK COUNTY

GKAS NYC Promotes Oral Health in East Harlem Suchie Chawla, D.D.S., M.D. We are proud to report that underserved children in District 4 East Harlem schools received critical oral hygiene awareness education early this year in a safe way. Three unique and engaging educational oral health video presentations created by our Give Kids A Smile NYC Steering Committee for lower, middle and upper school children, were part of the teaching curriculum in late February/ March. We were also back in the community

Corrective Jaw Surgery

When should you consult an OMS for corrective jaw surgery?

When a jaw-related problem cannot be resolved through orthodontia alone, the patient should be referred to an oral and maxillofacial surgeon (OMS). OMSs are uniquely qualified and trained to determine the appropriate procedure for each case and to work with the orthodontist and restorative dentist to assure a successful outcome.

Visit MyOMS.org for more information.

MyOMS.org © 2019 American Association of Oral and Maxillofacial Surgeons (AAOMS).

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levels of the ADA, as well as other dental associations and service organizations.

Congratulations to Dr. Spizuoco for being a part of this special program training future leaders!

New York County

cont.

NYCDS Golf Outing Returning, to New Venue

with our livestreamed Parent Workshop to reinforce good oral habits and provide guidance to parents on how they can help their children have good oral health.

In addition, we held an oral health poster contest again, since it was so popular last year. Sorely needed school-related prizes were awarded to one grand prize winner and three honorable mention winners from each school. These awards were made possible by a generous grant from the New York State Dental Foundation and Henry Schein.

After an almost three-year hiatus, New York County Dental Society will host its Sixth annual Golf Outing for the benefit of the NYCDS Fund.

The event will take place at the Westchester Hills Golf Club in White Plains on Tuesday, June 21. This year, the registration fee is $275, which includes a round of golf on a beautiful, newly renovated course; a sumptuous brunch; an open-bar cocktail hour; raffles; and a fantastic buffet dinner. There will be a putting contest, in addition to other contests, during the round—with prizes.

Further details about the Golf Outing, including registration, will be forthcoming.

NYCDS Member Completes ADA Diversity Program

Humanitarian Outreach

Dr. Stacy Spizuoco was one of a select group of dentists who participated in the ADA’s most recent leadership training program known as the Institute for Diversity in Leadership. Dr. Spizuoco has a private practice in Manhattan and has volunteered as a clinical instructor at Columbia College of Dental Medicine. She is actively involved with the humanitarian outreach World of Smiles.

Hundreds of dentists have been enrolled in the program since its inauguration, and institute alumni have gone on to serve as volunteer leaders at local, state and national

New York County Dental Society was pleased to sponsor the ACD Mentoring Lecture “Humanitarian Outreach: Program Development and Participation” on Feb. 16. The popular program focused on the development of an international outreach initiative in the Dominican Republic that provides comprehensive care for thousands annually.

Important to the discussion were the ethics and professional obligations of healthcare providers who participate in outreach. The challenges, rewards and joy that come with participation were also discussed.

The NYCDS members who founded World of Smiles, Inc., Drs. James Hudson, Yakir Arteaga and Jerry Halpern, were joined by Dr. Owen Insel, chief resident of oral and maxillofacial surgery, who has

NEW YORK COUNTY

participated in the outreach in La Romana.

Dr. Hudson was awarded the Mark Mintzer Award for Service in 2021.

CE Highlights We are pleased to return to in-person continuing education, while also offering virtual courses, to fit a variety of schedules.

Registering for CE courses is easy: go to www.nycdentalsociety.org; or call our education staff at (212) 573-8500. Upcoming courses are listed below.

• April 7: “Medications/Injection Options for Orofacial Pain Problems.”

Part 3 in Orofacial Pain Lecture Series, with Dr. Donald Tanenbaum. (virtual) • April 20: “Pediatric Sleep Apnea and Craniofacial Development.” Part of the ACD Mentoring Lecture Program, with Dr. Rebecca Binder. (virtual) • April 21: “Elusive Medical Problems and Orofacial Pain.” Part 4 in the Orofacial Pain Lecture Series, with Dr. Donald Tanenbaum. (virtual) • April 27: “Basic Life Support/ CPR Certification Course,” with Marc Reilly, Rescue Resuscitation. (in-person) • May 4: “Contemporary Implant Removable Prostheses,” with Dr. Kenneth Kurtz. (in-person) • May 11: “Basic Life Support/ CPR Certification Course,” with Marc Reilly, Rescue Resuscitation. (in-person) • May 18: “Hands-On Course on Indirect Posterior Dentistry,” with Dr. David R. Rice. (in-person) • May 18: “Peer Review: Facts, Findings, and Dispelling Myths.” Part of the ACD Mentoring Lecture Program, with Dr. Egidio Farone. (virtual) Visit www.nycdentalsociety.org for latest courses and registration information.

NEW YORK COUNTY

Stacy Spizuoco

Students who have benefited from the services of World of Smiles Inc.

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Experience » Elevate » Engage

Experience all membership has to offer There is no better time than now to engage with your dental community. Elevate your membership by connecting with dentists across the country, throughout New York State and with your local dental societies.

Dr. James Wanamaker Member since 2017

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for 2022 Today 3 EASY WAYS TO PAY 1 ONLINE: nysdental.org/renew 2 MAIL: Return dues stub and payment 3 PHONE: 1-800-255-2100

PAYMENT PLAN 6-month installment payment plan that runs January through June.

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OFFER EXTENDED Sign up to auto-renew your membership by February 15, 2022, you will be entered to win a Kindle Oasis.

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Component Presidents 2022

NEW YORK COUNTY Ioanna G. Mentzelopoulou

THIRD DISTRICT Gregory M. Vallecorsa

330 West 15th Street, Apt. 1D, New York, NY 10011

61 Outlook Drive S., Mechanicville NY 12118

BA, New York University, 1995. DDS, NYU College of Dentistry, 1999. GPR, Woodhull Medical Center, 2000. Pediatric residency, Interfaith Medical Center, 2002.

Certificate in Pediatric Dentistry, 2008.

Pediatric practice, New York City, 2004.

BS, Siena College, 2007. DDS, University of Detroit Mercy School of Dentistry, 2013. GPR, St. Peter’s Hospital, 2014. Attending, St. Peter’s Hospital.

General practice, Latham, 2015.

Fellow, International College of Dentists, American College of Dentists, Pierre Fauchard Academy. Member, American Academy of Pediatric Dentistry.

Enjoys snowboarding and dance.

Child: Theano.

SECOND DISTRICT Michael J. Donato Jr.

Member, American Dental Association, New York State Dental Association.

Enjoys working on cars including 1985 Saab Turbo.

Spouse: Kathryn. Children: Sophia-Rose and expecting second child in March.

FOURTH DISTRICT Robert W. Berls 19 Stony Brook Drive, Saratoga Springs, NY 12866

199 Clark Avenue, Staten Island NY 10314 BS, Saint Peters College, 1985. DMD, University of Medicine and Dentistry of New Jersey, 1989. GPR, Staten Island University Hospital, 1990. Certificate in Orthodontics, University of Medicine and Dentistry of New Jersey, 1993. Section Chief, Orthodontics, New York Presbyterian Brooklyn Methodist Hospital. Attending, Northwell Health Staten Island University Hospital.

Orthodontic practice, Staten Island, 1993.

Diplomate, American Board of Orthodontics. Fellow, Pierre Fauchard Academy, American College of Dentists, International College of Dentists. Member, American Association of Orthodontics, Northeastern Society of Orthodontists, Italian Dental Society, Psi Omega Dental Fraternity. Delegate, NYSDA House.

Enjoys softball, golf, cooking, gardening and raising German Shepherds.

Spouse: Elaine. Children: Nicolle, Michael III, Matthew.

BS, Yale University, 1996. DDS, Stony Brook University. GPR, Buffalo General Hospital, 2001. MS, University at Buffalo School of Dental Medicine, 2003. Certificate in Endodontics, University at Buffalo School of Dental Medicine, 2003. Faculty, Dental Residency Program, Ellis Hospital.

Endodontics practice, Schenectady and Clifton Park, 2003.

Past President, Schenectady County Dental Society. Member, American Association of Endodontists.

Enjoys playing and coaching lacrosse, golf, skiing and travel.

Spouse: Lisa Berls, DDS. Children: Erin and Sarah.

FIFTH DISTRICT Pablo R. Elizondo 311 W. Thomas Street, Rome, NY 13440 BA, St. Lawrence University, 1996. DMD, University of Pennsylvania School of Dental Medicine, 2009. GPR, Mohawk Valley Health System, 2010.

General practice, Rome, 2010.

Member, Oneida-Herkimer County Dental Society.

Enjoys cooking, skiing, cycling and travel.

Spouse: Kelly. Children: Sara and Julia.

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SIXTH DISTRICT Louis M. Giordano 864 Hooper Road, Endicott, NY 13760 BS, St. Bonaventure University, 1987. DDS, University at Buffalo School of Dental Medicine, 1991. GPR, Buffalo General Hospital, 1992.

General practice, Endicott/Endwell, 1992.

Fellow, International College of Dentists. Member, Academy of General Dentistry, American Academy of Craniofacial Pain.

Delegate, American Dental Association House. Delegate, NYSDA House.

Enjoys skiing, golf, playing hockey and spending time with family.

Spouse: Sharon. Children: Nick, Sam, Max, Lydia, Sophia.

SEVENTH DISTRICT Christopher W. Calnon 3220 Chili Avenue, Rochester, NY 14624 BS, SUNY Geneseo. DDS, University at Buffalo School of Dental Medicine, 2008. GPR, University of Rochester, 2009. Senior Clinical Instructor, University of Rochester, Eastman Institute for Oral Health.

General practice, Rochester, 2009.

Fellow, Pierre Fauchard Academy. Diplomate, American Academy of Dental Sleep Medicine. Member, American College of Dentists, Monroe County Dental Society.

Enjoys running, boating, cooking, home improvement and landscaping.

Spouse: Jennifer Calnon, DDS. Children: Erin and Ryan.

EIGHTH DISTRICT Joseph Gambacorta 4911 Anfield Road, Buffalo, NY 14221 BA, University at Buffalo, 1989. DDS, University at Buffalo School of Dental Medicine, 1993. MPH Candidate, University at Buffalo School of Public Health and Health Professions, 2022. GPR, Millard Fillmore Hospital, Buffalo, 1994. Associate Clinical Professor, Restorative Dentistry, University at Buffalo School of Dental Medicine. Associate Dean for Academic and Clinical Affairs, University at Buffalo School of Dental Medicine.

Fellow, American College of Dentists. Chair, Eighth District Council on Dental Education and Licensure, Eighth District Dental Society. Board Member, Eighth District Dental Society Foundation.

Enjoys horseback riding, sports memorabilia, leading domestic and global outreach missions.

Spouse: Charlotte. Children: Sarah, Patrick, Nicholas and Claire.

NINTH DISTRICT Stephen M. Ossen 584 Broadway, Hastings On Hudson, NY 10706 DMD, Tufts School of Dental Medicine, 1990. Certificate in Orthodontics, Boston University, 1992.

Orthodontic practice, Hastings On Hudson, 1993.

Member, American Association of Orthodontists. Delegate, NYSDA House. Alternate Delegate, American Dental Association House.

Enjoys golf, softball/baseball, skiing, woodworking and gardening.

Spouse: Damara. Children: Cayla and Tyler.

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Component Presidents 2022

NASSAU COUNTY Joseph Brofsky

SUFFOLK COUNTY Craig E. Smith

932 Broadway, Woodmere, NY 11598

180 East Main Street, Smithtown, NY 11787

MS, Brooklyn College CUNY, 1977. DMD, University of the East College of Dentistry, 1981. GPR, Kingsbrook Jewish Medical Center, 1982. Pediatric residency, Interfaith Medical Center, 1985. Assistant Professor, Hofstra University Medical School. Section Head, Pediatric Dentistry, Cohen Children’s Medical Center Northwell Health.

Pediatric practice, Woodmere, 1999.

Member, American Academy of Pediatric Dentistry. Board Member, New York State Dental Foundation, Project Accessible Oral Health. Ambassador, Give Kids A Smile, American Dental Association. Chair, Nassau County Dental Society Give Kids A Smile.

Enjoys volunteering with local food pantry, running, learning golf and spending time with grandson.

Spouse: Laurie. Children: Jenna and Emma.

QUEENS COUNTY Hanette S. Gomez 96-05 40th Road, Corona, NY 11368 Universidad Autonoma de Santo Domingo, 1984. DDS, New York University College of Dental Medicine, 1990.

General practice, Corona, 1990, and Howard Beach, 2005.

Fellow, International College of Oral Implantology. Member, New York State Forensic Society. Past President, NY Chapter Hispanic Dental Association. President, Dominican MedicalDental Association.

Enjoys cooking, gardening, travel and music.

Spouse: Ramiro Deiros. Children: Julio, Jamell, Mariliz, Giselle.

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MARCH 2022 • The New York State Dental Journal

BS, Trinity College, 1995. DMD, Tufts School of Dental Medicine, 2001. GPR, Long Island Jewish Medical Center, 2002. Certificate in Orthodontics, Tufts School of Dental Medicine, 2004.

Orthodontic practice, Smithtown, 2004.

Fellow, American College of Dentists. Member, American Association of Orthodontists, Greater Long Island Dental Meeting, NYSDA Council on Dental Practice. Alternate Delegate, NYSDA House.

Fiancé: Sonia Singh. Children: Madison, Corey.

BRONX COUNTY Don Safferstein One Fordham Hill Oval, Bronx, NY 10468 BA, University of Rochester, 1978. DDS, University at Buffalo, School of Dental Medicine, 1982. GPR, Buffalo General Hospital, 1983.

General practice, Bronx, 1985.

Member, NYSDA Committee on Substance Abuse and WellBeing. Alternate Delegate, ADA House. Delegate, NYSDA House.

Enjoys long-distance running, hiking, camping and travel with family.

Spouse: Vicki. Children: Dayna, Julie and Rachel.

continuing education

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 the following 30 True or False questions, all of which are based on articles that appear in this issue.

When you have completed the questionnaire, return it to the New York State Dental Foundation, along with payment of $60.

All 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/course-catalog.html.

❑

Orthognathic Surgery and Quality-of-Life Outcomes— Page 12-17 1. The purpose of the article was to evaluate the quality of life (QoL) following orthognathic surgery to treat severe dentofacial deformities. ❑ T or ❑ F 2. Orthognathic surgery does not include the goal of improving mastication. ❑ T or ❑ F 3. QoL can be measured using generic or disease-specific tools. ❑ T or ❑ F 4. The concept of QoL is objective. ❑ T or ❑ F 5. The Oral Health Impact Profile (OHIP) measures individuals’ perception of the negative impact from oral disorders on their well-being and QoL ❑ T or ❑ F

Enclosed is a check for the full amount of $60. (Make checks payable to the New York State Dental Foundation.) Mail to NYSDF, 20 Corporate Woods Boulevard, Suite 602, Albany, NY 12211. Questionnaires must be received within 90 days of Journal publication.

Please charge my: ❑ VISA ❑ MasterCard ❑ American Express

Telephone

Card #

Email

Expiration Date

ADA #

Name

License #

Address

NYSDA Member? ❑ yes or ❑ no

City

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Local/State Dental Society

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Read, Learn and Earn continued 6.

The use of QoL measures is a valuable metric for determining the outcome of care. ❑ T or ❑ F 7. Patients who participated in this project responded to preoperative and postoperative questionnaires via telephone survey. ❑ T or ❑ F 8. The highest improvement in the QoL data was noticed in the psychological domain. ❑ T or ❑ F 9. Surgical correction of the severe dentofacial deformity may lead to an extreme change in appearance and a radical alteration in facial profile. ❑ T or ❑ F 10. The benefit of increasing the QoL through orthognathic surgery should be discussed with the patient. ❑ T or ❑ F Papillon-LeFevre Syndrome—Page 24-29 1. Papillon-LeFevre syndrome (PLS) is associated with the premature loss of both deciduous and permanent teeth. ❑ T or ❑ F 2. PLS is easily treated by the dental and medical community. ❑ T or ❑ F 3. PLS is an autosomal recessive disease. ❑ T or ❑ F 4. PLS has definite racial and gender preferences. ❑ T or ❑ F 5. The treatment for PLS has remained unsuccessful. ❑ T or ❑ F 6. PLS is a type of palmoplantar keratoderma (PPK) associated with severe periodontal disease. ❑ T or ❑ F 7. Both patients in the study received upper and lower complete dentures for their final restorations. ❑ T or ❑ F 8. Juvenile diabetes is also associated with early alveolar bone loss in children. ❑ T or ❑ F 9. Patients with PLS have no contraindications in regard to dental implants. ❑ T or ❑ F 10. Isotretinoin improved the palmar and planter hyperkeratosis associated with PLS. ❑ T or ❑ F

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The New York State Dental Journal

Treatment of Peri-implant Soft-tissue Deficiency around a Narrow Diameter Implant with Subepithelial Connectivetissue Graft—Page 30-33 1. Narrow diameter implants and mini-implants are used to restore missing teeth on narrow ridges. ❑ T or ❑ F 2. Soft-tissue deficiencies are not associated with narrow ridge implant restorations. ❑ T or ❑ F 3. Inflammation associated with mini-implants can be effectively managed with autogenous connective-tissue graphs. ❑ T or ❑ F 4. The clinical patient was diagnosed with peri-implant mucositis. ❑ T or ❑ F 5. The donor site for the graph was the patient’s palate. ❑ T or ❑ F 6. The patient was advised to brush and floss the surgical site starting one day postsurgery. ❑ T or ❑ F 7. At six months, complete healing was achieved at the surgical site. ❑ T or ❑ F 8. Peri-implant mucositis can be initiated by a patient’s systemic condition and habits. ❑ T or ❑ F 9. Narrow-diameter implants can be exposed to more stress due to lower fracture resistance. ❑ T or ❑ F 10. There is strong evidence that poor plaque-control skills are related to initiation of peri-implant mucositis and peri-implantitis. ❑ T or ❑ F

CLASSIFIED INFORMATION

RATES: $60 for 45 words or less; 75 cents each additional word; Includes 30-day posting on NYSDA website. $10 additional for Journal box

FOR SALE RHODE ISLAND: State-of–the-art periodontal practice for sale or affiliation. Situated in freestanding building. Real estate also for sale. With very limited marketing, practice sees average of 25 new patients/month. 4 fully equipped operatories and expansion opportunity for two additional ops.

Collections $1.058M and EBITDA $250K. 100% FFS practice. 725 patients seen in last 12 months. To learn more, contact Professional Transition Strategies: sam@professionaltransitions.com; or call (719) 694.8320. We look forward to speaking with you.

ALBANY: Well-established general dental practice for sale in great location within 15 minutes of historic downtown Albany, NY. Situated in freestanding building with real estate also for sale. Opportunity for growth with additional days open per week. 6 operatories. Collections of $1.433M and EBITDA $430K. To learn more about this practice, please contact Professional Transition Strategies: sam@professionaltransition.com; or call (719) 694-8320.

We look forward to speaking with you.

1 column wide by 1 inch deep (min.), $100; each

MANHATTAN: 100% fee-for-service general practice. Office approximately 1,200 square feet, with 4 rooms plumbed, in prestigious “white-glove” building at 72nd Street & Central Park West. Gross production: $784,655 (2021)/gross collections: $756,993.

Overhead: 53%. Doctor produced $818/hour. Hygiene produced $413.58/hour on 2 days/week. On demand implant surgeon $2,705/patient. Practice open 4 days/week.

Doctor produced at only 57% capacity of available patient hours. Hygienist produced at 60.53% capacity.

Inquiries to: docslik@icloud.com.

additional 1/2 inch $40. Payment must accompany all ads. Copy due 1st of month, one month prior to date of publication. All ads are subject to editing by The Journal. Box replies to: NYS Dental Journal, 20 Corporate Woods Boulevard, Suite 602, Albany, NY 12211. Please use complete box number with replies.

includes brand new major equipment. Office highly visible, with plenty of parking. Whether you’re looking for space to move and expand your existing practice OR seek to purchase full patient-included practice with all amenities, this is opportunity you won’t want to miss.

Contact: r.countydental@gmail.com.

CAPITAL DISTRICT: Fee-for-service practice for sale. Fully modernized in equipment, decor and support area. Dentrix software with stations throughout office. Digital X-rays, 3Shape Trios scanner; four equipped operatories. Practice grosses $600K on three days/week. Experienced staff. Doctor willing to stay to introduce. Priced very competitively; it’s time

Dental Office and Property

Ithaca Practice for Sale

Unique Practice Opportunity Established for 33 years, this practice has earned an outstanding reputation in the community. With 1,900 square feet and 3 operatories, this handicap accessible practice offers digital X-rays and has plenty of on-site parking. Owner is retiring for health reasons.

Long term employees include one fulltime and one part-time Hygienist, fulltime Dental Assistant and an Office Manager.

Over $650K in annual collections and 1,960 active patients.

To learn more, please email: valleydesign88@gmail.com No Brokers Please

CENTRAL ADIRONDACKS: Nice, low-stress practice for sale. Been running practice with 2 employees using 2 operatories; third op could be added with very little remodeling. Asking price includes value of property and a little for existing equipment and supplies. Living and working inside Adirondack Park isn’t for everyone but unlimited outdoor activities make it very appealing for many. Made decision to live here 40+ years ago and have never had any regrets. Content to stay a while but could wrap up my work in just weeks if someone wants to sit down and get to work. Send email for more information and answers to your questions. tlswilso@gmail.com.

CLASSIFIEDS

ROCKLAND COUNTY: Take over my leased office space; rent or purchase opportunity. Rare find. State-ofthe-art, modern, 4-chair, fully furnished private office is turnkey. Freshly renovated 1,500-square-foot practice

General dental practice including property located in Ithaca N.Y. Sitting on just under an acre in beautiful country setting, this Finger Lakes area practice is only minutes from Cornell University and Ithaca College.

to retire. Building available to purchase. Inquiries to: JMK2715OC@yahoo.com.

number. Web only, $40 for 30 days. Box display:

FINGER LAKES AREA: Upstate NY. Heart of the Finger Lakes. Home/Office for sale. 5 operatories in 1,350 square-foot office. $650-750K/year. Full staff; 2 doctors each working 16 hours/week. Doctors refer out most specialty procedures and have healthy new patient flow and excellent hygiene recall. Laptops in all operatories. Long-established practice with great reputation. Great tax advantages with home /office. Beautiful area; top school system; year-round activities. Will stay for transition if necessary. Contact: Justin Baumann, Transition Consultant, by phone: (716) 266-9707; or email: jbaumann@ddsmatch.com.

UPSTATE: Charming, long-established, quality general practice located in gorgeous upstate NY. Turnkey opportunity has it all. Revenue near $1M. Low overhead; brand new equipment, including 2 Belmont chairs, NV laser, Dentrix/Dexus technology throughout. Steady stream of new patients; robust hygiene department and prime location on busy main street. Seller refers out most specialty services providing additional revenue potential for any buyer keeping these services in-house. Standalone, 2,170-square-foot, beautiful facility feels extra spacious with high ceilings and large windows. Four ops, with room to expand 1 more if wanted. Additional 1,120 square feet of space has separate entrance and could be turned into dental lab, space for dental specialist or anything else. Plenty of onsite parking. Real estate for sale or lease. Flexible post-transition options available. Don’t miss this exceptional opportunity. Contact Catherine Etters at Legacy Practice Transitions for details: atherine@ LegacyPracticeTransitions.com; or (610) 520-9677.

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WATERTOWN: New opportunity. General dental practice grossing approximately $1M. Located north of Syracuse in Watertown, close to Thousand Islands.

Practice has nine operatories with digital X-ray, CBCT, 3D printing and CEREC. Real estate also available.

Please contact Sean Hudson at (585) 690-6858, or sean@hudsontransitions.com, for more information.

Listing #6130.

SUFFOLK COUNTY: North Shore. Four-op, 1,200-square-foot general practice in desirable location. Mostly PPO. 1,500 active patients and referring out most specialist procedures. Easy Dental software.

Contact Scott Firestone at (516) 459-9258; or email: scott.firestone@henryschein.com.

ELMIRA: Live and work in bucolic setting. No more time wasted commuting. Practice and office building for sale. Six ops in well-established, successful FFS general practice. Retiring after 40 years. For details, contact seller by email: ajs101@gmail.com.

CLASSIFIEDS

NORTHEAST QUEENS: Long-established general practice. Gross revenues over $600K. Fully computerized office, including digital X-rays. Close to 700 active patients, mostly better PPOs, with 16 new patients/ month. No Medicaid; no capitation. Bring your skills in social media marketing, implantology and Invisalign to supercharge growth. Great potential in stable neighborhood with street visibility. Priced very reasonably for quick transition. Please contact ira@paragon.us.com; or call (516) 318-3900 for more information.

CAYUGA COUNTY: Long-established FFS general practice with revenues close to $900K on 3.5-day workweek. Over 1,200 active patients and close to 20 new patients/month. No Medicaid, capitation or PPO plans.

Modern office, including Cone beam, CEREC and fully computerized. Four treatment rooms, with room for expansion. Over $250K annually in hygiene production. Doctor willing to stay for extended term to ensure transfer of patient population. Live in beautiful Finger Lake region and earn exceptional living. Please contact ira@paragon.us.com or (516) 318-3900 for more information.

MANHATTAN: Co-op dental office for sale on Upper East Side. 2,000 square feet, with large waiting room, 5 chairs, completely digital and networked. Private and lobby entrances. Across from Central Park on beautiful block. Close to public transportation and major teaching hospitals. Office can be converted to residential space.

Contact for price or showing. Email: shmadg@aol.com; or call (917) 319-2343.

BRONX: 32-year-old, well running, beautifully renovated office for sale in Co-op City. 3 operatories, lab, sterilization room. Digital X-ray and computer. No Medicaid, DMO, HMO. Call (718) 862-9232; please leave message.

CICERO: Well-established general practice in community’s fastest growing suburb. Located in busy

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plaza with 1,460 square feet. Walking distance to area’s largest high school, creating potential for significant growth. Four ADec ops, sterilization center, new digital pan, Dentrix software and Dexis sensors.

Doctor refers out most specialty procedures. Healthy new patient flow and patient base, accepting mix of insurances, plus FFS. Gross just under $700K. Contact Transition Sales Consultant Donna Bambrick by email: donna.bambrick@henryschein.com; or call (315) 430-0643. #NY1677.

KINGSTON: High-producing practice in growing area, less than 2 hours from NYC. Revenue $1.7M+. 5 operatories in standalone building, which is also for sale.

Digital, FFS and paperless, with Dentrix. Equipment 6 years old. Perio associate one day/week. Seller will stay on if needed. 15 new patients/month, with dedicated staff. Contact Transition Sales Consultant Donna Bambrick by phone: (315) 430-0643; or email: Donna.bambrick@henryschein.com. #NY2560.

GATEWAY TO FINGER LAKES: Longstanding practice with original owner. Three years average collections —$255K. Open 4 mornings/week and 10 months/ year. Excellent growth potential. 4 ops; low overhead and cost of living. Area is gateway to Finger Lakes region, only five hours from New York City. Great family living, hunting, fishing, hiking and skiing. For details, contact Donna Bambrick by phone: (315) 430-0643; or email: donna.bambrick@henryschein.com. #NY220.

WEST ISLIP: Rare opportunity to purchase wellestablished general practice in highly desirable area of Suffolk County. Freestanding home-style office on town’s main street, very close to major hospital and medical offices. Equipped with five treatment rooms and one additional plumbed, along with intraoral camera and digital X-rays. Seller willing to sell real estate.

Averages 36 hours/week and utilizes fee-for-service and insurance plans. Specialties referred out. Contact Mike Apalucci by phone: (718) 213-9386; or email: michael.apalucci@henryschein.com. #NY2483.

AUBURN: Productive, growing practice in quaint CNY community. Outright sale or available for Associate leading to buyin. Located in village proper, with $700K revenue. Dental office occupies 3,200 square feet of 5,530 square feet, with four ops and one plumbed, not equipped. Large patient base and referring out many specialty procedures. Real estate also for sale, with rental apartment that brings additional revenue. For details, contact Henry Schein Professional Practice Transition Sales Consultant Donna Bambrick by email: donna.bambrick@henryschein.com; or call (315) 430-0643. #NY2624.

BRONX: 7-year, new facility, with 1,400 square feet of office space and 4 fully equipped operatories.

Turnkey; ground floor. Completely digital and constructed in accordance with newest technologies. Starting January 2020, office open 5 days/week, with steady flow of new and existing patients. Closed March through May 2020 due to pandemic but recovered beautifully.

The New York State Dental Journal

Rent very reasonable for area at $2,025/month. 3 digital Gendex X-ray machines and digital Vatech panorex.

Contact Mike Apalucci by phone: (718) 213-9386; or email: michael.apalucci@henryschein.com. #NY2678.

CAPITAL DISTRICT: Growing community close to downtown Albany on bus line, near major highways leading to NYC. Modern-feel office with four ops, Dentrix Ascend, Dexis, pan, Diode laser and more.

Two full-time hygienists, along with valued team working 4-day workweek, with systems in place and excellent collection policies. No HMOs or State insurance. Excellent opportunity for any dental entrepreneur. For details, contact Henry Schein Professional Practice Transition Sales Consultant Donna Bambrick by email: donna.bambrick@henryschein.com; or call: (315) 430-0643. #NY2712.

SOUTHERN OSWEGO: Excellent GP opportunity for sale or associate buyin. Growing community 15 minutes north of Syracuse. minutes from main highway. 4 fully equipped, up-to-date ops; new cabinetry and countertops. All equipment under 10 years old.

Paperless, with Dentrix, Dexis, digital pan, intraoral cameras and CariVu. Open 3.5 days/week with 5 days of hygiene. 3-year average revenue $833K. Great staff will be staying. Standalone building, with rental apartments also offered for sale or lease. For details, contact Henry Schein Professional Practice Transition Sales Consultant Donna Bambrick at (315) 430-0643; or email: donna.bambrick@henryschein.com. #NY1541.

NEW HARTFORD: Turnkey, attractive general practice in growing community of New Hartford. 4 ops, plus 1 additional. Open 4 days/week, with one full-time hygienist. Eaglesoft, laser, CEREC and digital pan. On main bus route; high-traffic road, with corner lot. 1,800-square-foot building also for sale.

Room to expand. FFS; no State insurance. Patient base of 1,100 and revenue of $620K. Doctor will remain for 3 years if needed. For details, contact Professional Practice Transition Sales Consultant Donna Bambrick at (315) 430-0643; or email: donna.bambrick@henryschein.com. #NY1950.

NASSAU COUNTY: 5 ops in newly remodeled 1,600-square-foot suite in busy downtown area of diverse, urban community. Dentrix, digital X-rays and Intraoral camera. 50 new patients/month and open 35 hours/week. PPO, Medicaid and some FFS and HMO. Specialties referred out. For details, contact Henry Schein Professional Practice Transition Sales Consultant Michael Apalucci at (718) 213-9386; or email: michael.apalucci@henryschein.com. #NY2598.

ADIRONDACKS: Experience beauty of the outdoors.

Busy general practice with 6 ops. Productive, strong practice; most procedures kept in-house. Dentrix, pan and new digital scanner. Building also for sale. For details, contact Donna Bambrick at (315) 430-0643; or email: donna.bambrick@henryschein.com. #NY2640.

BETWEEN UTICA AND SYRACUSE: Wellestablished GP transitioning to retirement. 5-op, productive practice, with current average revenue of $750K. 60% FFS on 4-day workweek. Real estate for sale. 4,000 square feet in standalone building.

Refers out all endo and ortho. Trios 3-color scanner, Amann Girrbach CAD/CAM unit, laser, cone beam and Open Dental management software. Great staff, with full-time hygienist. Located in stable community. For details, contact Transition Sales Consultant Donna Bambrick at (315) 430-0643; or email: donna.bambrick@henryschein.com. #NY2755.

UTICA SUBURB: 5 ops, designer A-dec cabinetry and equipment. Carestream sensors, intraoral cameras, digital Carestream scanner, Nomad handheld X-ray unit, Isolite units built into delivery systems. Strong hygiene program, with trained, committed staff. Main street location; walkable to restaurants; surrounded by businesses. Real estate for sale at reasonable price. Four-day workweek. Highly productive; no insurance participation but assists patients with reimbursement. For details, contact Donna Bambrick at (315) 430-0643; or email: donna.bambrick@henryschein.com. #NY2810.

NASSAU COUNTY: Well-established GP office for sale in desirable area. Large, 1,630-square-foot space, with 3 ops and 1 additional plumbed with cabinets.

Seller retiring but will make introduction in transition for determined timeframe to be discussed. PPO/FFS practice for past 30 years. Most difficult specialty treatment referred out, so huge growth opportunity. For details, contact Linda Zalkin at (631) 357-1003; or email: linda.zalkin@henryschein.com. #NY2848.

BROOKLYN: 2-operatory general practice in Mill Basin. Very busy practice. All new computers utilizing Dentrix software. Loyal staff will stay on with new owner. PPO practice. For details, contact Linda Zalkin at (631) 357-1003; or email: linda.zalkin@henryschein.com. #NY2903.

STATEN ISLAND: Wonderful family practice in well-designed, 2-op office, with 3rd op plumbed.

Digital X-rays, intraoral camera and Dentrix. Beautiful 3,700-square-foot property for sale with two-story, 1,800-square-foot office and patient-friendly, open-air area. High visibility neighborhood, with easy access off main highway. Mix of FFS/PPO, with gross of $287K on 28 hours/week. Great potential for more

FOREST HILLS: Queens general practice in popular neighborhood, with diverse urban community. Office features 1,600-square-foot space, with three equipped treatment rooms, digital X-rays and utilizes Dentrix software. Plans include PPO, Medicaid, plus FFS and small amounts of indemnity plans. Contact Transition Consultant Mike Apalucci at (718) 213-9386; or email: michael.apalucci@henryschein.com. #NY2841.

SUFFOLK COUNTY: Mature, private GP practice at desirable, suburban downtown village location. Open 26-30 hours/week, with 3 operatories and 1,000 square feet. Selling dentist is referring out all specialty services. For details, contact Michael Apalucci at (718) 213-9386; or email: michael.apalucci@henryschein.com. #NY280.

NEW YORK AREA: Endo practice with 4 ops.

Well-equipped, with up-to-date technology and equipment. Great location in standalone, beautiful building, with long-term lease available to buyer. For details, contact Linda Zalkin at (631) 357-1003; or email: linda.zalkin@henryschein.com. #NY2908.

NASSAU COUNTY: Well-established general practice with focus on prosthetics and cosmetics, located in standalone building in thriving community. Practice has three (3) ops in 1,200 square feet, with room for expansion. Gross collections $2.2M. Strong, fulltime hygiene program, averaging 25 new patients/ month. Dedicated and loyal staff. All equipment has been updated or replaced. Great opportunity, with seller willing to stay for agreed-upon transition period. To find out more, contact Transition Sales Consultant Linda Zalkin at (631) 357-1003; or email: linda.zalkin@henryschein.com. #NY2930.

LIVERPOOL: Grads, make an offer. Located in North Syracuse. Six ops with Pelton & Crane and 1 X-ray room with pan, Dexis and ScanX. Insurance practice. Professional building with parking. Working 4 days per week. For details, contact Henry Schein Dental Practice Transitions Sales Consultant Donna Bambrick at (315)430-0643; or email: donna.bambrick@henryschein.com. #NY2887.

CAPITAL DISTRICT: Historic brownstone, with six-car parking lot and ample street parking. Close to highways. General dental practice on first floor, with 3 rental units above. New windows throughout. Three operatories equipped with Dentrix and digital X-rays.

Grossing $500K on 4-day workweek. Very organized and meticulously clean; walk-in ready practice. Practice can easily grow and flourish with little effort. Asking $348K for practice and $575K for building. For details, contact Henry Schein Dental Practice Transitions Sales Consultant Donna Bambrick, (315) 430-0643; or email: donna.bambrick@henryschein.com. #NY2900.

ERIE COUNTY: Located on busy road, surrounded by established residential population and beautiful town. 3-op digital practice, well-positioned for future growth, with $307K gross revenue. Practice has crown and 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. To discuss details, contact Brian Whalen at (716) 913-2632; or by email: brian.whalen@henryschein.com. #NY1648.

QUEENS: Sunny, 3-op dental office. Best offer. Super clean, cheerful, tastefully decorated. Established over 20 years. Located on main shopping street, with high visibility. Subway/buses only 5-minute walk. Off-street parking available for up to 40 cars. Illuminated signage.

Turnkey leasehold sale for best offer. All 3 ops have large windows, modern-style chair/unit, Gendex X-ray, Dexis digital X-ray, Cavitron Ultrasonic, wireless intraoral camera with video screen. Entire office has 5 Dell computers, networked (one in each op and two at front desk), custom multi-drawer, high-end cabinetry, with mega storage. Dual-pump, high-speed evacuation, with new amalgam separator. Premium air compressor with low hours, modern autoclave and more. Perfect opportunity for general dentist or specialist, starting brand new practice or growing established patient base. Contact: sndastoria@gmail.com.

CLASSIFIEDS

GARDEN CITY: Beautiful, 4-op, 1,799-square-foot practice located in large multi-tenant professional building. Over 45 years of goodwill, with top-end equipment, Dentrix software, digital X-ray and pan.

Active patient count 2,800, working 25 hours/ week. Room for growth as most specialties referred out. 2019 gross = $374K. 35% FFS and 65% insurance-based practice. Take over long-established practice with huge growth potential. For details, contact Henry Schein Professional Practice Transition Sales Consultant Linda Zalkin at (631) 357-1003; or email: linda.zalkin@henryschein.com. #NY2772.

days, with additional procedures kept in-house. Contact Henry Schein Professional Practice Transition Sales Consultant Mike Apalucci at (718) 213-9386; or email: michael.apalucci@henryschein.com. #NY311.

ITHACA NY: General dental practice, including property, available for sale. Just under an acre in beautiful country setting, but only minutes from Cornell University and Ithaca College. 1,900-square-foot, handicap-accessible practice has three operatories with digital X-ray.

Plenty of onsite parking. Established practice of 33 years has outstanding reputation, with 1,960 active patients. Owner retiring due to health reasons. Longterm employees include one full-time and one part-time Hygienist, full-time Dental Assistant and office manager.

Over $650K annual collections. No brokers please.

Inquiries to: valleydesign88@gmail.com.

SCARSDALE: Eastchester. Office for sale or rent.

Available 1-5 days/week. 2 operatories, plus 1 unfurnished. Conventional-style office with low rent. Negotiable. Call (914) 777-8218; or email: shunzo3@live.com.

LOWER WESTCHESTER: 2-office general practice for sale. Locations in Larchmont and Bronxville.

Can separate. $500K gross last 3 years with 30-hour week and 10 weeks vacation. Doing only implant restoration, C&B and hygiene. No endo, perio or oral surgery. 2,000 active patients. Only PPO and FFS; no DMOs. Each office can easily be expanded to full time.

Larchmont: 800 square feet with 2 ops; can add 1 additional. Bronxville: 1,200 square feet with 3 ops; can add another op. Real estate available. Contact for details: esr77@optonline.net.

BROOKLYN: Profitable dental practice new to market. Excellent opportunity. Full-mouth rehabilitation practice ideal for general or specialty dentist due to

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keeping high level of specialty work inhouse. Having practiced in community for 40 years, current doctor interested in transitioning to retirement. Unique opportunity with large gross and low work hours; current doctor working only 40 hours/month. Collections $1.9M and EBITDA $615K. 9 total operatories; expansion an option, with two additional ops plumbed and ready. Great location. Doctor open to selling real estate. To learn more, contact Professional Transition Strategies: kaile@professionaltransition.com; or call: (719) 694-8320. More details here: https://professionaltransition.com/properties-list/brooklyn-ny-dentalpractice-for-sale.

CLASSIFIEDS

NORTHERN NEW YORK: Excellent GP opportunity.

Well-established family practice transitioning to retirement. Located minutes to Canada and short drive to Adirondacks. Abundant family outdoor activities: water and snow skiing, Bassmaster’s fishing, hiking, mountains and hunting. Successful, privately owned dental practice, owned by current, practicing dentist. Full support administrative staff, dental assistants and full-time hygienists.

Pleasant working conditions, great salary, exceptional staff and many valued patients. Great opportunity for outdoor enthusiast with their family to establish dental career with successful future. We will work beside you to help ensure your success. Once-in-a-lifetime opportunity for new graduate or experienced dentist looking to take advantage of great outdoors. We look forward to talking with you. All correspondence confidential. Remember: there’s no commitment to inquire. Please contact frontoffice@drcarlscruggs.com or call (315) 769-5811.

FOR RENT ROCKLAND COUNTY: Take over my leased office space; rent or purchase opportunity. Rare find. State-ofthe-art, modern, 4-chair, fully furnished private office is turnkey. Freshly renovated 1,500-square-foot practice includes brand new major equipment. Office highly visible, with plenty of parking. Whether you’re looking for space to move and expand your existing practice OR seek to purchase full patient-included practice with all amenities, this is opportunity you won’t want to miss.

Contact: r.countydental@gmail.com.

NASSAU COUNTY: Previous orthodontic office for lease next to general dental practice in well-maintained professional building. Property suited for any dental or medical professional. Located on Nassau/Suffolk border, next to Sunrise Highway and Sunrise Mall. Inquiries to: docroger1221@hotmail.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.

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WHITE PLAINS: Modern, state-of-the-art operatories available in large office with reception. Available FT/PT; turnkey. Rent includes digital radiology with Panorex, equipment, Nitrous, all disposables. Start-up or phase down. Need a satellite or more space? Upgrade or downsize. Please call (914) 290-6545; or email: broadwayda@gmail.com.

TRIBECA: Op for rent in brand new, 10-foot-ceiling dental office. State-of-the-art chair with curing light, Cavitron, camera and monitor. X-ray machine and TV in room. Inquiries by email to: patmoez@gmail.com.

MIDTOWN MANHATTAN: Remarkable opportunity. Madison at 49th Street. Office available for long-term lease. Fully built out, equipped and furnished office. Approximately 1,850 useable square feet, with 5 fully equipped ops, 2 private offices (1 plumbed for equipment), reception area, front desk area, small lab, storage and staff area. New lease to be negotiated with landlord. For someone looking for larger space, this is ideal opportunity to basically start work on day one and then update as you like. My lease expired after 32 years and I am transitioning into another opportunity. Can leave equipment and furniture or remove as you like. If you are thinking of building new office, all walls, water, air, oxygen, and nitrous lines are already in place, allowing tremendous savings in construction costs. Space available after April 1, 2022. For photos or questions, email: midtowndmd2@gmail.com.

UPPER EAST SIDE RENTAL: Part time. Newly renovated office with 1-3 windowed operatories for rent.

A-dec equipment, front desk space available, shared private office. Flat screens throughout office for best patient experience. 85th Street, between Lexington and 3rd Avenue. Please call or email for details. Phone: (212) 427-4277; or email: shariv@iadentistry.com.

MANHATTAN: Great location; next door to Grand Central Station. Two new dental treatment rooms and reception desk in large, elegantly renovated office.

Nitrous and CDR panoramic. Optional Hygienist services available. Please email Dr. Robert Lichtenstein: rlddspc@gmail.com.

WHITE PLAINS: Dental op for rent in modern, beautiful, 4-chair office, with panoramic and ceph units. Free parking in the center of White Plains. Very accessible to public transport (Metro North and buses). Open to rental by Specialist or GP. Rent negotiable. Inquiries to: 21eh1997@gmail.com.

SCARSDALE: Eastchester. Office for rent 1-5 days/ week. 2 operatories, plus 1 unfurnished. Conventionalstyle office with low rent. Would also consider outright sale. Negotiable. Call (914) 777-8218; or email: shunzo3@live.com.

The New York State Dental Journal

SERVICES DENTAL LEGAL SERVICES: Whether it be a dentist purchasing or selling dental practice, buying, selling, or leasing office space, employment matters, partnership agreements or litigation, the Law Office of Alan C. Stein, PC, will zealously advocate for your rights. With over 25 years of legal experience in dental transactions, the Law Office of Alan C. Stein can handle the most complex of dental transactions to the most basic. “I’m not just married to a dentist……I live dentistry!”

Zoom and in-person appointments available. Offices in Woodbury & Southampton, NY. Call the most trusted law firm for dentists today for your free consultation: (516) 932-1800 Find us online at: www.dentalattorney.net.

OPPORTUNITIES AVAILABLE MOUNT KISCO: Seeking associate general dentist.

Michele Leone-Renne PC has been in her Mount Kisco location for 10 years. Comprehensive, growing general dentistry practice seeks associate. We value each of our loyal patients and look for motivated team member who values quality of care given and provides high level of dentistry. Seeking associate to run the practice as if it were their own, with opportunity to assume ownership in future. Please send resume and cover letter via email: mleone-rennedds@hotmail.com.

SARATOGA COUNTY: Busy, multi-specialty office seeks specialists. Modern office in Saratoga County looking for Endodontist, Oral Surgeon and Periodontist associates. We provide full benefits and relocation costs. Earn up to $400K per year while you receive full employment benefits. Partnership opportunity available. All levels of experience welcomed to apply. Send resume to drneda@hotmail.com.

MIDTOWN MANHATTAN: Dentist opportunity available in beautiful midtown location. If you have small practice and want to grow it stress-free without any rent, overhead or staffing issues, then send your resume so we can speak. Well-established, organized business systems, with great trained staff to help you grow. Or if you have established practice and want new modern office to share overhead and continue your career, please get in touch. Email: drk@nycsmilespa.com.

AUBURN: Productive, growing practice in quaint CNY community. Outright sale or available for associate leading to buyin. Located in village proper, with $700K revenue. Dental office occupies 3,200 square feet of 5,530 square feet, with four ops and one plumbed, not equipped. Large patient base and referring out many specialty procedures. Real estate also for sale, with rental apartment that brings additional revenue. For details, contact Henry Schein Professional Practice Transition Sales Consultant Donna Bambrick

by email: donna.bambrick@henryschein.com; or call (315) 430-0643. #NY2624.

ASTORIA, BAYSIDE & BRONX: Dentists & specialists needed. Multi-specialty offices looking for general dentists to provide treatment for crowns, bridges and root canals. Oral Surgeon, Pedodontist and Endodontist positions available in 3 locations.

Must examine, diagnose and provide treatment counseling to patients in comprehensive manner; solicit patient feedback to improve service; direct assistants and other auxiliary personnel. Specialists must provide certificate of residency. Please email your CV to management@belldentalcare.com.

MANHATTAN SPACE SHARE: Share my office, inherit my practice. 40-year practice in excellent UWS Manhattan location. 2 operatories; low overhead.

Perfect for quality-oriented GP or prosthodontist with nucleus of patients. Practice all FFS, with no insurance contracts. Referring out all endo and most surgery. Email me; let’s talk. Contact: exceldent@protonmail.com.

MANHATTAN: Rapidly expanding state-of-the-art dental practice in downtown Manhattan looking for experienced Endodontist. High-end practice specializes in complex restorative, implant and aesthetic dentistry.

We strive to provide not only excellent, quality dental care, but also excellent, overall patient experience.

Responsibilities include patient consultation, discussing treatment options, treating patients, overseeing aftercare and coordinating with other specialists when necessary. About the Role: create unique, customerfocused dental experience for patients; utilize diagnostic data to determine needs and treatment goals; develop and discuss treatment plan options; collaborate with dental professionals to enhance patient experience and treatment; maintain detailed patient records; serve as resource for development of educational materials for Tend providers; prescribe medication. About You: DMD or DDS degree; successful completion of accredited endodontics program; board certification in endodontics preferred; current license to practice in New York; demonstrated commitment to professional development and CE; dedication to ensuring highest quality patient care; leadership skills that value collaboration and inclusive work environment; high level of integrity and dependability, with strong sense of urgency and resultsorientation; exceptional attention to detail. Contact Krista Sachse, Practice Manager, at (516) 650-5052; email: tadpracticemanager@gmail.com.

BRONX: Seeking Periodontist for well-established, busy, multi-specialty state-of-the-art practice 2-3 days/ month in FFS office. Many implant cases, with excellent fees. Come join great team with experienced, caring staff. Call Rosette at (718) 654-2320. Email resume to: williamsbridgedental@gmail.com.

WESTERN NEW YORK: The Chautauqua Center, a Community Health Center located in WNY nearby Lake Erie and Chautauqua Lake, hiring in both new offices in Jamestown and Dunkirk as we continue to expand. We offer variety of services and are truly unique health center, including primary care, dental, behavioral health, nutritional care, chiropractic care, an inhouse pharmacy and more. We also offer student loan repayment programs (e.g. $100K for 3-year commitment) to employees. Numerous other benefits, including staff appreciation days; malpractice, including tail coverage; manageable caseloads; licensure coverage; 403b retirement, including matching funds; to name a few. We focus on work-life balance and flexible schedules (4-day workweeks). If you would like to learn more about the good work we’re doing in Chautauqua County, such as offering veggie prescriptions to patients, prescriptions for play, launching health and wellness program, etc., we are happy to speak with you. Contact: aekstrom@thechautauquacenter.org.

INDEX TO ADVERTISERS Accounting Dentistry . . . . . . . . . . . . . . . . . . . . . 17 & 37

Choice Transitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Corcoran Wexler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

DDS Match . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Epstein Practice Brokers . . . . . . . . . . . . . . . . . . . . . . . . 10

First Republic Bank . . . . . . . . . . . . . . . . . . . . . . Cover III

Henry Schein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

CLASSIFIEDS

SARATOGA/LAKE GEORGE AREA: Fun, busy, FFS private office seeks dentist to join our team. $120K salary, with generous production bonus. Partnership possibilities; we are not an associate mill or commercial chain. Successful candidate will be competent in restorative and C&B. Seeking nice, caring person who will treat our patients with compassion and respect.

Excellent benefits, CE, office cruise, in-house lab. This is the office you are looking for. Please contact Wendy for more information. Phone: (518) 747-9527; email: ssrdental132@gmail.com.

MANHATTAN: Oral Surgeon. Rapidly expanding state-of-the-art dental practice in downtown Manhattan looking for experienced Oral Surgeon. High-end practice specializes in complex restorative, implant and aesthetic dentistry. We strive to provide not only excellent quality dental care but also excellent overall patient experience. Responsibilities include consulting with patients and analyzing patient data to determine patient needs and treatment goals; collaborating with other specialists; recording patient care; administering general and local anesthetics, when necessary; performing surgical procedures; prescribing medications; treating infections; providing emergency treatment; performing minor cosmetic procedures, such as chin and cheekbone enhancements; supporting and advising patients receiving long-term care. Requirements: Bachelor’s degree in biology, chemistry, or related field; DMD or DDS degree; license to practice as Oral Surgeon; exceptional attention to detail; outstanding hand-eye coordination and dexterity; wonderful bedside manner; excellent communicator who can empathize with patients. Flexible working hours. Contact Krista Sachse, Practice Manager at (516) 650-5052; email: tadpracticemanager@gmail.com.

Ithaca Practice Sale . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Jacobson Goldberg & Kulb . . . . . . . . . . . . . . . . . . . . . 20

ADA Transitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

MLMIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cover IV

NSS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 & 36

NYSDA Renewal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

NYSSOMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Queens Rental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Stein, Alan Esq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

TDSC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

The Smilist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cover II

UB Continuing Ed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

The New York State Dental Journal

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ADDENDUM

In Memoriam NEW YORK COUNTY Neal Demby University of Pennsylvania ‘68 473 County Highway 40 Worcester, NY 12197 November 28, 2021 Louis Rubins Columbia University ‘60 9 Westview Lane Scarsdale, NY 10583 November 12, 2020 SECOND DISTRICT Christopher Madison New York University ‘76 412 Poillon Avenue Staten Island, NY 10312 December 15, 2021 THIRD DISTRICT Joseph Corsetti University at Buffalo ‘61 602 Tranquil Sound Drive Cary, NC 27519 January 20, 2022

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Edmond Haven New York University ‘63 122 Devon Road Delmar, NY 12054 February 21, 2022 Sanford Krimmer University of Pennsylvania ‘52 31 White Pine Drive Albany, NY 12203 January 3, 2022 FIFTH DISTRICT Richard Myers University at Buffalo ‘63 PO Box 1378 Boca Grande, FL 32092 January 16, 2022 John Scullin University of Pittsburgh ‘47 4 Burkle Street, #122 Oswego, NY 13126 January 29, 2022

The New York State Dental Journal

SIXTH DISTRICT H. Callaghan Georgetown University ‘69 645 Pelham Road Saint Augustine, FL 32092 December 28, 2021 SEVENTH DISTRICT Victor Krym University of Pennsylvania ‘63 210 Whistle Stop Road Pittsford, NY 14534 January 29, 2022 Donald Smith Washington University ‘77 174 Village Square Painted Post, NY 14870 January 10, 2022 NINTH DISTRICT Gordon Kalmanson Temple University ‘67 406 Heritage Hills, Unit C Somers, NY 10589 January 6, 2022

Vincent Catalano Georgetown University ‘56 146 Sandalwood Lane Rhinebeck, NY 12572 January 19, 2022 John DeMeo University of Pennsylvania ‘44 100 Club Drive, #225 Burnsville, NY 28714 January 15, 2022 NASSAU COUNTY Mario Gambino Loyola University of Chicago ‘56 605 E. Penn Street Long Beach, NY 11561 January 19, 2020 SUFFOLK COUNTY Mortimer Glasgal University at Buffalo ‘56 1501 Santa Barbara Street, #E Santa Barbara, CA 93101 February 7, 2021

“First Republic helped me expand my practice with a small business loan. It was a simple process delivered with a personal touch.”

E I S D O R F E R D E N TA L G R O U P

James Eisdorfer, D.D.S., Owner

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NY State Dental March'20 Eisdorfer ND2017.indd 1

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