ISSUE 41: SPRING 2023
Dr. Kayleigh Eaves Temple, Editor

President’s Message

In dentistry, long days are spent focused on all sorts of connections: we strive to insure margins connect flawlessly, interproximal connections are intact, occlusal connections balanced, periodontal connections healthy. The only connection we avoid is the pulp!

Without connecting, things begin to drift and decay. The same applies to human connections. The connections that matter most are the interpersonal relationships we build with our patients, our staff, friends, and more importantly, our families. Our third annual ETDS Christmas party proved the perfect night to kick off the holiday season, celebrate the culmination of a good year, and connect with our fellow colleagues.

Again, thank you to everyone behind the scenes who worked so hard to put on this festive event, who sponsored a prize, and also to everyone who attended. What better way to connect and foster camaraderie than by sharing a delicious holiday meal? I was seated with peers less than ten years into their careers and embarking on brand new practices as well as a seasoned practitioner who practiced dentistry over fifty years and just recently embarked on the adventure of retirement.

Scanning the crowded ballroom, I recognized familiar faces from almost every ETDS meeting I’ve attended over the past 18 years mixed with new faces I haven’t yet had the opportunity to meet. Most of the dental specialties were represented, and many general dentists were in attendance. I observed dentists who practice here in Tyler, dentists who drove over from Longview, along with dentists with more rural practices such as myself. I spotted active leaders at the local and even state level next to those who quietly support our society through annual membership and regular attendance at our meetings (both integral to the continued success of our society). The evening encapsulated the different sectors of our shared profession that comprise the 3rd District of the Texas Dental Association and highlighted the advantages of connecting through organized dentistry.

We started 2023 with Dr. Andrew Johnson connecting us to the future with informative CE regarding advancements in 3D printing and even robotics! Dr. Duc “Duke” Ho, TDA president, provided insight into happenings at the state level: connecting us to our legislature, making connections with our dental schools, connecting with our dental hygienist colleague, and connecting with underserved communities.

The East Texas Dental Society is making it easier for members and their staff to connect with our new registration platform, CE-Go, providing easier CE registration and certification. Our spring meeting is an excellent way to connect with your staff and learn impressive ways to connect with your patients as Dr. Tal Wilkins provides a hands on course on dental photography. Additionally, we are creating some mentoring opportunities. If interested, please complete the survey included in this newsletter.

Finally, one of the best ways to connect is through service. Our board continually seeks fresh ideas and innovative leadership. If you’re willing to serve in any capacity, let one of us know.

Wishing you all a very happy new year,

Delaine Daniels, DDS

In dentistry, long days are spent focused on all sorts of connections: we strive to insure margins connect flawlessly, interproximal connections are intact, occlusal connections balanced, periodontal connections healthy. The only connection we avoid is the pulp!

Without connecting, things begin to drift and decay. The same applies to human connections. The connections that matter most are the interpersonal relationships we build with our patients, our staff, friends, and more importantly, our families. Our third annual ETDS Christmas party proved the perfect night to kick off the holiday season, celebrate the culmination of a good year, and connect with our fellow colleagues.

Again, thank you to everyone behind the scenes who worked so hard to put on this festive event, who sponsored a prize, and also to everyone who attended. What better way to connect and foster camaraderie than by sharing a delicious holiday meal? I was seated with peers less than ten years into their careers and embarking on brand new practices as well as a seasoned practitioner who practiced dentistry over fifty years and just recently embarked on the adventure of retirement.

Scanning the crowded ballroom, I recognized familiar faces from almost every ETDS meeting I’ve attended over the past 18 years mixed with new faces I haven’t yet had the opportunity to meet. Most of the dental specialties were represented, and many general dentists were in attendance. I observed dentists who practice here in Tyler, dentists who drove over from Longview, along with dentists with more rural practices such as myself. I spotted active leaders at the local and even state level next to those who quietly support our society through annual membership and regular attendance at our meetings (both integral to the continued success of our society). The evening encapsulated the different sectors of our shared profession that comprise the 3rd District of the Texas Dental Association and highlighted the advantages of connecting through organized dentistry.

We started 2023 with Dr. Andrew Johnson connecting us to the future with informative CE regarding advancements in 3D printing and even robotics! Dr. Duc “Duke” Ho, TDA president, provided insight into happenings at the state level: connecting us to our legislature, making connections with our dental schools, connecting with our dental hygienist colleague, and connecting with underserved communities.

The East Texas Dental Society is making it easier for members and their staff to connect with our new registration platform, CE-Go, providing easier CE registration and certification. Our spring meeting is an excellent way to connect with your staff and learn impressive ways to connect with your patients as Dr. Tal Wilkins provides a hands on course on dental photography. Additionally, we are creating some mentoring opportunities. If interested, please complete the survey included in this newsletter.

Finally, one of the best ways to connect is through service. Our board continually seeks fresh ideas and innovative leadership. If you’re willing to serve in any capacity, let one of us know.

Wishing you all a very happy new year,

Delaine Daniels, DDS

Recognition of Service

Presented to ETDS President, Dr. Delaine Daniels. Presented by, TDA President, Dr. Duc Ho.

Clinically Speaking

ONE OF MY FAVORITE PATIENTS- COACH JJ

By: Dr. Madison Mack

Meet Coach JJ, he is 49 years old. Coach’s chief complaint was “my front teeth keep chipping no matter who fixes them, and I don’t even like them when they are fixed.” Coach wants to know what his options are to give him a more pleasing smile.

Patient History:
1. Healthy 49 year old male
2. No history of snoring or sleep apnea
3. Periodontal health is stable/within normal limits
4. Financial considerations- moderate

Diagnostic Findings:
1. Dentoalveolar extrusion with wear
2. Broken teeth: 8 and 30
3. Missing tooth 18
4. Abnormal spacing between upper anteriors

We can all appreciate that these teeth are as wide as they are tall. Dental proportions are calculated by dividing the width of the clinical crown by its length. As a general rule, a tooth should be between 75% to 80% as wide as it is tall. So, if a central is 10 mm in length it should be 7.5 mm – 8 mm wide. This is definitely not the case for Coach. If we were to build these teeth to that proportion and send him on his way, not only would it look ridiculous but he would be back next week with one of these chipped again because these teeth are not in the correct position. We did a diagnostic work-up on Coach and determined that this case would require an interdisciplinary approach with pre-orthodontic bonding.

What’s our game plan?
1. Diagnostic models and wax up
2. Pre-orthodontic bonding
3. Orthodontics
4. Final restorations/porcelain veneers

After a wax up is complete, a clear PVS matrix is fabricated to aid in direct pre-orthodontic bonding. Flowable composite is injected into the matrix on teeth 6-11 to establish a normal height/width ratio, disregarding the tooths relationship in the arch and the occlusion. This allows the orthodontist to work with anatomically correct teeth and put them in a position in the patient’s arch that will look good in their smile and establish proper occlusion, thus eliminating any guesswork. This is a relatively long appointment and attention to detail is paramount!

We can all appreciate that these teeth are as wide as they are tall. Dental proportions are calculated by dividing the width of the clinical crown by its length. As a general rule, a tooth should be between 75% to 80% as wide as it is tall. So, if a central is 10 mm in length it should be 7.5 mm – 8 mm wide. This is definitely not the case for Coach. If we were to build these teeth to that proportion and send him on his way, not only would it look ridiculous but he would be back next week with one of these chipped again because these teeth are not in the correct position. We did a diagnostic work-up on Coach and determined that this case would require an interdisciplinary approach with pre-orthodontic bonding.

What’s our game plan?
1. Diagnostic models and wax up
2. Pre-orthodontic bonding
3. Orthodontics
4. Final restorations/porcelain veneers

After a wax up is complete, a clear PVS matrix is fabricated to aid in direct pre-orthodontic bonding. Flowable composite is injected into the matrix on teeth 6-11 to establish a normal height/width ratio, disregarding the tooths relationship in the arch and the occlusion. This allows the orthodontist to work with anatomically correct teeth and put them in a position in the patient’s arch that will look good in their smile and establish proper occlusion, thus eliminating any guesswork. This is a relatively long appointment and attention to detail is paramount!

(Patient is ready to return to the orthodontist)
(Coach after ortho is complete)
Following orthodontic therapy, Coach is happy with his smile and the positioning of his teeth. We are ready to move forward with his final restorations. Teeth are prepped and provisionalized, accurate natural dies are fabricated, and quality photos are taken to aid in the fabrication of porcelain veneers 6-11. Pressed lithium disilicate veneers are fabricated and custom stained. After veneers are tried in and approved by the patient they were bonded on using white-out luting agent to add a little more brightness to the restoration, or to slightly raise the value. The patient was extremely pleased with this outcome. He now has a smile he is proud to show off!
(Final restorations fabricated by Chris Mack DDS)
This case took approximately 20 months to complete, the duration of treatment was discussed in great detail with Coach before treatment began. We feel that it is very important to make sure the patient understands every aspect of the steps necessary to achieve an optimum result, prior to beginning treatment. Remember, it is an “explanation” before treatment begins but an “excuse” after.

Legislative Day

By: Dr. Mark Camp

District 3 was represented by Drs. Debrah Worsham, Dee Rea and Mark Camp at the Texas State Capitol for TDA Legislative Day. Although I don’t have official numbers, it appeared as though there were well over 100 TDA members present for this event. Our ETDS group had very productive conversations with Staff Members of multiple Legislators from our region.

The morning introductory session included a briefing from the State Comptroller Glenn Hegar, who shared some interesting facts. The most recent Texas budgetary cycle yielded a surplus of over 33 Billion dollars. Over the past 30 budget cycles, average State increases in tax collections have averaged about 5%, with the largest outlier from that range being 13%. This prior budget cycle saw an increase in tax revenues of 25.6%, which is not expected to be repeated in the future. With a strong economy, growing population (roughly 400 new births and 600 new residents per day), and inflationary forces, Texans are spending about 4.5 Billion more dollars per month than before January 2021. In January 2021, Texas had the 11th largest economy in the world. Today we have the 9th largest world economy and will soon move to 8th place.

During this 88th session of the Texas Legislature, there will be many groups trying to get some of the 33 Billion Surplus from the last budget cycle. One of TDA’s priorities is increasing funding for Medicaid Dental Services, which was last increased in 2007 and afterwards decreased from 2007 levels by about 3%. Recurring expenses are a tough sale at the Legislative level, but TDA is diligently fighting during the budgetary process to increase this funding to an inflation-adjusted level. Another funding priority of the TDA is to reinstate the Dental Education Loan Repayment Program (DELRP) for dentists who agree to practice at least 4 years in an underserved area. The repayment would be for a 4 year commitment and would repay loans up to $180,000.

Other priorities of the TDA include multiple topics. Proposed Dental Insurance Reform would include a time limit of 180 days on Retroactive Denials, ban the practice of insurance companies from prohibiting Dentists from charging for disallowed procedures, and allow Dentists to opt out of a contract when an insurance company leases a network to another company. Senate Bill 384 introduced in the Senate and supported by TDA would require dental exams before companies can start treatment with clear aligners. There are efforts to maintain current Scope of Practice issues and to maintain current Dental Practice Models to insure that licensed dentists remain the gatekeepers of dental services.

Until the Legislature dismisses on May 29, I encourage all members to pay attention to the TDA emails and “The Root” newsletter for details on current legislative issues. If you see something that is important to your practice, please call your legislator’s office and speak to someone about your concerns. We are all participants in a great profession in one of the greatest states, and lets fight to keep it that way.

District 3 was represented by Drs. Debrah Worsham, Dee Rea and Mark Camp at the Texas State Capitol for TDA Legislative Day. Although I don’t have official numbers, it appeared as though there were well over 100 TDA members present for this event. Our ETDS group had very productive conversations with Staff Members of multiple Legislators from our region.

The morning introductory session included a briefing from the State Comptroller Glenn Hegar, who shared some interesting facts. The most recent Texas budgetary cycle yielded a surplus of over 33 Billion dollars. Over the past 30 budget cycles, average State increases in tax collections have averaged about 5%, with the largest outlier from that range being 13%. This prior budget cycle saw an increase in tax revenues of 25.6%, which is not expected to be repeated in the future. With a strong economy, growing population (roughly 400 new births and 600 new residents per day), and inflationary forces, Texans are spending about 4.5 Billion more dollars per month than before January 2021. In January 2021, Texas had the 11th largest economy in the world. Today we have the 9th largest world economy and will soon move to 8th place.

During this 88th session of the Texas Legislature, there will be many groups trying to get some of the 33 Billion Surplus from the last budget cycle. One of TDA’s priorities is increasing funding for Medicaid Dental Services, which was last increased in 2007 and afterwards decreased from 2007 levels by about 3%. Recurring expenses are a tough sale at the Legislative level, but TDA is diligently fighting during the budgetary process to increase this funding to an inflation-adjusted level. Another funding priority of the TDA is to reinstate the Dental Education Loan Repayment Program (DELRP) for dentists who agree to practice at least 4 years in an underserved area. The repayment would be for a 4 year commitment and would repay loans up to $180,000.

Other priorities of the TDA include multiple topics. Proposed Dental Insurance Reform would include a time limit of 180 days on Retroactive Denials, ban the practice of insurance companies from prohibiting Dentists from charging for disallowed procedures, and allow Dentists to opt out of a contract when an insurance company leases a network to another company. Senate Bill 384 introduced in the Senate and supported by TDA would require dental exams before companies can start treatment with clear aligners. There are efforts to maintain current Scope of Practice issues and to maintain current Dental Practice Models to insure that licensed dentists remain the gatekeepers of dental services.

Until the Legislature dismisses on May 29, I encourage all members to pay attention to the TDA emails and “The Root” newsletter for details on current legislative issues. If you see something that is important to your practice, please call your legislator’s office and speak to someone about your concerns. We are all participants in a great profession in one of the greatest states, and lets fight to keep it that way.

MARCH SPEAKER SPOTLIGHT:

Dr. Talmadge D. Wilkins IV

DMD | FAGD

Dr. Tal Wilkins IV is a graduate of the Medical University of South Carolina College of Dental Medicine. He completed a general practice residency followed by training in Oral and Maxillofacial Surgery at the Medical College of Georgia, now Augusta University. He later became the Assistant Director of the GPR program at Medical College of Georgia. He is a visiting faculty member and serves on the Board of Advisors at the Pankey Institute where his focus is Advanced Restorative Dental Treatment, Complex Occlusion (Bite) Problems, and Aesthetics. Dr. Wilkins also is involved in all phases of Dental Implant treatment and is a leader in the field of Digital Dentistry and 3D Printing. Additionally, Dr. Wilkins is an active member of the American Academy of Cosmetic Dentistry where he is an accreditation Candidate, a fellow in the Academy of General Dentistry, and fellow in the International Congress of Oral Implantologists. He maintains a private practice in Aiken, South Carolina.

Elevating Dental Photography – Mastery of Manual Mode

Utilization of dental photography is paramount to providing exceptional dentistry for our patients. It aids in diagnosis, lab communication, post treatment review, and marketing and branding for your practice. Point and shoot photography and Auto mode has taken over how we take pictures. Where this is sometimes fine, there are limitations to what can be done with this type of photography. By utilizing manual mode and a DSLR camera, the limitations are gone. Taking pictures in manual mode and understanding the exposure triangle will allow the clinician to properly take whatever picture that is desired. Gone will be the days of settling for just an average photo. The clinician/photographer will be able minimally alter the setting to get a properly framed and exposed photograph, highlighting what is important to that particular photograph.

Utilization of dental photography is paramount to providing exceptional dentistry for our patients.  It aids in diagnosis, lab communication, post treatment review, and marketing and branding for your practice.  Point and shoot photography and Auto mode has taken over how we take pictures.  Where this is sometimes fine, there are limitations to what can be done with this type of photography.  By utilizing manual mode and a DSLR camera, the limitations are gone.  Taking pictures in manual mode and understanding the exposure triangle will allow the clinician to properly take whatever picture that is desired. Gone will be the days of settling for just an average photo.  The clinician/photographer will be able minimally alter the setting to get a properly framed and exposed photograph, highlighting what is important to that particular photograph. 

Learning Objectives
  1. Understanding the importance of dental photography in providing exceptional dentistry
  2. Recognizing the role of dental photography in diagnosis, lab communication, post-treatment review, and practice branding
  3. Appreciating the limitations of point and shoot photography and auto mode
  4. Acquiring the knowledge and skills to take photographs in manual mode using a DSLR camera
  5. Understanding the exposure triangle and its impact on photography
  6. Developing the ability to properly frame and expose photographs to highlight what is important
  7. Improving photography skills to achieve high-quality images and effectively communicate with labs and patients
  8. Moving beyond average photographs to produce exceptional images that support the practice’s goals.

UPCOMING EVENTS:

April 19, 2024

Speaker: J. William Robbins, D.D.S., M.A
Topic: A 50 Year Retrospective - My Failures and Lessons Learned
Location: The Summit Club
3700 Judson Rd., Longview, TX 75605
GOOGLE MAPS | APPLE MAPS
Interactive Zoom Available
Registration: 8-8:30
Class: 8:30-3:30
CE Credits: 6
Lunch provided for Doctors and Staff

Cost:
See Sidebar for info

September 20, 2024

Speaker: Dr. Kitrina G. Cordell, DDS
Topic: Pathology
Location: Green Acres Baptist Church - Crosswalk Center
Interactive Zoom Available
Registration: 8-8:30
Class: 8:30-3:30
CE Credits: 6

Cost:
See Sidebar for info

CE Requirements
for Dentists

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CE Requirements
for Hygienists

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CE Requirements
for Assistants

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