ISSUE 43: SPRING/SUMMER 2024
Dr. Kayleigh Eaves Temple, Editor
President’s Letter
By: Dr. Madison Mack
Springtime is a season of new beginnings and refocus, but as we set our goals for the rest of the year, we find ourselves in a dilemma of time. The year 2024 will provide us with 52 weeks, 365 days, 8,760 hours, or 526,600 minutes to use as we see fit. Time is our most valuable currency. We have the same number of hours per week, and how we choose to use that time reflects what is important to us. So what is important to you?
Outside of work we have priorities and obligations in our lives, and finding a work life balance can be challenging. None of us are able to control time; however, we are able to control how we spend our time. In other words, if life is a balancing act, what is worthy of your “YES”, and what deserves a “NO”? You will make time for the things you deem worthy.
I came across this quote by Margaret J. Wheatley recently, “There is no power for change greater than a community discovering what it cares about.” This resonated with me in many aspects of my life and sent me down a path of contemplation. I began to question “what do I care about?” and “how do I choose to spend my time?” I took pen to paper, and these were a few items that were at the top of my list:
- I want to empower myself and others around me to live a healthy and balanced lifestyle
- I want to prioritize quality time with my family
- I want to further my skills as a dentist to provide my patients with the best care possible
- I want to better myself as a community leader and practice owner
… so how do I achieve these things?
In our office the first thing you see when you walk through the staff door is our office motto. The sign reads, “We are not in the teeth business fixing people, we are in the people business fixing teeth.”
What does that mean?
Throughout the work day we all see numerous patients, and if we are not careful, the person we are treating can simply become a name on the schedule or an exam to check off. However, WE are the only dentist they will be seeing that day. Each time I walk into an exam room, I try to remind myself that the person in the chair is the most important thing to me at that time. Yes, they have teeth, and that is why they are seeking our expertise, but the teeth are just a part of the person and their story. Patients want to be listened to and heard! Let’s remember to be present. Patients truly do not know if you are a good dentist- it’s hard for them to adequately evaluate your dentistry. So how do they judge their experience?
- Did they like you, your office staff, and the environment?
- Did they feel heard and understood?
- Did it hurt?
- Do they like the way it looks?
- Was it as efficient as possible?
When we remember to treat the person and not just their teeth, the outcome is always most favorable.
When it comes to bettering oneself as a dentist, provider, business owner, and leader, I believe the key is to surround yourself with people you admire in hopes of becoming more like them. When I was originally asked to be a part of the ETDS board, I will be honest, I was a little overwhelmed. What did I have to offer this group of amazing leaders/dentists/specialists, and how could I make an impact on my community by saying YES? I decided that to be more like those I looked up to, I needed to surround myself with leaders like them! To make an impact on my community, I wanted to bring CE to our area that interested you, challenged you, and changed you. I would consider myself a bit of a CE junkie, but there is a big difference between attending CE and being engaged in CE. As a board, we have collaborated to bring new topics and concepts to improve our skills, knowledge, and hopefully entice our membership to participate in as many meetings in person as possible. If you VALUE what we are providing, then you will PRIORITIZE being a part of our community of learners.
Meetings have hopefully provided you with more than just learning about dentistry. I know that after our recent lecture with Dr.Uche, I changed the way that I think about many aspects of my patients’ health, as well as my own. Small changes that I have made in my life can potentially inspire those around me to implement the same changes.
I hope that ETDS has also given you a chance to get to know those in your community through fun socials, such as the Christmas party. My ultimate goal is that together, as a dental community, we can improve the community around us and serve as many people as possible. We are all so blessed, and I am a firm believer in giving back to bless others. Life sometimes gives us opportunities to volunteer and serve….SAY YES! You will not regret it.
As you contemplate how to spend your precious time, I encourage you to spend some of that time with us! As your president, I challenge you to be a part of discovering what WE care about as a community together. Get involved, come to our quarterly ETDS meetings, and stay plugged in. Find a mentor or be a mentor. Most importantly- LET’S ROOT FOR EACH OTHER!!
Certificate of Merit Awarded to Bethesda
In 1996, the TDA House of Delegates established the Certificate of Merit Award to be given annually to non-dental individuals and/or organizations that serve the dental health and welfare of disadvantaged patients in the state of Texas. At the January ETDS board meeting we enthusiastically decided that Bethesda Health Clinic, located in Tyler, was most deserving of a nomination for this prestigious award.
Bethesda literally means “house of mercy” or “house of grace”. Bethesda Health Clinic receives zero state or federal funding, relying completely on the community to both fund and volunteer to provide medical and dental services to low-income, working, uninsured East Texans. With 2,044 dental/3,548 medical patients seen in 2023, and nearly 6,000 dental/14,520 medical visits provided, we felt that Bethesda embodies everything this award represents.
We are overjoyed to announce that Bethesda has been awarded the 2024 Certificate of Merit, which will be presented at the upcoming TDA House of Delegates meeting in May. Thank you to all that have donated their time and funds to this wonderful community clinic!
TDA MEETING
This year’s TDA meeting was very exciting. Not only did Bethesda win the Certificate of Merit, our very own Dr. Wade Barker was honored with the TDA President’s Award for his outstanding work with TDA Smiles and Texas Mission of Mercy (TMOM). Dr. Barker serves as vice chair for the TDA Smiles Foundation, which funds Texas Mission of Mercy and other charitable dental care for underserved Texans. Dr. Barker was instrumental in computerizing Texas Mission of Mercy (TMOM), which has completely changed how TMOM functions. Congratulations, Dr. Barker, on this exceptional honor!
Expanding Availability of Health Insurance Options Through MEWAs
By: Dr. Mark Camp
In 2023, the Texas Legislature passed House Bill 290, amending the Insurance Code to expand access to Multiple Employer Welfare Agreements (MEWA). This means that TDA, through TDA Perks, will be able to offer additional healthcare insurance options to members. While TDA Perks has been providing individual and group health insurance for over 20 Years, MEWAs offer a new option for members. Whether it’s for yourself, your family, or your practice, MEWAs provide an additional layer of flexibility and choice.
Currently, the Texas Department of Insurance is developing the required MEWA rules. TDA’s Perks staff and advocacy team are actively involved to ensure smooth and efficient rule development. TDA Perks will update everyone once more news is available. The passage of HB 290 presents an exciting opportunity for TDA Perks to add a valuable choice to its existing healthcare options for TDA members, their families, and staff.
INTRODUCING JESSICA COE
We are excited to introduce Jessica Coe, RN, BSN as our new Executive Director of the East Texas Dental Society! Our previous director, Andrea Day, has moved on to other endeavors, though she continues to help us through this transition phase.
Jessica has been involved in dentistry for 10+ years, first as a dental assistant and then as a nurse for Drs. Kayleigh Temple, Aly Kennedy, and John Adcock (retired) at Tyler Periodontics since 2015. She has been working part-time at Tyler Perio since 2021. Jessica has been married to her husband, Cody, for 15 years; together, they have 2 young children, Cooper (6) and Parker (2).
We are thrilled to have Jessica! Please make her welcome at the next meeting.
Regenerative Bone Grafting Mini Series
Dr. Kayleigh Temple & Dr. Aly Kennedy
Periodontal disease affects a wide array of our patients – the prevalence of periodontal disease in the United States is estimated at 39.9% (NHANES, 2024) and 47.2% (CDC). This only increases as our patients age, with an estimated 70% of adults >65 affected (CDC). The treatment of periodontal disease starts with non-surgical initial phase therapy – Scaling and Root Planing – and progresses to the surgical phase for moderate to severe (Stage III-IV periodontitis) cases. In most cases of advanced periodontal disease, bone loss presents with both intrabony (vertical) defects and cratering. Regenerative bone grafting for the management of intrabony defects has been the treatment of choice in periodontal disease since the 1980s (Bowers, et al. 1989). This treatment method was enhanced by the addition of guided tissue regeneration (GTR) using both resorbable and non-restorable membranes in (Gottlow, 1986; Nyman, 1987). Both of these treatment approaches have been widely established in their ability to produce true regeneration (bone + PDL) and longterm success rates (Bowers, et al. 1989)
In recent years, the addition of growth factors to periodontal regenerative procedures has been well studied. Enamel matrix protein (Emdogain) was the first proposed growth factor, introduced in 1997, and is well studied. Platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) have been evaluated; limited improvement is apparent, and both of these remain inferior to the use of bone with a resorbable collagen barrier membrane but do appear to enhance soft tissue wound healing. Bone morphogenetic protein 2 (BMP-2) is also well established, though indicates are more limited due to increased risk of post-operative swelling as well as risks for use in females of reproductive age due to unknown fetal risk. Platelet-derived growth factor-BB (rhPDGF-BB) has come to the forefront of periodontal regeneration with well-established improvement in regenerative outcomes with a low risk of complications.
The American Academy of Periodontology Best Evidence Consensus in 2022 thoroughly evaluated the literature with regards to growth factors in periodontal regeneration (Avila-Ortiz, et al. 2022). In this meta-analysis, rhPDGF-BB used in combination with bone grafts produced the best results with regards to clinical attachment level gain, reduction in probing depths, and radiographic bone fill as compared to other factors (Tavelli, et al, 2022). Since this paper was released, we have been utilizing rhPDGF-bb (Gem-21S) as an adjunct in regenerative bone grafting in periodontal defects. Not only have we seen significant improvement in both short and longterm healing, but the predictability appears to be superior traditional methods. Another key recommendation of the BEC was the use of growth factors in patients with compromised wound healing. Many of periodontal patients are smokers and/or diabetic, both of which significantly compromise wound healing, further underscoring the role of growth factors in the modern management of periodontal disease. We present five cases for review to demonstrate the results we are seeing with this new frontier in periodontal disease management.
Periodontal disease affects a wide array of our patients – the prevalence of periodontal disease in the United States is estimated at 39.9% (NHANES, 2024) and 47.2% (CDC). This only increases as our patients age, with an estimated 70% of adults >65 affected (CDC). The treatment of periodontal disease starts with non-surgical initial phase therapy – Scaling and Root Planing – and progresses to the surgical phase for moderate to severe (Stage III-IV periodontitis) cases. In most cases of advanced periodontal disease, bone loss presents with both intrabony (vertical) defects and cratering. Regenerative bone grafting for the management of intrabony defects has been the treatment of choice in periodontal disease since the 1980s (Bowers, et al. 1989). This treatment method was enhanced by the addition of guided tissue regeneration (GTR) using both resorbable and non-restorable membranes in (Gottlow, 1986; Nyman, 1987). Both of these treatment approaches have been widely established in their ability to produce true regeneration (bone + PDL) and longterm success rates (Bowers, et al. 1989)
In recent years, the addition of growth factors to periodontal regenerative procedures has been well studied. Enamel matrix protein (Emdogain) was the first proposed growth factor, introduced in 1997, and is well studied. Platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) have been evaluated; limited improvement is apparent, and both of these remain inferior to the use of bone with a resorbable collagen barrier membrane but do appear to enhance soft tissue wound healing. Bone morphogenetic protein 2 (BMP-2) is also well established, though indicates are more limited due to increased risk of post-operative swelling as well as risks for use in females of reproductive age due to unknown fetal risk. Platelet-derived growth factor-BB (rhPDGF-BB) has come to the forefront of periodontal regeneration with well-established improvement in regenerative outcomes with a low risk of complications.
The American Academy of Periodontology Best Evidence Consensus in 2022 thoroughly evaluated the literature with regards to growth factors in periodontal regeneration (Avila-Ortiz, et al. 2022). In this meta-analysis, rhPDGF-BB used in combination with bone grafts produced the best results with regards to clinical attachment level gain, reduction in probing depths, and radiographic bone fill as compared to other factors (Tavelli, et al, 2022). Since this paper was released, we have been utilizing rhPDGF-bb (Gem-21S) as an adjunct in regenerative bone grafting in periodontal defects. Not only have we seen significant improvement in both short and longterm healing, but the predictability appears to be superior traditional methods. Another key recommendation of the BEC was the use of growth factors in patients with compromised wound healing. Many of periodontal patients are smokers and/or diabetic, both of which significantly compromise wound healing, further underscoring the role of growth factors in the modern management of periodontal disease. We present five cases for review to demonstrate the results we are seeing with this new frontier in periodontal disease management.
O’Dwyer MC, Furgal A, Furst W, Ramakrishnan M, Capizzano N, Sen A, Klinkman M. The prevalence of Periodontitis among US adults with multi morbidity using NHANES data 2011-2024. J Am Board of Fam Med, March 2023.
Periodontal Disease. Centers for Disease Control and Prevention. https://www.cdc.gov/oralhealth/conditions/periodontal-disease.html
Bowers GM, Chadroff B, Carnevale R, Mellonig J, Corio R, Emerson J, Stevens M, Romberg E. Histologic Evaluation of new attachment apparatus formation in humans. Part III. J Periodontal 1898, Dec;60(12):683-93.
Gottlow J, Nyman S, Lindhe J, Karring T, Wennstrom J. New attachment formation in the human periodontium by guided tissue regeneration. Case reports. J Cain Periodontal. 1986 Jul;13(6):604-16.
Nyman S, Gottlow J, Lindhe J, Karring T, Wennstrom J. New attachemtn formation by guided tissue regeneration. J Periodontal Res. 1987 May;22(3):252-4.
Avila-Oritz G, et al. American Academy of Periodontology best evidence consensus statement on the use of biologics in clinical practice. J Periodontol, 2022 Dec;93(12):1763-1770.
Tavelli L, Chen CY, Barootchi S, Kim D. Efficacy of biologics for the treatment of periodontal intrabony defects: An American Academy of Periodontology best evidence systematic review and network meta-analysis. J Periodontal, 2022 Dec;93(12):1803-1826.
UPCOMING EVENTS:
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
January 2025
Speaker: TBD
Topic: TBD
Location: TBD
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
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