ODA Journal: Summer 2025

Summer 2025 | Vol. 116, No. 2

Passion, Purpose, and Service Introducing ODA's 2025-2026 President, Dr. Twana Duncan page 19 www.okda.org

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journal | Summer 2025

ADVERTISERS 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

CONTENTS

Oklahoma Dental Association

Summer 2025 | Vol. 116, No. 2

EDITORIAL 5

Modern Day Myth Busting

by Mary Hamburg, DDS, MS

STATE ASSOCIATION ODA Calendar Executive Director Addresses House of Delegates 1 2 2025-2026 Officers Installed 1 3 Welcome ODA's Newest Team Member 1 8 ODA Leadership Academy 32 Annual Meeting Award Winners & Sponsors 4 8

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Editorial: Modern Day Myth Busting

FEATURES 6

2025 OU College of Dentistry Graduates

24 Office Space: Dr. Jarrod Lack, TLC Dental 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.

ADA NATIONAL NEWS 2 6 Oklahoma City Ceremony Honors Dentists

Who Aided in Bombing Response

27 ADA Launches Living Guidelines Program

1 4 The Gingiva-Brain Axis

1 6 End-of-Session Legislative Update 17 Legislator of the Year Awards

COVER STORY

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

1 9 Passion, Purpose, and Service: Introducing ODA's 2025-2026 President, Dr. Twana Duncan

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

CLINICAL

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

1 4 The Gingiva-Brain Axis: What Gum Disease May Tell Us About Neurodegeneration

by Stacy Sigler, RDH

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.

LEGISLATIVE LOOP

1 6 Legislative Loop

2 9 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.

Copyright © 2025 Oklahoma Dental Association.

Is Your Information Correct?

24 Office Space: Dr. Jarrod Lack

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.

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 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

CALENDAR See more online at OKDA.ORG/CALENDAR May May 30 Robie Herman Memorial Golf Tournament & CE benefiting 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

OFFICE & COMMUNICATIONS MANAGER Katie Douglas

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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 Affairs Meeting 9:00am ODA Office & Zoom

DIRECTOR OF COMMUNICATIONS & EDUCATION Jill Johnson

Stay connected with the ODA!

June 12 Oklahoma County Dental Society Next Level Study Club 6:00pm - 9:00pm McGarry Implant Institute More info online at okcountydental.com

August 1 ODA Board of Trustees Meeting 1:30pm ODA Office & Zoom August 25 First Bite Event for First Year Dental Students 5:00pm ODA Office More details available soon at okda.org/events August 6 National Fresh Breath Day August 11 National Align Your Teeth Day September Office 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

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.

EDITORIAL Modern Day Myth Busting

by Mary Hamburg, DDS, MS

her teeth. I recommended a fluoride regimen, and in which she at once declined treatment and went on to explain how toxic fluoride was. I am not going to lie - it was hard to keep a straight face as she declined fluoride with her mouth clearly showing the outcome of a zero-fluoride mentality.

Mary Hamburg, DDS, MS (right) serves as Editor of the Oklahoma Dental Association Journal.

Goiter is a funny word and a funny So why am I discussing the history name for a not-so-funny disease. of goiters in a dental journal?

In the 1920s, goiter was a lethal Addressing widespread diseases disease that plagued 30-60% of the with minimal intervention from a population, with the midwestern states community health perspective is being affected at a higher percentage beneficial to all communities. Today, rate. It was such a concern, the U.S. the benefits of a government agency military considered it a national health adding supplements to food or water crisis, accounting for a 30% loss of is negated with one viral take on the draftees preceding World War I. So internet allowing disinformation why is goiter a funny name now, but to overwhelm the scientific was a national health crisis 100 years knowledge and facts that support the ago? A public health initiative was set intervention. We all remember the into motion and continues to work Netflix show about root canals causing to this day to prevent goiters from breast cancer from a few years ago, plaguing our society. and we are all still seeing those effects today. And while water fluoridation A public health approach curtailed is not a new fight to the dental a public health crisis with a simple community, it is one that is building cheap adjustment to people’s daily steam in our Oklahoma communities. diet: ionized salt. A goiter is a swelling in the thyroid gland caused by My least favorite discussion in hypothyroidism due to a lack of iodine dentistry is with a patient who has in people’s diet. The midwestern a terminal dentition due to decay. areas like Michigan had the highest Yes, we could save the teeth with a rates due to a lack of iodine in the complete remake in your oral health ground water and plants. Thus, when regimen, or we can remove all the iodine was added to the dietary salt teeth. My patient a few weeks ago was in Michigan alone, it reduced the rate pondering this scenario when she from 30% to 2% in 10 years. asked what she needed to do to keep

The introduction of fluoridated water in 1945 was not the start of water fluoridation in the US. Water fluoridation 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, fluoridation 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 benefit children and adults throughout their lifetime, saving financial cost to the patient and improving quality of life.

I know I am preaching to the choir when spouting the benefits of fluoride, but the time is now to back up what we know to be beneficial to our patients in our communities. We need to have hard discussions with our neighbors and community leaders about the benefits of fluoride 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 fluoride is important and why you are an advocate for it. And it is not because we get a big check from the fluoride industry.

Continued on page 7

www.okda.org

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EDITORIAL, continued It’s because we want to minimize the number of children needing dental care and adults that are going without teeth. Both improve the financial 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 fortified grains in the US/Canada after it was noted that women and children did not have enough in their diet. The main concern was neural tube defects in children, causing diseases like spina bifida. 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 benefits 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 fluoridation is a valuable and necessary benefit to our communities, providing financial and economic gains to Oklahoma. Please help us make sure the people of Oklahoma understand the consequences of removing fluoride 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-certified 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.

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STATE ASSOCIATION NEWS Executive Director Addresses House of Delegates And, speaking of the ODA Annual Meeting, let’s just get the bad news over with first. 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.

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.

Good afternoon, ODA Delegates and Officers! 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.

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journal | Summer 2025

The 2024 Annual Meeting was down 45% from 10 years ago – and 57% from 15 years ago. This 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.

We finished 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 The ODA Annual Meeting is no longer getting increasingly difficult to appeal sustainable in its current format, and to younger dentists, especially those sadly, the vast amount of Association working in large group practices where financial and staff resources devoted to the value of membership is more keeping it afloat might be better spent difficult to demonstrate. You hear me on programs our members actually say this every year, but WE NEED want and need.

YOUR HELP. As Dr. Rogers just reported, reserve The list of 2024 non-renews is in your funds currently represent over 162% of packet. As leaders in your Component, the proposed 2025 operating budget, please reach out to these colleagues well above the required 30%. I want and encourage them to renew their to commend the Budget and Finance membership. Member-to-member Council for making some tough outreach is BY FAR our BEST decisions when building this year’s offense in building and maintaining a budget, as well as your Investments healthy market share. THANK YOU Committee for closely watching your in advance for your help with our investments and making strategic recruitment and retention efforts. decisions regarding the Association Since 2010, Oklahoma dentistry has reserves throughout the year. come together to provide $17.9 million Let’s shift to membership: We gained in donated dental care to more than 111 new members in 2024, 89 of 21,000 patients in need through the which were new graduates, 5 graduate Oklahoma Mission of Mercy. Mark students, and 17 members who came your calendar now for OkMOM 2026, back to us after lapsed memberships.

February 6 & 7, in Enid!

STATE ASSOCIATION NEWS, continued for attending those meetings with us years. One thing to come out of that and bringing real-world experience will be a Workforce Task Force that to the conversation. A compromise Dr. Duncan is convening next month was struck that will require insurance to address the hygiene and assistant The 2025 mission in Tulsa was financed shortage in Oklahoma. If you have companies to start reporting their DLR by a one-time-only ARPA grant from thoughts on the trajectory for that Task to the Insurance Commissioner with the State Legislature, and we are very very specific parameters – what they Force, she’d love to hear from you! grateful for that gift. 2026 is on us, so can and cannot include in their DLR – The ODA has several legislative that makes our gifts to the OkMOM which will, at least, bring transparency Legacy Fund more important than ever. priorities for 2025: the first, is our third to an unregulated industry, and will Again, a HUGE thank you to Dr. Tim attempt to establish a dental loss ratio help identify the bad actors in the (or DLR) in Oklahoma. DLR is the and Pamela Fagan and everyone who market. dental insurance premium revenue that has given so far! While the treatment So, fast-forward to this week … during OkMOM is completely donated, is spent on actual patient care instead Representative Marti’s bill, HB 2805, there is still a substantial cost of about of operating costs like marketing and which now contains the agreed-upon, $250,000 to operate the event each year. executive salaries. In other words, we are trying to pass a law that dictates the compromised language, has passed the If you haven’t yet joined the OkMOM minimum percentage they have to pay House and is now in the Senate.

Legacy, please help us continue the life-changing work done every year by out in actual patient care. The average And Senator Coleman’s bill – the one dental loss ratio is right around 50% in making your gift today. A special way with absolutely NOTHING in it – has to donate this year is our new Celebrate Oklahoma right now. Representative passed the Senate under false pretenses MOM with a Mission campaign. Please T.J. Marti, who you met earlier, and because he kept telling everyone that find a flyer in your packet that explains Senator Kristen Thompson, our other a substitute bill with the new language Legislator of the Year, ran identical how you can honor your mother, was coming, and it never did. But they companion, and very aggressive, bills or any other woman in your life, by kept passing it with “title off ” because making a one-time donation to honor that would have set the DLR at 85%, they trusted him that the new language or remember her. We will publish this required companies to rebate back to was coming. It now sits in the House. special list of donors and their mothers premium payers when they didn’t meet What we need now is for Senator in the next issue of the Journal. Again, the DLR, and would have redefined Coleman to honor the discussions “covered services” in Oklahoma to THANK YOU to everyone who has HE insisted we have back in February already given! Together, we will ensure tighten the already-existing law we and allow HB 2805 – our bill – to be passed in 2010. The new definition essential dental care continues to considered in Committee. So far, he would have closed the loophole that be provided during the Oklahoma has not done that and is showing no says our law does not apply in certain Mission of Mercy. signs that he intends to. Here is Senator situations like frequency limitations, Coleman’s contact information. Please This past February in Tulsa was a huge or when a patient has reached his/her write it down and call AND email him success! A special thank you to Drs. maximum. Senator Bill Coleman, Chair first-thing on Monday and ask him Lindsay Smith and Rieger Wood for of the Senate Insurance Committee, is to hear HB 2805 in Committee with reprising your roles as OkMOM corunning his own insurance-requested TITLE ON. We don’t want him for chairs. version of a DLR bill that has absolutely a second to say he didn’t hear from NOTHING in it and does NOTHING I also want to express my deepest any dentists on this issue. It is our #1 to help your patients. gratitude to the Oklahoma Dental priority, and we want to make sure he Foundation for serving as the ODA’s So, we have these two DLR bills – one knows that. true partner in all things OkMOM! We that has everything we want, and one, Unfortunately, one of the items we could not do it without them. requested by the insurance industry, were forced to give up as part of our that does less than nothing. Early in Later in today’s agenda, you will be compromise, was dropping the new session, we were summoned by Senator considering adoption of the next definition of non-covered services, so Coleman to a series of stakeholder ODA Strategic Plan. We had a great that was back-burnered to next year. session back in June when 25 members, meetings to see if we could negotiate students and staff, led by experts from something with which everyone can Continued on page 11 the ADA, came together to map out the live. A quick thank you to Drs. Brian Drew, Krista Jones and Shannon Griffin Association’s work for the next three And thank you to Dr. Chris Fagan for spearheading next year’s mission as we return to his hometown!

www.okda.org

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10 journal | Summer 2025

STATE ASSOCIATION NEWS, continued We WILL continue to fight for that change because it’s just good policy.

The 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.

with your legislators YEAR-ROUND because we will definitely 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 find information about our Botox and Dermal Fillers course I want to thank the ADA for a generous open to all dentists and hygienists on State Public Affairs grant that is May 2 & 3, our CPR course for the allowing us to outsource a robust whole dental team on May 16, and the educational campaign regarding the Inaugural Robie Herman CE and Golf need for meaningful dental insurance Tournament, benefitting DENPAC, on reform. Hopefully, you’ve seen the May 30 in Edmond. letters to the editor and opinion pieces by ODA members published in And we are looking for hole and other sponsorships for the tournament, so newspapers across the state, as well as even if you can’t or don’t play, there are the social media campaign aimed at still ways you can offer your support. educating legislators and the public.

Did you know that if you took advantage of every discount offered by our Rewards Partners, you would save an average of over $16,000 in just one year? That 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 find 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, flexibility, and support over the past year.

I have thanked many people today, but the MOST gratitude will always go to Enrollment in the ODA Leadership And before we leave the topic of my teammates … Shelly, Ansley, and Academy is now open! The ODA advocacy, I must mention that it Jill. They make me look good, but more Leadership Academy is a statewide is extremely important that you importantly, they make YOU look program designed to develop future contribute to DENPAC every year. good! I am grateful for their flexibility, leaders in organized dentistry by DENPAC is the way we MAKE and resourcefulness, creativity, generosity, preparing them to be future leaders KEEP friends in the Legislature. Your patience, and their commitment at the national, state and Component personal investment each year goes a to excellence. You can rest easily levels. Candidates should have a long way in helping the ODA protect knowing your ODA is in the MOST sincere interest in strengthening their your profession. If you haven’t done community and the dental profession. capable hands! And, just a side note, your part by giving this year, please Each Class is intended to be comprised TODAY marks Shelly’s TWENTYvisit the DENPAC table to make your THIRD year with the ODA! of one to three dentists from each contribution today!

Component, with all seven components And finally, I am so grateful to do Also, if you are not receiving the ODA represented being our ultimate goal. legislative alerts either by email or text, Applications are available now and something that still inspires me and that means we do not have your cell allows me to experience professional if you’re interested in learning more, number or a current email address (one see Ansley at the DENPAC table and growth and personal joy every day. that YOU actually see and read – not The staff can attest to the fact that visit with your component president an INFO AT email address that goes about sponsoring you. The 2026 Class I always tell prospective employees to your office manager). Please help us of the ODA Leadership Academy will during the interview process that communicate with you by updating graduate during this meeting next year we work FOR and WITH the most your information. We need every ODA in Norman. generous people, and I mean that. member engaging in our legislative When I count my many blessings, the If you are an ODA Leadership efforts to protect your profession and that is not possible if we can’t effectively Academy graduate, please stand so we ODA is always among them. THANK YOU for the opportunity to continue can recognize you. communicate with you. to serve as your Executive Director.

The ODA Rewards program offers YOU are the key to our legislative member-only discounts on products success. Grassroots lobbying is THE and services you use every day in MOST effective way to get legislators your practice and even at home, while to act on our behalf! We ask that you continue to foster strong relationships providing the ODA non-dues revenue generated by member use. www.okda.org

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STATE ASSOCIATION NEWS 2025-2026 Officers Installed

The 2025-2026 ODA Officers (left to right): Dr. Twana Duncan, Dr. Nicole Nellis, Dr. Colin Eliot, Dr. Sydney Rogers, and Dr. Matthew Bridges.

The Oklahoma Dental Association officially installed its new slate of officers during the annual House of Delegates meeting held April 12, 2025, in Tulsa. These 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.

12 journal | Summer 2025

Dr. Twana Duncan was installed The House of Delegates, ODA’s as ODA President and will lead the governing body, convenes annually organization in the coming year. to shape policy, recognize leadership, She is joined by Dr. Nicole Nellis as and discuss the future of dentistry President-elect, Dr. Colin Eliot as in Oklahoma. The 2025 officer Vice President, Dr. Sydney Rogers installation marked a moment of as Secretary/Treasurer, and Dr. transition and continued progress, Matthew Bridges as Speaker of the as these accomplished professionals House. Dr. Daryn Lu now assumes take the helm during a dynamic the role of Immediate Past President. time for the profession. Members can reach each officer through their official ODA email addresses found on page 4 to share concerns, ask questions, or get involved.

STATE ASSOCIATION NEWS Welcome ODA's Newest Team Member The Oklahoma Dental Association is excited to welcome Katie Douglas to the team as our new Communications and Office Manager, officially joining the staff on May 12. In this dynamic role, Katie is responsible for overseeing the day-to-day operations of the ODA office 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 fit 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 office contact, maintains records and databases, manages vendors and supplies, and helps coordinate the Mediation Review Program.

Katie Douglas Communications and Office Manager

Dayna S. Duke D.D.S.

Outside the office, 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.

Myron S. Hilton D.D.S., M.P.H.

Brandon Schultz D.D.S.

Zane Dubberstein Brent Haynes D.D.S., M.S.D. D.D.S.

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BEYOND THE ARCH The Gingiva-Brain Axis: What Gum Disease May Tell Us About Neurodegeneration

by Stacy Sigler, RDH

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 neuroinflammation and Aβ plaque formation. Its toxic enzymes, known as gingipains, have also been identified 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.

Stacy Sigler, RDH

Can periodontal pathogens trigger the onset and progression of Alzheimer’s disease? Emerging research suggests a significant connection between oral health and neurodegenerative diseases, particularly Alzheimer’s (Ryder, 2020). This article explores the role of specific periodontal pathogens in the development and progression of Alzheimer’s disease, highlighting the importance of oral health in cognitive function.

Oral Pathogens and Neuroinflammation 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.

Neuroinflammation 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 14 journal | Summer 2025

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 affect not only Alzheimer's etiology but also its prognosis.

What can the dental community do about this?

We start by reducing inflammatory bacterial loads through education and comprehensive care. Vigilance in A murine study linked oral P. gingivalis infection to its brain colonization and Aβ prevention and diagnosis are constant production, confirming BBB penetration suggestions because they are constant neglections. One-third of periodontal (Ilievski et al., 2018). A separate study on periodontal pathogen aggregatibacter cases are misclassified (Bunmi Tokede et al., 2024). According to the Journal of actinomycetemcomitans (Aa) found its extracellular vesicles (EVs) not only cross Clinical Periodontology, among patients at risk for severe periodontitis—half the BBB but can provoke the secretion of whom had seen a dentist within 6 of pro-inflammatory cytokines like IL-6 months—only 18.8% believed they and TNF-a. In this study, these EVs migrated through the trigeminal ganglion, had gum disease. While no formal altered neuronal firing patterns, and were studies reveal how often a clinician completes periodontal charting, the implicated as pathogenic pathways for systemic and neuroinflammatory diseases aforementioned statistics are revealing.

It suggests we either aren’t diagnosing (Ha et al., 2023). accurately or educating effectively.

A few other plausible BBB-penetration When patients don’t understand oral mechanisms include: disease, they rarely prioritize it. Perhaps we reframe oral hygiene instruction, • Perio-induced bacteremia (bacteria nutritional counseling, or health history in the bloodstream) and its review to include this new risk factor’s endothelial cell interaction (Dong et role. al., 2023) Documentation can be crucial when • Cytokine and pathogen-induced reviewing changes that could reflect systemic inflammation weakening cognitive decline, such as: behavioral the BBB's tight junction integrity changes, memory changes, speech (Demirel et al., 2024) patterns, gait, dietary changes (Alzheimer's caregivers report a 33.3% • Phagocytosed oral pathogens increase in sugary food preference, per transported via immune cells like microbially mutinous Trojan horses the journal Healthcare in 2024), and decline in oral health. Interdisciplinary (Dominy et al., 2019). collaboration between dental and A 2021 systematic review found medical professionals remains a crucial, statistical significance (p = 0.02) in the underutilized tool, and documentation increase of fusobacterium nucleatum can help bridge the gap.

(F. nucleatum) in Alzheimer's

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? The 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.

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.

diagnosis rates. J Clin Periodontol, 48(5), 612–620.

Ryder, M. I. (2020). The future of periodontal-systemic associations: Raising the bar. Periodontology 2000, 84(1), 9–13.

Tokede, B. O., et al. (2024). Diagnostic misclassification 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 Healthcare. (2024). Nutritional trends in REFERENCES Alzheimer’s caregiving: A population-based College of Dentistry. She holds dual bachelor’s degrees in science and business, review. Healthcare, 12(3), 413.

Borsa, L., et al. (2021). Fusobacterium and she practices at Downtown Dental nucleatum and Alzheimer’s disease: A Ilievski, V., et al. (2018). Chronic oral in Oklahoma City. Stacy has been systematic review. Journal of Alzheimer’s application of a periodontal pathogen results Disease, 83(2), 501–514. in brain inflammation, neurodegeneration, married since 2012 and has two fur kids.

She enjoys traveling, cooking, sports, and amyloid beta production in wild type Demirel, A., et al. (2024). Systemic mice. PLOS ONE, 13(10), e0204941. volunteering, and learning anything inflammation and blood-brain barrier new—especially when it comes to integrity: The role of periodontal pathogens. Journal of Clinical Periodontology. (2021).

Neuroimmunology Reports, 19, 100993.

Patient awareness of periodontal disease and healthcare. www.okda.org

15

LEGISLATIVE LOOP End-of-Session Legislative Update

by Lynn Means, ODA Executive Director

At the start of session, we introduced HB2805, a Dental Loss Ratio (DLR) bill authored by Rep. TJ Marti and Sen. Kristen Thompson. Meanwhile, the insurance industry filed 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. After two weeks of discussions, a compromise was proposed consisting of a less aggressive form of DLR, along with a redefinition of covered services that would have fixed 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 fix.

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

16 journal | Summer 2025

and that new DLR language would be inserted into the bill.

and higher premiums while insurance companies are routinely allowing less and less care.

HB2805 passed the House, and SB1101 passed the Senate without the agreedTHANK YOU for your efforts! THANK upon floor amendment. When the bills YOU for your engagement! YOU moved to the opposite chamber, Senate are the key to our legislative success.

Business and Insurance Chairman Grassroots lobbying is THE MOST Bill Coleman refused to hear HB2805, effective way to get legislators to act on making it dormant under legislative our behalf! We ask that you continue rules. HB2805 will not advance to foster strong relationships with your this session but remains eligible for legislators YEAR-ROUND because we consideration next year. Similarly, will definitely be coming back every Representative Tedford laid over SB1101 year to ensure necessary policies are in committee, causing it to also become addressed, and the voices of the dental dormant under the rules. profession are heard! Please take quality time over the next year reaching out to Although this is all very disappointing your State Senator and Representative. for you and your patients, our efforts Invite them to your office or buy them this session saw a higher member a cup of coffee and introduce yourself. engagement than ever before, clearly Tell them how this law would positively communicating to our lawmakers affect your patients and your small that establishing a meaningful DLR business. Advocacy does not end when in Oklahoma is of utmost importance the legislative session ends. The most to dentists across the state and the important time is in the off season. patients you serve. Your many, many MAKE FRIENDS WITH YOUR calls and emails also resulted in a LEGISLATORS. Make sure they know much better educated Legislature and who you are and where you practice, so a stronger foundation from which to when you call/email during session, you begin our efforts next year. Dental Loss are talking to a friend.

Ratio is simply good policy for all the Oklahomans who are paying higher

LEGISLATIVE LOOP ODA's Legislator of the Year Awards

ODA Immediate Past President Daryn Lu, DDS presents Rep. T.J. Marti (R)-District 75 with the Legislator of the Year Award at the Annual Meeting in Tulsa.

ODA Executive Director Lynn Means presents Sen. Kristen Thompson (R)-District 22 with the Legislator of the Year Award at the Oklahoma State Capitol.

www.okda.org

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18 journal | Summer 2025

COVER STORY 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 often—from Texas to California, Maryland, Nebraska, and eventually back to Oklahoma. This nomadic lifestyle fostered her lifelong love of travel and adventure.

“I’ve visited all fifty states and numerous countries,” she says. “My goal is to keep that list growing.”

After 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 different schools before graduating from Haworth High School, an experience that helped her become outgoing and adaptable.

“Together our voices are stronger.

We need each other to learn, grow, and prosper.”

“I learned to make friends easily and have maintained friendships for over fifty 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.”

by Jill Johnson, ODA Staff

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 Dr. Duncan addresses the House of Delegates her bachelor’s degree in just three in her first speech as the 2025-2026 ODA years. While attending the University President. of Oklahoma College of Dentistry (OUCOD), she joined the Oklahoma Once her Navy service was complete, Women’s Dental Organization she purchased an existing practice Student Chapter. It was through this in Antlers, Oklahoma, after the mentoring program that Dr. Mary previous dentist relocated.

Martin encouraged her to serve as president of the student chapter and “I hadn’t seen a single child during helped her and her classmates attend my Navy service, but on my first day in private practice, I completed my ADA meetings. pediatric requirements—and I loved “She taught me the importance of it,” she recalls. “My practice grew organized dentistry,” Dr. Duncan quickly because I was passionate explains. “Together our voices are about treating children and patients stronger. We need each other to with special needs.” learn, grow, and prosper.”

Dr. Duncan learned sign language After graduating from OUCOD in as a child to communicate with a 1991, Dr. Duncan joined the U.S. cousin who was born deaf, and this Naval Reserve. Her goal was to serve skill has become a blessing in her her country, build her clinical skills, practice. and refine her craft. From 1991 to 1994, she worked as the junior officer Continued on page 20 in charge at the Naval Air Station Dental Clinic in Kingsville, Texas. www.okda.org

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COVER STORY, continued Additionally, several of her team members are bilingual, helping the office better serve a broader range of families.

“The 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 reflects. “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.”

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. They 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 office can be that place for them.”

Her proudest day in dentistry came when her son, Dr. Caleb Smith, She attributes this growth to early recognition that running a successful joined the practice. dental practice requires dedication “Watching him choose dentistry and passion from every team member. and be passionate about serving “Dentistry isn’t something you go into Southeastern Oklahoma is a dream come true,” she says. expecting everyone to be thrilled to see you—especially not kids,” she says.

Her joy multiplied when his “But that’s the whole point. We focus classmate, Dr. Haley Harrington on children who are scared. We treat (OUCOD Class of 2022), joined the special needs patients, young and old, practice, as well. Dr. Harrington is because we know how few providers the daughter of Dr. Wes Nipper of are willing to see them.

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.

20 journal | Summer 2025

COVER STORY, continued

Dr. Duncan with her husband, Jack on vacation in Ibiza.

Dr. Duncan with her grandson who let her pull his first tooth!

Beyond her practice, Dr. Duncan and the gift, resulting in a $100,000 “I want this organization to thrive transformation of Little People’s her team are deeply committed to and remain meaningful to its volunteerism and community support. Park. members,” she says. “The ODA Each year, her office donates to more has a unique opportunity to grow Her team also volunteers annually than 25 area schools, supporting in membership, to lead in dental with the Oklahoma Mission of athletics, band, cheerleading, choir, education, and to address workforce Mercy, participates in the D-Dent and special needs events. She also shortages and mental health program, works with the VA and sponsors a scholarship at SEOSU for struggles affecting our members and Tribal Nations, and even staffs the future dental students, donates to the their teams.” concession stand at local football J. Dean Robberson Society, and serves games each season. In recognition of She also emphasizes the need for on its governing board. She also her dedication, Dr. Duncan received continued legislative advocacy. interviews candidates for the OUCOD the 2023 OUCOD Alumni of the admissions committee.

“We must push forward on passing Year Award and the 2024 ODA legislation that protects patients— Public Service Award.

In 2023, Dr. Duncan was named especially regarding dental loss Pushmataha County’s Citizen of the While her passion for dentistry ratio requirements for insurance Year, an honor she attributes in part remains strong, Dr. Duncan’s companies. to her long-term goal of revitalizing focus has expanded as she takes Antlers City Park. Her practice Continued on page 23 on her new role as President of the donated $34,000 in playground Oklahoma Dental Association. equipment. The City of Antlers and the Choctaw Nation matched www.okda.org

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22 journal | Summer 2025

COVER STORY, continued

“As long as we’re kind to one another, we’ll all flourish."

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

Too many plans avoid accountability, and we can’t let that continue. The 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.

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

again that dentistry is a craft 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 flourish.”

“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.

Dr. Duncan with her family on a Disney vacation. www.okda.org

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OFFICE SPACE Building the Dream: Dr. Jarrod Lack’s New Office Elevates Dentistry in Enid

by Jill Johnson, ODA Staff Photos provided by Jarrod Lack, DDS

For Dr. Jarrod Lack, building his new dental office 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. That vision came to life in his newly built office, designed not only to meet the growing needs of his practice, but also to reflect his passion for advanced dental care.

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The driving force behind the new space was Dr. Lack’s increasing focus on large implant cases. These complex procedures required larger, surgery-focused operatories and a fully equipped lab. Today, his new office features a high-tech lab outfitted with a zirconia mill, a 3D printer, and a dedicated workspace for a lab technician—an essential hub for crafting surgical guides, splints, dentures, and more. “The efficiency 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 defines Dr. Lack’s approach to dentistry. Every detail of the office was crafted with the patient experience in mind, creating an environment that feels both professional and comfortable.

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 difficult,” Dr. Lack admitted. Still, the office was built with the future in mind— designed to eventually welcome two additional dentists to work alongside him.

The impact of the renovation has already been significant. The 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 offer specialized, high-quality care that truly makes a difference in people’s lives.

“I’m proud of what we’ve created,” Dr. Lack said. “This office isn’t just a building—it’s a reflection 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

www.okda.org

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ADA NATIONAL NEWS 30 years later, Oklahoma City Ceremony Honors Dentists Who Aided in Bombing Response

by Mary Beth Versaci

Photo courtesy of Oklahoma County Dental Society

Association and students from the dental school helped where needed as part of the massive response efforts.

“The dental community not only provided staffing for the identification unit but also were amazing in providing the necessary antemortem records for comparisons,” Dr. Chrz said. “This outpouring of resources allowed the tremendous success of the dental Dentists who helped during the Oklahoma City bombing recovery efforts stand to be recognized March 30 identification operation.” during A Day of Remembrance at the Oklahoma City National Memorial & Museum.

Thirty years ago, in the aftermath of the Alfred P. Murrah Federal Building bombing in Oklahoma City that left 168 people dead, dentists worked 12-hour days for more than two weeks to help identify the victims. Those dentists were honored March 30 as part of A Day of Remembrance at the Oklahoma City National Memorial & Museum.

During the event, Bryan Chrz, D.D.S., who helped to establish and run the dental identification 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.

Of the 168 victims, 45 were identified through dental records alone while 77 were identified using dental records and fingerprints. Dr. Chrz said the motto in the dental unit was to treat each case as a single individual identification, giving each victim an equal and respectful consideration.

“It seemed we all were touched in some manner by the list of victims,” he said.

“I was deeply honored to be asked to play “We could see the toys that the children The ceremony was organized by the a part in recognizing the individuals from from the day care center used. Dr. Oklahoma County Dental Society, the medical and dental community that Charles Hurlburt, friend, educator and Oklahoma Dental Association, gave aid during the bombing response,” head of radiology for the OU College of Oklahoma County Medical Society, Oklahoma State Medical Association and Dr. Chrz said. “I was deeply moved by Dentistry, and his wife were checking on Oklahoma Osteopathic Association. The the emotions that came back to me as I her Social Security retirement benefits organizations presented 14 dentists and 68 toured the memorial for the first time when the building fell around their and spoke to those we were honoring.” physicians with medallions to recognize heads.” their roles in the recovery efforts following In his remarks, he shared how the Dr. Chrz said the responding dentists and the April 19, 1995, attack. response to the Oklahoma City bombing physicians worked seamlessly together is held as the gold standard for mass “The Oklahoma County Dental Society to show respect to the victims and disaster response. At the time of the was excited to partner with A Day of concern for the family members. After bombing, Dr. Chrz owned a private Remembrance to honor those in our reading the names of the dentists during practice in Perry, Oklahoma, and worked the ceremony, he offered final words of profession who stepped up and served during the tragedy of the Oklahoma City as a part-time assistant professor in gratitude for their efforts. bombing,” society President Troy Schmitz, operative dentistry at the University of “To these persons I have named, I repeat D.D.S., said. “The standards set in dental Oklahoma College of Dentistry. While the message on the Survivor Tree wall: he and others from the dental school forensics are still the standard for any large-scale tragedy throughout the world. answered the call from the state’s Office ‘To the courageous and caring who responded from far and near, we offer of the Chief Medical Examiner to lead Those who served never did so to be our eternal gratitude,’” he said. dental identification efforts, other recognized but absolutely deserve to be dentists referred by the Oklahoma Dental honored."

26 journal | Summer 2025

NATIONAL ADA NEWS ADA Launches Groundbreaking Living Guidelines Program for Oral Health In a significant advancement for evidence-based dentistry, The establishment of the program was officially announced the American Dental Association (ADA) has officially today through a press release and featured coverage in ADA launched the ADA Living Guidelines program—the first and News, with further outreach planned via social media and only known living guideline initiative focused on oral health. additional communications.

This landmark program is a collaboration between the ADA and the Center for Integrative Global Oral Health at the Looking ahead, the ADA will publish quarterly updates University of Pennsylvania School of Dental Medicine. through digital issues of The Journal of the American Dental Association (JADA). The first recommendation The ADA Living Guidelines program represents a from the program is expected later this year and will transformative shift from the traditional model of update the ADA’s 2017 guideline on evaluating potentially updating clinical guidelines every 3–5 years. Instead, the malignant disorders and oral squamous cell carcinoma in new approach maintains the same methodological rigor the oral cavity. while continuously integrating and publishing updates as new, high-quality evidence becomes available. This realFor questions or additional information, members and time model ensures that patients, dental professionals, stakeholders are encouraged to contact ADA Tripartite and policymakers have more timely access to the latest Development & Relations at clientservices@ada.org. recommendations supporting patient care and public health.

www.okda.org

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Endodontic Practice Associates

Dr. Spencer Hinckley and Dr. Percy Bolen

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

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

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www.endodonticpracticeassociates.com 28 journal | Summer 2025

CASE STUDY Achieving Stability in a Severely Resorbed Mandibular Ridge Using the Neutral Zone Technique

by Leyann Adi, Ajay Jain, DDS, and Angela Jarjoura

INTRODUCTION

and additional time investment.4, 5 Nonetheless, given the growing elderly highlight the key steps involved in the Successful rehabilitation of edentulous population and the infeasibility of fabrication of the mandibular denture patients with advanced ridge atrophy implant therapy in certain edentulous utilizing the neutral zone approach. continues to pose a considerable cases, the neutral zone technique may prosthodontic challenge. In individuals provide a suitable treatment alternative Primary impressions were obtained with sufficient remaining bone, stability in rehabilitating those with severely using alginate impression material with can be achieved by positioning denture atrophic residual ridges.4 perforated edentulous metal trays. teeth over the ridge crest.1 However, Custom trays were then fabricated on in patients with severely resorbed CASE REPORT the primary casts to ensure a close fit. mandibular ridges, deficient anatomy A 60-year-old female patient presented Border molding was carried out using often results in poor denture retention, to the Oklahoma University College ISO functional compound. reduced masticatory efficiency, and of Dentistry with the chief complaint, 1 discomfort.

“My dogs chewed up my lower denture, A final wash impression was made with poly vinyl siloxane light-bodied The neutral zone concept attempts to and I need a replacement” (Figure material. mitigate these functional limitations by 8a). Clinical examination revealed considering the dynamic equilibrium a completely edentulous oral cavity Master casts were fabricated using the between oral musculature and the with advanced resorption of the final impressions. prosthetic form. The neutral zone is mandibular alveolar ridge (Figure A special record base with fins was defined as the potential space in the 1a and 1b). Based on panoramic made and adapted to the mandibular oral cavity where the outward pressure radiographic findings and financial master cast (Figure 3). of the tongue balances the inward considerations, an implant-supported 2 forces from the cheeks and lips. By complete denture was determined to The record base shown in Figure 3 integrating functional muscular patterns be impractical (Figure 2). A treatment was adjusted in the patient's mouth to into the denture design, a balance can plan was proposed involving the ensure stability and complete seating be achieved that improves not only fabrication of a conventional maxillary during opening, closing, swallowing and mechanical fit but also stability and complete denture and a mandibular speaking. retention.3 complete denture using the neutral zone A mixture of grey stick compound and technique. As the maxillary denture However, the widespread integration cake wax were softened and placed on was fabricated using conventional of the neutral zone technique has been the record base. techniques, this report will primarily limited due to its procedural complexity Continued on page 31

Figure 1a. Maxillary ridge

Figure 1b. Resorbed mandibular ridge

Figure 2. Panoramic radiograph

www.okda.org

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CASE STUDY, continued

by Leyann Adi, Ajay Jain, DDS, and Angela Jarjoura

The 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).

Figure 3. Special record base with fins

The 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).

Figure 7. Wax try-in

Teeth arrangement was completed by verifying position against the plaster index to preserve the neutral zone (Figure 6).

Figure 4. Neutral zone recorded

Wax try-in was done and stabilization of the mandibular denture was verified by asking the patient to speak and swallow (Figure 7).

The dentures were sent to the lab for final processing and finishing.

The dentures were carefully evaluated and adjusted as necessary, with successful delivery demonstrated by the achievement of stability in the mandibular denture (Figure 8b).

Figure 5. Plaster index with lower record base

Figure 6. Teeth arrangement with plaster index

Figure 8a. Before

DISCUSSION The successful rehabilitation of edentulous patients involves the restoration of form, function, and esthetics while reconciling patientcomplicating factors1. The neutral zone technique offers 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 8b. After

www.okda.org

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32 journal | Summer 2025

CASE STUDY, continued

by Leyann Adi, Ajay Jain, DDS, and Angela Jarjoura

this alternative method emphasizes tooth and flange positioning that equilibrates tongue and perioral muscular forces to enhance stability without compromising function and esthetics.3, 4 Although other studies vary in procedural specificities, 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 fins 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 costeffective alternative.6 Nonetheless, considerable literature supports our findings 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 benefits, the added chair time, procedural complexity, and deficiency 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 benefit to those with advanced ridge resorption.

REFERENCES 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. The 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. The 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. After 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. After 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. www.okda.org

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34 journal | Summer 2025

CLASSIFIEDS PRACTICE FOR SALE

PRACTICE FOR SALE

North Texas OMS Practice for Sale

South Central Oklahoma

North Texas is a hub of economic growth, strong General Practice for Sale: 2600 sq ft, 5 ops, great communities, and a high quality of life, offering the visible location, 4 days per week, 8 days hygiene, perfect blend of opportunity and accessibility. This softdent, cerec, laser, intraoral cameras, digital well-established oral surgery practice, located between radiography, super staff, collections $1.1 million.

Oklahoma City and Dallas, has been serving the community for 20 years. The doctor is now seeking a Contact: Call or text (580) 221-4767. 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 PRACTICE FOR SALE for efficiency and patient comfort.

With nearly 500 new patients seen in 2024 – averaging 40 per month – growth potential is substantial, even with minimal advertising. The 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!

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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 ft.

Current Dr. can stay at least 1 year. Better than new.

Call 405-650-0945

EQUIPMENT FOR SALE Dentist retiring and selling all equipment. 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.

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

www.okda.org

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