ODA Journal: July/August 2022

July/August 2022 | Vol. 113 No. 4

University of Oklahoma College of Dentistry Class of 2022

Welcome to Organized Dentistry ODA Senior Signing Day Highlight Page 24

www.okda.org

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Joe Strunk, Strunk, Owner Joe Owner Joe@3000IG.com Joe@3000IG.com

Celebrating50 50years yearsof of Celebrating servingand andsupporting supporting serving the Oklahoma Dental the Oklahoma Dental Association!

Association!

Lydia Christine, Agent Lydia Christine, Agent Lydia@3000IG.com Lydia@3000IG.com

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Sheila Couey, Agent Sheila@3000IG.com Sheila Couey, Agent Sheila@3000IG.com

Guy Strunk, Agent Guy@3000IG.com

Contents

ADVERTISERS Thank you to these businesses who advertise in the ODA Journal

Oklahoma Dental Association

July/August 2022 | Vol. 113, No. 4

ASSOCIATION

Inside Front Cover 3000IG

04 Calendar of Events 08 ODA Member Benefit Corner

Back Cover Delta Dental of Oklahoma

09 ODA Marketing Coach

Authentic Dental Laboratory, Inc. Edmonds Endodontic Associates Endodontic Practice Associates Lewis Health Profession Services MedPro Mid-Continent Dental Congress ODASuppySource Southwest Dental Conference Valliance Bank

1 2 RDGP Recognition

10 ODA Partners Column 17 OkMOM 2023 1 8 2023 ODA Annual Meeting

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2023 ODA Annual Meeting

28 THE OKLAHOMA DENTAL ASSOCIATION JOURNAL (ISSN 0164-9442) is the official publication of the Oklahoma Dental Association and is published bimonthly by the Oklahoma Dental Association, 317 NE 13th Street, Oklahoma City, OK 73104, Phone: (405) 848-8873; (800) 876-8890.

Fax: (405) 848-8875. Email: information@ okda.org. Annual subscription rate of $39 for ODA members is included in their annual membership dues.

POSTMASTER: Send address changes to OKLAHOMA DENTAL ASSOCIATION JOURNAL, 317 NE 13th Street, Oklahoma City, OK 73104.

Periodical postage paid at Oklahoma City, OK and additional mailing offices.

AEGD Case Studies

LEGISLATIVE LOOP 2 2 2022 Legislative Session: OHCA to Move to Managed Care Medicaid 2 3 2022 DENPAC OKCapitol Club & Grand Level Members

SPOTLIGHT 24 Congratulations OUCOD Class of 2022 25 2022 ASDA Officers and Award Winners 2 6 Tribute to ODA 50-Year Members

FEATURES 2 8 AEGD Case Studies 33 New Dentist Corner: Leadership 34 Practice Management: Insurance

Cover Photos: 2022 OUCOD Graduates posing for a class photo.

ODA President and new graduates at the ODA. Welcome new members!

36 Hygiene Hotspot 38 Office Showcase 4 0 GHMF Practice Management Scholarship

CLASSIFIEDS 4 2 ODA Classified Listings

Subscriptions: Rates for non-members are $56. Single copy rate is $18, payable in advance.

Reprints: of the Journal are available by contacting the ODA at (405) 848-8873, (800) 876-8890, editor@okda.org.

Opinions and statements expressed in the OKLAHOMA DENTAL ASSOCIATION JOURNAL are those of the author and are not necessarily those of the Oklahoma Dental Association. Neither the Editors nor the Oklahoma Dental Association are in any way responsible for the articles or views published in the OKLAHOMA DENTAL ASSOCIATION JOURNAL. Copyright © 2021 Oklahoma Dental Association.

Is Your Information Correct?

Help the ODA keep you informed about legislative actions, CE opportunities, events, and other important member-only news.

Contact Kylie Faherty, ODA Membership Director, at kfaherty@okda.org or 800.876.8890 to provide the ODA with all of your current contact information.

www.okda.org

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ODA JOURNAL STAFF EDITOR Mary Hamburg, DDS, MS ASSOCIATE EDITOR Roberta A. Wright, DMD, MDSc, FACP EDITORIAL BOARD MEMBERS M. Edmund Braly, DDS, FACS, FAACS Daryn Lu, DDS Phoebe Vaughan, DDS Elizabeth Silver, DDS

CALENDAR OF EVENTS Visit the ODA’s online calendar at OKDA.ORG/CALENDAR for all upcoming meetings and events.

July 4 & 5 ODA Closed

DIRECTOR OF COMMUNICATIONS & EDUCATION Stacy Yates

July 15 Governmental Affairs Council ODA Building 9:00 a.m.

OFFICERS 2022-2023 PRESIDENT Robert Herman, DDS, MS president@okda.org

Membership & Membership Services Council ODA Building 11:00 a.m.

EXECUTIVE DIRECTOR F. Lynn Means

PRESIDENT-ELECT Paul Wood, DDS presidentelect@okda.org VICE PRESIDENT Daryn Lu, DDS vicepresident@okda.org SECRETARY/TREASURER Nicole Nellis, DDS treasurer@okda.org SPEAKER OF THE HOUSE Mitch Kramer, DDS speaker@okda.org

ODA Board of Trustees ODA Building 1:30 p.m.

July 29 Yoga with the ODA Salt Yoga (Tulsa) 10:30–11:30 a.m.

August 5 Solutions 101 Insurance Webinar Virtual 9:00–11:00 a.m.

August 13 Yoga with the ODA This Land Yoga (OKC) 12:00–1:00 p.m.

August 23 Student Fall Fest ODA Building 5:00 p.m.

August 26 & 27 Southwest Dental Conference Dallas, TX swdentalconf.org

September 2 & 5 ODA Closed September 9 Bikes & Brews Tour OKC 6:00 - 9:00 p.m.

September 21-24 OUCOD Alumni Weekend OUCOD September 30 NW District Dental Society Meeting & CE Oakwood Country Club 9:00 a.m.–3:00 p.m.

August 28 ADA District 12 Pre-Caucus Grapevine, TX

IMMEDIATE PAST PRESIDENT Chris Fagan, DDS pastpresident@okda.org ADMINISTRATIVE STAFF EXECUTIVE DIRECTOR F. Lynn Means DIRECTOR OF GOVERNANCE & FINANCE Shelly Frantz DIRECTOR OF COMMUNICATIONS & EDUCATION Stacy Yates DIRECTOR OF MEMBERSHIP Kylie Faherty PROGRAMS & OPERATIONS MANAGER Makenzie Dean SPECIAL PROJECTS & COMMUNICATIONS MANAGER Mackenzi Broadbent

Registration is Open

Stay connected with the ODA!

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SmilCon2022 will be held Oct. 13–15 at the George R. Brown Convention Center. Visit the registration page to view pass options.

Register now at smilecon.org

www.okda.org

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@okdentassoc @okladentassoc @okdentassoc @TheOKDentAssoc

V e t e r a n s D e n ta l D ay OU College of Dentistry Oklahoma Dental Association N ove mbe r 11, 2022

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www.okda.org

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ODA MEMBER BENEFIT CORNER Why is a membership with the ODA/ADA so valuable?

The ODA/ADA supports all members at the national, state and local levels. From helping you manage your practice more efficiently and advocating on your behalf to offering you tools and resources that help you find the answers for which you’re looking, we’re there every step of the way.

ADVOCACY

By: Makienzie Dean, Programs & Operations Manager Advocacy is the first step to creating change within the dental profession and is one of the most overlooked member benefits.

Whether we are advocating for legislation or are in opposition of a certain bill, dentistry must have a united front.

Being a member of the ODA shows that you stand in solidarity with your colleagues for the advancement of the profession and for the protection of your patients. A portion of your membership dues goes toward our efforts to advocate for the profession and protect dentistry at the local, state, and national levels.

For more information on ways to get more involved with the ODA’s advocacy efforts, please visit okda.org/ advocacy or contact ODA Executive Director Lynn Means at lmeans@okda.org.

We encourage you to take action and get involved in our advocacy efforts. The following are the top three ways you can be an advocate for your profession: 1. Become an Action Team Leader: Action Team Leaders (ATLs) are ODA members who are paired with Oklahoma senators and representatives. It is important for legislators to have an ATL because it puts a face on our organization.

It is easier to connect with legislators when we have those previous relationships formed.

TPP THIRD PARTY PAYER

2. Become a member of DENPAC: DENPAC is the political action committee of the ODA that works to make political contributions to dentistry-friendly, state-level legislative candidates. You can donate to DENPAC today by calling the ODA at 405.848.8873.

3. Keep up with ODA Legislative Alerts: ODA Executive Director Lynn Means constantly keeps ODA members updated on legislative issues. If you are not receiving these alerts, we do not have the best email address for you. To update your email, call the ODA at 405.848.8873 or email kfaherty@okda.org.

As a member of the Oklahoma Dental Association, you can be confident that there is an association supporting you and championing for the greater good of your profession. The Oklahoma Dental Association and the American Dental Association will continue to fight for what matters to you and to your patients. There is power in numbers and in organized dentistry!

ADA THIRD PARTY PAYER CONCIERGE TM

Your Key to Dental

Insurance Answers Dealing with dental benefit plans can be difficult. As a member of the ODA & ADA you have access to FREE one-on-one dental insurance assistance.

LEARN MORE & GET ANSWERS QUICKLY

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WWW.OKDA.ORG/TPP

Registration Now Open!

Southwest Dental Conference

EMPOWERING DENTISTRY AS ESSENTIAL HEALTH CARE

Hilton Anatole Dallas • August 26-27, 2022

www.swdentalconf.org

Leave Your Practice in Good Hands Secure Your Legacy ADA Practice Transitions make the process of selling your practice or hiring an associate more predictable and successful by matching based on a shared philosophy of care.

Start your profile today at ADAPracticeTransitions.com.

www.okda.org

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OKLAHOMA DENTAL ASSOCIATION REWARDS PARTNERS Insurance Products For You & Your Practice The insurance coverage you need for your business, personal life & employee benefits.

Answers On Employer Dental Plans The solution for dental practices & you receive a $300 discount.

Tours & Cruises Access to guided ocean, river and land-based tours designed to immerse travelers in the history and culture of people and places.

Staff Logo Apparel Save up to 10% on products and logo embroidery.

Debt Collection Services Members receive 10% off Tier 1 pricing.

Cybersecurity Protect your business and reputation from Cyberattacks!

Patient Payment Plans Help patients get what they need, without delay!

On Demand or In-Person Fitness Options More fully customizable and flexible than any single gym membership.

Expert HIPAA Compliance Use their software and one-on-one Compliance Coach guidance to avoid HIPAA fines.

Interpretation Services Save nearly 70% off of interpretation services compared to those who aren’t ODA members.

In-House Dental Membership Plan Provide better care for your uninsured patients, without insurance getting in the way.

Scrap Metal Recovery Receive 85-97% of the current market price.

Electronic Insurance Claims Receive e-claims for only .25 cents.

STO R E

Student Loan Refinancing You can save on your student loan debt!

Members are eligible to receive a special offer from Laurel Road.

AND Mortgages Offering savings for members looking to purchase a new home or refinance an existing mortgage.

Computers & Technology Members are eligible to save up to 30% off the everyday public web price of Lenovo’s entire product line.

Bio-Hazard Waste Removal & Treatment Receive special pricing for waste pickup.

Medical Evacuation Members receive reduced membership rates.

Luxury Vehicles Exciting member discounts on Mercedes-Benz vehicles.

Dental & Office Supplies Save on more than 65,000 products.

Secure Communications Solutions Receive preferred pricing & waived set-up fees.

Website Design & Marketing Services Members can save on websites.

Care For Your Air Providing powerful and consistent decontamination services for your practice.

The Leader In Amalgam Separation Members can receive a free NXT Hg5 Collection Container with Recycle Kit with purchase of an NXT Hg5 Amalgam Separator.

Appliances Access to member-only savings of up to 25% off MSRP on select GE appliances.

Scrubs, Lab Coats & More Members receive a 15% discount of all purchases in-store and online.

Emergency Medical Kits Save 10% on emergency medical kits & AEDs.

Special Services & Shipping Discounts Members have access to new & improved flat discount pricing.

Electronic Credit Card, Check Management & Payroll Processing Services Receive special pricing, efficiently pay your staff & manage general HR needs.

Empowered ePrescribing Simplify prescriptions with robust functionality and automation.

Point-Earning Credit Card The only credit card endorsed for ADA members.

On-Hold Messaging, Digital Video & Overhead Music Connect with your patients while they wait.

FOR MORE INFORMATION: OKDA .ORG/REWARDS-PROGRAM

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ODA PARTNERS COLUMN

These are endorsed companies of the ODA that save ODA members money while keeping dues lower by providing royalties to the ODA.

The ODA endorses companies that have been researched and proven to offer products and services that provide real savings. By being an ODA member, you’re automatically eligible for these savings.

Below is information about one of our NEWEST Partners. Learn about all of the Partners at okda.org.

Do You Suffer from

Head in Sand Syndrome?

“Head in Sand Syndrome” is common among dental professionals. It occurs when you believe your network is being properly protected against ransomware and the theft of patient data, only to find out that you did not have the correct security measures in place.

Black Talon Security specializes in Dental Cybersecurity, and we can work in conjunction with your current IT provider to identify and eliminate entry points into your network. A cyberattack against your practice will often cost you in excess of $100,000 and shut your doors for two weeks...we can help prevent that.

Our credentialed and highly-trained security team have specialized tools on your network and are constantly monitoring it to identify and stop an attack before it happens.

Contact us today at 800-683-3797 to learn how specialists can protect you better than your IT resources. Visit us at blacktalonsecurity.com

Trust the Cybersecurity Specialist

www.okda.org

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ARE YOU READY FOR STORM SEASON? DO YOU OR SOMEONE YOU KNOW Oklahomans all too welland thatDisaster you can Grant never be too The Oklahomaknow Dental Relief Program Board of Trustees prepared for severe weather, but where do you turn when recognizes Dr. E. Vann Greer for her exceptional support of the mission S T RofU G G L E W I T H S U B S TA N C E A B U S E ? youRDGP. need immediate relief in thewas aftermath of aby devastating the In 2010, Dr. Greer appointed the ODA president to revise storm?

The RDGP also contributes to the Oklahoma Health the outdated program Trust, and by 2012, a new version was registered with Professionals Program which is an outreach program Help is available!

The Oklahoma Dental aRelief and the State of Oklahoma.

She assembled Board ofDisaster Trustees anddesigned drafted bylaws, to support and monitor medical and allied health Grant Program (RDGP) is a charitable trust established policies, and procedures for adoption by that Board, which governs the professionals throughout Oklahoma who are experiencing to provide aid to dental professionals affected by natural difficulty with abuse. The services provided by program.

Greerdisability, was Treasurer from 2013-2021or and continues to serve assubstance a disasters,Dr. physical chemical dependence, other the OHPP are confidential and at no cost. Services include Trustee. hindering conditions. Over the last three years, the RDGP awarded $28,000 in disaster assistance to individuals and

expert consultation and intervention designed to encourage

The RDGP is a charitable entity offers aid toAid dental who, healthcare professionals to seek help for substance abuse dental organizations affected by that severe weather. is professionals and behavioral concerns. If you or someone you know because ofconfidentially misfortune, natural disaster, chemical Whether dependence, physical provided and without remuneration. needs help, please call the 24-hour confidential direct line disability, or otherathindering conditions, arethe not wholly you are affected home or office, contact RDGP to self-sustaining. This (405-601-2536).

The RDGP voluntary section on the ODA apply foralso immediate assistance 800-876-8890. program contributes to the Oklahoma Health Professionals Program, dues statement funds the ODA’s contribution to the Health which is an accepts outreachtax-deductible program designed to support and monitor medical andProgram.

The RDGP donations from individuals Professionals and dental around the country to provide allied healthorganizations professionalsfrom throughout Oklahoma who struggle with substance aid after devastating destruction caused by tornadoes and Whether you need help or want to provide help, don’t wait! abuse.

other natural disasters across the state. Funds are awarded Contact the RDGP manager today at sfrantz@okda.org to dental professionals who are victimized by the storms. or call 800-876-8890 Additionally, the funds are used for programs like the Tax-deductible donations to the program can be mailed to: Oklahoma Dental Foundation MobileSmiles Program to aid in OK Dentalyet Relief and Disaster Grant reliefRDGP effortsexists in several The toOklahoma award communities. financial aid to Oklahoma dentists relies solely onProgram donations.

317 NE 13th Street The RDGP relies solely onTo contributions from individuals donate, visit okda.org/programs/member-support Oklahoma City, OK 73104 and dental foundations. The donations received help prepare & provide for those Oklahoma dentists and dental foundations in need of resources after destructive storms.

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For grant application and program guidelines, visit okda.org/programs/member-support/

Endodontic Practice Associates Norman, Oklahoma

Dr. Spencer Hinckley and Dr. Percy Bolen

Serving the OKC Metro for 43 years - since 1977 Your patient’s experience is top priority 3D CBCT scanning for improved diagnosis Complex endodontic cases welcomed Complex and “heroic” teeth salvage Build-up and post & core placement available Cutting edge instrumentation and disinfection Zeiss microscopes used on every case Specializing in finding 4+ canals in molars Surgical and nonsurgical retreatment General anesthesia and oral sedation Open during pandemic shut-down

W

e pride ourselves in a trusted referral pattern that ensures your patient returns to you holding you in high regard - regardless of the reason for referral. We speak highly of you to your patient and reassure them they are in good hands in your care.

We value communication between you and our office. Give us a call to talk about anything.

We are even happy to help you navigate through a difficult case in your chair.

Phone: 405.329.7936 1.800.238.5215

Fax: 405.329.1722

www.endodonticpracticeassociates.com

www.okda.org

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RESERVE YOUR SPOT NOW

CALL OR EMAIL STEFFEN 417.350.0937 SSOP@EDPLABS.COM www.okda.org

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Our promise to never settle a lawsuit without your written consent Our promise to offer you options that fit your needs Our promise to provide unmatched defense success if a claim goes to trial Our promise to be there on your first day of practice and every day after Our promise to have the financial strength to protect you and your future

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A.M. Best rating as of 6/30/2021. All data is derived from MedPro Group records and calculations; claims data range is 2011-2020 unless otherwise indicated. MedPro Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company, PLICO, Inc. and MedPro RRG Risk Retention Group. All insurance products are administered by MedPro Group and underwritten by these and other Berkshire Hathaway affiliates, including National Fire & Marine Insurance Company. Product availability is based upon business and/or regulatory approval and may differ among companies. © 2021 MedPro Group Inc. All Rights Reserved. DENTAL-211162

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FEBRUARY 3 & 4, 2023

HEART OF OKLAHOMA EXPO CENTER

VOLUNTEER REGISTRATION OPENS OCTOBER 17 AT OKMOM.ORG

www.okda.org

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2023 OKLAHOMA DENTAL ASSOCIATION

APRIL28TH & 29TH

TULSA, OKLAHOMA Save the Date!

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1 Rewards points are earned with your ADA Visa credit card for eligible net purchases (purchases minus credits and returns). Some restrictions apply. Refer to the Program Rules at adavisa.com/faqs for additional information.

2 The APR may vary and as of 4/4/2022 the variable APR for Purchases and Balance Transfers is 10.24% - 22.24% based on your creditworthiness. The variable APR for Cash Advances is 26.24%. Cash Advance fee: 5% of each advance amount, $10 minimum. Convenience Check fee: 3% of each check amount, $5 minimum. Cash Equivalent fee: 5% of each cash amount, $20 minimum. Balance Transfer fee: 3% of each transfer amount, $5 minimum. There is a $2 minimum interest charge where interest is due. The annual fee is $0. Foreign Transaction fee: None. We may change APRs, fees, and other Account terms in the future based on your experience with U.S. Bank National Association and its affiliates as provided under the Cardmember Agreement and applicable law.

ADA is a registered trademark of the American Dental Association.

The creditor and issuer of this card is U.S. Bank National Association, pursuant to a license from Visa U.S.A. Inc. ©2022 U.S. Bank

www.okda.org

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Join us as we celebrate Mid-Continent Dental Congress and 80 years of excellence.

OUR 2022 SPEAKER LINEUP Kenneth Abramovitch, DDS, MS • Elizabeth Burns, DDS, RYT 200, CLC • Jeff Carter, DDS Pat Carter, IIDA • Carla Cohn, DMD • Scott Coleman, DDS • Todd C. Davis, DDS • Marianne Dryer, RDH, MEd Lee Fitzgerald, DDS • Marie T. Fluent, DDS • Theresa Groody, DHSc, EFDA, CDA • Penny Hatzimanolakis, RDH • Kevin Henry • Randy F. Huffines, DDS • Tija Hunter, CDA, EFDA • Mark E. Hyman, DDS • Jo-Anne Jones, RDH Jon M. Julian, DDS • Anne L. Koch, DMD • Mark T. Murphy, DDS • Shannon M. Nanne, RDH • Lane M. Ochi, DDS Leonard F. Tau, DMD • Christine Taxin • Ryan Vet • Tramain Watkins, CDT • DeWitt Wilkerson, DMD

COME PARTY WITH US! NEW FREE ATTENDEE SOCIAL EVENT! You won’t want to miss our Cheers to 80 Years Party on Thursday evening. Enjoy food stations, appetizers, drinks and live music by St. Louis’ favorite cover band, Griffin and the Gargoyles. Sponsored, in part, by Patterson Dental.

Registration opens in June at mcdcstl.org.

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www.okda.org

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LEGISLATIVE LOOP Legislative Overview & Political Update

2022 Legislative Session:

Oklahoma Healthcare Authority to Move to Managed Care Medicaid

By: Scott Adkins, ODA Contract Lobbyist

The 2022 Oklahoma Legislative session formally ended on Friday, May 27, with the Sine Die adjournment of the House of Representatives and the Oklahoma State Senate. Most legislation was finalized, and the budget passed, on Friday the 20th, to provide the Legislature with the required five legislative days for the Governor to sign or veto the final round of bills. The Oklahoma Constitution mandates that the legislature convene on the first Monday in February and must adjourn by 5:00 pm on the last Friday in May of each year.

Our state budget continues to be very strong. Oklahoma’s resistance to a complete COVID-19 economic shutdown, the rapid return of business activity, and a staggering amount of federal stimulus have resulted in huge budget surpluses for the coming fiscal year and likely the next. Total appropriations from the Legislature totaled $9.8 billion and still left almost $2 billion unspent.

In one of the final acts of the 2022 legislative session, the Oklahoma House and Senate passed SB 1337. This will provide the framework for the Oklahoma Healthcare Authority (OHCA) to begin the transformation of the state Medicaid program into a managed care delivery system. While almost every state has some sort of managed Medicaid scheme, most healthcare providers in Oklahoma have opposed moving to managed care. Over the last decade, there have been many attempts to change Medicaid. The ODA has always strongly opposed moving to a managed care delivery system and has never supported passage of SB 1337. But as a result of our decade long fight, we knew what to watch for and some things to anticipate.

While it’s not the outcome that we wanted, the ODA fought hard for many protections for dentists and their offices. Full implementation is set for October 1, 2023. Below, are some details of provisions specific to oral health and dentistry.

Dentistry will be separated from hospitals and most providers and carved out into our own program. The OHCA will issue two requests for proposals; one will handle hospitals, medical and the more comprehensive components, and a second will be issued that is specifically to dentistry.

A minimum of two dental benefit managers (managed care organizations) will be chosen by the OHCA to manage Medicaid dental services. As a result of efforts by the ODA, Oklahoma dentists will still operate under a fee for service delivery system, as capitation in a traditional sense, has been prohibited in the dental sections of the bill.

Until July 1, 2026, a rate floor will be established by the OHCA with minimum reimbursement requirements. All managed care organizations and dental benefit managers will be prohibited from reducing reimbursements below that level.

All dental benefit managers shall maintain a Medicaid Dental Advisory Committee, comprising EXCLUSIVELY Oklahomalicensed dentists and specialists, to advise dental benefit managers regarding metrics and quality measures.

Dental providers shall not be required to enter into any capitated contracts with any dental benefit manager.

No later than one year after implementation, the OHCA shall create a scorecard that separately compares each dental benefit manager. The scorecard shall report the average speed of authorization of services, rates of denials, member satisfaction survey results, provider satisfaction survey results, and possibly other reimbursement metrics. The scorecard will be published quarterly and will be provided to all members and published on the OHCA website.

The Oklahoma Dental Association will be engaging with the OHCA through every step of the process to ensure that our Medicaid providers are represented. While many protections, such as prompt pay provisions from last year’s efforts, are also in place, the ODA will be holding the agency accountable to our members. We will keep you updated as details emerge from the potential RFPs (requests for proposals) and our meetings with the Governor and the OHCA administration. As always, the focus of the Oklahoma Dental Association will be on the oral health of our citizens and on ensuring that our dentists have every resource available to manage their practice and provide exceptional patient care.

ADA SUPPORTS STUDENT LOAN INTEREST DEDUCTION ACT OF 2021

The ADA supports HR 4726, the Student Loan Interest Deduction Act of 2021, which would increase the student loan interest deduction from $2,500 to $5,000 and remove income limits so borrowers living in high-cost areas can receive the benefit. Dentists now have an average of nearly $305,000 in educational debt when they graduate, which can be a financial burden, especially for those who have nonpaying or low-paying residencies. HR 4726 will not replace comprehensive student loan reform, but will make debt more manageable. Learn more at ada.org/advocacy/student-debt.

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K

CAPITOL CLUB Dr. Jeffrey Ahlert Dr. Clay Anderson Dr. Glenn Ashmore Dr. Michael Auld Dr. Douglas Auld Dr. William Beasley Dr. Tamara Berg Dr. Bryan Blankenship Dr. Elizabeth Bohanon Dr. M. Edmund Braly Dr. Michael Breland Dr. C Todd Bridges Dr. Trace Bridges Dr. Matthew Bridges Dr. Nathan Brown Dr. Steven Brown Dr. Ronald Bulard Dr. Adam Bulleigh Dr. Jamie Cameron Dr. Tricia Cannon

WE DON’T FUNDRAISE. WE FRIENDRAISE! THANK YOU TO THESE 2022 DENPAC CAPITOL CLUB MEMBERS! Dr. Wuse Cara Dr. John Carletti Dr. Bobby Carmen Dr. Jennifer Chambers Dr. Tennille Cheek-Covey Dr. Raymond Cohlmia Dr. Matthew Cohlmia Dr. Russell Danner Dr. Susan Davis Dr. David Deason Dr. Stacia Dowell Dr. Brian Drew Dr. Twana Duncan Dr. Heath Evans Dr. Christopher Fagan Dr. Timothy Fagan Dr. Barry Farmer Dr. Sandra Grace Dr. Shannon Griffin Dr. Kevin Haney

Dr. Mark Hanstein Dr. Aaron Harman Dr. Edward Harroz Dr. Richard Haught Dr. Robert Herman Dr. Jeffrey Hermen Dr. Mathew Hookom Dr. Brad Hoopes Dr. Jennifer Jenkins Dr. Donald Johnson Dr. Eugenia Johnson Dr. Krista Jones Dr. Michael Kirk Dr. Jandra Korb Dr. Mitchell Kramer Dr. April Lai Dr. Robert Lamb Dr. Marti Levinson Dr. Juan Lopez

Dr. Daryn Lu Dr. David Marks Dr. Stephen Martin Dr. Alan Mauldin Dr. Stephen Mayer Dr. Glenn Mead Dr. Kenner Misner Dr. Mohsen Moosavi Dr. Paul Mullasseril Dr. Aaron Neale Dr. Nicole Nellis Dr. Robert Nowlin Dr. Karen Reed Dr. Roger Richter Dr. Ryan Roberts Dr. Erin Roberts-Svob Dr. Brant Rouse Dr. Mack Rudd Dr. Troy Schmitz

Dr. Scott Searcey Dr. Paul Shadid Dr. Steffan Sigler Dr. Floyd Simon Dr. Lindsay Smith Dr. James Sparks Dr. Sara Spurlock Dr. James Strand Dr. Steven Strange Dr. Carla Sullivan Dr. Jim Taylor Dr. Stephen Taylor Dr. Kara Tims Dr. Jonah Vandiver Dr. Nathan Villines Dr. Robert Webb Dr. Daniel Wilguess Dr. C. Rieger Wood Dr. Paul Wood

OKCapitol Club is for that “ABC” group of DENPAC members; or those who want to be “ABOVE AND BEYOND CONTRIBUTORS.” OKCapitol Club members truly understand the importance of the ODA’s participation in the political process and want to support candidates who are committed to the state’s oral health and the issues that affect your practice. OKCapitol Club members support those efforts even more by contributing an additional $300 to DENPAC ($470 total) per year. For more information about Capitol Club, contact Lynn Means at 800-876-8890 or lmeans@okda.org.

DENPAC Grand Level DENPAC funds our voice. Without our input, legislators are merely making decisions based on what sounds good, what makes the fewest people angry, or what is easiest for them.

Whether you like it or not, the campaign contributions we make to dentistry-friendly candidates are what opens those lines of communication. It’s what reminds legislators once they’re in office to go directly to the ODA for information, and not somewhere else.

For more information about DENPAC, contact Lynn Means at 800-876-8890 or lmeans@okda.org.

THANK YOU TO THESE 2022 DENPAC GRAND ($1,000) LEVEL MEMBERS!

Dr. Douglas Auld Dr. M. Edmund Braly Dr. Matthew Bridges Dr. Matthew Cohlmia Dr. Susan Davis Dr. Twana Duncan

Dr. Heath Evans Dr. Shannon Griffin Dr. Edward Harroz Dr. Richard Haught Dr. Krista Jones Dr. Mitchell Kramer

Dr. Robert Lamb Dr. Juan Lopez Dr. Paul Mullasseril Dr. Karen Reed Dr. Ryan Roberts

Dr. Steffan Sigler Dr. Lindsay Smith Dr. Daniel Wilguess Dr. C Rieger Wood Dr. Paul Wood www.okda.org

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On May 5, we celebrated the OUCOD Class of 2022 at the ODA building during our Annual Senior Signing Day. There were free drinks, food and giveaways!

Thank you to our sponsors!

24 journal | july/august 2022

Drs. William Yeary and Troy Schmitz awarding OUCOD student Jennifer Dinh with the Dr. Randy White Memorial Scholarship.

CONGRATULATIONS CONGRATULATIONS TO TO THE THE ASDA ASDA WINNERS WINNERS

NATIONAL NATIONAL AWARD AWARD OF EXCELLENCE OF EXCELLENCE

MICHAEL MICHAEL E. LINDLEY E. LINDLEY AWARD AWARD

Dr. Ali Dr. Agee Ali Agee

Dr. Jamie Dr. Jamie Watson Watson

CONGRATS CONGRATS The The following following were were chosen chosen this this year year byby the the OUCOD OUCOD Class Class of of 2022!

2022!

OUTSTANDING OUTSTANDING FULL FULL TIME TIME FACULTY: FACULTY:

Dr. Dr. Paul Paul Wood Wood OUTSTANDING OUTSTANDING PART PART TIME TIME FACULTY: FACULTY:

Dr. Dr. Jack Jack Willoughby Willoughby OUTSTANDING OUTSTANDING STAFF STAFF MEMBER: MEMBER:

Ms.Ms. Zenoba Zenoba Hines Hines

2022-2023 2022-2023 ASDA ASDA Officers Officers

PRESIDENT: PRESIDENT: Dorna Dorna Akhavain Akhavain VP: VP: Sherry Sherry Mina Mina SECRETARY: SECRETARY: Chelsea Chelsea Saffo Saffo TREASURER: TREASURER: Hunter Hunter Stephens Stephens VENDOR VENDOR COORDINATORS: COORDINATORS: Brian Brian Shelton Shelton & Cole & Cole Biermann Biermann HISTORIAN: HISTORIAN: Blake Blake Shadwick Shadwick WEBMASTER: WEBMASTER: Ranim Ranim Shawareb Shawareb MEMBERSHIP MEMBERSHIP COORDINATOR: COORDINATOR: Nichole Nichole Musick Musick LEGISLATIVE LEGISLATIVE LIAISON: LIAISON: Preston Preston Patrick Patrick COMMUNITY COMMUNITY AMBASSADOR: AMBASSADOR: www.okda.org JoshJosh Breece Breece

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Honoring Oklahoma Dental Association's Year Members

Each year, the ODA honors dentists who have been members of the Association for a significant amount of time. Dentists who have maintained their membership for 25, 35 and 50 years are gifted pins to celebrate these milestones.

These 50-year members were invited to attend the ODA House of Delegates meeting in April to be honored by their peers and receive their pin from the ODA President.

2022 Oklahoma Dental Association 50-Year Members Dr. Brant Worthington Dr. Chester Wilks Dr. Don Morton Dr. Gary Lott

Dr. James Murtaugh Dr. Thomas Coury Dr. Joseph Fallin Jr. Dr. Walter Davis Dr. William Blubaugh Dr. Kevin Avery Dr. Michael Forth

Dr. Joseph Fallin Jr. and Dr. James Murtaugh receiving their 50 year pin from ODA President Dr. Chris Fagan during the 2022 House of Delegates meeting in Oklahoma City.

Dr. Joseph Fallin Jr. and Dr. James Murtaugh recieiving their 50 year pin from ODA President Dr. Chris Fagan at the 2022 House of Delegates meeting in Oklahoma City.

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How has organized dentistry (ODA Membership) shaped your career in dentistry?

Organized dentistry is important because a group of people with a purpose is always more powerful than one individual. Being a member of the ODA has helped my practice grow and stay current with innovative procedures and ever-developing technology. The ODA’s insight has made my practice more successful and has helped me provide my patients with a better experience.

What is your favorite memory, moment, or accomplishment in your career?

Dr. Gary Lott

My favorite memories of 50 years in practice are my work’s impact on each individual. I view each patient’s case as a minor success because of its impact on their lives. When people smile, it conveys happiness and knowing that I had a part in giving them the confidence to show their personality to the world brings me great satisfaction.

Alva, OK University of MissouriKansas City Dental School What do you see as today’s new dentists’ biggest challenge?

Class of 1972 The biggest challenge new dentists face today is student debt. The rising cost of

tuition increases pressure on a young dentist, and it is an added burden to the daunting task of trying to start or purchase a practice. Everything in dentistry now is expensive. To be successful today, young dentists need almost as much business knowledge as they need knowledge of dentistry.

Where did you attend dental school, and when did you graduate?

I graduated from the University of Iowa in 1969, completed a Rotating Dental Internship (now GPR) at Children’s Hospital in OKC, completed Pediatric Dentistry back at Iowa and started practice in 1972. I ultimately practiced in a multispecialty group in northwest OKC.

What is your favorite part of dentistry?

Working with kids. Starting early with prevention and keeping them caries free, and when treatment is indicated, keeping the experience positive.

What is your favorite memory, moment or accomplishment in your career?

Dr. James Murtaugh Edmond, OK University of Iowa College of Dentistry Class of 1969

Capitation had a disastrous effect on the Medicaid patient population with participating dentists dropping from over 1100 to less than 100. As chair of the Medicaid Committee of the ODA and its representative on the Medical Advisory Committee to the Health Care Authority, I worked with Dr. Leon Bragg to implement a fee-for-service program which enabled these patients access to care.

The highlighted membersare arethose those who responded the by The highlighted50-year 50-year members who were able to be to reached ODA the Journal publication the before ODA before the Journal publicationdeadline. deadline.

www.okda.org

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ODA FEATURE

AEGD Case Studies

Case #1

By: Edith Quiñonez Lu, DDS A 63-year-old female presented to the OU Advanced Education in General Dentistry program in January 2020 as an external referral from a general dentist with a chief complaint of a fractured #11. The patient has a history of type II diabetes with HbA1c of 6.7% and reports it is being managed by natural supplements supplied by her naturopath.

The patient has a unilateral cleft lip and palate with congenitally missing #10. At the time that she presented to OU AEGD, the patient had a 5-unit conventional fixed partial denture (FPD) extending from teeth #8-9-X-11-12.

The patient reported that she has had several removable partial dentures and FPDs throughout her life. In mid-2020, the treatment she received included sectioning her existing bridge, extracting #11 and fabricating a new FPD extending from #8-9-X-X-12-13 which was delivered in September 2020. Six months later, the patient returned to the clinic with a mobile FPD and fractured teeth #8 and 9. The patient presented with high esthetic demands and was very adamant that she did not want a removable option.

The patient routinely carried a container filled with past dental appliances and provisionals and requested copies of her dental records (photographs and radiographs) at each appointment.

After thorough discussion, the proposed treatment plan included extracting #8, 9, 12, and 13 with socket grafting and an interim removable partial denture. Following adequate healing time, implants would be placed at the aforementioned sites planned for an implant-supported prosthesis.

A CBCT was obtained 4 months postextractions. It was noted that there was not sufficient bone for an implant at the left central incisor. A common challenge of cleft lip/palate scenarios is the importance of masking defects in a high 28 journal | july/august 2022

aesthetic zone. In this case, the option of porcelain gingiva was proposed; however, the patient was against this and stated she would prefer longer teeth instead.

Careful planning was necessary prior to implant placement and necessary records were captured for a diagnostic wax-up and a try-in was completed.

Full thickness flap without disrupting tissue covering cleft

The CBCT and intra oral scan were merged in the implant software, Simplant, for planning for guided implant placement. Six months after the extractions and bone grafting, guided implant surgery was completed. A full thickness flap was reflected avoiding the tissue in the area of the cleft. The bone adjacent to the cleft was very porous and of poor quality. Three implants were placed at sites #8, 12, and 13 (3.6 mm diameter, Astra PrimeTaper EV).

Allograft bone and collagen membrane were placed on a minor buccal dehiscence at time of placement.

Four months post-surgery, the implants were uncovered, impression copings were splinted for a preliminary implant-level impression to fabricate her provisional implant-supported FDP. The interim screw-retained prosthesis will remain in place for at least 1 month prior to fabrication of the final prothesis in order to confirm esthetics, tissue shaping, occlusion, and function .

ABOUT THE AUTHOR Dr. Edith Quiñonez Lu grew up in the Oklahoma panhandle and graduated from the University of Oklahoma College of Dentistry with her Bachelors of Science in Dental Hygiene in 2014 and her Doctorate of Dental Surgery in 2021. She recently completed her AEGD residency, is president of the Oklahoma Association

Pre surgical

Implant threads exposed facially at time of placement

of Women Dentists, and is proud to be in the cavity-free club. She and her husband, Daryn, have a general dentistry practice, LoFi Dental, in Edmond, OK.

Case #2 By: Neeral Patel, DDS A 26-year-old female patient presented to OU College of Dentistry’s AEGD program. The patient’s chief complaint was that all of her teeth felt mobile and she wanted dentures. Clinical findings showed that all teeth were mobile, ranging from Class I to Class III throughout. The findings were consistent with her radiographs, as all of her teeth showed excessively short roots. The initial diagnosis for this patient seemed to present as a dentin dysplasia. However, the patient displayed no other generalized dental features of the disease such as enamel or dentin defects. Upon further review of the patient’s medical history, she noted that several of her immediate family members had been diagnosed with osteopetrosis.

Osteopetrosis is a rare genetic condition that causes the densifying of bone due to a defect in osteoclastic activity (Osteopetrosis 2020). The number of members diagnosed with this in the patient’s family suggests an autosomal dominant pattern of inheritance, and thus there was a high probability of the patient inheriting the disease. Patients with osteopetrosis can have dental defects and deficiencies such as malformed or underdeveloped root structures. A 2018 study investigated a possible correlation between bone resorption deficiencies (which are the nature of ostepetrosis) and the formation of root structures. They concluded that statistically there was a direct correlation between abnormal osteoclastic activity and poor odontoblast differentiation, which are both essential in root formation. Though the mechanism is not yet fully understood, it is posited that this may be due to defects in the cell to bone matrix interaction (Huang 2017).

Knowing this information, clinicians can begin preparing patients to plan for the likely eventuality of partial or complete edentulism by discussing the prognosis and available treatment options.

Unfortunately, many patients with osteopetrosis are prone to osteomyelitis following extractions and other surgical procedures involving bone. Though it is uncommon for osteomyelitis to affect the maxilla in these patients, there is approximately a ten percent chance of osteomyelitis in the mandible. The study demonstrating this also, found that patients with more severe osteopetrosis were at highest risk for osteomyelitis. Nevertheless,

Intra-oral photo of the patients Maxilla

one must be careful and fully inform the patient of this potential risk when considering and completing surgical treatment, such as dental implants, for patients with osteopetrosis (Naval 2014).

Nonetheless, it can be challenging to justify a 26-year-old in traditional dentures. The emotional and psychological impact for the patient could be detrimental to her overall well-being.

Although placement of dental implants has potential risk associated, it must be considered as an option. We will choose to proceed with caution and inform the patient accordingly. The patient was presented with her treatment options, from traditional dentures to fixed hybrid prostheses. Due to a number of reasons, the patient has selected to proceed with maxillary and mandibular overdentures using the Atlantis CONUS concept prosthesis. The patient is excited to have her smile back and is awaiting treatment.

Reference 1. Huang H;Wang J;Zhang Y;Zhu G;Li YP;Ping J;Chen W; “Bone Resorption Deficiency Affects Tooth Root Development in Rankl Mutant Mice Due to Attenuated IGF-1 Signaling in Radicular Odontoblasts.” Bone, U.S. National Library of Medicine, 29 Dec. 2017, https://pubmed.ncbi.nlm.nih.gov/29292230/.

2. Naval L;Molini MS;Herrera G;Naval. “Dental Implants and Osteomyelitis in a Patient with Osteopetrosis.” Quintessence International (Berlin, Germany : 1985), U.S. National Library of Medicine, Oct. 2014, https://pubmed.ncbi.nlm.nih.gov/25126646/.

3. “Osteopetrosis.” NORD (National Organization for Rare Disorders), 17 Aug. 2020, https://rarediseases.org/rare-diseases/osteopetrosis/.

ABOUT THE AUTHOR Dr. Neeral Patel is an AEGD resident at the University of Oklahoma College of Dentistry.

Born and raised in Oklahoma City, he attended Westmoore High School before completing his Bachelor of Science in Biology at the University of Oklahoma. He completed his dental education at the University of Oklahoma prior to joining the AEGD team. He plans on practicing in the OKC metro area.

Intra-oral photo of the patients Mandible

Panoramic radiograph showing the lack of root structure

www.okda.org

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Case #3 By: Ana Ruzo, DDS A 27-year-old male presented to the OU College of Dentistry AEGD program with the chief complaint of “I don’t like my teeth, so I never smile.” The patient reports dental neglect over the years due to his dissatisfaction with his teeth. His clinical evaluation demonstrated a thick gingival biotype, hyperplastic gingiva resulting in multiple areas of pseudo pocketing, subgingival calculus, severe inflammation, generalized bleeding on probing, and significant plaque accumulation (Figure 1). Upon radiographic evaluation, the patient presents with normal bone levels. He underwent a full-mouth debridement with the hygiene department prior to completion of a comprehensive oral exam. He was diagnosed with plaque-induced gingivitis with altered passive eruption, as the CEJ was not palpable upon periodontal probing.

The treatment plan presented to the patient included the following: scaling to treat his generalized gingival inflammation, esthetic crown lengthening on maxillary teeth #4-13, and gingivectomy on mandibular anterior teeth #23-26.

After completing his dental hygiene appointments, planning began for esthetic crown lengthening in the maxilla. The procedure progressed as follows: the periodontal probe was used to bone sound and create an outline of the incisions for the initial gingivectomy. Next, a scalloped incision was made from #4-13, and the band of excess gingiva was removed exposing the maxillary crowns. Following this, a buccal flap was reflected spanning this area. A surgical handpiece was used to perform osteoplasty to be roughly 2-3 mm apical to the CEJ in order to establish a healthy

Pre-op photo at Initial Work-up appointment

Case #4

biologic width. Once refined, the flap was repositioned using interproximal PTFE sutures (Figure 2).

Two weeks later, the gingivectomy on the patient’s lower anterior teeth #23-26 was completed using the BiolaseTM laser. Ultimately, this treatment area was refined two subsequent times due to gingival rebound. The patient returned for post-operative follow-ups at 2, 4, 6, and 8 weeks after the surgery to ensure no additional gingival rebound was noted. At 8 weeks, the patient was extremely satisfied with the esthetics of his teeth and finally felt like he could smile proudly (Figure 3). Six months after the procedure, the patient reported that for the first time he smiled in a public picture – his new workplace headshot! Esthetic crown lengthening can be an impactful procedure that can not only change an entire smile, but more importantly the patient’s self-confidence and overall demeanor.

ABOUT THE AUTHOR Dr. Ana Ruzo was born and raised in Dallas, Texas.

She attended Southern Methodist University where she graduated with a Bachelor of Science degree in Biological Sciences with minors in Chemistry and Spanish. She received her doctorate at UT Health San Antonio College of Dentistry in 2021 and recently completed the AEGD residency at the OU College of Dentistry. Starting in August, Dr. Ruzo will be joining a private practice in Denver, Colorado.

Post-op photo immediately following esthetic crown lengthening surgery

8 week post-op

By: Meredith Turbeville, DDS A 67-year-old male presented to OU College of Dentistry’s AEGD program with a fractured maxillary palateless four-implant overdenture on locators. The patient’s chief complaint was that he wanted a new palateless prosthesis that would not fracture or rock. The patient's heavy occlusion from his mandibular natural dentition caused repeated fracture of his all-acrylic overdenture.

The patient chose to proceed with the Atlantis Conus overdenture.

The Atlantis Conus concept by Dentsply Sirona provides the patient with the “stable, comfortable, and palate-free option of a fixed restoration with the ease of maintenance of a removable denture” (Atlantis concept manual). Conus uses a tapered abutment design to retain caps that stabilize the denture better than a traditional locator while also being more affordable to the patient than a traditional fixed full-arch prosthesis.

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This ideal solution for the patient was achieved with the help of Team Dental Laboratory in Bethany, OK. At the first appointment, an implant level impression was made, and the patient’s denture was duplicated with acrylic. A bite registration and opposing cast were also sent to the lab. At the second appointment, a wax rim was tried in and adjusted as needed. A verification jig was used to verify the accuracy of the cast and implant relationship. The third appointment was a try-in of the custom Atlantis abutments.

A wax try-in of the new denture was completed to verify the esthetics, phonetics, occlusion, and verification of the metal framework. After noting required changes, this was sent to the lab for processing.

Upon delivery, the Atlantis abutments were placed and torqued.

Polymerization sleeves were placed along with the SynCone

caps. The SynCone caps were picked up in the denture chairside using Tokuyama Fast Rebase III. A nightguard that engages two implants was also given to the patient to prevent damaging the abutments at night. Home care was discussed with the patient. This includes removing the denture 10 times a day for the first few months to ensure the prothesis will continue to easily be placed and removed as there is a risk of cold welding the prosthesis in place. The patient should clean around the implants and the denture daily. The denture should be brushed with a soft toothbrush and Sensodyne tooth paste and placed in a solution of clear Listerine along with water when not being worn. The patient was given a plastic instrument to remove the prosthesis along with a crown remover if the prosthesis becomes too difficult to remove. The patient was pleased with the outcome.

SynCone caps in final prosthesis

Tapered Atlantis Conus Abutements

ABOUT THE AUTHOR Final Prosthesis Dr. Meredith Turbeville is originally from Fredericksburg, VA. She received Left: Nightguard only engaging 2 anterior implants Right: final prosthesis her bachelor’s degree from Southern Methodist University. She attended University of Texas Health Science Center at San Antonio College of Dentistry where she received her doctorate. After completing the AEGD residency at OU College of Dentistry, she will be an associate with Dr. Melanie Emerson in private practice in Midwest City, OK.

Case #5 By: Katherine Gamble, DDS The patient, an 85-year-old male, presented with localized areas of tooth decay and a large, radiolucent lesion periapically surrounding #18 which displayed class III mobility. The patient reported a health history significant for a diagnosis of multiple myeloma for the past 18 years. He has been treated with radiation and IV bisphosphonates. Due to the patient’s unique systemic diagnosis, research on treatment limitations and recommendations was necessary in order to develop a comprehensive treatment plan.

It is recommended that patients presenting with multiple myeloma be treated aggressively prior to bisphosphonate therapy.

Furthermore, significant emphasis should be placed on homecare and recall for caries and periodontal disease prevention. In this case, the patient had been receiving bisphosphonate therapy for the past 18 years, so treatment was conservative where possible.

Carious lesions were treated with silver diamine fluoride (SDF) and restorations were completed using Fuji II resin-modified glass ionomer. Tooth #18 was deemed non-restorable due to obvious extent of lesion. The extent of the lesion in bone warranted its extraction.

Patients with multiple myeloma are highly prone to infection, so it is vital to eliminate causes of infection as soon as they are observed and prevent them with excellent homecare and consistent recall. These patients often present with a history of extensive corticosteroid use and thrombocytopenia. If a patient presenting with multiple myeloma absolutely requires surgery, a medical consult is necessary to determine the patient’s most recent neutrophil count and platelet count. The neutrophil count must be above 1000 mm³ and the platelet count above 50x10^9/L to perform in office. Also, the platelet count should be above 30x10^9/L to perform an IAN block for other, non-extraction procedures.

Medical consult is further necessary to determine steroid therapy to prevent adrenal crisis for each patient as this is unique to each case. If the platelet or neutrophil count is too low, consult with the patient’s hematologist and consider performing extraction or required surgery in a hospital setting.

After consulting with the patient’s medical team, it was determined that the extraction of #18 be completed by an oral surgeon. The patient was given the appropriate referrals and he is awaiting surgery.

Medical guidelines reference: 1. Abed, Hassan & Burke, M. & Nizarali, Najla. (2018). Oral and dental management for people with multiple myeloma: Clinical guidance for dental care providers. Dental Update. 45. 383399. 10.12968/denu.2018.45.5.383.

ABOUT THE AUTHOR Dr. Katherine Gamble is originally from Peoria, IL, and graduated from Iowa State University with a Bachelor of Science degree in biochemistry. She attended Southern Illinois University School of Dental Medicine and graduated with her DMD in 2020. Currently, she is planning to work in private practice in the greater OKC metro area starting this summer. www.okda.org

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Case #6

By: Andy Cheung, DDS A 75-year-old female presents to the OU COD AEGD with a chief complaint of "I recently fell and broke my hybrid denture.” She explained that it was the result of a fall while on a hike in Colorado.

She was transported and treated for the initial trauma. She was informed that her left subcondylar region and mandibular symphysis had fractured, and her mandible was currently splinted together with the hybrid prosthesis. The patient was evaluated by the OU COD Oral Surgery clinic where it was confirmed that her mandible was indeed healed.

Upon evaluation of the patient, she had maxillary and mandibular implant-supported hybrid dental prostheses. Upon radiographic examination, it was noted that the implants were placed at uneven levels apicocoronally, some implants were restored at abutment-level and others at implant-level, and there were two different implant systems. The patient was interested in new maxillary and mandibular zirconia hybrid dentures. However, in order to restore this patient with the industry-standard of zirconia hybrid-over-zirconia hybrid, on average, the prosthetic space required for this is roughly 30mm (15mm per arch). After thorough evaluation, it was determined that this patient lacked the required prosthetic space, presenting with only 25mm of inter-arch space.

The inadequate prosthetic space, along with the poor implant positioning and multiple restorative platforms created several challenges technically that fabricating monolithic zirconia hybrids would be unpredictable. With these combined limitations, a custom titanium bar and cementable zirconia suprastructure was decided on for her final restorations.

The patient’s occlusal vertical dimension of her existing prostheses was recorded and a panadent facebow was made. The existing maxillary acrylic hybrid and mandibular zirconia hybrid were

removed. Implant and abutment level impressions were made using PVS with preformed resin ropes luting the copings together intraorally. The impressions were poured, and the prostheses was screwed onto the casts to ensure accuracy and to complete mounting onto an articulator. The records were then sent to Express Dental Laboratory. The “virtual meeting” function on TeamViewer allowed for easy digital communication regarding the bar and prosthetic design.

Next, the bar verification was completed. The patient’s existing hybrids were removed. All existing abutments were torqued per manufacturer’s specifications. The low-profile titanium bar was seated and confirmed with periapical radiographs.

Cementable PMMA prototypes of the overlay prostheses were seated over the upper and lower bars to confirm occlusion in maximum intercuspation as well as group function in excursive movements. Esthetics were confirmed in repose, smile, and profile view. Phonetics were confirmed, especially her fricative and sibilant sounds. The prototype prostheses were approved by the patient.

After wearing the prototypes, she will return for the final monolithic zirconia cementable overlay prostheses.

ABOUT THE AUTHOR Dr. Andy Cheung is originally from San Francisco, CA. He attended the University of California, Santa Cruz and earned his B.S. in molecular biology. He continued his education in Portland, OR at Portland State University for a post-bachelor program in chemistry and started his research at the Oregon Health and Science University designing and developing novel dental composites. He attend Tufts School of Dental Medicine where he received his D.M.D. After completion of the AEGD residency, he plans to practice in Oklahoma City, OK.

Digital plan of low-profie bar with prosthesis

Low-profie bar and PMMA over-lay prosthesis

L E A R N M O R E A B O U T T H E A DVA N C E D E DU C AT IO N I N G E N E R A L D E N T I ST RY ( A E G D ) P R O G R A M AT DE N T I ST RY. OU H S C . E DU / AC A DE M I C - PR O G R A M S / A E G D

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NEW DENTIST CORNER: LEADERSHIP By: Jennifer K. Harreld, DDS I had the absolute pleasure of being a candidate and graduating from this year’s Oklahoma Dental Association Leadership Academy. I want to share a little bit of my experience with you in hopes that if the happenstance presents itself to you, that you indeed say YES! I am a 2021 grad of the OUCOD who is eager to learn from those willing to share their insights. So when a dear friend and mentor, Dr. Tabitha Arias, shared this opportunity with me, I applied enthusiastically. The academy allowed me to sit in on a number of various Oklahoma organized dentistry meetings. I was able to see leaders from all corners of the state voicing their opinions on issues and discussing how we can appeal to state legislators in order to best serve our patients. For instance, the ODA represents the interests of protecting the doctor-patient relationship so that insurance companies cannot dictate patient treatment. It was so refreshing to see so many dentists with “can-do” attitudes, not simply sitting back and being told how to practice by insurance corporations. I witnessed many colleagues who communicated well with one another regarding what works and what doesn’t.

Unfortunately, many of our meetings were virtual, but as I sat on Zoom, it was apparent the order and the preparation that these leaders brought to each meeting. I enjoyed finding out what the ODA wanted to bring to its members, including benefits such

Reimagining tomorrow, together

Drs. Cheryl Flemming, Mary Temple-Goins, and Jennifer Harreld with their 2022 ODA Leadership Academy Award

as professional classified postings or even an ODA-sponsored discussion board for dental professionals - allowing networking and knowledge sharing within our Oklahoma community! During my time in the leadership academy, I pushed myself out of my comfort zone and created new networking relationships. As a dental professional, I am committed to lifelong learning, and receiving this opportunity with the most purposeful leaders in our state was a treasured adventure.

ABOUT THE AUTHOR

Jennifer K. Harreld is a 2021 DDS graduate from OU College of Dentistry. She was heavily involved in volunteering with Staples Society while in school. She has been practicing in Oklahoma City upon graduation. She also tries to help out at Good Shepherd on her days off. She plans to apply to AEGD to further her skills in general dentistry and return to eastern Oklahoma to serve her community.

Get expert advice to help you get where you want to go with the ADA Accelerator Series, created hand-in-hand with dentists like you!

• Focus on your well-being with resources from mental health organizations like NAMI Chicago and new member perk ClassPass • Set a course for financial success with financial expert and HerMoney.com CEO Jean Chatzky • Build your leadership skills with career coach and best selling author Ashley Stahl

Are you a new dentist? Do you have an interesting story or experience to share?

We want to hear from you! Email us at editor@okda.org so we can help you share your story.

Tackle your current challenges today for a better tomorrow.

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PRACTICE MANAGEMENT

Insurance: A Necessary Evil (Part I) By: Joe Strunk, Owner/ CEO of 3000 Insurance Group Property insurance limits and risk management tips help reduce potential dental practice claims.

Property Insurance can encompass your building or improvements and betterments to your leased space, as well as your business personal property, also known as contents.

Well-written insurance policies are on a Replacement Cost form.

This means that if your property is damaged, your insurance company will pay to replace the damaged property with new property of a similar kind and quality.

Limits of Insurance Tip Issue: It is imperative you review your insurance limits regularly.

The cost of construction, inflation, supply chain issues, and lower availability of skilled labor contribute to most property-related insurance claims being underinsured when the claim occurs.

Solution: Here are some simple tricks to help you determine if your limits of insurance are enough.

• Building: Speak to a contractor who builds medical/dental buildings. Ask them to give you a ballpark cost per square foot to rebuild a medical/dental structure in your area with similar construction.

• Leasehold Improvements : Always read your lease to determine exactly what you are responsible for insuring. If your landlord built out the space, they could likely give you an appropriate figure to do so again. Several real estate brokers will help you determine the proper amount. Remember, most leases make you responsible for the Leasehold Improvements in your space, especially if they were placed in your space by you or on your behalf.

• Business Personal Property: This would be anything you would take with you if you left the occupied space. We usually refer to this as “contents.” A good rule of thumb is to multiply the number of operatories you have by $80,000 to $100,000.

Each operatory may not cost this much to replace. Still, some shared items in the dental practice add up, such as computers, panoramic x-ray, crown milling, cone beam, dental supplies, waiting room furniture, etc. Those must be accounted for. In most cases, we have found that if you use this formula, you are pretty close to the limit of insurance you need. Alternatively, you could contact your dental sales representative or tech people and inquire about the replacement cost of your equipment should a catastrophe occur.

Risk Management Tip Issue: Water damage from a broken pipe or a broken water supply connection from a dental fixture continues to be the leading cause of claims in a dental practice. A typical Water Damage claim can keep a dental office closed for 6-8 months. Although insurance will 34 journal | july/august 2022

pay for this type of claim, it puts a lot of stress on the dentist. The dentist sometimes has to find temporary space(s) to treat patients, not to mention the time to work with the insurance company and contractors to repair the space.

Solution: Install an automatic or manual water shutoff valve. Make it part of your routine to shut off the water supply to your office when you leave the practice each afternoon/evening. This will prevent or significantly reduce a water damage claim.

Don’t miss the next article, Insurance: Necessary Evil Part II, where we will discuss filling the “gaps” in your insurance policy for your Dental Practice.

ABOUT THE AUTHOR

Joe Strunk, owner/ CEO of 3000 Insurance Group, started in insurance in 1997. He has an engineering degree from Oklahoma State University and a MBA from the University of Oklahoma. Joe has served as the President of the Independent Insurance Association of Oklahoma and holds designations as a Certified Insurance Counselor, Certified Advisor of Personal Insurance, and Certified Risk Manager. With over 25 years of experience, Joe specializes in working with Professional Associations and small businesses to satisfy their Property, Casualty, Life, and Health insurance needs.

3000 Insurance Group, an ODA Rewards Partner, is independently owned and locally operated to handle your insurance needs. We focus on Oklahoma City and offer affordable and reliable insurance choices across Oklahoma. We help you find the right combination of tailored, personalized insurance coverage at just the right price to fit your needs.

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HYGIENE HOTSPOT

Oral Care and Hospital-Acquired Pneumonia By: Susie Keepper MSN, APRN, AGCNS-BC, RDH Poor oral health is associated with a plethora of systemic diseases and infections such as Alzheimer's disease/dementia, diabetes, stroke, obesity, osteoarthritis, atherosclerosis, pancreatic cancer, central line-associated bloodstream infections, infective endocarditis, and helicobacter pylori infection [1],[2],[3],[5],[6],[7].

Another potentially life-threatening and preventable infection correlated with poor oral care is hospital-acquired pneumonia (HAP). HAP is extremely common in hospitalized older adults in acute care units due to a lack of appropriate oral hygiene.

Significance Proper oral hygiene is a significant factor in reducing the rate of HAP. Generally, HAP occurs approximately 48-72 hours after hospital admission [9]. Gram-negative bacteria proliferate and colonize the oropharyngeal space within 48 hours of hospital admission [10]. Anaerobic pathogens are aspirated into the lungs during sleep or swallowing [11]. Juve-Udina et al [4] discovered that mouth care and ambulation were the most frequently neglected patient care interventions. Thus, patients may need assistance with their oral care while hospitalized. Due to varying patient dependency levels, care systems management is a critical component in this conceptual model. Appropriate staffing and education are essential for improved patient self-maintenance and for dependent individuals who require more time for care delivery.

Population As of 2019, approximately 52.4 million people ages 65 years and older live in the United States [12]. It is estimated that 21 million or 40% of these individuals are admitted to the hospital with cardiovascular issues, hypertension, arthritis, pulmonary or kidney disease, or a combination of comorbidities. These illnesses make these individuals susceptible to opportunistic infections[14].

According to the CDC [15], one in five older adults has untreated dental decay, 35.6 million (68%) have periodontal disease, and 14 million (26%) are edentulous or wear dentures affecting mastication, nutrition, communication, and quality of life.

Barriers There are several barriers to providing proper oral health care in hospitals. A meta-analysis by Hoben et al [16] found that 45% of nurses refused to provide oral care because of patients resisting care; 24% of care providers felt they had a lack of knowledge, education or training; 26% experienced challenges when providing oral care; 31% responded a lack of time; 19% dislike providing oral hygiene; and 22% was contributed to insufficient staffing.

Additionally, nursing textbooks inadequately address oral care if at all [17]. Unfortunately, the lack of education or training allows the care team to deem oral care as optional or at their discretion.

Nursing Care Plans Nursing care plans are rarely checked by caregivers, and these plans include instructions for the care team regarding removable prosthetics or the type of assistance required for proper oral 36 journal | july/august 2022

hygiene [18]. Unfortunately, oral care is only discussed when the admitting nursing assessment indicates oral/dental problems. As there is a clear lack of education or training for nursing staff in this area, it is doubtful a nurse would inspect the oral cavity, and if so, would be unable to identify lesions.

Fundamental Right Hospitalized individuals have the fundamental right to be assisted in their oral care. Oral hygiene is seen as a low priority for nursing staff and is often missed or not offered at night. Fonseca et al [19] discovered oral care was not a part of routine nightly care in hospitals. Patients who did not receive oral care at night were found to be associated with a 13-26% increased risk for death [20].

Danckert et al [21] found patients who were 1) more dependent on assistance for activities of daily living (ADLs), 2) in an acute care unit, 3) male, or 4) did not have oral hygiene products at the bedside had the poorest oral care. Good quality oral hygiene decreases the incidence of HAP, and approximately 44-65% of hospitalized care-dependent adults do not receive adequate oral care [22].

Cost Routine oral care decreases virulent organisms, reduces HAP incidence, and reduces hospital costs by up to 41% [23].

Approximately 700 bacteria, spirochetes, fungi, viruses, protozoa, and phylotypes live in the oral cavity and replicate every 2-3 hours [24],[25],[26],[27] . Colonization and aspiration of oral pathogens in the oropharynx descend into the bronchi creating infection in the lungs [11]. Contributing risk factors associated with this include diminished or dysfunctional salivary flow, ineffective cough reflex, dysphagia, and the inability to perform or lack of oral care [28].

Gram-positive bacteria colonize in healthy individuals; however, gram-negative bacteria thrive in the mouth within 48 hours after hospital admission creating oral dysbiosis [10].

Hospital-acquired pneumonia is listed fourth among the most common nosocomial infections for patients, costing the United States healthcare system an estimated $255 billion annually [29],[30],[31] . The average length of hospital stay for HAP is between 10.4-33 days, with a mean treatment cost of $60,610 per patient [32], [31] . Baker and Quinn [33] found that 70.8% of 1300 hospitalized patients were in acute units. Enormous pressure is being placed on health care institutions to lower costs while increasing quality [34].

HAP accounts for approximately 10-15% infections of 1.7 million patients with a 20–50% mortality rate [30], [23]. HAP is an infection that occurs in a patient's lung parenchyma at least 48-72 hours after initial hospitalization, which was not present on admission and is diagnosed by auscultation, decreases in oxygen saturation and shortness of breath, change in cognition, chest x-ray, sputum specimen, blood test, or bronchoscopy [9],[35]. Of those who survive, older adults may experience decreased exercise capability, cardiovascular disease, cognitive decline, and reduced quality of life for months or years after recovery [36].

The Future Registered Dental Hygienists (RDH) may be the answer to HAP infections. Arizona has recently changed the scope-of-practice for RDHs living in the state. These RDHs are supervised by licensed physicians who must be available for consultation, but they do not need to be physically present for treatment [37]. RDHs have the education, knowledge, and expertise to bridge the gap in oral care and can play a pivotal role in the detection, implementation of prevention, and oral care protocol in a hospital setting. Oklahoma’s legislation, rules, and regulations need to be reassessed for RDHs to be employed by hospitals for the reduction of HAP and other systemic mouth care links. HAP is an expensive infection in terms of financial cost, saving lives, and quality of life. It is unethical for hospitalized individuals to suffer when a solution is available and ready to assist with oral care assessments and treatments. RDHs are the solution to this missing link between medical and dental collaboration. Oklahoma should be known as a progressive dental state with leadership qualities in advancing patient health.

ABOUT THE AUTHOR:

Ms. Keepper is an Advanced Practice Nurse, Clinical Nurse Specialist with an emphasis in gerontology, Registered Dental Hygienist, and a Reynolds Scholar at the University of Oklahoma-HSC. She completed her dental hygiene degree at Missouri Southern State University, Joplin, MO in 1998, her Bachelor of Science Nursing degree in 2014 at Central Methodist University in Fayette, MO, and her nursing Master's degree in 2018 at the University of Oklahoma-HSC. She has finished the nursing Ph.D. academic portion and is currently in the Doctor of Nursing Practice program at OU-HSC, focusing on introducing dental health in the hospital, interdisciplinary teams, and developing oral health quality improvements for hospitalized older adults.

She is an active member in the Oral Health Research Interest Group for the Gerontological Society of America, Oklahoma Oral Health Coalition, Oral Health Progress and Equity Network, legislative delegate for the Oklahoma Nurses Association, on the advisory council at Next Science, and a former board member of the Oklahoma Association of Clinical Nurse Specialist.

Susie lives in Oklahoma City, and her hobbies include cooking, reading, embroidery, gardening, traveling, serving on medical/dental mission trips abroad; and she has recently returned from Peru.

REFERENCES

1. Fernandes, C., Oliveria, F., Silva, P., Alves, A., Mota, M., Montenegro R., Burbano, R., Seabra, A., Filho, J., Lima, D., Filho, A., & Sousa, F. (2014). Molecular analysis of oral bacteria in dental biofilm and atherosclerotic plaques of patients with vascular disease. International Journal of Cardiology, 174(3), 710-712.

2. Abranches, J., Zent, L., Belanger, M., Rodriques, P., Simpson-Haidaria, P., Akin, D., Dunn, W., ProgulskeFox, A., & Burne, R. (2009). Invasion of human coronary artery endothelial cells by Streptococcus mutans OMZ175: S. mutans endothelial cell invasion.

Oral Microbiology and Immunology, 24(2), 141-145. https://doi.org/ 10.1111/j.1399-302X.2008.00487.x 3. Li, X., Kollveit, K., Tronstad, L., & Olsen I. (2000).

Systemic diseases caused by oral infection. Clinical Microbiology Reviews, 4. https://doi.org/ 10.1128/ cmr.13.4.547-558.2000 4.

Juve-Udina, M., Adamuz, J., Lopez-Jimenez, M., Tapia-Perez, M., Fabrellas, N., Matud-Calva, C., & Gonzalez-Samartino, M. (2019). Predicting patient acuity according to their main problem. Journal of Nursing Management. 27(8), 1985-1858. https://doi. org/10.1111/jonm.12885

5. Haworth, J., Zeng, L., Belanger, P., Rodrigues, P., Simpson-Haidaris, P., Simpson-Haidaris, P., Akin, D., Dunn, W., Progulske-Fox, A., & Burne, R. (2017). Oral hygiene as a risk factor in infective endocarditis. Dental Update, 44(9), 877-890. https:// doi.org/10.12968/denu.2017.44.9.877 6. Gerlovin, H., Michaud, D., Cozier, Y., & Palmer, J. (2019). Oral health in relation to pancreatic cancer risk in African American women. Cancer Epidemiology, Biomarkers & Prevention, 28(4), 675679. https://doi.org/10.1158/1055-9965.EPI-18-1053 7. Nijakowski, K., Lehmann, A., Rutkowski R., Korbalska, K., Witowski, J., & Surdecka, A. (2020).

Poor oral hygiene and high levels of inflammatory cytokines in saliva predict the risk of overweight and obesity. International Journal of Environmental Research and Public Health, 17(17), 6310. https://doi. org/10.3390/ijerph17176310 8. Kemp, G., Hallbourg, M., Altonji, D., & Secola R. (2019). Back to basics: CLABSI reduction through implementation of an oral care and hygiene bundle.

Journal of Pediatric Oncology Nursing, 36(5), 321326. https://doi.org/ 10.1177/1043454219849583

9. Lanks, C., Musani, A., & Hsia, D. (2019).

Community-acquired pneumonia and hospitalacquired pneumonia. The Medical Clinics of North America, 103(3), 487-501. https://doi.org/10.1016/j. mcna.2018.12.008

19. Fonseca, E., Pedreira, L., da Silva, R., Santana, R., Travares, J., Martins, M., & Goes, R. (2021). (Lack of) oral hygiene care for hospitalized elderly patients.

Revista Brasileira de Enfermagem, 74(suppl 2), 1-7. https://doi.org/10.1590/0034-7167-2020-0415

10. Miranda, A., Lia, E., Carvalho, T., Piau, C., Coasta, P., & Bezerra A. (2016). Oral health promotion in patients with chronic renal failure admitted in the intensive care unit. Clinical Case Reports, 4(1), 2631. https://doi.org/ 10.1002/ccr3.437

20. Paganini-Hill, A., White, S, & Atchison, K. (2011).

Dental health behaviors, dentition, and mortality in the elderly: the leisure world cohort study. Journal of Aging Research. https://doi.org/10.1590/0034-71672020-0415

11. Mandell, L. & Niederman, M. (2019). Aspiration Pneumonia. The New England Journal of Medicine, 380(7), 651-663. https://doi.org/ 10.1056/ NEJMra1714562

21. Danckert, R., Ryan, A., Plummer, V., & Williams, C. (2016). Hospitalization impacts on oral hygiene: An audit of oral hygiene in a metropolitan health service.

Scandinavian Journal of Caring Sciences, 30(1), 129134. https://doi.org/0.1111/scs.12230

12. U. S Department of Health and Human Services. (2020). 2019 Profile of older Americans. 1-26. https://acl.gov/sites/default/ files/Aging%20and%20Disability%20in%20 America/2019ProfileOlderAmericans508.pdf 13. Gil-Montoya, J., Antonio J., De Mello, A., Barrios, R., Gonzalez-Moles, M., & Bravo, M. (2015). Oral health in the elderly patient and its impact on general well-being: A non-systematic review. Clinical Interventions in Aging, 10, 461-467. https://doi.org/ 10.2147/CIA.S54630

22. Nguh, J. (2016). Oral care practice guidelines for the care-dependent hospitalized adult outside of the intensive care unit setting. Journal of Interprofessional Education & Practice, 4: 59-67. http://dx.doi.org/10.1016/j.xjep.2016.05.004 23. Maeda, K. & Akagi, J. (2014). Oral care may reduce pneumonia in the tube-fed elderly: A preliminary study. Dysphagia, 29(5), 616-621.https://doi. org/10.1007/s00455-014-9553-6

14. Mattison, M. (2021). Hospital management of older adults. General Dentistry. https://www.uptodate.com/ contents/hospital-management-of-older-adults

24. Deo, P. & Deshmukh, R. (2019). Oral microbiome: Unveiling the fundamentals. Journal of Oral and Maxillofacial Pathology, 23(1), 122-128. https://doi. org/10.4103/jomfp.JOMFP_304_18

15. enters for Disease Control and Prevention. (2021).

Older adult oral health. https://www.cdc.gov/ oralhealth/basics/adult-oral-health/adult_older.htm

25. Maddi, A. & Scannapieco, F. (2013). Oral biofilms, oral and periodontal infections, and systemic disease.

American Journal of Dentistry, 26(5), 249.

16. Hoben, M., Clarke, A., Huynh, K., Kobagi, N., Kent A., Huy, H., Pereira, R., Xiong, T., Xiang, H., & Yoon M. (2017). Barriers and facilitators in providing oral care to nursing home residents, from the perspective of care aides: A systematic review and meta-analysis.

International Journal of Nursing Studies, 73, 34-51.

26. Kamel, A., Basuoni, A., Salem, Z., & AbuBakr, N. (2021) The impact of oral health status on COVID-19 severity, recovery period and C-reactive protein values. British Dental Journal. https://doi. org/10.1038/s41415-021-2656-1

17. Jablonski, R. (2012), Oral health and hygiene content in nursing fundamentals textbooks.

Nursing Research and Practice. https://doi. org/10.1155/2012/372617 18. Coker, E., Ploeg, J., Kaasalainen S., & Carter, N. (2017). Nurses' oral hygiene care practices with hospitalized older adults in post-acute settings.

International Journal of Older People Nursing, 12(1). https://doi.org/10.1111/opn.12124

27. Munro, S. & Baker, D. (2018). Reducing missed oral care opportunities to prevent non-ventilator associated hospital-acquired pneumonia at the Department of Veterans Affairs. Applied Nursing Research, 44, 48-53. https://doi.org/ 10.1016/j. apnr.2018.09.004 28. Kanzigg, L. & Hunt, L. (2016). Oral health and hospital-acquired pneumonia in elderly patients: A review of the literature. Journal of Dental Hygiene, 90 Suppl 1(S1), 15-21.

29. Centers for Disease Control and Prevention. (2014).

Types of healthcare-associated infections. https:// www.cdc.gov/hai/infectiontypes.html 30. Haque, M., Sartelli, M., McKimm, J., & Bakar, M. (2019). Healthcare-associated infections - an overview. Infection and Drug Resistance, 11, 23212333. https://doi.org/ 10.2147/IDR.S177247 31. McNally, E., Krisciunas, G., Langmore, S., Crimlisk, J., Pisegna, J., & Massaro, J. (2019). Oral care clinical trial to reduce non-intensive care unit, hospitalacquired pneumonia: Lessons for future research.

Journal for Healthcare Quality, 41(1), 1-9. https:// doi.org/10.1097/JHQ.0000000000000131 32. Giuliano, K., Baker, D., and Quinn, B. (2016).

Non-ventilator hospital-acquired pneumonia in U.S. hospitals: Incidence and cost. American Journal of Infection Control, 44(6), S20-S21. https://doi. org/10.1016/j.ajic.2016.04.170 33. Baker, D. & B. Quinn. (2018). Hospital-acquired pneumonia prevention initiative-2: Incidence of nonventilator hospital-acquired pneumonia in the United States. American Journal of Infection Control, 46(1), 2-7. https://doi.org/10.1016/j.ajic.2016.04.170 34. Waxman, K. (2018). Financial and Business Management for the Doctor of Nursing Practice.

Springer Publishing Company.

35. Baselski, V. & Wunderink, R. (1994). Bronchoscopic diagnosis of pneumonia. Clinical Microbiology Reviews, 7(4), 533-558. https://doi.org/ 10.1128/ cmr.7.4.533 36. American Throasic Society. (2019). Top 20 pneumonia facts-2019. https://www.thoracic. org/patients/patient-resources/resources/toppneumonia-facts.pdf 37. Kaye, N. (2019). Expanding the oral health workforce to promote overall health: Arizona uses dental hygienists to improve hospital patient safety. National Academy for State Health Policy. https://www. nashp.org/expanding-the-oral-health-workforceto-promote-overall-health-arizona-uses-dentalhygienists-to-improve-hospital-patient-safety/

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Office Showcase

Espire Dental (Oklahoma City & Norman) By: Jim Spurgeon, DDS and Brett Leemaster, DDS As dentists dedicated to our local community in Norman, we never imagined we would join our office with a group dental practice. For some time now, we have noticed more and more offices changing ownership to corporate chains, and we had always fought against doing that. We did not want to become “production focused” or lose all that we have built over the past 30 years. At the beginning of COVID many things started to change in the dental industry, and we decided to investigate why so many practices were being purchased by corporate owners. Although we were not really interested in joining a dental group, we felt it would be prudent to at least learn more about the corporate world to help us compete more effectively.

We met over Zoom with about 16 different group dental organizations. One of the 16, Espire Dental, stood out as being different than the rest. Espire Dental was looking for top-quality, high-end practices that give their patients a “Ritz Carlton” type of experience. Espire was the vision of three incredible dentists fighting against what group dentistry was, and shaping their organization into what group dentistry could be. For us, that aligned with our philosophy of providing elevated, quality clinical care while creating incredible patient experiences.

Since joining Espire Dental in 2020, we have access to newer technology and a network of incredible Espire dentists— two of whom serve patients right here in Oklahoma City, Dr. Kevin Rykard and Dr. Greg Stewart. Not only are we clinically supported by our strong network of dentists, but we also have the support of an expert business team to allow us the time to focus on treating patients.

What Sets Us Apart Every team member at Espire understands the team goal of creating an exceptional patient experience. We’re combining the world’s best dental care with inspired hospitality. We’re putting future-forward, cutting-edge technology into the hands of our very capable team, and giving them freedom from all the barriers, limitations and frustrations that keep them from focusing on their patients. That’s what the power of group dentistry can be.

An “IDO” not a DSO As an “IDO”, an integrated dental organization, we are one group operating under one brand umbrella. We work together as a dynamic team across a network of locations to offer our patients access to the highest quality of dental care. Each practice receives business support from our Practice Support Center, Patient Care Center, and the network of other Espire dentists. It is invaluable to have like-minded dentists in the group for all to use as a resource for guidance and support.

Doctor Led As a group working collectively toward one mission, the organization truly values the dentists’ knowledge and expertise to drive the excellent care our patients have come to expect.

Our clinical director leadership model ensures care quality and continual development that drives progressive dentistry 38 journal | july/august 2022

throughout the organization.

We continue to take our practice to the next level with the latest in dental techniques and advanced dental technologies.

Equipping our practices with innovative technology such as CEREC machines, intraoral scanners, digital radiography equipment, and soft tissue lasers, allows us to provide the best treatment for our patients. Many of these tools are not available at other dental offices, but we believe prioritizing technology is an important way to demonstrate our commitment to providing patients with convenient and effective care.

Culture First A distinct difference in Espire’s model is to fuel our success through outstanding employee culture. We put our employee experience first, because we believe that superior patient outcomes and practice results are the byproduct of this focus. During our daily morning huddles, we share WOW stories with one another and discuss the enormous impact we have on our patients’ confidence and wellbeing. When you love what you do, work doesn’t feel like work! We employ the best and brightest who put patient care above all else.

Next Level Support Services When you spend your entire day providing dentistry to patients, the last thing you want to do at the end of the day is work in QuickBooks, post to social media, or struggle with all the tasks that go into the “business” of dentistry. Through financial, marketing, operations, and human resources support, Espire helps dentists like us get their lives back, because they take care of everything we don’t have time to do. Here are some of the ways that our support team continues to elevate the business of our practice: Recruiting, hiring, and onboarding of all positions (front office, clinical, and doctor) • Workplace safety • Team member training, engagement, and retention • Proven marketing strategy and initiatives that drive new patients • Support with AP, AR, and practice-level accounting • Insurance eligibility, benefits, and management of contracts • Preferred vendors, pricing, and access to leading technology and equipment • Operational support for day-to-day practice and schedule management

Since joining, we have been impressed with the caliber of dentists and team members who have come on board. We have dentists that are Kois instructors, Cerec instructors, social media gurus, sedation gurus, and more. We have found this to be a very valuable resource. If you are interested in learning more about our experience, we would be happy to talk to you.

Espire Dental Oklahoma City Drs. Kevin Rykard and & Greg Stewart 12445 St. Andrews Dr | Oklahoma City, OK 73120

Espire Dental Norman Drs. Jim Spurgeon and Brett Leemaster 550 24th Ave SW | Norman, OK 73069

ABOUT ESPIRE DENTAL

Espire Dental is a group of practices founded by doctors with a vision to create something extraordinary: a dental setting where excellence in dentistry meets inspired hospitality. Espire is pioneering a new practice category, operating as an Integrated Dental Organization (IDO) instead of a DSO, to create a large, top quality and unique group practice operating under a single, trusted brand. With a focus on elevated quality care, multi-specialty, and creating exceptional experiences for patients and employees, Espire believes that when you love what you do, work does not feel like work. Espire is a fast-growing group of 20 practices, looking to build its presence in the Western United States. Compassionate and expert dentists and team members are the heart and soul of Espire, and every day they are turning their own joy into the joy and beautiful smiles of their patients. In short, Espire is turning the group dental industry upside down. Learn more at www.espiredental.com. Contact Espire Dental: Dentists interested in joining Espire Dental may complete an inquiry form: EspireDental.com/practice-transition

NORMAN OFFICE

OKLAHOMA CITY OFFICE

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39

2022 GHMF Practice Management Scholarship For New Dental Practice Owners The Gillette Hayden Memorial Foundation was established in 1930 to honor the memory of Dr. Gillette Hayden and support the future of women dentist leadership in the American Association of Women Dentists and the Dental Profession. This year, one of the two inaugural scholarships being offered by GHMF is the Gillette Hayden Memorial Foundation Practice Management Scholarship 2022. The goal for this scholarship is to support a woman dentist practice owner in her efforts to learn the business of dentistry and at the same time encourage applicants to practice in health professional shortage areas.

The scholarship awardee will receive eight one-hour sessions sessions with Shelly Short of Zumwohl Consulting, Zum!! Simple Solutions for Sustainable Success. Shelly has been in the dental field for 39 years and been a dental consultant and coach since 1996. She has expertise in practice analysis, business management, clinical efficiency, non-surgical periodontal programs, team building, and interpersonal communication. Currently, she is a Clinical Assistant Professor and the Course Director for Practice Management at the University of Oklahoma College of Dentistry. She consults across the United States and has consulted in the U.K., Denmark, Switzerland, and Italy.

The scholarship sessions will be held via Zoom and will be recorded for the awardee to review and and use with new staff or associates in the future. Some of the topics that will be covered are- Workflows, Marketing, Leadership Development Coaching, Creating a Positive Work Culture, Dental Economics 101, Team Meetings, Hiring, Scheduling and Stress Control to name a few.

There will be follow-up reports after each session and a review at the beginning of the next session.

To qualify for the scholarship, you must be a current member of the American Association of Women Dentists, a Woman Dental Practice Owner, who holds a US or Canadian Dental License actively practicing dentistry 5 years or less within the US, Canada, Puerto Rico or the US Virgin Islands and practice in a Health Profession Shortage Area (HPSA).

A complete application along with Curriculum Vitae, 500-word essay on why you chose to practice in an HPSA and how the scholarship will impact your business, and a 90-second video of yourself should be submitted to the Gillette Hayden Memorial Foundation no later than November 1, 2022. One scholarship winner will be selected by the GHMF Board of Trustees and will be notified no later than December 31, 2022.

40 journal | july/august 2022

This is a great opportunity for a new practitioner to have access to and the knowledge of a Practice Management Consultant early in their career for continuing and enhancing their success in their dental practice in a Health Profession Shortage Area. The GHMF Trustees encourages all qualified applicants to please apply.

Please email all questions to: ghmfoundation@gmail.com Visit https://form.jotform. com/220933669451158, to complete the Scholarship Application.

Boost Patient Benefits Check out Health through Oral Wellness® (HOW®) is now available to subscribers and their dependents in more than 8,600 of our employer groups.

Available Now!

Register your practice location(s)* at DeltaDentalOK.org/HOWReg

DDOK members at higher risk for developing caries and/or periodontal disease could qualify to receive additional preventive benefits, based on the results of the HOW approved assessment performed in a dentist office.

Our staff is available to conduct HOW® trainings, which also qualify for one (1) hour of Category B CE credit.

Please contact our Provider Relations team for assistance at 405-607-2137 (OKC Metro), 800-522-0188, Ext. 137 (Toll Free) or via email at PR@DeltaDentalOK.org. www.okda.org

41

CLASSIFIEDS Looking to fill an open position in your office, need to sell dental equipment or a practice?

Check out the latest listings below and visit okda.org/classifieds for additional listings.

PRACTICE FOR SALE Rural Practice for sale. Alva, Oklahoma: Dentist is retiring after 50 years of a very successful practice. Dr. is ready to spend time with his Grandkids and cows Building is located in beautiful downtown Alva, Oklahoma. Looking for a highly motivated Dentist ready to walk in and work. A very large and committed patient base, in a great and caring community who are very supportive. A committed and highly trained and committed clinical and administrative staff For more information, please contact Dr. Lott at 580.327.3212 or at garylottdds@gmail.com.

OTHER Equipment for Sale: 2D Pano/Ceph 2012 Model Jana K. Oister D.D.S. Family Dentistry 2D Pano/Ceph was purchased and installed in 2012 Tube exposures 2166 Sirona Ortho XG Asking $5,000 This is in great condition. It is at the Patterson branch in OKC and ready for install. We are upgrading to 3D. For more information, please contact Dr. Jana Oister at 580.596.3541 or at jkodds@sbcglobal.net.

Place a Classified Ad Placing an ad with the ODA allows you to target your ad to a specific audience. Unlike other classified ad sources (local newspaper, other online classified sites, etc.), a listing with the ODA gives you exposure to the people who would be most interested in your ad. The online version of the ODA Journal contains active hyperlinks within the advertisement, ensuring you get maximum exposure for your ad.

SUBMIT A LISTING Submitting a classified ad is easy with our online form.

Find the form and more information at www.okda.org/classifieds.

PRICING ODA Members Online: Free ODA Journal: $40 for first 50 words (additional words $0.15 each)

Non-ODA Members Online or ODA Journal: $83 (>50 words) (additional words $0.32 each) Bundle (online & Journal) $149 (>50 words) (additional words $0.32 each)

QUESTIONS? Email: advertising@okda.org

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Visit: okda.org/classifieds 42 journal | july/august 2022

Advance Your Clinical Decision Making MEMBERS GET ACCESS TO RESOURCES FROM LEADERS IN SCIENCE AND RESEARCH

ADA clinical resources make the lives of ADA members easier, giving them more time to focus on what’s most important: patient care. Find the answers you need to make every visit a seamless experience for you and your patient.

O KL AHOMA H EALTH P ROFESSIONALS P ROGRAM Since 1983, the Oklahoma Health Professionals Program (OHPP) has provided services to over 1,000 physicians and health care providers with alcohol and chemical dependence. OHPP is an outreach program designed to support and monitor medical and allied health professionals throughout Oklahoma who are experiencing difficulty with substance abuse.

The OHPP continues to be a leader nationally in identifying problems, assisting in treatment, and returning to practice health care professionals who have suffered from substance abuse or dependency.

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QUALITY MEASURE REPORTING TO IMPROVE PATIENT OUTCOMES

The Journal of the American Dental Association

JADA Foundational Science Coming soon: JADA Foundational Science,

ADA Dental Experience and Data Exchange™

From cutting edge research to online CE,

ADA’s new cross-disciplinary, open access

Better data drives better patient outcomes.

ADA members get full access to dentistry’s

journal, bridges basic and clinical sciences in

Join the first dental data registry open to all

most-read scientific journal.

oral-health research.

practices to advance the profession’s clinical knowledge and improve population health.

OHPP services are confidential and include expert consultation and intervention designed to encourage health care professionals to seek help for substance abuse and behavioral concerns.

ADA.org/JADA 3

ADA.org/JADAFS

ADA.org/DERE

AMERICAN DENTAL ASSOCIATION

Updated: September 20, 2021

When an individual contacts the OHPP about a health care professional or about himself or herself, the director or designated associate director assesses the situation and assists in guiding the health care professional.

Participation with OHPP is voluntary and confidential.

OHPP will strongly urge a professional who is ill to get help, and although OHPP does not provide direct treatment, we will suggest specific treatment options.

We respond to the concerns of families, colleagues, and hospitals by providing coordinated interventions and referrals to treatment.

In addition, OHPP hosts a number of support group meetings open to all health care professionals, students, residents in recovery as well as those seeking peer support.

OHPP recognizes the difficulty of reporting a colleague who may be impaired. Because of the potential risk to patient care, OHPP encourages medical professionals to make referrals if a problem exists, no matter how long there has been a problem.

Direct Line: (405) 601-2536 Confidential Fax: (405) 605-0394 Robert Westcott, MD - Director

Sharing Smiles, The ADA Seal of Acceptance is honoring its 90th anniversary and ready for the celebrations – and innovations – to come!

Over the years, we’ve seen a lot of dental product trends come and go. And today, your patients have more choices than ever when it comes to taking care of their oral health at home.

Good thing there are more than 400 products with the ADA Seal of Acceptance.

When you see the Seal, you can trust that product has been independently evaluated by experts and found to be safe and effective.

As dental product innovations continue, the Seal has science-backed resources to help you facilitate conversations with your patients and recommend personalized products: • An interactive online database to search products by category, brand name and attributes • A downloadable chairside guide to quickly locate approved products when there isn’t a screen nearby • An interactive, 360-degree video to teach patients how ADA Seal products can support good oral health all day long

Scan this QR code or go to ADA.org/SealToolkit to access these resources and more!

www.okda.org

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44 journal | july/august 2022