NYSDJ November 2024

The New Premium Pricing Plan

Cover: Social media platforms are used for instant communication of information, which make them useful in learning situations. Dental educators benefit from knowing which platforms are most used by students to support their education and communicate with other students.

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NYS Workers’ Compensation & No-Fault Cases

The Good, the Bad and the Ugly

John A. Sorrentino, D.M.D.

In the interest of doing right by our patients, the good outweighs the bad.

18 Social Media Use by Dental Students in Dental Education

Ellen Lee, D.D.S.; Brian Chin, M.B.A.; Ningshu Lyu, D.D.S.; Yueqi Gao, D.D.S.; Yixin Bao, D.D.S.; Jacob Kim; Kaiden Park, D.D.S.

Study undertaken to evaluate dental student preferences for use of social media in dental education.

22 Guidelines for Interproximal Enamel Reduction (IPR)

Sewon Yang, D.D.S.; Min Seok Kim, D.D.S.; Eugene H. Bass, D.M.D.

Comprehensive step-by-step protocol for IPR is proposed,with further suggestions to assure the safety of the procedures and minimize potential iatrogenic side effects.

28 Exophytic and Focally Ulcerated Mass on the Mandibular Gingiva

Abrar Shamin, D.D.S., M.A.; Scott M. Peters, D.D.S.; Shahid R. Aziz, D.M.D., M.D., FACS, FRCSEd; Gregg Jacob, D.M.D., FACS While the majority of oral pyogenic granulomas remain less than 1 cm in size, they can grow to large sizes if neglected. Report of case of large pyogenic granuloma on mandibular alveolar ridge gingiva that grew in size due to failure to seek treatment.

I’m Mr. Brightside Optimistic Dentistry Can Maintain its Leadership Role in Dentist-Patient Decision-making

Deceptive managed care tactics have violated the dentist-patient relationship and undermined trust in the dental profession.

In the 2004 Killers pop song “Mr. Brightside,” the protagonist puts on a brave face as he painfully observes another man with his girlfriend. Similarly, individual dentists and our profession too often stand back and merely witness managed care organizations (MCOs) take our place as the primary decision-maker in our relationship with our patients.

While the song never relates whether Mr. Brightside intervenes and saves the relationship, we must eliminate MCOs’ intrusion into the dentist-patient relationship to protect patients’ autonomous right to informed decision-making. Dentistry must expose how MCOs manage costs to guard their own bottom line at the expense of patients’ best interests, fight MCOs’ deceptive schemes with ethical practice and legislative initiatives and support dental benefit plans that reaffirm dentists’ authority as the leader in oral healthcare decision-making.

“It

reimbursement plans, it involved no provider contracts, no dentist networks or reimbursement manipulations. Patients were treated by the dentist of their choice. Dentists informed patients of their condition and alternatives for care. Patients made informed decisions, underwent treatment and insurers paid to reasonable annual maximums.

started out with a kiss. How did it end up like this?”

Regretfully, dental insurance has remained largely unregulated, in part because the healthcare industry and society consider much of dental care a desirable, but nonessential service. Hence, MCOs gradually infiltrated this regulatory void with coercive provider agreements and heavyhanded cost-containment controls that limited both patients’ choice of dentists and treatment alternatives. It ended up as managed care, an opaque and oppressive collection of deceptions, onerous policies and illegal restrictions foisted upon the delivery of oral healthcare.

It started in the 1950s with dental indemnity insurance, a transparent and autonomous concept, instituted to provide increased access to affordable care and improve the public’s oral and general health. Along with direct

Deception 1: MCOs Protect Patients

MCOs utilize marketing tactics and plan limitations to create the false impression that they protect patients’ oral health and autonomy,

especially from overtreating and overcharging dentists. First, companies refer to their plan as “insurance,” similar to medical or dental indemnity insurances, to deceive patients into believing the plan will take care of all necessary dental needs. In reality, the plan functions merely as a discount or coupon on select services, not comprehensive insurance coverage. In fact, the plan protects the MCOs’ bottom line above patients’ oral health. MCOs calculate reimbursements to dentists on arbitrary costcontainment limitations that bear no relation to a fair fee to support treatment within the standard of care or best interest of the patient.

Second, the plan selects and engages “preferred providers” into a “network” that implies it includes a higher skill level of dentists who sought this desirable position and somehow qualified to participate. In the event outlier dentists attempt to overtreat, the MCOs protect the patient with preauthorization and utilization review mechanisms. If the company determines dentists overcharge, then the plan protects patients with a UCR fee schedule and costcontrol policies, such as least-expensive alternative treatment, bundling and downcoding.

Actually, most dentists do not prefer or desire to participate in discount plans with onerous limitations on treatment planning and poor reimbursements. Rather, MCOs indirectly pressure dentists to join the network using the threat of losing potential access to the plan’s member patients. Then, the company requires participat-

EDITOR

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

ASSOCIATE EDITOR

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

MANAGING EDITOR

Mary Grates Stoll

ADVERTISING/SPONSORSHIP MANAGER

Jeanne DeGuire

ART DIRECTOR

Ed Stevens

EDITORIAL REVIEW BOARD

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

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

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

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

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

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

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

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

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

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

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

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

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

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

PRINTER

Fort Orange Press, Albany

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

ing dentists to sign borderline unconscionable provider agreements that exploit dentists’ weaker bargaining power. Contract terms and mandatory fee schedules dictate treatment planning in the company’s financial interest. Hence, dentists participate only as a last-resort business decision and often terminate if or when their patient demographics and cash flow allow.

Third, plans create “Participating Dentist” and “Covered Services” lists allegedly to protect patients’ autonomy to select their dentist of choice and make informed decisions regarding their care. However, MCOs do not trust patients to select their dentist or make informed decisions on their oral health. MCOs influence member choices of dentists not only through limiting choice to the participant list and attempting to limit fees paid to out-of-network practitioners, but also through segmenting and grading the participant list into tiers based solely upon undisclosed dentist performance profiles that benefit the MCO profit margin.

Finally, MCOs severely limit patient autonomy in treatment planning through an extensive list of uncovered services, downgrading treatment planned to the least-

expensive treatment alternatives in the predetermination process and enforcing absurdly low annual maximums that have ignored increases in the cost of providing care and inflationary increases for decades. Ultimately, MCOs mistrust patients who, in collaboration with their dentists, will too often elect what the company deems nonessential and excessively expensive procedures and, therefore, MCOs devise reimbursement schemes to control dentistpatient decision-making.

Deception 2: Dentists and Lawmakers Condone MCO Tactics

The fact that dentists participate in MCO plans, and the law seemingly does nothing to prohibit certain deceptive policies and provider contract terms, gives the entire managed care operation the appearance of legitimacy. Dentistry must better inform the public that we are not willing accomplices in MCOs’ deceptive schemes that diminish both dentists’ and patients’ autonomy. We do participate in plans that can provide access to care for underserved populations. However, we have successfully supported and advo-

cated for legislation that prohibits coercive dental benefit schemes that interfere with informed decision-making, including, among others, the following:

• Dental Loss Ratio (“DLR”): Requires MCOs in many states to report to state legislatures the percentage of premiums and, in some states, requires a minimum percentage (approximately 80%) spent on patient care and quality improvement compared to administrative costs and profit.

“I just can’t look, It’s killing me, They’re taking control”

• Pre-existing Conditions: Prohibits claim denials based on patients’ conditions existing prior to date of commencement of the insurance.

• Gag Clauses: Prohibits clauses in provider contracts that “gag” dentists from saying anything negative regarding a plan. The legislation requires MCOs to submit a formal attestation that the MCO has complied with the Gag Clause prohibition.

• Hold Harmless Clauses: Recommends dentists obtain legal review before agreeing to hold the MCO harmless and indemnify the MCO for any liability it may incur related to the dentist’s acts or omissions even if an MCO restriction was at fault for a patient injury.

The ADA has collaborated with the National Council on Insurance Legislators to develop the Transparency in Dental Benefit Contracting Model Act and currently continues to fight the following new negative dental benefit trends:

• Affiliated Carrier Clauses: The ADA is advocating with state dental associations in 30 states to pass network leasing legislation that requires MCOs to clearly inform and give participating dentists the ability to opt out of the MCO leasing its network of dentists to another MCO, which could force dentists to accept fee schedules and processing policies different from those to which they previously agreed.

• Out-of-Network Fees: Recommend patients file complaints with their employers’ HR departments when MCOs reduce fees paid for out-of-network claims from the average amount dentists charge to the average amount insurers pay for services in that geographic area. The mere fact that MCOs instituted and dentistry must fight the above tactics exposes MCOs’ deceptions and reveals their profit-driven intentions. Possibly, the greater fight against dental benefit policy abuse occurs daily in every dentist-patient encounter. Regardless of exploitive provider agreement terms and MCO profit-driven costcontainment schemes, dentists remain legally and ethically accountable to deliver treatment within the standard of care and in the best interests of the patient.

Unlike Mr. Brightside, dentistry has no choice but to confront and expose MCO tactics and advocate for legislation to prevent them from taking control of the dentist-patient relationship. We must promote indemnity insurances and direct reimbursement plans that eliminate provider contracts that give MCOs legal standing and the opportunity to interfere with dentist-patient decision-making.

On the bright side, the dental profession’s ongoing commitment to acting in the best interests of patients and the public will enable us to save the dentist-patient relationship and continue to earn society’s trust.

REFERENCES

Farewell

This is my final editorial in my term as Editor of our New York State Dental Journal. I want to thank the NYSDA Board of Trustees, Managing Editor Mary Stoll and our members and readers for the privilege of serving over the past nine years in my editorial capacity. I also want to take this opportunity to welcome our next and capable editor, Dr. Stuart Segelnick.

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

1. The Killers, “Mr. Brightside,” by Brandon Flowers and Dave Keuning, Island Records, 2004.

2. Versaci M. 3 Dental Benefit Trends You Should Know. ADA News, Vol.55, No. 6, June 3, 2024.

D.D.S., J.D.

The Courts Strike Back

Issues of water fluoridation and noncompete agreements continue to undergo legal scrutiny, with no clearcut answers in the offing.

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

In a busy season for the judicial branch of government, two major court decisions have changed the playing field on noncompete agreements and on water fluoridation. More such court decisions can now be expected due to the 2024 United States Supreme Court decision in Loper Bright Enterprises v. Raimondo, which overturned the longstanding 1984 Supreme Court precedent of Chevron U.S.A. Inc. v. Natural Resources Defense Council, Inc.

The Chevron case created something known as the “Chevron doctrine,” a judicial principle that held that courts should give weight and preference to government agency decisions on and interpretations of otherwise ambiguous laws because government agencies possessed expertise in the subject matter areas of the laws they were entrusted to enforce.

The overruling of the Chevron doctrine leaves it up to the courts to determine the meaning of ambiguous laws. While that may seem superficially logical, it overlooks the reality that Congress frequently passes laws premised on the fact that expert agency input will help shape and implement those laws. Therefore, the laws are frequently not written by Congress in pre-

scriptive fashion with attention to detail but are painted in much broader brushstrokes. For the prescriptive style of codification, one needs to look to Europe and other countries that do not follow the common law system of Great Britain and the United States but use the civil law system. Only one state in the United States utilizes a civil law system—Louisiana—which follows civil law derived from the Napoleonic Code in effect from when France controlled the region. It is not clear that the Louisiana legal system inspires great confidence, although it did for Huey Long.

Questioning Safety of Water Fluoridation

With the end of the Chevron doctrine, the courts have now stepped in to give us decisions that reject Federal Trade Commission (FTC) regulations banning noncompete agreements and reject the United States Environmental Protection Agency (EPA) regulations finding water fluoridation to be safe at a level of 0.7 milligrams per liter (mg/L). Both decisions are of interest to dentistry. Because water fluoridation is of keen clinical interest to dentistry, let us begin with exploring the recent court decision from the United States District Court of the Northern

District of California—Food & Water Watch, Inc. v. United States Environmental Protection Agency.

In the Food & Water Watch case, litigation commenced way back in April 2017 that dragged on for over seven years, the court determined that water fluoridation at the EPA-determined optimal recommendation of 0.7 mg/L posed an unreasonable risk of harm to the public and that the EPA must engage in regulatory action to address this risk. The federal Toxic Substances Control Act (TSCA) allows for private citizens to file petitions with the EPA to compel consideration of proper regulation of toxic substances. Food & Water Watch filed such a petition in 2016 with the EPA over fluoride in water systems. The EPA rejected the Food & Water Watch petition on fluoride and the 2017 litigation then commenced challenging that EPA denial.

The court found that fluoridation of water at 0.7 milligrams per liter (“mg/L”)—the level presently considered “optimal” in the United States—poses an unreasonable risk of reduced intelligence quotient (IQ) in children. It should be noted that this finding does not conclude with certainty that fluoridated water is injurious to public health; rather, as required by the TSCA, the court found there is an unreasonable risk of such injury, a risk sufficient to require the EPA to engage with a regulatory response. The court did not dictate precisely what that response must be, but noted the TSCA leaves that decision in the first instance to the EPA. The court added that one thing the EPA can-

NYSDA Directory

OFFICERS

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BOARD OF TRUSTEES

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New York State Dental Journal

not do, however, is to ignore the risk found by the court to exist. The EPA has not yet said if it will appeal the decision to the United States Court of Appeals for the Ninth Circuit.

Unreasonable Risk

To succeed in a suit brought under the TSCA, Food & Water Watch had to prove, by a preponderance of the evidence, that a risk of injury to human health is present and that such risk is unreasonable. For a risk to be present, they had to show that some segment of the United States population is exposed to the chemical at issue at levels that either exceed or are too close to the dosage at which the chemical presents a hazard. The reasonableness of the risk is informed by several factors, including the size and susceptibility of impacted populations, severity of the harm at issue, and the frequency and duration of exposure. The court noted that there was little dispute in the case as to whether fluoride poses a hazard to human health. The court also noted that there was ample evidence establishing that a mother’s exposure to fluoride during pregnancy is associated with IQ decrements in her offspring.

Of particular importance to the court was the fact that the United States National Toxicology Program (NTP), the federal agency regarded as experts in toxicity, undertook a systematic review of all available literature near the time of publication that looked at whether fluoride poses cognitive harm, reviewing 72 human epidemiological studies considering this question. The court found that the NTP concluded that fluoride is indeed associated with reduced IQ in children, at least at exposure levels at or above 1.5 mg/L.

In addition, the court found that, notwithstanding inherent difficulties in observing effects at lower exposure levels, scientists have observed a statistically significant association between fluoride and adverse effects in children even at exposure levels less than 1.5 mg/L. The court found that the EPA’s pointing to technicalities at various steps of their risk evaluation to conclude that fluoride does not present an unreasonable risk and the EPA argument that the hazard level and the precise relationship between dosage and response at lower exposure levels was not entirely clear was unpersuasive on the entire risk issue.

The court opinion is 80 pages long, with the bulk of it being analysis of expert testimony and expert research publications on whether fluoride has an adverse effect on the IQ of children. The court concluded that the preponderance of the evidence, including testimony from the EPA’s own experts, was that there was a clear correlation between fluoride and lower IQs in children. The court stated that the scientific literature in the record provided a high level of certainty that a hazard is present; fluoride is associated with reduced IQ. The court noted that while there were uncertainties presented by the underlying data regarding the appropriate point of departure and exposure level to utilize in the EPA risk evaluation, those uncertainties did not undermine the finding of an unreasonable risk—in every scenario utilizing any of the various possible points of departures, exposure levels and metrics, the court found a risk is present in view of the applicable uncertainty factors that applied.

In an exceedingly odd comment, the court stated that water fluoridation had a long history in the United States and had been a source of political discord at times, adding

that controversy over fluoridation of drinking water had even found its way into Hollywood, citing the movie Dr. Strangelove (Columbia Pictures 1964), in which the character Gen. Ripper characterized fluoridation as a threat to our “precious bodily fluids” and “the most monstrously conceived and dangerous Communist plot we’ve ever had to face.”

If this is what the Supreme Court had in mind as the replacement of agency expertise with court analysis when it repealed the Chevron doctrine, court opinions should be much more entertaining from now on.

Noncompete Agreements Still Hold

The repeal of the Chevron doctrine is, of course, the proverbial mixed bag. In the case of noncompete agreements, the result is a happier one than for water fluoridation. The United States District Court for the Northern District of Texas has ruled in Ryan LLC v. Federal Trade Commission that the Federal Trade Commission (FTC) rule banning noncompete agreements that was scheduled to take effect on Sept. 4 exceeds the authority of the FTC to adopt and

is enjoined from being enforced nationwide. The FTC has appealed the decision to the United States Court of Appeals for the Fifth Circuit. Nevertheless, the rule banning noncompete agreements will not take effect as scheduled and is enjoined from any enforcement by the FTC at this time pending the decision on the appeal filed by the FTC.

The court in Ryan LLC held that the FTC had exceeded its regulatory authority in promulgating such a sweeping ban on noncompete agreements and that the ban was arbitrary and capricious.

The court concluded the text and the structure of the FTC Act revealed that the FTC lacked substantive rulemaking authority with respect to unfair methods of competition and, when considering the text, the court also concluded the FTC exceeded its statutory authority in promulgating the noncompete rule.

In addition, the court found that the evidentiary record did not support the rule, citing that the FTC relied on only a handful of studies that examined the economic effects of various state policies toward noncompetes. The court noted that the record showed that no state had enacted a noncompete rule as broad as the FTC’s rule. The court found that the FTC’s evidence compared different states’ approaches to enforcing noncompetes based on specific factual situations—completely inapposite to the FTC rule’s imposition of a categorical ban, and that the FTC provided no evidence or reasoned basis for a categorical ban.

Furthermore, the court held that the FTC’s lack of evidence as to why it chose to impose such a sweeping prohibition—one that prohibits entering or enforcing virtually all noncompetes—instead of targeting specific, harmful noncompetes renders the FTC rule arbitrary and capricious. The court found that the FTC rule is based on inconsistent and flawed empirical evidence, fails to consider the positive benefits of noncompete agreements and disregards the substantial body of evidence supporting these agreements. The court noted that the FTC’s alleged “compelling justifications” for its decision to not consider other exceptions or alternatives did not adequately justify the FTC rule. In fact, the court found that the FTC dismissed any possible alternatives, concluding that either the pro-competitive justifications outweighed the harm, or that employers had other avenues to protect their interests.

Consequently, the court ruled that it could not conclude the FTC noncompete rule fell within a “zone of reasonableness” or that it was “reasonably explained.” Therefore, the court concluded that the FTC rule was arbitrary and capricious. The court happily cited the Loper Bright Enterprises Supreme Court case in its opinion, although no mention of

any Hollywood movies (not even Jerry Maguire “Show me the money!”).

Interestingly, a different federal District Court in Pennsylvania reached the opposite conclusion than the federal District Court in Texas. Presumably, this split in federal District Courts will end up at the United States Supreme Court with all the losing parties appealing. Another spawn of the repeal of the Chevron doctrine in Loper Bright Enterprises. And still room for them to cite Hollywood and The Talk of the Town (“What is the law? It’s a gun pointed at somebody’s head. All depends upon which end of the gun you stand, whether the law is just or not.”).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.

NYS Workers’ Compensation & No-Fault Cases

The

Good, the Bad and the Ugly

John A. Sorrentino, D.M.D.

Agreeing to do a workers’ compensation or no-fault case can be a great practice builder and have a powerful and positive impact on the lives of people who have been devastated by a workplace or automobile accident. Yet, many practitioners hesitate or refuse to do these kinds of cases for a variety of reasons. Often, you are dealing with insurance companies that are unfamiliar with dental claims. Perhaps because these claims don’t crop up often, you are not familiar with the process, or you have heard stories of poor, or even no reimbursement.

I got my start learning the process when as a new dentist, one of my patients was involved in a motor vehicle accident and I saw it as an opportunity to help him. What follows is certainly not a complete guide, but over my career, I have completed many cases, which allows me to offer my experiences and the mixed results I have had.

The Good

The rules of workers’ compensation and no-fault claims are such that your compensation is 100% insurance reimbursement. The patient has zero out-of-pocket expenses. Every

case has a specific claim ID and a company representative who is assigned to that case. You most likely will be dealing with the same person throughout the process, and claims are processed using the ADA dental claim form.

By law, insurers have 30 days to pay electronic claims and 45 days to pay paper claims, as long as the claim is not disputed. Claims must be denied within 30 days of receipt by the insurer. If additional information is needed from the provider in order to adjudicate a claim, the information must be requested within 30 days of receipt of the claim.

Carriers will pay for copies of the documentation you submit, and New York State law allows you to charge for those copies. They often pay for procedures that most regular dental insurance will not. Often, these types of cases involve lawsuits. Your records are legal documents that attorneys from both sides will want to review. Take before and after photos of everything. They not only provide important documentation, but you will be compensated for all of them. Treatment procedures covered include things like models, local anesthesia codes D9211, D9215, and occlusal adjustment, codes D9951 and D9952.

While some companies, especially those based out of state, may try to negotiate the fees for treatment, you are not obligated to do so. New York State has a set dental fee schedule that applies to both workers’ compensation and no-fault insurance claims reimbursement. A copy of the fee schedule is available on the Workers’ Compensation Board website (https://www.wcb.ny.gov/content/main/hcpp/dentalFeeSchedule.jsp).

NYSDA members may also obtain a copy from the NYSDA office by calling (800) 255-2100, ext. 250. The fee schedule will give you a general idea of what your reimbursement will be. Implants and other major restorative services are covered, as long as they are related to the accident.

New York State and municipal public sector workers are covered by the New York State Insurance Fund (NYSIF). This is a self-funded state program that bears special mention. NYSIF is one of the easiest companies I have ever worked with. Many New York State public sector employees, such as peace officers and correctional officers, may experience dental trauma in their line of work. NYSIF will take predeterminations and claim submissions via email. They are usually very fast and in my experience, predeterminations and claims are adjudicated in a week or two.

The Bad

The rules of workers’ compensation and no-fault claims are such that your compensation is 100% insurance reimbursement. You cannot balance bill the patient. Although there are mechanisms for appeal when a claim is denied, and depending on whether you accepted an assignment of benefits (no-fault cases), if you misjudge what the compensation will be or if your appeal is unsuccessful, there may be no further recourse. Although the same fee schedule is used, both workers’ compensation and no-fault are subject to different policies. No-fault is regulated by the Department of Financial Services (DFS).

Sometimes, especially with motor vehicle accidents, you are dealing with an insurance company that has no knowledge of the dental market or the codes we use. One time, the insurance company paid my fee according to a pre-estimate. While I completed the case in a timely manner, this could have caused legal problems if I had failed to do so, or if the patient chose not to complete treatment. Once again, I attribute this to the company not being familiar with dentistry.

The fee schedule, which is set by the Workers’ Compensation Board, has not been updated since 2009, so be sure to review it before you start. Occasionally, you may have your clinical judgment questioned by an adjuster who does not know anything about dentistry.

The Ugly

The rules of workers’ compensation and no-fault claims are such that your compensation is 100% insurance reimbursement. There is no guarantee that the insurance company has any idea how dental coding and reimbursement work. One time, I had a company reimburse the patient instead of the office. The patient then proceeded to pocket the money and never returned our calls.

A more recent snafu occurred when one company, despite my NPI clearly on the claim form, sent the payment to the “Regent of California” instead of to my office. When the claim involves a company that does not have an affiliation in New York State, you have little recourse. I finally got reimbursed, but it took eight months.

No-fault claims are generally reimbursed by automobile insurance companies. Workers’ compensation plans are purchased by employers and may be self-funded or by a company that does not have a presence in New York State. The workers’ compensation program is governed by the New York State Workers’ Compensation Law, and the regulations are established by the Workers’ Compensation Board (WCB), which administers the program.

In my dealings with both the WCB and DFS, I have found their representatives to be professional, attentive, and they tend to return messages in a timely manner. They are at their best when dealing with in-state and automobile insurance companies. They may not be as much help when dealing with an out-of-state entity.

For the Good of the Patient

In my career, I have always tried to do what is best for my patients. Providing the best treatment you are capable of is only the starting point. We should not shy away from having to do a bit more paperwork or spend a little more time when a patient has been the victim of an unfortunate accident. We are not only restoring their health but their dignity as well. This is why I have found that the process is generally worth the effort. Rebuilding the smile of someone who has been devastated by trauma is one of the most rewarding things a dental practitioner can do. In the end, I would say that the good far outweighs the bad and the ugly.

If you have questions about the New York State workers’ compensation or no-fault programs, contact NYSDA at (800) 255-2100, ext. 250. p

Dr. Sorrentino is a member of the NYSDA Council on Dental Benefit Programs representing the Ninth District Dental Association. He has a private practice in Hopewell Junction and is also employed by the New York State Office of Children and Family Services, providing dental services to incarcerated youths.

Association Activities

Chad Gehani is International College Award Winner

DR. CHAD P. GEHANI, NYSDA and ADA past president, has been honored by the International College of Dentists, which presented him with its Outstanding Dental Leadership Award. Dr. Gehani, a clinician, leader, educator, mentor and humanitarian, was cited for his many significant contributions to the dental profession. Dr. Gehani received his award in September during the ICD’s Convocation in Nashville, TN.

Dr. Gehani has been instrumental in improving the art and science of dentistry globally for over 35 years. This includes making several visits to improve the oral health of the public in India, Pakistan and Bangladesh. He is responsible for setting up continuing education programs in India, so that that country’s standards of dentistry are equal to those in the United States. He has been and continues to be a sought-after speaker, mentor and guide to many prestigious dental universities in India and abroad.

In 1988, Dr. Gehani donated the latest American diagnostic technology to the Government Dental College in Mumbai, India, and $10,000 to aid in the treatment of needy children. From 1985 to 2000, he visited many dental institutions in India, Pakistan and Bangladesh to teach the faculty. In 1988, he donated a large number of books to Nair Hospital Dental College, Mumbai, for the transfer of technology, and hosted 10 dentists from India in his Manhasset, NY, home to teach them the latest in dentistry. In addition, in 1989, he funded the visit of two deans from dental colleges in India to various American dental colleges to learn more about the practice of dentistry in the United States.

In 2006 Dr. Gehani was awarded the New York State Dental Foundation Award of Excellence in Community Service, recognizing his years of serving the needy, including fighting to preserve dental Medicaid for the underserved and disabled. In 2015, he received the Congressional Ellis Island Medal of Honor in recognition of his dedication to service to humanity.

A past president of the Queens County Dental Society, Dr. Gehani currently serves as executive director of Queens County.

NYSDA Peer Assistance Coordinator Named to PAP Steering Committee

DR. ROBERT J. HERZOG, peer assistance coordinator for the NYSDA Committee on Substance Use Disorder and Well-Being, has been elected to the New York State Education Department Professional Assistance Program (PAP) Steering Committee. As a member of the Steering Committee, Dr. Herzog will assist in developing and reviewing policies and documents for approval by the PAP Board and State Education Department.

Dr. Herzog has served as a member of the Committee for Professional Assistance for over 15 years. The committee advises and guides the New York State Board of Regents and the State

Education Department in matters related to substance use disorder. He will continue in that role in addition to serving on the Steering Committee.

New York State’s Professional Assistance Program is a confidential alternative to disciplinary programs. It provides licensed professionals suffering from substance use disorders with the opportunity to receive treatment and maintain their licenses, provided there has been no patient harm. Many dentists have been very successful in their recovery because of what the PAP program has to offer. NYSDA commends those who enter the program and work to restore their lives.

If you or someone you know is facing a substance use disorder, please reach out to Dr. Herzog at (716) 830-3055, rherzog@roadrunner.com, or Jacquie Donnelly at NYSDA, (518) 689-2750, jdonnelly@nysdental.org. Your call is confidential.

Chad Gehani

Robert Herzog

Warning: Do Not Use the ADA Self-reporting CE Function

NYSDA has identified several problems with CE certificate uploads on the new ADA portal. To ensure that CE transcripts are compliant with New York State Education Department requirements, we recommend members use only CE Navigator. To create your CE Navigator account, please visit www.nysdentalnavigator.com.

Important Updates on CE Credit Tracking: FAQs

Q: Do I need to create a CE Navigator account?

A: CE Navigator is an exclusive NYSDA member benefit designed to help members track their continuing education credits. It also tracks NYS-mandated course requirements and sends reminders when they are due for renewal. The information is kept in New York State Education Department (NYSED)-compliant format, ensuring all requirements for the three-year licensure period are met. While not required, it is strongly recommended that members create an account for its simplicity and ease of use. Note: CE Navigator is not connected to the New York State Education Department.

Q: Will my CE history be available when I create an account?

A: No, your CE history will not automatically appear in your CE Navigator account. CE Navigator is designed to help you track requirements for your current license registration period, ensuring your transcript meets NYSED standards in case of an audit.

Q: How do I get my CE history?

A: Your past CE history is on the ADA platform, but it is not in a NYSED-approved format. We attempted to use this system as a registry but, ultimately, CE Navigator was the best way forward. While you can still access your CE history on the ADA Portal, it lacks the CERP provider and is not in chronological order, making it harder to review for current mandates. CE history is only needed for audits or credentialing (typically covering the last three years) and isn’t required for license renewal with NYSED. Should members face an audit, NYSDA will assist them in working with NYSED to verify past CE history.

Q: Should I use the ADA Portal for CE tracking?

A: No, we recommend you not use the ADA continuing education portal moving forward. We highly recommend using CE Navigator exclusively for all your CE tracking needs. CE Navigator provides a transcript approved by NYSED, while the ADA’s transcript does not meet NYSED standards.

Q: Is there an issue with ADA’s data system?

A: Yes, there is an ongoing issue with the ADA’s data system that’s affecting CE credit request processing. The ADA is working to resolve this as quickly as possible. We apologize for any inconvenience this may cause and thank you for your patience.

Q: How do I use CE Navigator?

A: CE Navigator is a self-reporting system where members enter their own course completions, certificates and tracking information. Resources for managing your account are available at www.nysdental.org/ce.

Q: Which courses will be automatically uploaded to CE Navigator?

A: Courses completed through the New York State Dental Association (NYSDA), your local dental society, NYS Dental Foundation, NYS Society of Oral & Maxillofacial Surgeons, and the NYSDJ-Read, Learn & Earn program will be added to your account within one to three weeks. Additionally, courses completed with SUNY Buf-

falo, Resident Rounds/hospitals, and selected professional associations will also be applied to your account.

Q: What happened to the CE Awards?

A: Due to the ongoing issues with the ADA CE history, NYSDA has discontinued its CE Awards. We will no longer send out the Lifetime CE Achievement certificate. Thank you for your understanding and support as we work to address the issues related to the new ADA platform and the launch of CE Navigator. NYSDA highly encourages you to use this tool for reliable, NYSED-approved continuing education tracking.

If you have any questions or need assistance, please don’t hesitate to reach out: ce@nysdental.org.

➤ Free for NYSDA Members

➤ Track Credit Hours

➤ Set Reminders for Mandated Courses, License Renewal, and more!

➤ Pull Transcript & Store CE Certificates

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

Social Media Use by Dental Students in Dental Education

Ellen Lee, D.D.S.; Brian Chin, M.B.A.; Ningshu Lyu, D.D.S.; Yueqi Gao, D.D.S.; Yixin Bao, D.D.S.;

Jacob Kim; Kaiden Park, D.D.S.

ABSTRACT

The purpose of this study is to evaluate dental student preferences for the use of social media in dental education. Our aim is to determine what students consider the best types of social media for dental education.

Social media allows users to share content using technology.[1] It allows people to maintain contact with friends and family, share their interests and helps them connect with people with similar interests. Social media also facilitates information sharing among users and assists them in exploring new things. These platforms help to share educational material and connect those with similar interests.

There are numerous social media platforms, including Facebook, X (formerly, Twitter), TikTok, YouTube, Instagram and LinkedIn. During the COVID-19 pandemic, there was a greater shift to online learning and communication. These platforms can be used to network, share photos and videos, and learn both new and old dental techniques.

Methods

A 14-question survey was sent through Surveys (Qualtrics) to the first-, second-, third- and fourth-year students at New York University College of Dentistry. This voluntary, anonymous survey asked the students what year of dental school they were in and their gender. They were asked: which social media platforms they use frequently, which platform provided the most awareness of current dental trends, which provided the most learning information, which pro-

vided the best means for organization and scheduling of events, which was best for communication among dental students, which was the best network for dental students, which was best for mental health, which was better for didactic learning, which was better for hands-on demonstrations and to write down any social media platform that was not listed that they used.

A total of 221 students responded to the survey. Each class has over 300 students.

As the chart shows, 37% of the total number of students said they use both YouTube and Instagram most frequently. Fifty-eight percent of the total number of students felt that Instagram provides the most awareness of current dental trends; 64% of the total number of students felt that Facebook was the best media platform for the organization and scheduling of events, as shown in Figure 1; 63% of the total number of students felt that YouTube provided the most learning information; and 57% of the total number of students felt that Instagram was the best communication among dental students, as shown in the chart.

Forty-seven percent of the total number of students use social media to destress, as shown in Figure 2; 62% of the total number of students felt that Instagram is the best networking for dental students, as seen in Figure 3; 44% of the total number of students felt that YouTube was best for

destressing; 84% of the total number of students felt that YouTube is the best media platform for didactic learning; 86% of the total number of students felt that YouTube is the best media platform for hands-on demonstrations. As shown in Figure 3, YouTube is the most popular platform overall. Other social media platforms that some students use include Snapchat, GroupMe and WhatsApp.

Discussion

Facebook is a global site that allows individuals to share photos, videos, music and comments. According to Kenny, in 2016,[2] Facebook was the most commonly used site by dental students. Facebook can be used to assist learners in collaborating with other people. It will also allow students to share their knowledge, work and ideas on the platform, which may be of assistance to others.

Figure 1. YouTube is popular for hands-on demonstration.

Figure 2. Social media is most used to destress and for communication.

Facebook, Instagram, LinkedIn, TikTok, X and YouTube are major social media platforms. Dental students in the research conducted by Rajeh,[3] reported they had an average of four social media accounts and spent at least three hours per week on social media. This study also reported that dental students used social media for entertainment (81.4%), dental education (70.8%), seeking basic information (63.3%), exchanging general thoughts (63.1%) and community general discussion (55.8%).[3] Our study showed that mental health (destress) and communication were the most common reasons social media was used (Figure 2).

X (formerly, Twitter) is a social networking site that allows its users to send “tweets” to their followers. Tweets are short postings and messages and can include images. X can be useful for interactive learning especially because of fewer advertisements and high interaction exchanges.[4] By using hashtags, users can access tweets related to a specific subject.

popular platform for the newer, younger generation, TikTok may be used to promote technologies like 3D printing, which is used by dentists for dentures, clear teeth aligners, dental models, surgical guides and dental crown substructures.

YouTube is a website where members can upload, share and comment on videos of any topic. Students and teachers can post videos with information that can assist in their education.[5]

TikTok is a video-sharing website that allows users to make and share short films. Young people mostly use this app to express themselves by singing, dancing, lip-syncing and even generating short creative movies. Because this is a

YouTube is a website where members can upload, share and comment on videos of any topic. Students and teachers can post videos with information that can assist in their education.[5] According to the study by Seo,[6] students reported a better understanding of traditional lectures by viewing the clinical periodontology microlecture YouTube videos before the class started. YouTube can be used to watch and learn how to do clinical procedures. Fu[7] found YouTube to be the most commonly used social media for learning clinical dental procedures in United States dental schools. Dental students claimed YouTube videos help them to expand their knowledge and clinical skills and improve their visualization and understanding of the procedures they had never performed before.[3,8,9] YouTube offers dental students a convenient way to learn the latest knowledge and techniques after graduation. Our study also showed YouTube was the most popular social media platform (Figure 3).

Figure 3. YouTube and Instagram were the most popular social media platforms.

Instagram is a website where users can post pictures and videos and connect with friends. These can be edited and organized with hashtags. Instagram offers visual aids; and these visual resources are particularly helpful in learning anatomy-related education in dental education.[10] Instagram can also be used to sell items from vendors, for selfpromotion, and to compare the effects of dental procedures on patients.[11]

A study comparing hands-on live demonstration vs. video-supported demonstration found that video-supported, instructor-guided presentation of dental operations may be equivalent to live hands-on demonstration in undergraduate dental education.[12] As a result, video content platforms such as YouTube and Instagram are more valuable and effective aids for students.

LinkedIn is a professional network that allows users to post their professional profiles to enable connections with potential employees and employers of companies. It is used for networking in a career. LinkedIn is one way for dentists to connect with other dentists. Students can use it to look for jobs.

Conclusion

There are many social media platforms on the Internet. They are used for instant communication of information. YouTube and Instagram are the two social media platforms that are used frequently (37%). Instagram provides the most awareness of current dental trends (58%), the best communication among dental students (57%) and the best networking for dental students (62%). YouTube provides the most learning information (63%), which is better for didactic learning (84%) and for hands-on demonstration (86%). Facebook is better for organizing and scheduling events (64%).

Dental students use social media tools to support their education and to communicate with other students. p

All the authors have declared they have no relevant relationships to any of the sites mentioned in this paper. Queries about this article can be addressed to Dr. Lee at el84@nyu.edu.

REFERENCES

1. Kaplan AM, Haenlein M. Users of the world, unite! The challenges and opportunities of social media. Business Horizons 2010:53(1):59–68.

2. Kenny P, Johnson IG. Social media use, attitudes, behaviours and perceptions of online professionalism amongst dental students. British Dental Journal 2016:221; (10): 651-655.

3. Rajeh MT, Sembawa SN, Nassar AA, et al. Social media as a learning tool: dental students’ perspectives. Journal of Dental Education 2020:85(4): 513–520.

4. van Schaijik B, Alshawa A, Hamadah O, et al. The role of Twitter in dental education: a systematic review. Journal of Dental Education 2021:85(9):1473, 8, 9. 1-1481.

5. McAndrew M, Johnston AE. The role of social media in dental education. Journal of Dental Education 2012:76(11): 1474–1481.

6. Seo CW, Cho AR, Park JC, et al. Dental students’ learning attitudes and perceptions of YouTube as a lecture video hosting platform in a flipped classroom in Korea. Journal of Educational Evaluation for Health Professions 2018;15, 24.

7. Fu MW, Kalaichelvan A, Liebman LS, et al. Exploring predoctoral dental student use of YouTube as a learning tool for clinical endodontic procedures. Journal of Dental Education 2022;86(6):726-735.

8. Burns LE, Abassi E, Qian X, et al. YouTube use among dental students for learning clinical procedures: a multi-institutional study. Journal of Dental Education 2020;84(10): 1151-1158.

9. Koumpouros Y, Toulias T, Koumpouros N. The importance of patient engagement and the use of social media marketing in healthcare. Technology and Health Care 2015;23(4): 495-507.

10. Douglas NKM, Scholz M, Myers MA, et al. Reviewing the role of Instagram in education: can a photo sharing application deliver benefits to medical and dental anatomy education? Medical Science Educator 2019;1117-1128.

11. Ooi HL, Kelleher MGD. Instagram dentistry. Primary Dental Journal 2021;10(1): 13-19.

12. Schlafer S, Pedersen K, Jørgensen JN, et al. Hands-on live demonstration vs. video-supported demonstration of an aesthetic composite restoration in undergraduate dental teaching. Journal of Dental Education 2021;85(6): 802–811.

Ellen Lee, D.D.S., is clinical assistant professor, Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY.

Brian Chin, M.B.A., Ningshu Lyu, D.D.S., Yueqi Gao, D.D.S., Yixin Bao, D.D.S., Kaiden Park, D.D.S., are recent graduates of New York University College of Dentistry, New York, NY.

Jacob Kim is a dental student at New York University College of Dentistry, New York, NY.

Guidelines for Interproximal Enamel Reduction (IPR)

Sewon Yang, D.D.S.; Min Seok Kim, D.D.S.; Eugene H. Bass, D.M.D.

ABSTRACT

The purpose of this review is to present current guidelines for interproximal enamel reduction (IPR) safety and to provide clinical protocols for the practitioner to follow to conduct safe and effective IPR. This comprehensive step-by-step protocol for IPR, including pre-, intra- and postoperative safety measures, is proposed with further suggestions to assure the safety of the procedures and to minimize the potential iatrogenic side effects of IPR.

Interproximal enamel reduction (IPR), or air-rotor stripping, has been recognized as a popular space-gaining method in orthodontic treatment procedures. Various other space-gaining methods, such as extractions, arch expansions or molar distalization by using mini-implants, are also utilized by practitioners. In addition, IPR has been recognized as a standard of practice for clear aligner therapy that provides relatively conservative orthodontic treatment to patients.

IPR is usually indicated for mild-to-moderate crowding that requires less than 8 mm of space gaining. Other indications include the correction of Bolton Index discrepancies,[9] dental esthetics, the enhancement of retention and stability of orthodontic treatment, and the correction of

the Curve of Spee.[6] The benefits of IPR include but are not limited to the following: 1) It is a less invasive procedure to attain space in a patient’s dentition compared to extraction therapy; 2) It provides the ability to create the precise amount of space necessary for tooth movement; 3) It results in a reduced incidence of post-extraction relapse following conventional appliance or fixed band removal.[5,9,11]

Even though IPR is recognized as a relatively safe/lowrisk procedure, the potential iatrogenic side effects of IPR include but are not limited to the following: 1) increased susceptibility to caries; 2) increased incidence of periodontal disease; 3) temperature sensitivity; 4) increased plaque accumulation; 5) residual furrows; and 6) soft-tissue trauma.[8] Therefore, it is important for the clinician to have a comprehensive understanding of the pre-, intra- and postoperative safety measures and to follow these guidelines in order to optimize patient outcomes.

This paper presents the currently available armamentarium for the practitioner to utilize to optimize patient outcomes.

Current Guidelines for IPR

A literature review was conducted to assess currently available guidelines pertaining to IPR. Articles were identified by searching databases (2023): PubMed and NYU Health Science Library. Keywords included: “Interproximal Enamel

Reduction”; “IPR”; “Air-rotor stripping”; and “Nonextraction orthodontic treatment.” Articles not available in full text were excluded.

The current guidelines in the dental literature for IPR safety are the following: 1) Case Selection and Space Analysis; 2) Leveling and Alignment; 3) Ensuring Adequate Access to Interproximal Areas; 4) IPR with Soft-tissue Protection; 5) Finishing and Polishing; 6) Topical Application of Fluoride or Casein Phosphopeptide-amorphous Calcium Phosphate (CPP-ACP).[9] What follows is a more comprehensive set of guidelines for practitioners to follow, including pre-, intra- and postoperative considerations (Figure 1).

Preoperative

Case Selection

Leveling and Alignment

Along with the space analysis and comprehensive exam, a practitioner should plan a proper sequence for IPR. When access to the interproximal area is not possible for various reasons, such as crowding, IPR procedures on crowded teeth have to be carried out at a later stage after required leveling and alignment are achieved.[9]

Acceptable oral hygiene, absence of dental disease, lack of previous proximal reduction, and adequate gingival retraction and visualization of contacts are prerequisites for successful IPR to be conducted.[9] The dentist should identify the complexity of the malocclusion and determine the proper sequence of treatment. If a multidisciplinary approach is required to address the malocclusion, a discussion with the specialists and the patient must be completed before the treatment, and informed consent for the comprehensive treatment plan should be obtained from the patient before proceeding with the IPR procedure.[8]

Space Analysis /Comprehensive Exam

A thorough space analysis should be conducted. A calculation of the exact amount of space required is necessary, as is a determination that the required space can be generated with IPR. IPR has a risk of causing irreversible enamel furrows, scratches and ledges, predisposing to plaque retention, and the risk of sensitivity if dentin is exposed.[9] Therefore, IPR should be planned only when necessary.

An adequate analysis is also required to maintain functional occlusion and to achieve the goals of Andrews Six Keys of Normal Occlusion.[1] Andrews Six Keys are the significant characteristics shared by all the nontreated orthodontic patients with normal occlusion. This includes consideration of the following: 1) molar relationship; 2) crown angulation; 3) crown inclination; 4) rotations; 5) spaces; 6) occlusal plane. One should ask if the space gained through IPR, followed by orthodontic alignment, would be sufficient to achieve Andrews Six Keys.

Enamel Thickness

Enamel thickness is an important factor to consider when planning how much enamel can be safely reduced. The amount of enamel is generally greatest in the region of the contact point and decreases towards the cemento-enamel junction. It is unaffected by gender, but there are some racial variations. Pre-existing interproximal wear can also affect the magnitude of enamel that can be removed. It is widely accepted that approximately 50% of proximal enamel can be removed by IPR without causing dental and periodontal risks.[7]

Standardized radiographs may help quantify the amount of enamel present; however, these should be used with caution due to the risk of overestimating the amount of enamel present. Approximately 0.25 mm of enamel reduction in the anterior region and 0.8 mm on each proximal surface of posterior teeth is a safe rule of thumb.[3,7,9]

Contact Point Location

The ability to visualize the contact point is a critical part of the IPR procedure. The absence of proper access might cause the practitioner to inaccurately impart the proper amount and location of the proposed enamel reduction. Contact point locations can be influenced by a variety of factors. Such factors include the shape and size of teeth, the mesio-distal inclination of proximal teeth, their rotations and pre-existing restorations. Enamel reduction leads to the apical movement of the contact point. Apical relocation of the contact point may impinge upon the

Figure 1. Proposed Protocol for IPR

biologic width of the periodontium or affect the formation of “black triangles.”[9] It is critical to preoperatively assess the ability to visualize and enable proper access to the contact points, in order to assess how the final contact point will be positioned after the procedure. Therefore, it is important to communicate with the patient and obtain informed consent about how variations of crown morphology may lead to a higher risk of creating ledges and less-than-ideal interproximal contacts.

Intraoperative

Soft- and Hard-tissue Protection

Proper retraction of soft tissues is necessary to perform IPR. Such measures to achieve retraction can include using a rubber dam, bite blocks, cheek retractors, cotton rolls and mouth mirrors. Utilization of four-handed dentistry is recommended to accomplish this. The extraoral cheek retractor provides soft-tissue retraction and better visualization of the dentition (Figure 2J).

Steel indicators, coil springs or wedges can be placed gingival to the contact point to minimize the risk of soft-tissue damage and to gain better visual access.[3,7] Firm finger

rest is necessary to avoid unstable use of the instrumentation. A hallmark study suggests that increasing the temperature in the dental pulp by greater than 5.5 °C while using a high-speed handpiece may lead to irreversible damage to pulpal tissue.[10] Therefore, mechanical instrumentation should be water- or air-cooled to reduce the heat imparted on pulpal tissue. If performing IPR on multiple interproximal contacts, changing heated instruments could reduce the risk of thermal damage to the pulp.[7]

Possible Sources of Distraction

All sources of distraction should be reduced or eliminated to prevent accidental damage to the soft and hard tissue of the patient. The involuntary movement caused by the distraction of the patient or the dentist may lead to lacerations and irreversible damage to the intraoral and extraoral tissues. It is important to establish proper communication with the patient in advance to avoid excessive movement during the procedure.

Armamentarium

Manual and mechanical instruments are available for enamel reduction, finishing and polishing, and to avoid soft- and

A) Diamond Interproximal Strip, Dentsply Sirona

B) Diamond IPR Hand Strips, ContacEZ

C) Mechanical IPR Diamond Strip with Handpiece, Intensiv

D) Safe-Tipped Diamond Burs, TOC Dental

E) Diamond Discs with Safe Guide, Strauss Diamond

F) Rotary Diamond Discs, Komet USA

Figure 2. (A-J) IPR Armamentarium

hard-tissue injuries. Interproximal diamond strips are manufactured in varying grits and sizes to allow a sequential increase of enamel reduction and are single or double-sided to allow specific surfaces to be reduced at a time (Figures 2 A,B,C). The manual diamond strips require greater time to accomplish enamel reduction. The mechanical diamond strips are faster but have a risk of causing thermal damage to the pulp tissue.

Safe-tipped diamond burs have non-cutting ends to prevent the formation of notches and allow for precise removal of enamel in the proximal surfaces (Figure 2D).

Rotary diamond discs are also manufactured in varying grits, sizes, and single or double-sided (Figures 2 E,F). These diamond discs are recommended for use in conjunction with the diamond disc guards to prevent any trauma to soft tissue (Figure 2G). New commercially available diamond discs with safe guides have non-cutting edges to prevent unwanted damage to soft and hard tissues (Figure 2F).

If a clinician wants better visualization of and access to the interproximal area, oscillating segment discs can be utilized (Figure 2H). These segment discs oscillate only par-

tially and help to achieve greater control over the reduction compared to the full 360° disc rotation. IPR gauges accurately measure the amount of enamel reduction, which enhances the precision of the procedure (Figure 2 I).

Postoperative

Topical Application of Fluoride or CPP-ACP

Under current guidelines for the postoperative treatment following IPR, in order to prevent caries development in the IPR sites, topical application of fluoride or CPP-ACP for facilitating remineralization of enamel should be prescribed. CPP-ACP is said to be effective in the regression of orthodontic white-spot lesions and was introduced to IPR protocols for postoperative protection of the reduced enamel.[2,4] Furthermore, proper oral hygiene regimens and plaque control are essential to prevent the potential side effects of IPR.

Proper Documentation of IPR

Comprehensive documentation of the IPR procedure and informed consent, including the sites treated, and the amount of enamel reduced in each site are necessary.

G) Disc Guard, Strauss Diamond

H) Oscillating Segment Discs, Komet USA

I) IPR Gauge, Dentsply Sirona

J) Extraoral Cheek Retractor, TOC Dental

Conclusion

IPR has been recognized as a standard of practice for clear aligner therapy. It is acknowledged to be a safe/low-risk alternative to space-gaining for orthodontic teeth alignment compared to extraction therapy. However, even though the IPR has a low risk associated with the procedure, it is important for the clinician to have a comprehensive understanding of the preoperative, intraoperative and postoperative safety measures put forth in this article. Adherence to these proposed guidelines allows practitioners to deliver safe and effective IPR to their patients. p

Queries about this article can be sent to Dr. Yang at sy2819@nyu.edu.

REFERENCES

1. Andrews LF. The six keys to normal occlusion. American Journal of Orthodontics 1972;62(3):296–309. https://doi.org/10.1016/s0002-9416(72)90268-0.

2. Chen H, Liu X, Dai J, Jiang Z, Guo T, Ding Y. Effect of re-mineralizing agents on white spot lesions after orthodontic treatment: a systematic review. Am J Orthod Dentofacial Orthop 2013;143:376-82.

3. Chudasama D, Sheridan JJ. Guidelines for contemporary air-rotor stripping. Journal Clinical Orthodontics: JCO 2007;41(6):315–320.

4. Giulio AB, Matteo Z, Serena IP, Silvia M, Luigi C. In vitro evaluation of casein phosphopeptide-amorphous calcium phosphate (CPP- ACP) effect on stripped enamel surfaces. A SEM investigation. J Dent 2009;37:228-32.

5. Gómez-Aguirre JN, Argueta-Figueroa L, Castro-Gutiérrez MEM, Torres-Rosas R. Effects of interproximal enamel reduction techniques used for orthodontics: a systematic review. Orthodontics & Craniofacial Research 2022;25(3):304–319.

6. Lapenaite E, Lopatiene K. Interproximal enamel reduction as a part of orthodontic treatment. Stomatologija 2014;16(1):19–24.

7. Livas C, Jongsma AC. Ren Y. Enamel reduction techniques in orthodontics: a literature review. The Open Dentistry Journal 2013;7:146–151. https://doi.org/10.2174/1874210601307010146.

8. Noar JH, Kneafsey LC. The ethics of interproximal reduction. Dental Update 2015;42(10):922–924.

9. Pindoria J, Fleming PS, Sharma PK. Inter-proximal enamel reduction in contemporary orthodontics. British Dental Journal 2016;221(12):757–763.

10. Zach L, Cohen G. Pulp response to externally applied heat. Oral Surg Oral Med Oral Pathol 1965;19:515-30.

11. Zhong M, Jost-Brinkmann PG, Zellmann M, Zellmann S, Radlanski R J. Clinical evaluation of a new technique for interdental enamel reduction. Journal of Orofacial Orthopedics = Fortschritte der Kieferorthopadie: Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie 2000;61(6):432–439.

Sewon Yang, D.D.S., principal investigator on this paper, is a recent graduate of New York University College of Dentistry, New York, NY.

Min Seok Kim, secondary investigator on this paper, is a recent graduate of New York University College of Dentistry, New York, NY.

Eugene H. Bass, D.M.D., faculty advisor on this paper, is a group practice director and clinical assistant professor, Department of General Dentistry and Comprehensive Care, New York University College of Dentistry, New York, NY.

Exophytic and Focally Ulcerated Mass on the Mandibular Gingiva

Abrar Shamim, D.D.S., M.A.; Scott Peters, D.D.S.; Shahid R. Aziz, D.M.D., M.D.; Gregg Jacob, D.M.D.

ABSTRACT

The pyogenic granuloma is a benign vascular proliferation which may present either on the skin or intraorally. While the majority of oral pyogenic granulomas remain less than 1 cm in size, they can grow to large sizes if care is neglected. Herein, we report a case of a large pyogenic granuloma on the mandibular alveolar ridge gingiva which grew to 10 cm x 10 cm in size due to failure to seek treatment.

The pyogenic granuloma, also referred to as the lobular capillary hemangioma, is a benign vascular proliferation commonly seen on the skin and in the oral cavity.[1] While cutaneous lesions represent benign neoplasms, intraoral pyogenic granulomas are considered non-neoplastic, reactive entities. The term pyogenic granuloma is somewhat of a misnomer, as it is not related to any known infectious agents and, therefore, not pyogenic in nature. Nor is it histologically similar to inflammatory granulomas.

Pyogenic granulomas of the oral cavity most often form in response to local irritation or trauma. A subset of intraoral pyogenic granulomas is seen in pregnant individuals and are believed to result from hormonal factors.[2] These are sometimes referred to as pregnancy tumors or granuloma gravidarum.

Oral pyogenic granulomas are seen more commonly in females. While they may present at any age, they are often seen in younger adults. The most common clinical presentation of an intraoral pyogenic granuloma is a pedunculated smooth or lobulated erythematous exophytic lesion. The gingiva is most commonly affected, and various irritants, such as chronic food impaction and overhanging dental restorations, may serve as etiologic factors. Other less commonly affected sites include the lips, tongue and buccal mucosa.[3]

Oral pyogenic granulomas are often less than one centimeter in size. They are typically treated by surgical excision, and the recurrence rate is low. Higher recurrence rates have been reported in women who are pregnant or in cases in which an irritative causative agent has not been identified and managed appropriately. Although non-neoplastic, pyogenic granulomas can increase in size if they are not treated.

Herein, we report a case of a large gingival pyogenic granuloma for which treatment had been neglected for several years.

Case Report

A 59-year-old female presented to an oral and maxillofacial surgeon for evaluation of a growth involving the left mandibular gingiva. She stated that it had been present for

three years and had slowly increased in size over this time. She did not seek treatment initially but now presented because the lesion prevented her from eating and drinking properly. The patient’s past medical history was not significant. She reported a familial history of oral squamous cell carcinoma. The extraoral examination was unremarkable for any facial asymmetries, lymphadenopathy, trismus or swellings.

On intraoral examination, a 10 cm x 10 cm pedunculated mass lesion of the left mandibular gingiva was observed (Figure 1). Panoramic radiograph demonstrated no intraosseous pathologies in the underlying area of the soft-tissue growth. An incisional biopsy of the specimen was performed for diagnostic purposes and demonstrated ulcerated surface epithelium and connective tissue containing granulation tissue composed of small-to-mediumsized blood vessels arranged in lobular aggregates (Figure 2). A diagnosis of a pyogenic granuloma was rendered, and the patient returned for excision of the remaining lesion.

The lesion was excised via electrocautery under local anesthesia with no complications and sutures were placed. There was proper healing and no sign of recurrence.

Discussion

The intraoral pyogenic granuloma is a reactive hyperplasia in response to various stimuli,[4,5] but it has also been classified as a benign tumor composed of capillary endothelial cells in extraoral locations[6] and, therefore, may sometimes be referred to as lobular capillary hemangioma. The oral pyogenic granuloma most commonly involves the gingiva, with the maxillary arch affected more often than the mandible.[7] Other less common oral sites include the lips, tongue, buccal mucosa and hard palate.[3,8] Some reports have found this is the most common gingival growth; however this may depend largely on the population.[9]

The pyogenic granuloma often presents as an exophytic growth that may be smooth or lobulated, with either a pedunculated or sessile base. The color may range from purple to red to pink, and may be related to the age and vascularity of the lesion.[12,13]

The pyogenic granuloma is a relatively common pathology affecting approximately 1% of the population, notably, younger patients in the third and fourth decades of life, with a slight female

Figure 1. Clinical examination revealed exophytic 10x10 cm mass lesion of left mandibular gingiva with focal area of ulceration.

Figure 2. Histologic evaluation (100x magnification) showed connective tissue demonstrating numerous small-to-medium-sized blood vessels arranged in lobular pattern.

predilection.[10] The gender predilection becomes less apparent in older patients. Pregnancy is associated with increased incidence of these lesions, potentially related to angiogenic hormone release.[11]

The pyogenic granuloma often presents as an exophytic growth that may be smooth or lobulated, with either a pedunculated or sessile base. The color may range from purple to red to pink, and may be related to the age and vascularity of the lesion.[12,13] It can present with an overlying yellow fibrinous membrane and may also be ulcerated.[14] Pyogenic granulomas tend to range from a few millimeters to a few centimeters in size but do not often surpass 1 cm in greatest dimension, rarely exceeding 2.5 cm in size.[5,13,15-17] The pyogenic granuloma we describe in this case report grew to several centimeters in size as a result of failure to seek treatment.

The clinical differential diagnosis for a pyogenic granuloma includes the “three Ps,” all of which can manifest on the gingiva or alveolar ridge. These consist of the pyogenic granuloma, peripheral ossifying fibroma and peripheral giant cell granuloma. Among these, pyogenic granuloma is the most common.[18] All three of these lesions are benign,

reactive entities that form as a result of local irritation or trauma. While there may be some subtle clinical findings which can help differentiate them, histopathology is required to ascertain a definitive diagnosis.

The clinical differential diagnosis may also include malignant entities. Gingival malignancies such as squamous cell carcinoma, metastatic carcinoma to the oral cavity and Kaposi Sarcoma may closely resemble the clinical appearance of benign, reactive gingival pathologies.[19-23] Many of these entities require a well-informed medical history, and biopsy is often indicated for definitive diagnosis.

A presumptive diagnosis of pyogenic granuloma can be made based on the clinical appearance of the lesion; however, histopathological confirmation is indicated for confirmation of the diagnosis. Microscopic examination of a pyogenic granuloma will demonstrate collections of small-to-medium-sized blood vessels often arranged in lobular aggregates. Ulceration of the surface epithelium is frequently observed. Histologic analysis of this patient’s lesion confirmed the diagnosis.

Pyogenic granulomas (PGs) are primarily soft-tissue lesions; while they may occasionally cause superficial cup-

ping of bone, they do not cause bony destruction. In rare instances, PGs may lead to bone loss.[24] Definitive treatment of pyogenic granuloma involves a complete surgical excision[12] with removal of any potential irritants. In nonvisible areas, such as the mouth, without concern of scarring, complete excision is the preferred treatment, as it likely provides the least chance of recurrence. Alternative medical treatments have been suggested for recurrent lesions.[8,25] Excision of granuloma gravidarum in pregnant patients is not always indicated since they may regress after delivery.[26]

Of the various potential etiologic factors of oral pyogenic granuloma, there were none that warranted this patient’s presentation. The patient did not seek treatment over a period of years, which permitted its growth to significantly expand beyond the average size reported in the literature.[5,13,15-17] The patient was partially edentulous in the mandibular quadrant and similarly edentulous in the left maxillary arch opposing it, which may have permitted continued growth of the lesion, as excisional treatment was neglected. p

Queries about this article can be sent to Dr. Aziz at Shahid.aziz@hmhn.org or Dr. Shamim at ashamim@mgh.harvard.edu.

REFERENCES

1. Wollina U, et al. Pyogenic granuloma—a common benign vascular tumor with variable clinical presentation: new findings and treatment options. Open Access Maced J Med Sci 2017;5:423–426.

2. Reddy NR, Kumar PM, Selvi T, Nalini HE. Management of recurrent post-partum pregnancy tumor with localized chronic periodontitis. Int J Prev Med 2024;5:643–647.

3. Peters SM, Koslovsky DA, Yoon A J, Philipone EM. Pyogenic granuloma in the tongue in a five-year-old: a case report. J Clin Pediatr Dent 2018;42:383–385.

4. Brierley DJ, Crane H, Hunter KD. Lumps and bumps of the gingiva: a pathological miscellany. Head Neck Pathol 2019;13103–113.

5. Verma PK, et al. Pyogenic granuloma—hyperplastic lesion of the gingiva: case reports. Open Dent J2012; 6:153–156.

6. Mills SE, Cooper PH, Fechner RE. Lobular capillary hemangioma: the underlying lesion of pyogenic granuloma. a study of 73 cases from the oral and nasal mucous membranes. Am J Surg Pathol 1980;4:470–479.

7. Cohen BA. Chapter 9 - Oral Cavity. In Pediatric Dermatology (Fourth Edition) (ed. Cohen BA) 240–263 (W.B. Saunders, 2013). doi:10.1016/B978-0-7234-3655-3.00009-6.

8. Debnath K, Chatterjee A. Management of recurrent pyogenic granuloma with platelet-rich fibrin membrane. J Indian Soc Periodontol 2018;22:360–364.

9. Truschnegg A, Acham S, Kiefer BA, Jakse N, Beham A. Epulis: a study of 92 cases with special emphasis on histopathological diagnosis and associated clinical data. Clin Oral Investig 2016;20:1757–1764.

10. Pyogenic Granuloma—European Association of Oral Medicine. https://eaom.eu/education/ eaom-handbook/pyogenic-granuloma/?v=7516fd43adaa.

11. Yuan K, Wing L. YC, Lin MT. Pathogenetic roles of angiogenic factors in pyogenic granulornas in pregnancy are modulated by female sex hormones. J Periodontol 2002;73:701–708.

12. Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: a review. Journal of Oral Science 2006;48, 167–175.

13. Marla V, Shrestha A, Goel K, Shrestha S. The histopathological spectrum of pyogenic granuloma: a case series. Case Rep Dent 2016 2016:1323798.

14. Regezi JA, Sciubba JJ, Jordan RCK. Oral pathology: clinical pathologic correlations. 492.

15. Amirchaghmaghi M, Falaki F, Mohtasham N, Mozafari PM. Extragingival pyogenic granuloma: a case report. Cases J 2008;1:371.

16. Baskaran A, Chandrasekar G, Lakshmi, V. Oral pyogenic granuloma: a case report. Journal of Scientific Dentistry2020;9:51–52.

17. Gordón-Núñez MA, et al. Oral pyogenic granuloma: a retrospective analysis of 293 cases in a Brazilian population. J Oral Maxillofac Surg 2010;68:2185–2188.

18. Salum FG, et al. Pyogenic granuloma, peripheral giant cell granuloma and peripheral ossifying fibroma: retrospective analysis of 138 cases. Minerva Stomatol 2008;57:227–232.

19. Vasilyeva D, Peters SM, Philipone EM, Yoon AJ. Renal cell carcinoma metastatic to the maxillary gingiva: a case report and review of the literature. J Oral Maxillofac Pathol 2018;22:S102–S107.

20. Scott PL, Motaparthi K, Krishnan B. Hsu S. Pyogenic granuloma-like Kaposi sarcoma: a diagnostic pitfall. Dermatol Online J 2012;18: 4.

21. Dhawad MS, Nimonkar PV. Metastatic carcinoma of gingiva mimicking pyogenic granuloma. J Maxillofac Oral Surg 2011;10:163–165.

22. Lima CF, Acay R, Anbinder AL, Almeida JD, Carvalho YR. Oral adenosquamous carcinoma mimicking a pyogenic granuloma: a challenging diagnosis. Braz Dent J 2016;27:781–786.

23. Ramesh R, Sadasivan A. Oral squamous cell carcinoma masquerading as gingival overgrowth. Eur J Dent 2017;11:390–394.

24. Goodman-Topper ED, Bimstein E. Pyogenic granuloma as a cause of bone loss in a twelveyear-old child: report of case. ASDC J Dent Child 1994;61:65–67.

25. Bugshan A, Patel H, Garber K, Meiller TF. Alternative therapeutic approach in the treatment of oral pyogenic granuloma. Case Rep Oncol 2015;8:493–497.

26. Torgerson RR, Marnach ML, Bruce AJ, Rogers RS. Oral and vulvar changes in pregnancy. Clin Dermatol 2006;24:122–132.

Shahid R. Aziz, D.M.D., M.D., FACS, FRCSEd, is professor of otolaryngology, Hackensack Meridian School of Medicine, Division Director, Oral and Maxillofacial Surgery, Hackensack University Medical Center, New Jersey, and clinical professor, Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine, Newark, NJ.

Gregg Jacob, D.M.D., FACS, is assistant clinical professor of surgery, Division of Oral and Maxillofacial Surgery, New York Hospital—Weill Cornell Medical College, New York, NY. He is affiliated with Northeast Facial and Oral Surgery Specialists, Florham Park, NJ.

Scott M. Peters, D.D.S., is former assistant professor of dental medicine at Columbia University Irving Medical Center, Division of Oral and Maxillofacial Pathology. He now holds the title of associate professor, Oral and Maxillofacial Pathology, Geisinger Health Systems, Danville, PA.

Abrar Shamim, D.D.S., M.A., is a 2024 graduate of Columbia University College of Dental Medicine and Columbia University Teachers College. He is a resident in oral and maxillofacial surgery at Massachusetts General Hospital and an MD candidate at Harvard Medical School.

Dr. Aziz Dr. Jacob Dr. Peters Dr. Shamim

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SUFFOLK COUNTY Summer Luncheon

Natalia Elson, D.D.S.

It was a wonderful privilege to engage the Stony Brook School of Dental Medicine’s Class of 2028 (46 students in all) over lunch on Aug. 7. We were joined by our president, Dr. Steven Feigelson; NYSDA Trustee Dr. Guenter Jonke; SCDS Past President Dr. Jeff Seiver; and SCDS Board Member Dr. Rekha Reddy. All shared information about their pro-

fessional journey and why ADA membership has been and continues to be important to them, as well as providing an overview of organized dentistry.

Special thanks to SCDS staff member Carol Deerwester, who worked with Stony Brook staff Daniella Zajac and Noe Escobar to arrange the luncheon. The future is bright for dentistry.

SUFFOLK COUNTY

Come September

Members benefitted from a great, informative and engaging lecture delivered by Dr. David Rice on Sept. 18. More than 60 dentists were on hand for the event in our fully renovated facility. A big thank you to Dr. Rice, and special thanks to our sponsors—MidCape Dental Lab, Henry Schein Dental, TD Bank Healthcare Practice Solutions, DDS Match, Garfield Refining and QOptics—for supporting the event.

Later in the month, on Sept. 27, Suffolk and Nassau County Dental societies hosted a wonderful practice management lecture delivered by Dr. Roger Levin.

And in October

On Oct. 2, about 60 members assembled for an excellent, engaging lecture by Dr. Brian Goodacre. This wrapped up our 2024 Seminar Series and continued to provide outstanding feedback on our new venue. Special thanks to our sponsors, Nobel Biocare/Envista, Mid-Cape Dental Laboratory, Henry Schein Dental and TD Bank Healthcare Practice Solutions Group. We hope to see all members at our 2025 Seminar Series Events.

On Oct. 9, we were pleased to bring a fantastic hands-on endodontics course taught by Dr. Anne L. Koch to Long Island. She provided members with a full day of instruction. Her presentation was fun, engaging and informative, with a one-on-one feel. Thank you Real World Endo and Brasseler for their support.

A reminder to members: Compliance Day is Dec. 4. Get your mandated courses in one day! Check it out at SuffolkDental.Org/Calendar.

Don’t Miss a Thing

Be sure to like/follow us on social media as 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, X, Instagram, LinkedIn and, even, Spotify, in addition to our traditional www.SuffolkDental.Org presence.

Dr. Anne Koch presents October endodontics course.

SCDS leaders meet with Stony Brook dental students over lunch, to reinforce importance of organized dentistry in their professional lives.

FOURTH DISTRICT

Help is on the Way

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

The University of Vermont (UVM) has partnered with Hudson Headwaters Health Network (HHH) to support our North Country patients. Their dental residency program will have rotations through counties in the Adirondacks, including Warren, adding needed support and services to the region.

Shredding Success

The first-ever shredding event at the 4th District office in Clifton Park on Sept. 27 was nearly at capacity. The event ran from 9 a.m.-noon. This free event translated into almost $200 in savings for each member who participated. We expect to make this an annual benefit for our members.

Welcome, New Dentists

Our annual new dentist meeting took place on Oct. 9 at the Mill on Round Lake. Although attendance at the meeting was down, the energy and atmosphere were electric. We are excited to welcome this next group of leaders to the society.

FOURTH DISTRICT

FOURTH DISTRICT

Golf and Learn

At our annual Golf Outing on Sept. 20, 70 members also completed the mandatory Infection Control continuing education requirement. Thank you to Hudson Headwaters and to Debra Galatioto for sharing her expertise and course information to help participants meet this licensure requirement.

Our fall golf tourney has become a staple for members. And each year we seem to add another foursome or two.

Well-represented

The Fourth District sent two delegates and alternates to represent our members, local interests and the state agenda at the annual meeting of the ADA House of Delegates. Thank you Drs. Korkosz, Cocozzo, Milza and Galati for volunteering their time, energy and expertise over the long weekend.

THIRD DISTRICT Annual Meeting

Paula Tancredi, Executive Director

This year’s Annual Meeting was one of our best. Held at 677 Prime in Albany on Sept. 26, it began at 4 p.m. with presentation of the mandatory updated Child Abuse Reporting continuing education course, a benefit to all district members.

Immediately following the course, the meeting was called to order and all nominations were confirmed. A vote was taken and our new officers were installed. They are: Dr. Mohamed Bayoumy, president; Dr. Lauren Heisinger, president-elect; Dr. Christopher Arena, vice president; Dr. Olivia Turner, secretary and treasurer.

The Third District thanks Kendra Zappia for her leadership as president in the past year. She now moves to the position of immediate past president. Congratulations and a big thanks to all. During the meeting, newly elected President Dr. Mohamed Bayoumy presented the Downes-Ripp Achievement Award to Dr. Steven Essig. This award is given in recognition of a member’s

Fourth District delegates and alternate delegates gave voice to local interests at annual meeting of ADA House in New Orleans.

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untiring commitment to dentistry or accomplishments of special note that contribute to the betterment of the dental profession. Dr. Essig served the Third District as vice-president in 2005, president-elect in 2006, and president in 2007. He recently retired from his position on the NYSDA Board of Trustees.

American College of Dentists Inducts Two Two dentists from the Third District were inducted as fellows into the American College of Dentists. This is the oldest national honorary organization for dentists. Members have exemplified excellence through outstanding leadership and exceptional contributions to dentistry and society and must be nominated by their dental colleagues for fellowship. Dr. Kendra Zappia was nominated by Dr. Wayne Harrison, and Dr. Christopher Arena was nominated by Dr. Julie Connolly. Congratulations!

THIRD DISTRICT

Announcements

Other big news at the Third District includes the birth of Dr. Greg Vallecorsa’s daughter Ahna on Sept. 13. Congratulations.

And it was with a heavy heart and sincere regret that we announce the passing of Dr. Michael Lozman on Oct. 11 in Albany. Born Nov. 22, 1937, Dr. Lozman had been a practicing orthodontist in Latham since 1971. Among the several leadership roles he held are president of the New York State Society of Orthodontics and the Third District Dental Society; member of the Dental Society of the State of New York Board of Governors; member of the New York State Board for Dentistry; and the first dentist to serve on the three-member panel of the New York Regents Review Committee. He was deeply involved in several charitable efforts over the years, including the Capital District Jewish Holocaust Memorial. He worked on restoration of numerous Jewish cemeteries in Eastern Europe, and he was recently appointed to the U.S Commission for the Preservation of America’s Heritage Abroad by President Biden.

THIRD DISTRICT

SECOND DISTRICT ADA HOD

Alyson Buchalter, D.M.D.

On Saturday, Oct. 19, the American Dental Association opened the annual meeting of its House of Delegates. As usual, it was an unprecedented event. Members of our tripartite from across the nation gathered in New Orleans to discuss, debate and decide the direction the ADA will move in with regard to issues that affect all members. Top of mind was workforce and ways the ADA, NYSDA and the SDDS can help with staffing.

During the four days of meetings, discussions and debates, votes were taken on ADA policies regarding dental loss ratio, CODA, license portability, veteran’s dental care, social media, dental plan yearly maximums and much more. Having clear policy aids the ADA as it advocates for legislation to help us in the daily conduct of our practices.

The SDDS thanks its delegates and alternate delegates who were part of the ADA 2nd Trustee District caucus (NYSDA). Thank you to Drs. John Demas, Paul Teplitsky, Alyson Buchalter, Trisha Quartey-Segaille, Valerie Venterina and Kirstin Wolfe for generously giving your time, energy and, most importantly, your extraordinary passion to help our members.

Congratulations to our own Emma Guzman. She was brilliant as a speaker at SmileCon, the ADA annual convention, held at the same venue as the HOD. Dr. Guzman’s presentation, “Thriving Together: Creating Empowering Connections,” showed attendees how to foster meaningful connections and inspire those around them.

Steven Gounardes

SDDS’s own Dr. Steven Gounardes has done it again. Already the recipient of many awards and accolades, Dr. Gounardes was further honored when NYU School of Dentistry presented him with its public service award for his many years of leadership in organized dentistry. Of course, his colleagues at the SDDS were not surprised, as we are well

Christopher Arena and wife, Carrie, following Dr. Arena’s induction into American College of Dentists.

Kendra Zappia, right, new inductee into American College of Dentists, meets up with college roommate Dr. Laura Sheridan.

aware of the treasure we have in Steve. Congratulations!

CE

SDDS continued its extraordinary 2024 CE program. A highlight of that program was the presentation on Sept. 27 in Staten Island when Dr. Kenneth Kurtz delivered talks on two topics. He first spoke on “Dental Implant Intervention for Syndromic and Non-Syndromic Childhood Partial Edentulism.” There was a wonderful discussion of aggressive vs. non-intervention for that population. He then presented “Implant-Retained Cantilevers: A Bridge Too Far?” All who were present said they appreciated the depth and breadth of the content.

Thank you to our presiding chair, Dr. Kirsten Wolfe, and Dr. Paul Albicocco from the Entertainment Committee for helping make the program a huge success.

GNYDM is 100

In a few short weeks, the Greater New York Dental Meeting will commence its 100th annual meeting! In addition to the many amazing CE programs and four days of exhibit hall fun, there will be a host of special events to commemorate this milestone year. As always, preregistration is free. There are many CE packages for you and your office staff to choose from.

Thank you to the SDDS members who serve on the Organization Committee: Drs. Saad Butt, Charles Mistretta, Natalie Mohadjeri and Steven Gounardes; our immediate past general chair, Dr. Richard Oshrain; and all the active members of the Advisory Committee, themselves past general chairs; as well as all the past OC members who continue to work hard for the meeting as troubleshooters. Their tireless work is the secret sauce that continues to make the GNYDM the amazing event it is.

Our appreciation extends as well to all who have volunteered to help at this year’s meeting, as well as to the current general chair, Dr. John Young from NYCDS, our partner in the meeting,

SECOND DISTRICT

SDDS delegation to ADA House includes, from left, Paul Teplitsky, John Demas, Valerie Venterina, Alyson Buchalter, Trisha Quartey-Segaille, Kirsten Wolfe.

Celebrating recognition of Steven Gounardes (at far right) by NYU are, from left, Jose Santana, John Cavallaro, Annamarie Truncali, Dominic Congiusta, Angela DeBartolo, Phyllis Merlino.

Members attending September CE program benefitted from two lectures, delivered by Kenneth Kurtz. Dr. Kurtz, center, is welcomed by Paul Albicocco and Kirsten Wolfe.

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for leading this year’s celebration. The meeting will take place at the Jacob Javits Convention Center Nov. 29-Dec. 4.

EIGHTH DISTRICT

CPR Recertification

Kevin J. Hanley, D.D.S.

On Nov. 4, the Erie County Dental Society offered a course for those needing recertification in CPR training. It took place at the Eighth District office. Attendees renewed their certification for another two years and earned 4 MCE hours.

Alumni Host Dental Meeting

The University at Buffalo Dental Alumni Association hosted its annual Buffalo Niagara Dental Meeting on Nov. 6-8. The Program Committee outdid itself this year, with many lectures covering a host of different topics.

On the opening evening, everyone was invited to attend and check out the exhibit floor, browsing the booths, catching up on the latest in dental technology and enjoying musical entertainment provided by Central Groove. The remaining days were packed with dental lectures and demonstrations.

On the next-to-last evening, the “Remember When” celebration was held so all alumni of UB School of Dental Medicine could meet and reminisce about their years of learning. The meeting ended with the annual Dinner Dance, recognizing all five-year reunion classes. Honored at the dinner was Dr. Marshall Fagin, who received the organization’s Honor Award. Dr. Brendan Dowd was recognized with the UBDAA’s Distinguished Service Award.

Brian Novy Presents Memorial Lecture

The Eighth District will hold its annual Dr. Rick Fink Memorial Lecture, an allday seminar, on Friday, Dec. 6, at Salvatore’s Italian Gardens in Depew. Dr. Brian Novy will lecture on “Codependent Cariology” and “Offensive Dentistry.”

The first lecture will help dentists understand why telling their patients to brush, floss and rinse with a fluoride mouthwash is only the first level of defense against caries. Dr. Novy’s discussion of CAMBRA, caries management by risk assessment, will provide dentists with a myriad of treatment options to fight decay. His presentation on “Offensive Dentistry” will demonstrate how the science of clinical cariology is having an impact on restorative techniques and technology. Salivary diagnostics and bioactive materials bring much more to the fight against caries.

Here Comes Santa

The Eighth District is again hosting a holiday party for members and their children. The party will take place on Saturday, Dec. 7, at Transit Valley Country Club in East Amherst. This is always a popular event for members and their families. Santa is expected to make an appearance, with gifts for all children in attendance.

It promises to be another wonderful time in the Eighth District, as long as you have all been nice this year!

President’s Installaton

The Eighth District and Erie County Dental societies will hold a joint President’s Installation Dinner on Saturday, Jan. 25, at the Roycroft Inn in East Aurora. This promises to be a great evening of celebration and camaraderie for all in attendance. Hope you’ll be there.

NINTH DISTRICT

Summer of Transition

Monica

Barrera, D.D.S.

Like other components throughout the country, the 9th staff spent the summer readying for the changeover from

Aptify to Salesforce, making it a busy time, in contrast to previous years, when summertime meant reorganizing the office or updating files and the like. This year, we spent the time taking Zoom training courses and figuring out ways to deal with life manually during a shut-down period and what turned out to be an extended stretch while bugs and fixes were being worked out.

We want to thank our members for their patience and understanding and their help identifying some of the issues they encountered.

Shredding Day

As we have for the past couple of years, the summer is also when the 9th provides its members with HIPAA-compliant paper shredding. This year’s event took place on June 22 at association headquarters. This member benefit has been very well-received, and we plan to continue to provide the service at least once annually.

Members Recognized

Our first big event after the “Go-Live” on Sept. 10 was our General Meeting on Sept. 18. There were snags but, nevertheless, it was a huge success. A renewed look at a venue we haven’t frequented in the past few years revealed a forgotten gem. Our members on the other side of the Hudson enjoyed the easier commute, and attendance was near pre-pandemic numbers. Dr. Salierno, guest speaker, was well-received. He even commented about how much fun he had doing the presentation.

NINTH DISTRICT

Sniffen Award recipient John Constantine, center, with Paul Patella, left, chair, Medal Committee, and President Duraid Sahawneh.

Dr. John Constantine was celebrated as this year’s D. Austin Sniffen Award recipient. Dr. Paul Patella presented him with a plaque and warm accolades.

Dr. Patella was himself recognized, along with other 9th leaders who completed their tenures in a variety of positions with the association. Also in line for recognition were the executives who will be leading the 9th in the coming year.

This all took place on Nov. 20 at the Westchester Country Club in Rye. At this meeting, Dr. Randy Huffines delivered a lecture on “Autoimmune Diseases and Dentistry.”

Giving Kids Smiles

In mid-October, we staged an extremely successful GKAS event at B’Above in Peekskill, at the invitation of B’Above who hosted last year’s GKAS event. We’ll be adding this location to our annual list, as they are welcoming and thankful and there are so many students there in need.

Also on the Calendar

Finally, on Nov. 7, the 9th provided the updated mandated Child Abuse course. A webinar, it was presented by the Center for the Prevention of Child Abuse of Poughkeepsie.

On Nov. 14, the 9th hosted a new dentist event, “Ask Me Anything,” at the Sleepy Hollow Hotel in Tarrytown. This was both an instructional and social get-together, an opportunity for members who are new to the profession and those more experienced to meet each

NINTH DISTRICT

other in a relaxed setting, where newer dentists could “Ask Anything” of a specialists’ panel in preparation for careers in general dentistry or a specific specialty.

NEW YORK COUNTY Lecture Offers Glimpse into Future

Andrew S. Deutch, D.D.S.

At the Sept. 9th General Membership Meeting, members eagerly came together to hear from Maxine Feinberg, D.D.S., on “Dental AI: It’s Here Like it or Not!” Dr. Feinberg, a New Jersey periodontist and chief strategy officer at Velmeni, an AI software company, delivered an eye-opening presentation on the future of dentistry.

Best known for her leadership as a past president of the American Den-

tal Association and the first woman to serve as president of both the New Jersey Dental Association and the New Jersey State Board of Dentistry, Dr. Feinberg shared her forward-thinking perspective. She explained how artificial intelligence and machine learning are reshaping the profession, from diagnosing pathologies to improving patient communication and even assisting with surgeries.

Attendees were inspired by the possibilities AI holds for the next era of dental care.

Members Schooled on Ethics and Legal Considerations

On Sept. 26, the NYCDS Ethics Committee hosted an insightful program, “Ethical Quandaries: Get Expert Guidance on Situations That Have or Can Occur.” The event featured two distinguished speakers: Dr. Paul Teplitsky, chair of

NEW YORK COUNTY

Volunteers screened about 40 preschooler at GKAS event in October at B’Above Headstart, Peekskill.

On hand for retirement planning program are, from left, Membership Committee Chair David Shipper; Mitchell Brill, Altium Wealth Management; President Suchie Chawla; David Goodman, PKF O’Connor Davies; Mark Epstein, Epstein Practice Brokerage, LLC.

NYCDS new dentists gained banking knowledge from Bank of America specialists at October session that also featured tips for making perfect cocktail.

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New York County cont.

the New York State Dental Association’s Council on Ethics, and Lance Plunkett, NYSDA General Counsel. During the hour-long session, the committee delved into key ethical and legal challenges faced by dental professionals, offering valuable perspectives on how ethical obligations and legal frameworks intersect in dentistry. Attendees gained practical guidance for navigating complex situations that can arise in their practices.

Planning for Retirement Dentists nearing the mid-point of their careers gathered on Oct. 9 for an informative program hosted by the New York County Dental Society. The event, “Thinking About Selling Your Practice and Retirement? Ideas for the Mid-Career Dentist,” was open to members and nonmembers and offered guidance to dentists with 20 to 30 years of experience.

Our expert speakers, Mark Epstein from Epstein Practice Brokerage, LLC;

Mitchell Brill, JD, MSFS, CFP, CAP, from Altium Wealth Management; and David J. Goodman, CPA, MST, from PKF O’Connor Davies, shared practical advice on how to prepare for a successful transition and make the most of life after dentistry, proving it’s never too early to start thinking about your future beyond the dental chair.

Attendees were also treated to a wine tasting, during which they learned about selections from Italy and Spain.

Banking and Mixology Fun

The program “Demystifying Banking for New Dentists: A Bank of America Perspective” on Oct. 24 gave new dentists insights into lending options and financial growth strategies. Bank of America shared tips on securing loans, choosing the right lender and expanding practices.

After the informative session, members were invited to mix their own cocktails and connect with peers. Bank of America showed everyone that banking and cocktails can mix, leaving attendees with valuable information into lending and new cocktail-making skills.

Celebrating

100 Years of

The Greater NY Dental Meeting

The New York County and Second District Dental societies come together to host the Greater New York Dental

NEW YORK COUNTY

Meeting Nov. 29-Dec. 4 (exhibit dates: Dec,1-4) at the Jacob K. Javits Convention Center, New York City.

This year, GNYDM is proud to offer a greatly expanded World Implant Expo, Annual Global Orthodontic Conference, 3D Printing Conference, Oral Health Symposium, Pediatric Summit, Women’s Program, Public Health Program, Special Needs programs and Dental Laboratory Education. Staff members can also take advantage of the many educational opportunities available.

With over six hours of free CE daily, the education program is an experience not to be missed! Register today to attend and sign up for courses and programs at www.gnydm.com.

Volunteer for Give Kids A Smile

Join NYCDS for Give Kids A Smile on Feb. 7, as we plan to make this year our biggest and most impactful year yet! As we embark on the event’s 11th year, we’ll be bringing together dentists, team members and volunteers to help provide dental care to over 1,600+ underserved children.

It’s just a half-day commitment, but the impact on both the kids and volunteers is lasting. Sign up to volunteer today!

Special Olympics Dental Clinic

Special Olympics is New York’s largest sports organization for people with intellectual disabilities. If you are looking for an

Members gather following General Membership Meeting with guest speaker Maxine Feinberg. They are, from left: Irina Reyzelman. Karina Zaygermakher, Janet Youn, Anna Viron, Whitney Mostafiz-Levinson, President Suchie Chawla, Dr. Feinberg, Yassmin Parsaei, Ioanna Mentzelopoulou, Mina Kim, Jacqueline Dikansky, Gail Schupak, Haemin Chin.

opportunity to give back to the community, then consider signing up for Special Olympics on Dec. 7. Together, we can make a difference, and it all starts with you!

Upcoming Continuing Education Schedule

Winter 2024-2025

12/11 Basic Life Support/CPR

12/18 ACD Lecture (virtual)

1/15 ACD Lecture (virtual)

1/22 Clinical Applications of Diagnostic Imaging Using CBCT (virtual)

1/27 HIPAA and Cybersecurity Essentials for Dentists

1/30 Mitigating Miserabl-odontics

2/12 Lazing is Amazing

2/19 ACD Lecture (virtual)

2/26 Basic Life Support/CPR

2/28 Infection Control and PostExposure Prophylaxis

2/28 Update on HPV and Oral Cancer

Spring 2025

3/3 Unleashing the Future: Metahumans and Artificial Intelligence in Digital Dentistry

3/7 Immediate Implant Placement and Restoration “The Esthetic Zone”

3/12

Dental Sleep Medicine: A View from 30,000 Feet, with Dr. Eugene Stantucci (virtual)

3/19 ACD Lecture (virtual) Visit www.nycdentalsociety.org for the latest course and registration information. Also, make sure to follow us on social media platforms (@nycds622).

NYSDA Endorsed Services

BANKING

Bank of America Practice Loans

800-932-2775

800-497-6076

US Bank Credit Card

888-327-2265

FINANCIAL SERVICES

CareCredit Patient Financing

800-300-3046 (#5)

Altfest Personal Wealth Management Financial Planning

888-525-8337

Best Card

Credit Card Acceptance 877-739-3952

Laurel Road

Student Loan Refinancing 855-245-0989

INSURANCE SERVICES

MLMIC

Professional Liability Insurance 800-683-7769 Bronx, Manhattan, Staten Island & Westchester

888-263-2729 Brooklyn, Queens, Nassau & Suffolk

888-744-6729 Other Counties

Arthur Gallagher Other Business 888-869-3535 Insurance

Long-term Care

Long-term Care Insurance 844-355-2596

OTHER

Henry Schein

Electronic Prescribing 800-734-5561

Prosites

Website Development 888-932-3644

SolmeteX

Amalgam Recycling 800-216-5505

Mercedes Luxury Vehicles 866-628-7232

Lands’ End Apparel for Staff 800-490-6402

UPS Delivery Services 800-636-2377

Travel Discounts

www.nysdental.org

iCoreExchange

888-810-7706

The Dentists Supply Company

888-253-1223

Alliance Risk Group

800-579-2911

Volvo

800-550-5658 ada.org/volvo

OnDiem

https://hub.ondiem.com

Component

FIFTH DISTRICT

We Remember and Honor

Pam Quinn, R.D.H., MSEd

The Fifth District has lost an important advocate, colleague and friend. Pamela P. Quinn, R.D.H., MSEd, took ill suddenly while giving a lecture on infection control at the Central New York Dental Conference on Sept. 12. She was taken to Upstate University Hospital and died two days later with her family by her side.

Those who worked with and knew Pam well were devastated to learn of her passing. Her death is a great loss to the Central New York dental community. She was a mainstay at most of our Board meetings, always happy to give an update on the status of the dental hygiene programs she oversaw and expertly answering questions from our governors and officers.

Pam graduated from Onondaga Community College (OCC) with a degree in dental hygiene in 1975. She loved being a hygienist and worked in private practice for several years. She returned to school to fulfill her dream

FIFTH DISTRICT

of teaching, receiving her BSEd in 1992 from SUNY Cortland. She began her career at Broome Community College, where she was coordinator of freshman clinics and instructor of infection control, medical emergencies and dental materials. She was also the co-developer of the dental assisting program leading to New York State certification.

In 2001, Pam was offered the position of assistant professor and department chair for the dental hygiene program at OCC. At the time, the program needed immediate attention, as the pass rates on the clinical and written boards were at an all-time low. She successfully turned the program around and the following year, it saw a huge increase in pass rates. As time went on, students recorded a 100% pass rate on both the clinical and written exams. Pam was able to convince the college to change the GPA requirements for incoming students. The difference was significant. Even though the program was successful, it, unfortunately, closed in 2004 and was transferred to a joint program in Rome between SUNY Canton and Mohawk Valley Community College (MVCC).

The SUNY Canton program was housed on the former Griffiss Air Force Base, where it occupied an old dental clinic. Pam took on the challenge of making this unique space work and produced an excellent class of graduates. In addition, the program offered dental services to vets, as the Veterans Administration was housed in the same building. This program closed in 2015, as the VA needed the clinic space for other medical purposes.

Never one to sit idle, in 2019, Pam received her MSEd from SUNY Cortland to further her teaching career. In February of 2020, she travelled to El Salvador as a member of a medical/dental team. During the COVID pandemic, Pam provided vaccinations for the Onondaga County Health Department, assisted and consulted with dental offices in writing their respiratory protection programs, provided OSHA-mandated

training, and conducted fit testing for the use of N95 respirators.

Recently, Pam had been working closely with the Fifth District to start a new program at MVCC in Rome. She was hired by MVCC as a consultant to develop the proposed program. Over the last few years, she had invested numerous hours into the design of the clinic, developing the curriculum, and working on applications with SUNY, the New York State Education Department and CODA.

We owe Pam a great debt of gratitude for all her hard work and dedication to the profession. She will be sorely missed by all, but especially by those who worked with her daily and found her to be always cheerful, kind, respectful and dedicated to whomever she worked with. She was the possessor of endless energy and a brilliant smile. It is heartbreaking knowing she will never get to see the end result of all her hard work. To celebrate the opening of the new dental hygiene program in its beautiful state-of-the-art clinic will be bittersweet. Pam will be missed but remembered and honored as one of the most significant dental professionals to come from Central New York.

SEVENTH DISTRICT

MCDS Unveils New T-shirts

Becky Herman, Executive Director

The Monroe County Dental Society unveiled new T-shirts in September. Shirts will be distributed to members during upcoming events and activities to create a sense of unity and comradery in the county.

Thank you to Crane Dental Lab, DDSmatch, GRB, J&L Dental, Morganstern DeVoesick, RTG Lab, Urgent Dental Care, Walsh Duffield and Bryan Gray, CPA.

Annual Meeting Features Presentation on Composites

Dr. Jeffrey Hoos presented “If You Can Do Composites Correctly, You Can Do

Pamela Quinn

Full Mouth Reconstruction” on a beautiful Friday in September at the Rochester Yacht Club. Thank you Kuraray for sponsoring the speaker and Bryan Gray, CPA, Clear Correct, DDSmatch, GRB, RTG Lab, Straumann, TD Bank, Vision Financial and Walsh Duffield for their sponsorship of the event.

Rochester Dental Study Club Hears from Aaron Sigona

Dr. Aaron Sigona presented “In Office Sedation and General Anesthesia” to the Rochester Dental Study Club in late September. Monroe County Dental Society (MCDS) members receive three two-hour CE events offered via Zoom free with their membership.

Dr. Sigona moved back to the Rochester area this summer and has been busy educating the community about the services he provides.

Jamie Collins Offers Wideranging Lecture

Jamie Collins, R.D.H.-EA, B.S., presented “Diverse Health Perspectives: Vaping, Autism Spectrum, and Diabetes Management” during the Monroe County Dental Society’s Annual Meeting on Oct. 11. The county changed its event format to include a four-hour afternoon lecture with happy hour to follow at the Irondequoit Country Club.

Thank you to our sponsors Benco Dental, Bryan Gray, CPA, Crane Dental Lab, Davie Kaplan, DDSmatch, GRB, Mercer Advisors, Morganstern DeVoesick, RTG Lab, Urgent Dental Care, Vision Financial and Walsh Duffield.

Diverse Perspectives and Lasting Impressions

Over 65 district members, Eastman Institute for Oral Health faculty and residents, and Rochester community members participated in our first diversity, equity and inclusion event, “Diverse Perspectives and Lasting Impressions in the Rochester Community” on Oct. 28 at the Eastman Institute for Oral Health. The event featured keynote speaker Dr. Adrienne Morgan,

SEVENTH DISTRICT

Addressing diversity in Rochester community are, from left, Eduardo Torrado, Alexis Ghanem, Adrienne Morgan, Rosemeire Santos-Teachout, Josue Padilla.

Eastman Institute for Oral Health residents with Dr. Alexis Ghanem, Seventh District Vice President.

Monroe County Board of Directors show off new T-shirts designed to bring unity to society.

Component

Seventh District cont.

vice president for equity and inclusion and chief diversity officer at the University of Rochester, along with four Seventh District members: Dr. Rosemeire Santos-Teachout, moderator and DEI 7th District Representative; Dr. Alexis Ghanem; Dr. Josue Padilla; and Dr. Eduardo Torrado.

Speakers shared personal and professional stories of resiliency, triumph, challenges and successes working in private practice, as faculty members and as volunteers in their churches, dental organizations and on mission trips.

Thank you to NYSDA and Dental Directions for their support of the event.

SEVENTH DISTRICT

Jeffrey Hoos, center, guest speaker at Seventh District Annual Meeting, with President William Hurtt, left, and Business Chair James Roland.

Members document their attendance at first-ever diversity, equity and inclusion event, Oct. 28, at Eastman Institute for Oral Health.

FOR SALE

WHITE PLAINS: General practice for sale in growing White Plains. Ground level; facing major road with street parking. Two ops with room for possible 3rd. Mostly FFS. Gross $400K with high net. Space includes kitchen, bathroom and zoned legal as residence. Practice and real estate for sale. Asking 50% net. Inquiries to: daisymolly2023@yahoo.com.

MANHATTAN: Midtown dental practice for sale. General practice offers prime ownership opportunity. With four operatories and nearly four decades of service, practice operates 3-4 days/week, serving 570 active patients. Collections

$1.172M and EBITDA $330K all on fee-for-service basis. Real estate also available for purchase. Enjoy NYC’s vibrant culture and amenities while owning thriving practice. Interested? Contact Professional Transition Strategies: bailey@professionaltransition.com; or call (719) 694-8320. Reference #NY62624.

BINGHAMTON AREA: Must-see, profitable general practice near Binghamton. Practice grossing over $600K with only 28-hour workweek. Hygiene booked out till March ‘25. Low overhead. 4 operatories with room for 5th. Over 1,000 square feet. FFS/PPO. Digital modern office with streamlined systems. No marketing. Attractive commercial building/home/office. No rent. All endo, oral/ perio surgery, most ortho and implants referred. Fantastic opportunity for both new graduates and established dentists. Transition support will be provided. Inquire by email for more info: mail005@aol.com.

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

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

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

CLASSIFIED

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

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

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

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

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

WESTERN NEW YORK: Fantastic opportunity to own, thriving practice in beautiful area. Well-established practice growing and has loyal patient base made up of 86% insurance and 14% FFS. Fully digital Pan, sensors, intraoral cameras and paperless charting all integrated with Eaglesoft. Building with off-street parking and additional rental units also for sale or lease. Outstanding staff and established patient base make wonderful opportunity for new owner’s future. Contact Practice Transition Consultant Brian Whalen

at (716) 913-2632; or email: brian.whalen@henryschein. com. #NY3665.

JEFFERSON COUNTY: Well-established, spacious, 3,500-square-foot practice in beautiful historic building housing 7 equipped ops with 8th op plumbed. Utilizes Dentrix software. FFS/PPO; only in network with 2 insurances. Strong hygiene program with dedicated team ready to stay. All specialties referred out. Revenue $837K and positioned for continued growth. Stunning property also for sale includes 4 fully-occupied residential apartment units. Doctor looking to stay for extended period. Contact Practice Transition Consultant Brian Whalen at (716) 913-2632; or email: brian.whalen@henryschein.com. #NY3719.

CAPITAL REGION: Turnkey opportunity for well-established dental practice in growing and desirable area conveniently located to downtown Albany, Saratoga and Schenectady with revenue of $800K. Attractive, efficient 2,505-square-foot space with 5 fully equipped treatment rooms. Standalone building offers excellent visibility on busy two-lane main road and also available for purchase. Digital office using Dentrix with pano X-ray upgradable to 3D. Four dedicated full-time employees and three part-time willing to stay after transition. Doctor refers out most specialties on 39-hour week. Must-see opportunity for any interested buyer looking to acquire successful primarily FFS dental practice. Contact Transition Sales Consultant Michael Damon: (315) 430-9224; or email: mike. damon@henryschein.com. #NY3942.

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

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

INDEX TO ADVERTISERS

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

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

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

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

BROOME COUNTY: Amazing opportunity to purchase well-established, highly profitable general practice in desirable city. Housed in attractive standalone building with ample parking, conveniently located less than one mile from shopping, restaurants and entertainment district. Spacious, 4,000 square feet; updated and well-designed for efficient workflow. 8 fully equipped treatment rooms with plumbed nitrous. 100% digital with modern technologies throughout. FFS with 3,425 active patients and steady new patient flow. Experienced, highly engaged team of 9 staff members awaits with robust hygiene program in place. Building available to buy or lease. Contact Transition Sales Consultant Michael Damon at (315) 430-9224; or email: mike.damon@henryschein.com. #NY4097.

OSWEGO COUNTY: Perfect opportunity to own well-established $1M GP practice residing in remodeled brick building with gorgeous riverfront views. Vibrant office located less than 20 minutes from future site of $100B state-of-the-art Micron Technologies semi conductor plant. Each well-equipped treatment room offers large windows overlooking river with beautifully maintained public park surrounding office. Well-designed 2,900-square-foot leased space offers 5 updated ADec treatment rooms with 6th op plumbed. 100% digital practice. Experienced team of professionals expected to stay after transition. 100% FFS with 7 days of hygiene on 30-hour work week. Primed for growth. Contact Transition Sales Consultant Michael Damon at (315) 430-9224; or email: mike.damon@henryschein.com. #NY4185.

SYRACUSE AREA: Attractive general practice in desirable, vibrant suburb of Syracuse is primed for growth. Situated on busy main road with ample parking. 15 minutes to downtown Syracuse and one mile to Township 5 where shopping, dining and entertainment options abound. Top-rated school district. 4-op digital practice is a must-see with affordable, 2,300-square-foot leased space. Room to expand to 2 more ops. Utilizes Eaglesoft PM with Schick sensors and 100% paperless. Refers out most endo, implants, perio and some extractions. Experienced team of professionals await post-transition. PPO-based practice open just 3.5 days per week. Very motivated seller. For more information please contact Mike Damon at (315) 430-9224; or email: Mike.damon@henryschein.com. #NY4235.

ROCHESTER AREA: Wonderful opportunity to own wellestablished, profitable practice in desirable, growing part of Monroe County. Immaculate, thriving general practice situated in professional office park with ample parking and conveniently located to major highways. Spacious 5,800-square-foot leased space updated and well-designed for efficient workflow. Features 12 fully equipped treatment rooms. 100% digital, paperless practice, with modern technologies throughout, including CBCT. FFS with 2,900+ active patients and steady new patient flow. Experienced, highly engaged team awaits with robust hygiene program in place. Don’t let this opportunity slip away .For more information, please contact Mike Damon at (315) 430-9224; or email: Mike.damon@henryschein.com. #NY4234.

ONTARIO COUNTY: Long-established, efficiently designed 1,800-square-foot leased space with 4 fully equipped treatment rooms and plumbed room for additional 5th room. Located in scenic community described as Gateway to beautiful Finger Lakes Region and just 25 minutes from downtown Rochester. Insurance-based practice. Utilizes Eaglesoft PM software. Refers out all specialties. Averages 15-20 new patients per month with zero marketing. Strong hygiene program, with practice positioned for growth. For more information, please contact Practice Transition Consultant Mike Damon at (315) 430-9224; or email: mike.damon@henryschein.com. #NY4198.

NASSAU COUNTY: Modern general practice built out less than five years ago in a standalone building. 5 operatories with plumbing in place for 6th; equipped with stateof-the-art technology, including an iTero scanner, CBCT imaging and digital X-rays. Located on high-visibility main road. Practice experiencing rapid growth, making it excellent opportunity for doctor just starting out or seasoned practitioner looking to expand their portfolio. For more information, please contact Practice Transition Consultant Jim Higgins at (914) 496-4856; or email: jim.higgins@ henryschein.com. #NY4134.

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

LIVINGSTON COUNTY: Wonderful opportunity to own well-established, thriving GP practice residing in beautiful, historic building with great curb appeal. $1.8M practice located in heart of town center in Western NY. Located less than 1 hour from downtown Rochester. 3,0000-square-foot clinical space offers 5 updated treatment rooms. Additional 1,500-square-foot space upstairs for apartment rental. Building for sale. 100% digital practice utilizing Dentrix software and other technologies. 60% FFS/40% PPO mix. Must see. Schedule visit today. For more information please contact Mike Damon by email: Mike.damon@henryschein. com; or call (315) 430-9224. #NY4251.

FOR RENT

MIDTOWN MANHATTAN: Beautiful, brand new, state-of-the-art office with 1-2 spacious operatories for rent. Brand new A-Dec chairs and A-Dec cabinets. Office has new CBCT. Very conveniently located in Midtown at 53rd Street and Madison Ave. Available Monday through Saturday; rent as few or as many days as needed. All ops have large windows and lots of sunlight. Perfect for GP or specialist. Please contact if interested in learning more: jpastagia@gmail.com.

ROCKLAND COUNTY: Shared dental office space for sublease in Suffern. Ideal location immediately off Exit 14B on NYS Thruway. Large, bright, professional dental office, one operatory, lab space available 3-4 days during week/weekend (day or night). Rent $2,000-$2,500 per month; depending on need. Viewings available Tuesday and Thursday (8 am-4 pm) by appointment only. Please contact Jennifer at (845) 357-5002; or via email: NYPOIA7@ gmail.com.

MIDTOWN MANHATTAN: Newly renovated office for rent. Please call to learn more about this opportunity. Phone: (212) 223-3005.

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

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

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

ROCKLAND COUNTY: Suffern. Space available for Specialist. 1 or 2 operatories in professional building with general dentist. Office has X-ray equipment, sterilization, dental chairs, reception area, large parking area, easy access to highways. For more information, please call or email: Phone: (845) 300-2283; or email: Nicoletta51347@gmail.com.

SERVICES

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OPPORTUNITIES AVAILABLE

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

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ADA Installs New Leaders at October Meeting Brett Kessler of Colorado

Becomes 161st President

DR. BRETT KESSLER, D.D.S., of Denver, CO, was installed president of the American Dental Association at the conclusion of the annual meeting of the ADA House of Delegates in October in New Orleans, LA. Dr. Kessler is the 161st president of the association.

Also taking office at the meeting were newly elected President-Elect Dr. Richard Rosato, D.M.D., of Concord, NH; Second Vice President Dr. Tamara S. Berg, D.D.S., of Yukon, OK; and Treasurer Dr. Cody Graves, M.B.A., D.D.S., F.A.G.D., of Goldthwaite, TX.

An ADA member for more than 27 years, Dr. Kessler has served on the HOD as vice chair of the Dental Wellbeing Advisory Committee and the Council of Dental Benefits Programs. Additionally, he has served as a Board of Trustees Liaison to the Council on Advocacy for Access and Prevention, Council of Communications and Council on Dental Practice. In 2010, he was presented with the Golden Apple Award, highest honor bestowed by the ADA, for outstanding leadership in mentoring. He is currently involved in discussions to understand the relationship between improving oral health and improving diabetes, Alzheimer’s disease, cardiovascular disease, kidney failure and other diseases.

An oral and maxillofacial surgeon, Dr. Rosato has been a volunteer leader and member of the ADA for 34 years. He has served as chair of the Council on Ethics, Bylaws and Judicial Affairs, the ADA Election Commission and the Task Force for the Sale of the ADA Headquarters. He currently owns his own practice, Capitol Center for Oral and Maxillofacial Surgery, PLLC.

Dr. Berg, a private practice dentist, has been an ADA member for 29 years, serving many leadership roles, including president of the Oklahoma Dental Association and member of the ADA Council on Membership. She has been an active member, leader and mentor with numerous other dental organizations, including the American Association of Women Dentists, American College of Dentists and Pierre Fauchard Academy.

Dr. Graves was elected to a three-year term as ADA Treasurer. A general dentist, he has served on the ADA Strategic Forecasting Task Force, the ADA Finance Service Task Force and the ADA Task Force on Dental Practice Recovery. He has also served on the ADA Strategic Forecasting Committee and was cochair of the Dentist to Tripartite Subcommittee. He is vice chair of MCBank’s Board of Directors, which has been serving on for 18 years. p

Brett Kessler

Richard Rosato

Tamara S. Berg Cody Graves