Thank you to the following businesses who support the Oklahoma Dental Association by advertising in the Journal:
Alliant Insurance Services
Armor CPR
BancFirst
Endodontic Associates
Endodontic Practice Associates
MedPro Group
Mobile Smiles Oklahoma
ODA Rewards Partners
Oklahoma Health Professionals Program
Southwest 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
Periodical postage paid at Oklahoma City, OK and additional mailing offices.
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.
5 Modern Day Myth Busting by Mary Hamburg, DDS, MS
STATE ASSOCIATION
4 ODA Calendar
8 Executive Director Addresses House of Delegates
12 2025-2026 Officers Installed
13 Welcome ODA's Newest Team Member
18 ODA Leadership Academy
32 Annual Meeting Award Winners & Sponsors
FEATURES
6 2025 OU College of Dentistry Graduates
24 Office Space: Dr. Jarrod Lack, TLC Dental
ADA NATIONAL NEWS
26 Oklahoma City Ceremony Honors Dentists Who Aided in Bombing Response
27 ADA Launches Living Guidelines Program
LEGISLATIVE LOOP
16 End-of-Session Legislative Update
17 Legislator of the Year Awards
COVER STORY
19 Passion, Purpose, and Service: Introducing ODA's 2025-2026 President, Dr. Twana Duncan
CLINICAL
14 The Gingiva-Brain Axis: What Gum Disease May Tell Us About Neurodegeneration by Stacy Sigler, RDH
29 Case Study: Achieving Stability in a Severely Resorbed Mandibular Ridge by Leyann Adi, Ajay Jain, DDS, and Angela Jarjoura
CLASSIFIEDS
35 Classifed Ads
Would you like to submit a case study, scientific article, or editorial for publication in the ODA Journal?
Email editor@okda.org with story ideas. Is Your Information Correct?
Help the ODA keep you informed about legislative actions, educational opportunities, events, and other important member-only news. Contact Ansley Jinkins at ajinkins@okda.org or 800.876.8890 to provide ODA with your current contact information.
Space: Dr. Jarrod Lack
ODA JOURNAL STAFF
EDITOR
Mary Hamburg, DDS, MS
ASSOCIATE EDITOR
Roberta A. Wright, DMD, MDSc, FACP
EDITORIAL BOARD MEMBERS
Daryn Lu, DDS
Sydney Rogers, DDS
Stacy Sigler, RDH
Roy L. Stevens, DDS
ODA OFFICERS 2025-2026
PRESIDENT
Twana Duncan, DDS president@okda.org
PRESIDENT-ELECT
Nicole Nellis, DDS presidentelect@okda.org
VICE PRESIDENT
Colin Eliot, DDS, MS vicepresident@okda.org
SECRETARY/TREASURER
Sydney Rogers, DDS treasurer@okda.org
SPEAKER OF THE HOUSE
Matthew Bridges, DDS speaker@okda.org
IMMEDIATE PAST PRESIDENT
Daryn Lu, 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
OFFICE & COMMUNICATIONS
MANAGER
Katie Douglas
CALENDAR
See more online at OKDA.ORG/CALENDAR
May
May 30
Robie Herman Memorial Golf Tournament & CE bene ting DENPAC Golf Club of Edmond
June National Smile Month
Dental Diversity Month
June 6
ODA Workforce Task Force Meeting 9:30am
June 6
Annual Meeting Task Force Meeting 1:00pm
June 6
Membership and Member Services Committee Meeting 2:30pm Zoom
To join the meeting or committee, email Ansley Jinkins at ajinkins@okda.org
June 12
Oklahoma County Dental Society Next Level Study Club 6:00pm - 9:00pm McGarry Implant Institute
More info online at okcountydental.com
June 14
ODA Ethics and Opioids CE Course 7:30am - 10:30am Zoom Webinar Register online at okda.org/events
July July 3-4 ODA Closed for Independence Day
July 11 RDGP Board of Trustees Meeting 10:00am Zoom
To join the meeting or board, email Shelly Frantz at sfrantz@okda.org
August
August 1
Council on Governmental A airs Meeting 9:00am ODA O ce & Zoom
August 1
ODA Board of Trustees Meeting 1:30pm ODA O ce & Zoom
August 25
First Bite Event for First Year Dental Students 5:00pm ODA O ce
More details available soon at okda.org/events
August 6 National Fresh Breath Day
August 11
National Align Your Teeth Day
September O ce Manager Appreciation Month
National Gum Care Month
September 1 ODA Closed for Labor Day
September 19 OU College of Dentistry Dean's Circle Dinner
More information available at dentistry.ouhsc.edu/ alumniweekend2025
Stay connected with the ODA!
ON THE COVER:
Twana Duncan, DDS, Oklahoma Dental Association's newlyinstalled President. She will serve in this role through May 2, 2026. Dr. Duncan practices in Antlers, OK.
Modern Day Myth Busting
Goiter is a funny word and a funny name for a not-so-funny disease. In the 1920s, goiter was a lethal disease that plagued 30-60% of the population, with the midwestern states being a ected at a higher percentage rate. It was such a concern, the U.S. military considered it a national health crisis, accounting for a 30% loss of dra ees preceding World War I. So why is goiter a funny name now, but was a national health crisis 100 years ago? A public health initiative was set into motion and continues to work to this day to prevent goiters from plaguing our society.
So why am I discussing the history of goiters in a dental journal?
by Mary Hamburg, DDS, MS
her teeth. I recommended a uoride regimen, and in which she at once declined treatment and went on to explain how toxic uoride was. I am not going to lie - it was hard to keep a straight face as she declined uoride with her mouth clearly showing the outcome of a zero- uoride mentality.
A public health approach curtailed a public health crisis with a simple cheap adjustment to people’s daily diet: ionized salt. A goiter is a swelling in the thyroid gland caused by hypothyroidism due to a lack of iodine in people’s diet. e midwestern areas like Michigan had the highest rates due to a lack of iodine in the ground water and plants. us, when iodine was added to the dietary salt in Michigan alone, it reduced the rate from 30% to 2% in 10 years.
Addressing widespread diseases with minimal intervention from a community health perspective is bene cial to all communities. Today, the bene ts of a government agency adding supplements to food or water is negated with one viral take on the internet allowing disinformation to overwhelm the scienti c knowledge and facts that support the intervention. We all remember the Net ix show about root canals causing breast cancer from a few years ago, and we are all still seeing those e ects today. And while water uoridation is not a new ght to the dental community, it is one that is building steam in our Oklahoma communities.
My least favorite discussion in dentistry is with a patient who has a terminal dentition due to decay. Yes, we could save the teeth with a complete remake in your oral health regimen, or we can remove all the teeth. My patient a few weeks ago was pondering this scenario when she asked what she needed to do to keep
e introduction of uoridated water in 1945 was not the start of water uoridation in the US. Water uoridation is quite common naturally or organically, and it is also gluten free! It is the 13th most abundant element on Earth available in water and air. We cannot escape it. And when added to water that is lacking it naturally, uoridation has shown to reduce caries risk by 50% in the general population. Fluoride not only strengthens teeth but also reduces the pH of the oral cavity, limiting bacterial growth. It is shown to bene t children and adults throughout their lifetime, saving nancial cost to the patient and improving quality of life.
I know I am preaching to the choir when spouting the bene ts of uoride, but the time is now to back up what we know to be bene cial to our patients in our communities. We need to have hard discussions with our neighbors and community leaders about the bene ts of uoride in the water and put at ease the unfounded fears of toxicity. Patients will ignore the talking head on their phones when the dentist that took care of them as a child explains why uoride is important and why you are an advocate for it. And it is not because we get a big check from the uoride industry.
Continued on page 7
Mary Hamburg, DDS, MS (right) serves as Editor of the Oklahoma Dental Association Journal.
It’s because we want to minimize the number of children needing dental care and adults that are going without teeth. Both improve the nancial and socioeconomic status of our communities.
Community health initiatives have vastly improved the lives of the public with limited cost. In 1998, folic acid was added to the forti ed grains in the US/Canada a er it was noted that women and children did not have enough in their diet. e main concern was neural tube defects in children, causing diseases like spina bi da. Since the introduction of folic acid in 1998, there was a 20-50% reduction in children born with the disease. Another advantage of additional folate in the diet with B6 and B12 is that it can reduce
heart disease, stroke, dementia and Alzheimer’s by checking the production of homocysteine reducing healthcare costs for pennies on the dollar.
For a public intervention to work, we need to make sure the public understands why the intervention is necessary. Not to say there are not pros and cons, but when the bene ts vastly outweigh the consequences, then it is up to the medical and dental communities to speak up in support for the good of our communities. Water uoridation is a valuable and necessary bene t to our communities, providing nancial and economic gains to Oklahoma. Please help us make sure the people of Oklahoma understand the consequences of removing uoride from our water treatment processes.
Dr. Mary Hamburg is a graduate of OU, completing her dental, periodontal, and AEGD training at the College of Dentistry. She practices as a board-certi ed periodontist in Midwest City and Lawton, and as an Assistant Clinical Professor at OU College of Dentistry she serves as the Director for the Advanced Education in General Dentistry (AEGD) program at OUCOD. She is a Fellow of the American College of Dentistry and the Pierre Fauchard Academy. Dr. Hamburg is a member of the Oklahoma Dental Association Board of Trustees, currently serving as Editor of the ODA Journal. She also serves as an executive board member of the Oklahoma Association of Women Dentists and the Smile for Success Foundation with the America Association of Women Dentist. She has lived in Norman, Oklahoma for over 10 years with her husband Dustin and their two boys Daxton and Caden.
STATE ASSOCIATION NEWS
Executive Director Addresses House of Delegates
Lynn Means
Executive Director Oklahoma Dental Association
What follows is a transcript of the Executive Director's verbal address to the House of Delegates meeting on Saturday, April 12, 2025.
And, speaking of the ODA Annual Meeting, let’s just get the bad news over with rst. Pre-registration was down again this year – 42% less than our preregistration number just last year. And only an additional 59 registered onsite, making a total registration of 339 this year, down 40% from last year.
e 2024 Annual Meeting was down 45% from 10 years ago – and 57% from 15 years ago. is is no one’s fault and Oklahoma is certainly not alone in this. Every state is facing the same challenges with their meetings, as well as the ADA. We discussed the Annual Meeting in depth during our Strategic Planning session last June, and I know Dr. Duncan is already making some preliminary plans dependent upon the outcomes of some decisions facing this body later in the agenda. What is plainly evident is that some major changes need to be made.
Good a ernoon, ODA Delegates and O cers! I want to extend a very special welcome to our ADA guests – Drs. Rosato, Reavis, Tulak-Gorecki and Boyle – thank you again for being with us today! And our FAVORITE ADA Board member, our very own Dr. Tamara Berg, ADA 2nd Vice President!
And Delegates, THANK YOU for taking time from your families and practices to represent your Component during this important meeting today. I’d also like to thank everyone who also serves on an ODA Council or Committee. We appreciate the extra time you contribute to the ODA. We tried something new this year, based on your feedback, and scheduled the House of Delegates at the end of the ODA Annual Meeting. We would love your additional feedback on the new schedule, so feel free to shoot me an email and let us know your thoughts.
e ODA Annual Meeting is no longer sustainable in its current format, and sadly, the vast amount of Association nancial and sta resources devoted to keeping it a oat might be better spent on programs our members actually want and need.
As Dr. Rogers just reported, reserve funds currently represent over 162% of the proposed 2025 operating budget, well above the required 30%. I want to commend the Budget and Finance Council for making some tough decisions when building this year’s budget, as well as your Investments Committee for closely watching your investments and making strategic decisions regarding the Association reserves throughout the year.
Let’s shi to membership: We gained 111 new members in 2024, 89 of which were new graduates, 5 graduate students, and 17 members who came back to us a er lapsed memberships.
We nished 2024 with a 72% market share of the almost 2,200 total licensed dentists in Oklahoma. Although the market share is down from 2023, the number of licensed dentists in Oklahoma increased by over 100. And our total number of members and full dues equivalent numbers were both slightly up. It’s also important to note that we processed 12 retired applications in 2024 and have already processed 11 since January 1st of just this year. And that trend will continue for the next several years.
But please know, we NEVER stop recruiting. Every member we are successful in retaining should be celebrated and I am enormously proud of our one-woman membership team, Ansley Jinkins, for these numbers. We work hard all year executing numerous recruitment and retention campaigns: emails, direct mail, texts, and personal phone calls. But it is getting increasingly di cult to appeal to younger dentists, especially those working in large group practices where the value of membership is more di cult to demonstrate. You hear me say this every year, but WE NEED YOUR HELP.
e list of 2024 non-renews is in your packet. As leaders in your Component, please reach out to these colleagues and encourage them to renew their membership. Member-to-member outreach is BY FAR our BEST o ense in building and maintaining a healthy market share. THANK YOU in advance for your help with our recruitment and retention e orts.
Since 2010, Oklahoma dentistry has come together to provide $17.9 million in donated dental care to more than 21,000 patients in need through the Oklahoma Mission of Mercy. Mark your calendar now for OkMOM 2026, February 6 & 7, in Enid!
STATE ASSOCIATION NEWS,
And thank you to Dr. Chris Fagan for spearheading next year’s mission as we return to his hometown!
e 2025 mission in Tulsa was nanced by a one-time-only ARPA grant from the State Legislature, and we are very grateful for that gi . 2026 is on us, so that makes our gi s to the OkMOM Legacy Fund more important than ever. Again, a HUGE thank you to Dr. Tim and Pamela Fagan and everyone who has given so far! While the treatment during OkMOM is completely donated, there is still a substantial cost of about $250,000 to operate the event each year. If you haven’t yet joined the OkMOM Legacy, please help us continue the life-changing work done every year by making your gi today. A special way to donate this year is our new Celebrate MOM with a Mission campaign. Please nd a yer in your packet that explains how you can honor your mother, or any other woman in your life, by making a one-time donation to honor or remember her. We will publish this special list of donors and their mothers in the next issue of the Journal. Again, THANK YOU to everyone who has already given! Together, we will ensure essential dental care continues to be provided during the Oklahoma Mission of Mercy.
years. One thing to come out of that will be a Workforce Task Force that Dr. Duncan is convening next month to address the hygiene and assistant shortage in Oklahoma. If you have thoughts on the trajectory for that Task Force, she’d love to hear from you!
is past February in Tulsa was a huge success! A special thank you to Drs. Lindsay Smith and Rieger Wood for reprising your roles as OkMOM cochairs.
I also want to express my deepest gratitude to the Oklahoma Dental Foundation for serving as the ODA’s true partner in all things OkMOM! We could not do it without them.
Later in today’s agenda, you will be considering adoption of the next ODA Strategic Plan. We had a great session back in June when 25 members, students and sta , led by experts from the ADA, came together to map out the Association’s work for the next three
e ODA has several legislative priorities for 2025: the rst, is our third attempt to establish a dental loss ratio (or DLR) in Oklahoma. DLR is the dental insurance premium revenue that is spent on actual patient care instead of operating costs like marketing and executive salaries. In other words, we are trying to pass a law that dictates the minimum percentage they have to pay out in actual patient care. e average dental loss ratio is right around 50% in Oklahoma right now. Representative T.J. Marti, who you met earlier, and Senator Kristen ompson, our other Legislator of the Year, ran identical companion, and very aggressive, bills that would have set the DLR at 85%, required companies to rebate back to premium payers when they didn’t meet the DLR, and would have rede ned “covered services” in Oklahoma to tighten the already-existing law we passed in 2010. e new de nition would have closed the loophole that says our law does not apply in certain situations like frequency limitations, or when a patient has reached his/her maximum. Senator Bill Coleman, Chair of the Senate Insurance Committee, is running his own insurance-requested version of a DLR bill that has absolutely NOTHING in it and does NOTHING to help your patients.
for attending those meetings with us and bringing real-world experience to the conversation. A compromise was struck that will require insurance companies to start reporting their DLR to the Insurance Commissioner with very speci c parameters – what they can and cannot include in their DLR –which will, at least, bring transparency to an unregulated industry, and will help identify the bad actors in the market.
So, fast-forward to this week … Representative Marti’s bill, HB 2805, which now contains the agreed-upon, compromised language, has passed the House and is now in the Senate.
So, we have these two DLR bills – one that has everything we want, and one, requested by the insurance industry, that does less than nothing. Early in session, we were summoned by Senator Coleman to a series of stakeholder meetings to see if we could negotiate something with which everyone can live. A quick thank you to Drs. Brian Drew, Krista Jones and Shannon Gri n
And Senator Coleman’s bill – the one with absolutely NOTHING in it – has passed the Senate under false pretenses because he kept telling everyone that a substitute bill with the new language was coming, and it never did. But they kept passing it with “title o ” because they trusted him that the new language was coming. It now sits in the House. What we need now is for Senator Coleman to honor the discussions HE insisted we have back in February and allow HB 2805 – our bill – to be considered in Committee. So far, he has not done that and is showing no signs that he intends to. Here is Senator Coleman’s contact information. Please write it down and call AND email him rst-thing on Monday and ask him to hear HB 2805 in Committee with TITLE ON. We don’t want him for a second to say he didn’t hear from any dentists on this issue. It is our #1 priority, and we want to make sure he knows that.
Unfortunately, one of the items we were forced to give up as part of our compromise, was dropping the new de nition of non-covered services, so that was back-burnered to next year.
Continued on page 11
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STATE ASSOCIATION NEWS,
We WILL continue to ght for that change because it’s just good policy.
e ODA also actively supports HB 1366, which will codify the Board of Dentistry’s supported dental compact in Oklahoma, which will aid in dentist and hygienist portability between states.
I want to thank the ADA for a generous State Public A airs grant that is allowing us to outsource a robust educational campaign regarding the need for meaningful dental insurance reform. Hopefully, you’ve seen the letters to the editor and opinion pieces by ODA members published in newspapers across the state, as well as the social media campaign aimed at educating legislators and the public.
And before we leave the topic of advocacy, I must mention that it is extremely important that you contribute to DENPAC every year. DENPAC is the way we MAKE and KEEP friends in the Legislature. Your personal investment each year goes a long way in helping the ODA protect your profession. If you haven’t done your part by giving this year, please visit the DENPAC table to make your contribution today!
Also, if you are not receiving the ODA legislative alerts either by email or text, that means we do not have your cell number or a current email address (one that YOU actually see and read – not an INFO AT email address that goes to your o ce manager). Please help us communicate with you by updating your information. We need every ODA member engaging in our legislative e orts to protect your profession and that is not possible if we can’t e ectively communicate with you.
YOU are the key to our legislative success. Grassroots lobbying is THE MOST e ective way to get legislators to act on our behalf! We ask that you continue to foster strong relationships
with your legislators YEAR-ROUND because we will de nitely be coming back EVERY year to ensure necessary policies are addressed, and the voices of the dental profession are heard!
We have some great CE programs coming up in May! In your packet, you’ll nd information about our Botox and Dermal Fillers course open to all dentists and hygienists on May 2 & 3, our CPR course for the whole dental team on May 16, and the Inaugural Robie Herman CE and Golf Tournament, bene tting DENPAC, on May 30 in Edmond.
And we are looking for hole and other sponsorships for the tournament, so even if you can’t or don’t play, there are still ways you can o er your support.
Enrollment in the ODA Leadership Academy is now open! e ODA Leadership Academy is a statewide program designed to develop future leaders in organized dentistry by preparing them to be future leaders at the national, state and Component levels. Candidates should have a sincere interest in strengthening their community and the dental profession. Each Class is intended to be comprised of one to three dentists from each Component, with all seven components represented being our ultimate goal. Applications are available now and if you’re interested in learning more, see Ansley at the DENPAC table and visit with your component president about sponsoring you. e 2026 Class of the ODA Leadership Academy will graduate during this meeting next year in Norman.
If you are an ODA Leadership Academy graduate, please stand so we can recognize you.
e ODA Rewards program o ers member-only discounts on products and services you use every day in your practice and even at home, while providing the ODA non-dues revenue generated by member use.
Did you know that if you took advantage of every discount o ered by our Rewards Partners, you would save an average of over $16,000 in just one year? at is TWENTY-NINE times your ODA dues! In 2024, the ODA received over $115,000 in royalties from our Rewards Partners – and that saved you $122.00 EACH in membership dues this year!
Please nd a list of ODA Rewards Partners in your packet. If you are buying from other companies, you are absolutely paying too much!
To the ODA Board of Trustees – thank you for your leadership, exibility, and support over the past year.
I have thanked many people today, but the MOST gratitude will always go to my teammates … Shelly, Ansley, and Jill. ey make me look good, but more importantly, they make YOU look good! I am grateful for their exibility, resourcefulness, creativity, generosity, patience, and their commitment to excellence. You can rest easily knowing your ODA is in the MOST capable hands! And, just a side note, TODAY marks Shelly’s TWENTYTHIRD year with the ODA!
And nally, I am so grateful to do something that still inspires me and allows me to experience professional growth and personal joy every day. e sta can attest to the fact that I always tell prospective employees during the interview process that we work FOR and WITH the most generous people, and I mean that. When I count my many blessings, the ODA is always among them. THANK YOU for the opportunity to continue to serve as your Executive Director.
STATE ASSOCIATION NEWS
2025-2026 Officers Installed
e Oklahoma Dental Association o cially installed its new slate of o cers during the annual House of Delegates meeting held April 12, 2025, in Tulsa. ese dedicated leaders will serve the Association and its members through May 2, 2026, helping guide the ODA’s mission of advancing the art and science of dentistry and promoting the oral health of Oklahomans.
Dr. Twana Duncan was installed as ODA President and will lead the organization in the coming year. She is joined by Dr. Nicole Nellis as President-elect, Dr. Colin Eliot as Vice President, Dr. Sydney Rogers as Secretary/Treasurer, and Dr. Matthew Bridges as Speaker of the House. Dr. Daryn Lu now assumes the role of Immediate Past President.
e House of Delegates, ODA’s governing body, convenes annually to shape policy, recognize leadership, and discuss the future of dentistry in Oklahoma. e 2025 o cer installation marked a moment of transition and continued progress, as these accomplished professionals take the helm during a dynamic time for the profession. Members can reach each o cer through their o cial ODA email addresses found on page 4 to share concerns, ask questions, or get involved.
The 2025-2026 ODA Officers (left to right): Dr. Twana Duncan, Dr. Nicole Nellis, Dr. Colin Eliot, Dr. Sydney Rogers, and Dr. Matthew Bridges.
STATE ASSOCIATION NEWS
Welcome ODA's Newest Team Member
e Oklahoma Dental Association is excited to welcome Katie Douglas to the team as our new Communications and O ce Manager, o cially joining the sta on May 12. In this dynamic role, Katie is responsible for overseeing the day-to-day operations of the ODA o ce and providing vital support to the communications and marketing team.
Katie is a proud graduate of Oklahoma State University, where she earned her Bachelor’s degree in Strategic Communications with an emphasis in Public Relations. Her background and passion for clear, engaging communication make her a natural t for this position, which bridges internal operations with external outreach.
In her new role, Katie manages the ODA’s social media platforms, supports the creation of digital newsletters and email communications, updates the association website, and contributes writing and graphic design support for publications like the ODA Journal. She also plays an important role in events, and membership initiatives. On the operational side, Katie serves as the primary o ce contact, maintains records and databases, manages vendors and supplies, and helps coordinate the Mediation Review Program.
Outside the o ce, Katie serves on the Make-A-Wish Young Professionals Board and enjoys discovering local hidden gems, attending live music events, and spending time with friends and family.
Combining over 70 years of experience and state-of-the-art technology to provide your patients with the best endodontic care.
Katie Douglas Communications and Office Manager
Myron S. Hilton D.D.S., M.P.H.
Brandon Schultz D.D.S.
Zane Dubberstein D.D.S., M.S.D.
Brent Haynes D.D.S.
Dayna S. Duke D.D.S.
BEYOND THE ARCH
The Gingiva-Brain Axis: What Gum Disease May Tell Us About Neurodegeneration
Can periodontal pathogens trigger the onset and progression of Alzheimer’s disease? Emerging research suggests a signi cant connection between oral health and neurodegenerative diseases, particularly Alzheimer’s (Ryder, 2020). is article explores the role of speci c periodontal pathogens in the development and progression of Alzheimer’s disease, highlighting the importance of oral health in cognitive function.
Oral Pathogens and Neuroin ammation
Studies have long broached correlation, but emerging research is now considering causative links between oral pathogens and brain health. Much like the discovery process linking gum and heart disease, it delves beyond mere "healthy habits create healthy people" reasoning and deep into our interconnected microbiology.
disease, has been discovered in situ in postmortem brain tissue of Alzheimer's patients, suggesting it can cross the blood-brain barrier (BBB) and lead to neuroin ammation and Aβ plaque formation. Its toxic enzymes, known as gingipains, have also been identi ed in the brain, and they degrade host proteins, disrupt immune responses, and facilitate bacterial invasion (Dominy et al., 2019). Gingipain levels correlate with tau protein pathology, a hallmark of Alzheimer’s disease, and promote Aβ plaque aggregation.
A murine study linked oral P. gingivalis infection to its brain colonization and Aβ production, con rming BBB penetration (Ilievski et al., 2018). A separate study on periodontal pathogen aggregatibacter actinomycetemcomitans (Aa) found its extracellular vesicles (EVs) not only cross the BBB but can provoke the secretion of pro-in ammatory cytokines like IL-6 and TNF-a. In this study, these EVs migrated through the trigeminal ganglion, altered neuronal ring patterns, and were implicated as pathogenic pathways for systemic and neuroin ammatory diseases (Ha et al., 2023).
Neuroin ammation and Aβ plaque have long been indicators of Alzheimer's pathology, but where do they originate? Porphyromonas gingivalis (P. gingivalis), a widelyknown key pathogen in periodontal
A few other plausible BBB-penetration mechanisms include:
• Perio-induced bacteremia (bacteria in the bloodstream) and its endothelial cell interaction (Dong et al., 2023)
• Cytokine and pathogen-induced systemic in ammation weakening the BBB's tight junction integrity (Demirel et al., 2024)
• Phagocytosed oral pathogens transported via immune cells like microbially mutinous Trojan horses (Dominy et al., 2019).
A 2021 systematic review found statistical signi cance (p = 0.02) in the increase of fusobacterium nucleatum (F. nucleatum) in Alzheimer's
by Stacy Sigler, RDH
patients, with its incidence linked to P. gingivalis, et al. Notably, the presence of periodontal disease at baseline was associated with a sixfold increase in the rate of cognitive decline over a 6-month follow-up period (Borsa et al., 2021), suggesting periodontal disease can a ect not only Alzheimer's etiology but also its prognosis.
What can the dental community do about this?
We start by reducing in ammatory bacterial loads through education and comprehensive care. Vigilance in prevention and diagnosis are constant suggestions because they are constant neglections. One-third of periodontal cases are misclassi ed (Bunmi Tokede et al., 2024). According to the Journal of Clinical Periodontology, among patients at risk for severe periodontitis—half of whom had seen a dentist within 6 months—only 18.8% believed they had gum disease. While no formal studies reveal how o en a clinician completes periodontal charting, the aforementioned statistics are revealing. It suggests we either aren’t diagnosing accurately or educating e ectively. When patients don’t understand oral disease, they rarely prioritize it. Perhaps we reframe oral hygiene instruction, nutritional counseling, or health history review to include this new risk factor’s role.
Documentation can be crucial when reviewing changes that could re ect cognitive decline, such as: behavioral changes, memory changes, speech patterns, gait, dietary changes (Alzheimer's caregivers report a 33.3% increase in sugary food preference, per the journal Healthcare in 2024), and decline in oral health. Interdisciplinary collaboration between dental and medical professionals remains a crucial, underutilized tool, and documentation can help bridge the gap.
Stacy Sigler, RDH
BEYOND THE ARCH, continued
Induction of blood–brain barrier breakdown and amyloid deposition by P. gingivalis in cerebral blood capillaries. Journal of Inflammation Research, June 2020
Building compassionate, invested rapport with patient families can be why so many dental clinicians have saved lives by spotting signs of cancer, autoimmune diseases, bone diseases, stroke risks, and more. Why shouldn't we add neurodegenerative diseases to our repertoire? e critical role of oral health in cognitive function underscores the potential for dental professionals to contribute to early detection and prevention of Alzheimer’s disease. Dentistry not only restores smiles but has the opportunity to preserve minds. Let’s not miss that opportunity.
REFERENCES
Borsa, L., et al. (2021). Fusobacterium nucleatum and Alzheimer’s disease: A systematic review. Journal of Alzheimer’s Disease, 83(2), 501–514.
Demirel, A., et al. (2024). Systemic in ammation and blood-brain barrier integrity: e role of periodontal pathogens. Neuroimmunology Reports, 19, 100993.
Dominy, S. S., et al. (2019). Porphyromonas gingivalis in Alzheimer’s disease brains: Evidence for disease causation. Science Advances, 5(1), eaau3333.
Dong, X., et al. (2023). Porphyromonas gingivalis induces blood-brain barrier permeability via Mfsd2a/Caveolin-1 mediated transcytosis. International Journal of Molecular Sciences, 24(2), 1234.
Ha, P. T., et al. (2023). Aggregatibacter actinomycetemcomitans vesicles disrupt blood-brain barrier via the trigeminal ganglion. Frontiers in Cellular Neuroscience, 17, 1056234.
Healthcare. (2024). Nutritional trends in Alzheimer’s caregiving: A population-based review. Healthcare, 12(3), 413.
Ilievski, V., et al. (2018). Chronic oral application of a periodontal pathogen results in brain in ammation, neurodegeneration, and amyloid beta production in wild type mice. PLOS ONE, 13(10), e0204941.
Journal of Clinical Periodontology. (2021). Patient awareness of periodontal disease and
Ryder, M. I. (2020). e future of periodontal-systemic associations: Raising the bar. Periodontology 2000, 84(1), 9–13.
Tokede, B. O., et al. (2024). Diagnostic misclassi cation in periodontal charting: An evaluation of accuracy in general dental practices. Journal of Dentistry, 140, 104682.
ABOUT THE AUTHOR
Stacy Sigler is a lifelong Oklahoman and graduate of the University of Oklahoma College of Dentistry. She holds dual bachelor’s degrees in science and business, and she practices at Downtown Dental in Oklahoma City. Stacy has been married since 2012 and has two fur kids. She enjoys traveling, cooking, sports, volunteering, and learning anything new—especially when it comes to healthcare.
End-of-Session Legislative Update
At the start of session, we introduced HB2805, a Dental Loss Ratio (DLR) bill authored by Rep. TJ Marti and Sen. Kristen ompson. Meanwhile, the insurance industry led SB1101, with Sen. Bill Coleman serving as its author.
HB2805, with its original language, passed out of the House Insurance Committee with the understanding that changes would be made later. A er two weeks of discussions, a compromise was proposed consisting of a less aggressive form of DLR, along with a rede nition of covered services that would have xed the loophole in our 2010 law; however, the insurance industry agreed only to the new DLR language and opposed the inclusion of the noncovered services x.
Rep. Tedford, the House author of SB1101 and Vice Chair of the Commerce and Economic Development Committee, made it clear he would not hear HB2805 if noncovered services remained in the bill, leading to its removal. With noncovered services removed, HB2805 then passed the House Oversight Committee. Meanwhile, Sen. Bill Coleman presented SB1101 in the Senate Insurance and Business Committee, stating an agreement had been reached
and that new DLR language would be inserted into the bill.
HB2805 passed the House, and SB1101 passed the Senate without the agreedupon oor amendment. When the bills moved to the opposite chamber, Senate Business and Insurance Chairman Bill Coleman refused to hear HB2805, making it dormant under legislative rules. HB2805 will not advance this session but remains eligible for consideration next year. Similarly, Representative Tedford laid over SB1101 in committee, causing it to also become dormant under the rules.
Although this is all very disappointing for you and your patients, our e orts this session saw a higher member engagement than ever before, clearly communicating to our lawmakers that establishing a meaningful DLR in Oklahoma is of utmost importance to dentists across the state and the patients you serve. Your many, many calls and emails also resulted in a much better educated Legislature and a stronger foundation from which to begin our e orts next year. Dental Loss Ratio is simply good policy for all the Oklahomans who are paying higher
by Lynn Means, ODA Executive Director
and higher premiums while insurance companies are routinely allowing less and less care.
THANK YOU for your e orts! THANK YOU for your engagement! YOU are the key to our legislative success. Grassroots lobbying is THE MOST e ective way to get legislators to act on our behalf! We ask that you continue to foster strong relationships with your legislators YEAR-ROUND because we will de nitely be coming back every year to ensure necessary policies are addressed, and the voices of the dental profession are heard! Please take quality time over the next year reaching out to your State Senator and Representative. Invite them to your o ce or buy them a cup of co ee and introduce yourself. Tell them how this law would positively a ect your patients and your small business. Advocacy does not end when the legislative session ends. e most important time is in the o season. MAKE FRIENDS WITH YOUR LEGISLATORS. Make sure they know who you are and where you practice, so when you call/email during session, you are talking to a friend.
LEGISLATIVE LOOP
ODA's Legislator of the Year Awards
ODA Immediate Past President Daryn Lu, DDS presents Rep. T.J.
(R)-District 75 with the Legislator of the Year Award at the Annual Meeting in Tulsa.
Marti
ODA Executive Director Lynn Means presents Sen. Kristen Thompson (R)-District 22 with the Legislator of the Year Award at the Oklahoma State Capitol.
Passion, Purpose, and Service: Introducing ODA's 2025-2026
President, Dr. Twana Duncan
Dr. Twana Duncan is a selfproclaimed "military brat." Her father served 22 years in the U.S. Air Force, and the family moved o en—from Texas to California, Maryland, Nebraska, and eventually back to Oklahoma. is nomadic lifestyle fostered her lifelong love of travel and adventure.
“I’ve visited all y states and numerous countries,” she says. “My goal is to keep that list growing.”
A er retiring as a Senior Master Sergeant (SMSGT), her father moved the family to McCurtain County, Oklahoma. Her mother began a second career as a special education teacher. Dr. Duncan attended 13 di erent schools before graduating from Haworth High School, an experience that helped her become outgoing and adaptable.
“I learned to make friends easily and have maintained friendships for over y years,” she shares. “Without strong friendships and positive relationships, I wouldn't have survived this career. Dentistry is hard, but being part of an amazing team, having forever friends I made in dental school, and relationships I’ve formed through organized dentistry—ODA, AAPD, AAWD, and AOS—make this career rewarding and bearable.”
“Together our voices are stronger. We need each other to learn, grow, and prosper.”
Dr. Duncan graduated with honors at age 17 and attended Southeastern Oklahoma State University on an academic Parsons Scholarship. She declared a double major in chemistry and biology and earned her bachelor’s degree in just three years. While attending the University of Oklahoma College of Dentistry (OUCOD), she joined the Oklahoma Women’s Dental Organization Student Chapter. It was through this mentoring program that Dr. Mary Martin encouraged her to serve as president of the student chapter and helped her and her classmates attend ADA meetings.
“She taught me the importance of organized dentistry,” Dr. Duncan explains. “Together our voices are stronger. We need each other to learn, grow, and prosper.”
A er graduating from OUCOD in 1991, Dr. Duncan joined the U.S. Naval Reserve. Her goal was to serve her country, build her clinical skills, and re ne her cra . From 1991 to 1994, she worked as the junior o cer in charge at the Naval Air Station Dental Clinic in Kingsville, Texas.
by Jill Johnson, ODA Staff
Dr. Duncan addresses the House of Delegates in her first speech as the 2025-2026 ODA President.
Once her Navy service was complete, she purchased an existing practice in Antlers, Oklahoma, a er the previous dentist relocated.
“I hadn’t seen a single child during my Navy service, but on my rst day in private practice, I completed my pediatric requirements—and I loved it,” she recalls. “My practice grew quickly because I was passionate about treating children and patients with special needs.”
Dr. Duncan learned sign language as a child to communicate with a cousin who was born deaf, and this skill has become a blessing in her practice.
Continued on page 20
Additionally, several of her team members are bilingual, helping the o ce better serve a broader range of families.
“ e ability to turn my practice into a place that feels safe—not just for patients, but for my employees and fellow doctors—has been one of the most surprising parts of my journey,” she re ects. “I have patients who have been with me since 1994. Some of my employees have been with me that long, too. I started with three employees. Now we’re a team of 30.”
She attributes this growth to early recognition that running a successful dental practice requires dedication and passion from every team member.
“Dentistry isn’t something you go into expecting everyone to be thrilled to see you—especially not kids,” she says. “But that’s the whole point. We focus on children who are scared. We treat special needs patients, young and old, because we know how few providers are willing to see them.
We want foster kids in braces because, for at least 24 months, they’ll see us every 6–8 weeks. If that’s the only consistency in their lives, we’ll gladly provide it.”
She continues, “It’s a privilege when a child puts their trust in you. ey might not always brush or remember their rubber bands, but especially teens in the system—they crave acceptance, guidance, and care, even when they don’t know it. My o ce can be that place for them.”
Her proudest day in dentistry came when her son, Dr. Caleb Smith, joined the practice.
“Watching him choose dentistry and be passionate about serving Southeastern Oklahoma is a dream come true,” she says.
Her joy multiplied when his classmate, Dr. Haley Harrington (OUCOD Class of 2022), joined the practice, as well. Dr. Harrington is the daughter of Dr. Wes Nipper of Ponca City.
“The ability to turn my practice into a place that feels safe has been one of the most surprising parts of my journey.”
Dr. Duncan served as a team lead for Pediatrics at the Oklahoma Mission of Mercy this year. She poses here with her team (left) and dental school classmates Dr. Todd Johnson and Dr. Jeff Ahlert (right) at the 2025 event in Tulsa.
Beyond her practice, Dr. Duncan and her team are deeply committed to volunteerism and community support. Each year, her o ce donates to more than 25 area schools, supporting athletics, band, cheerleading, choir, and special needs events. She also sponsors a scholarship at SEOSU for future dental students, donates to the J. Dean Robberson Society, and serves on its governing board. She also interviews candidates for the OUCOD admissions committee.
In 2023, Dr. Duncan was named Pushmataha County’s Citizen of the Year, an honor she attributes in part to her long-term goal of revitalizing Antlers City Park. Her practice donated $34,000 in playground equipment. e City of Antlers and the Choctaw Nation matched
the gi , resulting in a $100,000 transformation of Little People’s Park.
Her team also volunteers annually with the Oklahoma Mission of Mercy, participates in the D-Dent program, works with the VA and Tribal Nations, and even sta s the concession stand at local football games each season. In recognition of her dedication, Dr. Duncan received the 2023 OUCOD Alumni of the Year Award and the 2024 ODA Public Service Award.
While her passion for dentistry remains strong, Dr. Duncan’s focus has expanded as she takes on her new role as President of the Oklahoma Dental Association.
“I want this organization to thrive and remain meaningful to its members,” she says. “ e ODA has a unique opportunity to grow in membership, to lead in dental education, and to address workforce shortages and mental health struggles a ecting our members and their teams.”
She also emphasizes the need for continued legislative advocacy.
“We must push forward on passing legislation that protects patients— especially regarding dental loss ratio requirements for insurance companies.
Continued on page 23
Dr. Duncan with her husband, Jack on vacation in Ibiza.
Dr. Duncan with her grandson who let her pull his first tooth!
Too many plans avoid accountability, and we can’t let that continue. e only way we stay in the conversation is to remain actively involved.”
Dr. Duncan is clear about her priorities for the year: strengthening relationships, championing underserved communities, and ensuring all members feel seen and supported.
“I hope our board can make every member feel important and valued, whether you’re in a rural or urban area, private practice or a DSO, general dentist or specialist,” she says. “If you want to be more involved in the ODA, please reach out to me at twanaduncandds@sbcglobal.net. We need you.”
For Dr. Duncan, the future of dentistry—and her presidency—is a matter of determination, grit, and oldfashioned grassroots elbow grease.
With over 30 years of experience as a general dentist in Southeastern Oklahoma, Dr. Twana Duncan continues to lead by example. She’s immersed herself in her community and profession, proving time and
“As long as we’re kind to one another, we’ll all flourish."
again that dentistry is a cra that can be continuously improved—and that the best tools are kindness and love.
“As long as we’re kind to one another,” she says, “we’ll all ourish.”
Twana Duncan, DDS (third from left) on vacation with friends from dental school: Dr. Katherine Kelly, Dr. Lynn Jensen, Dr. Debbie Corwin, Dr. Janna McIntosh, Dr. Martha Carr, and Dr. Trena Stewart
Dr. Duncan with her family on a Disney vacation.
OFFICE SPACE
Building the Dream: Dr. Jarrod Lack’s New Office Elevates Dentistry in Enid
For Dr. Jarrod Lack, building his new dental o ce in Enid, Oklahoma wasn’t just about upgrading—it was about realizing a long-held dream. An Enid native, Dr. Lack had always wanted to return home to practice.
“I’d always envisioned creating a space that was exactly how I wanted it,” he shared. at vision came to life in his newly built o ce, designed not only to meet the growing needs of his practice, but also to re ect his passion for advanced dental care.
e driving force behind the new space was Dr. Lack’s increasing focus on large implant cases. ese complex procedures required larger, surgery-focused operatories and a fully equipped lab. Today, his new o ce features a high-tech lab out tted with a zirconia mill, a 3D printer, and a dedicated workspace for a lab technician—an essential hub for cra ing surgical guides, splints, dentures, and more. “ e e ciency and accuracy of 3D printing has been a great service for our patients,” he said.
From the moment patients walk through the door, they’re welcomed into a clean, modern, and pristine space—designed to immediately convey the quality and care that de nes Dr. Lack’s approach to dentistry. Every detail of the o ce was cra ed with the patient experience in mind, creating an environment that feels both professional and comfortable.
by Jill Johnson, ODA Staff
Photos provided by Jarrod Lack, DDS
While the results have been rewarding, the process wasn’t without its challenges. Chief among them? Finding the right dental professionals to share the space.
“Recruiting dentists to a more rural setting has proven to be di cult,” Dr. Lack admitted. Still, the o ce was built with the future in mind— designed to eventually welcome two additional dentists to work alongside him.
e impact of the renovation has already been signi cant. e expanded space allowed Dr. Lack to launch Enid Dental Implants, a side business focused exclusively on lifechanging full-mouth restorations. With advanced technology and a dedicated focus, his practice is now equipped to o er specialized, high-quality care that truly makes a di erence in people’s lives.
“I’m proud of what we’ve created,” Dr. Lack said. “ is o ce isn’t just a building—it’s a re ection of our commitment to providing the best care possible, and to growing our practice in a way that serves our community for years to come.”
TLC Dental
Dr. Jarrod Lack, DDS
3915 West Willow Rd. Enid, OK 73703
tlcdentalenid.com
ADA NATIONAL NEWS
30 years later, Oklahoma City Ceremony Honors Dentists Who Aided in Bombing Response
by Mary Beth Versaci
irty years ago, in the a ermath of the Alfred P. Murrah Federal Building bombing in Oklahoma City that le 168 people dead, dentists worked 12-hour days for more than two weeks to help identify the victims. ose dentists were honored March 30 as part of A Day of Remembrance at the Oklahoma City National Memorial & Museum.
e ceremony was organized by the Oklahoma County Dental Society, Oklahoma Dental Association, Oklahoma County Medical Society, Oklahoma State Medical Association and Oklahoma Osteopathic Association. e organizations presented 14 dentists and 68 physicians with medallions to recognize their roles in the recovery e orts following the April 19, 1995, attack.
“ e Oklahoma County Dental Society was excited to partner with A Day of Remembrance to honor those in our profession who stepped up and served during the tragedy of the Oklahoma City bombing,” society President Troy Schmitz, D.D.S., said. “ e standards set in dental forensics are still the standard for any large-scale tragedy throughout the world. ose who served never did so to be recognized but absolutely deserve to be honored."
During the event, Bryan Chrz, D.D.S., who helped to establish and run the dental identi cation section of the bombing response, recounted his memories from that time and read the names of the dentists in attendance, asking them to stand and be recognized. Not all the dentists who assisted with the response were able to attend.
“I was deeply honored to be asked to play a part in recognizing the individuals from the medical and dental community that gave aid during the bombing response,” Dr. Chrz said. “I was deeply moved by the emotions that came back to me as I toured the memorial for the rst time and spoke to those we were honoring.”
In his remarks, he shared how the response to the Oklahoma City bombing is held as the gold standard for mass disaster response. At the time of the bombing, Dr. Chrz owned a private practice in Perry, Oklahoma, and worked as a part-time assistant professor in operative dentistry at the University of Oklahoma College of Dentistry. While he and others from the dental school answered the call from the state’s O ce of the Chief Medical Examiner to lead dental identi cation e orts, other dentists referred by the Oklahoma Dental
Association and students from the dental school helped where needed as part of the massive response e orts.
“ e dental community not only provided sta ng for the identi cation unit but also were amazing in providing the necessary antemortem records for comparisons,” Dr. Chrz said. “ is outpouring of resources allowed the tremendous success of the dental identi cation operation.”
Of the 168 victims, 45 were identi ed through dental records alone while 77 were identi ed using dental records and ngerprints. Dr. Chrz said the motto in the dental unit was to treat each case as a single individual identi cation, giving each victim an equal and respectful consideration.
“It seemed we all were touched in some manner by the list of victims,” he said. “We could see the toys that the children from the day care center used. Dr. Charles Hurlburt, friend, educator and head of radiology for the OU College of Dentistry, and his wife were checking on her Social Security retirement bene ts when the building fell around their heads.”
Dr. Chrz said the responding dentists and physicians worked seamlessly together to show respect to the victims and concern for the family members. A er reading the names of the dentists during the ceremony, he o ered nal words of gratitude for their e orts.
“To these persons I have named, I repeat the message on the Survivor Tree wall: ‘To the courageous and caring who responded from far and near, we o er our eternal gratitude,’” he said.
Photo courtesy of Oklahoma County Dental Society
Dentists who helped during the Oklahoma City bombing recovery efforts stand to be recognized March 30 during A Day of Remembrance at the Oklahoma City National Memorial & Museum.
NATIONAL ADA NEWS
ADA Launches Groundbreaking Living Guidelines Program for Oral Health
In a signi cant advancement for evidence-based dentistry, the American Dental Association (ADA) has o cially launched the ADA Living Guidelines program—the rst and only known living guideline initiative focused on oral health. is landmark program is a collaboration between the ADA and the Center for Integrative Global Oral Health at the University of Pennsylvania School of Dental Medicine.
e ADA Living Guidelines program represents a transformative shi from the traditional model of updating clinical guidelines every 3–5 years. Instead, the new approach maintains the same methodological rigor while continuously integrating and publishing updates as new, high-quality evidence becomes available. is realtime model ensures that patients, dental professionals, and policymakers have more timely access to the latest recommendations supporting patient care and public health.
e establishment of the program was o cially announced today through a press release and featured coverage in ADA News, with further outreach planned via social media and additional communications.
Looking ahead, the ADA will publish quarterly updates through digital issues of e Journal of the American Dental Association (JADA). e rst recommendation from the program is expected later this year and will update the ADA’s 2017 guideline on evaluating potentially malignant disorders and oral squamous cell carcinoma in the oral cavity.
For questions or additional information, members and stakeholders are encouraged to contact ADA Tripartite Development & Relations at clientservices@ada.org.
n 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
We 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.
Dr. Spencer Hinckley and Dr. Percy Bolen
CASE STUDY
Achieving Stability in a Severely Resorbed Mandibular Ridge Using the Neutral Zone Technique
by
INTRODUCTION
Successful rehabilitation of edentulous patients with advanced ridge atrophy continues to pose a considerable prosthodontic challenge. In individuals with su cient remaining bone, stability can be achieved by positioning denture teeth over the ridge crest.1 However, in patients with severely resorbed mandibular ridges, de cient anatomy o en results in poor denture retention, reduced masticatory e ciency, and discomfort.1
e neutral zone concept attempts to mitigate these functional limitations by considering the dynamic equilibrium between oral musculature and the prosthetic form. e neutral zone is de ned as the potential space in the oral cavity where the outward pressure of the tongue balances the inward forces from the cheeks and lips.2 By integrating functional muscular patterns into the denture design, a balance can be achieved that improves not only mechanical t but also stability and retention.3
However, the widespread integration of the neutral zone technique has been limited due to its procedural complexity
and additional time investment.4, 5 Nonetheless, given the growing elderly population and the infeasibility of implant therapy in certain edentulous cases, the neutral zone technique may provide a suitable treatment alternative in rehabilitating those with severely atrophic residual ridges.4
CASE REPORT
A 60-year-old female patient presented to the Oklahoma University College of Dentistry with the chief complaint, “My dogs chewed up my lower denture, and I need a replacement” (Figure 8a). Clinical examination revealed a completely edentulous oral cavity with advanced resorption of the mandibular alveolar ridge (Figure 1a and 1b). Based on panoramic radiographic ndings and nancial considerations, an implant-supported complete denture was determined to be impractical (Figure 2). A treatment plan was proposed involving the fabrication of a conventional maxillary complete denture and a mandibular complete denture using the neutral zone technique. As the maxillary denture was fabricated using conventional techniques, this report will primarily
highlight the key steps involved in the fabrication of the mandibular denture utilizing the neutral zone approach.
Primary impressions were obtained using alginate impression material with perforated edentulous metal trays.
Custom trays were then fabricated on the primary casts to ensure a close t. Border molding was carried out using ISO functional compound.
A nal wash impression was made with poly vinyl siloxane light-bodied material.
Master casts were fabricated using the nal impressions.
A special record base with ns was made and adapted to the mandibular master cast (Figure 3).
e record base shown in Figure 3 was adjusted in the patient's mouth to ensure stability and complete seating during opening, closing, swallowing and speaking.
A mixture of grey stick compound and cake wax were so ened and placed on the record base.
Continued on page 31
Leyann Adi, Ajay Jain, DDS, and Angela Jarjoura
Figure 1a. Maxillary ridge
Figure 1b. Resorbed mandibular ridge
Figure 2. Panoramic radiograph
CASE STUDY, continued
e base was inserted into the patient’s mouth, and she was instructed to repeat the motions of swallowing, pursing lips, and licking lips to facilitate accurate recording of the neutral zone as the impression material set (Figure 4).
e obtained neutral zone impression was positioned on the master cast, where location grooves were created. Mounting plaster was then applied along the labial and lingual surfaces to create an index from which the wax rim was molded to replicate the neutral zone (Figure 5).
Teeth arrangement was completed by verifying position against the plaster index to preserve the neutral zone (Figure 6).
Wax try-in was done and stabilization of the mandibular denture was veri ed by asking the patient to speak and swallow (Figure 7).
e dentures were sent to the lab for nal processing and nishing.
e dentures were carefully evaluated and adjusted as necessary, with successful delivery demonstrated by the achievement of stability in the mandibular denture (Figure 8b).
DISCUSSION
e successful rehabilitation of edentulous patients involves the restoration of form, function, and esthetics while reconciling patientcomplicating factors1. e neutral zone technique o ers a viable approach to denture fabrication in patients with pronounced mandibular resorption through the alignment of oral musculature dynamics.1 Given the inevitability of alveolar resorption,
Continued on page 33
Figure 7. Wax try-in
Figure 8a. Before
Figure 8b. After
by Leyann Adi, Ajay Jain, DDS, and Angela Jarjoura
Figure 3. Special record base with fins
Figure 4. Neutral zone recorded
Figure 5. Plaster index with lower record base
Figure 6. Teeth arrangement with plaster index
CASE STUDY, continued
this alternative method emphasizes tooth and ange positioning that equilibrates tongue and perioral muscular forces to enhance stability without compromising function and esthetics.3, 4
Although other studies vary in procedural speci cities, the outcome of utilizing the neutral zone concept has yielded similar results. In particular, while others have incorporated upwardprojecting metal spurs into their record bases, this case employed acrylic ns for greater simplicity and ease of use.6 Furthermore, while others have utilized a putty index for wax rim fabrication and tooth arrangement, a plaster index was used in this case as a more coste ective alternative.6
Nonetheless, considerable literature supports our ndings that dentures fabricated with the neutral zone technique provide enhanced clinical outcomes including improvements in comfort, resistance to displacement, functional ease, and patient satisfaction.4, 5, 6 Even though tooth positioning may be varied compared to conventional dentures, a more natural function can still be obtained that facilitates proper tongue space, reducing food entrapment and enhancing speech clarity.3
Despite the numerous bene ts, the added chair time, procedural complexity, and de ciency in professional training have led to the under-utilization of the neutral zone technique by clinicians.4 Expanded recognition and application of this technique could substantially improve prosthodontic outcomes in the population’s growing number of edentulous individuals, providing a particular bene t to those with advanced ridge resorption.
REFERENCES
by Leyann Adi, Ajay Jain, DDS, and Angela Jarjoura
1. Kaur, A., Chhonkar, D. P. S., & Sarawgi, A. (2014). Neutral Zone Technique for Rehabilitation of Resorbed Mandibular Ridge. Journal of Mahatma Gandhi University of Medical Sciences and Technology, 1(1), 35-38.
2. Fish, E. W. (1933). Using the muscles to stabilize the full lower denture. e Journal of the American Dental Association (1922), 20(12), 2163-2169
3. Yeh, Y. L., Pan, Y. H., & Chen, Y. Y. (2013). Neutral zone approach to denture fabrication for a severe mandibular ridge resorption patient: Systematic review and modern technique. Journal of dental sciences, 8(4), 432-438.
4. Porwal, A., & Sasaki, K. (2013). Current status of the neutral zone: a literature review. e Journal of prosthetic dentistry, 109(2), 129-134.
5. Limpuangthip, N., Techapiroontong, S., & Prawatvatchara, W. (2024). A systematic review of patient-oriented outcomes following complete denture treatment: a comparison between the neutral zone technique and conventional approach. BDJ open, 10(1), 37.
6. Lukram, A., Dable, R. A., & Tandon, P. (2014). Neutral Zone-A Case Report. TMU J Dent, 1(4), 152-4.
ABOUT THE AUTHORS
Leyann Adi was born in Arlington, Texas and raised in Houston. She earned her Bachelor of Arts and Science in Nutrition, with a minor in Food and Culture, from the University of Texas at Austin. A er completing her undergraduate studies, she worked as a dental assistant before beginning her dental education. Leyann is currently a fourth-year dental student at the University of Oklahoma College of Dentistry.
Angela Jarjoura is a fourth-year dental student at the University of Oklahoma College of Dentistry. She is from Edmond and earned a Bachelor of Science in Biology from the University of Oklahoma. A er graduating, Angela plans to pursue advanced training and continue serving patients in Oklahoma.
Dr. Ajay Jain is a Clinical Assistant Professor in the OU College of Dentistry. He underwent an Advanced Maxillofacial Prosthetic hands-on training course at Southern General Hospital in Glasgow, Scotland. He has attended various national and international conferences and conducted hands-on workshops on maxillofacial prosthetics rehabilitation. He has been published in many publications, is a guest lecturer, and has guided several research projects for undergraduate and postgraduate students. He serves as a reviewer and editorial board member of various journals.
CLASSIFIEDS
PRACTICE FOR SALE
North Texas OMS Practice for Sale
North Texas is a hub of economic growth, strong communities, and a high quality of life, o ering the perfect blend of opportunity and accessibility. is well-established oral surgery practice, located between Oklahoma City and Dallas, has been serving the community for 20 years. e doctor is now seeking a successor to take over the thriving practice while they transition into retirement. Equipped with three surgical suites and two consult rooms, the practice is designed for e ciency and patient comfort.
With nearly 500 new patients seen in 2024 – averaging 40 per month – growth potential is substantial, even with minimal advertising. e real estate is available for purchase, providing an opportunity to secure long-term stability. With nearly $600,000 in seller’s discretionary earnings, this is an outstanding opportunity for an oral surgeon looking for a turnkey practice in North Texas.
North Texas OMS practice highlights:
• 3 surgical suites and 2 consult rooms
• Collections of $1.117 million
• SDE of $600,000
• Real estate available
• 40 new patients/month
Interested in learning more about this OMS practice in North Texas? Contact Professional Transition Strategies to learn more – email Bailey Jones: bailey@ professionaltransition.com or call: 719.694.8320. Reference #TX30625. We look forward to speaking with you!
PRACTICE FOR SALE
South Central Oklahoma
General Practice for Sale: 2600 sq , 5 ops, great visible location, 4 days per week, 8 days hygiene, so dent, cerec, laser, intraoral cameras, digital radiography, super sta , collections $1.1 million.
Contact: Call or text (580) 221-4767.
PRACTICE FOR SALE
Oklahoma City, OK
General Practice for Sale: Great location by I-240 / Tinker, Boeing, Northrop Grumman, South Mercy hospital. Room for 4 ops, lease building, 1500 sq . Current Dr. can stay at least 1 year. Better than new. Call 405-650-0945
EQUIPMENT FOR SALE
Dentist retiring and selling all equipment. ree 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.
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