ODA Journal: Summer 2026

Summer 2026 | Vol. 117, No. 2

Building Connections, Strengthening Dentistry Introducing ODA's 2026-2027 President, Dr. Nicole Nellis page 23 www.okda.org

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journal | Summer 2026

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CONTENTS Summer 2026 | Vol. 117, No. 2

EDITORIAL 6

Educating, Serving, Leading: 50 Years of the OU College of Dentistry by Dr. Paul Mullasseril

STATE ASSOCIATION

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Educating, Serving, Leading: 50 Years of the OU College of Dentistry

4

ODA Calendar

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Welcome New Members

8

ODA Workforce Task Force Update

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2026-2027 Officers Installed

10 ODA Executive Director House of Delegates Address 1 2 ODF Mobile Smiles Update 1 8 Congratulations ODA Leadership Academy Graduates 27 Congratulations OUCOD Class of 2026 34 ODA Rewards Partners

THE OKLAHOMA DENTAL ASSOCIATION JOURNAL (ISSN 0164-9442) is the official publication of the Oklahoma Dental Association and is published quarterly 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.

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

NATIONAL ADA NEWS 2 1 Deadline for Updated Digital Accessibility Regulation

Extended to May 2027

LEGISLATIVE LOOP

9 2026-2027 Officers Installed

1 3 A Successful Session for Oklahoma Dentistry

by Mark Yates 1 5 Oklahoma Strengthens Noncovered Services

Protections in New Law

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

17 Robie Herman Memorial Golf Tournament Photos

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

1 9 Ask Congress to Close the ERISA Loophole

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

2 3 Introducing ODA President Dr. Nicole Nellis: Building Connections, Strengthening Dentisty

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.

CLINICAL

1 8 2026 DENPAC Members

COVER STORY

ODA President 2 3 Introducing Dr. Nicole Nellis

2 8 Beyond the Arch: Gut Check: Why are more people dying from colorectal cancer before age 50?

by Stacy Sigler, RDH 32 Case Study: Differential Diagnosis of the Gingival Mass by Glen Houston, DDS, MSD

CLASSIFIEDS

Copyright © 2026 Oklahoma Dental Association.

35 Classifed Ads Is Your Information Correct?

Diagnosis of the 3 2 Differential Gingival Mass

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

Contact Ansley Bennett at abennett@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 Roberta A. Wright, DMD, MDSc, FACP EDITORIAL BOARD MEMBERS Philip Morton, DDS, PhD Stacy Sigler, RDH Glen Houston, DDS, MSD

ODA OFFICERS 2026-2027 PRESIDENT Nicole Nellis, DDS president@okda.org VICE PRESIDENT Tabitha Arias, DDS vicepresident@okda.org SECRETARY/TREASURER Erin Roberts-Svob, DDS treasurer@okda.org SPEAKER OF THE HOUSE Matthew Bridges, DDS speaker@okda.org IMMEDIATE PAST PRESIDENT Twana Duncan, DDS pastpresident@okda.org

ADMINISTRATIVE STAFF EXECUTIVE DIRECTOR F. Lynn Means DIRECTOR OF GOVERNANCE & FINANCE Shelly Frantz DIRECTOR OF MEMBERSHIP Ansley Bennett DIRECTOR OF COMMUNICATIONS Jill Johnson DIRECTOR OF EVENTS & EDUCATION Ramsey Tarrant OFFICE & COMMUNICATIONS MANAGER Katie Douglas

Stay connected with the ODA!

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journal | Summer 2026

CALENDAR See more online at OKDA.ORG/CALENDAR June National Oral Health Month June 12 Medicaid Task Force Meeting

Online & ODA Office 10:00am

June 12-13 ODA Botox and Dermal Fillers CE Course

Southern Hills Marriott Tulsa Register online at okda. org/events

July July 2-3

ODA Closed

July 24 Council on Governmental Affairs Meeting

Online & ODA Office 9:00am

July 24 Council on Membership and Member Services Meeting

Online & ODA Office 11:00am

July 24 ODA Board of Trustees Meeting

Online & ODA Office 1:30pm

August August 6 National Fresh Breath Day August 22 National Tooth Fairy Day August 21-22 Southwest Dental Conference Dallas, TX

September National Gum Care Month Dental Infection Control Awareness Month

October National Dental Hygiene Month Orthodontic Health Month October 1 Eastern District Dental Society Annual Meeting and CE Event

Pete's Place - Krebs, OK 6:00pm - 9:00pm Register online at okda. org/events

October 2 ODA Risk Management Webinar

Sept. 4-7

Online 1:00-3:00pm Details coming soon at okda.org/events

Sept. 11 OSHA and Infection Control Webinar

October 8-10 ADA 2026 Scientific Sessions

ODA Closed

Online 1:00-3:00pm See more info online at okda.org/events

September 18 ODA Membership Summit September 25 Components' CE and Business Meetings: Central, Southwest, and Northern

Online All dentists may attend the one-hour CE. Details coming soon at okda.org/events

LEARN MORE ABOUT ODA EVENTS AND CONTINUING EDUCATION ONLINE AT OKDA.ORG/EVENTS

Indianapolis, IN Learn more at ada.org/ education/scientificsession

October 16 ODA CPR & BLS Course

Details coming soon at okda.org/events

SAVE THE DATE

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EDITORIAL Educating, Serving, Leading: 50 Years of the OU College of Dentistry not new, but they are increasingly urgent, and they call for thoughtful, sustained action.

appropriate care while also giving students valuable, hands-on experience. It is a reflection of our commitment to meeting patients where they are and ensuring they receive the care they need when they need it.

One of the most impactful steps we have taken is increasing class sizes across our programs, with significant growth in both our dental and dental hygiene programs. These The pediatric dentistry residency will increases will have a positive effect soon celebrate its first graduating on communities across Oklahoma by class, in 2026. We have increased expanding the number of graduates next year’s class size by one for a total entering the workforce and helping of four residents per year. All of our practices care for more patients. programs remain fully accredited, Paul Mullasseril, DDS, MS Dean, OU College of Dentistry reflecting the strength and stability We are also proud to announce the of our academic mission. launch of a new Dental Assisting program beginning in 2026. This None of this work happens in addition reflects our commitment isolation. It is made possible This year marks a meaningful to supporting the full dental team through strong partnerships and the milestone for the University of and to ensuring that practices have continued support of our colleagues Oklahoma College of Dentistry as across the state. Investments in we celebrate the 50th anniversary of the support they need to provide efficient, high-quality care. student scholarships and initiatives our first graduating dental class in such as the Access to Care Fund 1976. For five decades, the college Expanding the workforce is only support clinical experiences for has prepared dentists who have gone part of the solution. We must also students while also expanding care on to serve communities across continue to find meaningful ways for Oklahomans.

Oklahoma and beyond with skill, to reach communities where access compassion, and a deep sense of remains limited. The MobileSmiles As we celebrate 50 years of dental responsibility. We take great pride in program is one example of how we graduates, we are reminded that the impact our graduates have made are doing just that. Following its our mission has always been rooted across the state, and as we reflect on launch in Guymon, the program has in service—to our students, to that legacy, we are equally focused on already provided care to hundreds our profession, and to the people the work ahead and the role we must of Oklahomans, bringing services of Oklahoma. That commitment continue to play in meeting the needs directly to communities that might remains as strong as ever. We are of our communities. otherwise go without. We are grateful for our partnership with encouraged by its early success and the Oklahoma Dental Association Oklahoma continues to experience and for the many dentists and team significant gaps in oral health access, look forward to expanding this members who share in this work particularly in rural and underserved model into additional areas. every day. areas. At the same time, practices We are also advancing how we across the state continue to face a care for patients with urgent The next 50 years will bring shortage of dental hygienists, which needs. The College’s Acute Care new challenges, but also new directly impacts patient access and Clinic represents an important opportunities. We look forward to practice capacity. These challenges are step forward, providing timely, meeting them together.

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journal | Summer 2026

www.okda.org

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STATE ASSOCIATION NEWS ODA Workforce Task Force Update

by ODA Staff

In 2025, Dr. Daryn Lu appointed a task • force chaired by Dr. Twana Duncan, to address dental workforce shortages in Oklahoma. The task force was comprised of general dentists, specialists, dentists from various practice modalities, and • representatives from the Oklahoma Dental Hygienists Association, and the Oklahoma Dental Assistants Association.

The task force collaborated with the Oklahoma Board of Dentistry to develop five key recommendations aimed at • addressing the workforce shortages in Oklahoma: •

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Create a dental hygiene licensure for foreign-trained dentists to practice dental hygiene.

journal | Summer 2026

Accelerate the RDH program by increasing class size and allowing the final part of their education to be gained in private offices with adjunct faculty.

Develop a program for assistants to be trained and graduate with all their expanded functions, with competencies in place upon completion Establish an expanded function certification for dental assistants to scale above the gumline for children’s (ages 0-12) prophys.

•

Change supervisory restrictions to allow RDHs to administer LA, films, laser, and N2O while the dentist is not in the office, and allow RDHs to supervise dental assistants in the same functions while dentists are not in the office.

The ODA Board of Trustees voted to support revisions to the State Dental Practice Act that enable these recommendations to be realized through legislation presented by the Oklahoma Board of Dentistry during the 2026 legislative session.

STATE ASSOCIATION NEWS 2026-2027 Officers Installed

ODA's 2026-2027 officers were installed May 2, 2026 at the House of Delegates Meeting in Norman, OK.

The Oklahoma Dental Association proudly welcomes its 2026–2027 officers and board leaders, who will help guide the association's mission of advancing the dental profession and advocating for oral health across Oklahoma.

Installed as officers for this year are: President: Dr. Nicole Nellis President Elect: Dr. Tamara Berg* Vice President: Dr. Tabitha Arias Secretary/Treasurer: Dr. Erin Roberts-Svob Speaker of the House: Dr. Matthew Bridges

Council and Committee Chairs: Dr. Doug Auld, Chair, Investments Committee Dr. Matthew Bridges, Chair, Council on Bylaws, Policy, and Ethics Dr. Ronnie Faram, Chair, Continuing Education Committee Dr. Chris Fagan, Chair, DENPAC Dr. Edward Harroz, Chair, Council on Budget and Finance Dr. Nicole Nellis, Chair, Council on Nominations Dr. Lauren Parker, Chair, New Dentist Committee Dr. Steffan Sigler and Stacy Sigler, Co-Chairs, Ok Mission of Mercy Dr. Lindsay Smith, Chair, Council on Governmental Affairs Dr. Mary Temple-Goins, Chair, ODA Annual Meeting Dr. Roberta Wright, ODA Journal Editor Dr. Whitney Yeates, Chair, Council on Membership and Member Services

The ODA also recognizes the additional leaders serving on the Board of Trustees and in key leadership Together, these leaders bring a wealth of experience, expertise, and roles throughout the organization: dedication to organized dentistry. As the ODA continues its work Dr. Addie Allen-Steed, Tulsa County Trustee on behalf of Oklahoma dentists and the patients they serve, the Dr. Doug Auld, Eastern Trustee association looks forward to the leadership and vision this team will Dr. Matthew Cohlmia, ADA Delegate provide in the year ahead.

Dr. Twana Duncan, Past President The ODA thanks each of these individuals for their willingness to Dr. Chris Fagan, Northwest Trustee serve and for their commitment to strengthening the profession and Dr. Shannon Griffin Lopez, ADA Delegate advancing oral health throughout Oklahoma.

Dr. Jandra Korb, Northern Trustee Dr. Paul Mullasseril, Dean, OU College of Dentistry To get involved with the ODA in a leadership role or to join a Dr. Lauren Parker, New Dentist Trustee council or committee, please visit okda.org/get-involved or contact Dr. Steffan Sigler, Oklahoma County Trustee the ODA team at (405)848-8873.

Dr. Lindsay Smith, ADA Delegate *Dr. Tamara Berg will officially take office on October 15, 2026 when Dr. Sara Spurlock, Central Trustee she concludes her term as ADA First Vice President.

Dr. Mary Temple-Goins, Southwest Trustee Dr. Dan Wilguess, ADA Delegate www.okda.org

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STATE ASSOCIATION NEWS ODA Executive Director House of Delegates Address I will report that we were up 13% over 2025’s pre-registration of 356, which is great news. Nowhere near where we were 10 or 15 years ago, but an increase.

And we picked up 39 more registrations onsite, putting us 4% over last year’s total registration.

AND the bigger our grassroots, the better. Please start TODAY emailing, calling, and texting them, and THANK YOU in advance for your help with our recruitment and retention efforts.

Before we leave membership, I’ll report on last year’s resolution directing the In an effort to try to offer you and your Membership Council to resurrect the teams quality CE apart from the Annual New Dentist Committee. Component Meeting, we started offering more one- Trustees appointed new dentists off courses in 2025, which I am pleased to represent their members on the to report yielded $43,000 in income last reimagined committee. They began year. And, so far, 2026 is following suit. meeting early last fall, and let me say, it has been a breath of fresh air!

As Dr. Rogers just reported, reserve Lynn Means funds currently represent over 156% of Chaired by New Dentist Trustee, Dr. ODA Executive Director the proposed 2026 operating budget, Lauren Parker, and also comprised of well above the required 30%. The the ASDA President and a large group Budget and Finance Council continues practice representative, this group May 2, 2026 to make tough decisions when building is engaged, full of ideas and brings a our Association budget. And your completely fresh perspective.

Good afternoon, ODA Delegates and Investments Committee closely watches Officers, and extending another special They are actively working on several your investments, making strategic welcome to our ADA guests – Drs. initiatives, like a restructured decisions regarding your reserves Nadershahi and Reavis – and our mentorship program, more meaningful throughout the year.

FAVORITE ADA Board member, Dr. Success Seminars for dental students, Tamara Berg, ADA 1st Vice President!

Membership: We gained 115 new and exploring a potential membership Thank you all for joining us today! members in 2025, 80 of which were new pilot for employee dentists. Suffice it to graduates, 14 graduate students, and say, we can expect great things out of And Delegates, THANK YOU for 32 members who came back to us after this group very soon! volunteering your time to represent your lapsed memberships.

We finished 2025 Component today. I would also like Since 2010, Oklahoma dentistry has with a 75.3% market share, up from to thank everyone who also serves on come together to provide $19.3 million 72.1% in 2024 – an over 3% increase! an ODA Council, Committee or Task We processed 20 retired memberships in donated dental care to more than Force and those of you in leadership at 21,000 patients in need through the in 2025, almost doubling 2024 and the Component level. Please know the keeping with the trend we expect to see Oklahoma Mission of Mercy. The 2027 gift of your time makes your profession for a while. And we’ve retired six more event will be a one-day event, so please stronger. members just since January 1of this year. mark your calendar now for OkMOM 2027, February 5th, in Oklahoma City!

First, reporting on the resolution this The ODA’s calling campaign in March And thank you to Dr. Steffan Sigler and House passed last year directing the was highly successful.

68% of the his partner in all things, Stacy Sigler, for President to appoint a task force to dentists contacted renewed following co-chairing next year’s mission! evaluate sunsetting the Annual Meeting. those conversations.

Thank you to The task force did their work and Ansley and Katie for calling every non- The 2026 mission in Enid was financed ultimately recommended to the Board in large part by a state allocation from renew last month! last July, that given the fact that the our Legislature, and we are so grateful meeting had just been downsized to a The list of 2025 non-renews is in your for that gift. That funding is in no way two-day event and moved to a smaller packet. As leaders in your Component, guaranteed next year, so please continue venue, we should give it one more year please reach out to these colleagues and to support the OkMOM Legacy Fund. with that format, following this meeting, encourage them to renew. Member-to- While the treatment during OkMOM to re-evaluate. So, that task force will member conversations WORK and our is completely donated, there is still a come back together again soon to market share MATTERS – especially substantial cost of about $275,000 to continue their work. at the State Capitol. The higher the operate the event each year – even more percentage of dentists in Oklahoma when we’re in OKC or Tulsa. If you we represent and speak for, the better, haven’t yet joined the OkMOM Legacy, 10 journal | Summer 2026

STATE ASSOCIATION NEWS continued please help us continue the life-changing much sense. BUT NOT THIS YEAR! You will find a list of ODA Rewards work done every year by making your Congratulations to us all!

Partners in your packet. The ODA one-time or monthly gift today.

Rewards program offers member-only I also want to thank the ADA for a discounts on products and services This past February in Enid was a generous State Public Affairs grant that you use every day in your practice and tremendous success, and we again thank assisted in funding a big part of our even at home. And your participation Dr. Chris Fagan for serving as event chair communications effort this session. provides the ODA non-dues revenue. a second time! If you volunteered your The ODA received $138,000 in Rewards And we are not done because dental talents in Enid this past February, please Partners royalties in 2025, reducing insurance is very broken and there is stand! your dues by $152 EACH this year. Take still A LOT to fix! How can you help advantage of those member discounts!

I also want to express our deepest us keep up the momentum into next If you are buying from other companies, gratitude to the Oklahoma Dental year? I will answer by asking you two you are absolutely paying too much!

Foundation for continuing to serve as questions: #1: Are you a member of the ODA’s TRUE partner in all things DENPAC? Your personal investment To the ODA Board of Trustees and OkMOM! We REALLY could not do it each year goes a long way in helping Executive Committee – thank you for without them! the ODA protect your profession. If you your leadership, flexibility, and support haven’t done your part by giving this over the past year. I am beyond grateful You guys, ELEVEN YEARS! We have year, please visit the DENPAC table to to work for a group of volunteers been trying to restore the original make your contribution today! And, meaning behind the non-covered services #2: Do you actually KNOW your State that are so fully committed to the Association, and to providing value to law we passed in 2010, but loopholed Representative and Senator? I hope you the member dentists we serve. in 2025, making it illegal for insurance see now that YOU are the key to our to price fix services they do not cover legislative success. It’s so important that I have thanked many people today, but REGARDLESS OF CONTRACTUAL we foster strong relationships with our the MOST gratitude will always go to LIMITATIONS … AND WE FINALLY legislators. my teammates … Shelly, Ansley, Jill, DID IT! Ramsey, and Katie! Thank you, ladies, Reach out to your state representative for your flexibility, resourcefulness, There are so many people to thank. I and senator – invite them for coffee creativity, generosity, patience, and will start with Dr. Lindsay Smith for his at your office one day this summer.

ESPECIALLY your commitment to steadfast leadership on our legislative Introduce them to your team and just excellence. Delegates, you have an efforts, and the entire Council on take 30 minutes to get to know them exceptionally talented team working for Governmental Affairs. Mark Yates and personally. Offer to serve as a resource you!

Maddy Hague, our fearless lobbyists at to them. They are not scary. They are Cornerstone, working day and night just people. And they need US to be Twenty years have flown by, and I – not letting up on the gas once. Next, who they are relying upon to get the know how very blessed I am – just how and they’ve been thanked 100 times, answers they need. much the ODA has provided my family but I’ll say it 100 more – THANK YOU and myself the past two decades. I am to Representative Anthony Moore and Those relationships are CRUCIAL and grateful to still love, love, love my job.

Senator Kristen Thompson, our small THAT’S what protects your patients and Truly. THANK YOU for the opportunity business and free market CHAMPIONS your business and continues to move the to continue to serve as your Executive for carrying our bill! But mostly, thank profession forward.

Director. you to every member of the ODA Congratulations again to our 10 ODA who called, emailed, and texted your legislators! YOU MADE THIS HAPPEN! Leadership Academy graduates! We Donate to the OkMOM are excited to watch how each of you Legacy Fund The opposition was loud and apparently continue to make contributions to had thousands and thousands of dollars the Tripartite, and we look forward to in patient premiums to spend on a highly working with you! The next class will orchestrated gaslighting campaign. graduate in 2028, and we will start But the truth prevailed and your hard taking applications for that class this work has finally paid off! The Governor time next year.

See a list of ODA's signed the bill on April 14 – thank you Upcoming CE Events to Kevin Stitt – and it goes into effect on If you are a past ODA Leadership November 1st. Most years can be pretty Academy graduate, please stand so we may recognize you. frustrating, not understanding or being able to explain why things didn’t go our way at the Capitol when they make so www.okda.org

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12 journal | Summer 2026

LEGISLATIVE LOOP A Successful Session for Oklahoma Dentistry Throughout the legislative process, officials about the issues impacting ODA members made a tremendous dentistry. Oklahoma voters will difference. Your phone calls, emails, select a new governor, along with text messages, and conversations with every other statewide elected official. lawmakers helped ensure that legislators Significant turnover is also expected understood the importance of this issue in the Legislature, with as many as 20 to both dentists and patients. In the new members joining the House of end, lawmakers chose to stand with Representatives and at least three new Oklahoma dentists and consumers members entering the Senate. over large dental insurance carriers.

This victory demonstrates the impact These changes present valuable grassroots advocacy can have when opportunities for ODA members to members speak with a unified voice. engage with incoming policymakers and help build strong relationships from the Mark Yates is Principal at Cornstone Public The ODA also continued its efforts to beginning. Educating elected officials Affairs and serves as a lobbyist for Oklahoma address workforce challenges affecting about the challenges facing dentistry— Dental Association. dental practices throughout the state. and the role dentists play in improving Representative David Smith, R-Arpelar, the health of Oklahomans—will remain The 2026 Oklahoma Legislature and Senator Roland Pederson, a top priority in the months ahead. adjourned Sine Die on May 14, marking R-Burlington, successfully advanced the close of a legislative session that House Bill 3934, which was also Finally, the team at Cornerstone delivered significant victories for signed into law by Governor Stitt.

The Government Affairs extends its sincere Oklahoma dentists and their patients. legislation establishes a three-year pilot appreciation for the opportunity pathway that will allow foreign-trained to represent the Oklahoma Dental The continued engagement and dentists to practice in Oklahoma.

Association. While we celebrate commitment of Oklahoma Dental the successes achieved this session, Association members across the state While HB 3934 represents meaningful there is still important work ahead. remain essential to advancing the progress, workforce shortages remain As preparations begin for the next profession at the Capitol. This year, one of the most pressing issues facing legislative session, we look forward to that engagement helped secure a major the profession.

The ODA will continue continuing to work alongside ODA legislative win with the passage of Senate working throughout the interim to members to advance policies that Bill 1942, the ODA's Non-Covered identify and develop additional policy strengthen the profession and improve Services legislation. Authored by solutions that can be considered during access to care for patients across Senator Kristen Thompson, R-Edmond, the next legislative session.

Oklahoma. and Representative Anthony Moore, As the legislative session concludes, R-Clinton, the bill was successfully passed Thank you for your continued support, by the Legislature and signed into law by attention now turns to the 2026 election cycle and the important engagement, and advocacy.

Governor Kevin Stitt. work of educating newly elected

www.okda.org

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14 journal | Summer 2026

LEGISLATIVE LOOP

Oklahoma Strengthens Noncovered Services Protections in New Law

by Olivia Anderson, ADA Staff

Association Council on Governmental Bill marks culmination of years of advocacy to close Affairs. “By closing the loophole in services, we restored loophole, restore balance in noncovered fairness to the marketplace, protected small dental practices, and ensured dental benefit plans

helped the bill avoid procedural roadblocks where opposition influence was expected to be strongest.

At the same time, the Oklahoma Dental that decisions about patient care are no Association mobilized a broad-based On April 14, Oklahoma Gov. Kevin Stitt longer dictated by insurance companies advocacy campaign. Dentists across the state engaged lawmakers directly signed into law a bill clarifying that dental that aren’t paying for those services.” through calls, texts and in-person insurance companies may not set fees for services they do not cover. The policy ADA president Richard Rosato, D.M.D. meetings, while the association deployed many communications tools, including is intended to restore the original intent offered his own congratulations and noted how Oklahoma’s win connects to legislative alerts, social media outreach, of the state’s 2010 noncovered services national advocacy. town halls and targeted educational law and marks a significant victory for materials for policymakers. Events like organized dentistry.

“Dentists in Oklahoma refused to quit legislative receptions and coordinated on an issue they knew, if passed, would media efforts kept the issue visible The legislation, Senate Bill 1942, benefit themselves and their patients,” advanced by the Oklahoma Dental throughout the session.

Association with support from the ADA, he said. “Great laws like this are exactly why we are pursuing the Improving The campaign faced significant closes a loophole created by a 2013 Dental Administration Act at the federal resistance, as insurance industry groups attorney general opinion that allowed insurers to impose fee restrictions under level, so that if a state has a noncovered and affiliated organizations mounted services law on the books, it applies to a well-funded opposition effort that certain contractual conditions. With all forms of coverage offered, including included proposed amendments and this bill, Oklahoma aligns more clearly self-funded plans.” messaging aimed at slowing the bill’s with the growing number of states that progress. Oklahoma Dental Association prohibit such practices outright.

The issue of whether third-party payers leaders said strong member engagement, should be allowed to dictate prices for With the original 2010 law, Oklahoma along with support from ADA staff and services they do not reimburse has been resources and state-level partnerships, was among the first states to establish a defining one for organized dentistry. helped overcome those challenges that dental insurers may not set fees for Dentists participating in insurance services they do not cover. However, networks already agree to significant Ultimately, the measure passed both a subsequent interpretation of the law discounts, often averaging about 55% chambers with broad bipartisan support, created a loophole that insurers used of their usual fees, for covered services. followed by a final push from members to continue influencing pricing for Extending those controls to noncovered urging the governor’s signature. noncovered services, allowing them to regulate fees in cases involving frequency services, advocates said, undermines “What ODA accomplished this year free-market principles and places limits, waiting periods or annual in our state legislature is a powerful disproportionate pressure on small maximums. example of what happens when dentists dental practices. speak with one voice through organized For the Oklahoma Dental Association, dentistry,” said Oklahoma Dental the bill’s signing marks the end of a long Oklahoma Dental Association leaders also emphasized the broader market Association President Twana Duncan, and deliberate advocacy campaign that D.D.S. “Our members showed up, spanned more than a decade and required implications. By leveraging their size, engaged their legislators, and stood firm sustained grassroots engagement as well large insurers can impose contract against well-funded opposition. From as coordinated messaging. Supporters say provisions that smaller competitors cannot match, contributing to industry the individual dentists calling their it will likely have a national impact, as states around the country may consider consolidation and limiting competition, legislators to the support we received which may ultimately impact patients from the ADA, organized dentistry similarly improving their noncovered through higher costs and reduced showed up in a major way. The result services laws. choice. is a meaningful, pro-patient, pro-small “The 2026 legislative session success business reform that brings balance back Addressing that imbalance, Senate in our state represents the culmination to the dentist-patient relationship in Bill 1942 moved in tandem with a of more than a decade of persistence, Oklahoma.” companion measure in the House. Early strategy, and grassroots advocacy decisions like routing the legislation The legislation is set to take effect from Oklahoma Dental Association through appropriations committees Nov. 1. and its members,” said Lindsay Smith, rather than insurance committees D.D.S., chair of the Oklahoma Dental www.okda.org

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All data is derived from MedPro Group records and calculations; claims data range is 2015-2024 unless otherwise indicated. MedPro Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company, PLICO, Inc., and MedPro RRG Risk Retention Group. All insurance products are administered by MedPro Group and underwritten by these and other Berkshire Hathaway affiliates, including Wellfl eet Insurance Company, Wellfl eet New York Insurance Company, and National Fire & Marine Insurance Company. Product availability is based upon business and/or regulatory approval and may differ among companies. © MedPro Group Inc. All Rights Reserved. Dental-260122

16 journal | Summer 2026

LEGISLATIVE LOOP Robie Herman Memorial Golf Tournament

May 29, 2026

www.okda.org

17

LEGISLATIVE LOOP Thank you, 2026 DENPAC Members GRAND MEMBERS Dr. Douglas Auld Dr. Tamara Berg Dr. M. Edmund Braly Dr. Matthew Cohlmia Dr. Twana Duncan Dr. Shannon Griffin Lopez Dr. Richard Haught Dr. Juan Lopez Dr. Nicole Nellis Dr. Steffan Sigler Dr. Lindsay Smith CAPITOL CLUB MEMBERS Dr. BDr. Jeffrey Ahlert Dr. Clay Anderson Dr. Tabitha Arias Dr. Glenn Ashmore Dr. Brandon Beaver Dr. David Birdwell Dr. Michael Breland Dr. Matthew Bridges Dr. C. Todd Bridges Dr. Nathan Brown

18 journal | Summer 2026

Dr. Adam Bulleigh Dr. Kristen Campbell Dr. Tricia Cannon Dr. John Carletti Dr. Bobby Carmen Dr. Jennifer Chambers Dr. Brian Chastain Dr. Carrie Chastain Dr. Logan Coffee Dr. Larry Coggins Dr. Susan Davis Dr. Brian Drew Dr. Kolton Erickson Dr. Heath Evans Dr. Christopher Fagan Dr. Ryan Fitzgerald Dr. John Folks Dr. Richard Freeman Dr. Sandra Grace Dr. Stephen Gray Dr. John Groves Dr. Jacob Hager Dr. Michael Hansen Dr. Richard Henry

Dr. Marilyn Hiebert Dr. James Hooper Dr. Brad Hoopes Dr. James Hulsey Dr. Benjamin Humphrey Dr. Karl Jobst Dr. Donald Johnson Dr. Krista Jones Dr. Michael Kirk Dr. Jandra Korb Dr. Leslie Ledbetter Dr. Marti Levinson Dr. Shannon Lewis Dr. Heng Lim Dr. Daryn Lu Dr. Edith Lu Dr. David Marks Dr. Stephen Martin Dr. Stephen Mayer Dr. Andrew McGarry Dr. Janna McIntosh Dr. Glenn Mead Dr. Paul Mullasseril Dr. John Phillips

Dr. Ray Plant Dr. Nathan Powell Dr. Dana Price Dr. Christopher Ray Dr. Brant Rouse Dr. Troy Schmitz Dr. Brandon Schultz Dr. Floyd Simon Dr. Lori Smith Dr. Caleb Smith Dr. Sterling Stalder Dr. Adelaide Steed Dr. Clinton Stevens Dr. Ryan Streight Dr. Stephanie Sugg Dr. Carla Sullivan Dr. Jim Taylor Dr. Ryan Theobald Dr. Kara Tims Dr. Jonah Vandiver Dr. Daniel Wilguess Dr. Brian Wilson Dr. Roberta Wright Dr. Kendra Yandell

www.okda.org

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20 journal | Summer 2026

NATIONAL ADA NEWS Deadline for Updated Digital Accessibility Regulation Extended to May 2027

by Mary Beth Versaci, ADA Staff

With the deadline fast approaching for certain dental practices to ensure their websites and other digital tools are accessible to people with disabilities to comply with an updated federal regulation, the U.S. Department of Health and Human Services Office for Civil Rights announced a revised timeline providing an additional year for compliance.

In May 2024, the Office for Civil Rights published a final rule — Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance — that updates, clarifies and strengthens Section 504 of the required to comply by May 11, while The American Dental Association Rehabilitation Act of 1973, including a those with fewer than 15 employees has published a digital accessibility covered entity’s obligations related to were given until May 10, 2027. guide to help dental practices comply digital accessibility.

However, after hearing concerns with the rule, which applies to all about the approaching deadline patient-facing digital tools, including The act prohibits discrimination on from a range of recipients of federal practice websites and mobile apps; the basis of disability in programs and financial assistance, HHS announced patient portals; online intake, consent activities that receive federal financial a new interim final rule extending and medical history forms; and assistance and provides protections the deadlines by an additional year. online payment and billing systems. for people with disabilities in federally Recipients with 15 or more employees A one-page accessibility essentials tip funded health and human services will now have until May 11, 2027, to sheet is also available for practices to programs. The rule clarifies that web comply, and recipients with fewer than download. content, mobile apps and medical 15 employees will now have until May kiosks must be accessible to people Making digital content accessible 10, 2028, to comply. with disabilities and meet defined means that everyone, including technical standards.

“We have heard about the challenges people with vision, hearing or our funding recipients face in meeting mobility disabilities, can perceive, The rule applies to any entity that the original deadline,” Paula M. understand, navigate and interact with receives federal financial assistance Stannard, director of the Office for it. Accessibility also ensures content from HHS, either directly or Civil Rights, said in a May 7 news works with assistive technologies indirectly. This includes dental release. “We believe that this extension and does not rely on a single sense or practices and dental clinics affiliated provides necessary flexibility, ensuring ability to be usable. It is not acceptable with hospitals or health systems; that recipients have the time to comply for dental practices to rely on phone dental schools and academic dental with accessibility standards and aligns calls or staff assistance as a substitute programs; Medicaid and Children’s our rules with those of our partners for providing accessible digital tools, Health Insurance Program dental at DOJ. At the same time, we remind the guide states. providers; community health centers recipients of their legal obligation with dental services; dental specialists; Find the guide and other resources to ensure that their programs and and dental researchers or companies activities are accessible to persons with on the ADA’s webpage on navigating receiving federal research funding. disabilities. Equal access to health and accessibility.

Under the original rule, organizations human services is a top priority for OCR.” with 15 or more employees were www.okda.org

21

22 journal | Summer 2026

COVER STORY Introducing ODA President Dr. Nicole Nellis: Building Connections, Strengthening Dentistry

by Jill Johnson, ODA Staff

As Dr. Nicole Nellis steps into her role as President of the Oklahoma Dental Association, she brings with her a deep commitment to organized dentistry, a passion for patient care, and a vision focused on supporting Oklahoma dentists through some of the profession’s most pressing challenges.

Her journey to dentistry began long before dental school.

“No one in my family is a dentist,” Dr. Nellis recalls. “The first time we found in writing that I wanted to be a dentist was in my reading journal in second grade.”

Her interest only grew from there.

Influenced by positive experiences with her childhood dentist—who also Dr. Nicole Nellis with her husband Stephen and son Mason. happened to be her father’s longtime friend—she dressed as a dentist That early passion eventually led program at the OU College of for Halloween in fifth grade, began her to the University of Texas Dentistry, where she trained under shadowing dental offices in sixth Health Science Center at San Drs. Shannon Griffin and Reiger grade, and landed her first dental job Antonio School of Dentistry, where Wood. Their mentorship helped working at a front desk when she was she earned her dental degree in refine her clinical skills while just 15 years old.

2014. While dental school was reinforcing the importance of demanding, it also introduced her to leadership and service. mentors who would shape both her As soon as she arrived in Oklahoma, professional and leadership paths.

Dr. Nellis transferred her ADA One of those mentors was Dr. Kevin membership and began her Gureckis, her clinic group director, involvement with the ODA—a who emphasized the importance decision that would become a of organized dentistry and lifelong defining aspect of her career. learning.

Building a Practice “He encouraged all of his students to be active in organized dentistry and a Community because that’s what you are supposed to do to protect your profession,” she After completing her residency, Dr. Nellis spent six months as an says. associate before realizing she wanted Following graduation, Dr. Nellis to create a practice of her own. continued her education through the Advanced Education in General Continued on page 25 Dentistry (AEGD) residency www.okda.org

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24 journal | Summer 2026

COVER STORY continued

Dr. Nellis is an avid NASCAR fan who rarely misses a race and regularly tunes into SiriusXM NASCAR Radio.

That opportunity came unexpectedly when she was shown a vacant dental office that had been closed for only a few months but remained fully equipped and ready to reopen.

Today, she considers building her practice to be her proudest professional accomplishment.

A Commitment to Organized Dentistry

The experience inspired her to become more involved at the state level, including service on the Council on Membership and Membership Services, where she later served as chair.

She received the keys to what would become Nellis Family Dentistry on Membership engagement remains December 7, 2015, and welcomed her Dr. Nellis’s leadership journey within one of her greatest passions and will first patients less than a month later, organized dentistry began almost be a major focus of her presidency. immediately after returning to on January 4, 2016.

Oklahoma.

Priorities for the Year Her vision was straightforward but powerful: provide high-quality dental She became active in the Tulsa Ahead County Dental Society, where the care in a comfortable environment late Dr. Jim Torchia encouraged her As ODA President, Dr. Nellis has while treating patients like family. to serve as the society’s New Dentist identified several key priorities for “I wanted to care for my patients like Chair. From there, she advanced the coming year. they were members of my own family, through leadership positions and learn their stories, and be a small part ultimately served as President of the First, she intends to continue supporting the strong programs, of their lives,” she says.

Tulsa County Dental Society from councils, and initiatives already 2020 to 2022.

Building a successful practice was serving ODA members. not without challenges. Like many Leading during the COVID-19 new business owners, Dr. Nellis faced pandemic presented unprecedented Second, she hopes to address declining membership numbers uncertainty during those early years. challenges, requiring adaptability by strengthening engagement and and steady leadership as the “The first year of owning my own helping dentists understand the business was incredibly challenging,” organization navigated rapidly value of organized dentistry. she says. “At times, I was nervous that changing circumstances.

I wasn’t going to succeed.”

A pivotal moment in her leadership “We need to do what we can to stop that decline and re-energize our Through mentorship, strategic planning, development came in 2017 when membership,” she says. and the support of an exceptional team, she completed the ODA Leadership Academy.

Another major concern is the practice flourished. By 2019, she was planning the construction of a “That’s where I learned exactly what Oklahoma’s workforce shortage. new building, and in February 2021, the ODA is and what the ODA does Nellis Family Dentistry moved into its for its members,” she says.

Continued on page 26 permanent home. www.okda.org

25

COVER STORY continued shortages, financial responsibilities, and patient expectations.

Dentistry to explore additional ways the ODA can support students and help them understand the value of membership before graduation.

“It’s easy to go to work every day, put your head down, and before you know it, you’ve dug yourself into a She is also excited about the hole mentally,” she says. return of the ODA’s New Dentist Committee and the opportunities it Her passion for the issue comes creates for developing future leaders. from personal experience. During dental school, she benefited from “I truly believe that early counseling services that helped her involvement in organized dentistry navigate periods of stress. Years later, leads to lifelong membership,” she as a new mother balancing a growing says. practice, staff responsibilities, patients, and family life, she A Lifelong Learner encountered similar challenges.

More than a decade into practice, Although she knew mental health Dr. Nellis remains energized by resources existed, finding them was dentistry’s constant evolution.

Dr. Nellis addresses the House of Delegates at the 2026 ODA Annual Meeting. not always easy.

She enjoys continuing education Fortunately, trusted colleagues opportunities and the challenge Practices across the state continue helped connect her with the support of staying current with new to struggle with staffing challenges, she needed. That experience technologies, techniques, and best and Dr. Nellis believes additional reinforced her belief that dental practices. strategic planning and collaboration professionals should have clear are necessary to develop meaningful access to resources and support “I always feel re-energized after solutions. attending a good course,” she says. before they reach a crisis point.

She also remains focused on advocacy As president, she hopes to strengthen That enthusiasm for lifelong learning efforts related to dental insurance mirrors the advice she received from awareness of available resources reform. While she celebrates the mentors early in her career and while encouraging conversations ODA’s recent legislative success around wellness and mental health continues to guide her professional regarding non-covered services, she throughout the profession. development today. recognizes that reimbursement rates and rising business costs continue to Investing in the Next create challenges for practitioners.

Generation “We have to continue our advocacy efforts at the State Capitol to improve Dr. Nellis is equally passionate about insurance reform so our dentists can engaging dental students and new continue to provide high-quality care dentists. for our patients,” she says.

She believes involvement in organized dentistry should begin Prioritizing Mental early and continue throughout a Health professional career.

One issue particularly close to Dr. Nellis’s heart is mental health.

She believes dentistry can be an isolating profession, especially when dentists face the combined pressures of practice ownership, workforce 26 journal | Summer 2026

“Students need to know what the ODA is doing to protect the profession of dentistry in Oklahoma,” she says.

She plans to work closely with faculty at the OU College of

COVER STORY continued Beyond the Dental Office

Stronger Together

As she begins her presidential year, Dr. Nellis hopes ODA members Outside of dentistry, Dr. Nellis enjoys recognize that they are not facing a wide range of interests. today’s challenges alone.

She is an avid NASCAR fan who Whether addressing workforce rarely misses a race and regularly shortages, insurance concerns, mental tunes into SiriusXM NASCAR Radio. health needs, or the future of the profession, she believes organized In the fall, she and her husband dentistry remains the strongest cheer on the Oklahoma Sooners vehicle for meaningful progress. each weekend. She is also a Barbie doll collector and a Lilly Pulitzer “We are all on this journey together,” enthusiast. she says. “The more dentists that join Most importantly, she treasures time us and are involved, the more success we will have as an organization.” with her husband and their young son, Mason, who is two and a half With a career defined by service years old. and a commitment to building meaningful connections, Dr. Nellis The family are active members of is well positioned to guide the ODA Boston Avenue United Methodist through the year ahead and help Dr. Nellis is sworn in as the 120th President Church in Tulsa. strengthen the profession for the of the Oklahoma Dental Association. future.

www.okda.org

27

BEYOND THE ARCH Gut Check: Why are more people dying from colorectal cancer before age 50?

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.

“Science is a tribute to what we can know, although we are fallible.”

— Jacob Bronowski

by Stacy Sigler, RDH

share one definitive certainty: we have to do something. If there’s one area people want to discuss less than the mouth, it’s the rectum. The dental field already handles the gritty business and delicate conversations of the mouth, so why should we further push the discomfort?

The unsettling truth is: because it’s more connected than you think.

WHAT CHANGED? The rise in early-onset colorectal cancer (EOCRC) is unlikely to be explained by a single factor. Current literature points toward a convergence of modifiable and non-modifiable risk factors, as well as emerging risk modifiers. In other words, the burden is cumulative. Non-modifiable risk factors for EOCRC include family history of CRC or polyps, inflammatory bowel disease, Crohn's disease, ulcerative colitis, Lynch syndrome, and familial adenomatous polyposis. Patients with a first-degree relative diagnosed with colorectal cancer are generally advised to begin screening at age 40, or 10 years earlier than the age at which their family member was diagnosed — whichever comes first.⁴ Modifiable risk factors include obesity, ultra-processed diets, low fiber intake, smoking, alcohol use, sedentary lifestyle, Type 2 diabetes, microbial dysbiosis (including possible antibiotic associations), and chronic inflammatory burden.³

We are in another epidemic. This time, there are no urgent CDC updates, but rather “I’m not sure the benefits outweigh the risk” from doctors or “I don’t want screenings there” from patients. We need to talk about it: Colorectal cancer (CRC) is now the leading cause of cancer-related death in men under 50 and in women under 50, recently surpassing breast cancer mortality within that age group.¹ Since 2011, cases have increased roughly 3% per year in people under the age of 50, and this early-onset CRC (EOCRC) is expected to double in incidence by 2030—that’s one in five CRC diagnoses.

The median age group diagnosed with CRC (patients over 50) has seen a Emerging research has also begun consistent annual reduction in CRC mortality rates since the early 1990s due examining environmental contributors such as endocrine-disrupting chemicals, to screenings.² microplastics, and nanoplastics.

A systematic review in 2025 found These have been identified in human incidence occurring highest between blood, placenta, and stool samples the ages of 40–49 and frequently in and are associated with oxidative advanced stages.³ So why have the stress and inflammatory signaling American Cancer Society and CDC pathways, though direct causation only recently lowered the recommended in colorectal carcinogenesis remains screening age, and why is that screening unconfirmed.⁵ Colibactin-producing age 45 instead of 40? At present, bacteria (such as E. coli) and other there seem to be more questions than microbial carcinogenic pathways may answers, but these skyrocketing statistics also contribute to chronic low-grade

28 journal | Summer 2026

inflammation and cumulative systemic stress.⁶ Gastrointestinal symptoms are increasingly normalized or overlooked.

Patients often attribute their GI symptoms to stress, diet, probiotic changes, reflux, or side effects of medications such as popular GLP1 receptor agonists. This lack of recognition could be contributing to a modern era of diagnostic delay.

The oral cavity may also represent an additional — and frequently overlooked — component of cumulative biologic burden.

PERIODONTAL PATHOGENS AS CANCER CATALYSTS Current research continues to link the oral microbiome to the development and progression of many diseases, citing well-known periodontal pathogens as diagnostic indicators and/or contributors. An increase in the bacterial load of specific bacteria facilitates chronic inflammation and subsequent cellular changes, resulting in a potentially increased risk for cancers.

Reducing the bacterial load and its associated inflammation may mitigate these health-threatening changes and their host cellular responses. In other words, pathogens and their mechanisms should be discussed as risk factors to many life-threatening illnesses.

In the case of colorectal cancers, Fusobacterium nucleatum (F. nucleatum) has been classified as an oncobiont—a microorganism found within or around tumor tissue that actively contributes to the genesis, progression, or treatment resistance of malignant tumors. F. nucleatum impacts immune response modulation, virulence factors, oncogenic microRNAs, intestinal metabolite interactions, DNA damage, and epithelial-mesenchymal

BEYOND THE ARCH, continued transition. It is similarly linked to oral, pancreatic, esophageal, and breast cancers. Not only might it negatively influence the cancers, but also their treatments such as chemotherapy and immunotherapy. A comprehensive 2024 review reports elevated levels of oral-derived F. nucleatum in colorectal cancer tissues and fecal samples, indicating ectopic colonization.⁷ It has been long established that transient bacteremia can arise from periodontal disease.

F. nucleatum originates from the oral microbial reservoir and is delivered via the circulatory system. This same study also supports that F. nucleatum inhibits anti-cancer lymphocytes (such as T-cells and NK cells) and disrupts cancer treatments via TLR4/NF-κB pathwayinduced autophagy.⁸

WHAT CAN DENTISTRY DO ABOUT IT?

While the generic answer is to continue doing our best to educate and create a healthy mouth, these ominous statistics outgrow the responsibility of a sole provider and suggest the A 2024 systematic editorial (and its burden of prevention and recognition accompanying graphic below) further should be shared. Prevention isn't illustrate that F. nucleatum affects “the so far outside our jurisdiction as we occurrence and progression of GI might believe: periodontal therapy, malignancies by colonizing the digestive reducing pathogenic bacterial load, oral tract, contributing to the proliferation, A 2020 study comparing PCR assays hygiene instruction, tobacco cessation, metastasis, and chemoresistance of on F. nucleatum in same-patient saliva nutritional counseling, and thorough cancer cells.”⁹ At this point, might we and CRC tumor tissue, alongside oral screenings are in every provider's murine studies of oral vs. hematogenous consider F. nucleatum a biomarker for routine care. cancer? routes, suggests that tumor-associated Continued on page 31 Figure 1. Proposed mechanisms by which F. nucleatum contributes to gastrointestinal malignancy, including digestive tract colonization, proliferation, metastasis, and chemoresistance.

Binding of F. nucleatum to receptors on the surface of tumor cells promotes malignant transformation through a variety of mechanisms, including the induction of DNA damage, modulation of the immune microenvironment of tumors, and regulation of non-coding RNA expression.

GC cells: Gastric cancer cells; GI cancer cells: Gastrointestinal cancer cells; Fn-GCEx: Exosomes secreted by F. nucleatuminfected GC cells; TLR4: Toll-like receptor 4; Gal-GalNAc: D-galactos-ß (1-3)-N-acetyl-Dgalactosamine; ESCC cells: Esophageal squamous carcinoma cells; MDSCs: Myeloid suppressor cells; PBMCs: Peripheral blood mononuclear cells; PMNs: Polymorphonuclear cells; NK cell: Natural killer cell.9 www.okda.org

29

Endodontic Practice Associates

Dr. Spencer Hinckley and Dr. Percy Bolen

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

W

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

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

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

Phone: 405.329.7936

1.800.238.5215

Fax: 405.329.1722

www.endodonticpracticeassociates.com 30 journal | Summer 2026

BEYOND THE ARCH, continued As previously stated, all of these are considered CRC risk factors if poorly managed. We simply need to inform patients of another valuable service in our repertoire: we are incorporating emerging cancer risk awareness into our preventive care. All we are doing is adding value to services we already provide. From there, the conversation can become more natural and engaging.

Patients start asking questions, and this gives providers the opportunity to educate with confidence and care.

medical evaluation remains crucial, but dental providers may also help bridge gaps in awareness through collaboration and accountability with physicians. The oral-systemic link is widely acknowledged. Why are we not linking our oral specialty into broader medical care? Interdisciplinary referrals and collaborative care could help our patients with advocacy and truly comprehensive care.

If the burden is cumulative, then every opportunity to reduce it matters.

Microplastic Exposure on Human Health: A Systematic Review of Mechanisms, Biomarkers, and Clinical Outcomes.

Cureus [Internet]. 2025 Dec 28;17(12):e100295. Available from: https://pmc.ncbi.nlm.nih.gov/ articles/PMC12848325/ 6. Pandey H, Tang DWT, Wong SH, Lal D. Gut Microbiota in Colorectal Cancer: Biological Role and Therapeutic Opportunities.

Cancers (Basel) [Internet]. 2023 Jan 30;15(3):866. Available from: https://pmc.ncbi.nlm.nih.gov/ articles/PMC9913759/

The most common symptoms are changes in bowel habits, hematochezia REFERENCES (blood in stool), persistent abdominal 7. Ye C, Liu Z, Pan C, Zhang X, pain, frequent diarrhea (more common) 1. American Cancer Society.

Zhao Z, Sun H. Review of oralor constipation, and unexplained weight derived Fusobacterium nucleatum Mortality Under 50 Declines for 4 loss. As previously mentioned, patients and ectopic colonization in of 5 Leading Cancers in U.S., but gastrointestinal malignancy. Cancer often dismiss these symptoms as stress, Colorectal Now Top Cancer Killer, Biol Ther [Internet]. 2024 Jan New ACS Study Finds [Internet]. habits, or medications. A 2024 study 30;25(1):2306676. Available from: Atlanta (GA): American Cancer reported that more than 50% of patients https://pmc.ncbi.nlm.nih.gov/ Society; 2026 Jan 26.

Available from: had symptoms at least 3 months prior articles/PMC10829845/ https://pressroom.cancer.org/underto diagnosis.¹⁰ Continuing education 50-mortality-declines could play an important role in helping 8. Abed J, Maalouf N, Manson A, providers feel more comfortable Earl A, Parhi L, Emgård JEM, 2. The University of Chicago et al. Colon Cancer-Associated discussing colorectal cancer risk factors, Medicine. Why are more people Fusobacterium nucleatum May under 50 getting colorectal symptom recognition, and appropriate Originate From the Oral Cavity cancer?

[Internet].

Chicago (IL): referral pathways. Emerging salivary and Reach Colon Tumors via the UChicago Medicine; 2026 Mar diagnostics and biomarker research Circulatory System. Front Cell 13.

Available from: https://www. may further strengthen dentistry’s Infect Microbiol [Internet]. 2020 uchicagomedicine.org/forefront/ role in interdisciplinary screening Aug 7;10:400. Available from: cancer-articles/why-are-moreand prevention efforts. As research https://pmc.ncbi.nlm.nih.gov/ people-under-50-getting-colorectalcontinues to evolve, dentistry may articles/PMC7426652/ cancer be uniquely positioned to recognize 9. Yu LC, Li YP, Xin YM, Mao M, 3. Kyrochristou ID, Lianos GD, patterns of risk long before disease Pan YX, Qu YX, et al. Application Kyrochristou GD, Georvasili V, progresses to advanced stages of Fusobacterium nucleatum as Tatsis V, Mitsis M, et al. Earlya biomarker in gastrointestinal Reducing patients' "these symptoms are onset colorectal cancer in patients malignancies. World J Gastrointest younger than 50 years: a systematic normal" assumptions can be life-saving.

Oncol [Internet]. 2024 Jun review of the literature. Ann Perhaps, however, one of the most 15;16(6):2271–2283. Available Gastroenterol [Internet]. 2025 Jun dangerous assumptions of colorectal from: https://pmc.ncbi.nlm.nih.gov/ 25;38(4):364–379.

Available from: cancer is that a patient is “too young” articles/PMC11236247/ https://pmc.ncbi.nlm.nih.gov/ to have it. Despite increasing awareness articles/PMC12277510/ surrounding EOCRC, barriers to 10. Skalitzky MK, Zhou PP, Goffredo P, Guyton K, Sherman screening and early intervention 4. Jones V. Colorectal cancer SK, Gribovskaja-Rupp I, screening: At what age should I get still exist, including insurance et al. Characteristics and a colonoscopy? [Internet]. Houston limitations and subsequent pressure Symptomatology of Colorectal (TX): MD Anderson Cancer on providers, patient hesitation, Cancer in the Young. Surgery Center; 2023 Jun 6. Available evolving screening recommendations, [Internet]. 2023 Mar 3;173(5):1137– from: https://www.mdanderson. and delayed symptom recognition.

1143. Available from: https:// org/cancerwise/colorectal-cancerWith projections suggesting that one pmc.ncbi.nlm.nih.gov/articles/ screening--at-what-age-should-iin five colorectal cancer diagnoses PMC10116569/ get-a-colonoscopy.h00-159619434. may occur in patients under 50 by html 2030,² reducing generalizations that 5. Ririe AK, Fatema N, Dina TJ, patients are “too young” for colorectal Kuchipudi JD, Tamanna P, cancer is vital. Encouraging patients Libriansyah L, et al. Impact of to recognize symptoms and seek www.okda.org

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CASE STUDY Differential Diagnosis of the Gingival Mass The pyogenic granuloma (a) is a common "tumor-like" growth of the oral cavity that is non-neoplastic in nature.

It is felt to represent an exuberant tissue response to local irritation or trauma.

The pyogenic granuloma typically presents as a smooth surfaced mass that may be ulcerated and the gingiva is, by far, the most common location intraorally. However, it may also be observed involving the lips, tongue, buccal mucosa, and cutaneous surfaces.

CLINICAL HISTORY

The fibroma (c) is the most common "tumor" of the oral cavity. Although it A 69 year old female presents with a chief may appear anywhere in the mouth, complaint of "my lower partial denture the buccal mucosa is the most common doesn't fit." Examination reveals a anatomic location. The labial mucosa, fluctuant, asymptomatic soft tissue mass tongue, and gingiva are also common involving the anterior mandibular lingual sites. It typically presents as a smoothgingiva. The patient notes that the "knot" surfaced, firm nodule with a broad, has been present for several weeks and sessile base. The fibroma is usually has slowly increased in size. The patient asymptomatic and not ulcerated. has a history of mild hypertension, fibromyalgia, chronic discoid lupus The peripheral giant cell granuloma erythematosus, and a long history of (d) is also a "tumor-like" growth of the tobacco (smoking) abuse. oral cavity that occurs exclusively on the gingiva or the edentulous alveolar ridge and presents as a nodular mass.

QUESTION #1 This lesion may be red to reddish-blue in The clinical differential diagnosis should color, exhibit a sessile or pedunculated include: base, and may or may not be ulcerated. a. Pyogenic granuloma The peripheral ossifying fibroma (e) is b. Pleomorphic adenoma c. Fibroma d. Peripheral giant cell granuloma e. Peripheral ossifying fibroma f.

Squamous cell carcinoma

ANSWER #1 Your differential diagnosis should include: a.

Pyogenic granuloma

c.

Fibroma

d.

Peripheral giant cell granuloma

e.

Peripheral ossifying fibroma

All four (4) of these entities can present intraorally as an isolated, circumscribed mass involving the gingiva.

32 journal | Summer 2026

by Glen D. Houston, DDS, MSD

QUESTION #2 Which of the following are indicated for this patient? a. Intraoral radiographic survey b. Biopsy the lesion c. Advise the patient to remove the denture for 10-14 days, then evaluate the area again for any change d. Adjust the denture

ANSWER #2 The following procedures are indicated in this case: a. Intraoral radiographic survey b. Biopsy the lesion (excision) The intraoral radiographic survey (a) will supplement your clinical observations and will also complete a comprehensive intraoral examination. Additionally, an isolated, asymptomatic mass involving the alveolar ridge/mucosa/gingiva is best managed by a biopsy, usually an excision (b).

There is little to be gained by advising the patient to remove the denture for 10-14 days (c). To adjust the denture (d) is another non-neoplastic, reactive lesion definitely not indicated in the treatment that occurs exclusively on the gingiva. It of this lesion. As indicated earlier, biopsy typically presents as a nodular mass with a of the lesion is warranted. pedunculated or broad sessile base. It may be red to pink in color and usually exhibits QUESTION #3 surface ulceration. This lesion usually involves the anterior segments of the jaws. Histologic examination of the lesion Although the pleomorphic adenoma (b) reveals the following: a proliferation may occur in the oral cavity and typically of loose mesenchymal tissue with presents as a nodular mass, it would not foci of hemorrhage, hemosiderin be included in the differential diagnosis deposition, and numerous aggregates of multinucleated giant cells. The overlying here because the attached mucosa is typically devoid of salivary gland tissue. surface epithelium is unremarkable.

Likewise, squamous cell carcinoma (f) may also occur intraorally, but this malignant neoplastic process typically presents as an area of leukoplakia, erythroplakia, or an ulcerated, fungating, exophytic mass. Only about four to six percent of these cases occur on the gingiva or the alveolar mucosa.

Based upon these microscopic features, the correct diagnosis for the lesion is: a. Pyogenic granuloma b. Peripheral giant cell granuloma c. Epulis fissuratum d. Neurofibroma

CASE STUDY continued ANSWER #3 The lesion is correctly diagnosed as (b) peripheral giant cell granuloma--see "Discussion" section.

The other possibilities are not considered here because (a) the pyogenic granuloma is composed of a highly vascular proliferation of granulation tissue which exhibits numerous endothelium-lined vascular channels that are engorged with erythrocytes. Epulis fissuratum (c) is also known as inflammatory fibrous hyperplasia and is composed of hyperplastic dense fibrous connective tissue with a chronic inflammatory cell infiltrate. The neurofibroma (d) is a neoplastic process of peripheral nerve sheath origin. It is composed of interlacing bundles of spindle-shaped cells which exhibit "wavy", "commashaped" nuclei in association with delicate collagen fiber bundles.

DISCUSSION The peripheral giant cell granuloma is a soft tissue lesion that is nonneoplastic and reactive/inflammatory in nature. This entity has been reported in the past under a great variety of terms such as peripheral giant cell tumor, osteoclastoma, giant cell epulis, and peripheral giant cell reparative granuloma. The variety of terms for

this lesion is indicative of the confusion over the true origin of this lesion. Even today there is no universal agreement concerning the pathogenesis of this entity.

From a clinical standpoint, the peripheral giant cell granuloma usually presents as a solitary, sessile, or pedunculated mass that occurs exclusively on the gingiva or alveolar mucosa. The lesion may be quite variable in size and is often red or hemorrhagic in appearance with surface ulceration present. The peripheral giant cell granuloma is more common in females than males, with a slight predilection for the mandible over the maxilla. The lesion may be observed in children as well as adults and may develop on either the anterior or posterior regions of the gingiva or alveolar mucosa. Radiographically, there may or may not be evidence of involvement of the underlying osseous tissue. It has been observed that in the edentulous patient, however, superficial erosion of the underlying bone is quite characteristic and presents a pathognomonic feature known as peripheral "cupping" of the bone.

The microscopic appearance of the peripheral giant cell granuloma is quite unique. This lesion is composed of a nonencapsulated mass of loose mesenchymal tissue containing

numerous multinucleated giant cells.

Capillaries are usually quite numerous along with foci of hemorrhage, hemosiderin deposition, and spicules of osteoid or bone. The overlying surface epithelium may be ulcerated.

The treatment of the peripheral giant cell granuloma is surgical excision. If only superficial excision is carried out, recurrence/persistence may be observed (10%-18% of the cases). In the past, it was common practice to remove the adjacent teeth at the time of the excision to prevent recurrence/persistence but this practice has now been abandoned.

REFERENCES Lester SR, Cordell KG, Rosebush MS, et al. Peripheral giant cell granulomas: a series of 279 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2014;118:475482.

Katsikeris N, Kakarantza-Angelopoulou E, Angelopoulos AP. Peripheral giant cell granuloma: clinicopathologic study of 224 new cases and review of 956 reported cases. Int J Oral Maxillofac Surg 1988;17:94-99.

Giansanti JS, Waldron CA. Peripheral giant cell granuloma: review of 720 cases.

J Oral Surg 1969;17:787-791.

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