December 2021 Texas Dental Journal

December 2021

TEXAS DENTAL

INSIDE:

HUMAN PAPILLOMA VIRUS VACCINE COUNSELING: A TEAM APPROACHwww.tda.org | December 2021 773

How to Ensure Your Office is OSHA & HIPAA Compliant Staying compliant with ever-changing regulations and requirements is challenging.

But Smart Training—the market leader in dental OSHA and HIPAA compliance—makes it easy. Choose from three offerings: OSHA and HIPAA Staff Training OSHArequired monthly safety and security meetings become effortless. All courses, scores, and safety meetings are automatically recorded.

OSHA & HIPAA Essentials Provides all documents required by OSHA and HIPAA: job hazard analysis, risk assessment, compliance binder, and supervisors’ training.

Platinum+ A complete, step-by-step dental regulatory compliance program that offers a guarantee against OSHA fines—the only one in the Texas dental industry. Smart Training compliance specialists provide evaluations of your practice and custom recommendations to ensure your office is safe and compliant with OSHA and HIPAA requirements (federal and State regulations).

Get Lee’s free popular compliance tips!

Hundreds of TDA members benefit from Lee Slaton’s invaluable to-the-point compliance tips every month. Go to the footer of

tdaperks.com to subscribe to “In the Know”— TDA Perks Program’s weekly e-newsletter—to have his tips and more delivered to your inbox.

Lee Slaton is VP of Healthcare at Smart Training.

TDA members can receive a complimentary compliance assessment ($250 value).

Call to check for availability and discounts.

Mention “TDA Perks.”

469-342-8300 Learn more at tdaperks.com (Compliance & Supplies)

774

Texas Dental Journal | Vol 138 | No. 12

Envolve Dental, Inc. is a wholly-owned subsidiary of Envolve Benefit Options, Inc., and Centene Corporation, a diversified, multi-national healthcare enterprise offering services to government sponsored healthcare programs, focusing on under-insured and uninsured individuals. We look forward to seeing membership grow through Ascension and Wellcare expansions in 2022.

Supported by the United Concordia National Medicare Advantage Network

Supported by the United Concordia National Medicare Advantage Network

In January 2022, Envolve will be the dental administrator for Wellcare and the newly rebranded Wellcare by Allwell (formerly Allwell).

Envolve administers the dental benefit for Ascension Complete, a plan created to provide affordable and quality Medicare coverage to help members get the care they need to feel their best. Ascension Complete will be expanding in January 2022.

The Envolve Dental Difference > PPO vs HMO – Envolve contracting remains the same regardless of whether the medical plan is an HMO or PPO. Envolve administers dental benefits under a single fee-for-service model without additional mandates or administrative burdens. The only exception is that members with an HMO medical benefit do not receive dental benefits when receiving care from out of network providers. > Reduced Administrative Burden – Envolve limits administrative burden by reducing the number of services that require prior authorization through Medicaid, and minimizing prior authorization requirements for both Medicare Advantage and Health Insurance Marketplace products. > Robust Provider Web Portal – Envolve’s provider web portal is designed to be a one-stop shop for submitting claims, corrected claims, appeals, and prior authorization requests. The portal can also be used to check claim status, update practice information and verify member eligibility.

High volume of members

Selective participation

Call To Join: (833) 274-1222

Innovative client solutions

EnvolveDental.com ©2021 Envolve, Inc. All rights reserved.

Partnership approach

or email ProviderContracts@ EnvolveHealth.com www.tda.org | December 2021

775

Contents December 2021 Established February 1883 n Vol 138, No. 12

FEATURES 788 | Human Papilloma Virus Vaccine Counseling: A Team Approach Jane C. Cotter, BSDH, MS, CTTS, FAADH Oral health risks of the Human Papilloma Virus (HPV), hepatitis viruses, and herpes simplex virus need to be discussed in the dental setting to assist in disease prevention. This article will focus on HPV and the HPV vaccine.

800 | 2020 TDA Smiles Foundation Report

Texas Winter Sunset with Oak Tree Silhouette Photo by: krisrobin, Bigstock

DEPARTMENTS

808 | Oral and Maxillofacial

780 | President’s Message

Month Diagnosis and

782 | Oral and Maxillofacial Pathology Case of the

Pathology Case of the Management 812 | Value for Your

Month

Profession: Free App

786 | TDA Governance:

CE Requirements, Audit

Notice of Grant Availability

Simplifies Meeting TSBDE Submissions; Debuts Early 2022

798 | In Memoriam TDA members, use your smartphone to scan this QR Code and access the online Texas Dental Journal.

776

Texas Dental Journal | Vol 138 | No. 12

814 | Advertising Briefs 823 | Index to Advertisers

Editorial Staff Daniel L. Jones, DDS, PhD, Editor Paras B. Patel, DDS, Associate Editor Nicole Scott, Managing Editor Barbara Donovan, Art Director Lee Ann Johnson, CAE, Director of Member Services

Editorial Advisory Board Ronald C. Auvenshine, DDS, PhD Barry K. Bartee, DDS, MD Patricia L. Blanton, DDS, PhD William C. Bone, DDS Phillip M. Campbell, DDS, MSD Michaell A. Huber, DDS Arthur H. Jeske, DMD, PhD Larry D. Jones, DDS Paul A. Kennedy Jr, DDS, MS Scott R. Makins, DDS, MS Daniel Perez, DDS William F. Wathen, DMD Robert C. White, DDS Leighton A. Wier, DDS Douglas B. Willingham, DDS

The Texas Dental Journal is a peer-reviewed publication.

Texas Dental Association 1946 S IH-35 Ste 400, Austin, TX 78704-3698 Phone: 512-443-3675 • FAX: 512-443-3031 Email: tda@tda.org • Website: www.tda.org Texas Dental Journal (ISSN 0040-4284) is published monthly (one issue will be a directory issue), by the Texas Dental Association, 1946 S IH-35, Austin, TX, 787043698, 512-443-3675. Periodicals Postage Paid at Austin, Texas and at additional mailing offices. POSTMASTER: Send address changes to TEXAS DENTAL JOURNAL, 1946 S IH 35, Austin, TX 78704. Copyright 2018 Texas Dental Association. All rights reserved.

Annual subscriptions: Texas Dental Association members $17. In-state ADA Affiliated $49.50 + tax, Out-of-state ADA Affiliated $49.50. In-state Non-ADA Affiliated $82.50 + tax, Out-of-state Non-ADA Affiliated $82.50. Single issue price: $6 ADA Affiliated, $17 Non-ADA Affiliated, September issue $17 ADA Affiliated, $65 NonADA Affiliated. For in-state orders, add 8.25% sales tax.

Contributions: Manuscripts and news items of interest to the membership of the society are solicited. Electronic submissions are required. Manuscripts should be typewritten, double spaced, and the original copy should be submitted. For more information, please refer to the Instructions for Contributors statement printed in the September Annual Membership Directory or on the TDA website: tda.org. All statements of opinion and of supposed facts are published on authority of the writer under whose name they appear and are not to be regarded as the views of the Texas Dental Association, unless such statements have been adopted by the Association.

Articles are accepted with the understanding that they have not been published previously. Authors must disclose any financial or other interests they may have in products or services described in their articles.

Advertisements: Publication of advertisements in this journal does not constitute a guarantee or endorsement by the Association of Association of the quality of value of Dental Editors and such product or of the claims made of Journalists. it by its manufacturer.

Board of Directors PRESIDENT Debrah J. Worsham, DDS 936-598-2626, worshamdds@sbcglobal.net PRESIDENT-ELECT Duc “Duke” M. Ho, DDS 281-395-2112, ducmho@sbcglobal.net PAST PRESIDENT Jacqueline M. Plemons, DDS, MS 214-369-8585, drplemons@yahoo.com VICE PRESIDENT, NORTHEAST Carmen P. Smith, DDS 214-503-6776, drprincele@gmail.com VICE PRESIDENT, SOUTHEAST Georganne P. McCandless, DDS 281-516-2700, gmccandl@yahoo.com VICE PRESIDENT, SOUTHWEST J. Ted Thompson, DDS 361-242-3151, tedito@aol.com 817-238-6450, pdalw@yahoo.com VICE PRESIDENT, NORTHWEST E. Dale Martin, DDS SENIOR DIRECTOR, NORTHEAST Elizabeth S. Goldman, DDS 214-585-0268, texasredbuddental@gmail.com SENIOR DIRECTOR, SOUTHEAST Glenda G. Owen, DDS 713-622-2248, dr.owen@owendds.com SENIOR DIRECTOR, SOUTHWEST Carlos Cruz, DDS 956-627-3556, ccruzdds@hotmail.com SENIOR DIRECTOR, NORTHWEST Teri B. Lovelace, DDS 325-695-1131, lovelace27@icloud.com DIRECTOR, NORTHEAST Jodi D. Danna, DDS 972-377-7800, jodidds1@gmail.com DIRECTOR, SOUTHEAST Shailee J. Gupta, DDS 512-879-6225, sgupta@stdavidsfoundation.org DIRECTOR, SOUTHWEST Richard M. Potter, DDS 210-673-9051, rnpotter@att.net DIRECTOR, NORTHWEST Summer Ketron Roark, DDS 806-793-3556, summerketron@gmail.com SECRETARY-TREASURER* Cody C. Graves, DDS 325-648-2251, drc@centex.net SPEAKER OF THE HOUSE* John W. Baucum III, DDS 361-855-3900, jbaucum3@gmail.com PARLIAMENTARIAN** Glen D. Hall, DDS 325-698-7560, abdent78@gmail.com EDITOR** Daniel L. Jones, DDS, PhD 214-828-8350, editor@tda.org LEGAL COUNSEL Carl R. Galant William H. Bingham, Advisor *Non-voting member **Non-voting attendee

www.tda.org | December 2021

777

Anesthesia Education & Safety Foundation Two ways to register: Call us at 214-384-0796 or e-mail us at sedationce@aol.com Visit us on the web: www.sedationce.com

NOW Available: In-Office ACLS & PALS renewals; In-Office Emergency Program

Live Programs Available Throughout Texas

Approved PACE Program Provider FAGD/MAGD Credit.

Approval does not imply acceptance by a state of provincial board of dentistry or AGD endorsement.

8/1/2018 to 7/31/2022.

Provider ID# 217924

Two ways to Register for our Continuing Education Programs: e-mail us at sedationce@aol.com or call us at 214-384-0796

OUR GOAL: To teach safe and effective anesthesia techniques and management of medical emergencies in an understandable manner.

WHO WE ARE: We are licensed and practicing dentists in Texas who understand your needs, having provided anesthesia continuing education courses for 34 years. The new anesthesia guidelines were recently approved by the Texas State Board of Dental Examiners. As practicing dental anesthesiologists and educators, we have established continuing education programs to meet these needs.

Dr. Canfield

New TSBDE requirement of Pain Management Two programs available (satisfies rules 104.1 and 111.1) Live Webcast (counts as in-class CE) or Online (at your convenience)

All programs can be taken individually or with a special discount pricing (ask Dr. Canfield) for a bundle of 2 programs:

Principles of Pain Management Fulfills rule 104.1 for all practitioners

Use and Abuse of Prescription Medications and Provider Prescription Program Fulfills rules 104.1 and 111.1

SEDATION & EMERGENCY PROGRAMS: Nitrous Oxide/Oxygen Conscious Sedation Course for Dentists:

Credit: 18 hours lecture/participation (you must complete the online portion prior to the clinical part)

Level 1 Initial Minimal Sedation Permit Courses:

*Hybrid program consisting of Live Lecture and online combination Credit: 20 hours lecture with 20 clinical experiences

SEDATION REPERMIT PROGRAMS: LEVELS 1 and 2 (ONLINE, LIVE WEBCAST AND IN CLASS) ONLINE LEVEL 3 AND 4 SEDATION REPERMIT AVAILABLE!

(Parenteral Review) Level 3 or Level 4 Anesthesia Programs (In Class, Webcast and Online available): American Heart Association Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) Initial and Renewal Programs NOTE: ACLS or PALS Renewal can be completed by itself at any combined program

Combined ACLS-PALS-BLS and Level 2, 3 and 4 Program

WEBCASTING and ONLINE RENEWALS AVAILABLE! Live and archived webcasting to your computer in the comfort of your home.

Here are the distinct advantages of the webcast (contact us at 214-384-0796 to see which courses are available for webcast): 1. You can receive continuing education credit for simultaneous live lecture CE hours.

2. There is no need to travel to the program location. You can stay at home or in your office to view and listen to the course.

3. There may be a post-test after the online course concludes, so you will receive immediate CE credit for attendance 4. With the webcast, you can enjoy real-time interaction with the course instructor, utilizing a question and answer format

OUR MISSION STATEMENT: To provide affordable, quality anesthesia education with knowledgeable and experienced instructors, both in a clinical and academic manner while being a valuable resource to the practitioner after the programs. Courses are designed to meet the needs of the dental profession at all levels.

Our continuing education programs fulfill the TSBDE Rule 110 practitioner requirement in the process to obtain selected Sedation permits.

AGD Codes for all programs: 341 Anesthesia & Pain Control; 342 Conscious Sedation; 343 Oral Sedation This is only a partial listing of sedation courses. Please consult our www.sedationce.com for updates and new programs.

Two ways to Register: e-mail us at sedationce@aol.com or call us at 214-384-0796

778

Texas Dental Journal | Vol 138 | No. 12

2021 - 2022 Course Calendar

DEC 3 DEC 11 JAN 6-8 JAN 14-15 JAN 28-29 MARCH 4-5 MARCH 11-12 April 22-23 MAY 13-14 June 17-18

Hands-on learning and live patient care!

Continued Education!

iHDS Symposium Followed by Christmas party Dr. Clark Whitmire levels 1 & 2: RECERTIFICATION COURSE A review and update on drugs, techniques, emergencies, and office preparation

Dr. Felipe Verde Natural Layering Direct Composite Master Course Federico Presicci Zirconia Bridge with Pink Ceramic Dr. Aldo Sordelli, Dr. Giancarlo G. Romero From CBCT to Surgical Guide Dr. Aldo Sordelli, Dr. Giancarlo G. Romero Ridge Preservation & Immediate Implant Placement Dr. Virgilio Gutierrez, Dr. Giancarlo G. Romero Immersive Dental Clinical Photography Course Spring IMPLANT FELLOWSHIP Session ONE Spring implant fellowship session two Spring implant fellowship Session three

SIGN UP NOW

Institute of Houston Dental Synergy Located at the Houston Dental Education Center 4548 Bissonnet St. Suite 210 Bellaire, TX 77401 Phone: 713.589.9603 Email: marketing@ihds-ce.com www.ihds-ce.com Houston Dental Education Center Approved PACE Program Provider for FAGD/MAGD credit.

Approval does not imply acceptance by any regulatory authority or AGD endorsement.

(02/23/2018) to (02/22/2022) Provider ID #391753

TDA10 for 10% Discount www.tda.org | December 2021

779

Chewon this D

uring this time of year we find ourselves focusing on gratitude, celebrations, shopping, and gatherings with family and friends.

While trying to attend any and all holiday related events, and do everything required of us, we sometimes find ourselves a little bit stressed and running in many different directions. Life at TDA is no different!

The TDA was recently featured in the State Spotlight section on the most recent ADA Power of 3 Webinar. These ADA sponsored webinars are open to state dental officers/leaders from all across the United States. President-elect, Dr Duc “Duke” Ho, and I highlighted Texas’ efforts to increase TDA membership through our personal peer-to-peer outreach efforts. We had several “atta boys and great job, Texas,” so I know our program was well-received by many.

My recent road trips have taken me to greater Houston, Brazos Valley, east Texas, and McAllen.

These included component society meetings with sit down meals, social get togethers with catered food under a tent in a dental office parking lot, photo shoots and interviews, and Christmas parties!

There is never a dull moment with TDA members, whether it’s renewing old acquaintances or meeting new friends, and especially with our family-like camaraderie!

As you read through this year’s final issue of the Texas Dental Journal, please take a moment to read the 2020 TDA Smiles Foundation Report. The report spotlights the generosity of our member dentists, dental students, team members and dental society staff who volunteer their time at Texas Mission of Mercy events across the state. It also covers the other programs that the foundation administers; The Refuge which provides dental care to survivors of domestic minor sex trafficking, scholarships to first-year dental students, and the Urgent Need Dental Care program. If you are interested in volunteering or in donating to the TDA Smiles Foundation, please visit its website at tdasf.org.

Please examine your 2022 dues statement which was mailed recently. The statement highlights tangible benefits offered by TDA: • •

Dental advocacy Personalized regulatory and compliance assistance

780 Texas TexasDental DentalJournal Journal | |Vol Vol 138 138| No. | No. 12 12

TDA President Debrah J. Worsham, DDS

• •

• •

•

National and state award winning scientific publications Monthly newsletter covering numerous dental related issues Peer review program The TDA Meeting where required CE may be obtained in one weekend TDA Perks Program with endorsed services, products, and preferential pricing to members

Your 2022 dues may be paid easily online at tda.org, whether in full or with 10 monthly installments complete with auto renew.

Dues statement questions may be answered by calling the TDA Member Services team at 512443-3675, Ext 137.

Stay connected with your peers and TDA’s resources. Get in gear and renew your membership today!

CELEBRATING 30 YEARS

Experience Matters Since 1992, our firm has worked with hundreds of dentists to facilitate their practice sales and appraisals. We look forward to many more years of representing clients and providing smooth transitions for dental practices all over Texas.

469-222-3200 | watsonbrowninc.com www.tda.org

| December 2021

781

ORAL

and maxillofacial pathology

Clinical History

case of the month AUTHORS Marzia Zendali

A 14-year-old male with a history of Ehlers-Danlos syndrome presented for evaluation of a large radiolucency in the mandible discovered on routine panoramic radiograph by his general dentist. He had no complaints and was unaware of any pathosis prior to the dentist’s examination. Clinical examination revealed no bony expansion or mucosal abnormality. All mandibular teeth tested vital. Subsequently, a CBCT study was performed. The CBCT reformatted panoramic image showed a large radiolucent lesion over the apices of roots #20 to 29 extending to the inferior border of the mandible (Figure 1A). There was no

Student Dentist, Texas A&M University College of Dentistry, Dallas, Texas

John Michael Ray, DDS, MPH Private practice, Plano, Texas

Hui Liang, DDS, MS, PhD Professor, Department of Diagnostic Sciences, Texas A&M University College of Dentistry, Dallas, Texas

Yi-Shing Lisa Cheng, DDS, MS, PhD Professor, Department of Diagnostic Sciences, Texas A&M University College of Dentistry, Dallas, Texas

Figure 1. Radiographic features of the lesion. A: CBCT reformatted panoramic image showing a large multilocular radiolucent lesion over the apices of roots #20 to 29 extending to the inferior border of the mandible. B-E: Cropped CBCT axial, coronal and sagittal images, and cross-sectional images showing that the lesion had well-defined corticated borders with few loculations.

782

Texas Dental Journal | Vol 138 | No. 12

root displacement or root resorption. The cropped CBCT axial, coronal, and sagittal images (Figure 1B-1D) and cross-sectional

CBCT images (Figure 1E) showed that the lesion had well-defined corticated borders with few loculations. Thinning of the

facial and lingual cortical plates and mild expansion of the lingual cortical plate without perforation were present.

www.tda.org | December 2021

783

ORAL

and maxillofacial pathology, continued

Figure 2. Histologic features of the lesion. A: Low magnification view showing vital bone, strips of fibrous connective tissue without cyst lining epithelium, and abundant extravasated blood. B: High magnification view showing a membranelike osteoid material in the wall of the bony cavity.

Figure 2A

784

Texas Dental Journal | Vol 138 | No. 12

A mucoperiosteal flap was elevated in the left anterior mandible. The labial cortex was perforated with an 18-Ga needle on a 10 mL syringe. Only air and scant blood was returned in the syringe. Upon surgical exploration, an empty cavity was encountered.

A window was created with a round bur in the labial cortex. A minimal amount of soft tissue was removed from the wall of the bony cavity and sent for microscopic evaluation.

Histologic examination reveals vital bone, strips of fibrous connective tissue,

and abundant extravasated blood (Figure 2A). A membrane-like osteoid material was also seen (Figure 2B). No cyst lining epithelium was found.

What is your diagnosis?

See page 808 for the answer and discussion.

Figure 2B

www.tda.org | December 2021

785

TEXAS DENTAL ASSOCIATION NOTICE OF GRANT AVAILABILITY 501(C) (3) NON-PROFIT DENTAL ORGANIZATIONS

JKJ Pathology Oral Pathology Laboratory

John E Kacher, DDS • Available for consultation by phone or email • Color histology images on all reports • Expedited specimen shipping with tracking numbers • Reports available online through secure web interface

Professional, reliable service with hightechnology solutions so that you can better serve your patients.

Eligibility: Grantees must be 501(c)(3) nonprofit organizations affiliated with dentistry.

Application: Letters of interest detailing the proposed project(s) and including a budget should be mailed to: TDA Board of Directors C/O Mr Terry Cornwell 1946 S IH 35, Ste 400 Austin, TX 78704 Deadline: Letters of Interest must be postmarked or emailed (tcornwell@tda.org) no later than January 31, 2022.

Approval: All letters of Interest will be reviewed and considered by the TDA Board of Directors no later than its March 2022 meeting.

Call or email for free kits or consultation.

Notification: All recipients will be notified in writing on or before May 15, 2022.

jkjpathology.com 281-292-7954 (T) 281-292-7372 (F) johnkacher@jkjpathology.com

Previous Recipients: In 2021, grants totaling $7,842.44 were awarded to the following organizations in Texas for charitable patient care: Capital Area Dental Foundation (Austin), The Family Place (Dallas), Network of Community Ministries (Richardson), and San Jose Clinic (Houston).

Protecting your patients, limiting your liability

786

The Texas Dental Association (TDA) announces availability of financial assistance for qualifying 501(c)(3) non-profit organizations affiliated with dentistry. The monies are derived from TDA Relief Fund interest income earned over the 2021 fiscal year. Grantees will be determined by the TDA Board of Directors.

Texas Dental Journal | Vol 138 | No. 12

For more information, please contact Mr. Terry Cornwell, TDA Governance Manager, 512-4433675, Ext. 146, or email tcornwell@tda.org.

Rule 110.16 High-Risk Sedation Management

Adult Sedation Recertification Level 1-3

20 CE HRS

6-8 CE HRS

HYBRID (ONLINE & IN-PERSON)

ONLINE OR IN-PERSON

Pediatric Sedation Recertification Level 1-2

Rule 110.17 Pediatric Sedation Management

6-8 CE HRS

20 CE HRS

ONLINE OR IN-PERSON

HYBRID (ONLINE & IN-PERSON)

Abuse & Misuse of Controlled Substances and Dental Pain Management

Initial Pediatric & Adult Certification

4 CE HRS

16 CE HRS HYBRID (ONLINE & IN-PERSON)

ONLINE ONLY

COMMITED TO QUALITY & SAFETY!

RATED! EXPERIENCE US!

ON-DEMAND AND IN-PERSON COURSES!

CONTACT US

888-761-2442

SPEAKER

DR. SHAWN SEIFIKAR Dentist Anesthesiologist, President of Southwest Sedation Education, Adjunct Professor, Texas A&M College of Dentistry

REGISTER ONLINE AT SWSEDATIONEDUCATION.COM

Dallas, Houston, San Marcos

LAW OFFICES OF MARK J. HANNA EXPERIENCED LEGAL REPRESENTATION FOR TEXAS DENTISTS •

Representation Before the Texas State Board of Dental Examiners

•

Medicaid Audits and Administrative Hearings

•

Employment Issues—Texas Workforce Commission Hearings

Mark J. Hanna JD Former General Counsel, Texas Dental Association

•

Administrative (SOAH) Hearings and Counsel

•

Professional Recovery Network (PRN) Compliance

•

Employment/Associateship Contract Reviews

•

Practice Acquisition and Sales

•

Business Organizations, PAs, PCs, and PLLCs

•

Civil Litigation

2414 Exposition Blvd., Suite A1 • Austin, Texas 78703 • Phone: 512-477-6200 • Fax: 512-477-1188 • Email: mhanna@markjhanna.com Not Board Certified by the Texas Board of Legal Specialization

www.tda.org | December 2021

787

Human Papilloma Virus Vaccine Counseling: A Team Approach Jane C. Cotter, BSDH, MS, CTTS, FAADH Texas A&M University, College of Dentistry, Caruth School of Dental Hygiene, Dallas, Texas, j_cotter@tamu.edu Author claims no disclosures or grant funding.

788

Texas Dental Journal | Vol 138 | No. 12

S

uccessful dental practices understand the importance of a cohesive and collaborative team approach to patient treatment.

Many dental offices outsource practice management counseling for their office to improve relationships, production, and emphasize a team approach to patient care. It is important that whatever staff member a patient confides in has the message the dentist/supervisor has agreed upon. Educating patients about sexually transmitted diseases and vaccines can be a difficult situation for many people, however, it is a vital part of disease prevention and one that should be addressed with each patient. Oral health risks of the Human Papilloma Virus (HPV), hepatitis viruses, and herpes simplex virus need to be discussed in the dental setting to assist in disease prevention. This article will focus on HPV and the HPV vaccine. Offering counseling, training, educational materials, and having an open discussion may help dental teams formulate a dialogue to increase the comfort level of each team member. Providing education on the virus itself, transmission, vaccine safety, and efficacy contributes to evidence-based information for team members to utilize.

www.tda.org | December 2021

789

The human papilloma virus (HPV) is the most common sexually transmitted infection (STI), and sexually active men and women are likely to be exposed and possibly contract at least one type of HPV at some point during their lifetime.1 HPV is limited to humans and does not jump across species.

HPV’s are a circular, nonenveloped double-stranded DNA virus with over 200 genotypes. It is small in size at 55 nm and contains 8000 base pairs in the genome. Of the more than 200 different strains of HPV,

790

there are over 30 which are sexually transmitted.1,2 Approximately 14 million new HPV infections occur each year, however many individuals will not know they are infected and will be asymptomatic. This makes it difficult to know when the individual became infected and by whom.2 Sexually transmitted HPV genotypes are separated into low-risk and high-risk groups. Low-risk groups generally cause no disease but can cause benign epithelial lesions on or around anogenital areas and the mouth or throat.3

Texas Dental Journal | Vol 138 | No. 12

Low-risk HPV groups are typically controlled or eliminated by the immune system. High-risk groups can cause several types of cancer depending upon the type of tissue infected. Of the 14 high-risk HPV types, HPV 16 and HPV 18 are responsible for most HPVpositive cancers.1 HPV spreads most commonly via skinto-skin contact. Less common modes of transmission are vertical and autoinoculation.

Vertical transmission from mother to child

can occur via breast milk, umbilical cord, placenta, or during passage through the birth canal. A meta-analysis of this mode of transmission identified eleven studies that demonstrated positive high-risk HPV results for both mother and infant, highlighting the importance of increased care during pregnancy.4 The use of latex prophylactics like condoms or dental dams or being in a mutually monogamous relationship are viable ways to reduce exposure to the virus.

The CDC recommends regular screening for cervical cancer for females and the HPV vaccine for both males and females to avoid HPV and health-related sequelae of HPV infection.2 Cancers caused by HPV include cancers of the cervix, vulva, vagina, penis, anus, and oropharynx.5 Data from the CDC show that the number of new HPV-positive cancer cases each year in females is 25,405 and in males is 20,424. For females, 47.8% were found in the cervix, 18.7% in the anus, 16.2% in the vulva, and 13.9% in the oropharynx. For males, 81.5% of HPVpositive carcinomas were found in the oropharynx, 11.7% in the anus, and 6.8% in the penis. The CDC estimated that 79% of cancers were attributed to HPV each year during 2013-2017. The 9-valent HPV vaccine could have prevented almost 90% of these cancers.6 Just under 35,000 new HPV-positive cancer diagnoses were reported in the United States during 2012-2016. The number of oropharyngeal cancers during that same time was 19,000.6 Texas ranked third in the nation with almost 880 new cases of HPV positive oropharyngeal cancer during 2012-2016.7 A population increase of 225% in HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) in the United States was reported from 1988-2015 with a concurrent

50% decrease in non-HPV related OPSCC.8 In the state of Texas, about 3,200 new cases of HPV-associated cancers occurred during 2013-2017. In Texas females, 59% were cervical, 12% were in the anus, 12% were found in the vulva and oropharynx, and 3% were vaginal. In Texas males, statistics show that 81% of HPV-positive cancers were found in the oropharynx with 11% in the anus and 8% in the penis. The incidence rate of HPV-positive oropharyngeal cancer in Texas was 4.5 cases per 100,000 population during 2310-2017.9 Low-risk HPV variants do not cause cancers but are associated with other health related conditions. Conditions such as genital and non-genital warts (HPV 1, 2 & 4), recurrent respiratory papillomatosis in children (HPV 6 & 11), Bowen disease in non-genital areas (HPV 2, 16, 34, and 35), and the rare emidermaodysplasia verruciformis (HPV 5, 8, 9, 12, 14, 15, 17, 19-25, 36-38, 47, and 49).10-13 The 9-valent HPV vaccine can prevent almost all of these rare health conditions.

Three vaccines to prevent HPV have been approved by the US Food and Drug

www.tda.org | December 2021

791

Administration (FDA); Gardasil®, Cervarix®, and Gardasil 9®. The first vaccines (Gardasil® and Cervarix®) became available in 2011 and prevented four HPV variants (Types 6, 11, 16, and 18). Gardasil 9® is effective in preventing 9 variants (Types 6, 11, 16, 18, 31, 33, 45, 52, and 58).14 As of 2017, only Gardasil 9® is available in the US.1 Gardasil 9® is a non-infectious recombinant 9-valent vaccine prepared from the purified virus-like particles (VLPs) of the (L1) protein of HPV types 6, 11, 16, 18, 31, 33, 45 52, and 58. Yeast cells are used to grow the VPLs and once released the particles are purified by a series of chemical and physical methods. Along with the purified VLPs, the vaccine contains aluminum-containing adjuvant and a purification buffer.14 Gardasil 9® is an intramuscular injection indicated for males and females ages 9-14 years of age for the prevention of HPV infection and HPV associated cancers. The vaccine regimen is typically 2 doses with the second dose administered at 6-12 months.

For ages 14-24, 3 doses are required, with the second and third dose administered 2 months after the initial dose and the third 6 months after the second dose.14 The FDA and CDC approved in 2018 and 2019, respectively, the vaccine for ages 27-45 to prevent reinfection and reduce the risk for HPV-related diseases.15 Vaccine efficacy has been shown to be high in the prevention of cervical cancer. Since the introduction of the vaccines in 2006, cervical cancer rates have declined. A study conducted by Oliver, SE et. al. showed that among 12-19-year-old females that received the quadravalent vaccine (4vHPV), the prevalence of HPV infections (6, 11, 16, and 18) decreased by 71%, and by 61% in the 2024-year age group.16 This study suggests herd immunity protection.16 A cross-sectional study conducted in 2019 by Chaturvedi et. al. showed oral HPV prevalence declined by 38% between 2009-2010 and 2015-2016 among un-vaccinated men aged 18-59 in the US. This decline in prevalence may be attributed to the increase in HPV vaccination among US females.17 The FDA reviewed clinical trials of the Gardasil®, Cervarix®, and Gardasil 9® vaccines and they were found to be safe and effective for use in the general population. In excess

792

Texas Dental Journal | Vol 138 | No. 12

Since the introduction of the vaccines in 2006, cervical cancer rates HAVE DECLINED. A study conducted by Oliver, SE et. al. showed that among 12-19 year-old females that received the quadravalent vaccine (4vHPV), the prevalence of HPV infections (6, 11, 16, and 18) decreased by 71%, and by 61% in the 20-24-year age group.16 THIS STUDY SUGGESTS HERD IMMUNITY PROTECTION.

www.tda.org | December 2021

793

of 120 million doses of HPV have been administered and there are robust data that show the vaccines are safe.18 In the US the Vaccine Adverse Events Reporting System (VAERS), Vaccine Safety Datalink (VSD), Post-Licensure Rapid Immunization Safety Monitoring System (PRISM), and Clinical Immunization Safety Assessment Project (CISA) detect possible safety problems associated with vaccines. Anyone can report adverse events and in the case of VSD, CISA, and PRISM these reporting agencies work in conjunction with healthcare organizations, the CDC, and the FDA. Analysis of the data from 6 different VSD sites from October 2015 through October 2017 showed that during this period almost 840,000 doses of the HPV vaccines were administered. The ages for this study sample ranged from 9-26 years.

After review of the data and reported adverse events, researchers reported that no new safety concerns were identified among the sample.19

794

The most common side effects of the vaccine include but are not limited to: pain at the injection site, mild fever, chills, feeling tired, headache, and muscle and joint aches.

Fainting has also been reported to be a side effect of the administration of HPV vaccine, however there is no research that shows a correlation to the vaccine itself. As with the new COVID vaccine, patients should receive the vaccine in a seated position and remain seated until they feel they are able to move without falling. There is no empirical evidence of HPV vaccine and infertility.20 Contraindications for receiving the vaccine include a life-threating allergic reaction to any

component of the HPV vaccine or previous dose or severe allergy to yeast.

Patients who have an allergy or sensitivity to latex should not receive the vaccine from a prefilled syringe as parts of the syringe may contain latex. If a patient becomes pregnant after receiving the initial vaccine dose, then delaying the second or third dose is indicated.

There is no evidence of harm to the mother or the fetus but further exposure to the vaccine is discouraged. Severely immunocompromised patients or have patients with minor illness should check with their healthcare provider before receiving any vaccination.20

The MOST COMMON SIDE EFFECTS of the vaccine include but are not limited to: pain at the injection site, mild fever, chills, feeling tired, headache, and muscle and joint aches.

Texas Dental Journal | Vol 138 | No. 12

Accurate and evidencebased education is extremely effective in promoting better health.

When patients understand the disease processes, risk factors, and prevention methods for this infection they are able to make informed decisions regarding their health. The use of decision aids such as brochures, videos, and models has been shown to facilitate the patient’s decisions on health care.21,22 The use of decision aids allows for respect of patients’ autonomy, assists in increasing a patient’s knowledge, and supports informed decisions regarding their health.22,23 A 2021 qualitative study of HPV-OPC survivors showed that both male and female survivors expressed shame and guilt upon receiving their diagnosis. Study respondents reported feelings of hesitancy and even betrayal regarding their spouses’ fidelity.

Additionally, most reported a reluctance to sharing their diagnosis with family and friends.24 Discussion, diagnosis, and evaluation for HPV-related diseases may produce feelings of anxiety and negative psychosocial and psychosexual

disturbances. Therefore, it is important for clinicians to educate patients in a non-judgmental and reassuring manner.25 Further, the knowledge and confidence of HPV immunization counseling and presentation of information must be similar among all staff members.

Studies conducted by Berenson et.al., and Cotter et. al., showed that among dental hygiene students and medical students, knowledge of HPV related disease and HPV immunization counseling increased after viewing a 1-hour training module.26,27 Both studies advocate for the addition of HPV immunization counseling to the medical and dental curricula.26,27 Offering a similar type of continuing education may increase the dental healthcare professionals (DHPs) ability to engage patients in effective HPV immunization conversations.

To assist DHPs in creating a team approach to HPV immunization counseling there are online sites that offer continuing education courses. Educational materials and decisions aids for staff and patients are available through

the CDC, the American Academy of Pediatrics, and the American Cancer Society.28-30 “You Call the Shots” is an interactive, web-based immunization training course consisting of learning modules that provide learning opportunities, self-testing, practice questions, and reference materials and a glossary available from the CDC.31 These educational sites are designed to facilitate DHPs in initiating the HPV immunization conversation and promote an open, non-judgmental environment for patients to ask questions and provide decision aids in several languages.

A common theme among HPV-OPC survivors is that they wish they had known more about HPV transmission, disease, and vaccination.24 As healthcare professionals, we are in a unique position to influence the prevalence of HPV-OPC in our patient populations. By creating a team approach to HPV immunization counseling we can reduce the stigma of HPV related diseases and educate patients to reduce their risk for HPV-OPC.

www.tda.org | December 2021

795

References 1.

2.

3.

4.

5.

6.

7.

8.

HPV and Cancer. National Cancer Institute.

Published October 8, 2019. https:// www.cancer.gov/about-cancer/causesprevention/risk/infectious-agents/hpv-andcancer#what-is-hpv CDC. STD Facts - Human papillomavirus (HPV). Centers for Disease Control and Prevention. Published 2019. https://www. cdc.gov/std/hpv/stdfact-hpv.htm Piña A-R ., Fonseca F-P., Pontes F-S.-C., et al. Benign epithelial oral lesions association with human papillomavirus.

Medicina Oral, Patologia Oral Y Cirugia Bucal. 2019;24(3):e290-e295. doi:10.4317/medoral.22817 Santana N, Santos T, Sato A, et al. Vertical transmission of human papillomavirus in pregnancy: a systematic review and metaanalysis. International Journal of Infectious Diseases. 2018;73:334-335. doi:10.1016/j. ijid.2018.04.4173 Cancers Associated with Human Papillomavirus (HPV). Published 2020. https://www.cdc.gov/cancer/hpv/basic_ info/cancers.htm CDC Centers for Disease Control and Prevention. Cancers Associated with Human Papillomavirus, United States—2013–2017.

USCS Data Brief, no 18. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2020.

Senkomago V, Henley SJ, Thomas CC, Mix JM, Markowitz LE, Saraiya M. Human Papillomavirus–Attributable Cancers — United States, 2012–2016. MMWR Morb Mortal Wkly Rep 2019;68:724–728.

DOI: http://dx.doi.org/10.15585/mmwr. mm6833a3external icon.

Pytynia KB, Dahlstrom KR, Sturgis EM. Epidemiology of HPV-associated oropharyngeal cancer. Oral Oncology.

2014;50(5):380-386. doi:10.1016/j. oraloncology.2013.12.019

796

Texas Dental Journal | Vol 138 | No. 12

9.

10.

11.

12.

13.

14.

15.

16.

HPV-Associated Cancers in Texas, 20132017; 2020. https://www.dshs.state. tx.us/tcr/data/modifiable/HPV-AssociatedCancers-in-Texas.pdf HPV 1, 2, & 4. web.stanford.edu.

Accessed July 8, 2021. https:// web.stanford.edu/group/virus/ papilloma/2004goglincarnevale/Papilloma/ HPV1.htm Recurrent respiratory papillomatosis | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program. rarediseases.info.nih.gov. Accessed July 8, 2021. https://rarediseases.info.nih. gov/diseases/111/recurrent-respiratorypapillomatosis Bowen Disease. NORD (National Organization for Rare Disorders). Accessed July 8, 2021. https://rarediseases.org/rarediseases/bowen-disease/#causes Epidermodysplasia verruciformis | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program.

Nih.gov. Published 2010. https:// rarediseases.info.nih.gov/diseases/6357/ epidermodysplasia-verruciformis GARDASIL® 9. MerckVaccines.com.

Published January 18, 2021. Accessed July 8, 2021. https://www.merckvaccines.com/ gardasil9/.

FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old. Case Medical Research. Published online October 5, 2018. doi:10.31525/ fda2-ucm622715.htm Oliver SE, Unger ER, Lewis R, et al.

Prevalence of Human Papillomavirus Among Females After Vaccine Introduction— National Health and Nutrition Examination Survey, United States, 2003–2014.

The Journal of Infectious Diseases.

2017;216(5):594-603. doi:10.1093/infdis/ jix244

17. Chaturvedi AK, Graubard BI, Broutian T, et al. Prevalence of Oral HPV Infection in Unvaccinated Men and Women in the United States, 2009-2016. JAMA. 2019;322(10):977. doi:10.1001/ jama.2019.10508 18. CDC. HPV Vaccine Safety. Centers for Disease Control and Prevention. Published November 25, 2019. https://www.cdc.gov/ hpv/hcp/vaccine-safety-data.html 19. Donahue JG, Kieke BA, Lewis EM, et al.

Near Real-Time Surveillance to Assess the Safety of the 9-Valent Human Papillomavirus Vaccine. Pediatrics.

2019;144(6):e20191808. doi:10.1542/ peds.2019-1808 20. CDC. Human Papillomavirus (HPV) Vaccine Safety Vaccines. Centers for Disease Control and Prevention. Published January 30, 2018. https://www.cdc.gov/vaccinesafety/ vaccines/hpv-vaccine.html 21. Coronado-Vázquez V, Canet-Fajas C, Delgado-Marroquín MT, Magallón-Botaya R, Romero-Martín M, Gómez-Salgado J. Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care. Medicine.

2020;99(32):e21389. doi:10.1097/ md.0000000000021389 22. Johnson RA, Huntley A, Hughes RA, et al.

Interventions to support shared decision making for hypertension: A systematic review of controlled studies. Health Expectations. 2018;21(6):1191-1207. doi:10.1111/hex.12826 23. Stacey D, Légaré F, Lewis K, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews. Published online April 12, 2017. doi:10.1002/14651858. cd001431.pub5 24. Cotten S. Removing the Stigma of HPV. RDH. 2021;41(4):20-21.

25. Diaz ML. Counseling the Patient with HPV Disease. Obstetrics and Gynecology Clinics of North America. 2013;40(2):391-402. doi:10.1016/j.ogc.2013.02.003 26. Berenson AB, Hirth JM, Fuchs EL, Chang M, Rupp RE. An educational intervention to improve attitudes regarding HPV vaccination and comfort with counseling among US medical students. Human Vaccines & Immunotherapeutics.

2019;16(5):1139-1144. doi:10.1080/2164 5515.2019.1692558 27. Cotter J, Wilson K, Mallonee L. Impact of HPV Immunization Training on Dental Hygiene Students’ Attitudes and Confidence Regarding HPV Preventive Education. Journal of Dental Education.

2019;83(2):e1-e6. doi:10.21815/ jde.019.164 28. Cancers Caused by HPV are Preventable.

Centers for Disease Control and Prevention. Published 2019. Accessed September 1, 2019. https://www.cdc.gov/ hpv/hcp/educational-materials.html 29. HPV Vaccination Resources for Health Professionals | American Cancer Society. www.cancer.org. Accessed July 8, 2021. https://www.cancer.org/health-careprofessionals/hpv-vaccination-informationfor-health-professionals/hpv-vaccinationresources-for-health-professionals.html 30. https://www.aap.org/en-us/advocacyand-policy/aap-health-initiatives/ immunizations/HPV-Champion-Toolkit/ Pages/Printable-Resources.aspx 31. HPV Vaccination | For Providers | Human Papillomavirus | CDC. www.cdc.gov.

Published March 17, 2020. https://www. cdc.gov/vaccines/vpd/hpv/hcp/index.html

www.tda.org | December 2021

797

THOSE IN THE DENTAL COMMUNITY WHO HAVE RECENTLY PASSED IN MEMORIAM Terry Boyd Bawcom

Edward K Hahn

Irving

Colleyville

2/11/44–11/10/21

6/23/30–10/20/21

Good Fellow: 1992 • Life: 2009 • Fifty Year: 2017

Life: 1995 • Fifty Year: 2005

Tina T Bui

Donald Essa Hanna

Kingwood

Corpus Christi

5/2/65–11/25/21

6/27/31–9/15/21

Good Fellow: 2019

Good Fellow: 1986 • Life: 1996 • Fifty Year: 2011

E Glenn Clark

John Frank Hanus Jr

Cedar Hill

San Antonio

7/18/40–9/28/21

12/18/27–8/25/21

Good Fellow: 1996 • Life: 2005 • Fifty Year: 2020

Good Fellow: 1981 • Life: 1992 • Fifty Year: 2006

Reginald Lynn Cranford

Willie H Heitman

Big Spring

Sugar Land

11/7/47–9/14/21

9/25/32–11/22/21

Good Fellow: 2000 • Life: 2012

Good Fellow: 1986 • Life: 1997 • Fifty Year: 2011

Todd R Ehrlich

Richard Glenn Jetton

Spicewood

Amarillo

9/26/69–10/26/21

3/17/32–10/28/20 Good Fellow: 1983 • Life: 1997 • Fifty Year: 2008

Noel Wayne Giesecke Houston

Steven Dale Martin

12/23/38–12/3/21

San Antonio

Good Fellow: 1989 • Life: 2003 • Fifty Year: 2014

9/1/54–10/1/21

798

Texas Dental Journal | Vol 138 | No. 12

Paul Edward McLerran

Cecil F Turner

San Antonio

Arlington

9/6/47–9/7/21

4/9/55–11/24/21

Good Fellow: 1999 • Life: 2012

James L Walters James T Mellonig

Dallas

Mico

10/22/44–8/29/21

1/9/42–11/16/21

Good Fellow: 1998 • Life: 2009

Good Fellow: 2014 • Life: 2007

John Morgan Young Monte Gerald Moore

San Antonio

Friendswood

10/29/32–9/27/21

4/12/36–7/28/20

Good Fellow: 2013 • Life: 1997 • Fifty Year: 2006

Good Fellow: 1989 • Life: 2001 • Fifty Year: 2014

George A Yzaguirre Carlos R Nunez

Corpus Christi

San Antonio

6/25/70–9/14/21

7/13/49–10/12/21 Good Fellow: 2013 • Life: 2018

Albert H Owen Austin 6/25/44–10/2/21 Good Fellow: 1998 • Life: 2009

George F Robinson Jr Houston 1/28/33–11/7/21 Good Fellow: 1990 • Life: 1998 • Fifty Year: 2015

SAVE THE DATE

April 7-9, 2022

Allison Kohnen Rohling Boerne 6/4/92–11/12/21

www.nodc.org Registration Opens January 2022

Carlos Gerardo Tello Fort Worth 8/9/56–10/21/21 Good Fellow: 2020

www.tda.org | December 2021

799

20 20 TDA SMILES FOUNDATION REPORT

800

Texas Dental Journal | Vol 138 | No. 12

LETTER from the TDASF CHAIR

LETTER from the TDA PRESIDENT

LETTER from the ACCESS CHAIR

www.tda.org | December 2021

801

TEXAS DENTAL ASSOCIATION SMILES FOUNDATION (TDASF)

TEXAS MISSION OF MERCY, INC.

$675,794

TEXAS MISSION OF MERCY (TMOM)

802

Texas Dental Journal | Vol 138 | No. 12

1,071

SMART SMILES

THE REFUGE

URGENT DENTAL CARE PROGRAM

EDUCATION

we love our

VOLUNTEERS

www.tda.org | December 2021

803

2020 FINANCIALS REVENUE

TOTAL $1,290,469

EXPENSES

TOTAL $1,029,865

804

Texas Dental Journal | Vol 138 | No. 12

Words from our

VOLUNTEERS

-Robert G. McNeill, DDS, MD

-Stephanie Ganter, DDS, MS

-Kent Macaulay, DDS

www.tda.org | December 2021

805

UPDATE

806

Texas Dental Journal | Vol 138 | No. 12

FOLLOW US

tdasmiles.org

www.tda.org | December 2021

807

ORAL

and maxillofacial pathology diagnosis and management—from page 785

Traumatic Bone Cyst Additional Follow Up Information Once the diagnosis was established, the patient returned, and a thorough curettage of the entire

lesion was performed using multiple approaches to ensure adequate bleeding of the cortical borders. The patient has responded well to the curative procedure, and new bone growth was noted in the affected area

10 months after curettage, demonstrating almost complete resolution with few small radiolucencies remaining in the follow-up CBCT images (Figure 3). All teeth have remained vital.

Figure 3. Ten-month follow-up CBCT study of cross-sectional images of mandible with cropped CBCT reformatted panoramic image showing signs of healing.

808

Texas Dental Journal | Vol 138 | No. 12

Discussion Traumatic bone cyst (TBC) is a non-epithelial lined cavity that is sometimes referred to as a “pseudocyst.”1 The name implies an association with trauma, and a theory of resulting hemorrhage that failed to heal properly has been proposed. In past studies, the association with trauma was observed in up to 70% of the cases; however, the traumahemorrhage theory is still not widely accepted as it has unpredictable findings, and the cause of TBC remains uncertain. Other theories include obstruction to blood vessels, local disruption to bone growth, and even an imbalance in calcium concentration.2 Since its pathogenesis remains mystifying, TBC has a plethora of names in scientific studies and publications, such as simple bone cyst, hemorrhagic bone cyst, solitary bone cyst, extravasation cyst, progressive bone cavity, and unicameral bone cyst.3 It occurs most often in long bones. In jaw bones, TBC appears most frequently in the mandible in the region between canine and the third molar.2,4 It can also be found in the

mandibular symphysis.

TBC is commonly found in young patients in the second decade of life and has a greater predilection for males than females.2,4 TBC can present as an isolated lesion or secondary to neoplastic or nonneoplastic bone lesions, such as cemento-osseous dysplasia (COD), fibrous dysplasia, ossifying fibroma, chondroblastoma, osteoblastoma, and osteosarcoma.5 TBC associated with a benign fibro-osseous lesion (BFOL) such as COD has been shown to heal slower after surgery than solitary TBC.6 Additionally, in the setting of TBC associated with BFOL, the patients’ age is older, most often occurring in the fifth decade of life for both men and women.7 Clinically, patients are asymptomatic, and most cases do not show any bony expansion. It is often revealed as an incidental finding on routine radiographs. However, some cases have reported symptoms such as pain, tooth sensitivity, and paresthesia.8 About 20% of the cases show bony expansion. However, the involved teeth remain vital without any root resorption or mobility. Additionally,

no displacement of teeth is noted. Radiographically, TBC typically appears as a unilocular radiolucency with a well-defined border.3 It is known to have a scalloping appearance between the roots in the dentulous areas. It can also occur in the edentulous areas, spanning 1 to 10 cm in diameter.2 Ehlers-Danlos syndromes (EDS) is a genetically heterogeneous group of 13 inherited connective tissue disorders. Most types of EDS are caused by mutations in genes encoding collagen types I, III, and V; enzymes responsible for modifying or processing these collagens; or enzymes involved in the synthesis of glycosaminoglycans in fibrous connective tissue.9 Clinical features of the EDS include hypermobility of joints, easy bruising, and notable elasticity of the skin.9 The oral manifestations include Gorlin sign in 50% of patients, easy bruising and bleeding of the oral mucosa, recurrent subluxation of the temporomandibular joint, and dental anomalies, such as malformed tooth roots, pulp stones, and www.tda.org | December 2021

809

ORAL

and maxillofacial pathology, continued

hypoplastic enamel.10 Dental malformations and considerable periodontal disease developed at an early age may be seen in patients with a rare form of Type VIII EDS. Gorlin sign is defined as the ability to touch the tip of the nose with the tongue.11 Odontogenic keratocysts (OKC) also have been reported in a handful of EDS patients.12,13,14 Traumatic bone cyst has not been reported to be associated with EDS. The TBC in the presenting case most likely represents coincidental bone pathology in an EDS patient.

The list of differential diagnosis for a welldefined radiolucency at the apices of teeth include periapical granuloma, radicular cyst, early stages of COD, odontogenic cyst or benign tumor, and non-odontogenic bone diseases.2,15 Since the mandibular teeth tested vital, the periapical granuloma and radicular cyst can be eliminated from the list. COD typically shows maturation stages, which reflect on radiographic presentations,

810

starting from a radiolucent lesion, becoming a mixed radiopaqueradiolucent lesion, and ultimately developing into predominantly radiopaque lesion surrounded by a thin radiolucent rim. It would be unusual for COD to reach the size of spanning apices of 10 teeth (shown in Figure 1) without showing any evidence of radiopacity.

Odontogenic tumors and non-odontogenic bone diseases such as central giant cell granuloma (CGCG) and aneurysmal bone cyst (ABC) are less likely. Odontogenic tumors, CGCG or ABC with the size of this case typically will show some degree of clinical expansion. Since the radiolucency was large but did not show any swelling or cortical expansion, the

Figure 1

Texas Dental Journal | Vol 138 | No. 12

diagnosis of odontogenic tumors, CGCG and ABC can be dismissed. The arteriovenous malformation also can be ruled out since a palpable thrill would be appreciable from the highflow lesion, along with warmth and possibly pain, ulceration, or bleeding.2 Odontogenic cyst, particularly OKC which has been found to be associated with EDS patients, and other bone diseases such as TBC and Langerhans cell histiocytosis should be considered. While they have overlapping radiographic signs, the surgical exploration and finding of an empty hole in the bone can persuade the clinician to make a provisional diagnosis of a TBC.

Diagnosing TBC consists of surgical exploration and pathologic confirmation.

A surgical finding of an empty cavity is essential to make the diagnosis.

The diagnosis is based on a combination of clinical, surgical, radiographic, and histopathologic findings.2 TBC are treated with surgical exploration and curettage. However, the simple act of surgical exploration has been found to induce bone regeneration even without curettage sometimes, and normal radiographic findings can be seen about 12-17 months after surgery.2 Periodic radiographs should be taken until complete resolution has been achieved. Overall, prognosis for TBC is good, with a recurrence rate of 1% to 2%.2 However, studies have shown that the prognosis decreases when multiple lesions or an association with cemento-osseous dysplasia exist.2 Packing with bone graft may ameliorate the prognosis, but more studies will be needed.2

References 1.

2.

3.

4.

5.

6.

7.

8.

Surej Kumar LK, Kurien N, Thaha KA. Traumatic bone cyst of mandible. J Maxillofac Oral Surg. 2015 Jun;14(2):466-9. doi: 10.1007/s12663-0100114-8. Epub 2010 Nov 25.

PMID: 26028875; PMCID: PMC4444671.

Neville, Brad W., Douglas D. Damm, Carl M. Allen, and Angela C. Chi. Oral and Maxillofacial Pathology. Fourth ed. 2016. 589591.

Satish K, Padmashree S, Rema J. Traumatic bone cyst of idiopathic origin? A report of two cases. Ethiop J Health Sci. 2014 Apr;24(2):183-7. doi: 10.4314/ ejhs.v24i2.13. PMID: 24795522; PMCID: PMC4006215.

Xanthinaki AA, Choupis KI, Tosios K, Pagkalos VA, Papanikolaou SI. Traumatic bone cyst of the mandible of possible iatrogenic origin: a case report and brief review of the literature.

Head Face Med. 2006 Nov 12;2:40. doi: 10.1186/1746160X-2-40. PMID: 17096860; PMCID: PMC1660580.

Mahomed F, Altini M, Meer S, Coleman H. Cemento-osseous dysplasia with associated simple bone cysts. J Oral Maxillofac Surg. 2005 Oct;63(10):154954. doi: 10.1016/j. joms.2005.05.322. PMID: 16182928.

Mupparapu M, Singer SR, Milles M, Rinaggio J. Simultaneous presentation of focal cementoosseous dysplasia and simple bone cyst of the mandible masquerading as a multilocular radiolucency. Dentomaxillofac Radiol. 2005 Jan;34(1):39-43. doi: 10.1259/dmfr/28162263.

PMID: 15709105.

Chadwick, J. W., Alsufyani, N. A., & Lam, E. W. N. (2011). Clinical and radiographic features of solitary and cemento-osseous dysplasia-associated simple bone cysts. Dentomaxillofacial Radiology, 40(4), 230-235.

Razmara F, Ghoncheh Z, Shabankare G. Traumatic bone cyst of mandible: a case series. J Med Case Rep.

9.

10.

11.

12.

13.

14.

15.

2019 Sep 18;13(1):300. doi: 10.1186/s13256-019-22207. PMID: 31530284; PMCID: PMC6749719.

Malfait, F., Castori, M., Francomano, C. A., Giunta, C., Kosho, T., & Byers, P. H. (2020).

The Ehlers–Danlos syndromes.

Nature Reviews Disease Primers, 6(1), 1-25.

Neville, Brad W., Douglas D. Damm, Carl M. Allen, and Angela C. Chi. Oral and Maxillofacial Pathology. Fourth ed. 2016. 703705.

Premalatha S, Sarveswari KN, Lahiri K. Reverse-Namaskar: a new sign in Ehlers-Danlos syndrome: a family pedigree study of four generations. Indian J Dermatol. 2010;55(1):86-91. doi: 10.4103/0019-5154.60360.

PMID: 20418985; PMCID: PMC2856381.

Starzyńska A, Adamska P, Adamski Ł, Sejda A, Wychowański P, Studniarek M, Jereczek-Fossa BA. Multiple odontogenic keratocysts in Ehlers-Danlos syndrome: a rare case report. BMC Oral Health.

2021 Mar 9;21(1):107. doi: 10.1186/s12903-021-014729. PMID: 33750365; PMCID: PMC7941700.

Carr RJ, Green DM. Multiple odontogenic keratocysts in a patient with type II (mitis) Ehlers-Danlos syndrome.

Br J Oral Maxillofac Surg.

1988 Jun;26(3):205-14. doi: 10.1016/0266-4356(88)901647. PMID: 3293654.

Ferreira O Jr, Cardoso CL, Capelozza AL, Yaedú RY, da Costa AR. Odontogenic keratocyst and multiple supernumerary teeth in a patient with Ehlers-Danlos syndrome--a case report and review of the literature. Quintessence Int. 2008 Mar;39(3):251-6. PMID: 18618041.

Dincer O, Kose TE, Cankaya AB, Aybar B. Traumatic bone cyst mimicking radicular cyst.

BMJ Case Rep. 2012 Dec 9;2012:bcr2012007316. doi: 10.1136/bcr-2012-007316.

PMID: 23220866; PMCID: PMC4544111.

www.tda.org | December 2021

811

VALUE

for your

Provided by:

profession

FREE APP

SIMPLIFIES MEETING TSBDE CE REQUIREMENTS, AUDIT SUBMISSIONS; DEBUTS EARLY 2022

S

taying on top of Texas State Board of Dental Examiners (TSBDE) CE requirements is a messy affair. There’s no clean and easy way of

keeping track of CE courses taken, which requirements are outstanding; and wrangling CE documentation in the event of a TSBDE audit. This is about to change with the early-2022 release of the new Dental Concierge app and learning management system commissioned by TDA and TDA Perks Program.

812

Texas Dental Journal | Vol 138 | No. 12

Here’s what Dental Concierge can do—and how it will streamline the process.

Track Completed CE. Dental Concierge neatly organizes all users’ CE completion documentation, sorting them into appropriate requirement categories they apply toward, and storing them in a digital vault until needed.

Progress toward meeting requirements is charted through a color-coded dashboard.

Documentation for courses completed through the app is automatically loaded and sorted into appropriate categories.

Information for courses completed outside the app need to be manually entered.

Users simply upload a photo of the completion certificate, check the box for the requirement it applies toward, and enter the completion date.

Show What’s Needed. Send Reminders.

Dental Concierge also shows users what courses and categories still need to be completed and fulfilled; and conveniently sends reminders as deadlines approach.

Reminders are sent via app alerts or emails at a frequency customized by the user.

Offer High Quality Courses at Low Cost.

A comprehensive library of ADA CERPqualified courses—live pre-recorded, and self-study—are available at lower cost to TDA members. All required categories except for PALS, BLS, ACLS and the Jurisprudence Assessment are offered.

Submit CE Documentation to TSBDE. When a CE audit notice is delivered, providing documentation to TSBDE will be a snap for Dental Concierge users. Dental Concierge enables its users to easily see and compile the required information for TSBDE. Dental Concierge will be available for download through Google Play and the Apple App Store, free of charge for TDA members. The app is available to non-TDA members for a monthly fee of $10.

Check TDA and TDA Perks Program websites (tda.org and tdaperks.com) and communications in the coming weeks for release date information.

And handily, other compliance-related custom reminders can also be set; for example, for meeting OSHA requirements or testing x-ray equipment. www.tda.org | December 2021

813

ADVERTISING BRIEFS PRACTICE OPPORTUNITIES AIRWAY HEIGHTS, WA: Pediatric Dentist in Spokane, WA. Benefits include: autonomy and mentorship as desired, $10,000 in CE (50% match), $3,000

dental annually, medical, 401K, moving expense options, associate % plus earned equity or partnership opportunity. Full day minimum. If interested email careers@ drcfamilydentistry.com to learn more.

ALL TEXAS LISTINGS FOR MCLERRAN &

Opportunities Online at TDA.org and Printed in the

ASSOCIATES: To request more information

Texas Dental Journal

dentaltransitions.com or contact us at 512-

on our listings, please register at www.

900-7989 or info@dentaltransitions.com.

ADVERTISING BRIEF INFORMATION

AUSTIN, ORTHODONTICS (ID #T510):

DEADLINE

This is a rare opportunity to purchase a

Copy text is due the 20th of the month, 2 months prior to publication (ie, January issue has a due date of November 20.)

MONTHLY RATES PRINT: First 30 words—$60 for ADA/TDA members & $100 for non-members. $0.10 each additional word.

ONLINE: $40 per month (no word limit). Online ads are circulated on the 1st business day of each month, however an ad can be placed within 24 business hours for an additional fee of $60.

SUBMISSION Ads must be submitted, and are only accepted, via www.tda.org/Member-Resources/TDAClassified-Ads-Terms. By official TDA resolution, ads may not quote specific incomes or revenues and must be stated in generic terms (ie “$315,000” should be “low-to-mid-6 figures”). Journal editors reserve the right to edit and/or deny copy.

814

Texas Dental Journal | Vol 138 | No. 12

turn-key orthodontic practice plus real estate north of Austin. The facility has a modern, spacious layout with 4 equipped chairs (and 2 additional plumbed operatories) and a digital pan-ceph. The real estate (built in 2007) is also available for purchase. AUSTIN (ID #T521): This highly productive, implant-focused, general dentistry practice located in a growing community approximately 30 miles from the Austin metro area. Current annual revenue is 7 figures with net cash flow in excess of 6 figures. The modern facility is located in a

retail space and equipped with 6

real estate. Excellent location situated in a

operatories, CBCT, and paperless charts.

rapidly growing community north of Austin.

The ideal buyer would be 1-2 high

The practice is located in a free-standing

producing doctor(s) who are well versed in

building, contains 4 fully equipped

placing implants. AUSTIN (ID #T522):

operatories, digital X-ray units, and CBCT.

This well-equipped, fully furnished, turn-

This 100% fee-for-service practice boasts a

key general dentistry practice in central

strong hygiene recall program, which

Austin has 5 operatories, primarily PPO,

produces a third of practice revenue and a

and is paperless with state-of-the-art

fantastic online reputation. SOUTH OF

technology: computers throughout, digital

AUSTIN (ID #T517): GD practice located

sensors, and an iTero Digital Scanner. The

in a rapidly growing community along the

office is located in a high visibility, mixed

I-35 corridor between Austin and San

use center (retail below, housing above) in

Antonio. The updated office features 5 fully

one of Austin’s most heavily trafficked

equipped operatories with computers,

areas. AUSTIN (ID #T524): This long-

digital X-rays, intraoral cameras and

standing, PPO/FFS general dentistry

paperless charts. The practice serves a

practice and real estate is located right in

large, FFS/PPO patient base, has a strong

the heart of Austin. The 2,000 sq ft facility

hygiene recall program, and an excellent

features 5 equipped operatories and is

online reputation. HOUSTON (ID

situated directly on a busy thoroughfare.

#H472): This established, boutique

With approximately 3,500 active patients,

practice is located in a highly desirable area

hygiene representing 40% of production,

of central Houston. The practice provides

and room to grow via adding additional

general, implant, and cosmetic dentistry

specialty procedures, we expect strong

services to a 100% FFS patient base and

interest in this practice. NORTH OF

has an excellent reputation in the local

AUSTIN (ID #T515): GD practice and

community. The beautiful facility features

www.tda.org | December 2021

815

ADVERTISING BRIEFS high-end finishes/décor, 3 fully-equipped

revenue of seven figures with exceptional

operatories, digital radiography, and a

profitability. The office features a 4-chair

CBCT. HOUSTON, PERIODONTAL (ID

ortho bay, 2 exam rooms, and digital pan/

#H476): Established perio practice in a

Ceph unit. The real estate is also available

growing suburb south of downtown

for purchase. HOUSTON (ID #H482):

Houston. There are 5 fully equipped

Located in a suburb of Houston in a

operatories, digital radiography, computers

spacious facility that boasts 10 operatories,

throughout, and a 3D Cone Beam CT in the

CBCT, and digital radiography. The practice

well-appointed 2,400 sq ft modern space.

serves a FFS/PPO patient base and has

The owner is open to a phased transition.

historically realized revenue of mid-to-

HOUSTON, ORTHODONTICS (ID

high-6 figures. HOUSTON (ID #H483):

#H478): This recently built, 2,000+

100% FFS GD practice and real estate.

square foot office is located in the upscale

Situated in a 2,200 square foot, free

Memorial area of Houston. There are 3 fully

standing building with 5 fully equipped

equipped operatories with a large

operatories. Hygiene production is very

breakroom that is setup to facilitate CE

healthy and the practice has seen 1,700+

courses. The breakroom can also be used

active patients in the last 24 months with a

to add an additional operatory. This is a

steady new patient flow. HOUSTON (ID

great turn-key opportunity for a start-up or

#H486): Located in a growing east Texas

relocation. The seller is disabled and

community, this general practice caters to a

motivated to sell. HOUSTON,

dedicated multi-generational active patient

ORTHODONTICS (ID #H480): This

base. The well-appointed 2,500 sq ft space

productive, FFS orthodontic practice

contains 5 fully equipped operatories,

occupies an attractive free-standing

digital pano, plumbed nitrous, and

building situated on a high traffic street in

computers throughout. HOUSTON (ID

a desirable community in the heart of East

#H487): 100% FFS practice in The

Texas. The practice has realized annual

Woodlands/Spring area. Modern facility

816

Texas Dental Journal | Vol 138 | No. 12

ADVERTISING BRIEFS with 4 equipped ops, digital x-ray sensors,

roughly 40% of the production being

an iTero, and paperless charts. This

generated from the hygiene program and

practice checks all of the boxes—strong

numerous specialty procedures being

profitability, an excellent hygiene program,

referred out, there is immediate upside

and further upside via numerous specialty

potential to be discovered. The office

procedures being referred out. HOUSTON

occupies 1,700 sq ft, has 3 equipped

(ID #H488): FFS/PPO practice and real

operatories with room for a 4th, digital

estate, growing suburb 45 minutes NE of

radiography, and computers throughout.

Houston. 1,800 total patients, steady flow

SAN ANTONIO (ID #T432): Located in a

of new patients, solid hygiene recall, and

growing suburb along the I-35 corridor

consistent revenue of high 6 figures per

north of San Antonio. The practice serves a

year. The office contains 6 fully equipped

large PPO/FFS patient base and has a

operatories, plumbed nitrous, digital X-rays, CBCT, and computers throughout.

HOUSTON (ID #H489): This highly profitable, general dentistry practice and real estate is located in an east Texas town.

The practice serves a large FFS/PPO patient base and is on pace to exceed seven figures in revenue in 2021 while

McLerran & Associates is the largest dental practice brokerage firm in Texas.

When it’s time to buy or sell a practice, we’ve got you covered.

P RAC T I C E S AL E S DS O T RAN S ACT I O N S

P RAC T I C E AP P RAISA LS ASSOCIATE PLACEMENT

maintaining a 45%+ profit margin. The office has 3 fully equipped operatories with possible room for expansion, digital radiography, and computers throughout.

HOUSTON (ID #H490): General/cosmetic practice located west of Houston in the

Austin

512-900-7989

DFW

214-960-4451

Houston

281-362-1707

San Antonio 210-737-0100 South Texas 361-221-1990 Emai l : t ex as@ den t al t r an si t i o n s.co m www.dentaltransitions.com

highly desirable Memorial area. With

www.tda.org | December 2021

817

ADVERTISING BRIEFS tremendous amount of untapped potential,

is located in a 2-story, free-standing

as approximately 40% of total production is

building and has a spacious layout that

derived from hygiene services and the

includes 6 fully equipped operatories (one

seller is referring out most specialty

additional plumbed for expansion, digital

procedures. The facility features 3 fully

sensors, a digital pano, CBCT, and

equipped operatories with space to add a

computers throughout. To request more

fourth operatory. SAN ANTONIO—WEST

information on our listings, please register

(ID #T454): GD practice and real estate,

at www.dentaltransitions.com or contact us

located in a rural community approximately

at 512-900-7989 or info@dentaltransitions.

75 miles west of San Antonio. Serves a

com.

PPO/FFS patient base, sees approximately 30+ new patients per month, and offers

AUSTIN, VICTORIA, SAN ANTONIO,

consistent annual revenue with substantial

AND DFW AREA (DDR DENTAL

upside potential through expanding the

Listings). (See also HOUSTON for

procedures offered in-house. The turn-key

other DDR Dental listings and visit www.

office features 3 fully equipped operatories,

DDRDental.com for full details. AUSTIN

digital sensors, intra-oral cameras, and a

—GENERAL/PROSTHODONTIC practice

digital pano. SAN ANTONIO (ID #T501):

provides comprehensive care but focuses

Located in a highly sought-after area along

on TMJ, occlusal rehabilitation and

Loop 1604 in north San Antonio. The

high-end cosmetic procedures. Must be

practice serves a large PPO/FFS patient

prosthodontist or like training to apply.

base and is located in a spacious office

Owner prepared to remain and train in

condo with 6 fully equipped operatories,

latest occlusal rehabilitation techniques.

digital pano, digital X-rays, and digital

Located in highly sought-after affluent

sensors. SOUTH TEXAS (ID #T460): GD

Austin area that is in very high demand and

Practice and free-standing building, located

closely proximate to downtown between

in a charming south Texas town. The office

entertainment and hi-tech corridors

818

Texas Dental Journal | Vol 138 | No. 12

ADVERTISING BRIEFS (in the “Heart of Austin”). In a single-

Christopher Dunn at 800-930-8017 or

story stand-alone building that draws

christopher@ddrdental.com and reference

from mature upscale neighborhood and

“Victoria Area or TX#567”. SAN ANTONIO—

nearby schools. Practice produces seven

GENERAL practice provides comprehensive

figures, in 5 operatories, (3 dental and 2

general dentistry in a growing major Texas

hygiene) within 2,000 sq ft. Immaculate

city. The practice is located in a highly

equipment, all digital with pano. Majority of

trafficked area near a major highway. This

patients 41 and older with 98% collection

practice is 1,536 sq ft with the ability to

ratio. NOTE: Practice recently acquired

expand into the office next door. It has 2

additional patient base that should boost

operatories with 1 used for hygiene. The

production, new patients and collections.

operatories are plumbed for nitrous. There

Contact Jim Dunn at 800-930-8017 or

is a good mix of patients ages, with the

christopher@ddrdental.com and reference

largest percentage between 30 to 65. The

“Austin Cosmetic or TX#560”. VICTORIA

practice has been at its current location

AREA—GENERAL practice provides a wide

for 35 years. The practice is mostly fee for

range of procedures for a small town near

service, with some PPO insurance accepted.

Victoria. Gross collections in the high-6

The practice has a 98% collection ratio.

figures. The practice has a broad mix of

Contact Christopher Dunn at 800-930-

patient ages. Most are middle- to high-

8017 or christopher@ddrdental.com and

income households. Practice is 100% fee

reference “San Antonio or TX569”.

for service. In a single story stand-alone building. Only 2 other dental offices within

AUSTIN: Associate to buy, planning on

15 miles. 2,800 sq ft. Expanded in 2000.

long transition. Prefer GP interested in

Located on a high visibility street. Does

orthodontics. Fee-for-service practice,

have digital X-ray and pano. This practice

43 years same location, long standing

uses mainly word of mouth as its source of

staff, beautiful view. Email Info@

new patients. 99% collection ratio. Contact

AustinSkylineDental.com.

www.tda.org | December 2021

819

ADVERTISING BRIEFS DALLAS: Don’t waste time and money

relocating. Need to move quickly on this

on buildouts when you can have a great

one. DFW 214-503-9696. WATS 800-583-

practice today. Great opportunity to start

7765.

your dental practice without having to pay a big loan and interest. Flexible lease

HOUSTON AREA: Several acquisition

options are available for well-qualified

opportunities in the greater Houston area.

dentists with no down payments and no

General, ortho, pedo practices available

interest for up to 2 years. Don’t waste time

for sale. Visit lonestarpracticesales.com or

and money on buildouts when you can

email houstondentist2019@gmail.com.

have a great practice today. Turnkey dental offices for sale in the Dallas Fort Worth

HOUSTON, COLLEGE STATION, AND

Metro and surrounding areas, the offices

LUFKIN (DDR DENTAL Listings). (See

are strategically located in areas for high

also AUSTIN for other DDR Dental listings

production with ample parking. Locations

and visit www.DDRDental.com for full

are ideal for emergency dental services,

details. LUFKIN—GENERAL practice on

Medicaid, insurance and FFS. Can be sold

a high visibility outer loop highway near

separately or as a package. Requirements

mall, hospital and mature neighborhoods.

Dentists need to have at least 2 years of

Located within a beautiful single-story,

experience in private practice/corporate

free-standing building, built in 1996 and

dentistry; credit and background check.

is ALSO available for purchase. Natural

For more information, please email

light from large windows within 2,300 sq

txpracticesales@gmail.com or call/text

ft with 4 operatories (2 hygiene and 2

214-995-0806.

dental). Includes a reception area, dentist office, a sterilization area, lab area, and

FORT WORTH: Practice for sale in the fast

break room. All operatories fully equipped.

growing southwest area. Average gross;

Does not have a pano but does have

6 operatories; Excellent lease. Seller is

digital X-ray. Production is 50% FFS and

820

Texas Dental Journal | Vol 138 | No. 12

ADVERTISING BRIEFS 50% PPO (no Medicaid), with collection

use by seller. A 60 percent of patients

ratio above 95%. Providing general dental

age 31 to 80 and 20% 80 and above.

and cosmetic procedures, producing

Four operatories in use, plumbed for

mid-6 figure gross collections. Contact

5 operatories. Digital pano and digital

Christopher Dunn at 800-930-8017 or

X-ray. Contact Christopher Dunn at 800-

Christopher@DDRDental.com and reference

930-8017 or christopher@ddrdental.

“Lufkin General or TX#540”. HOUSTON—

com and reference “Pearland General or

GENERAL (SHARPSTOWN): Well established

TX#538”. HOUSTON—PEDIATRIC (NORTH

general dentist with high-6 figure gross

HOUSTON): This practice is located in a

production. Comprehensive general

highly sought-after upscale neighborhood.

dentistry in the southwest Houston area

It is on a major thoroughfare with high

focused on children (Medicaid). Very, very

visibility in a strip shopping center. The

high profitability. 1,300 sq ft, 4 operatories

practice has 3 operatories for hygiene and

in single building. 95% collection ratio.

2 for dentistry. Nitrous is plumbed for all

Over 1,200 active patients. 20% Medicaid,

operatories. The practice has digital X-rays

45% PPO, and 35% fee-for-service. 30%

and is fully computerized. The practice

of patients younger than 30. Office open 6

was completely renovated in 2018. The

days a week and accepts Medicaid. Contact

practice is only open 3 and a half days per

Chrissy Dunn at 800-930-8017 or chrissy@

week. Contact Christopher Dunn at 800-

ddrdental.com and reference “Sharpstown

930-8017 or christopher@ddrdental.com

General or TX#548”. HOUSTON—GENERAL

and reference “North Houston or TX#562”.

(PEARLAND AREA) GENERAL Located

WEST HOUSTON—MOTIVATED SELLER:

in southeast Houston near Beltway 8.

Medicaid practice with production in the

It is in a freestanding building. Dentist

mid-6 figures. Three operatories in 1,200

has ownership in the building and would

sq ft in a strip shopping center. Equipment

like to sell the ownership in the building

is within 10 years of age. Has a pano and

with the practice. One office currently in

digital X-ray. Great location. If interested

www.tda.org | December 2021

821

ADVERTISING BRIEFS contact chrissy@ddrdental.com. Reference

adjusted production (whichever is higher)

“West Houston General or TX#559”.

For full-time position (33 hours or more per week) we offer a benefits package

THE WOODLANDS: Ortho for sale. Part-

that includes health insurance, 401K,

time orthodontic practice for sale in The

malpractice insurance, reimbursement for

Woodlands. Email craigpettey@att.net.

professional fees and continuing education courses. We can sponsor an H-1B work visa

WATSON BROWN PRACTICES FOR

if required. Recent grads welcome. Spanish

SALE: Practices for sale in Texas and

is helpful but not necessary. Interested

surrounding states, For more information

dentists please email your CV or any

and current listings please visit our website

questions to dfmego@gmail.com Please

at www.adstexas.com or call us at 469-

visit our website www.babyteethrgv.com

222-3200 to speak with Frank or Jeremy.

We look forward to speaking with you soon!

WESLACO: General dentist for pediatric practice in McAllen. Great opportunity for a general dentist interested in working in a pediatric dental office. Opportunity available full or part time. Our pediatric office sees patients 6 months to 21 years of age. Our philosophy is to treat our patients like family. Weslaco Pediatric Dentistry is an established pediatric dental practice, our office is computerized, has digital X-rays, and we have a wonderful staff. We offer a competitive daily base or a percentage of

822

Texas Dental Journal | Vol 138 | No. 12

YOUR PATIENTS TRUST YOU.

WHO CAN YOU TRUST?

ADVERTISERS Anesthesia Education & Safety Foundation.......... 778

Envolve Health..................................................... 775

Institute of Houston Dental Society...................... 779

If you or a dental colleague are experiencing impairment

JKJ Pathology....................................................... 786

due to substance use or mental illness, The Professional Recovery Network is here

Law Offices of Mark Hanna.....................................787

McLerran & Associates...........................................817

to provide support and an opportunity for confidential recovery.

New Orleans Dental Conference and LDA Annual Session......................................... 799

Southwest Sedation Education...............................787

Professional Recovery Network............................ 823

TDA Perks..................................... Inside Front Cover

PRN Helpline (800) 727-5152

Visit us online www.txprn.com

Watson Brown Practice Sales & Appraisals........... 781

www.tda.org | December 2021

823

824

Texas Dental Journal | Vol 138 | No. 12