September 2021 Texas Dental Journal

September 2021

TEXAS DENTAL

Meeting the Challenge of

Primary Care Dentistry

www.tda.org | September 2021

573

We’ll Take Care of Your Health Insurance.

What’s the real difference between purchasing insurance through TDA Financial Services Insurance Program and somewhere else?

You’ll always have attentive customer service from a team dedicated to TDA members and staff with TDA Financial Services Insurance Program. We work to make insurance easier for you and your staff.

Go to our portal to review, compare and buy your health insurance.

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Open Enrollment Begins Nov. 1 Portal at TDAmemberinsure.com Sign up for coverage effective Jan. 1 through the portal. 2022 rates will be available on Nov. 1.

Enroll or learn more at:

For more information, call:

tdamemberinsure.com

800-677-8644

Texas Dental Journal | Vol 138 | No. 9

Your practice is one of your most important assets.

DO YOU KNOW WHAT IT’S WORTH?

While no one likes to think about it, things do happen and it’s always important to be prepared.

Knowing your practice’s value can make the difference between selling your practice or having it become unsellable. That is why practice owners should have an up-to-date practice valuation.

Whether you are anticipating selling your practice and planning for retirement, recruiting a new associate who potentially may become a partner, or preparing for the unexpected, there are many reasons to have a current practice valuation.

A Henry Schein Professional Practice Transitions valuation considers both tangible and intangible assets of the practice and can provide the many key factors which influence the practice’s value.

To get started on your practice valuation or schedule a complimentary consultation, give us a call at 866-335-2947. www.henryscheinppt.com

866-335-2947

■

PRACTICE SALES

■

VALUATIONS

TRANSITION CONSULTING/ PLANNING ■ ASSOCIATESHIPS ■

© 2021 Henry Schein, Inc. No copying without permission. Not responsible for typographical errors.

21PT4334_plans options worth_7x9.5.indd 3

1/26/21 5:26 PM

www.tda.org | September 2021

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Contents September 2021 Established February 1883 n Vol 138, No. 9

FEATURES 590 | The Primary Care Dentistry for South Texas Project at the UT Health San Antonio School of Dentistry Hicks, Jeffery L., DDS, Dip. ABSCD Challa, Suman N., BDS, MSPH, Dip. ABDPH Hendricson, William D., MS, MA de la Torre, Magda A., RDH, MPH Marwaha, Rochisha S., BDS, MPH, DPH Department of Comprehensive Dentistry, University of Texas Health San Antonio, San Antonio, Texas

DEPARTMENTS 580 | President’s Message 582 | Oral and Maxillofacial Pathology Case of the Month 596 | Oral and Maxillofacial Pathology Case of the Month Diagnosis and Management TDA members, use your smartphone to scan this QR Code and access the online Texas Dental Journal.

576

599 | Calendar of Events

Texas Dental Journal | Vol 138 | No. 9

600 | Value for Your Profession: How to Create a Content Marketing Strategy That Attracts New Patients 604 | Advertising Briefs 614 | Index to Advertisers 615 | In Memoriam | Memorials/Honorariums

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

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2021 CALENDAR OF EVENTS

iHDS

2021 DATES

FACULTY & COURSE

Oct 8-9

Dr. Giancarlo Romero & Dr. Aldo Sordelli

8am-5pm

From CBCT to Surgical Guide

Oct 22-23

Dr. Virgilio Gutierrez & Dr. Giancarlo Romero

8am-4pm

Digital Photography

Oct 29-30

Dr. Giancarlo Romero & Dr. Aldo Sordelli

8am-5pm

Ridge Preservation & Immediate Implant Placement

& Provisionalization in the Esthetic Zone

Nov 5-6

Dr. Rolando Nuñez & Dr. Giancarlo Romero

8am-4pm

Severe Worn Down Dentition

Nov 18

Dr. David Alfi

Digital Orthognathic Surgery

THUR 6-9pm

Dec 3

iHDS Symposium

Followed by Christmas Party

FRI afternoon

Dec 11

Dr. Clark Whitmire

8am-4:30pm

Levels 2 & 3: Nitrous Oxide & Sedation Renewal

All events subject to change Stay current and connected: www.ihds-ce.com

THE

Institute of Houston Dental Synergy

i N S T I T U E of HOUSTON DENTAL SYNERGY

Located at the Houston Dental Education Center 4548 Bissonnet St., Suite 210, Bellaire, TX 77401 Call 713-589-9603 or send an email to marketing@ihds-ce.com iHDS

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Texas Dental Journal | Vol 138 | No. 9

Terry Watson, D.D.S.

Jeremy Brown, J.D.

Frank Brown, J.D., LL.M.

Free Dental Practice Valuation

Take the 1st step in selling your dental practice.

Contact us to receive a free practice valuation.

469-222-3200 * Call us for details on this offer.

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Chewon this Tell Your Story — Recruit a Member

W

hile writing my President’s message for the 2021 House of Delegates, I had time to reflect on how my life in organized dentistry began in a small district, the East Texas Dental Society (3rd). I remember how one dentist, Dr David Nichols, came up to me after I attended only 2 or 3 meetings and said, “You need to be our DENPAC rep.” I replied, “What’s DENPAC?” And the rest is history!

ONE member changed the course of my dental life journey.

If it weren’t for Dr Nichols, I might not even be a member of organized dentistry today. You see,

“

TDA President Debrah J. Worsham, DDS

I drive 90 miles one way to go to dental meetings in 3rd district!

As a young dentist, I had 3 kids along the way. I could have easily made excuses to not attend had I not been welcomed and become involved. But I had a job to do and a report to give. Dr Nichols took a chance on me. He made a decision to invest in me as he has in many others along the way!

I’m asking you to invest in organized dentistry, invest in the profession, invest in the growth of your local society. Could you ask just ONE prospective member to join you at a local society meeting?

Or could you shoot them a quick

It’s up to us to strengthen our profession.

Grab your phone and recruit a member today!

Dr. Debrah J. Worsham, TDA President

tda.org/recruitamember

580 Texas TexasDental DentalJournal Journal | |Vol Vol 138 138| No. | No. 9 9

”

message and tell your story? Let them know what you like best about being a member.

If you think you don’t have time or you simply wouldn’t know what to say, the TDA has made it easy for you. From now through the end of December, TDA is running a membership recruitment campaign and all the details on the campaign can be found at www. tda.org/recruitamember including a campaign overview, sample text messages, and emails you can use to reach out to a prospective member. The best part is if you recruit the most new members, you can win free TDA dues for 2022! And each new member you recruit gets 3 free months of membership, as part of our “15 for 12” campaign. It’s easy—they join now and get free dues through the end of 2021 with the commitment to join for 2022. Other states have used this program and they have had very high retention rates among those who joined.

Invite a colleague. Tell YOUR story.

Recruit a member today!

Practices For Sale Since 1968

We are pleased to announce...

Hassan Asghar, D.D.S. has acquired the practice of

John R. Loar, D.D.S. Seven Points, Texas

Harpreet K. Sidhu, D.D.S. has acquired the practice of

Rishad Merchant, D.D.S. Garland, Texas

We are please to have represented all parties in these transitions.

GREAT METRO SAN ANTONIO OPPORTUNITY: Located inside Loop 1604 in a medical complex with excellent street visibility and highway accessibility. The office is roughly 1,600 sq. ft. with 4 ops, computerized with Easy Dental. There are approximately 1,350 active patients, 75% PPO/25% FFS. Collections are $412K+ on an abbreviated schedule and currently refers out most surgery, endo, pedo, and implant placement, leaving ample opportunity for growth. Opportunity ID: TX-6797 FANTASTIC $1.39M OPPORTUNITY: This opportunity is for two Medicaid practices that collected $1.3M+ in 2019. This is an excellent opportunity to be an entrepreneur and oversee management while having associates to help with production. These offices have a total of 7 ops, updated computers and software, CBCT Pano at one office and digital Pano at the other. Opportunity ID: TX-6792 RARE SAN ANTONIO OPPORTUNITY: This practice is located in a busy retail center off of a well-traveled road and collects $445K+ on a 3-day workweek. There are 630 active patients with an average of 26 new patients a month. The paperless office has digital X-rays, digital Pano, and uses Dentrix. The office is 2,215 sq. ft. with 4 wellequipped ops and a 5th op plumbed. Opportunity ID: TX-6789 BETWEEN HOUSTON AND GALVESTON! This practice is 60% Medicaid and 40% PPO with a healthy hygiene program. The facility has 5 equipped ops with another op plumbed. Expect first-year earnings after all expenses and debt service to exceed $250,000 on a 4 day work week. If you want a practice where you like to work with kids but also enjoy the diversity of providing more complex dentistry for adults, then this practice could be the right practice for you. Opportunity ID: TX-6789 Go to our website or call to request information on other available practice opportunities!

800.232.3826

Practice Sales & Purchases Over $3.2 Billion

www.AFTCO.net

• Complimentary biopsy kits

Specializing in:

• Delivery via FedEx, local courier or USPS

• Conventional biopsy testing

• Diagnosis within two business days of receiving most biopsy specimens.

• Cytopathology • Histochemistry • Immunohistochemistry

• UT M.D. Anderson Cancer Center and UTHealth Medical School available for consultations as needed.

• Direct immunofluorescence testing

• Affiliated with UT School of Dentistry at Houston.

713.486.4411

go.uth.edu/Pathology

Our Pathologists: Jerry E. Bouquot, DDS, MSD Kalu U.E. Ogbureke, BDS, DMSc, JD, MSc

Ngozi N. Nwizu, BDS, MMSc, PhD Nadarajah Vigneswaran, DMD, DrMedDent

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ORAL

and maxillofacial pathology

Clinical History A 32-year-old male is a new patient in your practice. He is in good health and his health history is noncontributory. He is asymptomatic. You discover a 2.53 cm symmetrical, well circumscribed and corticated pericoronal radiolucency associated with the crown of unerupted #32 (Figure 1). There is no detectable bony expansion.

case of the month

What is your clinical/ radiographic differential diagnosis?

The patient is referred to an oral and maxillofacial surgeon who discovers a compressible “cyst” surrounding the unerupted tooth. It separates cleanly from the surrounding bone and the “cyst” is therefore enucleated and the unerupted tooth removed.

Figure 1. Patient presented with a well-defined unilocular corticated pericoronal radiolucency around unerupted #32.

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The specimen is submitted to an oral pathologist for interpretation. The cyst is lined by a thin and uniform stratified squamous epithelium without surface keratinization. The basal cells are cuboidal to flattened and the nuclei are not particularly hyperchromatic (Figure 2).

What is the final diagnosis?

What is your patient’s prognosis?

See page 596 for the answer and discussion.

AUTHORS John M. Wright, DDS, MS Regents Professor, Diagnostic Sciences, Texas A&M University College of Dentistry, Dallas, Texas

Mehrnaz Tahmasbi Arashlow, DDS Clinical Assistant Professor, Diagnostic Sciences, Texas A&M University College of Dentistry, Dallas, Texas

Paras Patel, DDS Assistant Professor, Diagnostic Sciences, Texas A&M University College of Dentistry, Dallas, Texas

Figure 2. Histologic features show a cyst lined by a uniform nonkeratinized stratified squamous epithelial lining without prominent basal cells.

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Made in USA • FDA Registered

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Texas Dental Journal | Vol 138 | No. 9

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

www.tda.org | September 2021

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In response to oral health needs in Texas, the University of Texas Health San Antonio School of Dentistry (UTHSA SOD) is undertaking a 5-year Primary Care Dentistry for South Texas project (PCDST) to expand and modify its primary care dentistry residency programs.

The Primary Care Dentistry for South Texas Project at the UT Health San Antonio School of Dentistry Hicks, Jeffery L. DDS, Dip. ABSCD Challa, Suman N. BDS, MSPH, Dip. ABDPH Hendricson, William D. MS, MA de la Torre, Magda A. RDH, MPH Marwaha, Rochisha S. BDS, MPH, DPH Department of Comprehensive Dentistry, University of Texas Health San Antonio, San Antonio, Texas Project funded by: United States Health Resources and Services Administration Grant # D88HP37558

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Abstract In response to oral health needs in Texas, the University of Texas Health San Antonio School of Dentistry (UTHSA SOD) is undertaking a 5-year Primary Care Dentistry for South Texas project (PCDST) to expand and modify its primary care dentistry residency programs.

Through innovative linking of the primary care postdoctoral programs (general dentistry, dental public health and pediatric dentistry), increased numbers of residents will be cross-trained to manage oral health problems, evaluate systems of care, and design surveillance systems to measure oral health status.

Residents from these advanced programs will be trained to provide care to rural populations and patients who are elderly, from vulnerable populations and those with complex medical illnesses and developmental disabilities. As a significant component of the project, dental residents will provide care in federally qualified health care centers (FQHCs) in rural areas surrounding San Antonio. This project also will provide telehealth capabilities for rural dental care providers and classroom and clinical training for medical providers in the care of patients with orofacial pain of dental origin.

key words Health, minority, oral health, access to healthcare, Texas

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Introduction

T

exas is the fastest growing large state, and the population in 2019 was 29.1 million, up from 25.1 million in 2010, representing an annual growth rate of 1.80%, the third highest in the U.S.1 Within the next decade, more than a third of Texas’ general dentists will be at or past retirement age.2 Texas’ aging dental workforce leaves many Texans unable to access dental care.

There is only one general dentist for every 2,764 Texans. About 20% of Texas counties have no practicing dentists, and a third have no dentists enrolled as Medicaid providers.

Because nearly 93% of dentists in the state practice in metropolitan areas, the shortage is most acute in rural Texas.3 Between 2008 and 2013, Texas ranked third worst among US states for the percent of

Texas’ aging dental workforce leaves many Texans unable to access dental care.

There is only one general dentist for every 2,764 Texans.

third graders who have experienced dental caries and seventh worst for the percent with untreated dental caries.4 The untreated caries prevalence among Mexican American and poor children was 33%.5 In 2016, Texas was ranked 43rd of 50 states in a composite score of: edentulism, Medicaid dental benefits, water fluoridation, state oral health plans, and basic screening survey.5 In 2019, 53% of Texas kindergarten children had experienced dental decay and 20% had untreated decay. By the third grade, 67% of children had dental caries and 21% had

untreated decay.7 In 2016, 59% of adults in Texas aged 18+ had a dental visit in the past year and 40% had not. Approximately 5 million Texans have no health insurance and only limited access to primary and preventive care.

Texas has the highest rate of those without health insurance in the U.S., and as many as 42% are uninsured in Texas’ border regions. Children without dental insurance are more than twice as likely to have dental needs and 4 times more likely to have urgent needs than children with private insurance.8 Over 3 million Texas children have

Medicaid coverage, but about one-third of Texas counties have no dentists enrolled as Medicaid providers.9 Texas has chosen not to implement a Medicaid insurance expansion. This decision left a coverage gap for nearly 1 million Texans who are not eligible for Medicaid, most of whom are working poor with no employee health insurance, denying them access to primary and preventive care.10 Many, if not most, schools of dentistry in the US have significant gaps in the care of patients from vulnerable, disabled and

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rural populations and in training of providers to deliver care in rural settings, and in managing oral health problems, evaluating systems of care, and designing surveillance systems to measure oral health status. Care in dental schools is provided generally in disconnected clinics and to limited numbers of persons with disabilities, especially the

developmentally disabled, and little oral health care is provided to patients in rural areas. We have established the Primary Care Dentistry for South Texas Project (PCSDT) project to address these shortcomings of the dental education process.

Our project’s was started in academic year 2020-21 and we will complete this initial iteration of the project in academic year 2024-25.

Outcomes To address the particular needs of the citizens of the State of Texas, our PCDST project will train residents from the University of Texas Health San Antonio School of Dentistry (UTHSA SOD) in primary care dental disciplines to deliver care effectively in clinics in rural as well as urban settings

Table 1. Project Objectives 1

Train increased numbers of residents in the Advanced General Dentistry, Dental Public Health, and Pediatric Dentistry residency programs.

2

Train oral care providers to manage oral health problems, evaluate systems of care, and design surveillance systems measuring oral health status, and address childhood obesity, the opioid crisis, and social determinants of health using telehealth modalities.

3

Inform, recruit and enroll increased numbers of trainees from underrepresented and disadvantaged groups, from rural areas and those in loan repayment programs.

4

Train residents in rural federally qualified health center dental clinics in underserved South Texas communities.

5

Care for patients who are aged, underserved, and/or have special health care needs.

6 7 8 9 590

Establish a special care clinic for patients with special health care needs.

Use mobile dental equipment for care in nursing homes in rural areas.

Use telehealth to connect, inform and advise providers in rural areas.

Increase the number of postdoctoral trained dentists who choose to practice in rural areas and with vulnerable populations.

Texas Dental Journal | Vol 138 | No. 9

and in nursing homes.

Residents will be trained to deliver comprehensive care with emphasis on designing care systems that consider vulnerable patients’ special health care needs, social determinants of health, ethnicity, and socioeconomic status.

Residents will be trained also in the use of telehealth modalities and will study and present using the Extension for Community Healthcare Outcomes (ECHO) videoconferencing

platform to present virtual clinics. ECHO is a model for lifelong learning for practitioners that aims to “move knowledge, not people” by connecting subject-matter experts with community health professionals serving populations with limited health care access.

The Oral Health ECHO will link UTHSA dental specialists with south Texas practitioners to provide guidance on patient management.

A high priority in our PCDST program is recruiting underrepresented minority (URM) candidates and those committed to practicing in rural and medically underserved south Texas communities. Each primary care dental residency program will prioritize the enrollment of residents and trainees who are URM, of rural or disadvantaged origin, and U.S. veterans.

Table 2. PCDST Project Outcomes 1

Increased overall number of primary care dentistry residents and increased number of residents from rural, underrepresented minority, and disadvantaged backgrounds.

2

Increased numbers of primary care residents and faculty trained in the comprehensive care of patients with special health care needs, the vulnerable elderly, the homeless, those with HIV/AIDS, with complex medical needs and underserved/vulnerable populations.

3

Increased numbers of primary care dentists trained to manage oral health problems, evaluate systems of care, and design surveillance systems to measure oral health status.

4

Creation of a Special Care Clinic providing training/care for persons with special needs.

5

Increased numbers of dentists and FQHCs trained in the use of telehealth modalities.

6

Increased numbers of postdoctoral-trained dentists who choose to practice in rural and/or underserved areas and with vulnerable populations.

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Activities of the Primary Care Dentistry for South Texas Project The project is establishing an innovative model for interprofessional Education of Dental Public Health, AEGD and Pediatric Dentistry Residents. We will design and develop specialized curricula needed in dental residency programs. For example, the DPH Video Curriculum, organized around clinical cases, will focus on the

core Dental Public Health Competencies that guide DPH residency education.

The project will create a standardized curriculum, training resources and cases for dental public health residents nationally and will be disseminated to other U.S. DPH residency programs. The AEGD, DPH, and pediatric dental programs collaboratively will implement a Comprehensive Care Curriculum (CCC). The CCC will provide didactic and experiential learning in the areas described below to enhance dental residents’ and other health professionals’ capacity to deliver oral health care for rural, underserved

and vulnerable/at-risk populations. We will facilitate the cross-training of dental public health, AEGD and pediatric dentistry residents in an interprofessional format, and provide a pathway for DPH residents to pursue a second residency program in our AEGD or pediatric dentistry residencies.

All of our school’s primary care dentistry programs’ residents will be provided experiential clinical training among rural, underserved and special needs populations in south Texas.

For example, once activity will include providing care at San Antonio’s homeless

Table 3. Comprehensive Care Curriculum Elements 1

Rural Dental Practice Management, Community Health Leadership and Promotion

2 3 4 5 6 7 592

Mini-residency in Geriatric Dentistry Obesity Counseling Vaping and Opioid / Substance Abuse Counseling Child and Adolescent Patients with Special Healthcare Needs HEENOT Health Assessment Workshop (Head, Ears, Eyes, Nose, Oral, Throat) Opioid Prescribing in Dentistry and Opioid Overdose Training

Texas Dental Journal | Vol 138 | No. 9

and transitional living facility, Haven for Hope, located in a mental health Health Professions Shortage Area.

We have enacted collaborations with our institution’s Schools of Medicine and Nursing and with rural area FQHCs (federally qualified health care centers), which are community health centers providing medical and dental care to underserved populations. Residents will rotate to the dental clinics in these FQHCs and be mentored by rural dental providers who care for underserved populations.

It is anticipated that, as a result of this training, residents in our Advanced Education in General Dentistry (AEGD), Pediatric Dentistry and Dental Public Health training programs will be better trained to

care for patients from rural, vulnerable, and special needs populations, and more likely to locate in rural communities during their practice careers.

Residents will provide comprehensive dental care for geriatric patients in our school of dentistry and for nursing home residents who are without funding sources and living in nursing facilities in rural south Texas. We have enacted agreements with nursing homes in rural areas and are creating advisory committees for our nursing home and special care clinic elements that include future patients’ families and advocates.

These advisory committees will help in the planning, designing and implementing all activities.

The UTHSA SOD will institute care for patients with special health care needs (SHCN) in the San Antonio and south Texas area by establishing a Special Populations Oral Health Education and Care Center. Dental primary care residents, clinical staff and faculty will receive training and supervised clinical experience in providing care for individuals with SHCN in the center. This clinic will be the largest facility in south Texas expressly devoted to training students and residents in oral health care for individuals with special needs, including those with intellectual and developmental disabilities, and will ultimately provide training also for the dental practice community.

Additionally, we will provide regional anesthesia and mandibular block www.tda.org | September 2021

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component/ objective. An annual, PCDST end-ofyear meeting will include a strengths/weaknesses/ opportunities/threats exercise to identify refinements in project operations, communications and management needed for the next year.

anesthesia training for emergency room (ER) physicians, physician assistants and nursing practitioners. We plan to help reduce the number of patients with pain from oral disease who require opioid medications and reduce the number of patients treated surgically in emergency rooms with resultant great cost to them and the treating emergency room.

Outcomes Assessment We will establish data collection systems and an annual end-of-year summaries of outcomes data for each training

As a Capstone Assessment at the conclusion of each primary care residents’ participation in the PCDST Project, we will assess the effect of the overall training experience on the residents’ perceptions of their abilities to provide care to underserved communities including self-assessment of confidence, intentions to use acquired knowledge and skills in future practice and intentions to establish their dental practice in rural and/or underserved communities.

We will track participating residents’ subsequent practice variables, including practice location, associated socio-economic characteristics of the practice area, and entry into rural/communitybased primary care in a health facility or public health workforce after residency completion. The tracking surveys will elicit

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participants’ self-report of their adoption/ use of skills taught in PCDST in their postresidency practice with focus on special health care needs, elder care, public health, cultural competency, health literacy, opioid and other substance use, and use of telehealth modalities. Location of practice will also be tracked, to determine whether more dentists are serving rural areas than would under non-project conditions.

Dissemination Follow-up and overall project progress will be submitted for publication in the Texas Dental Journal to provide updates on implementation and outcomes.

References 1. QuickFacts Texas United State Census Bureau, Department of Commerce, 2020. Available from: https://www. census.gov/quickfacts/TX 2. Professionally Active Dentists, State Health Facts, Kaiser Family Foundation, 2020. Available from: https://www.kff. org/other/state-indicator/total-dentists/ ?currentTimeframe=0&sortModel=%7B %22colId%22:%22Location%22,%22s ort%22:%22asc%22%7D 3. Kaiser Family Foundation, Custom State Report. Available from: https://www. kff.org/statedata/custom-statereport/?i =32495~32496~32497&g=tx&view=3 4. Florida Department of Health Public Health Dental Program. The oral health status of Florida’s third grade children 2013-2014, 2016. Available from: https://cod-oralhealthflorida.sites. medinfo.ufl.edu/files/2017/03/oralhealth-third-grade-2013-2014.pdf.

5. Oral Health in Texas Bridging Gaps and Filling Needs: A Report on the Burden of Oral Disease in Texas, Texas Health Institute, 2018. Available from: https://www.texashealthinstitute.org/ uploads/3/9/5/2/39521365/thi_report_ final.pdf 6. Oral Health America, A State of Decay, Volume 3, 2016. Available from: https://nhoralhealth.org/blog/wpcontent/uploads/2016/05/State-ofDecay-2016-Vol-3.pdf 7. U.S. Centers for Disease Control and Prevention, Oral Health Data, 2020. Available from: https://nccd. cdc.gov/oralhealthdata/rdPage. aspx?rdReport=DOH_DATA.ExploreByLo cation&isILocation=48&iclTopic=ADT&isl Year=2016 8. Texas has the most people without health insurance in the nation — again.

Texas Tribune, Sept 10, 2019. Available from: https://www.texastribune. org/2019/09/10/texas-has-mostpeople-without-health-insurancenation-again/ 9. Oral Health by the Numbers, Third grade Oral Health Screening Survey, 2017-2018 Texas Health and Human Services, Texas Department of Health Services, 2020. Available from: https:// dshs.texas.gov/dental/Oral-Health-bythe-Numbers.aspx 10. Medicaid Expansion in Texas: Potential Economic and Employment Implications, The Commonwealth Fund, 2020. Available from: https://www. commonwealthfund.org/publications/ issue-briefs/2019/aug/medicaidexpansion-texas-potential-economicemployment-implications

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ORAL

and maxillofacial pathology diagnosis and management—from page 583

Dentigerous Cyst (Follicular cyst) Diagnosis The final diagnosis for this lesion is dentigerous cyst (DC). Three things must be considered before developing a differential diagnosis for bone pathology. The nature of the pathology itself in relation to the surrounding normal bone is either radiolucent, mixed or predominantly radiopaque. Assessing the margins and how the pathology interfaces with the normal adjacent bone provides evidence of the biologic aggressiveness of the lesion. Lastly, the anatomic association with teeth provides insight into the underlying etiology and origin of the lesion.

In our case, the lesion is radiolucent. Most bone pathology produces osteolysis and radiolucency, so the differential diagnosis for radiolucent lesions is much greater than those for mixed or opaque lesions. Our lesion is symmetrical, suggesting

596

a benign process. The margins are well defined and often corticated.

Cortication is created by the normal bone adjacent to the lesion. Lesions that grow very slowly allow the adjacent bone to produce new bone in an attempt to wall off the process.

Cortication usually suggests a benign process. Lastly, our lesion is pericoronal in anatomic location.

Being tooth associated is highly suggestive of an odontogenic origin. The differential diagnosis in our case should include, therefore, odontogenic cysts and benign odontogenic tumors.

The differential would include dentigerous cyst, odontogenic keratocyst, calcifying odontogenic cyst (Gorlin cyst), glandular odontogenic cyst, ameloblastoma (especially the unicystic ameloblastoma), calcifying epithelial odontogenic tumor (Pindborg tumor), adenomatoid odontogenic tumor, squamous odontogenic tumor,

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odontogenic myxoma, odontogenic fibroma, ameloblastic fibroma and rarely other odontogenic tumors. The definitive diagnosis can only be established by biopsy and microscopic examination.

Most pericoronal radiolucencies are dentigerous cysts.

The pathogenesis of DCs is related to odontogenesis.

During odontogenesis, the enamel organ is responsible for the deposition of enamel on the surface of the crown. The cells of the inner enamel epithelium develop into ameloblasts that secrete enamel matrix onto the surface of the developing teeth. Once the full thickness of enamel is attained, the ameloblasts become more quiescent, becoming more cuboidal and are known as reduced enamel epithelium. The reduced enamel epithelium is organically attached to the surface of the enamel until the tooth erupts.

Outside the reduced enamel epithelium is a thin layer

of follicular connective tissue. This produces the follicular space seen radiographically on virtually every unerupted tooth; it is typically about 1-2mm thick.

Occasionally the reduced enamel epithelium separates from the tooth crown. Fluid begins to collect in the created space, slowly increasing it’s size and, eventually, leading to the formation of a dentigerous cyst. During this process, the reduced enamel epithelium slowly undergoes metaplasia, converting almost completely to mature squamous epithelium.

The etiology of the initial epithelial separation is unknown but is not related to inflammation. The definition of DC includes its unique pericoronal relationship to unerupted teeth. While all DCs are pericoronal, not all pericoronal radiolucencies are DCs, hence the need for a differential diagnosis and microscopic confirmation.

Dentigerous cysts are the second most common odontogenic cyst, behind apical periodontal cysts (radicular cysts) and they constitute between 1824% of all odontogenic

cysts biopsied.1-3 They are mostly diagnosed in the decades and most series show a male predominance, but rarely over 2:1.2-4 The tooth affected correlates with a tooth’s likelihood of being impacted and as many as 50% of DCs affect the mandibular third molars. Four DCs also occur around supernumerary teeth and odontomas.5,6 About 2.5% of cases are multiple, usually affecting the third molars, but these are not syndromic.7 Most patients with DCs are asymptomatic. As the cyst enlarges, cortical expansion can be appreciated.

Occasionally DCs occur around teeth that are erupting where the cyst breaks through the alveolar cortical bone and presents as a soft compressible mass on the alveolar ridge. This is a variant of DC known as eruption cyst.

Radiographically, DCs appear as well-defined, usually corticated, round or ovoid, unilocular radiolucencies surrounding the crown of unerupted teeth, usually third molars and canines. Occasionally they can be multilocular.

Displacement of the associated tooth and root resorption of adjacent teeth

may occur. The size of DCs is commonly greater than the normal follicular space (3 mm). Attachment of DC at the cementoenamel junction of the involved tooth is an important diagnostic clue.8 Care must be exercised when evaluating the size of the follicular space around unerupted teeth. Every unerupted tooth shows a pericoronal radiolucency representing the normal follicle and, as has already been mentioned, this can range up to 2-3mm.

Hyperplastic dental follicles can produce further follicular expansion radiographically and this will range from 2.5 mm to 5-6mm. As the follicular space exceeds 5-6mm, a pathologic process should be assumed and the most common pericoronal radiolucency over 6mm is DC.9 The microscopic features of DC are characteristic but not necessarily diagnostic.

Clinical/radiographic correlation is required with the knowledge that the cyst was in a pericoronal anatomic relationship to an unerupted tooth. The cyst lining is typically stratified squamous epithelium that www.tda.org | September 2021

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ORAL

and maxillofacial pathology, continued

is nonkeratinized. The basal cells are not palisaded or hyperchromatic like those in odontogenic keratocysts or cystic ameloblastomas but rather more cuboidal to flattened. The stroma of the DC consists of residual follicular connective tissue, which tends to be relatively loose and myxoid and often contains rests of odontogenic epithelium representing degenerating dental lamina following odontogenesis. The microscopic features of this follicular connective tissue can lead to a misdiagnosis of odontogenic myxoma or odontogenic fibroma.

On rare occasions, the epithelial lining of a DC can give rise to neoplastic transformation, including ameloblastoma, squamous cell carcinoma and mucoepidermoid carcinoma.10-12 Pathologists should be aware of this possibility and take care to rule out the occurrence of neoplastic transformation.

DCs are generally treated by conservative surgical removal, either enucleation or curettage. For those affecting third molars, the offending tooth is usually

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removed also. Large lesions can be marsupialized/ decompressed.13 The recurrence rate following removal is very low.

References 1. Daley TD, Wysocki GP, Pringle GA. Relative incidence of odontogenic tumors and oral and jaw cysts in a Canadian population. Oral Surg Oral Med Oral Pathol.

1994;77(3):276-280.

2. Josell SD, Reiskin AB, Gross BD. Dentigerous cyst with mural ameloblastoma. J Am Dent Assoc. 1979;99(4):634636.

3. Prockt AP, Schebela CR, Maito FD, Sant’Ana-Filho M, Rados PV. Odontogenic cysts: analysis of 680 cases in Brazil. Head Neck Pathol.

2008;2(3):150-156.

4. Shear M, Speight P. Cysts of the oral and maxillofacial regions 4 ed. Blackwell Munksgaard; 2007, p 59-75.

5. Byatnal AA, Byatnal A, Singh A, Narayanaswamy V, Radhakrishnan R. Bilateral impacted inverted mesiodens associated with dentigerous cyst. J Calif Dent Assoc.

2013;41(10):753-757.

6. Jayam C, Bandlapalli A, Patel N, Choudhary RS. A case of impacted central incisor due to dentigerous cyst associated with impacted compound odontome. BMJ Case Rep. 2014;2014.

7. Zhang LL, Yang R, Zhang L, Li W, MacDonald-Jankowski D, Poh CF. Dentigerous

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cyst: a retrospective clinicopathological analysis of 2082 dentigerous cysts in British Columbia, Canada.

Int J Oral Maxillofac Surg.

2010;39(9):878-882.

8. Scholl RJ, Kellett HM, Neumann DP, Lurie AG. Cysts and cystic lesions of the mandible: clinical and radiologic-histopathologic review. Radiographics.

1999;19(5):1107-1124.

9. Browne RM. Metaplasia and degeneration in odontogenic cysts in man. J Oral Pathol.

1972;1(4):145-158.

10. Gulbranson SH, Wolfrey JD, Raines JM, McNally BP. Squamous cell carcinoma arising in a dentigerous cyst in a 16-month-old girl.

Otolaryngol Head Neck Surg.

2002;127(5):463-464.

11. Houston GD. Oral pathology.

Ameloblastoma arising in a dentigerous cyst. J Okla Dent Assoc. 2007;98(9):28-29.

12. Spoorthi BR, Rao RS, Rajashekaraiah PB, Patil S, Venktesaiah SS, Purushothama P. Predominantly cystic central mucoepidermoid carcinoma developing from a previously diagnosed dentigerous cyst: case report and review of the literature. Clin Pract.

2013;3(2):e19.

13. Nascimento RD, Raldi FV, de Moraes MB, Cardoso PE, Holleben D. A large dentigerous cyst treated with decompression and orthosurgical traction: a case report. Gen Dent.

2015;63(1):e5-8.

Calendar

of events

JKJ Pathology Oral Pathology Laboratory

John E Kacher, DDS • Available for consultation by phone or email

Texas Mission of Mercy Schedule 2021 OCTOBER 21-22 2021: San Antonio, Texas Pre-Screening

• 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.

Call or email for free kits or consultation. jkjpathology.com 281-292-7954 (T) 281-292-7372 (F) johnkacher@jkjpathology.com

Protecting your patients, limiting your liability

NOVEMBER 5-6, 2021: San Antonio, Texas 30-40 Chairs

Due to the COVID-19 global crisis, please check each meeting’s website for up-to-date information related to cancellations or rescheduling.

THE TEXAS DENTAL JOURNAL’S CALENDAR will include only meetings, symposia, etc., of statewide, national, and international interest to Texas dentists. Because of space limitations, individual continuing education courses will not be listed. Readers are directed to the monthly advertisements of courses that appear elsewhere in the Journal.

www.tda.org | September 2021

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VALUE

for your

Provided by:

profession

How to Create a Content Marketing Strategy That Attracts New Patients

By Pete Johnson, Lasso MD

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You’ve probably heard

What Is It?

it before, but content

A content marketing strategy is a plan you develop to use content marketing to help you achieve your business goals.

Content is especially important in a complex market like healthcare, where many patients are not experts and want help understanding important choices they face.

is king—especially when it comes to digital marketing.

Publishing high-quality content audiences find engaging (i.e., content marketing) is a great way to educate and build trust with prospective patients. The effort could ultimately lead them to choose you as their provider.

But without a content marketing strategy, success or failure is a matter of luck— and you risk wasting all the effort and resources you invested. According to the Content Marketing Institute, 63% of businesses don’t have a written content marketing strategy.1 It’s no surprise a similar percentage of businesses (64%) say learning how to build one is one of their highest educational priorities.

In this article, we’ll focus on creating a content marketing strategy focused on the goal of generating new patients. We’ll explain why having one is important and give you a blueprint to create one on your own.

A good content marketing strategy for your practice can educate prospective patients and alleviate their concerns, tell them what makes your practice unique (and why they should choose you over the competitor down the street), and help you form a relationship with them.

Set Goals The first step is to define clear and measurable goals for your content marketing strategy. You can adjust your strategy according to the success (or failure) in achieving your goals.

For example, your goal might be to implement a search engine strategy that: • Generates 1,000 new views of your website • Generates 100 new inquiries • Converts 10 prospects to new patients

1. Rose, R. (May 6, 2020). “Content Management and Strategy: A Disruptive Change We Need [New Research].” Content Marketing Institute™. https://contentmarketinginstitute.com/2020/05/contentstrategy-research/

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VALUE

continued

Write a Mission Statement Next, write a mission statement for your strategy. You should include following.

Target Audience One of the most common mistakes in marketing is trying to succeed with everyone, which usually results in succeeding with no one. Instead, find a segment of the market that matches your strengths and is not already dominated by a competitor. Pick your target prospects carefully. Think like a general: concentrate your forces, divide, and conquer.

Example of a target audience: Families with a household income of over $100,000 that live in zip codes: 92130, 92014, and 92075

Content Type, Benefits Next, determine what your target audience’s concerns are. This will guide you on what kind of content they will want to read or see—and that you should provide.

Then identify how your targeted audience will benefit from your content marketing.

This should be related to your target audience’s concerns, identified in the previous step.

Example: Audience Concerns: Financing, patient comfort, whitening, flexible hours Benefits: Prospective patients will be able

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to educate themselves on the services we provide, discover how beautiful our practice is, receive promotional pricing, and schedule an appointment online without having to call the office.

Determine Preferred Delivery Channels. Develop a Distribution Strategy You’ll also need to determine how your identified audience likes to consume content—e.g. some like to read, others like seeing pictures or watching videos.

Also, find out what channels are more frequented by your target—social media, search engines? Then you can determine the type of content to produce and deliver.

You’ve defined your audience, the topics they are searching for, and where it goes for information. Now, how will distribute your content?

Social Media If your strategy points to social media, focusing on your personality and friendly staff is a good bet. You’ll want lots of photos with smiling faces and video with a personal touch.

You can include use of a social media holiday calendar to figure out which holidays line up with your social media strategy and add them to your content calendar.

Search Engines A search-based strategy relying on search engines needs content that’s much different from a program based on social media.

People searching on Google for a product or service you offer will be more interested in educational content and the big picture.

If you provide this, you’ve taken the first steps towards building trust with your target audience, and they will come to you for more information. Spend time to do a thorough SEO (search engine optimization) analysis and carefully choose your keywords. Your research and targeting can really pay off.

Example: Channels Frequented by Target Audience: Facebook, YouTube, TikTok, NextDoor, Yelp, Google Reviews Type of Content We’ll Provide: • Website and blog content (SEO focus) • Video for website (SEO and social media focus) • Promotional content (social media focus)

Create Content Now you’ll need to decide what content you’re going to create and produce it.

Use a strong mix of text, photo, and video content in your strategy so you communicate through all available media, regardless of the channel.

Create a Content Calendar, Execute It’s time to create a content calendar and finally execute your strategy. You can always make changes as needed.

When you succeed in the targeted audience segment, you can leverage that success and your growing reputation to add additional segments.

If you’re struggling with any of the above steps, there are plenty of companies that will gladly assist you. If you choose to work with a marketing company, it’s still a great idea to create your content marketing strategy mission statement and share it with them. This produces a more collaborative approach that will result in authentic content your target audience will find engaging.

Lasso helps dentists create predictable new patient flow through innovative digital & video marketing strategies. The TDA Perks Programendorsed company’s ROI software gives practice owners the ability to track where their marketing dollars are being spent and verify the effectiveness of the campaigns. Lasso is offering exclusive pricing to TDA members: Create a year’s worth of video & photo content (plus much more) for $850/month with its “Captivate Plan;” which includes 15+ videos, 12+ blogs and 20+ photos. Visit www.lassomd.com/tda-perks to learn more.

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ADVERTISING BRIEFS PRACTICE OPPORTUNITIES ALL TEXAS LISTINGS FOR MCLERRAN & ASSOCIATES: To request more information on our listings, please register at www.dentaltransitions.com or contact us at 512-900-7989 or info@dentaltransitions. com. AUSTIN, ORTHODONTICS (ID

#T510): This is a rare opportunity to purchase a 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 panceph. The real estate (built in 2007) is also available for purchase. NORTH OF AUSTIN (ID #T515): This established,

Opportunities Online at TDA.org and Printed in the

Texas Dental Journal ADVERTISING BRIEF INFORMATION

general dentistry practice and real estate is in an excellent location situated in a rapidly growing community north of Austin. The practice is located in a freestanding building, contains 4 fully equipped operatories, digital X-ray units, and CBCT. This 100% fee-for-service practice boasts

DEADLINE

a strong hygiene recall program, which

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

produces a third of practice revenue and

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.

a fantastic online reputation. CORPUS CHRISTI (ID #T437): This primarily FFS practice is located in the coastal community of Corpus Christi. With solid hygiene recall, a dedicated patient base, consistent revenue, and solid cash flow, this legacy office possesses many of the positive qualities of a prime acquisition target.

There are 3 fully equipped operatories with

SUBMISSION

room to build out an additional plumbed

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.

4th operatory, computers throughout,

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digital radiography and digital pano.

DALLAS—SOUTH OF FORT WORTH (ID #T448): This general dentistry practice is located in a smaller community just 35

miles south of Fort Worth. The turn-key

(ID #H480): This productive orthodontic

office is located in an attractive, 4,500 sq

practice occupies an attractive free-

ft, free-standing building and features 4

standing building situated on a high traffic

fully equipped treatment rooms, an ortho

street in a desirable community in the

bay with 4 chairs, CBCT, digital sensors,

heart of east Texas. The practice has a

and paperless charts. The practice serves

loyal fee-for-service patient base and has

a large, FFS/PPO patient base, annual

realized annual revenue of 7 figures with

collections of well over 7 figures over

exceptional profitability over the past few

the past 3 years with solid net cash flow.

years. The office features a 4-chair ortho

DALLAS SUBURB (ID #T512): This PPO/

bay, 2 exam rooms, and digital pan/ceph

FFS general dentistry practice is located in

unit. The real estate is also available for

a highly sought after suburb of Dallas. This

purchase. HOUSTON (ID #H481): This

turn-key office features 3 fully equipped

established, general dentistry practice is

operatories with paperless charts, digital

located in a highly desirable area in west

X-ray units, a digital pano, and a digital

Houston. The practice serves a large FFS/

scanner. HOUSTON, PERIODONTAL (ID

PPO patient base with over 2,000 active

#H476): This beautiful perio practice

patients. The office features 4 operatories

is located in a growing suburb south of

equipped with computers, digital X-ray

downtown Houston. There are 5 fully

units, a digital pano, and room for

equipped operatories, digital radiography,

expansion by way of equipping the 5th

computers throughout, and a 3D Cone

operatory. The real estate is also available

Beam CT in the well-appointed 2,400

for purchase. HOUSTON (ID #H482):

square foot modern space. HOUSTON

This general family practice is located in a

(ID #H472): This established, boutique

suburb of Houston in a spacious facility that

practice is located in a highly desirable

boasts 10 operatories, CBCT, and digital

area of central Houston. The practice

radiography. The practice serves a FFS/PPO

provides general, implant, and cosmetic

patient base and has historically realized

dentistry services to a 100% FFS patient

revenue of mid-6 figures. HOUSTON (ID

base and has an excellent reputation in

#H483): This 100% FFS, general dentistry

the local community. The beautiful facility

practice has been in operation for over 35

features high-end finishes/décor, 3 fully

years and is situated in a 2,200 sq ft, free

equipped operatories, digital radiography,

standing building with 5 fully equipped

and a CBCT. HOUSTON, ORTHODONTICS

operatories. Hygiene production is very

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605

ADVERTISING BRIEFS healthy and the practice has seen 1,700+

revenue with substantial upside potential

active patients in the last 24 months

through expanding the procedures offered

with a steady new patient flow, primarily

in-house. The turn-key office features 3

through word of mouth referrals. The

fully equipped operatories, digital sensors,

real estate is also available to purchase.

intra-oral cameras, and a digital pano.

HOUSTON (ID #H484): This attractive

SAN ANTONIO (ID #T464): This well-

practice is located in a high visibility

established set of practices is located in

retail center at a bustling intersection

the same facility in an upscale area of

in northwest Houston. The 1,750 sq ft

northwest San Antonio. Combined, the

leased space has a total of 5 plumbed

practices have around 2,600 active patients

operatories, and are fully equipped with

and collected over 7 figures annually over

a dental chair and cabinetry in the 4th,

the past 3 years. The practice is located

and digital radiography and computers

in a high-trafficked retail area, and is

throughout. This is a great alternative

equipped with 5 operatories, digital X-ray

to starting a practice from scratch. SAN

sensors, a digital pano, and a CEREC digital

ANTONIO (ID #T432): This established,

scanner and milling unit. SAN ANTONIO

general dentistry practice and building

(ID #T501): This established, premier

is located in a growing suburb along the

general dentistry practice is located in

I-35 corridor north of San Antonio. The

a highly sought-after area along Loop

practice serves a large PPO/FFS patient

1604 in north San Antonio. The practice

base and has a tremendous amount of

serves a large PPO/FFS patient base and

untapped potential, as approximately

is located in a spacious office condo with

40% of total production is derived from

6 fully equipped operatories, digital pano,

hygiene services and the seller is referring

digital X-rays, and digital sensors. SAN

out most specialty procedures. The facility

ANTONIO (ID #T506): This established,

features 3 fully equipped operatories

FFS/PPO practice and commercial real

with space to add a 4th operatory. SAN

estate is located in northwest San Antonio.

ANTONIO—WEST (ID #T454): This

The 4,100 sq ft facility boasts 5 equipped

established, general dentistry practice

operatories, a digital pano, computers

and real estate is located in a rural

throughout, and an additional 5 plumbed

community approximately 75 miles west

operatories available for expansion. SAN

of San Antonio. The practice serves a PPO/

ANTONIO (ID #T516): This established,

FFS patient base, sees 30+ new patients

general dentistry practice and real estate

per month, and offers consistent annual

is located in a desirable area in west

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Texas Dental Journal | Vol 138 | No. 9

ADVERTISING BRIEFS San Antonio. The practice treats a large

Located in highly sought-after affluent

PPO/FFS patient base, sees 20+ new

Austin area that is in very high demand

patients per month, and refers out nearly

and closely proximate to downtown

all specialty procedures (orthodontics,

between entertainment and hi-tech

oral surgery, implant placement, and

corridors (in the “Heart of Austin”). In

endo). The modern office features 6

a single-story stand-alone building that

fully equipped operatories with intraoral

draws from mature upscale neighborhood

cameras, digital X-ray sensors, nitrous,

and nearby schools. Practice produces 7

and a digital pano. SOUTH TEXAS (ID

figures, in 5 operatories, (3 dental and 2

#T460): This established, legacy practice

hygiene) within 2,000 sq ft. Immaculate

and free-standing building is located in a

equipment, all digital with pano. Majority of

charming south Texas town. The office is

patients 41 and older with 98% collection

located in a 2-story, free-standing building

ratio. NOTE: Practice recently acquired

and has a spacious layout that includes 6

additional patient base that should boost

fully equipped operatories (one additional

production, new patients and collections.

plumbed for expansion, digital sensors, a digital pano, CBCT, and computers throughout. To request more information on our listings, please register at www. dentaltransitions.com or contact us at 512900-7989 or info@dentaltransitions.com.

AUSTIN, VICTORIA, SAN ANTONIO, AND DFW AREA (DDR DENTAL Listings). (See also HOUSTON for

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.

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

other DDR Dental listings and visit www.

DDRDental.com for full details. AUSTIN: GENERAL/PROSTHODONTIC practice

Austin

512-900-7989

DFW

214-960-4451

provides comprehensive care but focuses

Houston

281-362-1707

on TMJ, occlusal rehabilitation and

San Antonio 210-737-0100

high-end cosmetic procedures. Must be

South Texas 361-221-1990

prosthodontist or like training to apply.

Emai l : t ex as@ den t al t r an si t i o n s.co m

Owner prepared to remain and train in

www.dentaltransitions.com

latest occlusal rehabilitation techniques. www.tda.org | September 2021

607

ADVERTISING BRIEFS Contact Jim Dunn at 800-930-8017 or

8017 or christopher@ddrdental.com and

christopher@ddrdental.com and reference

reference “San Antonio or TX569”.

“Austin Cosmetic or TX#560”. VICTORIA AREA: GENERAL practice provides a wide

AUSTIN: Associate to buy, planning on

range of procedures for a small town near

long transition. Prefer GP interested in

Victoria. Gross collections in the high-6

orthodontics. Fee-for-service practice,

figures. The practice has a broad mix of

43 years same location, long standing

patient ages. Most are middle- to high-

staff, beautiful view. Email Info@

income households. Practice is 100% fee-

AustinSkylineDental.com.

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

AUSTIN: Pediatric dentist. Progressive

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

pediatric dental practice in Austin is looking

Located on a high visibility street. Does

for an energetic pediatric dentist to join

have digital X-ray and pano. This practice

our team. We offer a comprehensive

uses mainly word of mouth as its source of

compensation package. New grads

new patients. 99% collection ratio. Contact

welcome to apply. Please email CV to

Christopher Dunn at 800-930-8017 or

joinourpractice2010@gmail.com.

christopher@ddrdental.com and reference “Victoria Area or TX#567”. SAN ANTONIO:

DALLAS: Office to share. Ready to cut back

GENERAL practice provides comprehensive

to a couple of days or start a new practice?

general dentistry in a growing major Texas

Share my beautiful, fully digital office,

city. The practice is located in a highly

located in the Richardson Telecom/City Line

trafficked area near a major highway. This

area. 5 ops, all computers (Eaglesoft) and

practice is 1,536 sq ft with the ability to

electronic services (support, back up, and

expand into the office next door. It has 2

patient communication) in place. Office

operatories with 1 used for hygiene. The

currently used 3.5 days/week but willing

operatories are plumbed for nitrous. There

to cut back to 3; must see to appreciate.

is a good mix of patients ages, with the

Contact jack@drjackbodie.com or 972-235-

largest percentage between 30 to 65. The

4767.

practice has been at its current location for 35 years. The practice is mostly fee-for-

DENTON: General dental practice for

service, with some PPO insurance accepted.

sale. Exciting opportunity north of the

The practice has a 98% collection ratio.

DFW metroplex. Experience the charm of

Contact Christopher Dunn at 800-930-

a small, close-knit community with easy

608

Texas Dental Journal | Vol 138 | No. 9

ADVERTISING BRIEFS access to all that DFW offers within an

instructions; assist the practice towards

hour drive. The current doctor is interested

excellence in oral health care requirements.

in transition options that include a

Candidates must have current Texas

straight buy out or affiliation. They would,

Dental Board License, CPR, DEA, NPI, and

however, prefer a short transition period.

malpractice insurance. New graduates are

The practice itself is an hour north of the

welcome to apply. Contact Rosie Mireles

DFW metroplex and just minutes outside

at rosiem@starcitydental.com or 915-591-

the great community of Denton. 5 fully

7117.

equipped operatories. Over 2,600 active patients. Visit our website for collections

FORT WORTH: Practice for sale in the fast

and EBITDA amounts. To learn more, email

growing southwest area. Average gross;

Kaile Vierstra with Professional Transition

6 operatories; Excellent lease. Seller is

Strategies: kaile@professionaltransition.

relocating. Need to move quickly on this

com or call: 719-694-8320. https://

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

professionaltransition.com/properties-list/

7765.

denton-tx-area-general-dental-practice-forsale/ EL PASO: Well-established, dentist owned and operated practice, seeking an associate dentist for a part-time position

DIOX HANDHELD X-RAY UNIT Voted #1 Handheld Unit in the USA 3 Year Warranty • 100% FDA Approved

$3795

in El Paso. Associate dentist will work along with the owner dentists in a teamoriented environment that allows you to focus on what you do best, dentistry. We offer guaranteed base and percentage of production with uncapped earning potential. An ideal candidate is dependable and adaptable, committed to patient care, provide accurate exams and patientfocused treatment planning; Deliver patient-focused preventive, restorative, and surgical procedures; compassionately communicate treatment plans and

Call Dr Scott for free 2nd opinion

1-800-508-4050 www.DDSprices.com

www.tda.org | September 2021

609

ADVERTISING BRIEFS HOUSTON AREA: Several acquisition

focused on children (Medicaid). Very, very

opportunities in the greater Houston area.

high profitability. 1,300 sq ft, 4 operatories

General, ortho, pedo practices available

in single building. 95% collection ratio.

for sale. Visit lonestarpracticesales.com or

Over 1,200 active patients. 20% Medicaid,

email houstondentist2019@gmail.com.

45% PPO, and 35% fee-for-service. 30% of patients younger than 30. Office open 6

HOUSTON, COLLEGE STATION, AND

days a week and accepts Medicaid. Contact

LUFKIN (DDR DENTAL Listings). (See

Chrissy Dunn at 800-930-8017 or chrissy@

also AUSTIN for other DDR Dental listings

ddrdental.com and reference “Sharpstown

and visit www.DDRDental.com for full

General or TX#548”. HOUSTON: GENERAL

details. LUFKIN: GENERAL Practice on a

(PEARLAND AREA) GENERAL Located in

high visibility outer loop highway near

southeast Houston near Beltway 8. It is

mall, hospital and mature neighborhoods.

in a freestanding building. Dentist has

Located within a beautiful single-story,

ownership in the building and would like

free-standing building, built in 1996 and

to sell the ownership in the building with

is ALSO available for purchase. Natural

the practice. One office currently in use by

light from large windows within 2,300 sq

seller. 60% of patients age 31 to 80 and

ft with 4 operatories (2 hygiene and 2

20% 80 and above. Four operatories in use,

dental). Includes a reception area, dentist

plumbed for 5 operatories. Digital pano and

office, a sterilization area, lab area, and

digital X-ray. Contact Christopher Dunn at

break room. All operatories fully equipped.

800-930-8017 or christopher@ddrdental.

Does not have a pano but does have

com and reference “Pearland General or

digital X-ray. Production is 50% FFS and

TX#538”. HOUSTON: PEDIATRIC (NORTH

50% PPO (no Medicaid), with collection

HOUSTON). This practice is located in a

ratio above 95%. Providing general dental

highly sought-after upscale neighborhood.

and cosmetic procedures, producing

It is on a major thoroughfare with high

mid-6 figure gross collections. Contact

visibility in a strip shopping center. The

Christopher Dunn at 800-930-8017 or

practice has three operatories for hygiene

Christopher@DDRDental.com and reference

and two for dentistry. Nitrous is plumbed

“Lufkin General or TX#540”. HOUSTON:

for all operatories. The practice has digital

GENERAL (SHARPSTOWN). Well established

X-rays and is fully computerized. The

general dentist with high-6 figure gross

practice was completely renovated in 2018.

production. Comprehensive general

The practice is only open three and a half

dentistry in the southwest Houston area

days per week. Contact Christopher Dunn

610

Texas Dental Journal | Vol 138 | No. 9

ADVERTISING BRIEFS at 800-930-8017 or christopher@ddrdental.

their patients and their community. Our

com and reference “North Houston or

practice is an office supported by Pacific

TX#562”. WEST HOUSTON: MOTIVATED

Dental Services (PDS), which means you

SELLER—Medicaid practice with production

won’t have to spend your career navigating

in mid-6 figures. Three operatories in 1,200

practice administration. Instead, you’ll

sq ft in a strip shopping center. Equipment

focus on your patients and your well-

is within 10 years of age. Has a pano and

being. Add on excellent benefits, including

digital X-ray. Great location. If interested

malpractice insurance, medical, dental

contact chrissy@ddrdental.com. Reference

and vision insurance, retirement plans and

“West Houston General or TX#559”.

much more and you’ll feel well taken care of throughout your career. The average

KATY: Now is the time to join Grand Lakes

full-time PDS-supported associate dentist

Dental Group and Orthodontics. You will

earns low-6 figures in their first year. The

have opportunities to learn new skills from

average income for a PDS-supported owner

our team of experienced professionals. If

dentist, whose practice has been open

you’re ready to take your career to the next

at least 2 years, is mid-6 figures. As an

level and gain valuable experience, apply

associate dentist, you will receive ongoing

today! You’ve invested the time to become

training to keep you informed and utilizing

a great dentist, now let us help you take

the latest technologies and dentistry

your career further with more opportunity,

practices. If you are interested in a path to

excellent clinical leadership and one of the

ownership, our proven model will provide

best practice models in modern dentistry.

you with the training needed to become an

In working with our practice you will have

owner of your own office. PDS is one of the

the autonomy to provide your patients

fastest growing companies in the US which

the care they deserve. In addition, you’ll

means we will need excellent dentists like

enjoy the opportunity to earn excellent

you to continue to lead our growth in the

income and have great work-life balance

future. Apply now or contact a recruiter

without the worries of running a practice.

anytime. We’d love to chat, get to know

You became a dentist to provide excellent

you and share more about us. Pacific

patient care and have a career that will

Dental Services is an equal opportunity

serve you for a lifetime. With us, you

employer and does not discriminate

will have a balanced lifestyle, fantastic

against any employee or applicant for

income opportunities, and you’ll work for

employment based on race, color, religion,

an office that cares about their people,

national origin, age, gender, sex, ancestry, www.tda.org | September 2021

611

ADVERTISING BRIEFS citizenship status, mental or physical

focus on your patients and your well-

disability, genetic information, sexual

being. Add on excellent benefits, including

orientation, veteran status, or military

malpractice insurance, medical, dental

status. Apply here:http://www.Click2Apply.

and vision insurance, retirement plans and

net/gwy6pkn22knbzwzx PI106822492.

much more and you’ll feel well taken care of throughout your career. The average

KATY: Now is the time to join Highlands

full-time PDS-supported associate dentist

Dental Group. You will have opportunities

earns low-6 figures in their first year. The

to learn new skills from our team of

average income for a PDS-supported owner

experienced professionals. If you’re ready

dentist, whose practice has been open

to take your career to the next level and

at least 2 years, is mid-6 figures. As an

gain valuable experience, apply today!

associate dentist, you will receive ongoing

You’ve invested the time to become a

training to keep you informed and utilizing

great dentist, now let us help you take

the latest technologies and dentistry

your career further with more opportunity,

practices. If you are interested in a path to

excellent clinical leadership and one of the

ownership, our proven model will provide

best practice models in modern dentistry.

you with the training needed to become an

In working with our practice you will have

owner of your own office. PDS is one of the

the autonomy to provide your patients

fastest growing companies in the US which

the care they deserve. In addition, you’ll

means we will need excellent dentists like

enjoy the opportunity to earn excellent

you to continue to lead our growth in the

income and have great work-life balance

future. Apply now or contact a recruiter

without the worries of running a practice.

anytime. We’d love to chat, get to know

You became a dentist to provide excellent

you and share more about us. Pacific

patient care and have a career that will

Dental Services is an equal opportunity

serve you for a lifetime. With us, you

employer and does not discriminate

will have a balanced lifestyle, fantastic

against any employee or applicant for

income opportunities, and you’ll work for

employment based on race, color, religion,

an office that cares about their people,

national origin, age, gender, sex, ancestry,

their patients and their community. Our

citizenship status, mental or physical

practice is an office supported by Pacific

disability, genetic information, sexual

Dental Services (PDS), which means you

orientation, veteran status, or military

won’t have to spend your career navigating

status. Apply here:http://www.Click2Apply.

practice administration. Instead, you’ll

net/ygmfkqjp6prswyc3.

612

Texas Dental Journal | Vol 138 | No. 9

ADVERTISING BRIEFS NORTH HOUSTON: General dental

SAN ANGELO: West central Texas

practice. New to the market is an exciting

orthodontic specialty practice grosses

general dental practice for sale north

low-7+ figures annually with 60%

of Houston. The practice is located in

overhead;100% fee for services. Well

the highly desirable community of The

established in community with strong

Woodlands, within an hour of downtown

doctor and patient referrals. 200+ starts

Houston. The current doctor is interested

annually. Practice was recently appraised.

in affiliation with a group, to continue the

Doctor will stay for smooth transition.

upward trajectory of the practice. Set in

Inquire to hilltoportho@gmail.com.

an expansive retail center, the practice is prominent and easy for patients to visit.

SAN ANTONIO: General dental practice.

5 operatories and expansion opportunity

San Antonio general practice with doctor

for 2 additional plumbed ops. 35 new

interested in partnering with a group and

patients per month. To learn more, email

continuing to grow the practice. Located

Kaile Vierstra with Professional Transition

in an office complex within 15 minutes

Strategies: kaile@professionaltransition.

of downtown San Antonio, the practice is

com or call: 719-694-8320. https://

in a prime location off Loop 410. 5 fully

professionaltransition.com/properties-list/

equipped operatories. Nearly 3,000 active

north-houston-tx-general-dental-practice-

patients and 20 new patients per month.

for-sale/

Visit the website to review collections and EBITDA. To learn more, email Kaile

NORTH TEXAS. Come establish your

Vierstra with Professional Transition

practice in a growing, robust, friendly town

Strategies: kaile@professionaltransition.

just 1 hour north of Dallas. Office is located

com or call: 719-694-8320. https://

on busy street across from park and

professionaltransition.com/properties-list/

football stadium. 4 operatories (1 unused),

san-antonio-tx-general-dental-practice-for-

panoramic, laboratory, private office,

sale/

reception area. Outdoor shipping container for storage. General practice includes oral

WATSON BROWN PRACTICES FOR

surgery, endodontics, crown and bridge,

SALE: Practices for sale in Texas and

and removable prosthetics. Call 903-647-

surrounding states, For more information

3177.

and current listings please visit our website at www.adstexas.com or call us at 469222-3200 to speak with Frank or Jeremy. www.tda.org | September 2021

613

YOUR PATIENTS TRUST YOU.

WHO CAN YOU TRUST?

ADVERTISERS AFTCO.................................................................. 581 Anesthesia Education & Safety Foundation.......... 585 Card Connect.............................................Back Cover DentalPost............................................................ 584

If you or a dental colleague

Discount Dental Services, Scott Brown, DDS........ 609

are experiencing impairment due to substance use or mental illness, The Professional Recovery Network is here to provide support and an opportunity for confidential recovery.

E-VAC, Inc............................................................ 584 Henry Schein Financial Services........................... 575 Institute of Houston Dental Society...................... 578 JKJ Pathology....................................................... 599 Law Offices of Mark Hanna.....................................615

McLerran & Associates...........................................607

Professional Recovery Network............................ 614 TDA Perks..................................... Inside Front Cover UTHealth School of Dentistry at Houston.............. 581

PRN Helpline (800) 727-5152

614

Visit us online www.txprn.com

Texas Dental Journal | Vol 138 | No. 9

Watson Brown Practice Sales & Appraisals........... 579

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

IN MEMORIAM

Lyndel C Stripling Dallas May 25, 1948–August 25, 2021 Good Fellow: 2001 • Life: 2013 William Clive Pierce II Georgetown September 21, 1934–August 13, 2021 Life: 2000 • Fifty Year: 2010 Larry B Schrader Austin December 22, 1944–September 8, 2021 Good Fellow: 1998 • Life: 2009 Samuel Boyd Holder Linden April 15, 1938–September 4, 2021 Good Fellow: 1991 • Life: 2003 • Fifty Year: 2016

MEMORIAL/HONORARIUM

Those in the dental community who have recently passed

Memorial and Honorarium Donors to the Texas Dental Association Smiles Foundation Dr Franklin Eggleston

submitted by Dr Larry Spradley

Dr Michael Vaclav

submitted by Dr Larry Spradley

Dr Michael Vaclav

submitted by Dr Jerry & Betty Long Your memorial contribution supports: • Educating the public and profession about oral health • Improving access to dental care for the people of Texas Please make your check payable to: TDA Smiles Foundation, 1946 S IH 35 Austin, TX 78704

www.tda.org | September 2021

615

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