ODA Journal: November/December 2024

November/December 2024 | Vol. 115, No. 6

Trailblazing Leadership Oklahoma Dentist and ODA Member Dr. Tamara Berg Elected Second Vice President of the ADA page 8 www.okda.org

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journal | November/December 2024

ADVERTISERS Thank you to the following businesses who support the Oklahoma Dental Association by advertising in the Journal: Alliant Insurance Services Best Card Endodontic Associates Endodontic Practice Associates Hopkins Dental Implant Institute iCore Connect Mobile Smiles Oklahoma ODA Rewards Partners Oklahoma Health Professionals Program Rocky Mountain Dental Conference Suction Solutions Tobacco Settlement Endowment Trust 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, 317 NE 13th Street Oklahoma City, OK 73104

CONTENTS

Oklahoma Dental Association

November/December 2024 | Vol. 115, No. 6

EDITORIAL 7

It's Fall - Time to Sign Up for OkMOM

by Lindsay Smith, DDS

STATE ASSOCIATION 1 6 ODA's Top 24 Wins of 2024 24 ODA Awards Nomination Form

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Editorial: It's Fall - Time to Sign Up for OkMOM

ADA NEWS 8

Oklahoma Dentist Selected as Second Vice President of the American Dental Association

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Texas Court Strikes Down Corporate Transparency Act

30 Community Water Fluoridation is Safe

LEGISLATIVE LOOP 11

Oklahoma Dental Association's 1 6 Your Top 24 Wins of 2024

Introducing our ODA Lobbyist Team: Samantha Davidson Guinn

1 4 Election Analysis provided by Cornerstone Government Affairs

CLINICAL 17 Case Study: Broken Implant Collar

by Dominque Angibeau, DDS

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

1 9 Case Study: Non-Healing Ulcer Under Tongue

by Elena V. Dupalo, DDS and Kathleen E. Higgins, DDS, MS

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

2 1 Research: What Happened to WREB?

by Mark Christensen, DDS, MBA

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

CLASSIFIEDS

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.

35 Classifed Ads

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Case Study: Non-Healing Ulcer Under Tongue

Would you like to submit a case study, scientific article, or editorial for publication in the Journal?

Email editor@okda.org with story ideas.

Is Your Information Correct?

Copyright © 2024 Oklahoma Dental Association.

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

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Legislative Loop: Introducing ODA Lobbyist Samantha Davidson Guinn

Contact Ansley Jinkins at ajinkins@okda.org or 800.876.8890 to provide ODA with 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 Meredith Turbeville, DDS

ODA OFFICERS 2024-2025 PRESIDENT Daryn Lu, DDS president@okda.org PRESIDENT-ELECT Twana Duncan, DDS presidentelect@okda.org VICE PRESIDENT Nicole Nellis, DDS vicepresident@okda.org SECRETARY/TREASURER Sydney Rogers, DDS treasurer@okda.org SPEAKER OF THE HOUSE Mitch Kramer, DDS speaker@okda.org IMMEDIATE PAST PRESIDENT Paul Wood, DDS pastpresident@okda.org

ADMINISTRATIVE STAFF EXECUTIVE DIRECTOR F. Lynn Means DIRECTOR OF GOVERNANCE & FINANCE Shelly Frantz DIRECTOR OF MEMBERSHIP Ansley Jinkins DIRECTOR OF COMMUNICATIONS & EDUCATION Jill Johnson DIRECTOR OF MEETINGS & EVENTS Lindsay Dennis

CALENDAR See more online at OKDA.ORG/CALENDAR January 10 Council on Nominations Zoom at 8:00am January 10 Student Legislative Lunch OU College of Dentistry January 13 Annual Meeting Planning Committee Zoom at 3:00pm January 13 Legislative Town Hall #1 Zoom at 6:00pm Register to attend: okda.org/denpac January 17 Legislative Town Hall #2 Zoom at 1:00pm Register to attend: okda.org/denpac January 13 Annual Meeting Planning Committee Zoom at 3:00pm

January 17 Oklahoma County Dental Society Dinner and Officer Installation Lively Hotel 5:30pm

February 25 ODA/DENPAC Legislative Reception ODA Office, 5:00pm - 7:00pm Register to attend: okda.org/denpac

February Children's Dental Health Month

February 28 ODA Women in Dentistry Luncheon First National, OKC 11:00am - 1:00pm

February Gum Disease Awareness Month February 7-8 Oklahoma Mission of Mercy Exchange Center at Expo Square, Tulsa February 14 Council on Government Affairs ODA Office & Zoom 8:00am February 21 ODA Council on Bylaws, Policy, and Ethics Meeting ODA Office & Zoom 12:00pm

March 3-7 Dental Assistants Recognition Week March 6 Dentist Day March 7 ODA Board of Trustees Meeting ODA Office & Zoom 1:30pm March 7 Southwest District Component Meeting March 24 ODA Board of Trustees Meeting Zoom at 5:30pm

SAVE THE DATE OKLAHOMA MISSION OF MERCY

February 7-8, 2025 Exchange Center at Expo Square - Tulsa Volunteer registration now open at okmom.org

ODA/DENPAC LEGISLATIVE RECEPTION February 25, 2025 ODA Office Register to attend online at okda.org/denpac

ODA WOMEN IN DENTISTRY LUNCHEON

February 28, 2025 First National Center - Oklahoma City Online registration opens in January at okda.org/events

ODA ANNUAL MEETING

Stay connected with the ODA!

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journal | November/December 2024

April 11-12, 2025 Southern Hills Marriott - Tulsa Registration opens January 10 at odaannualmeeting.org

DENPAC GOLF TOURNAMENT May 30, 2025 The Golf Club of Edmond

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journal | November/December 2024

EDITORIAL It's Fall - Time to Sign Up for OkMOM!

Lindsay Smith, DDS Tulsa, OK OkMOM Co-Chair 2025

I don’t know about you, but I love this time of year. We are finally getting that great fall weather, and with it, we enjoy college football, Major League Baseball playoffs and fireside chats on the patio.

And if it’s October, it means registration has opened for the annual Oklahoma Mission of Mercy (OkMOM). The 2025 event will be held at the Tulsa Fairgrounds on February 7 and 8!

This will mark the third time the event has been held here in Green Country, including the inaugural OkMOM in 2010. Since that year, over 19,000 patients have been treated with over 116,000 dental procedures at a value of $16.5 million.

And this year, we are proud and grateful to be the beneficiaries of an American Rescue Plan Act (ARPA) grant from the State of Oklahoma that will completely underwrite the event.

With around 1,500 patients treated each year, OkMOM truly fills a need in our state as we are helping serve

those who are experiencing a barrier classmates, dental school faculty, and to their dental care. colleagues whom you may not get to see as much as you would like.

The need is great with over 50 percent of Oklahomans having no I encourage you to get a group of dental benefit plan, 31 percent of classmates and work a shift together, third graders experiencing untreated side-by-side. Bring your entire staff decay in our state, and 43 percent of and spend a day team building our state’s population not seeing a while providing a service to those dentist in the past year. less fortunate in our community.

Or bring an aspiring dentist to OkMOM serves an integral part of experience the camaraderie of our shouldering this burden in our state, great profession, ensuring the next as each OkMOM patient receives generation of dentists also learns to an average of $900 in care annually. have a servant heart.

This is life changing service focusing on removing pain and infection for I look forward to seeing you all these patients.

February 7th and 8th, 2025 at the Exchange Center at Expo Square Our profession is in a unique Tulsa Fairgrounds! position to help decrease the burden on our healthcare system by We need all the support we can get, minimizing emergency room visits and every volunteer will be a vital with basic dental procedures such as part of OkMOM 2025. extractions and fillings. By providing Thank you in advance for your these basic services focusing on immense generosity. I am so proud emergent care, we can have an to be part of the Oklahoma Dental impact on the health of our state for Association, Oklahoma Dental years to come.

Foundation, and the Oklahoma Whether you have volunteered Mission of Mercy! for every OkMOM since 2010, For more information on the experienced one or two events, or Oklahoma Mission of Mercy and will be volunteering for the first time to register to volunteer, please visit in 2025, THANK YOU for taking okmom.org. the time away from your families, practices, and busy schedules.

This event would not be possible without each and every one of you, and we are profoundly grateful.

Additionally in 2025, we are excited to offer Veterans the opportunity to be pre-screened on Thursday and receive care first when the clinic opens Friday morning.

Always a fun weekend, OkMOM is a place where you can reconnect with www.okda.org

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NATIONAL ADA NEWS Oklahoma Dentist Selected as Second Vice President of the American Dental Association ADA Corporate Communications

Tamara S. Berg, D.D.S., a private practice dentist in Yukon, Oklahoma, is the new Second Vice President of the American Dental Association (ADA).

opportunities within the field,” said Dr. Berg, Second Vice President of the ADA for the 2024-2025 term.

and Professionalism award; the ODA Distinguished Dental Service award, the Oklahoma University College of Dentistry Alumnus of the Year award and the Robert K. Wynn Public Information award, among others.

“I’ve experienced the same issues you have, and together, we will Dr. Berg was recently elected at the collaborate to find innovative and Dr. Berg graduated from the ADA House of Delegates Meeting at sustainable solutions that improve ADA SmileCon™ in New Orleans, La., the patient experience and help us be University of Oklahoma College of Dentistry and resides in Yukon, on Oct. 22. more successful on every level.”

Oklahoma with her husband Lowell Dr. Berg has been an engaged member Dr. Berg has been an active member, and two sons Karsten and Clayton. of the ADA for 29 years, serving many leader and mentor with numerous leadership roles including President other dental organizations, including of the Oklahoma Dental Association the American Association of Women (ODA) and a member of the ADA Dentists, the American College Council on Membership. of Dentists and Pierre Fauchard Academy. Dr. Berg has also been “Being in private practice for more honored with several awards, with than 30 years, I have witnessed highlights including the ODA Ethics firsthand the challenges and

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journal | November/December 2024

NATIONAL ADA NEWS Texas Court Strikes Down Corporate Transparency Act

by Olivia Anderson, ADA

A U.S. District Court for the Eastern District of Texas issued a nationwide preliminary injunction Dec. 3 that blocks enforcement of the Corporate Transparency Act. The move comes less than one month before the rule’s year-end filing deadline hits.

and infringes on First Amendment protections. Judge Amos L. Mazzant III agreed that the act appears ‘likely unconstitutional.’

“For good reason, plaintiffs fear this flanking, quasi-Orwellian statute and its implications on The Corporate Transparency Act was our dual system of government. enacted in 2021 to crack down on As a result, plaintiffs contend money laundering operations posing that the [Corporate Transparency as businesses, requiring qualifying Act] violates the promises our businesses to disclose their beneficial Constitution makes to the people ownership information to a database and the states,” the judge wrote. maintained by the U.S. Department “Despite attempting to reconcile the of the Treasury’s Financial Crimes [Corporate Transparency Act] with Enforcement Network. the Constitution at every turn, the government is unable to provide the But in Texas Top Cop Shop v. court with any tenable theory that Garland, the plaintiffs alleged that the the [Corporate Transparency Act] Corporate Transparency Act oversteps falls within Congress’s power.”

Congress’ jurisdiction to regulate interstate and foreign commerce The decision follows a March case,

National Small Business United v. Yellen, in which a federal judge in the U.S. District Court for the Northern District of Alabama ruled that the Corporate Transparency Act is unconstitutional. FinCEN appealed the decision, which is currently pending in the 11th Circuit.

It is unclear how FinCEN will respond to the nationwide injunction, but affected entities are currently no longer mandated to comply with the Corporate Transparency Act filing Jan. 1, 2025, filing deadline.

The ADA said it will continue to work with Congress, its small businesses D.C. partners and the new administration to look for a permanent solution.

www.okda.org

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10 journal | November/December 2024

LEGISLATIVE LOOP Introducing our ODA Lobbyist Team

by ODA Staff

Senate. She also held leadership What is your strategy for roles in healthcare policy and helping the ODA achieve communications. Samantha our goals? holds a JD from Oklahoma City University School of Law and a BS in We are developing a comprehensive Agricultural Communications from plan and strategy to develop key champions for dentistry within the Oklahoma State University. legislature. This is best accomplished through a “grass roots” campaign/ initiative. Nothing resonates better MORE ABOUT with legislators than hearing from SAMANTHA constituents. Through fundraising efforts, as well hosting coffee, How do you stay informed lunch, or dinner meetings with about legislative and legislators, we can develop these regulatory developments? key relationships that translate into champions for our policy items.

I stay informed through multiple ways. We have a legislative tracking How do you handle service that monitors legislation potential conflicts of ODA Lobbyist Samantha Davidson Guinn throughout the process. I constantly interest? monitor the news to track what The Oklahoma Dental Association Cornerstone Government Affairs elected officials and industry are is proud to announce that we have is very intentional about conflict pushing or saying in the media. contracted with Cornerstone, checks and prefer long term I also keep in close contact with a bipartisan, employee-owned elected officials, agency staff, other partnerships with our clients. consulting firm specializing in federal lobbyists, and industry leaders both Integrity and trust is all we have in and state government relations, public during and outside of the legislative this industry, and we are committed affairs and strategic communications, session to keep a pulse on the latest to serving as that trusted advisor for political consulting, grant consulting developments. our clients. and business advisory services.

Cornerstone provides a team of lobbyists and brings a broad and diverse range of services that are based on the team’s significant experience working in and with state and local government, as well as solid working relationships across Oklahoma.

What is your approach to building and maintaining relationships with policymakers?

I really try to get to know policymakers well before I ever have an “ask” of them. It pays huge dividends to take the time to really understand he or she as a person Samantha Davidson Guinn, Principal by asking questions about his or and Counsel at Cornerstone her family, hobbies, district they Government Affairs in Oklahoma represent, and businesses outside City, joined the firm in 2023. of the legislature. It is honestly one She has extensive experience in of my favorite parts of lobbying, to government and policy, previously genuinely get to know policymakers. serving as Deputy Attorney General Once I have a request or need to of Oklahoma, Policy Director lobby a policymaker on something, for Governor Stitt, and Senior I have already built that relationship Policy Advisor in the Oklahoma and there’s a trust that’s developed.

How do you measure success – personal and professional?

I measure success by my ability to accomplish goals and by making a difference. I feel most accomplished when I’ve either achieved a goal or by doing something that is bigger than me. I want to make a positive impact in my community. Success to me is feeling that I’ve done that.

continued on page 13 www.okda.org

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12 journal | November/December 2024

LEGISLATIVE LOOP Introducing our ODA Lobbyist Team, continued I’ve held several staffing roles within state government. Over the years, I learned what a difference a lobbyist Absolutely. I genuinely love getting to I spend free time with family and can make for both the client, as well know people. I think it would be hard friends. I love being outdoors, riding as the state. I enjoy that what I do to be in my profession if I were not horses, hiking, attending concerts, can have a lasting impact for my a people person. I’m an extrovert in trying new restaurants, and water client and their business and/or the the truest form. I get my energy from skiing at the lake. state as a whole. being around people.

Would you say you are a people person, and why?

How do you spend your free time?

Who would you have What have your three most dinner with – anyone past prominent achievements as or present – and why? a Lobbyist been?

This past session we were able to overturn the Governor’s veto for a client. This was an extremely difficult task, but we were able to accomplish it. This was an interesting task for me as I’ve previously served in the Governor’s administration, which leads me to my second most prominent achievement. I wasn’t a lobbyist at the time, but in the Governor’s first term, I served as the Policy Director. We successfully passed agency reform, as well as put millions back into the state’s rainy day fund. Lastly, I’d say anytime we are able to defend a client against legislation which negatively impacts their industry it is a rewarding achievement.

I would have dinner with Reba McEntire. I grew up listening to her music. As a gal who grew up in a small town in Oklahoma, she’s always inspired me.

Why did you become a lobbyist?

Who is your mentor(s) and why?

Former State Senator and current Corporation Commissioner, Kim David, has always been a mentor to me. As a senate staffer, she really empowered me early in my career.

She’s always been a sounding board and confidant. I’ve also looked up to her success and the way she carries herself.

In college I was chosen to participate What inspires you? in a leadership program. We spent the year studying how policy affects Making a positive impact. I want the different quadrants of the state. to leave this earth better than I We traveled to the state capitol, as found it. well as Washington, D.C., to meet with policymakers. It was during this program that I really caught the political bug. I wanted to be a part of the political process and help shape policy for my state.

www.okda.org

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LEGISLATIVE LOOP 2024 Election Analysis provided by Cornerstone Government Affairs

Cornerstone Government Affairs has assembled the following report to assist our clients like Oklahoma Dental Association in providing results from the 2024 election and understanding the impact on the nation’s politics and policies of those results.

OKLAHOMA OVERVIEW Oklahoma remains solidly Republican and has maintained its trifecta.

With 101 members in the House of Representatives and 48 in the Senate, more than 80% of elected officials are Republicans. While rural areas of the state remain strongholds for the GOP, metropolitan areas such as Tulsa and Oklahoma City are showing slight signs of becoming more politically mixed. Gov. Kevin Stitt (R-OK) and Lt. Gov. Matt Pinnell (R-OK) will both serve out the remainder of their terms, which extend through the end of 2026.

GOVERNOR

KEY TAKEAWAYS 



Significant leadership changes are on the horizon in the Legislature.

The Republican Party maintained its dominance in Oklahoma, securing all Congressional seats and most Legislature seats.

In his final term, Gov. Stitt (R) has achieved numerous wins that align with his conservative agenda. Gov. Stitt lowered the state’s personal income tax, expanded school choice, increased teacher pay, and redirected funds to classrooms across the state. In the health care space, he worked to improve rural health care access and manage Medicaid costs.

Gov. Stitt has also focused on attracting business investments, further promoting economic growth in the state. As Gov. Stitt is term limited, Oklahoma will see a shift in leadership, with the upcoming gubernatorial race in 2026 already shaping up to be highly competitive. Potential contenders include Attorney General Gentner Drummond, U.S. Rep. Kevin Hern (R-01), House Speaker Charles McCall (R-22), Lt. Gov. Matt Pinnell, and Superintendent of Public Instruction Ryan Walters.

OKLAHOMA SENATE The Oklahoma State Senate is composed of 48 members, with 40 seats held by Republicans. Former Senate President Pro Tempore Greg Treat (R-47) will complete his term on Nov. 20, 2024, leaving the leadership position open. Initially, Sen. Greg McCortney (R-13) was elected as Sen. Treat’s successor, but in a surprising upset, Sen. McCortney lost his reelection bid, creating a significant shift in Oklahoma’s political dynamics.

His unexpected defeat has led to a reshuffling of Senate leadership. Currently, Sen. Lonnie Paxton (R-23) has been chosen as the President Pro Tempore designate, awaiting confirmation by the Republican Caucus in November and a full Senate vote in January. Several newly elected senators will take office in February, filling seats left vacant by resignations, term limits, or election losses. Despite these leadership changes, the Senate is expected to maintain its focus on key priorities including education reform, budget transparency, mental health initiatives, and balanced tax policy to enhance state services and fiscal responsibility.

OKLAHOMA HOUSE The Oklahoma House of Representatives consists of 101 members, with 20 held by Democrats. As the 2025 legislative session approaches, set to convene on Feb. 3, 2025, the House will see significant leadership changes. Former Speaker Charles McCall (R-22), the longest-serving Speaker in state history, is term-limited, making way for Rep. Kyle Hilbert (R-29) to become the youngest Speaker in Oklahoma’s history. With new leadership in both the House and Senate, expectations are high for the announcement of committee assignments, which will follow the Republican caucus retreat after the election. The departure of several long-serving members due to term limits and election losses has left many key leadership and committee

14 journal | November/December 2024

LEGISLATIVE LOOP 2024 Election Analysis, continued provided by Cornerstone Government Affairs

roles up for grabs. In this new landscape, the House is expected to prioritize economic diversification, investments in state infrastructure, and potential tax reforms in the upcoming session.

BALLOT INITIATIVES This November, Oklahoma voters decided on two constitutional amendments, both proposed by state lawmakers and approved by Gov. Stitt for the ballot. State Question 833 would permit the creation of Public Infrastructure Districts (PIDs), governed by a board of trustees. These districts would fund public works projects within their boundaries through a special tax, affecting only properties within the district. All property owners in the proposed area must agree to form a PID. State Question 833 failed to pass with 61% of Oklahomans voting no. State Question 834 seeks to clarify that only U.S. citizens can vote in Oklahoma.

While it would not change existing law, supporters say it adds clarity, while opponents argue it feeds into anti-immigrant sentiment. State Question 834 passed overwhelmingly with 80% of Oklahomans voting yes.

State Question 832, which would raise the state minimum wage to $15/hour by 2029, has been delayed until June 2026 by the Governor.

CONGRESSIONAL ELECTIONS In Oklahoma’s 2024 congressional elections, the Republican party retained all five of its U.S House seats. In the 5th Congressional District, Rep. Stephanie Bice (R-05) solidified her hold on the seat with 60% of the vote, continuing to represent the district with a strong majority, further cementing the GOP’s strength in the state. Urban areas within the state like Oklahoma City and Tulsa have shown gradual demographic shifts in recent elections. The competitive 2020 race between Rep. Stephanie Bice, who narrowly won with 52.1%, and Kendra Horn at 47.9% highlights these emerging dynamics, yet all Republican candidates ultimately retained their positions across the board. Oklahoma did not have a Senate election in 2024, as both Sen. James Lankford (R) and Sen. Markwayne Mullin (R) continue their terms from previous victories.

PRESIDENTIAL ELECTION President-elect Donald Trump once again carried the state by a wide margin, securing all seven of the State’s electoral votes and further reinforcing Oklahoma’s position as a Republican stronghold in presidential elections. Notably, President-elect Trump won all 77 counties in Oklahoma for a third time.

Oklahoma remains one of the most reliably conservative states in the nation, and its strong Republican base, particularly in rural areas, played a key role in delivering decisive electoral votes.

GENERAL SUMMATION The 2024 election results continue to reinforce Oklahoma’s reputation as a reliably Republican state, with the GOP maintaining control of all statewide offices and congressional seats. The continued control of Republicans in both urban and rural areas suggests that the state’s conservative policies will remain unchanged. However, 2026 will bring significant changes with the election of a new governor, as Gov. Stitt is term limited. Additionally, new legislative leadership could potentially reshape the state’s political landscape and key priorities. Issues within economic growth, infrastructure development, and tax reform will likely remain priorities as Oklahoma moves forward under a Republican trifecta.

www.okda.org

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16 journal | November/December 2024

CASE STUDY Broken Implant Collar

by Dominique Angibeau, DDS

In this case, we will be discussing a broken implant collar.

The patient is 70 years old with a history of asthma, joint replacement, latex allergy, and thyroid disease. Dental history included history of composite restorations, amalgam restorations, root canal therapy, crowns, extractions, and implants. Patient clenches, grinds and occasionally wears her nightguard.

She presented with a fractured #4 and a loose implant crown on #3. As we examined the implant crown and fractured tooth, we noticed a fracture on the implant collar. The fractured implant collar was causing the implant crown's looseness and gingival irritation. It was decided to establish access to the cement-retained implant crown, remove the crown, and smooth out the broken portion of the implant. In addition, #4 would be extracted and an immediate implant placed.

FIGURE 1

#3 implant with broken collar and #4 root tip.

The treatment began with accessing the implant crown.

Diamond burs were used to access the abutment screw through the occlusal of the crown. The implant crown/ abutment was then removed. A diamond bur was used to smooth out the collar fracture. Smoothness was determined by the continuity from the fracture to the rest of the collar. The adjacent tooth, #5, was then extracted and an immediate implant was placed. Afterward, there were post-operative appointments for implant placement FIGURE 2 and adjustments to the collar as needed until inflammation #3 implant crown placed back on implant after collar was refined. in the area was resolved.

Immediate placement of #4 implant.

After 2 months of post-operative appointments, the tissue around #4 did not improve. A catch was still felt around the collar. At the second stage of implant surgery, the implant collar was then smoothed again along with a portion being removed. Pt was then seen for an additional post-operative appointment and the area was healing well.

In conclusion, long-term implant maintenance should take collar fracture into consideration in relation to bone loss and inflammation as a cause. Shear/lateral forces are not recommended on implant prosthesis, but patients with occlusal wear habits may need further monitoring of the occlusal wear after delivery.

It is important to treatment plan occlusal guards for all with implant patients with destructive occlusal wear patterns and emphasize compliance. In this case, compliance with occlusal guard could have saved not only tooth #4 but implant #3 as well.

FIGURE 2

Periapical radiograph of #3 implant and #4 implant. #3 implant collar is still visible.

ABOUT THE AUTHOR Dr. Dominique Angibeau is a general dentist practicing in Houston, originally from Missouri City, TX. She earned a Bachelor of Biological Engineering from LSU and completed her dental education at the University of Texas School of Dentistry at Houston, followed by a residency at the University of Oklahoma College of Dentistry.

Known for her compassionate approach, she prioritizes strong dentist-patient relationships and patient education to promote oral health. Dr. Angibeau is an active member of the ADA, AGD, and Spears Education, staying current on advancements in dental care.

In her free time, she enjoys dining out, live music, traveling, pilates, reading, and college football. www.okda.org

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STATEMENT OF OWNERSHIP, MANAGEMENT, AND CIRCULATION 1.

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Publication Title: Oklahoma Dental Association Journal Publication Number: 284-980 Filing Date: November 5, 2024 Issue Frequency: every other month Number of Issues Published Annually: 6 Annual Subscription Price: $56 Complete Mailing Address of Office of Publication: Oklahoma Dental Association 317 NE 13th St, Oklahoma City, OK 73104 Contact Name: Jill Johnson, (405) 848.8873 Editor Name: Mary Hamburg, DDS Managing Editor: F. Lynn Means Complete Mailing Address of Headquarters or General Business: Oklahoma Dental Association 317 NE 13th St, Oklahoma City, OK 73104 Full Names and Complete Mailing Addresses of Publisher, Editor and Managing Editor: Publisher: Oklahoma Dental Association, 317 NE 13th St, Oklahoma City, OK 73104 Editor Name: Mary Hamburg, DDS Managing Editor: F. Lynn Means Owner: Oklahoma Dental Association, 317 NE 13th St, Oklahoma City, OK 73104 Known Bondholders, Mortgagees, and Other Security Holders Owning or Holding I Percent or More of Total Amount of 16.

Bonds, Mortgages, or Other Securities: None 17.

Tax Status: Has Not Changed Publication Title: Oklahoma Dental Association Journal Issue Date for Circulation Data: September/October 2024 18.

18 journal | November/December 2024

Extent and Nature of Circulation a. Total Number of Copies (Net press run) b. Paid Circulation 1. Mail Outside-County Paid Subscriptions Stated on Form 3541 2. Mail In-County Paid Subscriptions Stated on Form 3541 3. Paid Distribution Outside the Mails Including Sales Through Dealers and Carriers, Street Vendors, Counter Sales, and Other Paid Distribution 4. Paid Distribution by Other Classes of Mail Through the USPS c. Total Paid Distribution [Sum of 15b] d. Free or Nominal Rate Distribution 1. Outside-County included on PS Form 3541 2. In-County included on PS Form 3541 3. Other Classes Through the USPS 4. Free Distribution Outside the Mail (Carriers or Other Means) e. Total Free Distribution (Sum of 15d) f. Total Distribution (Sum of 15c and 15e) g. Copies Not Distributed h. Total (Sum of 15f and g) i. Percent Paid (15c divided by 15f times 100) Electronic Copy Circulation Publication of Statement of Ownership required.

Will be printed in the November/December 2024 issue of this publication Signature and Title of Editor, Publisher, Business Manager, or Owner F. Lynn Means, Managing Editor, November 5, 2024

Average No. Copies Each Issue During Proceeding 12 Months

No. Copies of Single Issue Published to Filing Date

1,440

1,438

1,440

1,438

85

60

85 1,525 25 1,749 94% 1,440

60 1,498 25 1,934 96% 1,438

CASE STUDY Non-Healing Ulcer Under Tongue

by Elena V. Dupalo DDS and Kathleen E. Higgins, DDS, MS

A 58-year-old woman presents to the clinic with a chief complaint: a non-healing ulcer under the tongue with REFERENCES tenderness and burning. This patient started a new sublingual prescription medication one month before Chamoli, A. (2021, July 28). Overview of oral cavity squamous cell this appointment, and she reports consistent burning. carcinoma: Risk factors, mechanisms, and diagnostics. National Her social history is significant for tobacco use, one Library of Medicine. Retrieved April 6, 2021, from https:// pubmed.ncbi.nlm.nih.gov/34329869/ half-pack per day for the past 20 years, and daily alcohol consumption. During clinical examination, an ulcerated McCord, C. M. (2021, September 21). Oral Squamous Cell 1.0 x 0.5 cm mixed red and white exophytic lesion was Carcinoma Associated with Precursor Lesions. National Library of detected in the left floor of the mouth extending from the Medicine. https://pubmed.ncbi.nlm.nih.gov/34193432/ mandibular gingiva to the depth of the mandibular lingual vestibule. A biopsy of this lesion confirmed a diagnosis of Regezi, J. A. (2010). Oral Pathology: Clinical Pathologic Correlations (15th ed.). Elsevier. https://doi.org/9780323297684 oral squamous cell carcinoma.

Seven years prior, the patient was referred from a private dental office for a mixed red and white lesion with uneven borders on the left floor of the mouth. A biopsy of the area revealed a diagnosis of mild epithelial dysplasia.

Mild, moderate, and severe dysplasia can precede oral squamous cell carcinoma. Unlike other areas of the body, there is not always a predictable rate of transformation for any grade of dysplasia into oral squamous cell carcinoma.

Therefore, any grade of epithelial dysplasia requires excision and careful monitoring. Oral squamous cell carcinoma is the most common malignancy of the oral cavity, with high rates of morbidity and mortality. Even with advances in medical and surgical procedures, the 5-year survival rate is only 50-60%.

This clinical case highlights the importance of routine follow-up for any biopsy-proven diagnosis of epithelial dysplasia.

Non-healing ulcer under the tongue found during comprehensive evaluation

ABOUT THE AUTHORS

Dr. Higgins is originally from the Washington, DC area and completed her undergraduate, masters, and doctorate education in Virginia.

Upon graduation from Virginia Commonwealth University School of Dentistry in 2017 she pursued oral pathology residency training at New York Presbyterian Queens.

During residency she reviewed countless oral biopsies, treated oral medicine patients, as well as taught students, residents, and medical colleagues. She went on to complete a Head and Neck Pathology Fellowship at the University of Chicago, where she participated in both an active oral pathology biopsy service as well as the head and neck surgical pathology service that included examination and review of large head and neck cancer cases. In her free time she enjoys cooking and spending quality time with her husband and their English Bulldog, Scully.

Dr. Dupalo, a long-time resident of Sacramento, CA, has deeprooted ties to her community. She began her academic journey at San Jose State University, earning a Bachelor of Science in Health Science with a major in Social Work. Driven by her passion for dentistry, she pursued her doctorate at the University of California, San Francisco, graduating in 2019. After completing an Advanced Education in General Dentistry (AEGD) residency at the University of Oklahoma College of Dentistry, Dr. Dupalo is excited to return to Sacramento. She is eager to rejoin a private practice, bringing with her a wealth of new skills to better serve the community she knows and loves. www.okda.org

19

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RESEARCH What happened to WREB? The Merger of Regional Testing Agencies

by Mark Christensen, DDS, MBA

INTRODUCTION

enabled a standardized and anonymous WHAT CHANGED appeals process and a practice Before the 1970s, most states developed (occupational task) analysis to support Certain sections of the clinical licensing and administered a clinical assessment examination (endodontic treatment, for examination content. for licensing qualification. Regional example) have long been conducted as a WREB continued to operate until testing agencies arose in the 1970s simulation. An initiative to move from August 2021, when it merged with as states in various regions began a patient-based format to a more highly CDCA. Before the merger, WREB collaborating to create and administer simulated format for all examination examinations were recognized for the clinical examination required for sections was already underway when dentist licensing. Collaboration offered licensing in approximately 44 states. the COVID-19 pandemic struck. In the many advantages, particularly for states CDCA (ADEX) examinations were spring of 2020, the pandemic suddenly accepted for licensing in 48 states. lacking a dental school or convenient precluded performing the clinical Oklahoma began accepting the WREB licensing examination with patients. examination facility. As regional states collaborated, examination administration Why, after almost half a century of This accelerated developments and became standardized, examination enabled, of necessity, the creation and successful operation, did WREB so content became unified, and the number suddenly disappear? And what does acceptance of an entirely simulated of participating states grew. and more highly standardized clinical this portend for the other remaining assessment.

The Western Regional Examining Board regional testing agencies?

(WREB) was one of several regional Sometimes overlooked, however, is WREB was the regional agency that testing agencies that administered a that in November 2019, a few months most Western states initially joined. clinical assessment to help inform the before the onset of the pandemic, Many of these states did not have a jurisdictional authority responsible for California also began to accept the dental school or facility to conduct dentist licensing in the United States.

ADEX examination for dentist licensing. a clinical assessment. Member states Other widely recognized regional When this occurred, no state exclusively without a dental school when WREB testing agencies are the Northeast required the WREB examination. Both was founded include Alaska, Arizona, Regional Board of Dental Examiners Idaho, Montana, Nevada, New Mexico, examinations were no longer needed.

(NERB), the Commission on Dental When the pandemic struck, WREB and and Utah. These states sent students Competency Assessment (CDCA), the CDCA (ADEX) were testing at schools to dental schools out of state across Central Regional Dental Testing Service the country. Some of these students nationwide.

(CRDTS), the Southern Regional Testing wished to return to their home state to Their examination results were Agency (SRTA), and the Council of practice. For this reason, they frequently recognized as satisfying the clinical Interstate Testing Agencies (CITA). persuaded their school to host the examination requirements for WREB examination. Hence, WREB was licensing in almost all states, and their Oklahoma began accepting the WREB examination for dentist licensing in 1997. early on invited to examine candidates examinations were offered at many of In 2005, the WREB examination replaced in schools across the country. the same sites. the Texas Board of Dental Examiners’ In 2006, the California Dental Board Having two different clinical own state-specific clinical exam for and Division of Consumer Affairs began examinations for the same purpose in dentist licensing. The transition to WREB recognizing the results of the WREB was part of a broader effort to standardize Dental Examination for dentist licensing the same space became confusing for students trying to decide which exam to dental licensure across various states. in California. For almost fifteen take, dental education programs trying years afterward, WREB continued WREB introduced or reinforced to determine which exam to host, and innovations over the years that advanced administering dental examinations state boards tasked with meaningfully patient-based clinical assessment. These at schools in the West and across distinguishing the differences. The the country for applicants seeking included strict candidate anonymity, reasons for regional testing agencies licensure in Western states, particularly finally disappeared. The regional robust examiner calibration, test California. specifications that include the criteria structure no longer served states, against which candidate performance stakeholders, or the dental profession. is judged, and a transparent scoring continued on page 23 methodology. Regionalization also www.okda.org

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22 journal | November/December 2024

RESEARCH What happened to WREB, continued Recognizing this and that gaining or recognized for licensing by almost every DISCUSSION even retaining market share would have jurisdiction, including Puerto Rico, The shift away from patients to allrequired the development of a robust Jamaica, and the U.S. Virgin Islands. simulation and the consolidation of marketing department and the allocation Passing an ADEX hand-skills regional testing agencies signifies the of a significant portion of candidate beginning of a new chapter for initial examination fees to marketing that would (psychomotor) clinical licensing dentist licensing. What does this mean not necessarily improve the quality of the examination is currently a requirement or pathway for initial licensing in every for the remaining independent regional examination or benefit the profession, testing agencies: CRDTS, SRTA, and WREB initiated a conversation with other state except New York and Delaware.

Delaware has its version of a clinical others? testing agencies. licensing examination. New York requires Regional innovation initially introduced In the beginning, regional exams completing a post-graduate residency new ideas. These ideas and practices provided important benefits. They program of at least a year. Except for were shared at national meetings, enabled: these and a recent idiosyncratic and problematic Board decision in Nebraska improving the quality of all exams.

• For states: sharing the burden of However, the regional testing agencies to accept only CRDTS, the ADEX developing and administering exams. Dental Examination administered by that now remain are operating in the same space and using rhetoric about the CWC has become the national clinical • For students: increased benefits of “competition” as an excuse assessment standard for dentist licensing. standardization and exam results to propagate the existence of no longer Like CODA and the Joint Commission’s portability.

National Board Dental Examination, the needed entities. Since students decide • For schools: simplified test ADEX Dental Examination is also being which examination to take, competition preparation of students. in the same space for candidates and administered internationally. schools is geared toward making the • Better implementation of the The ADEX Dental Examination exam more attractive to students, i.e., Standards for Educational and administered by CWC is now the cheaper, easier to access or pass, etc.

Psychological Testing (candidate national clinical licensing examination Competition for students now is not anonymity, examiner calibration, for dentistry. This assertion depends on likely to improve the examination psychometric standardization, how “national” is defined, but consider quality or even sustain the established documentation, and the production that, as of this writing, the ADEX Dental standard. of technical reports).

Examination: The clinical licensing examination is After 2020, multiple regional • Is administered at every dental not a consumer item like a washing examinations competing for market share school in the country. machine, automobile, or computer; in the same space: it is an assessment instrument for • Is administered to more than • Unnecessarily complicated things 6500 graduating student candidates determining clinical competency or a measure of applicant quality for states. each year. that contributes to the standardized • Unnecessarily confused and • Satisfies the clinical exam licensure requirements for entry-level licensing complicated things for students. requirements in almost all licensing Licensing is a tool of regulation, an jurisdictions (96-98%). aspect of government.

• Unnecessarily complicated things for schools.

• Has multiple national offices and Governmental regulation is best served 800-850 examiners nationwide. by a single, uniform standard that is • No longer benefited the dental universally accepted, clearly identified, professions.

• Is now explicitly codified as the and readily addressed. required clinical examination for On August 3, 2021, CDCA and WREB licensing in approximately a third Most jurisdictions also require the merged to become a single agency: (17) of states. completion of a CODA-accredited CDCA-WREB. A year later, on August dental education. One entity, CODA, 1, 2022, another regional testing agency, • Is now being administered currently accredits dental education CITA, combined with CDCA-WREB. internationally and achieving programs. It would not be better if The resulting agency, CDCA-WREBinternational recognition like two or three accrediting agencies CITA (CWC), now uniformly administers CODA and the Joint Commission’s were competing for schools. Multiple the ADEX examination at every dental National Board Dental accrediting agencies competing for school nationwide. The results of this Examination. examination are universally portable and continued on page 25 www.okda.org

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RESEARCH What happened to WREB, continued schools in the same space would not likely improve dental education standards. Instead of proposing an additional accreditor, those concerned about the quality of dental accreditation should first work with CODA to improve the already existing, universally recognized accreditation process.

assessment standard or redefine themselves and the role they will play in supporting dental regulation going forward.

REFERENCES 1 Northeast Regional Board of Dental Examiners (NERB) in 1969, Central Regional Dental Testing Service (CRDTS) in 1972, Southern Regional Testing Agency (SRTA) in 1975, and Western Regional Examining Board (WREB) in 1976.

testing cycle. Nebraska Governor Jim Pillen has urged the Board to reconsider and expand testing options to address the state's shortage of dentists. Accessed Oct 11, 2024, at: https:// alliancetimes.com/gov-pillen-calls-on-stateboard-to-expand-access-to-dentists-in-nebraska/ In its meeting on October 4, 2024, the Nebraska Board again approved recognition of the ADEX Dental Examination for initial dentist licensing beginning July 1, 2025 (for the 2025/2026 testing cycle). Accessed Oct 23, 2024, at: https:// dhhs.ne.gov/licensure/LU%20Agendas%20 Minutes/100424dentminutes.pdf

Having multiple manufacturers compete for contracts to supply parts for a manufactured product is preferable. But 11 CDCA-WREB-CITA is now administering the this is not about parts suppliers; it’s about 2 WREB examinations remain named or codified ADEX Dental Examination at the University of La a professional standard—establishing in the rules or regulations for the licensing of Salle Bajío located in Leon, Guanajuato, Mexico, dentists in many U.S. jurisdictions. Applicants and documenting a standard measure and King Abdulaziz University in Jeddah, Saudi who passed a WREB examination before WREB’s Arabia, a dental school already accredited by of competence or applicant quality— merger with CDCA still have clinical examination CODA. Accessed Oct 10, 2024, at: https://www. to support licensure. In this context, credentials to satisfy the licensing requirements in lasallebajio.edu.mx/oferta/idp_en.php and https:// having a single, uniform standard that most states. www.arabnews.com/node/2411191/saudi-arabia is universally recognized is preferable.

3 Christensen ML. The Changing Face of Dental Competition for establishing the standard Licensing Examinations. J California Dental Assoc in the same space where the test taker 2023; 51:1. Accessed Oct 10, 2024, at: https://www. ABOUT THE AUTHOR (student) is the decision maker is tandfonline.com/doi/full/10.1080/19424396.2023 .2176578 only liable to reduce the quality of the standard.

4 Dental Board of California, Department of Consumer Affairs, Meeting Minutes, Jan. 27, 2006.

There also are ethical issues. Should Sacramento, CA. [cited 2022 Oct 20]. Accessed the infiltration or manipulation of state Oct 10, 2024, at: https://www.dbc.ca.gov/about_us/ boards be attempted in the interest of meetings/minutes/20060127_board.pdf testing agency preservation? Should 5 Acadental DTX CompeDont™ development to a substantial portion of candidate simulate enamel, dentin, caries, and pulp tissue in examination fees be spent on attorneys simulated teeth. [cited 2024 Feb 24]. Accessed Oct and lobbyists or on flying spokespersons 10, 2024, at: https://acadental.com/product_page.

Mark L Christensen, DDS, MBA is an around the country to make presentations php?id=282084279-72592283 assistant professor at the University of Utah to gain or hedge against the loss of 6 Dental Board of California Votes (Nov. 15, 2019) School of Dentistry. He has been a state market share? How does this benefit the to Implement the ADEX Dental Examination for dental board member, commissioner for profession? Such questions have become Licensure Immediately. American Board of Dental the Commission on Dental Accreditation, Examiners, Inc.; 2019 [cited 2022 Oct 5]. Accessed relevant for the smaller regional testing commissioner for the Joint Commission Oct 10, 2024, at: https://www.cdcaexams.org/ agencies that now may be struggling to on National Dental Examinations, and wp-content/uploads/2019/11/Press-Release-CAremain viable. chair of the Committee for an Integrated Board-and-ADEX-Dental-Licensure.pdf CDCA, WREB Announce Merger, The Commission on Dental Competency Assessments, Linthicum, MD; 2022 [cited 2022 Oct 24].

WREB’s recent merger and disappearance Accessed Oct 10, 2024, at: https://adextesting.org/ cdca-wreb-announce-merger/ signal the beginning of a new era. The

CONCLUSION

7

era of regional dental testing agencies, 8 CDCA-WREB, CITA Announce Combination, which lasted approximately half a century The Commission on Dental Competency and benefited professional regulation in Assessments, Linthicum, MD; 2022 [cited 2022 Oct 24]. Accessed Oct 10, 2024, at: https://www. its heyday, is now closing. The smaller cdcaexams.org/cdca-wreb-cita-announce-pendingindependent clinical testing agencies combination/ that remain will likely struggle to retain 9 ADEX Dental Initial Licensure Acceptance market share. Some of their examiners may already be examining for CWC. The (map) [cited 2024 Feb 24]. Accessed Oct 10, 2024, at: https://adextesting.org/ smaller remaining agencies will likely need to choose how they, too, will come 10 Nebraska stopped recognizing the American Board of Dental Examiners (ADEX) exam for together to support the preservation of a single national clinical (psychomotor) dentist licensing starting with the 2023-2024

Examination (CIE) that developed and validated the Integrated National Board Dental Examination (INBDE). He has been president of WREB and of the American Association of Dental Boards.

Dr. Christensen is a Life Member of the ADA and the AADB, and a fellow of the International College of Dentists and the American College of Dentists.

www.okda.org

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26 journal | November/December 2024

SPONSORED CONTENT Maximizing ePrescribing Software: Best Practices Provided by ODA Partner, iCoreConnect Written by Robert McDermott, President & CEO

ePrescribing software is no longer the • new kid on the practice efficiency block.

For many dental practices, it’s time to consider whether you’re maximizing your • ePrescribing solutions.

And yet, not all ePrescribing software is created equally. So, when choosing your software, look for a few key features, some of which are standard, some of which are not: •

Integration with EHR Systems - Seamless communication and data sharing between ePrescribing software and EHR systems ensures accurate and up-to-date patient information.

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Clinical Decision Support - Real-time alerts and suggestions help dentists make informed prescribing decisions, • including drug interactions, allergies, and contraindications.

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Medication History Tracking Comprehensive access to a patient’s medication history prevents duplications and ensures continuity of care.

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Real-Time Benefits Verification Instant checks on patient insurance coverage and medication costs provides cost-effective prescribing options.

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Electronic Prior Authorization Streamlined process for insurance approvals when medications require prior authorization.

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EPCS and State PDMP integration Secure and compliant prescribing of controlled substances, meeting DEA and state regulations.

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Patient-Specific Dosing Recommendations - Tailored dosing recommendations based on patientspecific factors.

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Refill Management - Simplifies the refill process, including automatic reminders and refill requests.

approaches to maximize their ePrescribing software solution.

A few fundamental strategies include: Drug Interaction and Allergy Alerts Conducting comprehensive staff - Immediate alerts for potential training, ensuring all dental providers drug interactions and known allergies, improving patient safety. and supporting staff are thoroughly trained in using the ePrescribing system.

It’s great to have tools around, but if Secure Messaging and your staff doesn’t know what it can do or Communication - Encrypted how to use it, you certainly won’t get the messaging capabilities for secure most out of it. communication between dentists and pharmacies.

Ensure ePrescribing solution integration with EHRs and practice management Audit Trails and Reporting systems. A unified system allows dental Detailed logs and reports of providers to access comprehensive all prescribing activities for patient information, including transparency, accountability, and medication history and insurance regulatory compliance. details, in real time.

Mobile Accessibility - Access to Customizing ePrescribing workflows to ePrescribing features via mobile match the specific needs of your practice devices adds flexibility and from templates, alerts, and default convenience. settings can streamline the prescribing Customizable Templates process and reduce the time spent on Predefined and customizable each prescription. prescription templates streamlines Leverage the software’s reporting the process for commonly and analytics to provide valuable prescribed medications. insights into prescribing patterns and Remote Prescription Cancellation practice performance, from frequent - Cancel prescriptions remotely if prescription errors or delays in the needed, ensuring patients do not prescribing process. receive medications that are no Ultimately, maximizing the potential longer necessary or safe. of ePrescribing software involves a Pharmacy Directory multifaceted approach that includes Comprehensive directory of staff training, system integration, pharmacies to facilitate direct workflow customization, data-driven transmission of prescriptions to the improvements, and patient engagement. patient’s preferred location.

These strategies can help ensure dental practices get the most out of their Adherence Monitoring Tools ePrescribing software.

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Insurance Compliance - Ensures prescriptions are aligned with insurance formularies, promoting cost-effective and covered medication However, to fully leverage the benefits, dental practices must adopt strategic choices.

today to improve the efficiency and safety of prescription management while significantly enhancing patient satisfaction and trust. Visit iCoreConnect.com/OK22 or call 888.810.7706. ODA members receive substantial discounts on iCoreRx.

www.okda.org

27

It's Time to Renew Your ODA and ADA Membership!

The 2025 Oklahoma Dental Association membership renewal period begins this month.

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Help keep the dental professional strong. Renew today! okda.org/membership/renew-today Choose a Payment Plan Did you know you don’t have to pay your ODA/ADA/Component (Tripartite) dues all at once?

ODA understands that it may work better for you to remit your membership dues over multiple payments instead of all at once. We are excited to provide you with the opportunity to pay your 2025 membership with one of the following convenient payment plans: • • • •

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The ODA will process auto renew payments on the 15th of each month. One-time renewal payments will be processed on January 15.

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To take advantage of our payment plan or automatic renewal options, contact Ansley Jinkins ODA Director of Membership at ajinkins@okda.org or 405.848.8873

28 journal | November/December 2024

Endodontic Practice Associates

Dr. Spencer Hinckley and Dr. Percy Bolen

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

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29

NATIONAL ADA NEWS Community Water Fluoridation is Safe Provided by American Dental Association

U.S. District Court Judge Edward Chen Act, which allows citizens to petition The ADA has reaffirmed its stance that specified in his Sept. 24 ruling that community water fluoridation is safe the EPA to consider whether a chemical although his finding does not “conclude presents an unreasonable risk of injury and beneficial to oral health, following with certainty” that fluoridated water a federal judge’s ruling that the U.S. to health.

Environmental Protection Agency must is harmful to public health, there is This ruling comes after the Department take action regarding fluoride in drinking evidence that fluoride in drinking water. While the EPA is required to take water poses a potential risk of cognitive of Health and Human Service’s National Toxicology Program released decline. action, the ruling did not ban or in any “Monograph on the State of Science way limit the addition of fluoride to “Given the seriousness of reduced IQ, Concerning Fluoride Exposure and public drinking water supplies. and the ample support in the record that Neurodevelopment and Cognition.” The the United States population is at risk In a Sept. 25 statement, the ADA said August report found that drinking water of experiencing IQ decrements of over at more than twice the recommended it remains “staunchly in support” of community water fluoridation at optimal four IQ points, the severity of the hazard limit is “consistently associated” with at issue weights in favor of finding the levels to help prevent tooth decay. lower IQ in children. risk at issue unreasonable,” wrote Judge “The district court ruling against the The report notes that the findings are Chen.

Environmental Protection Agency limited to fluoride exposures that are provides no scientific basis for the ADA Several advocacy groups petitioned to more than double (≥1.5 mg/L) what to change its endorsement of community establish a case that fluoride posed an the Centers for Disease Control and water fluoridation as safe and beneficial unreasonable risk of harm sufficient to Prevention currently recommends for require a response by the EPA under to oral health,” reads the release. the optimal level of community water the amended Toxic Substances Control fluoridation (0.7 mg/L).

NATIONAL ADA NEWS Community Water Fluoridation is Safe, continued An ADA expert committee examined the Act] leaves that decision in the first “This information is not always based instance to the EPA. One thing the EPA on research conducted according to report, stating the monograph does not provide any new conclusive evidence that cannot do, however, in the face of this impartial and evidence-based scientific warrants changes in current community Court’s finding, is to ignore that risk,” he methodology; and the conclusions water fluoridation practices for public wrote. drawn from research are not always health policy consideration. scientifically justifiable or without bias,” ADA President Linda J. Edgar, D.D.S., the release concludes.

The ADA continues to endorse said in a statement that oral health is essential and that community water fluoridation of community water as a For more information on community fluoridation has been proven to prevent water fluoridation and ADA advocacy, necessary way to prevent tooth decay and promote oral health. The Association at least 25% of tooth decay in children visit ADA.org/fluoride. notes that the CDC named it one of the and adults.

10 great public health achievements of the 20th century and that for more than “The scientific weight of sound evidence 75 years scientific evidence has pointed to around the benefit of community water fluoridation is clear and compelling,” Dr. fluoridation as safe and effective.

Edgar said.

Judge Chen said the Toxic Substances Control Act requires the EPA to engage Because of the widespread with a response since the court found an misinformation circulating online and in social media around community unreasonable risk of injury. He did not state what exactly the response must be. water fluoridation, the ADA urged its members to be cautious of “pseudoscientific information.”

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AEGD CASE PRESENTATION Vertical Root Fracture

by Lauren Parker, DDS

A 64-year-old female presented to the OU College of Dentistry AEGD clinic with a chief complaint of pain on biting on her upper right side. It was determined that #4 had a vertical root fracture spanning mesiodistally across the entire occlusal surface of the tooth. The fracture was so extensive that when placing an explorer on the fracture line, the two portions exhibited mobility and splayed out. The tooth was deemed non-restorable.

After discussing various treatment options, the patient chose to have the tooth extracted and an implant placed. The tooth was extracted the same day. After extraction, a corticocancellous bone graft and collagen plug were placed. Primary closure was obtained. The patient had a family wedding planned four months from the day she presented for the extraction and stated that she would like to have a tooth in that area for the wedding.

Due to the urgency, the Dentsply Azento System was chosen.

The Azento System is a digital platform that streamlines the process of placement and immediate loading of single tooth implant restorations. After three months of healing, a CBCT and iTero full-mouth intraoral scan were taken and uploaded onto the Azento platform to create a surgical and restorative treatment plan. The treatment proposal was ready to review and approve within a few days. Once necessary changes were made, the Azento kit was approved, sent for processing, and shipped. The kit included the implant, a custom Atlantis abutment and temporary crown, a custom healing abutment, surgical guide, and all necessary twist drills to prepare the osteotomy. Both a custom abutment and temporary crown or a custom healing abutment are included to use dependent on the outcome and stability achieved on the day of surgery.

On the day of surgery, the surgical guide was placed and stabilized by the adjacent teeth. The guide includes an access hole to allow for adequate irrigation during placement of the implant. A tissue punch drill was used to remove the tissue through the guide. The osteotomy was then prepared using the Astra EV twist drills.

An Astra 4.2x9mm PrimeTaper EV Osseospeed implant was placed. Excellent primary stability was achieved at 35 Ncm. ABOUT THE AUTHOR A timing marker on the surgical guide was used to rotate the Dr. Lauren Parker was born and implant to the correct position for placement of the custom raised in Norman, Oklahoma abutment. The custom abutment and temporary crown and attended the University of were tried in to verify seating and then cemented together extraorally using Rely-X luting cement. The screw-retained Oklahoma where she received her crown and abutment were placed and torqued to 15 Ncm. Bachelor of Arts in Psychology.

The access hole was closed with tefflon tape and flowable She then attended the OU College resin composite. The temporary crown was taken entirely out of Dentistry where she received of occlusion and the patient was informed to avoid chewing her DDS and recently completed in that area. The patient was extremely excited to leave with her AEGD residency. Dr. Parker a tooth that day and even more excited to have it done prior will be joining a private practice to the wedding. She will be seen back after three months of in Norman. healing for the fabrication of her final restoration. www.okda.org

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34 journal | November/December 2024

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PRACTICE FOR SALE

POSITION OPEN

Hygienist - Oklahoma City, OK

South Central Oklahoma

Associate Dentist

Hygienist position for family practice office in South OKC. Monday through Thursday 8am to 5pm. Some experience preferred. Email resume to dasokc@gmail.com or call 405-632-5562

General Practice for Sale: 2600 sq ft, 5 ops, great visible Oklahoma City, OK location, 4 days per week, 8 days hygiene, softdent, We are a well-established, privately-owned dental cerec, laser, intraoral cameras, digital radiography, practice located in Oklahoma City. Our focus is super staff, collections $1.1 million. on delivering high-quality dental care in a patientcentered, compassionate environment. With a loyal Contact: Call or text (580) 221-4767. patient base and a dedicated team, we pride ourselves on building long-term relationships with our patients PRACTICE FOR SALE and providing comprehensive dental services.

Oklahoma City, OK Position Overview: Prime location second generation dental practice We are seeking a motivated and skilled Associate space for lease. Located on 4440 NW Expressway Dentist to join our team. The ideal candidate will in Oklahoma City with great visibility, up to $150k be passionate about patient care, have excellent buildout allowance, 50,000 VPD. Call 214-405-1935 communication skills, and be eager to grow within a or email : Pakzadadvisory@gmail.com. supportive and collaborative environment.

EQUIPMENT FOR SALE Dentist retiring and selling all equipment, which will be available November 1, 2024.

Three complete operatories including: Adec 311 dental chair unit; Digital Shick X-rays & computers; Suction system; Handpieces - Electric and air operated; Schumacher surgical equipment & Forceps. Also: Adec LISA water steam sterilizer; Assistina handpiece cleaner/oiling system 301; PLUS all hand instruments, scalers, and supplies; stackable electric washer/dryer and refrigerator.

Call Charlie for more info at 405-249-2308.

JOB OPENING Associate Dentist, Stigler, OK

PRACTICE FOR SALE

Key Responsibilities:

Oklahoma City, OK

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Provide high-quality dental care to patients of all ages, including preventive, restorative, and cosmetic treatments

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Perform examinations, diagnoses, and treatments with a focus on patient comfort and education Collaborate with our experienced dental team to ensure a smooth and efficient workflow Maintain accurate patient records and adhere to all practice protocols and safety standards

General Practice for Sale: Prime OKC Metro Area dental practice minutes from downtown. Features include 5 remodeled operatories, 9,000 active patients, 12-15 new patients monthly, and a 4-day workweek.

With $725,000 in collections and $205,000 in SDE, it offers strong financials. A 50/50 partnership opportunity is available as one doctor plans for retirement.

Contact: Headwaters Practice Transitions at bailey@headwaterstransition.com or (719) 694-8320 (Ref: HWO11724)

PRACTICE FOR SALE

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Qualifications: • •

DDS/DMD from an accredited dental school Active Oklahoma dental license (or ability to obtain one) Strong clinical skills with a commitment to continued education and professional development Excellent communication and interpersonal skills

• Claremore, OK Private practice located in Stigler, OK seeking associate with possible buyout in future. Very General Practice for Sale: 3 -3.5 days/ wk, producing well established office that has been in business • approximately 700k/yr, 6 days hygiene/ wk, Dentrix, for 45 years with a loyal patient base. Only Dexis imaging, digital pan, laser, refer out most What We Offer: private practice in Haskell County, located speciality work, 2000 sq/ft building for sale located between Eufaula Lake and Kerr Lake. Office is in • Competitive salary and benefits package in Claremore on busy state hwy. We take 4-6 weeks prime location right on the main highway across vacation/yr, doctor retiring.

• A supportive and well-trained team, allowing you from Choctaw Travel Plaza. Building is 2000 to focus on patient care sq ft, has 3 DR operatories, 1 hygiene operatory, Contact: (918) 810-5948 • State-of-the-art equipment and a modern, break room has capabilities to be another comfortable work environment operatory if needed. Equipment is older but fully functional. Office is open Tuesday-Thursday If you are a dedicated and compassionate dentist 8 to 5, and Friday 8 to 3 (only hygiene patients are Oklahoma City, OK looking to join a thriving practice, we would love to seen on Saturdays currently). Office has Dentrix hear from you!

Great location by I-240 and Sooner, Close to Tinker, software. Currently providers for 4 insurance Boeing, Northrop Grumman, and Pratt-Whitney, How to Apply: Please send your resume and a cover companies including Medicaid and have FFS and South Heart Hospital. Dr can stay at least 1 year. letter to kevintm526@yahoo.com or contact us at patients as well. Practice offers preventive, Build out is 6 years old. Better than new.

405-535-6976 for more information. restorative, crown/bridge, denture/partials, some oral surgery, and some implants. Definite Call 405-741-9000. growth potential since the office currently refers for orthodontics, endodontics, periodontics, and some oral surgery and implants.

See more classified ads or place your own ad Email lyndiejoan@gmail.com or online at okda.org/classifieds call (918) 448-0181.

POSITION OPEN

www.okda.org

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36 journal | November/December 2024